Nervous disorders of men : the modern psychological conception of their causes, effects, and rational treatment

NERVOUS
DISORDERS OF MEN

THE MODERN PSYCHOLOGICAL CONCEPTION

OF THEIR CAUSES, EFFECTS, AND

RATIONAL TREATMENT

BY

BERNARD HOLLANDER, M.D.

*i

AUTHOR OF "THE MENTAL FUNCTIONS OF THE BRAIN",
"MENTAL SYMPTOMS OF BRAIN DISEASE",

"FIRST SIGNS OF INSANITY",
" HYPNOTISM AND SUGGESTION ", ETC.

LONDON

KEGAN PAUL, TRENCH, TRUBNER & CO., LTD.
NEW YORK: E. P. DUTTON AND CO.

1916

vx I

13

BY THE SAME AUTHOR

NERVOUS DISORDERS OP WOMEN

THE MODERN PSYCHOLOGICAL CONCEPTION

OF THEIR CAUSES, EFFECTS, AND

RATIONAL TREATMENT.

ABNORMAL CHILDREN

(NERVOUS, MISCHIEVOUS, PRECOCIOUS, AND BACKWARD)

A Book for Parents, Teachers,
and Medical Officers of Schools.

**: •'• ILLUSTRATED .'

Printed in Great Britain

PREFACE

THIS book treats of the numerous nervous
illnesses of men, in which the mental factor
plays a large part, and which are known
as functional disorders, to distinguish them
from organic diseases. Until recently patients
suffering from these disorders were not taken
seriously, and their treatment is still left
largely to men outside the profession. These
are the patients who are attracted by patent
medicine advertisements and by the numerous
lay practitioners specialising in one form of
treatment : in electricity, massage, physical
exercise, diet treatment, or other specific ; or
who have faith in " Christian Science," " Higher
Thought," and other cults, and seek the treat-
ment of " mental healers."

Now, however, that research into the func-
tional disorders of the nervous system is carried
on with the same zeal as into the organic dis-
orders by physicians, eminent also as psycho-

35801)1

iv NERVOUS DISORDERS OF MEN

legists, and medical men are paying more
and more attention to psychotherapy, there can
be no longer any excuse for people exposing
themselves to the dangers of treatment by un-
qualified persons. On the other hand, functional
disorders occurring more in private than in
hospital practice, and there being no sys-
tematic instruction in psychotherapy except
in one or two of our Institutions, it is not
only the lay public that has vague notions
of this subject, but there must be also a large
number of medical practitioners who lack the
experience of its practical application and would
like to learn what can be done by this mode of
treatment for the benefit of the nervous sufferer.
To them I address this book, not as a textbook,
but rather as a series of essays on the various
disorders of the nervous system, giving my
personal observations and reflections, the result
of long experience, and dwelling more especially
on the mental causes and effects, and the counsels
and treatment which I have found the most
successful.

The book, being written in non-technical
language and containing wholesome advice,
should appeal also to those who have the care

PREFACE v

of nerve patients, and to other lay readers desirous
of practical and useful information on the
subject of nervous disorders. I am aware, of
course, that every health teacher is confronted
with the danger that his hygienic enlightenment
may be sought by patients who are already
dwelling too much on their troubles ; but even
these, I hope, may read the book with advantage,
learning how nervous disorders may be caused
and aggravated by unhealthy mental habits and
profiting by the directions given for the acquisi-
tion of self-control.

This volume is limited to the discussion of
nervous disorders peculiar to men, and is a
companion volume to one on Nervous Disorders
of Women. Of course, many of the complaints
are common to both men and women, but their
causation and to some extent their treatment is
different in the two sexes and justifies the
description being given in separate volumes.

BERNARD HOLLANDER, M.D.

57, WIMPOLE STREET,
LONDON, W.,

November, 1915.

CONTENTS

CHAPTER I

PAGE

"NERVOUSNESS," THE TENDENCY OF OUR AGE . . 1

CHAPTER II

MENTAL SYMPTOMS OF NERVOUS EXHAUSTION.
Loss of Mental Energy, Memory and Will Power.

Fits of Depression . . ... 24

CHAPTER III

OTHER SYMPTOMS COMMON TO NERVOUS EXHAUSTION.
Loss of Mental Control.
Obsessions and Morbid Fears . . 42

CHAPTER IV
INSOMNIA . . . ... 61

CHAPTER V

NERVOUS DYSPEPSIA . . ... 80

CHAPTER VI

NERVOUS DISORDERS OF THE HEART, CIRCULATION, AND
RESPIRATION . . . ... 95

CHAPTER VII
HEADACHE, NEURALGIA, AND OTHER PAINS . . 106

CHAPTER VIII

Loss OF MUSCULAR CONTROL.

Nervous Tremors and Muscular Spasms . . . 120

vii

viii NERVOUS DISORDERS OF MEN

CHAPTER IX PAGE

MENTAL INSTABILITY.

The Semi-Insane . . . . 131

CHAPTER X
THE EFFECTS OF ALCOHOL.

The Drink and Drug Habits . ... 140

CHAPTER XI
THE "CHANGE OF LIFE" IN MAN . . 162

CHAPTER XII

GENERAL TREATMENT OF NERVOUS DISORDERS.

Hygienic Physical Measures . . . .171

CHAPTER XIII

THE POWER OF SUGGESTION IN DAILY LIFE AND MEDICAL
PRACTICE, AND OTHER METHODS OF PSYCHOTHERAPY . 191

CHAPTER XIV
THE METHOD OF APPLYING "SUGGESTION" TREATMENT.

Directions for Auto-Suggestion . . .211

CHAPTER XV

EXAMPLES OF "SUGGESTION" TREATMENT . . 227

INDEX 246

NERVOUS
DISORDERS OF MEN

CHAPTER I

"NERVOUSNESS," THE TENDENCY OF OUR AGE

IT is an often-repeated commonplace to-day,
that in consequence of the progress of civilisation
and the increase of brain activity entailed
thereby, nervousness in all its forms has become
much more common than formerly. We have
no statistics to prove the increase in the minor
nervous disorders ; but as regards the severer
ones, such as the brain troubles resulting in
insanity, we have official figures at our disposal
which are distinctly startling. In 1860, for
instance, the proportion of insane to the normal
population was 1 in 536 ; in 1870 1 in 427 ; in
1880 1 in 357 ; in 1890 1 in 337 ; in 1900 1 in
289 and in 1910 it was 1 in 274, and in 1913 it
was 1 in 266. If the unofficial and borderland
cases were included, the ratio would be still more

a NERVOUS DISORDERS OF MEN

alarming. But it is not insanity that we intend
to discuss, but the minor nervous disorders,
so-called functional disorders, from which nearly
all of us suffer at one time or another of our lives.

The question is naturally asked : To what is
this increase of nervous disorders due ? Most
people will agree that it is largely due to the
advance of civilisation ; to the wear and tear,
worry and anxiety of modern life ; to the break-
neck race for wealth, place and power, the
increased luxury and the struggle to maintain
appearances ; to the custom of working at high
pressure, the intense competition in all pursuits,
and the feverish activity of life in general. Not
only are we always in a hurry, but we should
be ashamed to admit that it was otherwise.
Our haste is further increased by the greater
rapidity of communication, and such factors as
steam, electricity, telegraph and telephone.
Then the roaring traffic grates on our nerves, if
not consciously, at least unconsciously. All this
tends to undermine nervous stability.

It is true that the modern apparatus of
civilisation, mechanical, hygienic, political, has
done much to diminish or even to abolish the
graver hazards of life and the ruder calls upon
our physical energy, and that upon the whole
it is both labour-saving and life-saving. Take,

" NERVOUSNESS " 3

for example, the telephone or the frequent letter
deliveries in our cities. They certainly make
intercourse between man and man easier in
respect of any one communication. But a
result is the multiplication of acts of communi-
cation. Every day the modern business man
has more numerous and quicker dealings than
he used to have. On each dealing there is a
saving of time and trouble, but may not this
be more than offset by the pace and variety of
mental adjustments involved in a day's work ?
The motor-car makes it easier and quicker for
a commercial traveller or doctor to go his rounds ;
but he can and does see more clients or patients
in a day, and thus the length of intervals and
the aggregate amount of rest as he moves from
house to house are reduced. The humble village
inhabitant has to-day a wider geographical
horizon, more numerous and complex intel-
lectual interests than had the Prime Minister of a
petty State a century ago. If he but reads his
paper, let it be the most colourless provincial
rag, he takes part, certainly not by active
interference and influence, but by a continuous
and receptive curiosity, in the thousand events
which take place in all parts of the globe. A
cook receives and sends more letters than a
University professor did formerly, and a petty

4 NERVOUS DISORDERS OF MEN

tradesman travels more, and sees more countries
and people, than did a reigning Prince of olden
times.

All these activities, however, even the sim-
plest, involve an effort of the nervous system
and a wearing of the tissues. Every line we read
or write, every human face we see, every con-
versation we carry on, every scene we perceive
through the window of the flying express, starts
into activity our sensory nerves and our brain
centres. Even the little shocks of railway
travelling, not perceived by consciousness, the
perpetual noises and the various sights in the
streets of a large town, our suspense pending the
sequel of progressing events, the constant ex-
pectation of the newspaper, of the postman, or
of visitors, cost our brain wear and tear.

Another cause for the increase of nervousness
is the increased complexity of the brain as time
goes on. The brain of the child, the idiot, or
the savage is a simple organ compared with that
of an adult of a civilised nation, and the com-
plexity is ever increasing as the struggle for life
becomes more severe. The march of education
demands that more shall be learned, and com-
petition on every hand and in every walk and
calling perpetually urges men to fresh efforts
and new paths of enterprise. Such increased

" NERVOUSNESS " 5

complexity must as a matter of course lead to
frequent disturbance of the brain and its func-
tions. The adjustment between all the different
relations and related parts must be easily put
out of order, as in any very elaborate piece of
machinery ; and, as in the latter, if the restora-
tion is not speedily effected and the balance of
the parts restored, the defect will increase and
the machine will turn out bad work or no work
at all.

As a rule, the active intellectual man is more
readily apt to collapse under mental excitement
than the individual of coarser fibre. The in-
sensitiveness which belongs to the unintelligent
is generally recognised. Savages are not troubled
with nervous disorders, partly because their
brain is less complex than that of civilised man
and partly because they lead a simpler and more
natural life.

The nervous tendency is becoming general.
Many men are never really ill, nor well either ;
that is to say, they are never ill enough to con-
sult a physician, and never well enough to enjoy
work or the pursuit of pleasure. In professional
men the nervous tendency shows itself in alter-
nating paroxysms of exaltation and depression,
in oversensitiveness to criticism, and in pre-
mature breakdown. In business men it shows

6 NERVOUS DISORDERS OF MEN

itself in " hustling," in the hurry to make
money. Some people rush through life ; it
makes no difference where and when you meet
them, they are always in a hurry. They make
a great fuss, a big noise, and keep their mind and
body working under a great strain. The nervous
tendency reveals itself also in the morbid
effusions of modern writers, whose principal
themes are adultery, suicide and neurosis, and
reflect the pessimism and morbid distortions of
the modern mind. It shows itself in the decline
of self-restraint, in the ambition of a very large
section of the community to gratify its every
appetite, satisfy its every whim, and obtain
pleasure, and as much of it as possible, at any
price and irrespective of all else. The un-
natural and unwholesome desire to be regarded
as " somebody " makes slaves of otherwise
intelligent people and must be blamed for a
great deal of our present-day unhappiness,
heart-ache and sorrow. Their mind is ever filled
with thoughts of discontent, because they do
not possess wealth and the artificial prestige and
power which are supposed to accompany riches.
Thousands of men labour under the lash of debts
and mortgages for no other reason than that they
may enjoy the delusions of luxury. The idea
that one must have fine clothes, diamonds, or

" NERVOUSNESS " 7

automobiles, in order to maintain his place in
society, has wrought the ruin and compassed
the downfall of many otherwise happy families.

The " nervous " temperament predominates.
It enables men to work more, but it also renders
them more apt to exhaust their reserve force.
Even if a man of nervous temperament is idle,
the activity of his brain does not necessarily
cease ; only, its energy, having no proper outlet,
will be turned inward and lead to self-observa-
tion and introspection. I have seen patients
with well-developed brains and especially large
frontal lobes who had never been trained to use
their dormant capacities. Having no need to
work for a living, or their occupation being
too simple to engross their attention, they
became victims of self-contemplation and
suffered from various nervous ills. There is
only one remedy for such men, and that is
interesting pursuits. If useful interests were
gained in early life such men would be saved from
the peevishness, irritability and hypochondriasis
of later years.

The large head is not always of an intellectual
type, frequently the constitutional predisposition
is of an emotional character. Such men have
strong affections as a rule ; they lack the power
to be indifferent ; they take things to heart

8 NERVOUS DISORDERS OF MEN

easily. They are sensitive, frequently over-
conscientious and lacking in self-confidence.
They dwell more on their shortcomings than
on their good qualities. Now, the effect of
emotions is that they disturb the functions of
the various bodily organs, temporarily only,
it is true ; but the man of nervous temperament
is given to self-observation and is readily
addicted to auto-suggestion, and both these
factors help to make the disturbed function
more or less permanent.

Doubtless one can say that in most cases of
nervous disturbance many causes co-operate,
and that if we examine individual cases we shall
find that the most important of these causes is
usually an inherited tendency; but this pre-
disposition has only too often been fostered by
faults in education and training in childhood, an
education which has neglected the inculcation
of self-control, self-denial and the habit of
taking a healthy and kindly interest in every-
thing and everybody.

A sound brain and nervous system rarely
sutler from overwork, unless the work is done
badly. The healthy adult brain is capable of
doing much more work than it generally does
do. There are few brains that are worked to
their utmost, and nervous disorders are rarely,

" NERVOUSNESS " 9

if ever, produced by regular and sustained labour,
where the supply of force and power is equal to
the demand. Fatigue is really very rare,
transient and accidental in the case of men
whose thinking is productive and fertile. On
the other hand, it is very common and
almost chronic among those who let life conquer
them, among inactive men of meditative but
non-productive brains, and even among those few
men of real talent, who work only when inspired,
work by spurts, so to speak, and then indulge in
long periods of repose.

Many of the exhausting neurotic and psycho-
neurotic affections are due to the failure of hard-
worked men to secure such mental relaxation
as will permit complete repair of nervous waste.
Some men never get completely away from the
set of thoughts with which they are occupied
in their respective vocations. Waking or sleep-
ing these thoughts are with them. Even when
they try to turn to something else, their mental
activity continues in the old groove to some
extent, and so prevents the rest that is necessary
for the repair of tissue. Under these conditions
re-creation does not take place quite so well as
it should, and even sleep does not relieve them
from the burden of their mental work.

Some men through stress of business neglect

10 NERVOUS DISORDERS OF MEN

Nature's laws ; they become careless about
their mode of living, neglect to care sufficiently
for their body, are careless about their meals,
shun exercise and recreation, " burn the candle
at both ends " ; all for the sake of their work.
Their only thought is for their work. No wonder
they break down in health. What would not
have worried them before does so now ; what
before was natural manly anxiety becomes rest-
less uneasiness, perhaps even actual depression ;
they become apprehensive and irritable ; their
digestion is disturbed and sleep prevented until
they are totally unable to attend to their
work.

Intellectual work alone is one of the least
formidable causes of nervous exhaustion. The
man who attends to his duties free from worry,
anxiety, or other depressing emotions is not
likely to fall a victim to nervous exhaustion.
If he brings too lively an ardour to his work, or
if he prolongs his exertions beyond measure,
the result will be a state of fatigue more or less
profound according to the degree of resistance
of his brain, and nothing more. Fatigue and
the embarrassment of cerebral activity that
follows it will, of themselves, put an end to this
over-pressure, or will at least restrain it within
just bounds ; the nervous exhaustion that may

"NERVOUSNESS" 11

result from it will in such a case be speedily
reparable.

The great majority of those who suffer from
nervous exhaustion are people who are unable
to do things that they have to do. As a rule,
people do not become nervous wrecks while
they are succeeding ; but they go to pieces
when they begin to fail. They begin to worry
and they go down. The human mind can accom-
plish wonders in the line of work, but it is soon
wrecked when directed in the channels of worry.
The brain-work that over-drives and exhausts
is that which accompanies care for the morrow,
worry caused by the end to attain, or fear of
failure, whether the matter at issue be one of
industrial or commercial affairs in which the
fortune is engaged, or one of an examination or
competition on which the future depends. We
wear ourselves out, not by hard work, but by
anxious thought regarding the adjustment of
work, and by nervous irritation at the failure
to accomplish an impossible task. Work and
worry are closely allied. Worry and anxiety are
common in this age of stress and competition.
Worry means a harassing preoccupation with
matters upon which no amount of taking
thought can be of the slightest avail, and often
with regard to questions which are not deserving

12 NERVOUS DISORDERS OF MEN

of the anxiety bestowed upon them. Worry
means emotional strain, and emotions are not
limited to the brain, but affect the bodily organs
as well ; that is why worry, anxiety, fear, dis-
appointments, remorse, in a word, all states of
sorrow and disquiet, exhaust the nervous energy.

No kind of psychic activity can be so per-
sistently followed as worry. A fit of anger
exhausts itself in a short time. Concentrated
intellectual work reaches the fatigue point after
a few hours. But worry grows by what it feeds
on. One can worry more and worry harder on
the fourth day than one can on the first. Every
normal activity is strangled by it. The effects
of overwork uncomplicated by worry are soon
removed by rest ; but rest from work thus
complicated only redoubles the worries, the
doubts and the scruples, gives rise to insomnia
and thus causes additional damage.

When a strong and active mind breaks down
suddenly in the midst of business it is worn out
by worry rather than overwork. Work never
killed a man, but worry drives many thousands
of men and women to early graves. Worry
exercises its influence upon man with a demon-
like subtlety ; it destroys his elasticity of gait ;
it contracts and narrows his normal breadth of
intellect ; it creates an atmosphere of misery in

" NERVOUSNESS " 13

which all things are contorted ; it robs life of
all its brightness, its pleasures, and its charms.
Worry is a cause of nervous exhaustion, and the
man or woman suffering from nervous exhaustion
worries on account of their worry. In other
words, they magnify trifles until they really
assume proportions of importance ; in fact, they
make mountains of molehills. They are given
to introspection, retrospection and apprehension.
Some people are born worriers. Their minds
are engrossed with small points that irritate
them, or filled with apprehensions of what is
about to go wrong. Folks are constantly looking
for trouble, crossing bridges before they come
to them, and one happy disappointment never
teaches them its lesson ; they go on worrying
just the same. Constantly regretting the things
that they have not done in the past, they brood
over their failures and look forward with dread
to that which may be, but very often is not.
The dread of adversity constantly imposes
numerous restrictions upon their enjoyment of
the present hour, and the calamities which never
happen and the griefs which never befall them
are perpetually casting shadows across their
sunniest paths. It is, indeed, the insane culti-
vation of the garden of trouble which brings to
them so bountiful a crop of the minor ills of life,

14 NERVOUS DISORDERS OF MEN

and which renders their minds and bodies weak
and fretful.

Some people are worried by a haunting
memory or remorse of some past failure, sickness,
or loss of property ; in some, the cause may be
found in the suppressed memory of a disagree-
able experience making mischief without con-
scious knowledge of the person. Others are so
organised that there is frequent cause for
conflict between " the flesh and the spirit/'
that is to say, between the instinctive desires
and the moral nature. When a conflict occurs
between the repressed instinct and the conscious
mode of life, a neurosis or psychosis is liable to
develop. Again, in some we find a wrong
method of thinking, a point of view mentally
false or inadequate, or a careless allowance of
unwholesome mental moods, i.e. uncontrolled
emotions. True, no man is responsible for the
random thoughts that come flitting in and out
and the sensations which arise in him spontane-
ously, but we are all responsible for the thoughts
and feelings we deliberately entertain, hold and
dwell on.

All anxious emotions, if too long indulged in,
have the effects of lowering the health and
weakening the mental control. If any one be
subjected, for example, to adverse circumstances

" NERVOUSNESS " 15

for any length of time, to business worry or
strain, financial difficulties or the never-ceasing
worry of an unhappy domestic life, the strong,
stable, healthy-minded man will remain that no
longer. He has acquired just those conditions
which are apt to cause nervous breakdown.
Thus overwork, mental strain, grief or shock,
when they do not in themselves produce dis-
orders, may contribute to their development by
lowering health and weakening mental control,
and then the man of average mental stability
passes into the second grade and becomes the
man of neurotic temperament. The nutrition
of the nerve cells has been deranged and they
recruit their exhausted energy with increased
difficulty. They no longer accumulate to the
same degree as in health the force that they
discharge ; and there ensues a chronic enfeeble-
ment of nerve strength, a nervous weakness
and exhaustion. This state of exhaustion of the
nervous centres produces conditions that are
favourable to the development of a pathological
mental state of depression, irritability, loss of
will power, morbid fears and obsessions.

By worrying, we raise the blood pressure and
hinder still further the proper working of the
intellect, which is largely dependent on the
maintenance of a well-balanced circulation

16 NERVOUS DISORDERS OF MEN

through the brain, and this in turn is dependent
not only on certain physical conditions, but also
on the state of mind. The care-free and the
joyous are able to do a vast amount of brain
work, experiencing but little mental fatigue ;
whereas the victims of worry and grief, and
similar unhealthy mental states, find themselves
on the verge of brain-fag after engaging in the
most ordinary mental activities.

Most people try to overcome worry by simply
resisting it, thereby increasing it many times.
They would find that much more good can be
accomplished by surrender than by resistance
to it. If irritating or annoying memories,
or thoughts of any kind, are in any way awak-
ened, we should try to ignore them, not mind
them, and they will fade away. A large per-
centage of those things which harass and vex
us are robbed of their power if we but become
thoroughly reconciled to their presence. It is
our perpetual resistance that gives them such
great power to disturb us. If we do not mind
the source of the worry, we cease to fear it, and
the intellect will find means of conquering it
without the embarrassment of an emotion
which only hinders it. Forethought is an
intellectual force highly necessary to the smooth
running of our daily affairs ; while fear thought.

" NERVOUSNESS " 17

anxious thought, is an emotional hindrance
wholly unnecessary and even highly injurious.
Instead of resistance we must try to direct our
attention away from ourselves. The best thing
is to get up and do something, or to get out and
see something. We should get up some hobby
to secure a diversity of interests. We should
be philosophical, enjoy the present, enjoy things
as we go along, live only one day at a time.
There is no need to live our whole past through
every day. Most of our worries are due to a lack
of confidence in our own ability, to a sense of
past failure and of future impotency ; hence it
is necessary to teach the man who worries how
again to become confident and self-reliant.

It will be seen that in our search for mental
causes we must be as conscientious as we are
accustomed to be in our physical investigations.
We must search the mind of the patient for the
source of his discomfort in exactly the same
spirit as we search the body for physical dis-
comfort. We shall generally find some un-
healthy mental states, such as depressive
emotions, apprehensions and fears, illogical
doubts and scruples, habits of morbid intro-
spection and self-consciousness, derangement of
moral perspective, excessive concentration of the
attention on particular organs, and so on.

18 NERVOUS DISORDERS OF MEN

A frequent sign of nervous breakdown is that
people do not heed the signs of fatigue produced
by overwork or excessive worry, but fly to
stimulants — alcohol, tea, coffee, or drugs — and
with their pernicious aid suspend the warning
signal of exhaustion. Unquestionably, alcohol
is frequently taken by hard-working men to
remove the sense of fatigue and to " oil the
wheels of business," and what is most disastrous
of all — to enable the worker to overwork him-
self. Thus many men become addicted to alcohol
or drugs, and such a habit, when once established,
produces a fresh series of nervous symptoms.

As our strongest passions and emotions are
those connected with the sexual organs, it is not
surprising that we frequently find the pre-
disposing or exciting cause of a nervous disorder
in sexual habits and the emotions associated
with their activity. Excessive sexual indulgence,
natural and unnatural, leads to nervous dis-
orders ; on the other hand, sexual symptoms
are apt to appear in persons suffering from
nervous exhaustion, causing the patient still
further distress. Sometimes there is only a
lack of desire, but more often there is actual loss
of potency, and sexual hypochondriasis is very
common. These patients feel that they are
losing virility or they dread the loss of it, and

" NERVOUSNESS " 19

often fall into the hands of quacks who support
their fancy. Some of them attribute the troubles
with which they are afflicted to the habits which
they practised in youth, especially when at
school. They have often got this idea from the
numerous books that are published on this
subject by well-meaning but incompetent people
or by charlatans. Whatever the cause, these
symptoms usually disappear and potency is
restored with the improvement in the nervous
energy of the patient by appropriate constitu-
tional treatment.

Nervous symptoms are also common when men
approach middle age and, like women, undergo
the " change of life."

Sometimes nervous disorders develop in people
predisposed to them under the influence of a
sudden fright, such as the mental shock caused
by railway accidents. Generally speaking, shock
is a state due to a sudden exhausting or de-
pressing influence for which the individual is
usually unprepared. This state of preparedness,
that is to say, the attitude of the individual so
far as expectation is concerned, is very important.
It is a somewhat curious fact that many persons
engaged in occupations or exposed in ways
fraught with more or less likelihood of danger
rarely suffer from nervous troubles, [while

20 NERVOUS DISORDERS OF MEN

those who are unconscious of any impending
injury succumb at once upon its happening.
Statistics show that there is a comparative
absence of nervous disorder among those who
are on the look-out, or who are consciously
" taking their chances." It is also a noteworthy
fact that the amount of fright and shock is
often disproportionate to the degree of danger
experienced.

Curiously, among middle-aged men it is not
only the man who has led an exciting life, full of
anxiety and worry, who is apt to break down,
but sometimes men begin to ail from similar
symptoms who have led a quiet and humdrum
existence. The monotony of the lives they lead
year in, year out, doing practically the same kind
and amount of work without much variation,
eating the same kind of food, from day to day,
living in the same house and rooms without the
slightest change even in the arrangement of the
furniture, the same friends, often anything but
stimulating in their conversation — causes the
nervous system to revolt against all this mono-
tony and symptoms of a nervous breakdown
appear. Such men readily get well if a " change "
is ordered, a change of air, a change of scene, of
diet, and of company. All men who have to
sit at desks doing the same kind of uninteresting

"NERVOUSNESS" 21

work all the year round, and year after year,
are subject to this form of disorder, unless they
take care to have some interests besides.

Other abnormal modes of life — such as con-
tinuous confinement in bad air, unhealthy
occupations, bad dwellings, faulty nutrition,
and everything in general that reduces a person's
general health and disturbs digestion and
nourishment — make the nervous system less
capable of resistance.

Anaemia, exhausting diseases, syphilis, in-
fluenza and malaria often lead to nervous dis-
orders owing to changes in the blood causing
defective nutrition of the nerve centres, thus
diminishing their resistance and rendering them
more vulnerable. Further, the altered secretions
and excretions of certain cells and organs of the
body circulating in the blood-stream influence
the nerve centres and, in addition, certain
abnormal chemical messengers — toxins — when
present in the blood, are able to produce painful
irritation of the nerves, while others produce
fatigue, mental lassitude and despondency.

Many of the nervous disturbances described
in this book are usually put under two headings.
One is —

NEURASTHENIA, by which is meant an exhaustion
of nervous energy giving rise to fleeting pains,

22 NERVOUS DISORDERS OF MEN

abnormal sensations, mental instability, moral
vacillation, constant worry, and most char-
acteristic of all, a chronic sense of fatigue which
is not relieved by either rest or sleep. The other
is —

PSYCHASTHENIA, by which is meant a form of
nervous exhaustion which is largely, if not
wholly, due to psychic disturbances, the physical
state of the patient having but little to do with
the prevailing nervous weakness, loss of mental
energy, fears, dreads, obsessions and melan-
cholic tendencies.

This work not being intended as a textbook,
I have not made use of these terms, and there
are other reasons why I have omitted them.
Both these terms are made to include an ever-
increasing range of symptoms, some of them
identical in both disorders ; neither do they
constitute separate diseases in the sense that
there is a distinct treatment for each. A man
may have any of the symptoms of neurasthenia
and not be a neurasthenic ; and the same is
true of psychasthenia, which literally translated
means psychic exhaustion, which is inconceiv-
able. Debility of the nervous centres, on the
one hand, and unhealthy mental states, on the
other — such as wrong thinking, evil mental
habits and unwholesome mental moods — can

" NERVOUSNESS " 23

bring about functional disorder of any organ of
the body through the nerves which connect it
with the brain and spinal cord. As a rule they
occur both together, one induced by the other,
for which reason the general term PSYCHO-
NEUROSES is frequently used ; and health cannot
be regained until the nervous energy has been
restored and healthy mental states substituted
for the unhealthy ones. For these functional
troubles there are no specific remedies. We
must treat the patient, not alone his disorder.
This is the principle which I have followed in
my practice and which forms the basis of this
work.

CHAPTER II

MENTAL SYMPTOMS OF NERVOUS EXHAUSTION

LOSS OF MENTAL ENERGY, MEMORY AND
WILL POWER. FITS OF DEPRESSION

ONE of the commonest symptoms of nervous
disorder is weakness. Patients complain that
the least exertion, whether mental or physical,
produces an inordinate sense of fatigue. Lassi-
tude is constant and hinders the commencement
of any activity, renders its execution painful,
and is so little mitigated by rest that it is by no
means uncommon to hear patients complain
that they are as tired after a night's rest as when
they went to bed.

A tired feeling is a prominent symptom of
nervous exhaustion. The first sign is usually a
feeling of undue weariness after moderate or
even slight exertion. Gradually all activity be-
comes painful. The patient cannot read without
becoming tired, nor listen to a conversation of
any length ; still less can he write, or apply
himself to any other work. He feels vague

24

MENTAL SYMPTOMS 25

diffuse pains, his appetite becomes languish-
ing, sometimes he grows thin, but often
enough he keeps his flesh and has an
illusory appearance of relatively good health.
He may be well nourished, muscularly well
developed, have had no immediate prostrating
illness or shock, nor has he been called upon
to bear any strain which ought not to have been
compensated for by appropriate rest and change ;
yet he is conscious of a want of brain tone,
sluggish action of mind, and of a deviation from
his normal condition of intellectual acuteness,
activity and vigour. His conviction of fatigue
exaggerates still more the fatigue itself. True
fatigue is doubled by the auto-suggestion of
fatigue ; it is aggravated by the emotional
fatigue from thinking about it.

Mental fatigue depends to a large extent on
the condition whether one is emotionally pre-
occupied or not. When the mind is peaceful the
nerve units are able to carry out their work
with the expenditure of a minimum amount of
energy; but when we are emotionally preoccupied,
working with a feeling of anxiety, anticipating
a possible difficulty, the work will be fatiguing.
Another fatiguing distraction is the habit ac-
quired by so many nervous people of watching
themselves while they do their work, when the

26 NERVOUS DISORDERS OF MEN

very attention they bring to bear upon the
effort that they are making is sufficient to
hinder the action which they wish to perform.
It is simply a case of the intervention of psychic
phenomena which are focussed upon an act
which, to be performed under the most favour-
able conditions, ought to be in some degree
automatic. Again, many of these patients are
constantly telling people they are tired and worn
out, and they are everlastingly telling the same
thing to themselves, little dreaming that this
very contemplation and reiteration of their
feelings is directly adding to the sum of their
fatigue. If they were to accept their fatigue as
a matter of course they would find that rest would
soon cure it. They must learn not to empha-
sise their fatigue, or to magnify their weariness,
by undue contemplation.

If the patient does not recover from his
fatigue, he soon becomes painfully sensible of
feeling mentally below par, and recognises his
inability to use efficiently his powers of mind.
He suffers from a torpid state of intellect, a
mental malaise unfitting him for any kind or
degree of cerebral work. The effort to think is
irksome and painful, causing, if persevered in,
dizziness, headache, painful confusion of thought
and mental depression. The patient complains

MENTAL SYMPTOMS 27

of an incapacity to control and direct the faculty
of attention. He finds that he cannot, without
an obvious and painful effort, accomplish his
usual mental work, read or master the contents
of a letter, newspaper, or even a page or two of
his favourite book. The ideas become restive,
and the mind lapses into a flighty condition,
exhibiting no capacity for steady continuity
of thought. The patient has so little control
over his ideas that in his speech he, so to say,
" runs off the lines " by introducing a great
number of non-essential accessory ideas, which
both obscure and delay the train of thought,
and he needs to be frequently led back to his
subject.

Confusion of thought is extremely common,
that is to say, a state of mind in which there
appears to be a flow of disconnected and in-
congruous ideas, and in which the flow of
language, at any rate, is disconnected and in-
coherent. The confusion is due to a functional
weakness in the logical combination and asso-
ciation of ideas, as a result of which the threads
of thought are continually broken, the train of
thought rendered imperfect, and often totally
unrelated ideas are admitted into the mind.

The power of attention is weakened and the
memory either wanders or is inconsistent in its

28 NERVOUS DISORDERS OF MEN

associations. The patient is inattentive from
sheer lack of power of application and mental
endurance. He sometimes reads whole pages
without having understood what he has read.
Fully recognising his impaired and failing
energies, he repeatedly endeavours to con-
quer the defect, and, seizing hold of a book,
is resolved not to succumb to his sensations
of intellectual incapacity, physical languor,
and cerebral weakness. In his attempt to
comprehend the meaning of the immediate
subject under contemplation he reads and re-
reads with a determined resolution, and an
apparently unflagging energy, certain striking
passages and pages of his book, but without
being able to grasp the simplest chain of thought
or follow successfully an elementary process of
reasoning ; neither is he in a condition of mind
fitting him to comprehend or retain, for many
consecutive seconds, the outline of an interesting
story or narrative of facts. Hence, after a time,
only that which can be followed without an
effort is welcome.

