Preventable Diseases Part 21

Within the past few months one of the leading neurologists of New York, a man whose practice is confined exclusively to mental and nervous diseases, stated in a public address that purely or even chiefly imaginary diseases were among the rarer conditions that the physician was called upon to treat. Shortly after, two of the leading neurologists of Philadelphia, one of them a man of international reputation, practically repeated this statement; and they put themselves on record to the effect that the vast majority of those who imagined themselves to be ill were ill, though often not to the degree or in precisely the manner that they imagined themselves to be.

Obviously, then, this possible realm of suffering in which the mind can operate is very much more limited than was at one time believed. In fact, imaginary diseases might be swept out of existence, and humanity would scarcely know the difference, so little would the total sum of its suffering be reduced.

Another field in which there has been much general misunderstanding and looseness of both thought and statement, which has again led to exaggerated ideas of the direct influence of the mind over the body, is the well-known effect of emotional states, such as fright or anger, upon the ordinary processes of the body. Instances of this relation are, of course, household words,--the man whose "hair turned white in a single night" from grief or terror; the nursing mother who flew into a furious fit of pa.s.sion and whose child was promptly seized with convulsions and died the next time it was put to the breast; the father who is prostrated by the death or disgrace of a favorite son, and dies within a few weeks of a broken heart. The first thing that is revealed by even a brief study of this subject is that these instances are exceedingly rare, and owe their familiarity in our minds to their striking and dramatic character and the excellent "material" which they make for the dramatist and the gossip. It is even difficult to secure clear and valid proof of the actual occurrence of that sudden blanching of the hair, which has in the minds of most of us been accepted from our earliest recollection.

More fundamental, however, and vital, is the extent to which we have overlooked the precise method in which these violent emotional impressions alter bodily activities, like the secretions. Granting, for the sake of argument, that states of mind, especially of great tension, have some direct and mysterious influence as such, and through means which defy physical recognition and study, it must be remembered that they have a perfectly definite physiological sphere of influence upon vital activities. Indeed, we are already in a position to explain at least two-thirds of these so-called "mental influences" upon purely physical and physiological grounds.

First of all, we must remember that these emotions which we are pleased to term "states of mind" are also states of body. If any man were to stand up before you, for instance, either upon the stage or in private, and inform you that he was "scared within an inch of his life," without tremor in his voice, or paling of his countenance, or widening eyes, or twitching muscles, or preparations either to escape or to fight, you would simply laugh at him. You would readily conclude, either that he was making fun of you and felt no such emotion, or that he was repressing it by an act of miraculous self-control. The man who is frightened and doesn't do anything or look as if he were going to do anything, the man who is angry and makes no movement or even twitching suggesting that fact, is neither angry nor frightened.

An emotional state is, of course, a peculiarly complex affair. First, there is the reception of the sensation, sight, sound, touch, or smell, which terrifies. This terror is a secondary reaction, and in ninety-nine cases out of a hundred is conditioned upon our memory of previous similar objects and their dangerousness, or our recollection of what we have been told about their deadliness. Then instantly, irrepressibly, comes the lightning-flash of horror to our heart, to our muscles, to our lungs, to get ready to meet this emergency. Then, and not till then, do we really feel the emotion. In fact, our most pragmatic philosopher, William James, has gone so far as to declare that emotions are the after-echoes of muscular contractions. By the time an emotion has fairly got us in its grip so that we are really conscious of it, the blood-supply of half the organs in our body has been powerfully altered, and often completely reversed.

To what extent muscular contractions condition emotions, as Professor James has suggested, may be easily tested by a quaint and simple little experiment upon a group of the smallest voluntary muscles in the body, those that move the eyeball. Choose some time when you are sitting quietly in your room, free from all disturbing thoughts and influences.

Then stand up and, a.s.suming an easy position, cast the eyes upward and hold them in that position for thirty seconds. Instantly and involuntarily you will be conscious of a tendency toward reverential, devotional, contemplative ideas and thoughts. Then turn the eyes sideways, glancing directly to the right or to the left, through half-closed lids. Within thirty seconds images of suspicion, of uneasiness, or of dislike, will rise unbidden in the mind. Turn the eyes to one side and slightly downward, and suggestions of jealousy or coquetry will be apt to spring unbidden. Direct your gaze downward toward the floor, and you are likely to go off into a fit of reverie or of abstraction.

In fact, as Darwin long ago remarked, quoting in part from Bain: "Most of our emotions [he should have said all] are so closely connected with their expression that they hardly exist if the body remains pa.s.sive. As Louis XVI, facing a mob, exclaimed, 'Afraid? Feel my pulse!' so a man may intensely hate another, but until his bodily frame is affected he can hardly be said to be enraged."

And, a little later, from Maudsley:--

"The specific muscular action is not merely an exponent of pa.s.sion, but truly an essential part of it. If we try, while the features are fixed in the expression of one pa.s.sion, to call up in the mind a different one, we shall find it impossible to do so."

It will also be recollected what an important part in the production of hypnosis and the trance state, fixed and strained positions of these same ocular muscles have always been made to play. Many hypnotists can bring their subjects under their influence solely by having them gaze fixedly at some bright object like a mirror, or into a crystal sphere, for a few minutes or even seconds.