In this condition of nervous exhaustion the in-
valid is incapable of exercising continuity of
thought for any lengthened period, and at times
he is quite unable to think at all. This mental
prostration disqualifies him for any occupation

MENTAL SYMPTOMS 29

requiring the active use of the intellectual
powers. He throws aside his favourite books,
and even the newspapers, formerly a source of
so much pleasure, become devoid of interest and
distasteful. He neglects his ordinary vocation,
feeling in mind blase and able only to sit quietly
in a state of mental abstraction or saunter
about in a condition of gloomy reverie.

In this state of nervous ill-health serious
injury is occasionally done to the delicate
organisation of the brain by injudicious attempts
to exercise, stimulate and force into activity
the morbidly flagging and sluggish mental
faculties. But the appearance of such symptoms
indicates that the brain, although not in any
way diseased, is quite unfit for any degree of
sustained action, and that perfect repose and
periods of prolonged and uninterrupted rest are
necessary to a restoration of its enfeebled energies.

The faculty of memory is not infrequently
impaired owing to the power of attention being
diminished. The loss of memory extends, in
well-developed instances, to an inability to
recall proper names, dates, even single words.
Without attention there can be no memory. The
power of recalling past events becomes defective
because these patients are unable to sustain the
effort of attention necessitated by the search

30 NERVOUS DISORDERS OF MEN

for the forgotten incident, and because the
greater number of the events that have taken
place after the onset of their malady have been
perceived by them feebly, and hence are badly
associated with their conscious personality.
Often beset by some fixed idea, some hypochon-
driacal preoccupation, they live, so to speak, in
a state of perpetual absent-mindedness ; this is
one of the causes that makes them perceive in
a vague and uncertain manner the incidents of
which they are witnesses. Thus they are unable
to recall events to their memory even when they
are still recent.

Apprehensiveness, which is natural to all of
us, becomes greatly exaggerated. There are
persons who manifest the emotion of anxiety
upon the least pretext, and from this morbid
susceptibility arises a nearly constant state of
uneasiness. They are subject to doubts, hesi-
tations, fears concerning the most ordinary
circumstances and acts of life, because they
become quite incapable of willing effectively.
Some of these patients are congenitally appre-
hensive ; in others, an exaggerated apprehen-
siveness is acquired by habits which lower the
tone of the nervous system. They not only
lose initiative, the power to undertake new
enterprises, but they find it difficult to make up

MENTAL SYMPTOMS 31

their minds as to details of the ordinary affairs
of life. These patients say that they cannot do
things, their friends say " they will not," and
the physician, taking the middle course, which,
as usual in human affairs, has much more of
truth than either of the extremes, says " they
cannot will." There is an inability to " make
up the mind," to come to a decision, to exercise
a choice. This morbid perplexity of the in-
tellect expresses itself in the actions. The
patient no longer dares to do anything without
endless precautions. There is a condition of
doubt and an irresolution which is nearly always
shown about the simplest details of everyday
life. The patient is in a condition of constant
hesitation from the most trivial motives, with
inability to reach any definite result. He will
hesitate a long time before he is able to decide
whether to put on the right boot or the left,
which foot to begin with in going upstairs,
which pen to select out of a tray, what word to
use to express his meaning, whether to walk
this way or that, whether to take a stick or an
umbrella. If he writes a letter, he reads it over
several times for fear he may have forgotten a
word or offended against orthography. If he
is locking a door, he verifies several times the
success of his operation. He worries usually

32 NERVOUS DISORDERS OF MEN

over such trifles as whether he stamped a letter
before posting it, whether it was properly
addressed, whether he left a certain door open,
or closed another door, whether a gas-jet is
thoroughly turned off, a clock wound, and so on.
And when, after numerous doubts and ques-
tionings and prolonged vacillation, a decision
is reached, the sufferer finds little or no satis-
faction in it, feeling certain that a different
course should have been chosen. This pro-
pensity for doubting is absolutely unbounded.
The patient is never certain of anything except
that he is the most afflicted of mortals. This
doubt and the indecision result directly from
over-conscientiousness. It is because of an
undue anxiety to do the right thing, even in
trivial matters, that the doubter ponders in-
definitely over the proper sequence of two
equally important, or unimportant, tasks. When
a patient has reached this stage he requires
proper psychic treatment. He must be taught
mental discipline and must be supplied with
fresh motives for action drawn from those
dispositions of his character which are elevating
and healthy, but have been neglected by him. The
treatment must be individual and may be helped
by complete diversion of mind, serious occupa-
tion, and the cultivation of larger interests.

MENTAL SYMPTOMS 33

Sometimes such a patient will for ever ask
questions, especially about his ailment. If he
is not interrogating himself he is perpetually
questioning others. He must know the how,
wherefore, and why of everything. Every
answer he receives is met by further questions,
so that he becomes a nuisance if not an em-
barrassment to everybody with whom he comes
in contact. If such a patient is much to be
pitied, those who have the care of him are
hardly less so. The need of reassurance leads
him incessantly to question the people around
him. In spite of formal affirmation, doubt
arises each moment in his troubled mind; and
he will reiterate during whole hours the same
questions which reiterated and varied replies
will never satisfy. His ailment is a subject of
which he never wearies, sometimes the only one
on which he can converse. He will return to it
again and again with the same person, feeding
his hopes on the same assurances and consoling
himself with the same sympathies.

Mental irritability is another common condi-
tion, and is evinced more frequently in a man's
domestic circle than in any other sphere. He
frets and worries and becomes ill-tempered and
even passionate over mere trifles, which, under
normal conditions, would pass his observation

34: NERVOUS DISORDERS OF MEN

without special notice. He who is dissatisfied
with himself is always more disposed to quarrel
with others. The patient may get so fidgety
and restless, rushing about, worrying everybody
and fussing around until his friends dread the
sight of him. He requires the attention of the
entire household, and his shifting moods keep
everybody about him in a mingled state of
anxious solicitude and justifiable resentment.
He finds it hard, even as a muscular manifesta-
tion, to evolve a smile and, except on very
rare occasions when he momentarily forgets
himself, he never makes the attempt. Tears,
however, are always close to his eyes, ready to
flow on every possible occasion — with one
exception ; the view of his own household,
reduced by his conduct to weeping, leaves him
with eyes as dry as parchment.

Irresolution, hesitation, and the general en-
feeblement of the will-power react upon the
character. Such a person cannot meet the
ordinary ills of life with a normal degree of
fortitude ; he grows discouraged with the
smallest failures, magnifies every obstacle and
professes inability to surmount it; he creates
painful emotions by representing to his mind
ideas of danger or of evil, or fear. He seems
incapable of looking at questions calmly. Slight

MENTAL SYMPTOMS 35

troubles and indispositions affect him seriously,
and grave ones often cause profound depression.
He makes mountains out of molehills, then
toilfully climbs these self-created mountains,
when clear-eyed reason would discover that the
mountain needs no climbing, being only a mole-
hill.

Even the most trivial of the routine tasks
before him assumes portentous proportions, and
anything out of the ordinary seems to him im-
possible of accomplishment. His motto is :
" Never do to-day what you can avoid entirely
or put of! indefinitely." Consequently, to his
detriment, financially and otherwise, he post-
pones important engagements and seldom forces
himself to a decision in matters of moment.
Particularly is this true of engagements at a
distance. At the mere thought of their fulfilment
he grows sick with apprehension ; the actual
fulfilment is downright agony. First come the
terrors of the departure — the noise, bustle and
confusion of the railway station. Then, with
the journey actually begun, comes the realisation
that every turn of the wheels is taking him
further and further away from the only place
in which he feels at all comfortable, namely, his
home. At this he tries to divert his mind by
reading, but finds his attention divided. What

36 NERVOUS DISORDERS OF MEN

if anything should happen to him in his present
situation ? This thought sets him quaking with
dread, and he tries in a variety of ways, but
with indifferent success, to banish it from his
mind. At the end of the journey he is absolutely
exhausted, and groans in spirit at the thought
that his mission is yet to be accomplished. He
wishes himself safely at home again, but pulls
himself together as best he can to face the
existing situation. What he suffers in mind and
body during his stay is more easily imagined
than described. It is enough to say that he
does not know a happy moment until he finds
himself back again at his original starting-point.
The patient is easily discouraged, shy, timid
and fearful, and has lost confidence in himself
and his own ability. He awaits with apprehen-
sion the outcome of every act, and doubts its
justification and fitness. There develops a self-
torture and an exaggerated feeling of liability.
The ego will often become intensely exaggerated,
and although the patient may be diffident in
manner, still he is extremely self-conscious and
shy, and he often labours under the idea that,
whether at a party or in the street or at any
place of public amusement, he is the observed
of all observers. Walking up the gangway of a
theatre or across a large room where people are

MENTAL SYMPTOMS r37

sitting round, or being singled out for conversa-
tion at a dinner-party amid expectant silence,
is a terrible ordeal to him. Whatever is said,
done or left undone by others is analysed with
reference to its bearing on himself. If others
are indifferent it depresses him, if they appear
interested they have an ulterior motive, if they
look serious he must have displeased them, if
they smile it is because he is ridiculous. That
they are thinking of their own affairs is the last
thought to enter his mind. It is hard for him
to realise that the general gaze has no peculiar
relation to himself. He often becomes over-
conscientious and distresses himself needlessly
with worries about business or family matters.
He neglects his social duties, deliberately retires
into solitude, and declares himself unable to
manage his affairs. By the time this stage is
reached the sufferer has become a consummate
egotist. He has a deep-rooted conviction that
nobody else in the wide world ever was or ever
could be so afflicted. There are spells of more
or less intense depression, and often the un-
reasonableness of these is appreciated by the
individual, but he cannot rid himself of his
morbid feelings. He now suffers from melan-
choly, but he is not insane, for however con-
vinced of his trouble he is still looking for

38 NERVOUS DISORDERS OF MEN

sympathy and possible help ; whereas the insane
person, suffering from melancholia, is as a rule
too downcast to care whether sympathy is
offered or not, and would prefer death to cure.
Much depends on the reserve nervous force,
the reserve energy, a man possesses. Persons
in normal health, when they are tired, allow at
times the dark curtain of discouragement to
unfurl itself too far, but they regain control of
themselves and soon recover their smiles, some-
times a little ashamed of the ease with which
they have allowed themselves to be cast down ;
whereas the man with little reserve nervous
force who meets with a temporary trouble will
drift into a condition of anxiousness and fear,
and become depressed. It is toward the pessi-
mistic side that he always leans. The slightest
happenings are catastrophes for him, the
smallest failures discourage him. He magnifies
the obstacles which rise before him, and draws
back at the sight of them. He is overcome by
a telegram without having learned its contents ;
he reads between the lines of a letter, and
ascribes to any occurrence whatever the least
probable and the most terrible causes. With
him the dark curtain hangs very low, and he
does not know how to raise it by a consoling
reflection.

MENTAL SYMPTOMS 39

The habit of looking at the gloomy side of
things is easily formed, and, once acquired, it
becomes very forceful. Mental depression has
a contracting effect on the personality, tends to
keep the thoughts in one groove, on one set of
ideas or objects, and that a narrow one. A
patient in this condition is like a person living
always in one small room with the blinds down :
self-centred and miserable.

Nervous and sensitive people feel easily hurt
and aggrieved and then their perception becomes
so modified that they can see nothing on the
brighter side of things. One may be dissatisfied, but
one should not be discontented. All the world's
progress is due to dissatisfaction with existing
conditions and the putting forth of courageous
efforts to improve the same ; all the sorrow of
the world is born of discontent with our present
circumstances. Psychic contentment is not
incompatible with the highest degree of dis-
satisfaction. Pessimism and optimism are
largely a matter of habit. Normally, the mere
process of living is of itself a positive delight, a
continuous delight, and the smile with which we
greet everybody and everything is not taught
by convention. Misery is abnormal. Trouble
does not actually exist. Trouble exists only in
the fear thought of our own minds. We must

40 NERVOUS DISORDERS OF MEN

make a positive effort to extend the scope
of our mental action and think of things outside
of ourselves and our own interests. The attitude
of mind that should be cultivated is one in which
it is realised that, though there may be many
sources of evil in the world, there is a preponder-
ance of good even in the worst environment.
If there were no clouds we should not enjoy the
sun. Our happiness depends more on ourselves
than on circumstances. Opportunities for making
the best of things will be found by a cheerful
disposition. An excellent way is to try to cheer
up other people, if we cannot cheer ourselves.
After forgetfulness of self, the best cure is
thoughtfulness for others.

Much can be done for the relief of depression
by the influence of facial expression and bodily
attitude. If we assume a weak, slovenly carriage,
shuffling gait and inelastic step with the body
bent forward and insist on putting our features
into the shape which ordinarily expresses sad-
ness, our attitude will be reflected internally,
and we shall become as sad as our expression.
On the other hand, if the features are drawn,
even by force of will, into the state that ordinarily
expresses cheerfulness and contentment, we
shall be tempted more and more to feel that way,
until at last even internal melancholy may be

MENTAL SYMPTOMS 41

dissipated. If a man throws back his shoulders,
walks with a bold carriage and sure step, and
takes in large breaths of air, expanding his chest
and stimulating his circulation, his whole body
as well as his mind feels the effect. Moreover,
his associates will respond to the mood he is in,
thus reinforcing his condition.

But it is not by advice alone, however excel-
lent, that we shall get the patient well. We must
first ascertain and remove the cause of the nervous
exhaustion, which has given rise to the excessive
fatigue and the mental symptoms of doubt, in-
decision, and depression, and restore the nervous
energy, before we can appeal to the patient's
reason with any hope of success.

CHAPTER III

OTHER SYMPTOMS COMMON TO NERVOUS
EXHAUSTION

LOSS OF MENTAL CONTROL.
OBSESSIONS AND MORBID FEARS

NERVOUS debility and exhaustion, if at all
protracted, is almost sure to produce a variety
of mental symptoms, nearly all of which are
due to one factor, weakening of mental control.
One of the commonest complaints is loss of
power to resist the invasion of certain ideas
that obtrude themselves upon the patient's
mind and, for the moment, completely occupy
it. They are recognised by him as being
foreign to his personality and his modes
of thought, and are not, at any rate in most
cases, blended with his individuality, but held
as unreasonable and morbid, by the patient
himself. They are simply ideas or feelings that
he cannot get rid of at the time. Practically
they are only exaggerations of the experiences
of most, if not all, normal individuals, and it is

42

OTHER SYMPTOMS 43

only through the degree of this exaggeration
that they carry their victims over the borderland
of mental health.

Even normal persons sometimes are annoyed
by some persistent idea, but the idea vanishes
when not seriously entertained. The person,
however, who is suffering from brain-fatigue or
nervous exhaustion cannot shake off the obses-
sive idea, which may be either ideational or
emotional.

The majority of IDEATIONAL OBSESSIONS are
harmless and unattended by mental distress, or
interference with health or occupation ; but any
of them may, if the nervous energy has been
weakened, attain to such magnitude as completely
to overwhelm and temporarily to cripple the
subject. They do this not only by occupying
all his attention by their prominence, but by
destroying natural rest by their persistence, and
by causing great distress if they are resisted ; or,
if uncomplied with, by producing remorse and
agony of mind. Their fixity is recognised by
the patients themselves as something clearly
morbid, and they feel that it constitutes an
obstacle to the normal course of ideas and
actions, an extraneous element in the normal
current of thought which no effort is able to
dislodge. When the idea is in itself of trifling

44 NERVOUS DISORDERS OF MEN

importance, it is its fixity only which renders it
unpleasant. Probably the idea which is pre-
sented in an unusually insistent manner does
not assume the character of a fixed idea until
its particular insistence has become an object
of attention and a cause of uneasiness, and has
been rendered not only harassing but is also
feared. Such fixed ideas may consist of words,
numbers, phrases, or melodies, or there may be
obsessions of counting objects uselessly, re-
peating words of formulae, of stepping in a cer-
tain way, of touching certain things in a regular
order, or uttering obscene words.

The EMOTIONAL OBSESSIONS are more fixed
and more serious. They are generally based on
memories of a disagreeable character, of which
the details may be forgotten, but not the event
itself. We often remember against our will
matters that we would rather forget. Such
capacity to forget painful experiences differs
greatly in different people and is greatly
diminished when the nervous system is debili-
tated. Not only are emotional obsessions dis-
tressing in themselves, but they are accompanied
by a disagreeable form of emotion, generally
that of fear. Hence the long list of " phobias,"
which include disgust, dread, or aversion, absurd
and unnatural, towards many things, harmless

OTHER SYMPTOMS 45

and harmful. Such aversions are claustrophobia,
the horror of being in an enclosed space ; agora-
phobia, the horror of being in an open space ;
mysophobia, the horror of uncleanliness, and so
forth. In these cases there is a morbid and
irrational horror which is well known by the
subject of it to be morbid and irrational, but
which yet dominates his conduct. Sometimes
the natural repugnance associated with certain
acts is enormously exaggerated ; thus there may
be fear of contamination, of contagious diseases,
of going into dangerous places. Or the fixed
ideas consist in the representation of the im-
possibility of accomplishing certain acts, a
representation which is translated into a real
impossibility. Or they consist in the repre-
sentation of involuntary phenomena, which,
however, may actually take place through the
simple suggestive effect of the representation,
as in the fear of blushing or in obsessive in-
somnia. Or they may originate with some
special experience ; an apparently narrow escape
from being run over may be the inciting cause
of a dread of crossing streets ; a sudden morbid
impulse or suggestion to throw one's self down
may be the cause of a phobia as regards all high
places. Some unpleasant experience, or the
mere reading of one in a sensational newspaper

46 NERVOUS DISORDERS OF MEN

paragraph, may give rise to the fear of being
alone, of sleeping alone in a room, or being left
alone in a railway compartment. In all cases,
it is the weakened inhibition that is at fault.
It is easy to see how almost any variety of ob-
sessions of dread may thus arise, and most of
us can, from our own experience, appreciate
their possibility. Given the necessary suscepti-
bility, circumstances doubtless dictate the
direction the phobia shall take.

As regards the agoraphobe and claustrophobe,
the fear of being in an open space or in an
enclosed space, as the case may be, is a derivative
of the instinct of self-preservation. This primi-
tive instinct prompts the aversion from all those
situations and circumstances which threaten
bodily injury. It gives rise to that indescribable
feeling of unpleasantness which most people
experience on looking down from a great height,
even though they may be quite efficiently
guarded from falling. There is no danger of
falling ; there is an insurmountable railing at
the edge of the precipice, which is manifestly
a completely efficient safeguard ; yet it is
impossible to approach the edge voluntarily, and
if we are compelled to approach the edge a
horrible feeling is experienced which cannot be
suppressed or reasoned away.

OTHER SYMPTOMS 47

When persons afflicted with agoraphobia enter
an open space, or pass through a street that is
devoid of people, they are immediately overcome
by the imperative idea of the impossibility of
going on, and thus they become so anxious and
nervous that they are actually paralysed ; while
if they keep close to the houses or are accom-
panied by someone, they have no difficulty
whatever. The painful situation in which the
patient finds himself leads to anxiety and to
physical manifestations, such as a rush of blood
to the head, mental confusion and palpitation,
as a result of which the painful feeling becomes
still more intense. The patient recognises the
absurdity of his dreads, and in a feeble way
strives against them ; but the lassitude of will is
too great to be overcome and he returns to his
fears and anxieties. The claustrophobe who is
shut up in a railway carriage, or the agoraphobe
who is in an open space, is as thoroughly and
completely aware of his safety, and of the
irrationality of his terror, as the person on the
edge of the cliff who is safeguarded by a stout
railing from falling over ; but none the less is he
incapable of utilising his knowledge to suppress
his panic.

Another noteworthy example is the fear of
fire. Both in his own house and in public

48 NERVOUS DISORDERS OF MEN

buildings the victim of this fear is at once thrown
into a panic by the faintest smell of smoke whose
exact origin he does not know. At home he is
unwilling to have even the tiniest fire burning
in a grate unless he can be present to keep an
eye upon it, and he never retires for the night
without assuring himself that the range and
furnace are in a perfectly safe condition. If he
plans to spend some time in an hotel he makes it
his first duty, after being shown to his room, to
acquaint himself thoroughly with the location
of the nearest fire-escape.

Frequently the dominant element is the fear
of fainting in a public place and the com-
motion that would follow such a mishap. The
sufferer, by his over-exalted powers of imagina-
tion, pictures to himself this scene in minutest
detail. In his mind's eye, he sees people crowding
about him, thrown into utmost confusion by
his plight ; the uprushing ambulance with its
driver urging on his horse and sounding his
gong ; and the casualty ward of a hospital with
its bustling attendants. His other senses rapidly
supply the remaining details of this picture,
which may come to his mind even when he is
sitting in the quiet atmosphere of the home and
produce an anguish of mind and body fully
equal to that experienced in the localities

OTHER SYMPTOMS 49

mentioned. Thus a person may have a fear
of railway trains, of theatres, of church, of
crowded and solitary places, of social entertain-
ments, but in each of these it may be the same
and only fear — that of fainting ; just as another
person fears water, knives, fire-arms, high places,
and gas, when his real fear is suicide, these
objects being conceivable methods by which
suicide can be effected.

The patient resists, combats, represses, denies,
and fights his fixed ideas, and all the while his
mental warfare constitutes an ever-present
source of auto-suggestion which tends to grow
stronger and stronger. To overcome obsessions
by volitional effort, it is far better to make that
effort in the direction of thinking of other
subjects, or of doing some work that has nothing
to do with the obsession, than to " reason it out "
and make efforts of will directly in the teeth of
them. My advice to the victims of obsessions is
to disregard them, not to mind them, not to
fear them. It is the only way of getting rid of
them. Evade them rather than stand up to
them, should be the rule in most cases. Turn
into a side road rather than meet your enemy in
the face of his line of communication. Better
to switch the mind on to a loop line and let the
foe pass by. Singing or whistling to keep up

50 NERVOUS DISORDERS OF MEN

courage is no mere figure of speech. If at the
same time everything possible is being done to
improve the tone of the nervous system, the
constitutional apprehensiveness will disappear
and there will be less likelihood of a relapse.

Fixed ideas often lead to IMPULSIVE ACTIONS,
due again to defective mental or emotional
control. Some people naturally have little
self-control, and that little has not been culti-
vated during their youth, so that it takes a
small occasion for them to lose it. Every one of
us has his brain traversed sometimes by foolish
abnormal impulses, but these sudden and un-
usual conditions do not pass into action because
they are bound down by a contrary force, an
inhibitory will-power, wThich simple fatigue often
renders unstable and precarious ; the will, we
must remember, being the power not only to
do something, but also to leave something
undone.

A large number of people have impulses to
perform useless, bizarre, and even dangerous
acts. At certain moments they feel the desire
for these actions arising in them. They are
fully conscious of the absurdity of these actions
and judge them at their true worth. There is
more or less serious and real struggle between
the tendencies which urge them on and the

OTHER SYMPTOMS 51

judgment which holds them back. Such people
often resist when the act appears to them really
bad ; they yield when, rightly or wrongly, they
regard the act as of little consequence. The act
once performed, the patient experiences a peculiar
satisfaction, a feeling of relief, which is in turn
followed by remorse for having committed it,
should it be of an immoral or criminal nature,
and often by a great anxiety, lest the obsession
should again occur.

These impulses are as manifold in their form
as are the obsessions of doubt or fear, and vary
in their importance and severity from the simple
easily rejected suggestion, as to say or do some-
thing wrong, to the most inconvenient or danger-
ous impulses to serious crimes, such as assaults,
arson, suicide, or homicide. Many of these
patients seek medical advice to counteract the
obsession, for fear their dangerous impulses
may be put into action.

Theft is very common. The article stolen is
usually not made use of, or is replaced unawares.
It is the shame of being regarded as a genuine
thief that prevents a frank confession. The
majority of patients, however, have only a
" fear " of stealing when seeing valuables ex-
posed ; they suffer agonies in consequence, but
their impulse is successfully repressed.

52 NERVOUS DISORDERS OF MEN

I have seen patients who at the sight of
knives were overcome by an impulse to kill
someone, perhaps someone near and dear to
them. Most of these patients knew that they
were not likely to do anything silly or criminal,
but they dreaded that they might do so one day
and suffered intense agony in consequence.
There was generally a history of nervous break-
down or of unwholesome habits which gradually
lowered the nervous energy, on the restoration
of which by appropriate treatment all these
symptoms disappeared.

There are patients who come to the physician
worked up because they fear they may commit
suicide. Every now and then the thought comes
to them that some time or other they will perhaps
throw themselves out of a window, or be tempted
to drop in front of a passing train, or over the side
of a steamboat, or impulsively take poison. Some
nervous people become quite disturbed by these
thoughts. Their nervousness over the fear of this
may serve to make them supremely miserable.

Very few men, shaving themselves with an
ordinary razor, have not sometimes had the
thought of how easy it would be to end existence
by drawing the edge of the razor through the
important structures in the neck. Now there
are persons who at moments of worry and

OTHER SYMPTOMS 53

nervousness are so affected by this thought that
they have to give up shaving themselves. Such
patients need firm and convincing reassurance
that there is no danger that they will commit
suicide, because it is extremely rare that patients
who dread it very much and, above all, those
who dread it so much that they take others into
their confidence in the matter, take their own
lives. The very fact that the thought produces
so much horror and disturbance in them is the
best proof that they will not impulsively do
anything irretrievable in this way.

Coming back to the discussion of morbid
fears, their range is boundless. To enumerate
them all would be an endless task. There is
one form of fear which, however, merits separate
consideration. It is the fear of sickness.

In some persons there is a MORBID ANXIETY
AS TO HEALTH, and extremely exaggerated, if
not illusory, ideas as to the existence of certain
bodily disease, leading to the concentration of
the attention upon, and consequent exaltation
of, physical sensibility, resulting often from
passing physical sensations or slight ailments,
which eventually assume to the deluded imagi-
nation a grave and significant character. No
part of the body is exempt from these fears,
but usually the attention is centred upon the

54 NERVOUS DISORDERS OF MEN

obscure and inaccessible organs. The patient
may present the picture of health, or he may
have some real ill regarding which he is unduly
anxious. As a rule there is a retardation, if not
inhibition, of the functional activity, a lowered
tone, of that organ on which the patient's
attention is concentrated and which he expects
to go wrong. There is an apprehension or fear
of disease, not a genuine conviction, hence the
patient talks to everyone he meets about his
ailments to get some further clues about their
realities. At first he will be amenable to reason ;
but if not dealt with firmly and if the nervous
disorder is not treated, which lies at the root of
his trouble, his fear may give way to a decided
belief, a fixed idea.

The subjects generally lead sedentary and
solitary lives and their morbidity is often accen-
tuated by reading quack literature. They show
extraordinary pertinacity in seeking cures for
their ailments. Nearly all of them complain
either of actual pain or of some form of bodily
discomfort. There is often a state of mental
gloom and depression. They are apt to be
irritable, emotional, restless, and sleepless. Their
minds may be so occupied with their miserable
condition that work, or even amusement, is
quite out of the question.

OTHER SYMPTOMS 55

We all of us get tired ; but we know what it
is, and we are assured beforehand that a little
rest is all that we need. The nervous person,
however, is frightened ; he takes his weariness
with great concern and makes it last longer by
the attention that he pays to himself. The
human mechanism is so complicated that hardly
a day goes by without our noticing some creaking
in the works. Sometimes it is gastric trouble,
or a slight pain or palpitation of the heart, or a
transient neuralgia. Full of confidence in our
comparative health we keep right on, making
light of these little ailments. Some persons,
however, are fascinated by the idea of sickness ;
it becomes a fixed idea with them.

A common, and at the same time, secretly
nourished fear is the fear of insanity. The anguish
occasioned by it is indescribable. This fear is
caused in part by queer feelings in and about
the head, in part by memory defects, and,
lastly, by the unwelcome presence of whimsical
ideas and constantly recurring impulses to do
things which the sufferer recognises as entirely
foreign to his normal self.

As a matter of fact there is not in these
patients the profound alteration in character we
are wont to observe in insanity. Intimate
letters may be rambling, and overcharged with

56 NERVOUS DISORDERS OF MEN

petty details of distresses and incapacities, but
they do not betray aberration of mind, as those
of the insane almost invariably do. The insane
person, like one in a dream, is apt to be as un-
aware of his symptoms as the sufferer from,
nervous exhaustion is morbidly alive to them. The
latter's mind may be occupied with his complaint
to the exclusion of some better thoughts and
impulses, but is rarely perverted or blinded.
He is certain that he is ill, and in his
belief he is justified, but he is always open to
argument as to the cause or seat of his dis-
comfort, and his confidence is to be won. He
rarely loses hope entirely and seeks each new
physician with fresh prospects of relief. If he
is sad, his sadness is the natural event of baffled
hopes and thwarted enterprises. He may shun
society, but he does so only because conversation
wearies him and people get on his " nerves."
In his solitude and centred in himself he may
develop eccentric or crazy habits, but rarely
insanity.

The patient suffering from nervous exhaustion
wishes to make the effort to act, but he cannot,
fatigue setting in quickly. The insane patient
suffering from melancholia has no such wishes ;
he is indifferent towards everything and feels
as if paralysed. The mental depression of the

OTHER SYMPTOMS 57

former is not immovable ; under the influence
of some stimulus, as that of enlivening society,
he may recover at least temporarily. With the
latter the gloom is constant. The former, as a
rule, consults the physician of his own accord,
desirous to get rid of his various symptoms.
The latter rarely takes the initiative, but so
alarms his family that it is they who consult the
physician. The former is never without hope ;
the latter has no desire to live.

Another common fear is the fear of heart
disease, with its popularly supposed termination
in sudden death. Fear of cancer is also not
uncommon. Others fear sexual disease or brood
over what they regard as the penalty of youthful
wrongdoing. Such patients are especially likely
to become the prey of quacks, who levy heavy
tribute on their unwholesome fancies.

The suffering of the world is out of all propor-
tion to the actual disease. Many people who
have little disease suffer a great deal, partly
from over-sensitiveness, partly from concentra-
tion of mind on their ailments, and partly from
such ignorance of whatever pathological condi-
tion is present that they grow discouraged and
morbid over it. In such people a vicious circle
is formed when anything is the matter. First
they dread a particular illness. This keeps them

58 NERVOUS DISORDERS OF MEN

from enjoying life as before and they restrict
their activities. Perhaps they become over-
careful of their diet and reduce it below the
normal limit for healthy activity. This causes
them to have less energy for work and disturbs
their sleep. Then a host of minor symptoms,
supposed to be due to the disease, whatever it
is or they think it is, but really consequent upon
the unhealthy habits that have been formed,
begin to develop.

The patient may be merely " apprehensive "
about his health and be amenable to reason ;
he may let himself be convinced by arguments
when they are skilfully put before him. Such
patients may exaggerate the importance of their
symptoms and attribute them to an impossible
cause ; they are, however, quite willing to be
set right, and, once convinced of their error,
their suspicions may altogether vanish. Others
there is no need to convince that they are
deceiving themselves ; they know it as well as
their doctors do. It is rarely that they are under
any delusion as to the groundlessness of their
apprehensions ; much of their distress arises
from their being unable to control fears that
they realise are " foolish " ; they are disturbed
by it just as we sometimes are in ordinary life
at the thought of a danger that we know to be

OTHER SYMPTOMS 59

chimerical. Others, again, are no longer beset
by fears ; they have true delusions, such as
having cancer of the stomach or some other
incurable complaint. They are not simply
apprehensive, they are convinced ; fear has
given place to a decided belief, a fixed idea.

The rational treatment of morbid fears must
be founded on a careful study of individual
cases, the recognition of the special cause, a neu-
tralisation of all unfavourable suggestions, and
occupation of mind that will enable the patient
to rid himself of the annoyance occasioned by
them and the physical symptoms that so often
develop as a consequence. The patient has to
learn not to fear the intrusion of strange thoughts
and feelings, to regard them with indifference.
Being robbed of their significance they soon fade
away and disappear altogether. Both dreads and
obsessions require the practice of mental dis-
cipline and self-control ; otherwise, even when the
nervous system has been put right, the old
mental habits will bring about another relapse.
All such nervous sufferers will do well to take
up new lines of study or new hobbies in order
to think as much as possible of things outside
of themselves and their own interests. They
ought to observe others as much as possible
and not themselves. As has been pointed out

60 NERVOUS DISORDERS OF MEN

already, they should make a point of cheering
up other people. Their good humour will act
on them by reflection. Let them cultivate also
the habit of contentment and avoid worrying
over things which cannot be changed. A large
percentage of the things which harass and vex
us would be robbed of their power of annoyance
if we became reconciled to their presence.

CHAPTER IV
INSOMNIA

AMONG the symptoms of nervous disorder there
is one of great importance because of its
frequency and the aggravation that it causes
in the patient's condition. This is insomnia.

Sleep varies in degree and kind. It may be
wanting altogether ; it may be too short ; it
may be too prolonged ; it may not be deep
enough ; it may be interrupted ; it may be
disturbed by dreams ; it may be unrefreshing,
or it may be too profound. Want of sleep will
in time wear out the finest and strongest brain.
All sorts of diseases result from want of sleep.
Of course, as in everything else, the widest
differences may be observed between one person
and another in regard to the amount of sleep
required. What is sleeplessness to one person
may not be so to another. There are men who
require not more than five hours' sleep, others
must have seven hours regularly, and there are
some who sleep nine hours and even more.

62 NERVOUS DISORDERS OF MEN

Much depends on the nature of the occupation and
on habit ; and there are in this matter, too, good
and bad habits. The habit of sleeping too little
is less frequent than that of sleeping too much.
There are some hard brain workers who sleep
very little and yet enjoy good health if they live
otherwise correctly. This fortunate power of
rapid recuperation may be said to be one of the
characteristics of greatness. At all events, it
has occurred with sufficient frequency in great
and successful men to have done great harm
among average individuals. No one ever got
too much healthy, natural sleep. Some anaemic
and nervous individuals recuperate with such
extreme slowness that they require ten, twelve,
or thirteen hours of sleep properly to redress the
balance. As a rough working average it may be
stated that the majority of vigorous adults
require about seven hours' sleep. As a rule, it
is not the length of sleep, but its quality which
is at fault.

The majority of patients suffering from
nervousness sleep badly, but their insomnia
appears under very different forms. There are
patients who get to sleep with difficulty. They
go to bed tired, but when they are in bed sleep
does not come. Certain patients fall asleep
easily, but they wake up at the end of a few

INSOMNIA 63

hours and cannot get to sleep again ; many fall
asleep toward morning at the hour when they
ought to get up. Again, some describe their
sleep at night as abnormally profound, but
complain that they are so little refreshed by it
that they remain drowsy and lethargic during
the day, unable to attend to business. Drowsiness
is the opposite condition to insomnia and is
equally a sign of nervous exhaustion.

Many patients find their insomnia caused by
various painful sensations, such as palpitations
and anguish, or dyspeptic troubles. It seems to
them as though they could go to sleep if they
could be relieved of all these discomforts.
Others sleep, but with agitated sleep, disturbed
by dreams and nightmares. Sometimes they
preserve no memory of the dream, but are
conscious of having had an interrupted and
disturbed sleep by their state of feeling in the
morning.

Besides work and worry, the general rush of
life of modern civilisation does not tend to
healthful sleep. At the present day, when so
many people, either from choice or necessity,
spend their time in passing from one form of
excitement to another, from work to play and
play to work in a limited number of hours, and
the nervous system is always in a state of

64 NERVOUS DISORDERS OF MEN

tension owing to newspapers, telephones, tele-
graphs and motor-cars, it is not to be wondered
at that sleeplessness is so common a trouble.
Then there are the traffic noises in town; and when
our nerves are upset by them and we seek the
quiet of the country or seaside we find that we
have become sensitive to the noises made by
dogs, birds, the rustling of leaves, or the beating
of the sea waves against the shore, noises of
which in perfect health we should have taken
no notice.

A clock that strikes the quarters has spoiled
many a night. To others, the mere ticking of
the clock is enough to keep them awake. Some
people are more sensitive to one kind of noise
than to another. Recurrent noises are the worst,
causing people to lie awake in the expectation
that they will recur.

Excess of light in a bedroom, such as proceeds
from a fire, or in summer from the early morning
light, often prevents sleep. Change of climate,
especially to high altitudes, or in some indi-
viduals even to the seaside, or sleeping in a
strange bed, sometimes gives rise to a temporary
insomnia. Eating late dinners or suppers by
those unaccustomed to them ; or the failure to
obtain the habitual " night-cap," whether it be
a glass of hot milk or something stronger, in

INSOMNIA 65

those accustomed to it, will delay sleep in others.
As a rule, the generous feeders sleep better than
the careful eaters, the continued congestion of
the digestive organs depleting the brain and
favouring sleep, provided no dyspeptic troubles
arise.

Sleeplessness may arise in persons in health
from keeping irregular hours. A rule that should
be followed by everyone is to practise going to
bed at a definite hour every night and to get up
at a definite time every morning ; moreover,
to get up immediately on waking. Regularity
in the habit of retiring is of more importance
than going early to bed. All our functions are
regulated by habit. We often have an appetite
at the hour for dinner, even when we have not
spent our strength or exhausted our capital,
and when we have taken food a few hours
before. Our eyelids grow heavy at the time
when we habitually go to bed, although we
have displayed no particular activity during the
day-time; and by training ourselves to definite
time for sleeping, and avoiding all exciting
causes prior to going to bed, sleep is almost sure
to come.

Regularity in the hour of rising should also
be practised. Except invalids, no person should
lie in bed during the morning hours when not

66 NERVOUS DISORDERS OF MEN

asleep. To those awakening in the middle of the
night and unable to get to sleep again, I have ad-
vised getting up and doing some unexciting me-
chanical work for half an hour, rather than
remaining fidgety in bed. Getting up under these
circumstances soon produces a tired feeling, and
the body being cooled a little, the warmth of the
bed is again appreciated and sleep is more likely
to follow.

Another good rule is to train one's self to fall
asleep without delay immediately after retiring.
We cannot sleep if we continue to think. In
some people the thoughts are fixed on a
disturbing subject ; some are kept awake by
wrorry and fears, while others suffer from too
vivid an imagination. The fancy, instead of
becoming gradually subdued, until the super-
vention of unconsciousness, increases in activity ;
while myriads of fantastic thoughts crowd upon
the mind in endless procession and baffle every
attempt at repose. During the early part of
the night such persons lie awake for several
hours, tormented by a constant succession of
thoughts and emotions of the most varied
character, and not till towards morning do
they usually succeed in falling asleep. The
patient must enforce upon his consciousness the
fact that nothing can be gained by reconsidera-

INSOMNIA 67

tion of the sins of omission or commission in the
hours past, or at least nothing so valuable that
it should be allowed to lessen the period of
needed rest. Though it is not easy to empty the
mind, to stop its involuntary activity, the
patient can train himself to replace the
active labour of the mind with peaceful contem-
plation, to turn the thoughts into different
channels. Sometimes this is best accomplished
by physical means, sometimes by fixing the
attention on merely idle but pleasant notions.
Many active-minded people of intelligent habit
find a dose of light literature a useful means of
altering the current in which thought has been
running, and read poetry or fiction before bed-
time. But they should be careful not to
get so interested that they keep awake to
read. The book should not be so dull that it
cannot be read at all ; on the other hand, it
must not be exciting, or it will murder sleep.

There is one preoccupation which is especially
dangerous ; it is that of sleep itself. There is
ample reason to believe, and many cases support
such a conclusion, that a great deal of the
insomnia of nervous patients originates in, and
is fostered by, an obstinate and continued be-
lief that sleep is impossible. When the patient
does not sleep and is impatient because he does not

68 NERVOUS DISORDERS OF MEN

sleep, and keeps turning over and over, and
growing more and more vexed, he creates a
state of agitation which hinders sleep.

During the hours of insomnia the mental
condition of the patient is very variable. I have
seen some who do not suffer at all. They admit
coolly that they do not sleep, but they do not
experience any unpleasant sensation. Others
become impatient and grow vexed. They turn
over incessantly in bed, get up, and go back to
bed again. They toss from side to side, remove
the bedclothes, change their position continually
in the vain endeavour to become unconscious.
The peripheral nerve irritation occasioned by
their contortions only serves to perpetuate the
condition of cerebral wakefulness. When, as
frequently happens, sleep at last supervenes,
it is no longer physiological in character ; but,
on the contrary, is perverted by dreams and
unconscious cerebration to such a degree that
it affords little or no refreshment. Daylight
finds these patients completely prostrated and
unable to resume their accustomed activities
with the requisite amount of energy.

As to dreams, all we can say of them is that
they appear to be due, to put it crudely, to
different areas of the brain or parts of the body
varying in the degree of their fatigue and conse-

INSOMNIA 69

quently soundness of their sleep. A study of a
large number of the dreams which psychologists
have analysed shows that the greater part of
the material out of which the dreams are fashioned
is furnished by the previous waking thoughts
of the dreamer, particularly those disconnected
ideas which coursed in a passive fleeting way
through the mind, or rather which made up the
stream of consciousness just before going to
sleep. Another source of these dream elements
—although a less rich one — is the thoughts of
the preceding day, and even earlier mental
experiences. The same might be said of ideas
and feelings which had dominated the psycho-
logical life of the individual through a long
period of time, and the subconscious mental
experiences of which the individual is only dimly
aware. There are a multitude of events which
are so completely forgotten that no effort of the
will can revive them, which may nevertheless
be reproduced with vividness in our dreams.
In the opinion of modern investigators, dreams
are related mainly to dissociated, suppressed,
or dormant past experiences, dormant wishes
or desires, and originate chiefly in the sub-
conscious mental life. In their opinion, the
world of dreams is the embodiment of our hopes
and fears. The thoughts which we recall on

70 NERVOUS DISORDERS OF MEN

awakening are merely the manifest thoughts of
the dream, but by a process of psycho-analysis
we can get at the latent thoughts. The former
are absurd and meaningless, while the latter are
the actual innermost thoughts of the individual.

The troubled or horrid dreams which occur
during sickness are probably due to the torturing
of the brain by the toxins with which the blood
is loaded. Similarly, the gruesome visions and
nightmares which embitter the slumbers of
those under the stress of violent emotions and
mental suffering are due to similar action by the
fatigue-poisons produced by these states.

While perfectly normal sleep is dreamless, yet
a moderate amount of dreaming, especially if
the images evoked are of a pleasing or indifferent
character, is quite compatible with good and
refreshing slumber. Persistent or frequent bad
dreams are, like insomnia, a sign of ill-health,
and should be regarded and treated as such.

Those patients who approach the night with
a fixed idea that they will not sleep and who
count the bad nights which they have already
had, persuaded that this one will follow in line
and resemble the others, should remember that
the best preparation for sleep is confidence that
one will sleep, and indifference if one does not.
It is necessary for the patient to lose all fear of

INSOMNIA 71

insomnia and to approach the subject of sleep
with a perfect indifference, which may be
summed up in this idea : " If I sleep, so much
the better ! If I do not sleep, so much the worse,
but it does not matter either ! " Sleep comes
when one is not looking for it ; it flies away when
one tries to catch it. It may be pointed out to
these patients that it is a mistake to elevate
sleep into a fetish ; that the world does not
come to an end because one person, however
important, is unable to sleep ; and that the
most certain method of keeping such an elusive
entity from embracing one is in pity to implore
its advent with outstretched hands, or to summon
it peremptorily and impatiently with clenched
teeth.

In some persons thoughts keep on trooping
through the mind in a regular procession and
thus prevent sleep. Such persons, if they cannot
otherwise stop thinking on retiring, may achieve
success by allowing the train of thought to
inarch on with all its energy, while they begin
to concentrate the mind on relaxing the body,
when it will usually be found that the train of
thought slows down just in proportion as the
muscles are relaxed. Or else, if this fails, the
patient should try, as I have mentioned before,
to think of something pleasant and attractive,

72 NERVOUS DISORDERS OF MEN

but calm and reposeful. To the romantic, the
moonlight on a quiet sea may be suggested ;
to the more material, a comfortable armchair
in front of a fire ; but he must go on thinking
about it. He must concentrate all his attention
upon it, and must not be surprised if at first the
charm fails to work. When the attention tires,
a not too interesting book may be temporarily
appealed to, and then the experiment repeated.
If the patient can be induced to act thus for
several nights in succession without allowing his
thoughts to revert in pity to his sleepless state,
it is astonishing what success will often ensue ;
more especially if, by an appeal to his reason
and proper pride, one has succeeded in enlisting
his real co-operation.

The one procedure which most universally
disposes to sound sleep is one which is within
the reach of all, and that is getting well tired.

Another rule which I always impress upon
my patients is to have done with all serious
thoughts before entering their bedroom. None
but cheering and soothing reflections, if any,
should take place prior to going to bed. Any
topic which stimulates the brain to great
activity, whether intellectually or emotionally,
must be carefully excluded. There should be
a period of absolute quiet before retiring to bed.

INSOMNIA 73

In order to sleep well patients must be
thoroughly comfortable in bed. Most people
find they sleep easiest with a reasonably firm
pillow, not too low, so that the head is a little
higher than the body ; others raise the head of
the bed, so that there is a gentle slope. The
lateral position is to be preferred to lying on the
back. Sensitive persons sometimes obtain sleep
by changing their position in bed, or, better
still, the position of the bed. It is held by some
of great importance whether the bed faces
North, South, East, or West.

As regards the room to sleep in, a good bed-
room should be spacious, not encumbered with
furniture and draperies, since much fresh air
is needed when sleeping. Active ventilation is
not less necessary, and should be so arranged
as to avoid currents of cold air; for the skin
during sleep, in consequence of the increased per-
spiration, is very sensitive to cold, and the body
is more easily chilled asleep than awake. The
bed should therefore be placed near the inner
wall, as far as possible from the windows and
the fireplace, to avoid the draughts which are
strongest at these spots. Some people sleep
well when they have a change of room, and
others when they have a change of air. A
holiday, with a complete change of scene and

74 NERVOUS DISORDERS OF MEN

distinct change of activities, will often do much
to cure insomnia.

Sources of local irritation must be removed.
For example, where the feet are persistently
cold, warmth may be applied to them. Some-
times a hot bath or hot sponging, followed by
very gentle drying, will bring on sleep by allaying
nervous irritability.

Diet has little influence on sleep, except when
insomnia is due to disturbances of digestion.
The processes of digestion probably go on more
slowly during sleep, but they are perfectly
carried out, as is illustrated by the almost
invariable habit among animals of going to
sleep directly after a meal. Indeed, a moderate
amount of food in the stomach or intestines
seems to promote slumber. Many night-
workers, for instance, sleep much better for
taking a light supper or a hot drink with a
biscuit just before retiring. It is difficult to
get to sleep on " an empty stomach," or at
least when the stomach has been empty so long
that gnawing and hunger are felt. On the other
hand, an overloaded stomach is not conducive
to refreshing sleep, although that condition
makes one drowsy. In cases where indigestion
produces insomnia no food should be taken four
hours or more before sleeping time, or, if this

INSOMNIA 75

is found to be disadvantageous, the food should
be of the lightest description.

The prescription frequently made for chronic
insomnia is that of rest or a vacation. Un-
fortunately both of these recommendations are
usually more easily given than taken. Absolute
vacancy of mind is talked about but never
attained, and relief from mental activity means
in reality relief from the habitual current of
anxious thought, from care and responsibility,
matters which in such cases are apt to be beyond
the control of the physician. It is to be remem-
bered that the disturbances of sleep which are
the most difficult to manage come from within ;
and if a vacation is taken the occupation must
be such as will displace morbid activities by
healthy ones, not intense, but sufficient to pre-
dominate. If the patient has nothing else to
think about, he will be sure to think of his
troubles.

The most dangerous of all counterfeits of sleep
is that induced by drugs. At the present day,
when so many, either from choice or necessity,
spend their time in passing from one form of
excitement to another, when such an enormous
amount of work or play has to be got through
in a limited number of hours, it is not to be
wondered at that sleeplessness is so common a

76 NERVOUS DISORDERS OF MEN

trouble, or that specifics for its relief should be
so eagerly sought after and so recklessly em-
ployed. It goes without saying that there is no
drug that can produce physiological sleep ;
there are many which produce a state of un-
consciousness resembling sleep, and some of
these are unfortunately much resorted to for
this purpose. Though permissible in skilled
hands their habitual use is dangerous, both
because they are all poisons and because they
smother the symptom, suppress a danger signal,
without doing anything to relieve the diseased
condition which causes it. The man who works
all day in an ill- ventilated room and takes little or
no exercise, or the woman who slaves over her
housework or her needlework or embroidery and
almost forgets that there is such a thing as open
air, the business man who is driving himself too
hard and keeps up on stimulants, the individual
who is in the early stage of some disease, when
they find that they cannot sleep, instead of regard-
ing it as nature's danger signal, demanding inves-
tigation and change of habits, swallow some
sleeping draught and persist in their suicidal
course until a breakdown results, that they can
no longer shut their eyes to. There is no such
thing as uncaused sleeplessness any more than
there is uncaused loss of appetite, of strength,

INSOMNIA 77

or weight. All of them are signals of trouble
and should be promptly regarded and investi-
gated as such. Narcotics have their place
in medicine like other poisonous drugs, but
that place is becoming steadily smaller as
cases are more painstakingly and intelligently
studied.

The sense of well-being and illusory strength
induced by alcohol and other stimulants, and
the sleep so easily procured by drugs, are specially
dangerous to the nervous person whose moral
courage and self-control are at fault. He readily
falls a victim to narcotic indulgence. The sleep-
lessness which is often so distressing and ex-
hausting is frequently only an expression of the
nervous irritability and obsessions of the sufferer.
Temporarily to dull his sensibilities with drugs
is a sure way of intensifying the condition
which it should be our endeavour to remedy in
some more rational manner.

Of course, no doctor will forget that sleep-
lessness is frequently a symptom of bodily trouble,
and that it is necessary to discover the under-
lying cause. We may have to remedy digestive
derangements, to relieve local irritations, to
correct disturbances of circulation, to relieve
anaemia and debilitated conditions, and to secure
due regard to sanitary requirements.

78 NERVOUS DISORDERS OF MEN

A large number of cases, especially those
suffering from insomnia through worry, anxiety,
overwork, and other mental conditions, can be
cured by " suggestion," and this method is
often effective even when organic causes are the
trouble. Thus it has been my good fortune to
send to sleep almost instantaneously a patient
suffering from cancer, who was kept awake by pain
for which morphia injections had ceased to give
relief.

Obstinate cases often do well by the applica-
tion of mild currents of electricity, especially
galvanism. Its value is not sufficiently recog-
nised. In happy contrast to the influence of
sleep-compelling drugs, which are frequently a
source of danger and usually occasion unpleasant
sensations on the day following their administra-
tion, electricity, when administered carefully by
a qualified medical man, induces a sleep that is
pleasant in character and has no evil conse-
quences. Further, not only is sleep produced,
but the patient derives general benefit from the
influence of electric currents. Sometimes the
result is immediate, at other times a more
prolonged course of treatment is required. I
have found the effects to be not merely tem-
porary, but permanent.

Often a combination of electrical treatment

INSOMNIA 79

and psycliotherapeutics achieves the desired end.
Anyhow, in the great majority of cases sleep
can be procured without the aid of drugs, and
astonishing successes are not infrequent even after
powerful drugs have failed.

CHAPTER V

NERVOUS DYSPEPSIA

THE great majority of the dyspeptics of the
present day are so because their nervous power
has run down, or has been incontinently con-
sumed in other directions without any regard
for the needs of the stomach. It is positively
rare to observe cases of nervous disorders with-
out digestive troubles. They vary infinitely as
to intensity and symptomatology. In some
cases indigestion is the principal symptom com-
plained of, and the mistake is made by the in-
experienced and unqualified of treating by local
measures indigestion which originates in a dis-
ordered nervous system.

In health there is a blessed unconsciousness
of the very existence of a stomach; but if
dyspepsia be present the patient can think of
little else. A healthy man does not know that
he has such a thing as a stomach, a dyspeptic-
does not know that he has anything else. With
the neurotic, the dyspepsia is an abiding trouble ;

80

NERVOUS DYSPEPSIA 81

he is obsessed by his gastric symptoms, dwells
upon them continually, sits in judgment upon
every article of food presented to him, yet it is
obvious to everyone that if it were not the
stomach it would be some other organ that
would be occupying his thoughts.

Once certain people get the notion that they
are troubled with indigestion, their minds dwell
on it to such an extent that they are likely to
limit their eating more than they should, and
to disturb digestive processes by thinking about
them, and using up in worry nervous energy
that should be allowed to flow down to actuate
digestion.

Nervous patients often say they have no
appetite, that even though they eat, their food
has no taste. Such people have lost their eating
instinct to a certain degree. They eat merely
from routine, or because food is placed before
them. They would usually just as soon not eat.
If a number of courses are presented to them,
they eat such as they care for and take a con-
ventional amount of each kind of food presented,
but they have no particular feeling to guide
them in the matter of quantity.

Dyspepsia is probably much more dependent
on the mental state than on any other factor.
At moments of depression, just after bad news

82 NERVOUS DISORDERS OF MEN

has been received, the appetite is absent, or is
very slight, and digestion itself proceeds slowly
and unsatisfactorily. On the other hand, when
there is a cheerful mental condition, appetite
is vigorous and digestion is usually quite capable
of disposing of all that is eaten. The unfavour-
able influence of the mind on digestion is seen
in all those who are particular about their food.
Everyone knows how repulsive may be the
feeling produced by being told that something
eaten with a relish contained some unusual
ingredient, or was cooked under unclean condi-
tions. Food that agrees quite well with people,
so long as they do not know too much about it,
often fails to be beneficial after they have seen
how it has been prepared.

Sedentary occupations, involving mental work
and little physical effort, seem especially to
predispose to some form of indigestion. Few
of those who live what is called the intellectual
life escape suffering from some of its symptoms.
In many cases dyspepsia is primarily due to over-
concentration of attention on digestion. In
others it is due to over-occupation with business,
worry, or serious thought, at times when the
digestive processes need all the energy. Men are
at work from 10 to 6, and often enough bring
home their professional or business worries

NERVOUS DYSPEPSIA 83

with them, their brains being all the while in
a state of turmoil. In the midst of this they
eat and drink, and expect their stomachs to
digest. But if they have exhausted their
nervous supplies, where is the stomach to get
its motive power ? The tired man, even though
he may be hungry, can only eat a hearty meal
at the risk of serious disturbance of digestion.
In these days of hurry-scurry, our brains run
ahead and take no thought for the stomach, and
in consequence there is almost a necessity for
many of us to suffer from a slow digestion.
And a slow digestion means that as regards
symptoms there will be more or less distension
after food.

The habit of indulging in excessive meals is
another cause of dyspepsia. The patient is often
a highly-strung and vigorous person, who ex-
hausts himself by his work, and feels stimulated
and sustained by food, and eats more than he
can digest, though he may obtain temporary
relief by eating. Or he is very fond of the
pleasures of the table, and having a good appe-
tite, between his attacks he is led to indulge it
whenever any dish to which he is especially
partial is before him. Many of these people are
not aware that they are eating more than is
good for them, for the ordinary estimate of the

84 NERVOUS DISORDERS OF MEN

necessary amount is far too high. Overfeeding
leads to flatulence, drowsiness, and a loss of the
wonted energy. The fortunes of the quack pill
vendors show the extent of this vice. Every
man should rise from table not satiated, but
wishing to eat more.

Very few men realise also the fact that the
process of digestion uses up nervous power.
Most people imagine that the more they eat the
more strength they will acquire; whereas the
truth is that beyond the amount of food needed
by each individual to repair waste in proportion
to his expenditure in muscular or mental work,
the rest is superfluous, and consumes in the
disposal of it nervous energy that might other-
wise be utilised in more valuable ways.

The gastric symptoms due to failure of nervous
power are characterised by their extreme
irregularity, the patient not uncommonly feeling
very ill one day and quite well the next without
obvious reason for the change. The most
constant complaint is of vague discomfort,
which rarely amounts to actual pain. It is
generally worst in the morning and decreases
toward evening ; it is increased after meals, a
sensation of fullness being felt as soon as a small
quantity has been eaten.

The discomfort has little relation to the

NERVOUS DYSPEPSIA 85

amount or the kind of food taken ; it is increased
by worry and excitement, whilst some new
interest, whether it be a change of surroundings,
the visit of a friend, or a new medicine, leads to
its temporary disappearance. Thus, when alone
or with dull company, food of any kind may be
simply repulsive, and, if taken, may induce a
painful sensation. But the same food, taken in
the company of congenial associates, may be
not only enjoyed by the palate, but digested
with ease and comfort. Often the patients feel
worse when the stomach is empty and are
relieved by eating. In others the symptoms
come on after eating, though, perhaps, not until
several hours have elapsed. The appetite is
always diminished, especially when there is
worry or anxiety, though it varies considerably
from day to day. As insufficient food is taken
the nervous system becomes more depressed ;
this reacts again on the digestion, a vicious
circle being produced. Most patients complain
of flatulence, which may be nothing more than
the result of misinterpreting the sensation of
fullness, no excess of gas being present. Nausea
sometimes occurs, and occasionally vomiting.

These patients are almost always irritable and
find difficulty in exercising sufficient self-control
to make life pleasant to themselves and their

86 NERVOUS DISORDERS OF MEN

friends. We know very well how our feelings
vary with our bodily condition, how dismal the
world looks during a fit of indigestion, and what
a host of evils disappear as the abused stomach
regains its tone. The effect of indigestion may
be seen in the records of history and literature.
It has led to the loss of battles ; it has caused
many crimes and inspired much sulphurous
theology, gloomy poetry, and bitter satire.

On the other hand, the influence of the brain
on digestion has not escaped the observation of
physicians in any age. The effects of the emo-
tions— such as love, anger, worry, and anxiety
— on the appetite are found described in the
literature of the ancients.

Seeing what important influence the mental
and nervous states have upon digestion, we must
not be misled into treating the purely local symp-
toms as quacks do, judging by their eloquent
advertisements in the daily Press; but once
having assured ourselves by a thorough ex-
amination that there is no organic cause for the
trouble complained of by the patient, we must
study him as a whole, not only from the point
of view of his animal functions but from the
psychological point of view. We must consider
not only what he eats or drinks, but be interested
in what he thinks.

NERVOUS DYSPEPSIA 87

There is hardly a patient suffering from
nervous dyspepsia who has not tried one or
more quack nostrums. Much mischief is done
in this way. What these patients do not know
is that their indigestion is merely a symptom and
not the disease they are suffering from. On the
other hand, until they have been examined by
a physician they cannot know whether this
indigestion is, or is not, a sign of organic and
maybe even malignant disease.

The proper treatment is to study first of all
the causation of the disorder, and to do this a
perfectly clear diagnosis is necessary. A patient
may come complaining simply of indigestion,
when a careful and tactful examination will
reveal the cause in the shape of some depressing
circumstance. In such a case neither drugs nor
diet, but a change in some life circumstance,
gives the clue to successful treatment. If the
indigestion is due merely to nervous exhaustion,
we must raise the nervous power ; we must
remember that the indigestion is not the disease,
and that we have to treat the patient's main
disorder — his nervous debility.

Only after we have corrected all extraneous
sources of trouble should we attend to the diet.
This is just the opposite rule from that which
obtains amongst this class of dyspeptics. They

88 NERVOUS DISORDERS OF MEN

are too fond of " pampering " the stomach. A
man who continuously and anxiously considers
the kind of food he eats — whether it is going to
agree with him or not when he eats it — is a
dyspeptic, and will always remain so. The vast
majority of men are led by their instincts to a
reasonably nutritious and sensible dietary, and
the more completely we can keep our minds off
our digestions and the " chemical " choice of
our food, the better it is for us. The individual
who thinks the world is going to be saved by
eating brown bread or any other article of diet,
regardless of the fact that what agrees with one
may upset another, is a crank. It is not even
well for us to consider too nicely the amount of
water or food taken, or whether it is digestible
or not. The really healthy stomach ought to
be and is capable of disposing of not only the
digestible and the difficult of digestion, but the
indigestible. Any other kind of stomach is not
worth having.

What is the use to the invalid patient to be
told of the nutritive properties of certain foods,
when he never assimilates them. We must
prescribe foods which the particular stomach
will digest. All cases of nervous disorder want
guidance and moral influence, more particularly
in reference to diet than to any other curative

NERVOUS DYSPEPSIA 89

agent; and each stomach must be treated
according to its own respective requirements,
and, I might even go so far as to say, its own
peculiarities. A patient should be guided largely
by his own experience of what is good and bad
for him. We must not forget that some per-
fectly wholesome foods are literal poisons to
certain stomachs, and those which after repeated
trials steadily disagree had better be avoided.
If prejudice exists with regard to certain foods,
there will be no relish for them ; and unless these
prejudices can be removed the foods either will
not be taken, though they represent important
nutritional elements, or else they will be taken
in such small quantities and digested with so
much consciousness of their presence and such
difficulty as to be a disturbing factor for health.
For food to be digested, it must first of all be
attractive to the taste. If it be unattractive it
will not stimulate the juices indispensable to
good digestion. Without appetite there can be
no healthy digestion, and foods that pall on
the appetite are just as surely defective as
foods as those that are deficient in nutritive
value. The dyspeptic who is confident that a
certain food will disagree with him is almost
sure to experience indigestion if he eats that
particular food.

90 NERVOUS DISORDERS OF MEN

Many persons of middle age suffer through a
monotony of diet. Our aims should be to keep
our food range as wide as possible. Anything
which tends to limit and monotonise diet
exercises an injurious effect upon the general
vigour of the system. Both stomach and bowels
may be trained to perform their work regularly.
Habit means probably more with these organs
than any other factor. Our digestive tract is
largely dependent on habit. We get hungry
three times a day or twice a day, according to
the custom that we have established. Countries
differ radically in the matter ; and nearly always,
when a man goes from one country to another
in early years, he changes to the habits of the
new country, though if he goes after middle age
he usually clings to those that he is used to.

If we accustom ourselves to dining every day
at a particular hour, every day at that hour the
stomach will become congested and secrete
gastric juice without any intervention of our
will. If, for once, we give it nothing to eat, it
will suffer and cry famine ; if for a long time
together we disturb its habits, and the hours of
our meals become irregular, the stomach gets
out of order.

If, to digest our food, we should enjoy it, it
should of course be taken leisurely and in a

NERVOUS DYSPEPSIA 91

pleasant frame of mind. The cheerful society
of friends should not be absent ; and the longer
time spent over the meal enjoyed in company, the
greater the benefit from it. Next to anxiety,
the worst foe to digestion is hurry. Haste cuts
short mastication, and on the perfection of that
process chiefly depends the rapidity with which
the assimilation of the food can be effected. The
actual indication of a sufficiency of food is the
feeling of satisfaction, not satiety, which is
always a symptom of excess. This feeling of
perfect comfort the hurried eater cannot know.
The patient should not be too fatigued before
commencing a meal, otherwise the stomach will
not work efficiently. If he is too tired a few
minutes' mental as well as physical rest should
be allowed. Eest from work is again advisable
after the meal, to give the stomach an oppor-
tunity of placing its machinery in running order.
Many people immediately after a meal jump up
from the table, continue whatever business or
pleasure is in hand, and never give a thought
to the long-suffering and patient stomach, until
the stomach gives its owner some discomfort
or pain. The hours at which meals are taken,
then, must be so arranged as to avoid the system
being tired when it tackles the food ; and to
allow of a little rest after the meal to start the

92 NERVOUS DISORDERS OF MEN

complicated process of digestion freely on its
way.

The quantity of food required to keep one in
sound condition varies so largely that it is
impossible to lay down more than a tentative
average standard. The quality is a matter of
custom and environment ; here, too, no rigid
universal rule can be enforced. Doubtless, most
of us eat too much. Vegetarianism suits some,
but for the bulk of mankind mixed diet is the
best.

Quite a number of people take too much salt
with their food, and in this way aggravate the
tendency to acidity ; others are too fond of
highly seasoned food or of pastry or sweet things ;
or, again, the quantity of liquid imbibed at a
meal may be too large. In such cases a care-
ful revision of the diet is absolutely necessary.

Often a change of environment that takes
patients away from the ordinary cares of life is
sufficient to make all the difference between
ease of digestion and extremely uncomfortable
dyspepsia.

It is evident from what has been said that it
is extremely unwise for patients to treat them-
selves and still more foolish to indulge in quack
remedies. It is only a qualified physician who
can judge whether the indigestion is a symptom

NERVOUS DYSPEPSIA 93

of organic or functional disorder, and whether
it is due to local disturbance or is a sign of debility
of the nervous system in general.

Nervous dyspepsia is another of those dis-
orders which are most amenable to " suggestion."
I have seen even chronic vomiting relieved by it.
After all, it is nothing more wonderful than the
fact known to seafaring men that those who
direct a ship cease to be seasick when its safety
is in danger. At the same time, while insisting
on the importance of the mind in the treatment
of these functional disorders of digestion, this
does not imply that tonic remedies which stimu-
late the appetite and add tone to the muscles of
the stomach should not be used when duly
indicated. They are often helpful. If pre-
scribed in connection with changes in the
patient's habits, and especially such as direct
liis attention away from his digestive tract, and
from wrong persuasions as to food-taking, the
good they accomplish will be lasting.

Let me add a few words about CONSTIPATION.
There are more people sick because of it than
for any other reason. Any number of special
causes may be at the root of constipation, but
the commonest is certainly physical inactivity.
Another cause lies in the kind of food we eat.
We take so much trouble nowadays to have it

94 NERVOUS DISORDERS OF MEN

nourishing, digestible and perfectly prepared,
that we often fail to give the stomach and intes-
tines enough work to do. " Predigested " and
" concentrated " foods have a place in the world,
but it is not that of a regular diet.

Another sure method of achieving constipation
is that of delaying to answer the calls of the
system when they come. If a man kept a regular
time each day for attending to the business of
disposing of the waste products of his body, the
system would soon adjust itself and be ready to
respond at the right moment. Regularity in
this matter is essential to healthy living.

Often enough, the root of the difficulty lies
not so much in bad habits of the body as in bad
habits of mind. Worry and nervousness weaken
the digestion. Discouragement and low spirits
lead the straight road to constipation. Melan-
choly tends to aid constipation and constipation
tends towards melancholy.

Then there is the practice of using laxatives.
It lies at the back of thousands of chronic cases
of constipation. A man who uses a laxative to
help him out of an inconvenience is not hitting
at the root of the difficulty at all. The conditions
that gave rise to it will probably remain, and
they will make trouble again.

CHAPTER VI

NERVOUS DISORDERS OF THE HEART,
CIRCULATION, AND RESPIRATION

THE heart has its own special work to do, and
will do it well if left alone, but it constitutes a
centre to receive and to distribute sympathy,
through its nervous connections, greater than
that of any other organ in the body. Everyone
is only too familiar with the way in which the
heart becomes affected by anything which dis-
turbs the feelings, the emotions, and the recep-
tive nerve centres. The action of the heart is
most natural and regular when it is least thought
of. On the other hand, emotional disturbances
act unfavourably upon the heart and blood
vessels. Any agitation of the mind almost
immediately produces a conscious thumping of
the heart against the chest wall. Worry, sus-
pense, anxious anticipation, disappointment,
consciousness of failure or of failing health, the
" hunted " feeling that comes of overwork and
arrears, regret, sorrow, despair — all such de-
pressing influences wear out not only the nervous

95

96 NERVOUS DISORDERS OF MEN

system, with which they are immediately related,
but the cardiovascular system as well.

The nervous heart presents three typical
characteristic features, which are exemplified by
the rapidity, the tension, and the irregularity of
the pulse. Excitability of the pulse is a common
feature. The least thing — any little noise, the
presence of a stranger, or any slight excitement
—will start the pulse off at a very rapid and often
irregular rate. The pulsations of the heart are
distinctly felt by the patient as palpitations and
are attended with more or less severe pain in the
region of the apex. In some cases, however,
there is no real disturbance, but that in some way
the heart action has become noticeable to the
patient.

Palpitation is a condition in which one is
conscious of the beating of the heart ; the
severity varies from a mere sensation of fluttering
to a violent and tumultuous throbbing and
hammering of the heart against the chest wall,
causing acute distress. These palpitations, and
the distressing sensations by which they are
accompanied, disturb the minds of the patients,
who soon believe themselves to be affected with
some grave lesion of the heart. As a matter of
fact, these attacks have no gravity, but they
return frequently, and their reappearance occurs

THE HEART, CIRCULATION, ETC. 97

under the influence of the most diverse and often
the most trifling causes ; a slight emotion, even
a moderate physical effort, or the work of
digestion, suffices to provoke them.

Often the beginning of the cardiac unrest is
found in some stomachic symptoms. The
distension of the stomach with gas is often a
mechanical reason for interference with the heart
action. The patient complains of heart trouble
when he is really suffering from indigestion.

The excessive smoker, especially the cigarette
smoker, often complains of palpitation of the
heart. He complains that this palpitation
wakens him in the middle of the night, when he
finds that his heart is beating violently, and that
he feels restless and uncomfortable, and that he
cannot go to sleep again until the heart has
quietened down.

In the nervous heart caused by worry and
anxiety, the heart is so irritable, so ill-tempered,
so fractious, and so sensitive that it — figuratively
speaking — tumbles about, kicks, starts, and
plunges in a manner which becomes exceedingly
distressing and almost unbearable. At times the
slightest movement of the body will produce
this effect, walking upstairs, ascending a hill,
reading an article which touches the feelings,
or eating or drinking anything which disagrees.

98 NERVOUS DISORDERS OF MEN

The heart, like the brain, is a creature of
habit. If it once gets out of training and
assumes vicious propensities it takes a vast deal
of moral persuasion, and something more, to
put it right again.

To give useful advice to a man whose heart
and vessels present evidences of wearing out from
nervous stress is not an easy task. The physician
or practitioner who undertakes this responsible
duty should possess not only professional know-
ledge, based on experience, but an intimate
acquaintance with the affairs of life, and as far
as possible an insight into the character, dis-
position and circumstances, personal, domestic
and public, of the individual.

Medicines in such cases are seldom of use.
If there are some cases where they act favourably
by suggestion, there are others, more numerous,
where the use of an anodyne gives to the disease
the stamp of reality, which is exactly what it
ought not to have in the patient's mind. It
awakens the idea of an organic affection when
the first consideration of the physician ought to
be to dissipate all fear and all idea of danger.
Many functional disturbances of the heart will
disappear entirely with judicious regulation of
life, hygienic living and psychotherapy. The
removal of inhibiting influences originating in

THE HEART, CIRCULATION, ETC. £9

the mind and the suggestion of favourable mental
influences are as important for the heart as for
the other organs of the body.

Whilst it is not always necessary, and fre-
quently is highly inadvisable, to stop work
altogether, there must be a limit to the amount
and length of even purely intellectual work, and
sufficient provision must be made for sleep,
recreation, and distraction. The patient must
be freed from worry, which is often very difficult,
and he must beware of mental occupation of a
nature which at an unexpected moment may
provoke emotional excitement in the form of
vexation or passion. The most important
condition of all is that the patient does not
worry over his condition, for that hampers his
heart's action still further.

Patients suffering from these functional de-
rangements of the heart often make them a
pretext for avoiding exercise and for taking
stimulants, whereas exercise and fresh air are
what they need. Exercise of some kind or
another is one of the important features of all
the health resorts which specialise in the treat-
ment of heart diseases, and as it has to be
arranged according to the individual condition,
the patient should not neglect to consult a
properly qualified physician.

100 NERVOUS DISORDERS OF MEN

Sometimes the nervous attack of the heart
leads to a sensation of GIDDINESS, when the
patient feels like fainting. Surrounding objects
appear clouded and swaying and the patient is
in need of steadying himself by holding on to
something. Giddiness may arise from other
causes and a correct diagnosis is of first impor-
tance for successful treatment.

In other cases there are attacks of nervous
palpitation and great discomfort about the heart,
resembling ANGINA PECTORIS, which is a serious
affection, and also common in nervous sufferers.
It is frequently a source of terror and anxiety
for the persons attacked by it, and is peculiarly
apt to throw them into a state of extreme
dejection and depression.

The pseudo-angina may resemble a true attack.
The patient suddenly experiences in the region
of the heart a feeling as of being gripped, a
sensation of constriction, which quickly becomes
extremely painful and radiates immediately into
the left shoulder and arm. He is a prey to
anguish, to inexpressible terror. His breathing
is short and quick ; his face pale and livid ;
his extremities are pale, cold, and apparently
bloodless. The pulse is small and feeble, and the
heart-beats are almost imperceptible. After a
duration of some minutes the crisis terminates

THE HEART, CIRCUtATlbN, ETC. id

by an evident change in the state of the circula-
tion. The face becomes red and hot ; the
energy of the heart-beats increases, and every-
thing returns into order. Emotional excitement
and mental anxiety figure very largely in the
formation of pseudo-angina.

True angina occurs in most cases in consequence
of hardening of the arteries of the heart or of
some valvular lesion that interferes in some way
with cardiac nutrition. A definite sign is arterial
degeneration in various parts of the body. When
there are no signs of arterial degeneration and no
significant murmurs in the heart, it should be
made clear to these patients that they are not
suffering from a fatal disease, but only from a
bothersome nervous manifestation, which is
compatible not only with continued good health
but with long life. It must not be forgotten
that neurotic patients exaggerate their pains and
describe their distress in the heart region as
extremely severe, when all they mean is that,
because their pain is near their heart, it produces
an extreme solicitude and that a dread of death
comes over them because of this anxiety. For
the treatment of pseudo-angina, mental influence
is all-important.

Besides the nervous heart, there are numerous

DISORDERS OF THE CIRCULATION. From the

102 NERVOUS DISORDERS OF MEN

sympathetic system of nerves come tiny nerve
twigs which lie along the blood vessels and
regulate the circulation in the various parts of
the body and limbs. When these little automatic
regulators are weak and irritable they render
the patient over-susceptible not only to external
conditions, such as atmospheric changes, caus-
ing chills, pallor, " dead fingers " sensation,
etc., but to internal conditions, as produced
by the various emotions, which then cause
Hushing, flushing, and abnormal perspiration.

MORBID BLUSHING although not, strictly
speaking, a serious disorder, is, to say the least,
extremely disagreeable to the victim. It is
simply the manifestation of a weakness in the
nervous system. Probably the most prominent
exciting cause is self-consciousness, either by
introspection or by the attention being drawn
to the external portions of the body while under
examination by others. If a modest individual
of a delicate nervous organisation is in company
with a number of persons, and imagines that the
people around him are regarding him critically
and are entertaining rather a disparaging opinion
of him, he is very liable to manifest his abnormal
self-consciousness by blushing, or even by
becoming embarrassed in his conversation, and
stammering. Blushing is common in those of

THE HEART, CIRCULATION, ETC. 103

delicate nervous organisation, while those of
coarse natures are very little affected by it.
Many cultivated and scientific men are prone
to blush inordinately from humility and diffi-
dence, having a low opinion of their own ability,
while the ignorant egotist is never known to
blush. Blushing rarely occurs in solitude or in
darkness ; it occurs most often when observation
is directed towards the personal appearance, and
then results from embarrassment and self-
consciousness. Many of these inordinate blushers
are timid and melancholic. They seek solitude
and are excessively sensitive when meeting
people. Many of the victims of this disorder,
if relating an incident or anecdote, will often
lose the thread of the story by their concern as
to what their auditors may be thinking of them.

In severe cases the mental confusion is very
marked, the heart throbs violently, there is a
sensation of suffocation, and the breath becomes
short. There is a peculiar sensation at the pit
of the stomach often followed by constriction of
the throat. Palpitation of the heart is a very
common condition immediately preceding the
act of blushing. Many blushers experience a
feeling of dread as part of the emotional state.

In a large number of cases the individual
completely loses the power of thought for the

104 NERVOUS DISORDERS OF MEN

time being. The mind is completely paralysed,
and, in popular language, he is " covered with
confusion." There is an instinctive desire for
self-concealment. The blusher either averts the
head or looks downward. The expression, " I
wished I could have sunk through the floor,"
which is sometimes used, aptly expresses the
mental condition of the patient at this time.
When a person has once suffered from this
disorder, he is liable to have subsequent attacks ;
for the nervous system is highly impressionable,
and the condition once well developed is apt to
be perpetuated by slight influence.

Blushing is generally confined to the face on
account of its extreme vascularity, and therefore
having a great supply of vasomotor nerves ;
the face, moreover, being the portion of the
body most exposed to view and upon which
attention is concentrated in looking for recogni-
tion, or in studying character or discerning
beauty or homeliness.

For purposes of treatment one must go back
to the origin of the mental trouble and dispel
the primary morbid mental condition, the self-
consciousness, uneasiness, shyness, timidity, and
the various preoccupations which drive the blood
to the face, and one must give the patient
confidence in himself.

THE HEART, CIRCULATION, ETC. 105

Here we must discuss also NERVOUS DISORDERS
OF RESPIRATION. One often notices disturbances
of the respiration in nervous patients ; slight
acceleration of the respiratory movement, irregu-
larities of rhythm, and sighs. Many complain
of a purely subjective sensation of distress.
Shortness of breath is often a harassing symptom.
Much can be done for it by deliberate training
in deep breathing and proper exercise.

ASTHMA, i.e. spasm of the bronchial tubes, is
common in nervous patients. It may occur
under many circumstances and is frequently
secondary to some other disease ; but true
spasmodic asthma afflicts chiefly those of a
nervous temperament and is brought on by
emotional influences. It does not end fatally;
but, when once contracted, exhibits a recurrent
persistence which makes the sufferer's life
miserable and drives him to one quack remedy
after another, then to one doctor after another.
It is certainly amenable to suggestion treatment
by the elimination of the exciting causes and
the ever-present psychical factor.

CHAPTER VII

HEADACHE, NEURALGIA, AND OTHER PAINS

HEADACHE is unquestionably the most common
of all common ailments. In spite of the improve-
ment in the general health of the community,
due to more hygienic living, more healthy food
and better ventilation, headache, instead of
decreasing, has increased to a great degree.
Any number of headache cures are advertised
in the daily papers, in the street cars, on the
signboards, even in medical journals, and besides
these nearly every druggist has his own special
preparation for headache, so it would seem as
though literally many millions of doses of these
headache cures must be taken every week.

There are, of course, organic headaches due
to definite pathological conditions, but the great
majority of headaches are the result of over-
attention to certain sensations and queer feelings
about the head, some of them normal, some of
them only slightly abnormal, which are annoy-
ances rather than pain and are emphasised by

106

HEADACHE AND NEURALGIA 107

the concentration of attention on them until
they become a torment. With regard to all
headaches, even the most genuine variety, there
are certain considerations that are of value.
Most people think that it is the brain itself that
is suffering pain, and not a little of their suffering
is due to the fact that they dread the effect of
such pain upon the brain tissues and its possible
consequences upon their mental state. Such
people will be much relieved to be told at once
that the brain itself is not sensitive, has no feel-
ing, and when exposed it may be touched with
impunity without causing any pain. It is the
structures surrounding the brain that are sensi-
tive. It is not the pressure upon the brain tissue
itself that is the underlying cause of the pain,
but pressure upon the sensitive structures
connected with the brain. Patients find their
pain much more bearable as soon as they are
assured that headaches do not lead to mental
disturbances.

The symptoms vary somewhat when it is
purely a nervous headache and when a nervous
headache is associated with an anaemic, hyperse-
mic, or toxic condition of the blood.

Nervous headache is a dull, nagging ache
together with a sense of pressure. In certain
cases there is a constant feeling as though the

108 NERVOUS DISORDERS OF MEN

head were weighted down by a heavy helmet,
or as though it were itself too heavy for the
shoulders and tended to fall backward. Often-
times there is a sensation of burning in the scalp,
and the area involved actually feels hot to the
touch. Many other annoying sensations in this
region are also complained of, notably a feeling
as if the scalp were drawn tightly over the skull
or as if it were encompassed by a constricting
band. The most familiar sensations referred to
the interior of the skull are those of fullness or
emptiness, lightness or heaviness. Practically
all these uncomfortable feelings, whether they
appear to emanate from the scalp or from within
the skull, are increased by mental application.

The proximate cause of ancemic headache is
deficiency of blood within the cranial cavity.
It is a common sequence of all forms of debility.
Sometimes those affected by this variety of
headache complain of a sensation of tightness
about the forehead ; sometimes the pain mani-
fests itself in clawing sensations, which are
particularly well marked at the vertex. What-
ever the location of the pain may be, it is almost
invariably less pronounced when the subject is
in the recumbent position than when the body
is maintained in an erect attitude. Less pain
is therefore felt during the latter part of the

HEADACHE AND NEURALGIA 109

night and early morning than during the day.
In the more serious cases the simple act of rising
is sufficient to cause vertigo and even fainting ;
indeed symptoms of giddiness and weakness in
the lower extremities are almost constant accom-
paniments of this form of headache.

In hypercemic and congestive headache the
subject complains of a severe tensive pain, and
at the same time experiences a sensation of
fullness, as though the cranium were too small
for its contents. As a rule the painful sensations
are not circumscribed in character, but are
distributed throughout the entire extent of the
cranium. The pain is constant, and is aug-
mented by assuming the recumbent posture ;
consequently sleep is more or less profoundly
affected. All forms of mental or physical
exertion are followed by exacerbations of pain
accompanied by more or less giddiness. Sensory
disturbances are also common, and may consist
in functional exaltation or depression. The
subject is extremely irritable and may be aroused
to inordinate passion by the most trivial circum-
stances ; he is pessimistic, depressed, and lachry-
mose, and inclined to find fault with all about
him.

Toxic headache is caused by some chemical
change in the constitution of the blood. Some-

110 NERVOUS DISORDERS OF MEN

times the subject complains of a heavy, dull
sensation in the head, which may or may not be
accompanied by giddiness. Again, the pain is
sharp, and is described as splitting or boring.
According to the extent of the intoxication, the
faculties of the mind are more or less affected.
There may be actual delirium as in violent
febrile disturbances, or the only symptoms
noticed may be heaviness and slight mental con-
fusion.

Migraine, sick or bilious headache, comes on
in paroxysms and is frequently one-sided.
Fatigue and excitement, digestive disturbance,
and over-stimulation of the eyes are likely to
bring on an attack, which is generally accom-
panied by nausea and vomiting.

For the treatment of headache I have
rarely had to employ drugs in all my varied
experience. A headache powder does not grapple
with the cause of the headache any more than
a laxative affects the cause of constipation or a
spoonful of pepsin the cause of indigestion. We
have cut out the symptoms, but the root of the
trouble is still untouched. In headache, as in
other ailments, our first duty is to ascertain the
cause. By removal of the cause we can get rid
of the symptom. Having eliminated any organic
source of irritation, such as eye-strain, for

HEADACHE AND NEURALGIA 111

example, and attended to the constitutional
requirements, we must correct any hygienic
transgression and faulty mental attitude by
psychotherapy, to which we shall refer in greater
detail when we speak of pain further on in this
chapter. When the headache is really severe
I have frequently found the application of a
weak galvanic current to the affected region
most efficacious, the pain being removed almost
instantaneously, probably owing to the influence
of the electricity on the circulation and on the
brain cells.

Frequently the patients complain not of head-
ache but of NOISES IN THE HEAD, which are
sometimes so loud and continuous as to become
most disturbing. We exclude, of course, those
noises due to ear disease. We are dealing only
with such causes as variations in the quantity,
quality, and pressure of the blood, either in the
ear itself or in the brain, such as are in-
duced in adults by worry, excitement, fatigue,
debility, or indigestion. These noises may be
either ringing, whistling, hissing, cracking,
pulsating, soft blowing, continuous or inter-
mittent. In many cases all these sounds are
absent, but the subject is still greatly annoyed
by hearing the beat of his pulse in the ear when
his head is on the pillow.

112 NERVOUS DISORDERS OF MEN

Nothing can be imagined more painful or
harder to bear than a continual noise in the
ears such as some unfortunate patients describe.
The enjoyment of life is destroyed, the temper
soured, and the power of work greatly reduced.
It is exceptional that patients get accustomed
to the noise in their ears, and are able to follow
the advice so freely tendered to them by their
doctors and friends, that they should forget all
about it and think of something else ; on the
contrary, in the large majority of cases no amuse-
ment or change of occupation and scene has the
slightest influence upon it, and the trouble is
felt as keenly after it has lasted for years as it
was when it first began. Still, it is by " sugges-
tion " treatment that the best results are
achieved.

PAIN IN THE BACK AND LIMBS is not un-
common in nervous exhaustion. The spine may
be tender to pressure. There may be dis-
inclination to move or twist the body, but not
so marked as in lumbago, sprain, or more serious
and deeper troubles. It is very important that
an accurate diagnosis should be made.

With these spinal pains there is often a general

HYPER^STHESIA Or OVER-SENSITIVENESS. The

patient, not unfrequently, is painfully sensitive
to heat and to cold, to a depressing atmosphere,

HEADACHE AND NEURALGIA 113

and to every change of wind. Patients may be
so sensitive that a slight draught or the slamming
of a door gives rise to acute pain. " Numbness,"
" coldness," " deadness," and other sensations
of the hands and feet are also common.

Hypersensitiveness is a common sign of
fatigue. A noise that one does not hear when
one is rested will be perfectly distracting when
one is tired. Instead of making the nervous
system a less responsive instrument, fatigue
makes it more responsive ; more responsive but
less serviceable. For at the same time that
irritability is increased, power is decreased
Irritability and weakness usually go together.
A loss of self-control in small things, that is
the symptom described in different terms; but
another name for it is irritability.

At first it seems odd that this undue sensitive-
ness to slight stimuli should be so sure an effect
of fatigue ; but it means that the resistance-
gates are down, and we become aware of sensa-
tions pouring in from all sides, slight sensations
that ordinarily we do not notice because — by
the laws of attention — they are quietly shut out
from our consciousness. But when our attention
is tired — no longer focussed, but scattered, all
these slight nerve pricks attack us insistently,
and we cannot neglect them. We have all seen

114 NERVOUS DISORDERS OF MEN

— and, alas, been an integral part of — some
audience that was trying to endure the last half-
hour of an unendurable speech. Everybody
was shifting his position, crossing one leg over
the other and back again, moving the fingers,
playing with watch-charms or chains, yawning,
twitching, folding programmes, wiping eye-
glasses, twisting moustaches. Those are all
fatigue signs.

Often there is both a physical and mental
hypersensitiveness, the patient being peculiarly
alive to all sorts of sources of annoyance. The
ordinary impressions made during everyday life
upon the senses, which to the healthy individual
are pleasant or indifferent, or at any rate easily
tolerable, become obtrusive evils ; while the well-
meant efforts of friends, often in the direction
of social entertainment and amusement, are so
many further sources of irritation. If such
patients are asked whether they are nervous
they are often indignant at the question, though
they readily own that they abhor the slightest
noise, or a domestic upset, and that they are
oversensitive to emotional stimuli. Temper may
not be easily ruffled, but they are ready " to
jump out of their skin " at the jarring of a door,
and are in agony at hearing the leaves of a
book turned over. To many the mere thought

HEADACHE AND NEURALGIA 115

of a saw being ground or of a pencil squeaking
on a slate, or of a cork being cut by a blunt
knife, produces a momentary shiver, goose-skin,
and a more or less lasting sense of discomfort.
It is torture to some to hear others converse ;
others say, that on the most trivial occurrence,
they " feel all of a tremble, all of a shake."

NEURALGIA, a painful condition of one or
more nerves, is also common. Such a neuralgic
attack is always preceded by a condition of
debility resulting from general or special causes.
The onset of the malady is usually heralded by
vague muscular twitchings or sensations of
pricking, quickly succeeded by evanescent dart-
ing pains. The pains are recurrent in character
and succeed each other with ever-increasing
frequency and intensity, until, in the more
severe attacks, the patient suffers the most
excruciating agony. These pains are sometimes
regional and are ascribed by the subject to
particular areas, which are found to correspond
to the course of a nerve trunk. At other times
they are ambulatory and dart from place to
place. The most common of the regional forms
are facial neuralgia and sciatica. Both these
affections are readily influenced by the applica-
tion of galvanism to the affected nerve. Such,
at all events, is my personal experience. Of late,

116 NERVOUS DISORDERS OF MEN

since the introduction of radium, radium ionisa-
tion has given splendid results even in chronic
cases, where the pain could previously be
mitigated only by opium or morphia.

With reference to all these conditions of
hypersensitiveness and pain, whether general
or localised, physical or mental, psychotherapy
is very important. For we must remember
that the conditions are often due to such con-
centration of mind on a particular portion of the
body that the ordinary sensations of that part,
usually experienced quite unconsciously, be-
come first a source of uneasy discomfort, and
later an ache or pain. There may be some
slight physical disturbance which calls attention
to the part, but there is no really serious patho-
logical condition. While such pains are spoken
of as imaginary, it must be remembered that this
does not mean that they are non-existent.
On the contrary, they may be much more real
to the patient than physical ailments. While
pain may be thus created by concentration of
attention, it must not be forgotten that what the
mind can do in increasing pain is even more
formidable than in originating it. Many a
chronic pain is made worse by complaining
about it and resisting it. If the pain were
calmly accepted as a matter of fact, it would

HEADACHE AND NEURALGIA 117

immediately lose much of its torturing power. It
is the dread of pain which tempts so many
patients to the use of drugs, which do serious
harm, and for which a habit is easily acquired.

In functional disorders more than in any other
we have to distinguish between the actual
symptoms and the interpretation which the
patient inevitably places upon these symptoms.
Undoubtedly, the actual pains and aches and
discomforts, great as they are, which nervous
people endure, cause a less appreciable amount
of suffering than the meanings which they assume
these aches and pains and discomforts to convey.
On the other hand, we must remember that
people do not get nervous for the " fun of the
thing." It is a somewhat superficial view which
is condensed in the undoubtedly clever saying,
that some folk " enjoy poor health." If they
enjoy it, it is not ill-health to them, no matter
what it may appear to be to those about them.
There is no enjoyment about real ill-health,
whether it be physical or mental in origin ; it
is a serious and depressing business. It is
extremely important to grasp the fact that
patients suffering from functional nervous dis-
orders are really suffering acutely, sometimes
more acutely than patients with gross organic
nerve disease. Because their symptoms are

118 NERVOUS DISORDERS OF MEN

largely of a subjective character, and appear to
one who does not suffer them as trifling and
unreal, these patients are sometimes given to
understand that there is really nothing the
matter with them, that their trouble is purely
imaginary ; with the effect that they are driven
into the hands of quacks, who are only too glad
to claim a cure where doctors are supposed to
have failed.

The sufferer seems always able to bear
the pain that is present, and it is only the
cumulative effect of the pain that is past and
the anticipation of the discomfort to come that
make the pain unbearable. Nearly always it is
much more the dread of what the pain may mean,
and the lack of power to endure, which gradually
develops as a consequence of suffering, that
constitute the worst features of pain. There
are many neurotic people whose susceptibility
to pain has been so much increased by their lack
of self-control and their tendency to react easily
to pain, that even slight pain becomes a torment.
Habits of introspection and the lack of serious
occupation of mind of many people leave them
the victims of over-attention to themselves.
The whole question of the treatment of pain
involves the study of the individual much more
than it does the affliction which causes the pain.

HEADACHE AND NEURALGIA 119

What seems unbearable pain to many may be
little more than a passing annoyance to others.
What would be, under ordinary circumstances,
intolerable torture, especially to sensitive people,
may, because of intense preoccupation of mind,
remain absolutely unnoticed. For example, in
the excitement of a panic men suffer what would,
under other circumstances, be excruciating agony
and yet do not know that they are hurt. The
oversensitive patient must be trained to bear dis-
comfort for a while until his mind is diverted
to other things than the concentration of
attention on those functions which is causing
their disturbance.

CHAPTER VIII

LOSS OF MUSCULAR CONTROL
NERVOUS TREMORS AND MUSCULAR SPASMS

As before stated, a tired feeling is often the
first symptom of nervous exhaustion. The
first sign is usually a feeling of undue muscular
weariness after moderate or even slight exertion,
such as a short walk. The patient finds that his
legs soon get tired, and by degrees he becomes
conscious of the fact that exercise is no longer
a source of enjoyment. The sufferer rises more
or less exhausted in the morning, and his exhaus-
tion tends to increase until late in the afternoon,
when, curiously enough, he usually begins to
improve. Any form of activity which involves
the co-ordinated use of certain muscles quickly
brings on a feeling of exhaustion in these muscles.
As the exhaustion becomes more or less
chronic other symptoms arise, such as MUSCULAR

RESTLESSNESS AND UNCERTAINTY OF THEIR

ACTION. Indeed, the world seems filled with
nervous, fidgety persons, who are constantly

120

LOSS OF MUSCULAR CONTROL 121

engaged in numerous physical activities which
are wholly useless and unnecessary. Among
such nervous activities are wriggling movements
of the body, inability to hold the hands naturally
and composedly, resulting in restless movements
of them ; restless movements of the fingers,
twiddling of an object, such as a pencil, biting
the nails, general tremor, bending of the legs,
inco-ordinate gait ; or, if sitting, fidgeting of
the legs, crossing and recrossing them, tossing
the foot, tapping the foot on the floor, beating
an incessant tattoo with the hands on the chair
Some part of their anatomy must be in rhyth-
mical and incessant action. Others will twist
their moustaches or play with the hair. Others
are everlastingly fixing their clothes or adjusting
their necktie ; they seem never to be able to
complete their toilet. Some are addicted to
giggling, to " nervous laughter," " sheepish "
expression, or inability to look one straight in the
face, the eyes glancing up, down, on one side,
or askance, and these physical signs are accom-
panied often by mental confusion, flurry, the
employment of wrong words, the making of
ridiculous remarks and the doing of ridiculous
things.

These unconscious muscular actions, habitual
gestures and tricks of physiognomy are more or

122 NERVOUS DISORDERS OF MEN

less distinctive of classes. There is the rustic
who scratches his head, the horseman who whips
his riding-boot, the thinker who finds inspiration
in fingering his beard or tearing paper to pieces,
the heavy dragoon who tugs at his moustache,
the old drum-major who twirls his cane, the
bashful girl who puts a finger in her mouth or
who bites her nails, the impatient visitor who
is kept waiting and drums with his fingers on
window-panes or tables, and persons who whilst
talking nervously move their legs.

All these needless and useless actions consti-
tute a tremendous nervous and vital drain
on the victim's constitution, a constant leakage
of nervous force and muscular energy.

Such patients should exercise persistent quiet
discipline ; but when they are told of this and
are persuaded to attempt it they make such
determined effort to overcome the affection that
they make themselves more conscious of it than
before, with the result that their movements
are emphasised. Therefore we have to teach
the patient how to relax both his mind and
muscles by suggestion and auto-suggestion.

There is generally some amount of MUSCULAR
TREMOR. Tremor is, of course, natural in certain
conditions. Besides being an expression of
weakness, as in old age, or fatigue, or the feeble-

LOSS OF MUSCULAR CONTROL 123

ness of convalescence, or of organic disease, or
toxic states, tremor is a sign in many people of
transient emotion, of fear, of excitement, of
anger, or of grief; it is as natural a motor
expression in some mobile natures as laughter
or crying is of uncontrolled mirth or grief.
Such tremor is capable in nervous persons of
passing over the line of healthy functional
manifestation and becoming a symptom of
disorder and lack of emotional control.

Once a tremor has been observed by the ner-
vous subject, a fear arises of trembling again,
and this, together with the discomfort which it
causes the subject who experiences it, increases
the emotion which makes the trembling lasting.
Tremors also persist by reason of the very state
of contraction into which the subject puts
himself when he becomes concerned about his
tremors and tries to stop them. Hence in the
treatment it is important to remove the " fear "
of tremor, besides attending to the general
health.

Some patients suffer from muscular spasms,
so-called NERVOUS TICS, arising from emotional
excitement, mental and physical shock, strain
or exhaustion, and any condition which lowers
the general health. A tic is a psychical affection
in which the inhibitory power of the will is so

124 NERVOUS DISORDERS OF MEN

feeble that a movement which originally served
a definite purpose becomes exaggerated and can
be controlled only, if at all, at the cost of great
mental discomfort. The tiqueur realises the
foolishness of his tic, and a conflict occurs
between the illogical desire to perform it and
the logical desire to restrain it.

In simple tics the facial muscles are most
often affected, but the head, shoulders, or arms
may also be involved, and sniffing or coughing
and every variety of weird sound may also
occur. Often it is originally merely a response
to some irritation, as, for instance, when the eye
is screwed up in the effort to see with an un-
corrected error of refraction. This motor re-
sponse is normal, but it becomes abnormal when
it continues after its cause has disappeared, as
it then no longer serves any useful purpose.
An occasional blink is thus replaced by a series
of futile flickerings of the eyelids. It is seldom
that more than one tic is practised at a time.
Some special kind of grimace may persist for
days or weeks and then cease as suddenly as it
began, only to give place to other forms of tic
in succession. The tic becomes most evident
upon excitement or fatigue, and increases with
self -consciousness. The treatment of tic depends
in a large measure on the proper recognition of

LOSS OF MUSCULAR CONTROL 125

the mental condition of the patient and the
removal of the irritating cause.

To this category belongs another common
affection ; STAMMERING AND STUTTERING.

Stammering is a bad habit, occurring in self-
conscious, shy and other nervous persons, and
once established it increases the original nervous-
ness, so that the patient becomes still more
afraid to speak. This constant fear and dread of
speech failure is at the bottom of nearly all
permanent stammering. Stammering and all
speech defects are much worse when the patient
is labouring under excitement. In ordinary
conversation with friends the stammerer may
have little difficulty ; but as soon as he
begins to talk with those with whom he is un-
familiar, his speech defect becomes noticeable.
When the others present are entire strangers
and, above all, strangers whom he wishes to im-
press favourably, his stammering becomes pro-
nounced. The mental element is the most
important factor. Just as soon as consciousness
of the task supervenes his power of co-ordination
fails and stammering begins.

There are many systems to train people to
overcome this speech defect. All of these
systems have their successes and their failures.
When the patient has confidence in the teacher

126 NERVOUS DISORDERS OF MEN

and his method there is practically always quite
a remarkable improvement at the beginning.
Not infrequently after a month or so there is a
tendency for the patient to drop back into old
habits, discouraged as a consequence of loss of
confidence. I have with very few exceptions
succeeded in curing the defect by psychotherapy.
The patient is put at ease and made to breathe
properly, and, while in the relaxed state of ease
and comfort, is made to forget any fears he may
have and taught how to become less self-
conscious and how to exercise self-control. The
attention must be centred on something besides
speech itself ; it must be so directed that he is
unconscious of the co-ordination necessary for
speech and so accomplishes it without difficulty.
Even very bad cases have recovered under such
treatment, which, of course, requires both
patience and sympathy.

Mention should be made here also of the so-
called OCCUPATION NEUROSES. These affections
present one feature which is common to them all,
namely, that certain actions, previously accom-
plished with perfect ease, are rendered difficult
or even impossible in consequence of cramp,
tremor, paralysis, or acute neuralgic pain,
whereas other movements are performed by the
same muscles without difficulty or discomfort,

LOSS OF MUSCULAR CONTROL 127

As a matter of course, the upper extremities,
and particularly the hands and fingers, are
most liable to be thus affected, because these
parts have more work thrown on them. The
cases in which the lower extremities are involved
are comparatively few in number. The most
common examples are writers' cramp and piano-
forte players' cramp.

WRITERS' CRAMP occurs almost exclusively
as a sequence to worry, domestic or financial, in
persons whose avocations require them to write
for many hours daily. The majority of the
sufferers are those who are compelled to write
a good legible hand and overtax their muscles.
Weakly subjects with a predisposition to nervous
affections are most liable to be attacked, and
when the symptoms have appeared they are apt
to be aggravated by excesses of all kinds, and
in fact, by anything which tends to lower the
tone of the nervous system. In a considerable
number of patients a cure has been effected by
the use of galvanism, the application of which,
however, must be adapted to each particular
case.

Sometimes it is not a true inability but only
a dread of inability to write. For example, I
saw a clerk who wrote without difficulty when
at home, but was immediately seized with cramp

128 NERVOUS DISORDERS OF MEN

when he was obliged to write in his office. It
was the presence of his superiors who sat in the
same room which caused the attack. He recog-
nised himself that in the presence of his chiefs
the fear of not being able to write was the only
cause of his helplessness.

Finally, though it is not strictly a functional
disorder, I should like to say a few words on that
terrible affliction — EPILEPSY. We distinguish
principally two forms, one minor one — petit mal
—in which the patient simply loses conscious-
ness, and a major and more serious one — grand
mal — in which the loss of consciousness is accom-
panied by convulsions and other symptoms.
Those who have studied the subject most in
recent years agree that the great majority of
cases of epilepsy are not primarily due to ac-
quired causes, but to some congenital defect, so
that there is an inherent instability of the
nervous system. This makes the patient liable
to explosions of nerve force, figuratively speak-
ing, boilings over of nervous energy, when not
properly inhibited. Once such a paroxysm
occurs it is likely to happen again, and very
often it brings on gradual degeneration of the
nervous system and of mentality. In many
cases, however, this degeneration can be delayed
or even completely prevented by putting the

LOSS OF MUSCULAR CONTROL 129

patient under favourable conditions. In recent
years we have come to realise that epilepsy is
more favourably influenced by a simple outdoor
life in the country without worries and cares,
with carefully regulated exercise in the open air,
and special attention to the digestive tract, than
by any formal remedial measures or drug treat-
ment. The fewer the emotional storms, the less
likelihood of repetitions of attacks of epilepsy.
These patients need, above all, to realise that
they cannot live the strenuous life nor even the
ordinary busy life of most people. If they will
but take this to heart and not attempt to engage
in busy occupations, they may live quite happy
lives ; and if mentally content and without
worrying anxieties, they will have so few attacks
as to incur only to a slight degree the dangers
inevitably associated with fits of unconscious-
ness. When living a quiet placid life without
worry about themselves or their concerns, the
number of the epileptic attacks decreases in a
noteworthy degree and the intervals between
them become longer and longer. No medicine is
so effective in prolonging the intervals between
attacks as this placing of the patient in
favourable conditions of mind and body. Our
experience with the colony system has em-
phasised this fact. Considerable success has been

130 NERVOUS DISORDERS OF MEN

attained in suitable cases by " suggestion " treat-
ment.

There is also a purely functional epilepsy—
HYSTERO-EPILEPSY — consisting of convulsive fits
in hysterical subjects, but this malady is rare in
men.

CHAPTER IX

MENTAL INSTABILITY
THE SEMI-INSANE

IT may appear from a perusal of the previous
chapters as if all men with an unstable nervous
system were necessarily miserable. But this is
by no means the case. There are people with
an inherited nervous defect who are subject to
periodical attacks of instability, in which,
however, they are not only highly contented, but
declare they feel better than ever and can
accomplish more than they have ever been able
to do.

Even perfectly healthy people of sound stock
have their moods, being at one time happy and
cheerful and better fitted for work, without any
special cause, and at other times unhappy and
depressed without being able to account for the
change in their mood. One day we find an
acquaintance emotionally elevated, gay, and full
of projects, the next time we meet him he has
the "blues," and in place of being lively he is

131

132 NERVOUS DISORDERS OF MEN

taciturn and depressed. Ask him the cause of
his exaltation, he can give no reason except
that he feels unusually well. Many of us are
also duller in the morning than in the evening ;
the early hours are filled with gloomy fore-
bodings, which, as the day grows older, vanish
and are replaced by a sense of well-being. Some
people spend their lives in a seesaw between
depression and pleasurable exaltation, content-
ment and discontentment. In some there is a
periodic depression, in some periodic excitement,
while in others the two mental states follow
each other alternately. In the life of nearly
every man or woman there are two periods of
depression or exaltation which recur with a
'• certain degree of regularity. These conditions
often depend upon the state of physical health,
the change of seasons, the amount of physical
or mental work accomplished or to be done, or
any one of a thousand intrinsic or extrinsic
factors.

With reference to DEPRESSION, even a per-
fectly normal person under the influence of some
sorrow may feel the memory of it renewed at
every turn. It meets him when he awakens,
and is with him when he goes to sleep. He
cannot escape from its importunity, it crosses
and obstructs his path, and often succeeds in

MENTAL INSTABILITY 133

diverting the logical current of his thoughts and
actions. Such a state of mind is not, however,
produced in a healthy subject, except in definite
relation to some misfortune, nor does it con-
tinue indefinitely. But there are people who
are born pessimists, who see everything from the
dark side and derive no comfort from the mere
pleasure of living. Sometimes they manifest a
morbid suspicion of everything and everybody,
and detect an interested or malicious motive in
the most innocent actions of others, always
looking out for an evil interpretation. Slight
causes, external and internal, produce extra-
ordinary depression with marked symptoms.
The voluntary power is impaired, the patient is
deprived of resolution, his will becomes paralysed
and he is inactive ; he thinks slowly, he moves
slowly, and this retardation applies to all his
actions. There is a disinclination for work, even
amusements are felt as nuisances. The subject
finds no pleasure in anything, he shuns society,
is averse to speaking, and when he does talk it
is in regard to his personal condition. He is
hypersensitive, broods over his real or fancied
trouble, he suffers acute misery, and wishes
he were dead.

Such is the depressed person, but there are
others just as unbalanced, if not more so, whose

134 NERVOUS DISORDERS OF MEN

disorder results in an EXALTATION of all the
mental functions, creating a feeling of extra-
ordinary happiness and well-being. Their good
spirits, except for an occasional slight abate-
ment, seem inexhaustible ; they make dangers
invisible, misfortunes light, life easy and its
struggle pleasant, with nothing but certain
triumph at its end. All the intellectual functions
are accelerated. There is a rapid flow of ideas,
so rapid sometimes that the patient cannot
express them quickly enough, and he may lose
the thread of conversation, or " run off the line,"
so to say, by introducing a great multitude of
non-essential accessory ideas, which both obscure
and delay the train of thought. His ideas may
get confused, or he may run to death one idea,
or have strange ideas which irresistibly force
themselves into consciousness.

Sometimes such patients have a wonderful
facility of expression and an inexhaustible
command of language. Not only so, but the
choice of phrases and words, the flow of con-
versation adorned by jests, anecdotes, and
pleasantries, varied according to their audience,
shows a mental brilliancy which is more often
than not quite unexpected and unlooked for in
the individual. They may be so brilliant
and witty that their friends remark what

MENTAL INSTABILITY 135

good company they are, often without a sus-
picion that the increased vivacity is the result
of a morbidly excited nervous system. This
exuberance of thought, speech, and action,
which resembles that of the first degree of
drunkenness, ends by overcrowding and narrow-
ing the field of useful activity or of logical
thought. They sometimes possess the faculties
of imagination, invention, and expression in a
very high degree ; but the things they are lacking
in more or less completely are judgment, con-
tinuity and unity of direction in their intellectual
achievements and in all acts of life. The result
is that, in spite of certain superior qualities, these
individuals are incapable of behaving themselves
in a reasonable way and of regularly practising
any profession, even though it be below what
they would seem to be capable of. This is so
marked that it seems as though their whole life
had been nothing but a contradiction between
an apparent richness of means and poverty of
results.

Frequently these patients are not only ex-
tremely verbose, but will unburden their mind
even to chance acquaintances and undesirable
persons, and similarly they may write not only
incessantly but even to complete strangers.
At the same time it may be noticed that they

136 NERVOUS DISORDERS OF MEN

have lost the sense of proportion and of the
fitness of what ought to be said or written.
They are often petulant, they make no efforts
to avoid being insolent, they join in discussions
for which they are incompetent, pry into other
people's affairs, fly into a temper for no just
cause, and affect great sensitiveness on the
subject of their honour. They take offence
easily, are inclined to noisy arguing, and may
even become violent without adequate cause.
If they have followed hitherto a quiet mode of
life, they may now seek frivolous society and the
pleasures of the drinking saloon, and, in fact,
give way to excesses which are beyond the limits
of propriety and decency. The thing that char-
acterises these subjects is a notable weakness,
or even an entire lack of the power of control,
of the superior brain over the passions and
instinctive desires. The result is that they are
the slaves of their passions and propensities.

These patients fear nothing. They feel better
than ever, they do not want to consult a doctor
or take the most elementary precautions, they
are indifferent to their physical surroundings or
hold them in contempt. They will take any risk
and boast of it. They are optimists in every
respect, and from optimism it is only a short
step to ideas of pride and grandeur. Their

MENTAL INSTABILITY 13?

feeling of self-satisfaction and self-importance
is often so much increased thai) they will admit
only their own point of view and their own plans,
and in consequence of an overstimulated imagi-
nation they may think themselves underrated
geniuses. Indeed, for the time being, they may
have all the qualifications of the genius, except
the one of being able to materialise their ideas.
They lack the ability to do, as well as to con-
template. They may dream of revolutionising
the race with their ideas, but it never comes to
anything. In the pursuit of their extravagant
plans they completely lose sight of the realities
of life, keeping their gaze fixed only upon the
results, while they never take into serious con-
sideration the difficulties and insufficiencies of
their methods. Yet, frequently, they hold to
their ideas, however unusual and absurd, till
everything is coloured and distorted by them.
Sometimes, however, the projects are as quickly
abandoned as they are formed, and embrace
spheres of labour and enterprise that are un-
known and foreign to their experience. Others
are inclined to reckless speculations, or they buy
things they do not want, and therefore, if they
have the control over business affairs, financial
losses or other catastrophes are likely to be the
result.

138 NERVOUS DISORDERS OF MEN

The excitement of these patients is complicated
by insomnia, but the sleeplessness is not ex-
hausting or felt as unpleasant, and they suffer
but little ; on the contrary, they may exaggerate
their power of resistance to sleep and boast of it.
In order to occupy the long hours of wakefulness
they concoct schemes and plan amusements and
enterprises, into which they try to draw their
friends and acquaintances. They allow them-
selves no time for resting, they have no time for
proper meals at regular intervals, being driven
about by constantly changing impulses or
projects. In this condition they are sometimes
very eccentric. They either have some peculiar
habit, or wear some odd style of clothes, or have
a queer manner of wearing their hair, or of
walking, or writing, or speaking. The eccen-
tricity is often shown by an imperious or obses-
sional tendency which drives the subject along
some intellectual or moral line of action to the
total exclusion of any useful or practical occu-
pation.

After a few days or weeks the patient may
return to his normal life, and if the attack was
a mild one will feel none the worse for it, or if
more serious he may brood over the follies he
committed during the period of excitement.
Some recover perfectly, in others the normal

MENTAL INSTABILITY 139

periods gradually shorten and chronic mental
disorder may be the end.

Between attacks much can be done to ward
of! succeeding ones by so regulating the patient's
life, occupation, and environment that excite-
ment and strain are reduced to a minimum.
Everything contributing to bodily and mental
stress should be avoided as far as possible. Out-
door life in the country is the one most to be
desired. Especially is it important that plenty
of sleep is regularly secured. Hurry, worry,
ambitious undertakings, indulgence in stimu-
lants, things that reduce the bodily tone and
harmony — all these are fruitful sources of re-
currence. Wise supervision of the patient should
be maintained by some competent person without
the patient realising that it is being done. In
severer cases treatment in a Mental Hospital,
private or public, may be necessary.

CHAPTER X

THE EFFECTS OF ALCOHOL
THE DRINK AND DRUG HABITS

IN quite small quantities alcohol acts first of all
as a stimulant, puts the person in an agreeable
frame of mind, and fires the imagination, and
gives vivacity to the conversation. That is why
it is given at dinner-parties. It puts the guests
in good humour, in a happy frame of mind, and
makes them more attractive to one another.
The stimulant effect does not last, however, it
is only immediate. Alcohol soon ceases to have
a stimulating effect and acts as a sedative, giving
repose to the body and a quietness to the mind
and conscience. It is to produce these latter
results that it is taken by people in misery or
trouble ; not as a stimulant, for then it would
increase their sadness, but as a sedative to their
feelings. Those persons who have not had a
happy life find a glass of wine a pleasant com-
panion ; it causes diminution of sensibility,
drowns their trouble and grief, and if it does

140

THE EFFECTS OF ALCOHOL 141

not give complete felicity and forgetfulness it
dulls thought and obscures the painful feeling.
They know that they may feel a little stupid,
but they also know that all things they may
view will appear in a rosier light. The man
drinks because it makes him cheerful, modifies
the course and colour of his ideas, and gives him
forgetfulness or sleep. He has some disquietude
or a troubled conscience, and the glass of wine
or spirits puts him into an agreeable frame of
mind, and modifies the course and colour of his
ideas, and may even give him imagination,
eloquence, and courage. Indulgence gives relief,
but the danger is that the experiment may be
repeated until it is not the pleasing sensation
of intoxication that is craved after so much as an
escape from sobriety which has become intolerable.

A list of reasons for imbibing was once given
in Punch, which showed the absence of a guiding
rule. One man took a glass because he was
merry, and another because he was sad ; one man
because a friend had come to see him, and another
because his friend had left him ; one because
he had a daughter married, and another because
he had a daughter buried ; one because he had a
rising, and another because he had a sinking ;
and so on.

It is not of these minor and temporary causes

142 NERVOUS DISORDERS OF MEN

of which we wish to speak here, but of the
deeper reasons for drinking which produce
harmful effects and may lead the person to
become a " drunkard " or " alcoholic." Not
everyone who drinks, even to excess, is an
alcoholic ; only those persons can be regarded
as such who either continually or at certain
periods suffer from a craving for alcohol.

All the reasons advanced by our temperance
advocates have a good deal of truth in them,
but would not drive a man to drink unless he
were already a " weak character." He takes to
drink, not so much from outward as from inward
causes, by reason of his defective mental consti-
tution. It is not everybody who can become a
drunkard ; there must be a nervous predis-
position, frequently hereditary. At the present
day, when drunkenness is looked upon as dis-
graceful by the more educated classes, excessive
drinking has vastly diminished. Total abstinence
societies have been established for something
like a hundred years, with the result that
moderate people have become more moderate,
and many moderate persons have become tee-
totalers. It is also probable that some mentally
unstable persons have been saved by abstinence
from becoming drunkards. But the actual
number of habitual drunkards has not materially

THE EFFECTS OF ALCOHOL 143

decreased in spite of all this temperance energy.
It is fair, therefore, to conclude that, while
unbalanced temperaments and instincts of self-
indulgence are inherited, the actual way in
which these instincts will manifest themselves
depends upon the surrounding conditions which
may happen to prevail.

Some people seem to think that craving for
drink is created by the sight or presence of a
public-house. Yet they have only to ask them-
selves how it is that they pass the public-house
not only with indifference, but with loathing ;
and it will be borne in upon them that their
contention is somewhat faulty. The truth is
that nobody becomes a drunkard from choice or
accident. Before a man takes to drink as a vice
he has a taste for it, a predisposition which
grows out of some physical defect, constitutional
in the first instance, but liable to be aggravated
by poor food, unwholesome surroundings, bodily
wear and tear, and loss of moral tone.

Doubtless a few cases of alcoholism can be
attributed solely to force of example, but even
in these we must consider the brain disposition
of the person upon whom the example exerts its
influence. Several people may be thrown open
to the same examples and temptations, and yet
it is probably only the minority that succumbs,

144 NERVOUS DISORDERS OF MEN

and is not this because of the different
susceptibility or instability of the brains in
question ?

Most liquors are taken for the sake of the
effect and not because they taste nice. Indeed,
to many people they are so nauseous that it
requires a good deal of resolution to swallow
them. To the temperate man and the abstainer
drink offers no allurements, it satisfies no crav-
ing, it yields them no delight, and has for them
no temptation. They are sober not because of
their superiority of resistance, but they do not fall
because, having no desire, they cannot be tempted.
Many persons could not get drunk if they tried.
They are drink proof, not because of any superior
virtue, not because of any superiority of self-
control, but because drink has for them no
temptation. Others have such unpleasant sensa-
tions if they exceed a small quantity of alcohol
that they are compelled to leave off long before
they have taken enough to make them drunk.

It used to be thought that there was some
subtle influence in beer or spirits which led
those who begin by taking one glass to advance
to two, ten, or twenty glasses. But closer
observation has shown that it is only in the weak-
minded that the habit of drinking creates a
morbid desire for more drink, overcomes the

THE EFFECTS OF ALCOHOL 145

will, blunts the moral sensibilities, and makes
everything subservient to its demands, until the
habitual intoxicating cup thrusts itself per-
petually upon his thoughts, gradually occupying
them so as to exclude all other ideas. The
resistance and prayers of his friends are of no
avail ; he declares he is driven by irresistible
necessity to strong drink — " he will go mad
without it."

I would recommend as an ideal standard that
no one should drink or smoke before he is twenty-
five years of age. After that total abstinence
would be easy and certainly set a fine example.
If there is the slightest tendency to excess it is
the only way of salvation. If a man decides
against total abstinence let him drink wine or
light beer only, and drink no or only extremely
diluted spirits. He should drink only once
a day and that at dinner, or if he drinks more
often, still only with meals. He should swear
off solitary drinking, drinking between meals,
drinking to seal a bargain, or to welcome a
friend, or to pay for a service, or to join in or
return a " round " of drinks when in company.

To no class of persons is intemperance more
dangerous than to those inheriting an unstable
nervous system. The researches of numerous
investigators have shown that, speaking gener-

146 NERVOUS DISORDERS OF MEN

ally, the insane, the weak-minded, the epileptic,
and those who have sustained grave head
injuries are susceptible in unwonted degree to
the evil influence of alcohol. Persons so afflicted
are poorly equipped with power of resistance,
either because of defective hereditary endow-
ment, or because factors in their early develop-
ment have rendered them unduly susceptible
to toxic substances, so that they are profoundly
affected by an amount that would only cause
a mild exhilaration in a more stable organisation.
For such unstable persons there can be no half-
way course ; they cannot be temperate. Such
persons must be total abstainers.

When alcohol is imbibed freely we have first
of all slight excitement and a feeling of well-
being, in which speech and gestures become more
animated. There is at first a paralysis of the
inhibitory apparatus, the loquacious stage, when
the person becomes talkative, gay, and lively ;
he thinks he is very funny and even witty, when
perhaps he is uttering the most commonplace
remarks, or reiterating the most fatuous state-
ments. The general expression becomes one of
silly self-satisfaction, with a fatuous smile,
which may be blended with a look of astonish-
ment. The ideas become crowded together and
confused. The curb which fear of public opinion

THE EFFECTS OF ALCOHOL 147

puts on the free expression of emotions and ideas,
and the veil which hides the real moral dis-
position, are removed, whence the justification
for the saying in vino veritas. There is inter-
ference with the processes of thought, ideas
succeed each other so rapidly that there is no
time to arrange them in orderly sequence. The
emotions get unstable, the mood becomes,
without any very obvious reason for the differ-
ence, gay, or sad, or full of tenderness. Whether
the excitability will tend towards joy, melan-
choly, or anger depends on the environment ;
the person laughs sometimes at the least little
thing ; weeps, or grows sentimental or maudlin ;
gets angry at the slightest cause. He may be
argumentative and even pugnacious ; he may
be profane, obscene, abusive, threatening, and
may be violent. The exaggerated feeling of
strength and well-being soon passes ; his move-
ments are poorly controlled ; his gait becomes
staggering and his speech thick.

So long as the person is seated he may speak
and discuss subjects quite distinctly and ration-
ally, and yet when he attempts to walk he may
not be able to take one step, in fact, may not be
able to stand. On the other hand, he may be
able to walk quite steadily, yet be unable to
articulate one word,

148 NERVOUS DISORDERS OF MEN

This particular stage of drunkenness often
leads to considerable difficulty in police-court
cases. For the person in this condition has lost
control of the muscles of locomotion, but has
control of the muscles in connexion with speech,
and, having steadied himself against the counter,
he can speak coherently and quite distinctly.
The policeman having seen the staggering gait
swears that the man was drunk ; the bar-
attendant, having heard the clear speech, declares
the man was sober, otherwise he would not have
supplied him.

A little later the conduct becomes more and
more reckless ; his smile a besotted grin ; his
intellect more and more dulled ; a temporary
paralysis may supervene, the person becoming
insensible and unconscious. After sleep he
wakens with headache, weakness, nausea, and
loss of appetite.

It is related in an old rabbinical legend that
after Noah had planted the vine that God had
given him, Satan secretly watered it with the
blood of a lamb, of a lion, and of a pig. The order
in which these animals are named, though
very likely without intentional significance, is
interesting, for it corresponds roughly to the
successive stages of acute vinous intoxication ;
first, the stage of mildly soporific euphoria ;

THE EFFECTS OF ALCOHOL 149

secondly, that of noisy, garrulous, and actively
quarrelsome excitement ; and lastly, that of
bestial and abandoned lethargy. It is during
the second stage that a very large proportion of
all crimes of violence are committed, and the
sudden and often explosive appearance of this
phase is not at first sight apparent.

ACUTE ALCOHOLISM generally follows excessive
drinking in otherwise normal persons, but what
may be excess to one person need not be so to
the other. Persons suffering from shock, dis-
tress, physical disease, accidents, or any brain
defect, temporary or permanent, and lastly,
persons not accustomed to alcohol, may feel the
effects of its intoxication after very small
quantities, which would have no effect at all on
the habitual drinker. Acute alcoholism generally
develops suddenly. The chief mental charac-
teristics of acute alcoholism are terror, mental
distress, and confusion of ideas. Repugnant
visual hallucinations are frequent and the patient
may smell or taste poisons. Chief amongst the
physical signs is a fine muscular tremor, most
marked when the attention is distracted. If the
movement is made rapidly the alcoholic may
carry a glass to the mouth without spilling the
contents, but if the attempt is made slowly the
feat will be difficult of accomplishment.

150 NERVOUS DISORDERS OF MEN

The continued excessive use of alcohol has its
effects on the nervous and mental health in
other ways than in producing acute alcoholism.
CHRONIC ALCOHOLISM shows itself in gradual and
progressive mental deterioration and in certain
physical changes that show the deplorable
effects of the poison on the central nervous
system and on the bodily organs and functions.

We have the ordinary public-house drunkard,
one who begins his carouse in early morning ; he
is found there as soon as the doors are opened.
His loquacity as the day goes on becomes more
and more intense, and he claims a certain
familiarity with everyone he meets. At the close
of the day he may or may not be quite intoxi-
cated ; if he is so it is generally of the noisy or
hilarious type, and probably will make night
hideous by his noises.

The habitue of the West End club. This
class of individual is very cantankerous, irritable,
and infirm of purpose. He will remain in the
smoking-room all day imbibing at intervals ;
he is talkative to the various members and liable
to be quarrelsome if contradicted or crossed in
any way. Many of such cases ultimately suffer
from loss of power of their limbs. He is a source
of uneasiness to many of his friends, and his judg-
ment in any matter requiring tact or discretion

THE EFFECTS OF ALCOHOL 151

is most deficient, and his advice when given
would probably do much more harm than
good if followed out, as his mind is fast
degenerating.

I now come to a type so often met with, that
of the self-satisfied alcoholic. He is not com-
pletely under its influence, and is able to control,
to a certain extent, his actions. He has a
familiar smile on his countenance, and is anxious
to tell strangers his private affairs. He will
insist upon shaking hands repeatedly, and though
his conversation is variable his mind will revert
to some small grievance which he will have
exaggerated into one of gigantic proportions,
and to which he will keep alluding, apparently
forgetting that he had previously done so ; a
partial loss of memory is here characteristic.

The mental enfeeblement is slow but pro-
gressive. At first the person feels unable to
apply himself to the tasks he formerly did with
ease ; his mind wanders ; he has a growing
sense of fatigue ; later he shows impairment of
judgment, poverty of ideas, and gradual failure
of memory. While forgetfulness is characteristic
of all forms of chronic alcoholism, the loss of
memory may be so prominent as to constitute
a special form of the disease. The characteristic
sign of this type of the malady is the instan-

152 NERVOUS DISORDERS OF MEN

taneous forgetfulness of events that have only
just transpired. Thus names, or the simplest
sentences, repeated over and over again to the
patient, are totally forgotten either instantly or
after the lapse of a few moments, nor does
there exist any possibility of their recall in the
future.

There is marked enfeeblement of the will, so
that there is not the power, and often not the
desire, to rise out of the rut of habit. Some of
them honestly desire to lead a sober life, but fail
in the struggle. This enfeeblement of the will-
power is not confined to the inability of the
patient to resist his alcoholic craving, but
extends to other matters as well ; so that he loses
his power of initiative and of asserting himself,
and becomes incapable of performing any work,
except according to routine, and so becomes the
tool of other people, by whom he is influenced
and easily diverted from his purpose.

The person gradually undergoes a change in
character ; he becomes untruthful, loses his
finer sense of honour, he — little by little — grows
lax about things concerning which he was
formerly most particular. He becomes indif-
ferent to his own interests and regardless of the
feelings or prosperity of his relatives and family.
He sees those depending upon him suffering

THE EFFECTS OF ALCOHOL 153

want and shame, yet pursues his downward
course, seemingly indifferent to their needs or
their entreaties. Sometimes he falls so low that
he will pawn the clothing his wife has earned in
order that he may procure money to buy more
drink. Another striking feature is an unreason-
able irritability, which frequently leads to out-
breaks of passion of a blindly impulsive character,
of which his family or his associates are often
the victims. Wife-beating, inhuman treatment
of children, attacks upon associates on the
slightest provocation, are of daily occurrence
during the stage of inebriety.

Along with these symptoms muscular weak-
ness is apparent ; a fine tremor may come to be
a pretty constant symptom, but coarser muscular
twitchings also occur, and there is a painful
condition of the nerves of the limbs, namely,
neuritis. Frequent headaches, dizziness, diffi-
culties in speech and gait are common, and
convulsive seizures of an epileptoid character
may appear. In the pronounced forms of
chronic alcoholism we find a more decided
blunting of common sensations. Chronic alco-
holism often leads to insanity. Continuous
inebriety tends also to bring about dilatation of
the heart and lessen the vigour of the muscular
movements of the stomach, which are necessary

154 NERVOUS DISORDERS OF MEN

for good digestion. It may also cause inflamma-
tion of the mucous membrane of the stomach,
giving rise to nausea and vomiting.

One of the problems of the day is how to treat
the dipsomaniac. There are many chronic
drinkers who recognise their danger and sincerely
wish to be cured, more especially those who
suffer from dipsomania at irregular intervals.
When they regain normal consciousness they
experience a feeling of profound despair and
make the most solemn promises, perhaps actually
drinking nothing but water, but in a few weeks
or months the whole affair begins again. These
are the cases in which treatment by " sugges-
tion " is successful. The result has in many
cases been astonishing. So much attention has
been given to the details of institutional care, and
to the contending claims of the many medicinal
agents which are supposed to have remedial
virtues, that there has been some tendency to
lose sight of the fact that the condition to be
dealt with is at bottom a disorder of the will,
and that it can only be really cured by restoring
the patient's power of self-control. Psychical
treatment is so essential that even the best
conceived physiological remedies will fail to do
all that they should if they are not seconded by
influences that act on the patient's mentality.

THE EFFECTS OF ALCOHOL 155

This point, which, of course, has to be considered
in the treatment of practically all diseases, is
naturally of the greatest importance in connexion
with disorders where there is a predominant
mental element. But it is not merely as affecting
the action of medicines that this mental factor
has to be taken into account ; it has an even
more potent influence on the efficacy of treat-
ment by restraint. When the weaning from the
alcohol habit has been effected, not by re-
education and restoration of the will, but by
compulsion, this compulsion is very apt to excite
a latent hostility which remains as a sub-
conscious fixed idea to revive at some moment of
weakness under the guise of a return of craving.
This is undoubtedly the reason why restraint
fails to produce a lasting cure in many cases of
alcohol addiction, and it shows the extreme
importance of accurate psychological study in
dealing with patients of this sort.

The old method of treatment was to hypnotise
the patient and then make post-hypnotic sugges-
tions by telling the subject that when awake
he would not desire or relish the drink to which
he is addicted, or that his arm would be paralysed
when he tried to raise the glass to his lips. These
are not good suggestions, and I am not surprised
that such patients after a time relapse into their

156 NERVOUS DISORDERS OF MEN

old state. My method has always been to make
a suggestion in harmony with the natural
feelings of the patient, to make it seem that it is
his own strength of will and not the effect of
suggestion that has cured him of his habit.
Having acquainted myself beforehand with his
dominant propensities and controlling thoughts,
his beliefs, prejudices, and mental environment,
and having first secured his confidence, I then
talk to him sympathetically in regard to the
failing which he wishes removed. The best
instincts have to be discovered and engaged.
There is some element of good in every item of
humanity, which can be elicited and drawn out.
This means that the treatment must be indi-
vidual. Sometimes it is effective to tell the
patient that, when next he is tempted to drink,
he will realise the awful picture he makes of
himself and the disgust with which his wife and
children, and all those whom he respects and
holds dear, will observe him ; and that this
scene will be so vivid before his eyes that he will
experience no difficulty in withstanding the
temptation. In all cases one must provide the
patient with some strong counter-motive to
break the habit and annul the recurrent craving.
It is necessary, too, to enquire into and remove
the exciting causes, to attend to the general

THE EFFECTS OF ALCOHOL 157

nutrition of the body, and to see that the mind
is occupied appropriately.

Patients addicted to the drink or other
pernicious habit are readily cured by this
method, the only condition being their willing
co-operation.

THE MORPHIA HABIT

Second only in importance to alcohol, among
the chemical poisons that produce a chronic
intoxication showing psychical features, stands
opium with its derivatives.

To some extent the notorious intolerance of
the present generation to pain is largely re-
sponsible for the increase, a toothache or a
neuralgia being sufficient cause or excuse for the
sufferer to fly to morphine, or some other nar-
cotic, for relief. It is of the greatest importance
to recognise that the anodyne and soothing
properties of opium are peculiarly seductive to
some individuals, and are apt to be sought long
after the causes which led to its employment
have passed away. What happens is this : the
patient has become accustomed to his dose and
awaits it so soon as the effects of the last one
have passed off. He tells us of vague pains and
miserable feelings which appear to demand

158 NERVOUS DISORDERS OF MEN

recurring doses, but these feelings are commonly
nothing more than the pains of craving for fresh
intoxication, a habit having already set in.
Hence the extreme unwisdom of permitting
nurses or relatives to administer opiates or give
hypodermic doses of morphine at their discretion
in any case.

The victims of the drug habit are, as a rule,
addicted to the practice of it in secret, and take
infinite pains, with supreme subtlety, to hide
it from their nearest and dearest relations.
This fact indicates a measure of shame and a
recognition of the fact that their habit is one
which, if known, would entail reprobation, and
possibly ostracism, in their social surroundings,
together with the institution of measures to put
a stop to the indulgence. The habit of mor-
phinism is readily detected on stripping the
patient by the scars of numerous punctures,
especially on the left arm.

The first effect of morphia is to make one think
quickly and clearly, but this soon passes away
and a dreamy state supervenes. Persons who
continue the use of morphia fail to get the acute
effects, but they are held in its power because
of its ability to exhilarate them temporarily,
enough to make them forget their troubles.
They find to their dismay, however, that in

THE EFFECTS OF ALCOHOL 159

order to get this result they must increase the
quantity of the drug and repeat the dose oftener.
It is not that the patient has a pleasure in drug-
taking, but that it is heaven for him to have the
drug as it is hell to be without it. No physician
should ever place a hypodermic syringe, or a
prescription for morphia, renewable at will, in
the hands of his patient with instructions how
to use it.

The permanent effect upon the faculties in
those instances in which the abuse of the drug
has been long continued, or the amount taken
excessive, is shown in impairment of memory
and lessened ability to apply one's self to physical
or mental work. The stability of the emotions
is conspicuously affected. Persons indulging in
morphia are easily dejected and irritated.

Anxiety, especially at night, is often experienced.
These patients often complain of numbness, or
hypersensitiveness ; their pupils are usually
contracted, their gaze is often furtive or staring ;
they are usually pale, with marked pallor of lips
or ears. Some of them get hypochondriacal ;
some become weak and tremulous, lose flesh,
suffer from dizziness, fainting spells, profuse
perspiration and palpitation.

The moral nature undergoes grave changes,
as shown in pronounced moral obliquities, and

160 NERVOUS DISORDERS OF MEN

in the resort to any means, no matter how
unscrupulous, even actual forgery and theft,
to obtain the drug. The idea of personal
responsibility falls to the lowest ebb ; thought,
action, and even the most imperative duties
are shunned. While the largest numbers of
these unfortunates are not insane in the stricter
sense of the word, there is always present a
certain degree of ethical obliquity, irritability,
peevishness, and moroseness. They lie un-
blushingly. It is never safe to believe the word
of a morphio -maniac ; his conscience is ob-
tunded and he will prevaricate with or without
reason.

In order to cure the drug habit we must treat
the patient rather than the habit. He must be
braced up, must be made to understand that if
he wants to quit the habit, no matter how
slavishly he is addicted to it, he can do so. The
first and absolutely necessary preliminary of the
treatment is to lift up the patient in his own eyes
and make him understand that, low as he has
sunk, his case is not hopeless, that his degrada-
tion is not at all uncommon nor so rare as he
might think, and that men and women have
succeeded in lifting themselves out of conditions
worse than his. If mild tonics are applied for
a time so that the symptoms due to the physio-

THE EFFECTS OF ALCOHOL 161

logical effects of the excessive use of the drug
are minimised, treatment by " suggestion " can
then be used on the lines described under treat-
ment of the drink habit. Excellent results have
been thus achieved.

CHAPTER XI

THE "CHANGE OF LIFE" IN MAN

THAT the physiological changes in the female
sexual organs during the " change of life " are
often accompanied by definite nervous and
mental disorders is universally known. But
that the changes in the glandular structure of
man during the same period also give rise to
similar disorders, though not in the same degree,
has hitherto attracted little attention. As a
rule, no notice is taken of the " change of life "
in man, but there are many men in whom at this
period nervous and mental disturbances do
occur similar to those in women, only that in
the female sex they are severer and attention
is drawn to them because of the cessation of the
menses. Nearly every man between 45 and 55
years of age becomes conscious of a change in
his feelings and character as well as in his bodily
state.

The " change of life " affects profoundly,
more in some, less in others, the entire constitu-

162

THE " CHANGE OF LIFE " IN MAN 163

tion, mental and physical. Nature is kind to the
majority and imperceptibly prepares the system
for the change, so that they pass through it with
comparatively little trouble. With some the
change is so gradual as not to be taken particular
notice of, with others the change is more or less
abrupt. A man, hitherto full of energy, en-
thusiasm, and cheerfulness, discovers that the
pleasures of life no longer offer the same enjoy-
ment to him, that the society of younger men is
apt to bore him, that they belong to a new
generation, whose interest and enjoyments are
no longer his own. His views, political, social,
or scientific, for which he has hitherto fought
with all his energy, become moderated. He sees
the defects of reform movements, if not their
utter hopelessness. His entire conduct is now
more influenced by reason than by emotional
impulse. He gets more domesticated. His
family has an increased interest for him. Alto-
gether he has grown more serious and sedate,
but he and his friends think this is only natural
with the advance of years, and trouble no
further about it.

One of the chief constitutional symptoms is a
tired condition, often implying an instinctive
feeling that work, exertion, and effort are not
always entirely worth the doing. Physiologically

164 NERVOUS DISORDERS OF MEN

and psychologically, energising by itself is no
longer felt to be so necessary. The tired feeling
often leads to a lowering in the desires and ideals.
Pleasures that cost little and imply small exertion
are preferred to pleasures of the higher sort that
need some strenuousness to attain them. Bad
habits begin to show their cumulative effects,
and the recovery after indiscretions is less certain
and slower. There is a slackening of the in-
tellectual powers with inability to concentrate
the attention and diminished energy for work.
The intellectual processes are both retarded and
more difficult. There is no longer the same
intuition and inspiration and former concentra-
tion. In intellectual workers the imaginative
power is diminished, hence it is difficult for them
to originate new work. In consequence they
become dissatisfied with their occupation and
lose self-confidence. It can be noticed that they
get easily irritated, that they get easily dis-
satisfied and are addicted to grumbling, in short,
that nothing pleases them. They are impatient
of opposition. They are easily provoked to
anger, even by persons they love. Family
events, the theatre, music and the sight of misery
excite their feelings to an unusual extent. In
one word, their tendency is to become " effemi-
nate." Many patients complain, in addition, of

THE " CHANGE OF LIFE " IN MAN 165

what is commonly called " stage-fright." The
brilliant orator, the distinguished performer, the
proud speculator now dread public assemblies,
or when engaged in their respective avocations
come suddenly to a standstill. Their memory
fails them, they forget what they intended to
say, or play, or reckon. After one or more
experiences of this nature they are overcome by
chronic fear ; dreading some misfortune, they do
not know of what kind, they can only say that
they feel they will always be helpless or ill.
The diminished capacity for work makes them
fear poverty. In consequence of their anxieties
sleep is disturbed, although genuine insomnia is
the exception. Sleep is uneasy, less deep, and
consequently less refreshing than formerly. The
subject has to coax somnolence and resorts to
various devices to gain his object. He be-
comes sad and depressed ; he feels the burden
of responsibility weighing heavily upon him,
perhaps that life has been somewhat of a failure
and that he has accomplished very little in spite
of all he has tried to do ; the " love of life " is
diminished, and not infrequently attempts are
made at self-destruction, which take the family
all the more by surprise since no real motive
can be found to account for such conduct. This
state is associated with a peculiar sensitiveness

\

166 NERVOUS DISORDERS OF MEN

to the action of alcohol and tobacco, which even
in reduced quantities give rise to distressing
sensations. More or less persistent headache is
a common feature. Already noticeable on
awakening in the morning, it is apt to get worse
as the hours go by, and ere the day's work is
over it may assume a throbbing character. It
is specially apt to be caused or intensified by
intellectual effort, by alcohol, or by excitement
of any kind. The freshness of the complexion
is lost, the skin has grown darker and rougher,
the face begins to show wrinkles, the lustre of
the eyes is fading, the various bodily organs get
fatigued more quickly and require more rest
than hitherto, and when worked to excess
painful sensations are apt to follow. The
sexual desire as well as potency is diminishing
and sexual hypochondriasis is not uncommon.

At the same time, the defence against disease
is lowered and often this is the beginning of the
end, the time when the first signs of that illness
sets in, to which in after years the man succumbs.
For both sexes, the climacterium is a period for
the readaptation of the bodily machinery to a
more modified functional activity. If at this
period there are cares and sorrows, mental or
physical over-exertion, it will be more difficult
than ever to retain the elasticity. At any other

THE " CHANGE OF LIFE " IN MAN 167

time the body would have recovered easily.
Now there is not enough vitality and nervous
energy, or only after a period of long inactivity.

In order to cure the physical and psychical
disturbances accompanying the male climac-
terium, we must treat the nervous system. The
success is striking. Most of the cases recover
their former health and energy in a very short
time. It is by strengthening the nerve centres
that we accomplish a cure, not by local stimula-
tion. Electricity does wonders in such cases.
It has the effect of a general tonic in conditions
of debility and exhaustion. It regenerates the
nerve-force, increases the vitality, and gives
resistance to disease. It is a thousand pities
that its practice should be left so largely in the
hands of quacks.

The patient must be made to realise that if
his body has lost in elasticity it will now gain
in massive strength, that if his thought-engine
throbs with less violent pulsation it will now gain
in cool, orderly and harmonious vibrations, and
that sound maturity can be quite as efficient and
enjoyable, though not so exuberant, as youth.
It is no use sighing for days that have gone ; he
must enjoy the glory and triumphs of manhood
without regrets for the past or fears for the
future.

168 NERVOUS DISORDERS OF MEN

He should keep up his exercises and recrea-
tions and not drop any of his outdoor interests
unless he can acquire other ones in their places.
So long as he likes to take active exercise and
sport and feels exhilarated and refreshed by
them, he should keep them up. When he feels
that they are getting a little too much for him,
when he does not feel fresher for them next day,
he should cut them down a little in intensity.

Much the same principles apply in the matter
of eating. He should follow his appetite, checked
by the results of his personal experience. As
the old saying runs, a man at forty is " either
a fool or a physician " in the matter of diet. He
has usually found out for himself what kinds
and amount of food agree with him and what
do not. Most men after forty-five, or certainly
after fifty, will notice a slight but distinct falling
off in appetite. This is a hint that the body
cannot utilise as much food as before, and should
be acted upon.

Obesity at this age is not a disease, but in
nine cases out of ten a normal healthful process,
a laying-by of capital against the evil days that
are coming. Fat laid on after forty-five is
usually lost before seventy, and is neither a
sign nor a cause of disease, " Anti-Fat " adver-
tisements to the contrary notwithstanding.

THE " CHANGE OF LIFE " IN MAN 169

Unfortunately, shortly after the age at which
this deposit of fat-surplus occurs the body engine
is apt to show signs of wear and tear, and
original defects in tubing, boiler, steam gauge,
and gearing reveal themselves under the strain ;
but it is not the first change that causes the
second. The dreaded fatty degeneration of the
heart and liver has nothing whatever to do
with general increase in body weight, however
generous. It occurs more often in the emaciated
than in the obese. Therefore let no one hesitate
to laugh and grow fat, or starve himself for fear
the " fat will get round his heart." Nearly all
weight-reducing diets and treatments reduce
strength also and are dangerous if long persisted
in. Fatness is perfectly compatible with the
highest grade of efficiency.

Next as to sleep : the man at this period of life
should take plenty. Time spent in sound sleep
is never wasted. The man of middle age will
find that he cannot take quite as much sleep as
formerly ; he tends to wake earlier and more
easily, but this should make him the more
insistent to take all that he possibly can. He
cannot stand the loss of sleep as he once did.
If he has been up till the small hours he is more
apt to feel ill-effects of it next day.

A great point is to keep up variety in mental

170 NERVOUS DISORDERS OF MEN

occupations and to keep up the interest in many
things so as to prevent early mental torpor.
Exclusive devotion to work has the result that
amusements cease to please ; and when recrea-
tion becomes imperative, or is the only thing
left as in old age, life becomes dreary from lack
of its sole interest — the interest in business. The
man of middle age must not plan too soon
retirement from business unless he has a hobby
or another pursuit to retire on, as well as a
competency. If he is so unfortunate as to have
no hobby, by all means let him beg, borrow, or
hire one. Better still, two, one indoor and one
outdoor. The hobby should be commenced
while he is still at active work, since the inclina-
tion and aptitude to begin something new
becomes increasingly difficult as one grows
older. The exercise of the brain in intellectual
pursuits keeps that organ, and with it the entire
body, young, and business men would do well
to choose some intellectual hobby. It is highly
instructive to observe the longevity in men of
high intelligence. They usually are or have been
engaged in those callings which require the
continued exercise of the intellectual faculties
upon comparatively new matter, or upon new
combinations of familiar data.

CHAPTEK XII

GENERAL TREATMENT OF NERVOUS
DISORDERS

HYGIENIC PHYSICAL MEASURES

MANY a patient suffering from a milder form of
nervous disorder feels better for a " change."
A short release from his burdening duties, a
break in the monotony of his work, often does
wonders. He should seek conditions and in-
fluences which give fair chances for the recu-
peration of his energies, and which are adapted
to his abilities, his knowledge and social con-
dition, and are full of joyful associations and
emotions.

Patients suffering from a severer form of
nervous disorder have frequently to be recom-
mended to take absolute REST for a time,
to withdraw completely from the occupation,
whether it be of business or pleasure, which has
exhausted their nervous system, and from the
source of worry which has depressed their
mentality. Speaking generally, such separation

171

172 NERVOUS DISORDERS OF MEN

is beneficial for the patient when those living
with him display either exaggerated tenderness or
disobliging indifference, or an irritating want of
comprehension of his feelings of malaise and his
sufferings. In such case he is better isolated
from his family and those surroundings in which
his ailment developed or which helped to make it
chronic . In withdrawing from his habitual circles
the patient further escapes the often too attentive
care of his relatives and the incessant questions
about his health, or one symptom or another of
his complaint, with which they overwhelm him ;
he breaks away, so to speak, from that moral
atmosphere made up of solicitude and com-
miseration, and sometimes also of ironical
indifference, by which his mental depression and
the irritability of his temper have been fostered.
In the milder cases complete rest from work
is not to be recommended ; they will do better
by cutting down their obligations. Complete
rest is likely to make them less able for work,
to diminish their fitness instead of increasing it.
For the one thing which requires an expenditure
of energy is the setting in motion. This alone is
painful. The wise simply manage so as to be
always in motion. The man who does not work
regularly and without interruption is constantly
obliged to renew the setting in motion, to compel

GENERAL TREATMENT 173

his brain to become attentive, to constrain his
intellect by command to a given task, and this
the most gifted find fatiguing. Still there are
some brain workers for whom the perfection of
a holiday will be found in doing nothing, in the
simple contemplation of nature : the sight of
the sea, of the forest, of the country. This
razes from their minds the manifold associations
and stimuli of their ordinary lives.

So-called " rest-cures " are often beneficial to
those whose nervous systems are greatly ex-
hausted, but there are few patients so seriously
ill that they require to stay in bed all day ; and
I have known a good many who were rendered
so irritable and restless by " rest in bed " that
their condition was worse after the " cure "
than at the commencement of the treatment.
It has to be remembered that, if we isolate the
patient, we place him under artificial conditions
and cannot judge of his real progress ; for he will
have to return to those surroundings which
brought about his neurosis.

Sometimes the patient tries TRAVELLING as a
remedial measure in the hope that it may do
him good. It is quite true that a change of
scene and surroundings, combined with relief
from work, is very beneficial in diverting the
patient's thoughts from himself and restoring

174 NERVOUS DISORDERS OF MEN

him to a healthier frame of mind. But again,
a physician's advice is required ; for we have to
remember that a nervous patient is frequently
not only jaded in mind and body, and unable
to stand the strain of travelling or to take an
interest in sight-seeing, but he is also suffering
from digestive derangements and sleeplessness,
and these latter conditions are often aggravated
by travelling. He should not start off on a sea
voyage before his physical condition has im-
proved, for not for everyone is the life on board
a ship suitable, certainly not in a case of
mental depression. Life on board ship is in
itself — by its monotony and want of interest —
depressing to many travellers, and it is rarely
that a ship's doctor has had any special experi-
ence of nervous disorders. We see sometimes
evidences of the non-success of this mode of self-
help in the newspaper paragraphs, which chronicle
the accidents to persons when taking sea voyages
for their health. There is no objection, however,
to a patient going on a sea voyage when still
fairly fit or during the period of convalescence.
A holiday is an event in the spiritual life, and
in proportion as we have or have not the gifts
of the spirit, so we enjoy a holiday, or fail to
enjoy it. The very words we use of a holiday
proclaim its spiritual significance ; for we call

GENERAL TREATMENT 175

it a change, or recreation — that is to say,
conversion, or regeneration.

Peace of mind, readiness to please and be
pleased, simplicity and reverence are factors of
a holiday no less essential than fresh air, exercise,
sight-seeing, and sport. But this peace of mind,
though it thrives well on solitude and silence,
thrives likewise on a great crowd in a strange
city. It needs only to be free ; it must have the
liberty of the spirit of holidays. One of us finds
that freedom in the loneliness of the country,
another finds it in the companionship of un-
familiar fellow-creatures ; there is no accounting
for what we falsely call tastes, but are in reality
diversities of gifts. One word of advice : the
holiday-maker should not take with him the
same clothes and talk which he has been using
all the season.

There is a conviction in the minds of many
people that in matters regarding the recuperation
of health there is nothing like the SEA. " A blow
from the briny " is a very common recommenda-
tion in cases of slackness, and is meant to suggest
that sea air is salutary. In not a few cases this
is a delusion. It is true that as a rule there is
nothing to be said against the quality of sea air ;
it is cool, pure, and clean, its supply is unlimited
and ever fresh ; yet it is not always that the

176 NERVOUS DISORDERS OF MEN

individual seeking strength can respond to the
powerful and exciting stimulus of the bracing
sea air; the digestive, secretory, circulatory,
and eliminatory systems may be goaded to an
energy of which they are incapable by reason
of a general debilitated condition ; they are not
able to do their work without exhaustion, and
the last state may be worse than the first. When
sea air disagrees with the temperament digestive
disturbances arise ; and if the excretory functions
are not in good going order, as in the case of the
so-called bilious individuals and plethoric per-
sons, headaches, giddiness, and a train of other
symptoms make an appearance. As a rule the
effect upon such cases of the less stimulating
country air is magical. When that is so, it
means that the great human machine and its
complexes gain vigour best by repose. When
strength has been restored in this way, the tonic
air of the sea may then be tried with the greatest
advantage. There can be no more satisfactory
formula for the restoration of the hard-worked
person than first a soothing, restful environment
at home or in the country and then a tonic one
of sea or mountain air. To plunge straight into
the tonic, invigorating air of the seaside is an
irrational procedure for many " run-down "
cases.

GENERAL TREATMENT 177

Then as to BATHING, its chief value lies in its
exhilaration. It does not do to make a penance
of it. Not all persons can enjoy it, and to some
it does positive harm. One may be clean
without bathing. The benefit derived from the
morning bath is in the reaction, the glow that
follows it, not in the cold plunge itself. Cold in
general, and cold water in particular, are
superb tonics, first to the nervous system,
through its branches in the skin, second to the
heart and blood-vessels as shown in the glow,
and third to the muscles and digestive glands.
But, like any other tonic, while a small dose
stimulates, a large one depresses; and the size
of the dose depends entirely on the bather. For
a strong, vigorous man or woman in the prime
of life, nothing is better than the cold plunge.
It is the reaction that we should aim at. If we
do not get this the bath is a failure, if not an
injury. For persons less vigorous, the tempera-
ture of the bath should be modified to a degree
which enables one to lie in it for at least half a
minute with comfort; for the shock of sudden
cold has its dangers, especially after fifty, when
the arteries are losing their elasticity. The best
temperature is the one that gives the best re-
action, and consequently most pleasure, and all
baths should be taken in a reasonably warm room.

178 NERVOUS DISORDERS OF MEN

As in the cold bath, so there is no benefit
gained by heroically enduring chilliness,
shivering, and acute discomfort in sea water,
under the impression that because it is dis-
agreeable it is manly and bracing and will in
the long run do good. Sea bathing should
be regarded solely as an enjoyment, and practised
as such. The strong will find it a bracing and
exhilarating sport, and may indulge in it freely,
not only without harm, but with great benefit.
The weak and relaxed and under-vitalised, and
especially all who know themselves to be below
par in any respect, should indulge in it most
sparingly.

As regards hot baths, these also have their
uses and their drawbacks. They have two
distinct purposes of utility, the purely mechani-
cal one of cleansing, the other for just the opposite
function of the cold bath, soothing and relaxing
instead of toning up and invigorating. The
relaxing and soothing effects of the hot bath are
very real, and, under proper circumstances, of
great value. Partly by virtue of its heat, partly
by the steam which is inhaled in the course of
it, and partly by its stimulating effect upon the
excretory glands of the skin, the hot bath has
a remarkable effect in removing aches and pains,
or " taking the soreness out of " tired muscles.

GENERAL TREATMENT 179

For these purposes it should obviously be taken
at or near bedtime, when the day's work is over,
and the skin may safely remain relaxed for at
least one to three hours afterwards. For the
average man or woman a bath of this description
taken in the evening is perfectly legitimate and,
indeed, a beneficial procedure. It has also
usually the desirable effect of inducing sleep in
those who are disposed to insomnia.

However, it may become a source of danger
by its very attractiveness. It is soothing and
so enjoyable that it is easy to carry it to such
an extreme as to relax the skin and produce a
more or less permanently depressing effect on
the nervous system by its overuse.

Then as regards MUSCULAR EXERCISE. Un-
doubtedly, a man who works hard with his mind
feels better for a few moments of physical exer-
cise ; remaining fixed in one's chair at a desk is
not a healthful practice. But physical exercise
is advantageous only if it be moderate ; other-
wise it simply adds to the fatigue of the brain.
Prolonged and fatiguing exercises, taken not for
any enjoyment in them, but, as a matter of
conscience, " to build muscle," are distinctly
dangerous. The heaviest strain of exercise is
thrown not on the muscles, but on the heart and
blood- vessels. Training should be directed to the

180 NERVOUS DISORDERS OF MEN

nervous system. The mere increase in strength
of a particular muscle counts for little. It is the
rapid, accurate, purposeful combination of a
dozen muscles with the eye, the ear, the sense
of touch and resistance that forms two-thirds of
training. And this is done solely through the
nervous system.

One must not look at exercise merely for its
effect on the muscular apparatus. Its psycho-
logical value is as important as its physiological.
People often take up home gymnastics with
religious enthusiasm and get splendid results
out of them — for a time. Few keep it up long.
That does not mean that the exercise system is
at fault. It simply means that it failed to
hold the interest. If a man forces himself to
exercise simply because he thinks it his duty,
more than half its benefits are lost. For a really
valuable exercise is one which reaches beyond
the muscles and the digestive organs ; it braces
up and stimulates the mind. The kind of exer-
cise that hits the mark is the kind a man likes
for its own sake.

There are many people who keep well and who
do their work successfully without ever taking
any formal exercise at all. A man who takes an
intelligent interest in the character of his food, who
eats properly, attends to the demands of his

GENERAL TREATMENT 181

bowels, keeps his skin in good order, and pro-
vides himself with a decent amount of mental
relaxation — such a man can often go for a long
time without any special exercise.

But a man who eats big dinners must have
bodily exercise. So must a man who works in
a badly ventilated room. So must a man who
has a tendency to worry, or to constipation, or
to headache. Indeed the number of those who
escape the need is very small.

It is the quality of muscular effort that counts
rather than quantity. So long as muscular
effort is strengthening the heart and developing
the nervous system and increasing the appetite,
it is doing good ; beyond this it is physiologically
valueless, often harmful, however great an
economic or sporting value it may have. So
long as exercise gives pleasure, exhilaration,
it is doing good. When it is not enjoyed, it
is either neutral or harmful physically. Some
men cannot do without a considerable amount ;
others keep " fit " with little or none.

For men of middle age exercise is necessary
but difficult to prescribe, for they have not the
speed for quick games, nor the suppleness for
gymnastics ; yet they eat and drink more, and
more richly, than the young, for the pleasures
of the table outlast others, and, seeking neither

182 NERVOUS DISORDERS OF MEN

fame among men nor love of women, they sit
long over meat and wine.

Old age needs little exercise ; sunshine and
good company cheer the old man. He needs
restraint more than incentive. We must see
that the old man's machinery works with as
little friction as possible.

A word of warning as to intermittent excesses
in the way of exercise may not be out of place.
Men who lead a sedentary life rush off to the
country for the week-end and play golf or tennis,
or take long walks all the time, returning to
town on Monday feeling the reverse of "fit."
They have, in fact, fatigued their muscles with
work to which habitual inaction has made them
unequal, and the result is that they are poisoned
by an excess of waste products, engendered by
the unwonted exertion. Exercise needs to be
conducted with care ; it is not at all times
good, nor in all degrees. Many suffer from lack
of it, but many from taking it indiscreetly.

Walking is perhaps the best and most readily
available form of exercise for most people, but
has one disadvantage. As soon as the walk
becomes too much of a routine, and the ground
gone over has lost its interest, or is even of such
a nature as to permit introspection or occupation
with other things, rather than with the sur-

GENERAL TREATMENT 183

roundings, then walking loses most of its efficacy
as a form of exercise. That is probably why
people find golf such a healthy exercise. They
get a walk while at the same time their thoughts
are centred on the game with its endless varieties,
and they can be so absorbed in it that for the
time they cannot think of anything else ; and for
the class of patient we are speaking of this is
just what is necessary for them.

Exercise should be allied with pleasure ; it
is for recreation. The mere motion to a place
is not enough, unless to move is gladness simply ;
as oftentimes it is in sunshine for the beauty of
it and in storm for the pleasure which the contest
gives. A man will say he takes enough exercise,
because rising late and eating a full meal in too
short a time he walks at top speed to his station
or his office ; another, because when exhausted
with the day's work he forces himself to walk
a long way home. The one hurries, the other
fatigues himself ; neither effort is the exercise
that brings health, but a strain that often
causes disease. So it comes that there is a
philosophy of exercise, and its practice should
be varied to each age and condition of life.

The patients whom we have under considera-
tion often fail to appreciate the nervous and
mental origin of their numerous complaints and

184 NERVOUS DISORDERS OF MEN

seek MEDICINAL AID for their individual symp-
toms, whether it be headache, backache, pains
in the limbs, dyspepsia, palpitation, insomnia,
and the rest. They seem to suppose that the
drugs fit diseases in a perfect way. The physician
does not always give drugs because he thinks it
will cure the disease ; he has to give a pre-
scription sometimes because the patient is not
happy till he gets it ; too often he is not happy
even then. The popular belief in the all-sufficing
efficacy of drugs is widespread. The aristocratic
patient no more believes that his disorder can
be cured without the aid of a prescription than
his poorer fellow-mortal, who, when ill, attends
regularly at the hospital or dispensary in order
to obtain the bottle of physic, which he looks
upon as indispensable to the restoration of his
health. The popularity of the bottle depends
upon the basal idea that in some mysterious way
it represents the doctor's intelligence and skill
in a form capable of being swallowed, and so
brought into direct contact with the disease.
There are numberless occasions when drugs are
given, there being at the time no distinct indica-
tion for giving any, but the sick are not reasonable
beings, and, unless they have a bottle of medicine
to anchor their faith to, they are in a state of
unrest that is positively harmful to their pro-

GENERAL TREATMENT 185

gress. But there are multitudes who are not
in this parlous state, who are capable of listening
to reason; but having been taught to look for
their prescription or their bottle of medicine, they
have no idea of the value of advice only or of
the need of the watchful eye. It is very dis-
appointing when, after we have been giving
advice for about an hour and nattered ourselves
on having made an impression, we are met with
the question on leaving : " Are you not going
to give me a prescription ? 3:

The advance of civilisation has done little or
nothing to decrease the hopeful spirit which
throughout the ages has prompted man to believe
in the curative power of drugs. No doubt, the
cut-and-dry method of prescribing in the out-
patient departments of hospitals is responsible
to some extent for the implicit belief in the
physic bottle. The patient wishes for cure and
immediate relief ; he or she believes that the
physician who has studied so much has some
remedy already prepared for such disease, and
all that he will have to do is to go to the
pharmacist and get it. He listens only dis-
tractedly to the counsels on hygiene which the
serious physician gives him, and he looks upon
them merely as measures intended to favour the
medicinal action, which no doubt they often are.

186 NERVOUS DISORDERS OF MEN

The general idea of treatment amongst the
public seems to be that certain preparations
relieve certain symptoms, and that when par-
ticular phenomena present themselves the same
remedies must be used, no matter what the
origin of these symptoms. Slight ailments,
vague aches and pains, are borne with a varying
amount of patience by different individuals.
In many, the least departure from health is a
signal for the self -administration of drugs.
Taking drugs without consultation with a
medical practitioner is undoubtedly on the
increase, and it is the delight of some individuals
to advise their friends to take certain things for
the relief of their ills. Many of the popular
preparations are of course harmless, only con-
taining simple ingredients ; but when more
potent remedies are used, such as narcotics, the
risk becomes serious.

It is very common for patients when they
suffer from nervous exhaustion or are " run
down " to ask a physician for a " tonic," and
often they get it. This is a mistake, for many of
the nervous symptoms due to exhaustion require
a " sedative " medicine and not a tonic. Tonic
remedies may be given when the tremors,
palpitation, morbid fears, etc., have disappeared ;
then they will prevent a relapse, but to give

GENERAL TREATMENT 187

them in the early stage frequently aggravates
the patient's condition.

Certainly, we must raise the vital energy of
the patient, but the physician must choose the
proper time for it. There is a great difference
in vital energy. One man has more of it than
another. One man recovers rapidly and surely
after a nervous breakdown, while another drags
along through years of semi-invalidism. Func-
tional nervous disorder is due to an enfeeblement
of nerve force, and to this the treatment must
be directed as well as to the mental s}7'mptoms.
A valuable agent for raising the tone of the
nervous system, the resisting power, and the
general vitality of the patient is ELECTRICITY.
There are several reasons why electricity
has been tardily established as a therapeutic
agent. Until recently there was a great lack
of precision in the knowledge possessed con-
cerning it. Besides this, electricity has always
appealed to the human imagination, and in the
hands of quacks and charlatans has been utilised
to impress that large section of the public which
is gullible ; but with the effect of raising the
distrust and prejudice of medical men against
a therapeutic measure for which marvellous
powers were claimed. Lay practitioners may
understand the machine which they are using,

188 NERVOUS DISORDERS OF MEN

and have some general knowledge of electricity ;
but they know little or nothing of the anatomy
and physiology and the diseases of the nervous
system. Because electrical treatment fails to
do any good in these cases, and sometimes does
positive harm, there is a prejudice against the
treatment not only on the part of the public,
but also on the part of a good many medical
men who have not studied nervous diseases
very closely, and have never been called upon
to give electrical treatment. On the other hand,
physicians who do know all about the good
effects of electricity have been too much in the
habit of recommending lay practitioners, over
whom they can have little or no control. Even
if the electricity is applied in accordance with
the instructions received, there is the mental
element in all nervous disorders which must
never be neglected, and none but a medical man
can be a skilled psychotherapist. The conse-
quences of electrical applications in the hands of
non-medical persons may be disastrous. When
we think of it, a man or woman who has
taken a three months' course in some hospital
or quack medical institution can set up in
practice for himself, and advertise electrical
treatment in competition with men who spent
five or six years in their medical education

GENERAL TREATMENT 189

and several years more in getting skilled in their
specialty.

Gradually the utilisation of electricity is
passing out of the hands of pretenders and
showmen, and its value and merit are becoming
recognised by thoughtful men and scientific
workers, who see in it a vast power for good if
kept within the compass of its applicability.
Medical electricity has been undergoing very
important developments during the last few
years, and to an extent scarcely realised by
those who are not intimately associated with
the subject. It is now much more scientifically
understood, and electrical applications are cor-
respondingly more accurate and reliable. The
day has gone past when a more or less intelligent
manipulation of a few switches was considered
a sufficient qualification for the practice of
electro-therapeutics. The best results will be
obtained only by those whose medical and
scientific training has been comprehensive.

Often the nervous system is too exhausted for
the patient to respond to psychotherapeutic
influence. When by electrical, medicinal, or
other treatment we have improved his general
constitutional condition, he feels " fit " again,
and his morbid fears or other abnormal feelings
disappear without any special effort. On the

190 NERVOUS DISORDERS OF MEN

other hand, where they are more deeply rooted,
the patient's attendances for electrical treatment
give us an opportunity — which we might not
get otherwise — of employing such " suggestion "
therapy, persuasive and analytical methods, as
may suit his individuality, and thus both his
mental and physical health are restored.

CHAPTER XIII

THE POWER OF SUGGESTION IN DAILY LIFE

AND MEDICAL PRACTICE,
AND OTHER METHODS OF PSYCHOTHERAPY

IT is a popular error that SUGGESTION is practised
only by medical men, and chiefly as hypnotic
suggestion. We cannot escape its influence.
First of all, there are the subconscious elements
of our character which act on us as a constant
suggestion, fashioning, after their own image, all
our impressions and all our thoughts. Every
man, of necessity, sees other men and Nature
itself through the prism of his own individuality.
Thus the wicked man believes in the wickedness
of others, and the pessimist is convinced deeply
that everything is wrong, when only himself is
wrong. On the other hand, there are people
who scarcely ever act from motives originating
within themselves, but whose entire lives are
lived in obedience to the suggested ideas and
feelings of others. The feelings of affection,
esteem, awe, or fear, which those who are talking

191

192 NERVOUS DISORDERS OF MEN

to us inspire in us, surreptitiously prepare the
paths of our understanding, and our reason is
often taken in a trap. Somebody's optimistic
reflection can give us strength, and, on the other
hand, his ill-humour can take away all our
enthusiasm and energy. Some individuals seem
to have a " winning way " with them, and are
able to induce others to fall into their way of
thinking and to do for them what they wish
done. We let ourselves be captivated by their
superficial eloquence, by the charm of their
language. Even the most resolute characters are
influenced by suggestion. It is only required that
the suggestion should be made artfully. The
idea need only be introduced discreetly and
gradually in order to succeed. By indirect
suggestion, the subject has no consciousness that
his views are being modified. Besides, an idea
introduced almost unnoticed is likely to lie
latent for a period, and, when it does assert
itself, it will appear to the subject to have
been originated by himself.

Children are trained almost wholly by
suggestion. Next to the parental influence,
the suggestions received during school life have
the greatest influence on the formation of
the future character. Suggestion lies at the
bottom of all forms of moral and religious

THE POWER OF SUGGESTION 193

teaching. It is, in fact, the basis of education.
We are all open to suggestion, but some are
more so than others. The maintenance of social
life depends to a great extent on the degree
of power of making and receiving suggestions;
and the firmest friends and the happiest
couples in life are frequently those who are in
this respect well matched. The measure of
pleasure we get from life depends more on our
suggestibility than on any other factor. Some
people can be happy even in misery. Books are
often bought because of their suggestive titles ;
fashionable clothes are worn because of the
suggestion of wealth and respectability. Certain
foods, the habit of open or closed windows, and
other idiosyncrasies and whimsies often produce
the pleasures of comfort, or displeasures and dis-
comforts, not by their actual effects, but by
suggestion.

There are certain classes of persons whose
intellectual labours are characterised by sugges-
tibility in a very marked degree, as, for example,
authors. What can flatter an author more than
to hear that his novel made men and women
laugh or weep, or was effective in creating good
morals or wicked conduct ? And what is the
object of the dramatist and actor but to suggest
certain thoughts and feelings to the audience,

194 NERVOUS DISORDERS OF MEN

to make them think, laugh, or cry, at his will ?
The transformed emotion may be suppressed and
is usually not lasting, but with a few, it is some-
times strong enough to prevent their enjoying
their supper and sleep that night.

Even in business, suggestion plays an important
role. The best salesman is he who can dispose
of goods that the purchaser did not intend to
buy, at least not at the price asked. The best
buyer is he who can make a man sell his
goods at a figure which he regrets as soon as
they part. The art of advertising depends
almost entirely on its power of sugges-
tion. The daily repetition of a statement
suggests that the assertion is a fact.

Suggestion influences not merely our mental
states, but can affect the bodily functions. It
is a fact of observation that pleasant, joyful,
exalting emotions are accompanied by a feeling
of well-being and capacity, by an increase in the
vital functions and an invigoration of the whole
organism ; while, by certain depressive and
distressing emotions, the contrary effect is pro-
duced and the nutrition of the body suffers.
Everyone knows how the receipt of an un-
pleasant letter may make him lose all appetite
for food and even cause him indigestion or
headache, how fear may actually paralyse the

THE POWER OF SUGGESTION 195

muscles and keep him " rooted to the spot,"
how sudden shock will sometimes result in
instant death, how long-continued grief or
mental strain will sap the strength of the body.
On the other hand, the mental disposition can
be influenced by the bodily functions. Nobody
is constantly the same self. We vary not only
at different periods of our life, but on different
days, according to our bodily state ; sometimes
sanguine, sometimes gloomy ; sometimes genial,
sometimes reserved ; sometimes apathetic, some-
times energetic. It is evident, therefore, that
not only can the body be weakened through the
agency of the mind, but it can be strengthened
also by the same agency.

We are constantly influencing others and are
constantly influenced by others ; but not only
does mind act on mind, our mental states
influence our bodily states and our bodily states
influence our mental states. It is the scientific
study of this action and reaction which has been
taken up by numerous expert psychologists
within recent years, and the results of which are
being utilised nowadays by physicians in the
treatment of disease under the name of psycho-
therapy.

The first essential for successful psychotherapy
is that the patient have faith in the skill, the

196 NERVOUS DISORDERS OF MEN

judgment, and the honesty of his medical
adviser. If the patient lacks confidence in the
physician he is not likely to carry out his in-
structions with that accuracy and exactness of
detail which is at all times the secret of success.
The physician, observing that the patient fails
to obey him, loses his interest in the case, and
unfortunately the patient is the sufferer under
these circumstances. It is the patient who first
acts psychically on the physician ; and the manner
in which the patient first acts towards the
physician is quite as important a factor in
successful psychic treatment as is the demeanour
of the physician himself. Where there is no
psychic contact the enthusiasm, the joy in
one's work, diminishes. Hence it is this
psychic contact which plays the determining
role in psychotherapy. Without it medicines
may be administered and surgical operations
performed effectively ; but successful suggestions
cannot be implanted.

Wherever this psychic contact evolved from
sympathy is present, it will not be difficult for
the physician to extend that measure of tran-
quillity and patience which the nature of psycho-
therapy demands. This very demand, in fact,
makes the practice of psychotherapeutics im-
possible for many physicians. Time and patience

THE POWER OF SUGGESTION 197

are factors of the greatest importance. To listen
to the never-ending complaints of nervous
patients is always a tax on both time and
patience ; but he who tries to hurry his patient,
he who receives these complaints restlessly,
without interest, or even with a hint that the
complaints are foolish or imaginary, will never
achieve the slightest success in this form of
treatment. There are no fancied ills. There
are physical ills and mental ills. Mental ills are
just as real as physical ills. A person may be
ailing because he persuades himself that he is
ailing ; but in that case his mind is so affecting
his body that he is actually ailing physically,
though the cause of the trouble is mental.

If the patient feels that he has not confidence
in the doctor he has consulted, the best thing
for him to do is to seek the advice of a physician
in whom he has confidence, and to follow out
his treatment, for one, two, or three months if
need be, until the desired result is obtained.
On the other hand, if he feels that he is losing
rather than gaining ground, he would be foolish
to continue any mode of treatment which is
delusive, useless, and unsatisfactory.

This is of all things the most important.
Many a patient becomes chronic, when he might
have been cured long before, simply because of

198 NERVOUS DISORDERS OF MEN

the advice of his too anxious friends to consult
this man or that, or to take this or that quack
medicine, which cured Mr. So-and-so when every-
body had given him up. I need scarcely say that
this is very unfortunate for the patient.

The difference between a successful doctor
and another who, perhaps with greater mental
gifts and larger knowledge, fails to win the
confidence of patients is mainly one of person-
ality. The man who impresses sufferers and their
friends with belief in himself will — assuming him
to be honest — do far more good than he who,
whatever may be his scientific attainments, has
not the power of inspiring faith ; in a word, the
miracle of cure — in the class of cases with which
we are here dealing — is largely wrought by
psychotherapy, of which the most important
element is the personal influence of the physician,
by which he is able to soothe the patient's fears,
allay his anxieties, make him face the situation
calmly so that he may not use up any of his
vital force in useless worry, but, on the contrary,
employ all his available psychic energy in helping
nature to overcome whatever disturbance there
is within the organism.

The mental element in disease is a universal
and constant fact, but it prevails in different
cases to a different extent. I could relate

THE POWER OF SUGGESTION 199

remarkable cases of cures by mental impressions
only. There are no two cases alike ; and not only
are the easily recognisable differences of sex and
age, occupation and education, financial means,
temperament and capacity, decisive; but all
the subtle variations of prejudices and beliefs,
preferences and dislikes, family life and social
surroundings, ambitions and prospects, memories
and fancies, diet and habits must carefully be
considered. Every element of a man's life-
history, impressions of early childhood, his love
and his successes, his diseases and his distresses,
his acquaintances and his reading, his talent,
his character, his sincerity, his energy, his
intelligence — everything germane to the indi-
vidual— ought to determine the details of the
psychotherapeutic method. As it is impossible
to determine all those factors by any sufficient
enquiry, most of the adjustment of method must
be left to the instinct of the physician, in which
wide experience, solid knowledge, tact, and
sympathy must be blended. Even the way in
which the patient reacts on the method will often
guide the instinct of the well-trained psycho-
therapist. The securing of personal information
is of the utmost importance, because very
often details of life and habits are discovered
that can be so modified by instruction as to

200 NERVOUS DISORDERS OF MEN

bring about a disappearance of unfavourable
influences.

In the next place, let me emphasise the
importance of a correct diagnosis in each case.
It is as important to know what sort of a patient
has a disease, as what sort of a disease a patient
has. This does not mean merely determining
the name of the disease ; it means obtaining a
complete grasp of the patient's condition — why
is he ill ; what prevents him from getting well ;
what, if any, cause is still in operation ? Indeed,
I am realising more and more that the successful
psychotherapist must be first of all a skilled
physician with a wide experience of men and
women, not alone in disease, but also in health.
Often some departure from proper ways of
physical living will be found to be the starting-
point. It may have been unavoidable when it
occurred, or have been thought so at least, or
more likely not thought about at all until the
mischief was done.

Every case needs a special method and is
in a way amenable to special procedures of
verbal suggestion. All who have had prac-
tice among nerve patients know how much,
in spite of very many points of resem-
blance, they really differ from one another in
their tendencies, their sensitiveness, their char-

THE POWJER OF SUGGESTION 201

acter, their social aspirations, and their degree
of intelligence ; all of which are conditions that
require from the physician, if he is to conduct
the psychical treatment well, the most varied
modes of address and manner. Consequently,
before undertaking the psychical treatment of a
nerve patient, we want to enquire not only into
his history, his hereditary and personal antece-
dents, but also into the persons around him, the
circumstances in which he first became ill and
the real causes, moral or other, of his nervous
exhaustion.

Analysis will often discover as the funda-
mental difficulty a sort of derangement of moral
perspective. Trifles have come to occupy the
foreground so completely that they obscure or
altogether hide the larger and more important
things beyond them. This is often because
trifles do really and naturally occupy too large
a share of his daily attention. The application
of a little reasoning power to the consideration
of such matters will, if the trouble be not too far
advanced, reduce things to something like their
proper perspective.

The mind and will of nervous patients is
essentially weak and vacillating ; hence arises
the necessity for the controlling influence and
guiding efforts of a will superior to their own.

202 NERVOUS DISORDERS OF MEN

What they want is disciplined treatment, under
someone who, whilst having plenty of sympathy,
can mix it with firmness and authority, so as
to check the ramifications of disordered feeling
and make the patient realise how to help himself.
Where worry has played a prominent part in
the causation of the patient's illness, and where
it has been impossible to remove its source, the
physician's task becomes a formidable one and
will necessitate the exercise of the finest tact,
founded upon a wide knowledge of human nature
and of the various moral agencies which may be
brought beneficially to bear upon it. It will do
little good to tell this type of patient that he
should not worry ; he knows as much himself,
and, if he does not, his relatives or his friends
have told him so long before he has reached the
physician. They have also told him, in a spirit
of genuine sympathy, that he should cease to
think so much about himself, or that he ought
to take a rest, or become interested in some
hobby or in outdoor sports. Perhaps they have
even lent him books, which he has read with
hopeful diligence, about the value of optimism
and of cheerfulness and self-control, with well-
meaning hints as to the best method of culti-
vating these estimable qualities. But in the end
it has come to nothing, and why ? Because it

THE POWER OF SUGGESTION 203

is merely touching the fringe of the problem.
What this man wants to know is, not that he
should cease to worry, which is obvious, but how
he is to cease to worry. And whoever can answer
this problem gets at the root of the matter.
Discouraged, weary, pessimistic, the patient
comes to the psychotherapist asking, though he
does not know it, for a practical philosophy of
life. His own has broken down ; or else he had
never anything worth the name and never really
felt the need of it until the present crisis brought
him sharply to the realisation that such a thing
is indispensable.

The patient has to be taught to think for
himself and how to exercise MENTAL DISCIPLINE.
As a rule he is complaining that he lacks decision,
cannot concentrate at will, and that his thoughts
are uncontrolled and wandering. Mental disci-
pline gives force and efficiency to the mental
powers, and strength to character. The patient
is also likely to admit that he has got into a mental
groove from which he cannot extricate himself.
He is likely to admit that he has lost all interest
in subjects that do not directly concern himself ;
but he may be unwilling to believe, or may even
resent the suggestion, that his mental state is
due to a large extent to his never having thought
for himself and having taken all his thoughts

204 NERVOUS DISORDERS OF MIEN

second-hand, and thus having given his brain
no work to do. That is how he became intro-
spective and watched the internal working of
his bodily machinery, to which the original and
busy man pays little or no attention.

Of course, when the attention is fixed exclu-
sively upon a diseased idea, it is very difficult
for suggestion to find an entrance into the brain.
Therefore the preliminary to all successful
treatment is to remove unfavourable sugges-
tions— mostly due to imperfect knowledge — be-
fore favourable suggestions are made. It will
require considerable patience and perseverance
to succeed ; but even with very obstinate
patients there is a way of making an impression
on the brain, and once an entrance is gained into
the fortress of the mind, the gates for the ad-
mission of other impressions can be widened and
widened till all resistance is broken.

The morbid ideas of the patient are the result
of irritation of certain brain cells. It is not the
idea itself, but the recurrence of the idea, which
is morbid. Hence it is not always advisable to
go direct against his ideas, but rather to try to
direct the current of his thoughts into other
channels. It is wonderful how sometimes a
single impression made upon the mind by means
of suggestion, a single hopeful idea introduced

THE POWER OF SUGGESTION 205

into it, may suddenly change the whole current
of feeling and divert it from a morbid into a
healthy channel. If we can once fix the atten-
tion upon any belief, or a happiness which is
capable of attainment, we have made easy the
way to recovery. If we can inspire by our
assurance any glimmering hope of restoration,
we have ministered powerfully to composure and
serenity of mind and entered on the path that
leads to ultimate cure.

In order to gain mental control, the cultivation
of a hopeful spirit is of importance. Pessimism
as a working principle of life is utterly bad from
the point of view of mental stability. Human
nature, as a general rule, absolutely needs for
its continual mental health the support of an
inspiring optimism. Those who look for trouble
will always find it knocking at the door. I do
not mean to convey, however, that all men have
it in their power to be optimistic or pessimistic,
just as they wish. That is not so. These condi-
tions of feeling, to a large extent, come by
temperament ; but most men also have some
choice in this as in other affairs of life. It is a
wholesome determination not to allow the pin-
pricks of life to upset one.

The patient must be taught how to forget his
troubles. We all try to remember too much.

206 NERVOUS DISORDERS OF MEN

We are cultivating the memory but not the art
of forgetfulness, which is equally important.
A well-trained memory is a very useful faculty
to possess, but if the health is sound and the
brain clear the impressions we receive will in
any case be more vivid and therefore more
lasting. A defective memory is often a sign of
disturbed health ; and when this is attended to,
no artificial aids for improving the memory will
be necessary. The patients under consideration
too often remember what they should forget.
To let their disappointments, their failures, their
disagreeable experiences, linger in their minds,
not only dissipates their mental energy, but
reacts upon their body, impairing digestion,
disturbing sleep, and the general health suffers
in consequence. Forgetting is a splendid mental
calisthenic and a good medicine for these
patients. When the remembrance of unpleasant
happenings crowds into their mind, they should
use their will-power and turn their thoughts to
happier things. Let them take up a book and
read, or go out into the fresh air. Let them fill
the mind so full of other matters that there will
be no room for the disagreeable memories.
Let them go to sleep every night with the
thought of pleasant things before them and
begin the next day as though it was the first

THE POWER OF SUGGESTION 207

day of their life and their only day, and let them
make this day a record of sweet memories.
To forget — that is what they need. Just to
forget — themselves, their petty annoyances, their
bitter disappointments, their mental difficulties,
their bodily sensations. Let them learn to forget,
make a study of it, let them practice it. Let
them become experts in the art of forgetting
what is not worth remembering, and they will
add immeasurably to the health of both mind
and body.

Not alone can functional disorders be bene-
fited by suggestion, but various symptoms of
organic disease can be also efficiently relieved.
In all cases of serious organic disease there is
a strong nervous element. The patient is apt
to be agitated, perhaps he sleeps badly, or there
may be pain. Now, if we can soothe the nervous
system, secure sleep, and remove pain — and we
can do all this — we are going a long way to
improve the patient's condition. If we can
alleviate the symptoms we have achieved a great
deal. If, for instance, pain is disturbing diges-
tion, rest, and the general mental capacity, the
relief of pain places the patient on an altogether
different footing from that on which he was before.
In the same way with sleeplessness. If we can
relieve sleeplessness in many cases the funda-

208 NERVOUS DISORDERS OF MEN

mental cause of that sleeplessness may be better
treated. But as long as sleeplessness persists
we are unable to attack the real cause. Often
an illness is made worse by the fears of the
patient. By suggestion treatment we can calm
and quieten the patient's natural apprehension,
and thus avert the worst effects of a disease.

Suggestion treatment does not constitute the
entire psychotherapy. To apply it successfully
we must use scientific methods of PSYCHO-
ANALYSIS and synthesis, that is to say, we must
dissect the mental tendencies of the patient
until we find the real root of his trouble, and we
must give them a new direction, together with
moral therapy and hygienic physical measures.
When we analyse the mind of the patient, it is
often found that some painful experience in
early life, of which he has lost recollection, has
brought about a mental conflict and is still
exercising an influence, though unconsciously,
on his present thoughts, feelings, and actions,
and is the source of his nervous derangement.
In some cases the mere confession gives relief,
and in others the fact that the hidden influence
is brought under conscious mental control brings
contentment, secures the proper mental adjust-
ment, and leads to recovery.

Many physicians claim to use psychotherapy

THE POWER OF SUGGESTION 209

who use only the method of PERSUASION, which
consists of explaining to the patient the true
reasons for his condition and making an appeal
for the reform of his habits. This does very well
in the simpler cases when done methodically,
but it is my experience that by the time
most nervous patients come to the physician,
they have got beyond the influence of mere persua-
sion and require not only to be told to reform
their habits, but to be shown how to reform them.
Often they know perfectly well where they have
offended, but lack the power to break themselves
of their unhealthy physical or mental indulgences.
We may correct errors of interpretation by
persuasion, but to eradicate pathological con-
victions and to combat apprehensions, " sugges-
tion " treatment must be employed.

In both methods, that of persuasion and that
of suggestion, the mental mechanism, which has
engendered the nervous disorder, must be taken
apart bit by bit and be built up again
on a rational basis by the process of RE-
EDUCATION. We must show the patient in
what way he has sinned ; how much his pre-
occupations, his reproaches, and remorses are
exaggerated, and how useless they are ; what
is the exact origin of his auto- and hetero-
suggestions ; we must show him his errors of

210 NERVOUS DISORDERS OF MEN

interpretation of pathological phenomena, and
what is the influence which emotional causes
exert upon him. We must get the patient to
realise his previous misconceptions, must uproot
undesirable habits, which bad education, imita-
tion, neglect, etc., have developed in him ; we
must teach him to minimise his difficulties, to
stop the magnification of trifles, and to gain
self-control ; in short, we must aim at bringing
about a rational mental adjustment.

It will be seen that it is not by any one method,
but rather by a combination of the various
methods which constitute psychotherapy, that
we can hope to restore the patient to health.
But what I wish to lay particular stress on is
that in our successful teaching of self-control
and mental discipline lies the future happiness
of the patient and the prevention of his relapse.

CHAPTER XIV

THE METHOD OF APPLYING "SUGGESTION"
TREATMENT

DIRECTIONS FOR AUTO-SUGGESTION

SUGGESTIBILITY is, as we have seen, a charac-
teristic of all human beings, but there are
methods which increase that suggestibility.
Let me describe the one method which I have
found almost invariably successful.

The patient is put in a comfortable position
on a couch or arm-chair, in a quiet room, is asked
to breathe regularly and deeply, and to compose
himself in such a way as to bring about thorough
relaxation of his muscles. The relaxation of
the body and cessation from any voluntary
muscular contraction is intended to stop the
numerous leaks of nervous energy, and the
regular deep breathing is to purify the blood and
favour its circulation through the brain. All
victims of despondency, all downcast and crest-
fallen people are shallow breathers.

The patient is then asked to gaze intently for

212 NERVOUS DISORDERS OF MEN

a while on some object, a picture, crystal, or
subdued light, or to listen attentively to a
monotonous sound, and to concentrate his
thoughts thereon. This process helps to prevent
the eyes from wandering all round the room and
seeing the pictures, books, and furniture ; it
helps to prevent other sounds being heard,
shuts out distracting and exciting thoughts,
prevents the mind from wandering, and pro-
duces a passive subjective condition suitable for
suggestion and auto-suggestion. In very sus-
ceptible subjects a state of drowsiness may be
produced, the eyelids may get heavy, when the
patient will find it a relief to close his eyes and
rest in a peaceful condition. In recent years
this state of abstraction with relaxation has been
spoken of as the hypnoidal state, because it is
a state which resembles the preliminaries of
sleep.

By the concentration of his attention we have
put the subject in the condition of objective
passiveness, in which the brain is at rest, the
muscles are relaxed, all distracting thoughts are
warded off, and the mind is completely absorbed
to the exclusion of all external sensations. We
have done the same as any man does in ordinary
circumstances when he wants to concentrate on
a subject ; he stops people talking to him and

"SUGGESTION" TREATMENT 213

withdraws his attention from distracting sounds
and all outside impressions for a while. An
orator trying to make a speech to a roomful of
talking people will not make very much impres-
sion ; but when his audience has been quieted, the
ideas he presents will have some definite weight.
In suggestive therapeutics the physician is the
orator and the restive audience is represented
by the turbulent thoughts of the patient.

We can now proceed to talk to the patient
about his ailment, reassure him of his power to
control his cravings, and to put away doubts
and questionings which are irrational and en-
tirely due to habitual tendencies that he has
allowed to grow on him. All conceptions and
ideas which we put forth are such as would
appeal to the patient's reason, and do not come
into collision with either his convictions or his
feelings. For this purpose it is of course abso-
lutely necessary to know what chords are likely
to respond, and how we may build up the dis-
integrated personality. We explain to the
patient the true reasons for his condition ; we
show him in what way he has erred, what are
the faults of his character and reasoning that
brought about his present condition. We point
out to the patient how much his preoccupations
and reproaches and remorses are exaggerated,

214 NERVOUS DISORDERS OF MEN

and how useless they are. We endeavour to
establish confidence in himself, and to awaken
the different elements of his personality which
will enable him to regain self-control. We try
to get the patient to turn his attention away
from that which is painful and concentrate it
upon what is agreeable and hopeful, to think of
other and higher things than his own person,
to control and order his thoughts and sensations
that he may dominate them, and not be
dominated by them. By the concentration of
attention, the patient also forgets his internal
sensations.

Just as pain can be made more acute by think-
ing of it, so it can be diminished by withdrawing
the attention from the painful part. From the
candidate in a competitive examination who
forgets his toothache till he comes out of the
examination room, to the soldier in action
unconscious of the bullet wound till he faints
from loss of blood, we have instances enough of
intense concentration of attention on other events
which has often made the resolute spirit alto-
gether unconscious of conditions which would
have been appalling to the ordinary man.

The patients do not lose consciousness ; they
know what is taking place, though they may
close their eyes and be willing to abstract their

"SUGGESTION" TREATMENT 215

minds. The suggestion given is received by
them in full consciousness ; it does not escape
from the control of their personality. And if
they are docile subjects, convinced of the
intellectual superiority of the physician, quite
disposed in consequence to obey him, and
vividly impressed by the method and by what
they expect of it, it is easy to understand that
they accept and carry out the " suggestion "
that has been given to them. But this suggestion
is, on ultimate analysis, only a suggestion
received in the waking state, facilitated perhaps
by the belief of the invalid in the efficacy of this
mode of treatment and by the ceremonial
associated with it. This form of treatment
presents no dangers. The physician does not
impose his will upon the patient ; he acts only
as a guide and teacher to enable him to discipline
himself and to co-ordinate his scattered forces.
It is certain that suggestion treatment, thus
understood and applied, is able to render real
service, as the examples quoted in the next
chapter will show.

In this subconscious state any resolution that
is passed by the subject is likely to be carried
into action. Thus a person, whose will has be-
come so defective that he is unable to break
himself of a certain habit, can determine in that

216 NERVOUS DISORDERS OF MEN

state that he will no longer give way to it.
He states to himself the reasons why he ought
not to give way to it, why it would be positively
disastrous for him to go on as he has done —
and, indeed, that man will find, when the
temptation occurs again, that all his reflec-
tions are so vividly brought before him that
he will have no difficulty in resisting it.

We do not know why the resolutions made in
this state should have such a powerful effect ;
we do not know, for the mechanism of the brain
machine is still a mystery to us. But that the
brain is capable of working unconsciously some-
times more efficiently than in the conscious state,
of that we have several examples. Thus it
happens sometimes that, when we try to recall
a name, we fail to remember it in spite of the
most determined efforts. We leave off thinking
about it and begin doing something else, and after
a few minutes the desired name is remembered,
as if of its own accord. The lesson we can draw
from this is that we should not be disappointed
if an effort of will fails, for the brain can act
intelligently without our being conscious of the
manner in which it works. The effort made
has been enough to set in motion our mental
activity in a manner unknown to us and to
make the missing word reappear in consciousness,

" SUGGESTION " TREATMENT 217

while our thoughts, at the actual time, seemed
occupied with other subjects. Again, many
persons can wake at any time they desire and
find that, for this purpose, they need only fix
their attention on the hour determined for a
few moments before going to sleep. Similarly
we can produce profound modification in our-
selves by simply affirming what we desire. By
keeping a particular thought vividly in our
minds just at the moment of going to sleep,
once sleep has supervened this idea will continue
to develop and unfold itself without effort ; and
what is more, will often, thanks to the state of
mental concentration, do so with more logical
precision than would have been the case in the
waking state.

Why is the time before going to sleep so well
adapted for suggestion and auto-suggestion ?
Because we are then in a dark and silent room,
our eyes are shut to all visual impressions, the
muscles are relaxed, and our body is in comfort,
and we have dismissed all disturbing thoughts
from our mind. This is exactly what is done
in our treatment. The patient is installed
where nothing can distract his senses or excite
his mental faculties, his attention is completely
released and therefore able to be directed to
any idea upon which he is told or chooses to

218 NERVOUS DISORDERS OF MEN

concentrate; and experience has taught us that
under such conditions, the idea thus strength-
ened has its power of realisation greatly
increased.

It is not absolutely necessary to wait until
going to sleep for the exercise of auto-suggestion.
After a little practice, we are able to concentrate
for suggestion at any time and anywhere during
the day by just isolating ourselves for a moment,
and concentrating the mind on the suggestion.
The willing should not be intense, there should
not be any strain or struggling. It ought rather
to be like a quiet, firm desire, impressed clearly
and with conviction. The attention is focussed
upon it, and then the idea is dismissed ;
and, although conscious attention is diverted
from it, the idea realises itself unperceived.

As before mentioned, we are most susceptible
to psychic suggestion at the moment when we
are on the verge of sleep. A man who is ambi-
tious for himself will take advantage of the
opportunity this offers; and, when he goes to
sleep, will make sure that the thoughts
admitted into his mind are strong and healthy
thoughts — thoughts of joy, of success, and
accomplishment. This is not romance. It is
certain fact that a man can make suggestions
to himself at this time, and that there wil] be

"SUGGESTION" TREATMENT 219

a positive effect for good upon the spirit and
efficiency of his life. It will be seen that this
state is very similar to the one a devout person
is in when offering a prayer; and, like a genuine
prayer, a genuine resolution for reform, in the
subconscious state, strengthens the moral quali-
ties and increases the nervous energy that helps
the recovery from disease.

Now, in ordinary people, this power of sugges-
tion does not come of itself ; it must be educated.
If this auto-suggestion were so easy, the patient
would never have drifted so far as he has done.
He requires the assistance of a physician, who
has the right judgment of his psychic condition,
his individual qualities, constitution, temper,
disposition, and the mood he happens to be in
at the time, and who must possess, of course,
vast patience, abundant good nature, and tact.
Some physicians fail in trying to use this treat-
ment either because they are not trained for it,
or they cannot judge the suitability and sugges-
tibility of the patient for it, or give the proper
suggestions in the right manner. Others again,
when using psychotherapy, ignore the physical
needs of the organism, which should be first
attended to.

If the suggestionist is an expert, he will know
how to re-educate his patient by introducing

220 NERVOUS DISORDERS OF MEN

into the stream of mental life new and healthy
complexes, sound ambitions, and hopeful visions
of the future, which henceforth affect the whole
personality. The physician, having previously
searched the mind of the patient for the source
of his disorder in the course of listening to his
complete story, and having discovered the
mental attitude of the patient toward his ailment
and the false point of view which has resulted
in the neurosis, now sets forth the right way to
regain health and to effect a readjustment to
life. As already insisted on, a necessary condi-
tion is a thorough understanding of the indi-
vidual, his past life, his aims and desires, in a
word, the contents of his inner world. In
gaining this knowledge, we also learn his false
conceptions of his own state, which themselves
help to perpetuate his nervous state. One
further step is to remove these by substituting
for them correct ideas and by fixing them firmly
in the mind. Finally, we must take up his
special problems, his work, his domestic life,
his pains and aches, his obsessive ideas, his
special habits, in short, everything which enters
into the orbit of his existence.

The patient is taught how to concentrate,
how to focus on any given subject, and he is
now counselled to do the same throughout the

"SUGGESTION" TREATMENT 221

day : to focus his attention on whatever he has
in hand, whether it be matters of business or
pleasure. He is led to adopt new habits, to
gain new interests and enthusiasms in harmony
with his nature and possibilities, and to become
absorbed in them. He is told also that, when he
leaves the room, he is to use his powers of
observation ; to notice on his way home and
wherever he may go all objects that may
interest him, to be on the look-out for them, so
that he may have no opportunity for self-
introspection, and may not be disturbed by
any thoughts which are undesirable or un-
welcome to him.

After the suggestions, resolutions, and auto-
suggestions have been made, the patient is asked
to dismiss the whole subject from his mind and
to try to sleep naturally for a few minutes ; or,
at all events, to remain in a condition of repose
for a while before getting up.

This method has the advantage that nearly
everybody can be subjected to it. It is different
from that of hypnotism, since the person is not
sent to sleep and no suggestions need necessarily
be made by the operator, but by the patient
himself in accordance with his own ideas, and
he is increasing his own will-power. The usual
objection to hypnotism was that it deprived a

222 NERVOUS DISORDERS OF MEN

person of his will. In the suggestion treatment
there need be no such apprehension, for its whole
efficacy lies in the operator strengthening the
will of the patient. For example, in many of the
disorders we have mentioned, we have a lack of
control over the powers which constitute mind
and character. By suggestion treatment we
restore that control, and teach the patient
mental discipline. Our treatment is therefore
educational. Re-education is the most important
of the therapeutic processes. Such a patient
has learned how to help himself, and he need
not fear a relapse to his old condition.

The ailments in which psychotherapy is of the
most conspicuous value are those characterised
by pain, insomnia, abnormal nervous irritability,
nervous tremors and spasms, depression of
spirits, phobias, obsessions, moral obliquity,
perversions of all kinds, drink and drug habits.

Individuality is not destroyed nor weakened,
but often greatly strengthened by the treatment.
A subject who has lost his evil habits, in whom
better ideals have been introduced, has lost
nothing of force of individuality ; it has only
been improved and turned to better account.
Self-control has not been diminished, but, on
the contrary, the subject has been made able to
do the thing which in his best moments he de-

"SUGGESTION" TREATMENT 223

sired to do, but was not able to accomplish
unaided.

Patients who are addicted to perverse habits
which undermine their physical health and
destroy their mental energy are readily cured by
this method, the only condition is their willing
co-operation. Unfortunately a good many of
them do not want to be re-educated and to be
taught how to exercise self-control. What they
want is the performance of a miracle. They
know nothing of suggestion treatment ; but they
have heard of hypnotism, and see in it a cure
which requires no personal effort. They would
like to rely on the doctor rather than on them-
selves. Many a patient addicted to alcohol,
drug-taking, or other bad habit has come to me
hoping that I would merely look at him to
send him to sleep and he would wake up in a
few minutes or half an hour completely cured.
True, such miracles have been performed ; but
they are just rare enough to be miracles. Only
if the patient is willing to submit to the regular
process of treatment though it cost an effort on
his part, and only if he is perfectly sincere in his
desire, can he be cured.

If we can succeed in getting a patient into a
passive condition, we can give him suggestions
which attack the unnatural impressions of his

224 NERVOUS DISORDERS OF MEN

subconscious mind, we can teach him to look with
disgust on his former violations of nature, and
to find pleasure in natural and healthy modes
of life. We try to improve his character by
suggestions of self-restraint, which will remain
operative whenever temptation occurs. He carries
out the instructions which we have given him
because they are in accord with his altered
subconseiousness, and so he passes on to a new
and happy life — not only relieved but cured of
the habits which bred disease. Surely to turn
the wavering, the despondent, the drug-seeking,
into the buoyant, the energetic, the independent,
to snatch from the gloomy toils of melancholy,
or from the bondage of alcohol, men and women
who have many years of life before them, and
to render those years active and happy to the
individual and of benefit to the community ; to
do this, surely, is to perform a task of which any
physician may well be proud, and which is
worthy of more recognition than the physician
generally receives.

In conclusion, let me repeat the directions for
auto-suggestion :—

1. The patient must practise first of all to
get his mind into a state of peacefulness and
calmness. Let him seek a quiet room where he
is undisturbed, and let him take up a position

"SUGGESTION" TREATMENT 225

of ease, or lie comfortably on a couch, with all
the muscles relaxed. Then let him breathe deeply
and regularly, but without an effort. If thoughts
run through his brain he is not to try to resist
or control them, but just to give way to them.
He is not to worry about them, but to surrender
himself to them, as if he did not care. Eesistance
only increases the nervous tension. Non-
resistance will soon put him at ease.

2. Having succeeded so far, the next time he is
in that state of calmness let him try to think of
something pleasant, something that delights him
to contemplate, allowing his imagination free
play. In this manner, he will gradually acquire
the power of focussing on an idea, and of ignoring
his external surroundings and internal sensa-
tions.

3. After being able to produce this condition
successfully, he may in this state of calmness
focus on something he wishes to achieve ; for
example, to be able to sleep, to have freedom
from bodily pain and discomfort, to become
self-possessed or cheerful, or to be able to work
hard without feeling weary, and to subdue
irritability and the habit of worrying. He must
be serious with his suggestion. His conviction
must be in it, but there should be no strain, no
tension, no struggling. It ought rather to be

Q

226 NERVOUS DISORDERS OF MEN

like a quiet, firm desire. Having expressed his
desire or resolution deliberately, he must dismiss
the subject and turn his thoughts again to his
work or whatever he has in hand, or simply rest
peacefully for a few minutes.

For example, in order to obtain sleep let the
patient get first of all into a condition of repose,
as already described, without tension of either
muscles or mind, and with no conscious effort ;
then let him concentrate on the idea of sleep,
repeating to himself : "I shall sleep within a
few minutes soundly and uninterruptedly, and
undisturbed by any discomfort or pain, and I
shall wake at eight o'clock in the morning feeling
perfectly refreshed and cheerful." Having made
his suggestion with confidence in its success, let
him think no more about it, but remain per-
fectly at ease; and if sleep does not come at
once he must not be disappointed, but should
think of something pleasant, allowing his imagi-
nation free play. If positive thoughts, such as
" I shall sleep," prove unsuccessful, let him try
negative thoughts, such as : " I shall not be able
to keep awake." He may think of something
else then, or try to read a book ; and he will soon
find that he is getting drowsy and will fall
asleep.

CHAPTER XV

EXAMPLES OF "SUGGESTION" TREATMENT

THE difficulties the psychotherapist has to
contend with are many. The first and most
important condition for his success is that the
patient has faith in him. But how is this
possible when the patients are sent to him — not
infrequently — only after all other methods have
failed, and their belief in doctors in general has
been considerably shaken and their resources
have been strained ? The psychotherapist is
then expected — by some, at all events — to
succeed at a single interview ; and if he fails,
the whole method of psychotherapy is con-
demned.

There is much ignorance, too, as to the kind
of cases that would be benefited by such treat-
ment ; and the mistake is frequently made, more
by patients than by doctors, of regarding the
various methods of psychotherapy as an exclu-
sive system of treating functional disease, as if
it were the sovereign remedy for all nervous

227

228 NERVOUS DISORDERS OF MEN

disorders. I do not suggest that every case of
nervous disorder should receive this form of
treatment, nor do I wish it to appear that every
case treated by suggestion is always cured. But
considering the supposed wonders of the various
cults of faith healing, I want to show that psy-
chical treatment can be carried out by a qualified
physician in a legitimate and scientific manner
with absolute success and freedom from danger.
Another obstacle is that we are sometimes
forbidden to give any medicine, or use any other
measure whatsoever, to improve the constitution
of the patient. Yet it must be obvious,
that, while the patient is in an exhausted state
and his nerves are irritable and react too quickly,
we cannot secure that placidity of mind which
is so necessary for our treatment. Medical
psychotherapists, unlike other mental healers,
do not rely on psychical influence alone, but em-
ploy other measures as well ; for even where
it is simply a question of curing a patient's
" bad habits," his physique is likely to have
suffered, and we have to restore not merely the
mental condition, but the health of the organi-
sation with which mind is connected and upon
the normal state of which its soundness depends.
It is the duty of the physician, when called
upon to treat a patient, to carry out not one,

EXAMPLES 229

but all of the measures which have been shown
by years of experience to be advantageous.
Medicinal, hygienic, dietetic, physical and moral
measures, have all to be employed according to
the individuality of the patient and the nature
of his complaint. We must not, as Christian
Scientists and other cults do, relegate tried
methods to the dust-heap, but recognise that,
even if there be no actual disease of the body,
the patient, owing to his habitual indulgence
of morbid thoughts or habits, has weakened his
constitution, and may suffer from a state of
nervous exhaustion or irritability, which require
treatment on established lines. Psychical treat-
ment alone, and physical measures alone, are
insufficient ; the two must be combined, and
for the proper application of both, medical as
well as psychological knowledge is essential.
The patient who has been treated by psycho-
therapy alone is likely to have a relapse, because
the constitutional condition which has given
rise to the complaint has not been attended to.
The patient who has received constitutional
treatment only, whether by medicine or any
other physical measure, may still be subject to
his morbid thoughts, because no attempt has
been made to cure him of his unhealthy mental
habits.

230 NERVOUS DISORDERS OF MEN

The following are examples of the treatment
of nervous disorders by psychotherapy :—

Case of Nervous Exhaustion with Imperative
Ideas and Loss of Will-Power :—

Successful merchant, aged thirty-six, of splendid
physique, explained that he was afraid of going
to a theatre or any public hall for fear that he
would shout " Fire," and that he had to force
his handkerchief in his mouth to prevent himself
from doing so. At the same time, he suffered
from complete indecision, could not make up
his mind to do anything ; and if it was made up
for him, he was sure to stop in the middle of any
action he commenced. For example, his business
necessitated his travelling from London to
Glasgow, and he delayed for days before he
could make up his mind to do so, and ultimately,
when he did start, he got out at Carlisle to return
home. Letters which had been written after
many efforts were repeatedly destroyed, and
finally, if they were fortunate enough to reach
the letter-box, he was anxious to reclaim them
from the post. Education of the will by means
of suggestion, assisted by some physical measures
to influence the source of his affection, restored
the patient in a few weeks.

EXAMPLES 231

Case of Nervous Exhaustion with Insomnia : —
Patient, a professional man, forty-eight years
of age, had to do unusual hard work and to
undergo considerable anxiety. The first symp-
tom which he noticed was sleeplessness, which
gradually got worse. He either did not go to
sleep at all on getting into bed, or, if he dropped
asleep from utter weariness, he woke up again
in about half an hour and lay restless during
the remainder of the night. Besides this, he
complained of a feeling of great exhaustion, total
disinclination to work, and to bodily exercise
of any kind, of weakness in the back and pain at
the nape of the neck. He was easily excited and
worried by little things, and extremely intolerant
of noise or of being asked any questions. He
was often troubled with a sense of vague alarm
and distressing sensations in the head. He
disliked his meals and generally suffered from
flatulence. The patient was treated with the
application of the constant current to the spine
and head, and psychotherapeutic influences were
brought to bear during the treatment. He almost
immediately began to sleep well ; and after two
weeks the patient felt like another man, being
able to exert himself both mentally and bodily,
to enjoy his meals, and to take an interest in the
concerns of daily life.

232 NERVOUS DISORDERS OF MEN

Case of Nervous Exhaustion with Headache,
Giddiness, and Impaired Memory : —

A lawyer, aged thirty-eight, had experienced
considerable domestic anxiety, to which he
attributed his illness. He complained of a
sensation of weight and pressure at the top of
the head and in the temples, and of giddiness.
He felt a swimming sensation and " unsteadi-
ness " in the head, especially on assuming the
erect posture, which caused him sometimes to
be uncertain and swaying in his walk. His
memory and power of application were very
much impaired. He was irritable to slight
noises, easily excited, and on examination his
reflexes were found exaggerated. Galvanism
was applied to the spine and head with satis-
factory results. The mental symptoms gradu-
ally yielded to " suggestion," and three weeks
after the commencement of the treatment the
patient was able to resume his work in excellent
health.

Case of Nervous Exhaustion with Lack of Con-
centration, Application, and Loss of Memory :—

Patient, a captain in the army, aged thirty-
three, was ordered home on leave from his
Indian station, being unfit for work. Could not
remember any orders, nor solve the simplest

EXAMPLES 233

problem of tactics. " His mind was a blank,"
and " he felt weak all over," he said. Although
he had already had ten months' rest, and was
treated during that time, he had made no improve-
ment. His last doctor sent him to me for treat-
ment by suggestion. After ten days' treatment,
patient was able to start work with a military
coach, and in a month's time he left perfectly
cured.

Case of Agoraphobia :—

A man, thirty years of age, found himself
mixed up in an affair which gave him a great
fright. Thereafter, although he had preserved
his perfect lucidity of mind and directed his
business as well as ever, he could not remain
alone, either in the street or in a room and needed
to be accompanied everywhere. If he did go
out alone, which very rarely occurred, he found
himself seized with a sense of anguish at the
sight of a public square or of an open space of
any considerable extent. If he had to cross one
of the squares, he had the feeling that the distance
was one of several miles and that he would
never be able to reach the other side. This
emotion diminished or disappeared if he went
around the square following the houses, or if he
was accompanied. A medicinal sedative and

234 NERVOUS DISORDERS OF MEN

regular suggestion treatment put him right in
a few weeks, and there was no recurrence of his
complaint.

Case of Chronic Headache : —

Patient, forty-five years old, had repeated
attacks of headache, one or two per week, during
which he grew pale, and after a few minutes of
agonising pain, in which he distorted his face
and rolled his eyes, he appeared almost un-
conscious. He then revived, shaking all over.
At the first two sittings, only sleep was suggested.
On the third day, being fairly somnolent, a mild
galvanic current was applied to the head, while
explanatory suggestions were made as to the
beneficial effect of electricity. On the fifth day,
patient acknowledged the soothing effect of the
current and went to sleep after the operation.
On the seventh day he had completely recovered,
and there was no return of his complaint, as
shown by a report a month later.

Case of Hypersensibility :—

Gentleman, thirty-five years of age, after
various financial and family troubles, had a
nervous breakdown, and was treated by different
physicians for a considerable period, and al-
though better, was left with hypersensibility of

EXAMPLES 235

nerves. The closing of doors in his house, the
twittering of birds in his garden, the jarring of
glasses carried on a tray, the dropping of even
a light article, creaking boots, etc., all noises,
however slight, whether real or anticipated,
caused him intense agony and awful irritability.
Patient submitted to treatment by suggestion.
He retained full consciousness during my
presence, but fell asleep afterwards, at first for
a few minutes, then for a quarter, half, and a
whole hour, waking up calm and composed.
He noticed noises less and less, and after a
fortnight he was able to resume his former
occupations and pursuits.

Case of Noises in the Head and Hearing of
Voices : —

Patient, a major in the army, forty years of
age, suffered from insomnia, buzzing in the left
ear, and the hearing of voices, which tortured
him so much that he was afraid of going mad.
No hereditary disposition nor previous illness.
On examination it was found the power of hearing
was not diminished and was equal on both sides.
His ears had been previously examined by an
aurist, who could discover no disease. At first
he heard voices, conveying words of insult, at
night only, thus preventing his sleeping. He

236 NERVOUS DISORDERS OF MEN

suspected a neighbour of this and challenged
him, but that gentleman proved that on those
nights he had been away from home. Then he
suspected others and got equally satisfactory
explanations. He then recognised that these
voices must be hallucinations ; but they became
more and more distinct, and he began to hear
them during the day and in the street. Then
arose impulses to attack strangers, which he
controlled only with difficulty. The voices
always conveyed the same insults, quite close
to him, and they were most distinct when he
stopped his right ear up. Patient was convinced
that he was suffering from hallucinations of
hearing, yet he was full of anxiety lest he might
give way to homicidal impulse. He was put in
a state of somnolence, and suggestions were
made to give him greater control over himself,
minimising the significance of the hallucinations
and lessening the distinctness of the voices. At the
same time a mild galvanic current was applied to
the left ear. This process was repeated for four
weeks. All hallucinations had disappeared by
then and the patient was able to resume his duties.

Case of Nervous Exhaustion with Impotence :—
Patient, aged forty-eight, journalist by pro-
fession, married for about a year, in conse-

EXAMPLES 237

quence of overwork and anxiety got into a state of
complete nervous derangement. He was utterly
incapable of any mental or bodily exertion and
had lost all virile power, which distressed him
greatly. Horrible thoughts came into his head
which rendered his life perfectly intolerable.
His judgment and intellect were not impaired,
but he had not the slightest control over the
dreadful ideas which constantly flitted across
his brain and made work absolutely impossible.
One day he attempted suicide, but was saved
by his wife, who brought him to me. I used
suggestion treatment during the first week, and
made the patient understand that there was
nothing to worry about, that his want of virile
power was entirely due to his nervous exhaus-
tion and would return when his nervous system
improved. The second week I applied galvanism
to the spine daily, not neglecting at the same
time to teach the patient the importance of
mental discipline and the value of concentra-
tion. At the end of the second week patient had
lost all his disagreeable thoughts, was cheerful
in conversation, and at the end of the third week
he returned to work feeling perfectly fit.

Case of Nervous Exhaustion complicated by
Dyspepsia : —

Patient, a merchant, forty years of age, as a

238 NERVOUS DISORDERS OF MEN

result of overwork and anxiety had developed a
neurasthenic condition, become somewhat hypo-
chondriacal, and complained of severe dyspepsia.
He consulted various specialists for gastric dis-
orders, and their examination of the gastric
juice, lavage of the stomach, and regulations as
to diet had impressed still more strongly upon
the mind of the patient the idea of a true
stomachic affection. When I examined the
patient, I certainly found distension due to
flatulence ; but the indigestion was mental in
origin, and due in great measure to the fanciful
diet the patient had indulged in since the com-
mencement of his illness, and to his peculiar no-
tions and antipathies . I ordered galvanic treatment
to the stomach and, at the same time, began to
influence his prejudices. The treatment was by
no means easy ; but after a few visits, the patient's
common sense gained the upper hand, and from
that time he made a rapid recovery.

Case of Loss of Power and Shooting Pains in
Legs after motor-car accident : —

Patient, aged thirty-three, of nervous dis-
position, was in a motor-car accident two years
before, from which he escaped with a shaking.
He complained of a loss of power in his legs.

EXAMPLES 239

and after a few days of severe shooting pains,
he consulted a physician, who declared his
affection to be of a functional nature. After
taking some medicines and not getting better,
he was recommended to try psychotherapeutics.
I proposed combining galvanic treatment to the
spine and lower limbs with " suggestion " treat-
ment. He soon got better, gained power, and
lost the painful sensations.

Case of Functional Paralysis of Left Arm :—

Talented young man, twenty-three years of
age, after strenuous work at teaching and some
early worry over his personal prospects, felt a
sudden loss of power and sensation in his left
arm and left leg. The lower limb recovered, but
the arm remained powerless by his side. When
lifted to the shoulder, it dropped heavily to the
side. Sensation had returned. The doctor
to the college and a specialist diagnosed func-
tional paralysis ; but no improvement resulting
from their treatment, they recommended " sug-
gestion " to be used. Success was achieved at
the fourth sitting. The patient was then able
to lift his left arm and to resist any attempts to
pull it to his side. He preserved absolute
control over his limb afterwards.

240 NERVOUS DISORDERS OF MEN

Case of Stammering : —

Solicitor, aged thirty-five, consulted me for
general nervousness, self-consciousness, and
stammering, which did not affect him always,
but chiefly in the presence of clients, and actually
interfered very much with his professional
success. " I believe," he said, " that if I could
only be relieved of the consciousness that I had
ever stammered, I should stammer no longer."
Patient had to attend a board-meeting of
directors of a company that afternoon ; so I used
suggestion at once that he would not trouble
at all about the events this afternoon, would
forget that he ever was nervous and self-con-
scious, that he would now be self-reliant, and
would speak on this occasion without any
involuntary break in his voice and without any
hesitation whatever. Patient was not quite so
successful, but he acknowledged he got over the
ordeal much better than he would have done if
he had not come to me. Suggestions were then
continued and his general nervousness was
attended to ; with the result that he got over his
speech defect completely.

Case of Hystero-Epilepsy :—
Patient, a clerk, eighteen years old, had the
first attack when ten years old, and the attacks

EXAMPLES 241

had recurred about twice a week si ce. It
was believed that he lost consciousness in these
attacks, in which he fell to the ground, made
irregular movements with his arms and legs and
twitched his face ; it was noticed, however, he
had never bitten his tongue nor injured himself
in any way, nor did he sleep after the attack,
as is the rule with genuine epileptics. He had
been better for some two years, but relapsed six
months later after a fright. My own observa-
tion : " Patient previous to attack gets very
irritable, breathes heavily, gets into c dreamy
states/ talks indistinctly, falls with his eyes
wide open, with twitching of his limbs and face ;
and after five minutes he appears exhausted,
breathes again more quickly, and gets up in
another two minutes as from a dream, wondering
what has happened." I tried hypnotism in this
case and succeeded immediately. At the first
three sittings, patient was allowed to remain in
deep sleep for an hour, without any suggestions
being made, except that he, on waking up, would
feel well and strong. On the fourth day, he was
told a minute after the commencement of the
sleep that he would wake up, open his eyes,
know his surroundings, but would remain under
my influence. He was questioned then about
his attacks, and impressed with the desire to

242 NERVOUS DISORDERS OF MEN

control his premonitory symptoms of compres-
sion of the chest and irritability. He was shown
how to breathe deeply, make his limbs rigid,
including the arms and fingers, to put his feet
firmly on the ground, and to " determine " not
to have an attack. After some tests that he was
really still under control, he was told to forget
that it was I who had given him these instruc-
tions, but that he himself, when premonitory
signs appeared, would get into these attitudes
as if they originated with him, and feel quite
determined and confident that he would defeat
the attack. The sittings were continued for a
fortnight on alternate days and then one a week
for a month. Patient had no more attacks, and
the premonitory symptoms occurred only twice
during the first week and once the succeeding
week ; after that they ceased. He reported
himself as having kept well two years later.

Case of Mental Torpor, Fugitive Pains, and
Palpitation from excessive cigarette smoking :—

Young man, aged twenty-eight, who became
conscious of the injurious effect cigarette smoking
had on him, and who had persistently tried to
break off the habit, but failed, came to seek my
aid. He told me he smoked incessantly from
early morning till night, and that he could not

EXAMPLES 243

do his work as well as formerly, being disturbed
by pains and palpitation and a confused head.
I got him into a somnolent state, in which I told
him that he would control his inclination, that
he would reduce the number of cigarettes he
smoked to ten that day, and that he would wake
up with a feeling of encouragement and deter-
mination that this time he would succeed in
breaking his habit. On the following visit I
reduced the number to five cigarettes, and ex-
plained to the patient that the reduction would
already have the effect of clearing his head,
getting the heart more regular, and restoring
his health in general. By the end of the week
he had left off smoking altogether, and he re-
ported some weeks after that he had not felt
the slightest inclination to smoke any more.

Case of Drink Habit : —

A curate, thirty-two years of age, suffering
from exhaustion and insomnia owing to pro-
longed overwork, took to secret drinking, but
was after a time found out and lost his position.
This blow weakened his self-control still more,
when his relatives interested themselves, and
after trying various homes for him brought him
to me for " suggestion " treatment. I ordered
a companion for him at once, prescribed a

244 NERVOUS DISORDERS OF MEN

medicinal sedative, and stopped all alcohol.
Then I tried to induce the hypnotic state, but
though I got no further than mere somnolence,
I reasoned with him, explained to him that he
would feel no ill-effects from having abstained,
that he would feel perfectly content all day and
sleep well at night, and that this improved
condition without drinks would have the effect
of convincing him that he could do without them,
and would make him resolve earnestly never to
touch alcohol again, not even under the pressure
of unhappiness. The suggestions were repeated
daily at first and then at prolonged intervals.
Gradually he was allowed money of his own and
to go out without his companion. After two
months, the companion was discharged. The
patient, who went to reside with a sister of his,
still reported himself every few weeks for about
a year. Then I used my influence with a clerical
friend who takes a great interest in the reform
of inebriates to give him another chance, and I
have recently heard that he is doing well at his
work and has had no relapse.

Case of Morpliio-Mania : —

In this case morphia injections were ordered
for severe pains in the leg after an accident in
South Africa, and the doctor allowed the patient

EXAMPLES 245

to go on with them when he wanted to return to
England. Patient gradually got addicted to
morphia, was in agony or at least could do no
work without it. The plan on which I practised
suggestion in this case was as follows : I ascer-
tained that the strongest character-trait of the
patient was his strong love for his son. By pre-
senting to him a mental picture of his own
degradation before his son, and the disgust the
boy must feel at the sight of his depraved father,
and by impressing him with the possibility of
his premature death, and thus of not being able
to direct the education of his son, nor see him
grow up, and by other similar suggestions, the
patient's reason and will-power grew strong
enough to enable him to cease his pernicious
habit, and it has not recurred again.

R2

INDEX

Abnormal Impulses, 60, 236

— Perspiration, 102

— Pulse, 96

Absent-mindedness, 27, 30
Accidents and Nervous Dis-
orders, 19

Agoraphobia, 45, 46, 47, 233
Alcohol, Effects of, 77, 140-161
Alcoholism, 18, 140, 149-153,
161

— Treatment of, 154-157, 225,

243

Angina Pectoris, 101
Anxiety, Abnormal, 14, 17, 30,

32, 35, 58, 95, 97, 165
Appetite, 25, 81, 89
Application, Lack of, 24, 27, 232
Apprehensiveness, 30, 35, 58
Asthma, 105

Attention, Weakness of, 27, 35
Auto-suggestion, 209, 211, 216,

219, 224-226

Backache, 112

Baths and Bathing, 177

Blushing, Fear of, 45

— Morbid, 102

— Treatment of, 104
Brain Forcing, Evils of, 29

— Increased complexity of, 4
Breathing Exercise, 211, 226

Cancer, Fear of, 57
Case of Agoraphobia, 233

Cigarette Habit, 242

Drink Habit, 243

Case of Drug Habit, 244

Fear of being left alone,

233

Fire, 230

Open Spaces, 233

Fixed Ideas, 230

Functional Paralysis, 239

Giddiness, 232

Headache, 232, 234

Hypersensitiveness, 234

Hypochondriasis, 237

Hystero-Epilepsy, 241

Imperative Ideas, 230

Insomnia, 231

Lack of Application, 232

Concentration, 232

Will Power, 230

Loss of Memory, 232

Mental Control, 235

Mental Energy, 232,

235, 245
Muscular Control,

240
Muscular Energy,

238

Mental Irritability, 235

Morbid Impulses, 236

Morphia Habit, 244

Nervous Dyspepsia, 237

i Nervous Exhaustion, 230,

231, 232, 233, 236, 237, 238

Noises in the Head, 235

Pains, 238, 242

Palpitation, 242

Sensitiveness to Noises,

235
Sexual Impotence, 236

246

INDEX

247

Case of Shooting Pains, 238

Sleeplessness, 231

Stammering, 240

Writers' Cramp, 127

Causes of Nervous Disorders,
1-23

Change of Life in Man, 19, 162-
170

Surroundings, 20, 64, 75,

85, 92, 171

Cigarette Habit, 97, 242

Circulation, Nervous Disorders
of, 15, 101-104, 108, 109

Civilisation and Nervous Dis-
orders, 2, 64

Claustrophobia, 45, 46, 47

Climacterium, Male, 19, 162-170

Concentration Exercise, 211, 214,
220

— Lack of, 232
Conduct, Disordered, 135
Confusion of Thought, 27, 103,

134

Constipation, 94
Contamination, Fear of, 45

Depression, Mental, 22, 26, 37,
54, 56, 81, 131-133, 165

— Treatment of, 39
Diagnosis, Importance of, 200
Diet, 58, 65, 74, 82, 83, 85, 87, 89,

168

Digestion, 80-94
Disease, Fear of, 45, 53, 57
Disordered Conduct, 135
Doubts, Mental, 31, 32
Dreams, 63, 68
Drink Habit, 18, 140, 149-153,

161
Treatment of, 154-157,

223, 243

Drowsiness, 63, 84
Drug Habit, 18, 157-161, 223,

244

— Treatment, 70, 75, 87, 92, 94,

98, 106, 110, 184-187,
228
Dyspepsia, Nervous, 80-94, 97

— Treatment of, 87-93, 237

Education and Nervous Dis-
orders, 3, 5, 7, 9

Electrical Treatment, 78, 111,
115, 127, 167, 187, 190, 231,
232, 233, 234, 236, 237, 238,
239

Emotions, Uncontrolled, 7, 14

Epilepsy, 128

Exaggeration of Trifles, 34, 38,
201

Exaltation, Mental, 133-139

Exercise, Muscular, 76, 99, 168,
179-183

Exhausting Diseases and Ner-
vous Disorders, 21

Fainting, Fear of, 48

Falling, Fear of, 46

Fatigue, 9, 10, 24-41, 56, 83, 91,

113, 120, 124, 163, 166
Fear of being left alone, 46, 233

Blushing, 45, 102

Contamination, 45

Dangerous Places, 45

Disease, 45, 53, 57

Enclosed Places, 45, 46, 47

Faulting, 48

Falling, 46

Fire, 47, 230

High Places, 46, 49

Insanity, 55

Knives, 49, 52

Open Places, 45, 46, 47,

233

Sleeplessness, 45, 67, 70

Stealing, 51

Suicide, 49, 62

Tremors, 123

Uncleanliness, 45

Water, 49

Fears, Morbid, 44-60, 165

— Treatment of Morbid, 59

Fidgetiness, 34, 66, 68, 120

Fire, Fear of, 47, 230

Fixed Ideas, 42-60, 70, 204, 230

Flushings, 102

Forgetfulness, 29, 151, 159, 165,

206, 232

248 NERVOUS DISORDERS OF MEN

Fright, 19

Functional Paralysis, Case of,
239

Giddiness, 100, 109, 110, 232
Gymnastics, 180

Head, Noises in, 111, 235
Headache, 106-111, 166

— Treatment of, 110, 232, 234
Heart Disease, Fear of, 57

— Nervous Disorders of, 95-101
Heredity of Nervous Disposition,

8
Hobbies, Necessity of, 7, 17, 59,

170

Holidays, 173
Hopefulness, Importance of, 134,

136, 204.. 205. 214, 220
Hygienic Physical Measures,

171-190, 229
Hypersensitiveness, 64, 103, 112-

119, 133, 234

Hypnotism, 155, 221, 241, 244
Hypochondriasis, 18, 53, 166,

237
Hystero-epilepsy, 130, 240

Ideas, Fixed, 42-60, 70, 204,

230

Ill-temper, 33, 54, 85, 113, 153
Impotence, 167, 236
Impulses, Abnormal, 50, 236
Inactivity, Mental, 9, 20
Indecision, 24, 29, 31, 34, 35,

152, 201, 230
Indigestion, 80-94, 97

— Treatment of, 87-93, 237
Insanity, Diagnosis of, 55

— Fear of, 55

Insomnia, 45, 60-79, 138, 165

— Treatment of, 65-79, 207,

2 6, 231

Instability, Mental, 131-139
Instinct of self-preservation, 46
Intellectual Work and Nervous

Disorders, 5, 10
Introspection, 7, 17, 25, 102, 204

! Irritability, 33, 54, 85, 113, 153,

235
Isolation Treatment, 172

Kleptomania, 51
Knives, Fear of, 49, 52

Lack of Application, 24, 27, 232

Attention, 27, 35

Concentration, 232

Loss of Self-confidence, 8, 36,

102, 126, 164, 214
Memory, 29, 151, 159, 165,

206, 232
Mental Control, 27, 42-60,

235
Mental Energy, 24-41, 206,

232, 235, 245

Moral Control, 152, 159

Muscular Control, 120-130,

240
Muscular Energy, 148, 153,

238
Will-power, 24, 29, 31, 34,

35, 152, 201, 230

Male Climacterium, 19, 162-170
Medicinal Treatment, 70, 75, 87,

92, 94, 98, 106, 110, 184-

187, 228
Melancholia, 37
Memory, Loss of, 29, 151, 159,

165, 206, 232
Mental Changes in " Change of

Life," 165

Chronic Alcoholism, 151

Morphinism, 158

— Conflict and Nervous Dis-

orders, 14

— Confusion, 27, 103, 134

— Control, Loss of, 27, 42-60,

235

— Depression, 22, 26, 37, 54, 56,

81, 131-133, 165

— Discipline, 59, 203

— Disorders, Statistics of In-

crease in, 1

INDEX

249

Mental Doubts, 31, 32

— Energy, Loss of, 24-41, 206,

232, 235, 245

— Exaltation, 133-139

— Fatigue, 9, 10, 24, 25, 56

— Inactivity and Nervous Dis-

orders, 9, 20

— Instability, 131-139

— Irresolution, 24, 29, 31, 34,

152, 201, 230

— Irritability, 33, 54, 85, 113,

153, 235

— Symptoms of Nervous Ex-

haustion, 24-60
Migraine, 110
Monotony of Life and Nervous

Disorders, 20
Moods of Man, 131
Moral Control, Loss of, 152, 159
Morbid Anxiety, 14, 17, 30, 32,

35, 58, 95, 97, 165

— Blushing, 45, 102

— Fears, 44-60, 165, 230, 233

— Impulses, 50, 236
Morphia Habit, 18, 157, 223, 244
Muscular Control, Loss of, 120-

130, 240

— Energy, Loss of, 148, 153, 238

— Exercise, 76, 99, 168, 179-183

— Relaxation, 211, 225

— Restlessness, 34, 66, 68, 114,

120

— Spasms, 120-130

- Weakness, 148, 153, 238
Mysophobia, 45

Nervous Disorders, Causes of,

1-23
Electrical Treatment of,78,

111, 115, 127, 167, 187-190,

231, 232, 233, 234, 236, 237,

238, 239
General Treatment of, 171-

190

Increase in, 1

Medicinal Treatment of, 70,

75, 87, 92 94, 98, 106, 110,

184-187, 228

Nervous Disorders, Psycho-
therapy of, 191-245

caused by Accidents, 19

Alcoholism, 18, 149-

153

Anxiety, 14, 17, 30

32, 35, 58, 95, 97, 165

Civilisation, 2, 64

Increased Complexity

of Brain, 4

Disorders of Circu-
lation, 15

Drink Habit, 18, 149-

153

Drug Habit, 18, 157,

244

Education, 3, 8

Exhausting Diseases,

21

Inactivity, 9, 20

Indigestion, 21

Intellectual Work, 5,

10

Mental Conflict, 14

Monotony of Life, 20

Overwork, 8, 12, 83

Sexual Disorders, 18

Shock, 19

Social Causes, 2, 4, 6

Stimulants, 18

Toxins, 21, 70, 109

Uncontrolled Emo-
tions, 7, 14

Unhealthy Mental

States, 22

Unhealthy Occupa-
tions, 21

Unhealthy Surround-
ings, 21

Worry, 11-17

of Circulation, 15, 101-104,

108, 109

Digestion, 80-94

Heart, 95-101

Respiration, 105

Sexual Function, 18, 57,

166, 167, 230

— Dyspepsia, 80-94, 237

— Energy, Reserve of, 38

250 NERVOUS DISORDERS OF MEN

Nervous Exhaustion, 10, 13, 15,
21,22 24-60,230,231,232,
233, 236, 237, 238

— Temperament, 7

— Tendency, General, 6
and Heredity, 8

— Tics, 123

— Tremors, 122
Neuralgia, 115
Neurasthenia, 21
Nightmares, 63

Noises, Sensitiveness to, 64, 113,
114, 235

— in the Head, 111,235

Obesity, 168
Obsessions, 42-60, 70

— Treatment of, 49, 204, 230
Occupation Neuroses, 126

— Treatment, 170
Occupations, Unhealthy, 21
Optimism, 134, 136, 204, 205,

214,220

Over-eating and Indigestion, 83
Overwork and Nervous Dis-
orders, 8, 12, 83

Pains and their Treatment, 106-
119, 207, 214, 225, 238, 242
Palpitation, 96, 103, 242
Paralysis, Functional, 239
Patient and Physician, 196
Persistent Ideas, 42-60, 70, 204,

230

Persuasion Treatment, 209
Perverse Habits, Treatment of,

216, 223, 228

Pessimism, 38, 39, 131, 205
Petit Mai, 128

Phobias, 44-60, 165, 230, 233
Physical Measures, 171-190, 229
Physician and Patient, 196
Pianoforte Players' Cramp, 127
Psychasthenia, 22
Psycho-analysis, 201, 208
Psycho-neurosis, 23
Psychotherapy, 191-245
Pulse, Abnormal, 96

Questioning Mania, 33

Recreation and Nervous Dis-
orders, 9

Re-education, Psychotherapy by,
209, 219, 222

Relaxation, Muscular, 211, 225

Reserve Nervous Energy, 38

Respiration, Nervous Disorders
of, 105

Rest Cure, 171

Restlessness, 34, 66, 68, 120

Sciatica, 115

Sea-air, 175

Sea-bathing, 178

Sea- voyage, 174

Sedatives and Tonics, 186

Self-confidence, Lack of, 8, 36,
102, 126, 164, 214

Self-consciousness, 17, 36, 103,
124

Self-control, 113, 214, 222

Self-preservation, Instinct of, 46

Semi-Insane, 131-139

Sensibility to Noises, 64, 113,
114, 235

Sexual Function, Nervous Dis-
orders of, 18, 57, 166, 167,
236

Shock, 19

Shooting Pains, 238

Shyness, 36, 97, 125

Sleep, 60-79, 169

Sleeplessness, 45, 60-79, 138, 165

— Treatment of, 65-79, 207, 226,
231

Smoking, Effect of, 97, 242

Social Causes of Nervous Dis-
orders, 2, 4, 6

Solitude, Fear of, 46, 233

Spasms, Muscular, 120-130

Stammering, 102, 125, 240

Stealing, Fear of, 51

Stimulants causing Nervous Dis-
orders, 18

Stuttering, 125

Suggestion in daily life, 191

INDEX

251

Suggestion Treatment, 78, 93,
112, 130, 155, 161, 191-245

Suicide, Fear of, 49, 52

Surroundings, Change of, 20, 64,
75, 85, 92, 171

Tics, 123

Timidity, 36, 97, 125

Tired Feeling, 9, 10, 24, 25, 56,

163, 166

Tobacco Intoxication, 97, 242
Tonics and Sedatives, 186
Toxins and Nervous Disorders,

21, 70, 109

Travelling, Effects of, 173
Treatment by Drugs, 70, 75, 87,

92, 94, 98, 106, 110, 184-

187, 228
Electricity, 78, 111, 115,

127, 167, 187-190, 231, 232,

233, 234, 236, 237, 238, 239

Hypnotism, 155, 221

Persuasion, 209

Physical Measures, 171-

190, 229

Psycho-analysis, 201, 208

Re-education, 209, 219,

222
Suggestion, 78, 93, 112,

130, 155, 161, 191-245
— of Alcoholism, 154-157, 223,

243

Angina Pectoris, 101

Asthma, 105

Blushing, 104

"Change of Life" Dis-
orders, 167

Cigarette Habit, 242

Constipation, 94

Depression, 39

Drink Habit, 154-157, 223,

243

Drug Habit, 160, 223, 244

Dyspepsia, 87-93, 237

Epilepsy, 129

Fixed Ideas, 49, 204, 230

Headache, 110, 232, 234

Heart Disorders, 98

Treatment of Hypersensitive-
ness, 116-119, 234

Hystero-epilepsy, 240

Indecision, 32, 222, 230

Indigestion, 87-93, 237

Inebriety, 154-157, 223,

243
Insomnia, 65-79, 207, 226,

231

Lack of Application, 232

Concentration, 232

Will-power, 32, 222,

230

Loss of Memory, 232

Mental Control, 214,

222, 235
Mental Energy, 41,

232, 235, 245
Muscular Control,

122, 240
Muscular Energy,

187, 238

Mental Depression, 39

Instability, 139

Irresolution, 32, 222,

230

Irritability, 235

Morbid Blushing, 104

Fears, 59, 233

Morphia Habit, 160, 223,

244

Muscular Restlessness, 122

Weakness, 187, 238

Nervous Disorders, General

171-190
Exhaustion, 41, 230,

231, 232, 233, 236, 237, 238

Tics, 124

Neuralgia, 115

Noises in the Head, 112,

235

Obsessions, 49, 204, 233

Pains, 116-119, 207, 214,

225, 238, 242
Perverse Habits, 216, 223,

228

Respiratory Disorders, 105

Sensitiveness to Noises,

235

252 NERVOUS DISORDERS OF MEN

Treatment of Sexual Impotence,

236
Sleeplessness, 65-79, 207,

226, 231

Stammering, 125, 240

Worry, 16, 94, 202, 225

Writers' Cramp, 127

Tremors, Nervous, 123
Trifles, Exaggeration of, 34, 38,

201

Uncleanliness, Fear of, 45
Unhealthy Mental States, 22

Unhealthy Occupations, 21

— Surroundings, 21

Verbosity, 134, 135, 146

Walking Exercise, 182

Water, Fear of, 49

Will-power, Loss of, 24, 29, 31,

34, 152, 201, 230
Worry, 11-17, 63, 81, 82, 95, 97,

99

— Treatment of, 16, 94, 202, 225
Writers' Cramp, 127

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