A graphic ill.u.s.tration of the importance of muscular action in emotional states is the art of the actor. Not only would it be impossible for an actor to make an audience believe in the genuineness of his supposed emotion if he stood gla.s.sy-eyed and wooden-limbed declaiming his lines in a monotone, without gestures or play of expression of any sort, but it would also be impossible for him to feel even the counterfeit sensation which he is supposed to represent. So definite and so well recognized is this connection, that many actors take some little time, as they express it, to "warm up" to their part, and can be visibly seen working themselves up to the pitch of emotion desired for expression by twitching muscles, contractions of the countenance, and catchings of the breath. This last performance, by the way, is not by any means confined to the stage, but may be seen in operation in clashes and disagreements in real life. An individual who knows his case to be weak, or himself to be lacking in determination, can be seen working himself up to the necessary pitch of pa.s.sion or of obstinacy. There is even a lovely old fairy-tale of our schoolboy days, which is still to be found in ancient works on natural history, to the effect that the King of Beasts himself was provided with a small, h.o.r.n.y hook or spur at the end of his tail, with which he lashed himself into a fury before springing upon his enemy!

What, then, will be the physical effect of a shock or fright or furious outburst of anger upon the vital secretions? Obviously, that any processes which require a full or unusually large share of blood-supply for their carrying out will be instantly stopped by the diversion of this from their secreting cells, in the wall of the stomach, in the liver, or in the capillaries of the brain, to the great muscular ma.s.ses of the body, or by some strange, atavistic reflex into the so-called "abdominal pool," the portal circulation. The familiar results are just what might have been expected. The brain is so suddenly emptied of blood that connected thought becomes impossible, and in extreme cases we stand as one paralyzed, until the terror that we would flee from crashes down upon us, or we lose consciousness and swoon away. If the process of digestion happens to be going on, it is instantly stopped, leaving the food to ferment and putrefy and poison the body-tissues which it would otherwise have nourished. The cells of the liver may be so completely deprived of blood as to stop forming bile out of broken-down blood pigment, and the latter will gorge every vessel of the body and escape into the tissues, producing jaundice.

Every one knows how the hearing of bad news or the cropping up of disagreeable subjects in conversation at dinner-time will tend to promote indigestion instead of digestion. The mechanism is precisely similar. The disagreeable news, if it concern a financial or executive difficulty, will cause a rush of blood to the brain for the purpose of deciding what is to be done. But this diminishes the proper supply of blood to the stomach and to the digestive glands, just as really as the paralysis of violent fright or an explosion of furious anger. If the unpleasant subject is yet a little more irritating and personal, it will lead to a corresponding set of muscular actions, as evidenced in heightened color, loud tones, more or less violent gesticulation, with marked interruption of both mastication and the secretion of saliva and all other digestive juices. In short, fully two-thirds of the influences of emotional mental states upon the body are produced by their calling away from the normal vital processes the blood which is needed for their muscular and circulatory accompaniments. No matter how bad the news or how serious the danger, if they fail to worry us or to frighten us,--in other words, to set up this complicated train of muscular and blood-supply changes,--then they have little or no effect upon our digestions or the metabolism of our liver and kidneys.

The cla.s.sic "preying upon the damask cheek" of grief, and the carking effect of the Black Care that rides behind the horseman, have a perfectly similar physical mechanism. While the primary disturbance of the banking balances of the body is less, this is continued over weeks and months, and in addition introduces another factor hardly less potent, by interfering with all the healthful, normal, regular habits of the body,--appet.i.te, meal-times, sleep, recreation. These wastings and pinings and fadings away are produced by mental influence, in the sense that they cannot be cured by medicines or relieved at once by the best of hygienic advice; but it is idle to deny that they have also a broad and substantial physical basis, in the extent to which states of emotional agony, despair, or worry interfere with appet.i.te, sleep, and proper exercise and recreation in the open air. Just as soon as they cease to interfere with this normal regularity of bodily functions, the sufferer begins to recover his health.

We even meet with the curious paradox of individuals who, though suffering the keenest grief or anxiety over the loss or serious illness of those nearest or dearest to them, are positively mortified and ashamed because their countenances show so little of the pallid hues and the haggard lines supposed to be inseparably a.s.sociated with grief. So long as the body-surplus is abundant enough to stand the heavy overdrafts made on it by grief and mental distress, without robbing the stomach of its power to digest and the brain of its ability to sleep, the physical effects of grief, and even of remorse, will be slight.

It must be remembered that loss of appet.i.te is not in itself a cause of trouble, but a symptom of the stomach's inability to digest food; in this instance, because it finds that it can no longer draw upon the natural resources of the body in sufficient abundance to carry out its operations. The state is exactly like a tightness of the money market, when, on account of unnatural retention or h.o.a.rding in some parts of the financial field, the acc.u.mulation of sufficient amounts of floating capital at the banks for moving the crop or paying import duties cannot be carried out as usual. The vital system is, in fact, in a state of panic, so that the stomach cannot get the temporary credit or capital which it requires.

A similar condition of temporary panic, call it mental or bodily, as you will, occurs in disease and is not confined to the so-called imaginary diseases, or even to the diseases of the nervous system, but is apt to be present in a large number of acute affections, especially those attended by pain. Sudden invasion of the system by the germs of infectious diseases, with their explosions of toxin-sh.e.l.ls all through the redoubts of the body, often induces a disturbance of the bodily balance akin to panic. This is usually accompanied and aggravated by an emotional dread and terror of corresponding intensity. The relief of the latter, by the confident a.s.surance of an expert and trusted physician that the chances are ten to one that the disease will run its course in a few days and the patient completely recover,--especially if coupled with the administration of some drug which relieves pain or diminishes congestion in the affected organs,--will often do much toward restoring balance and putting the patient in a condition where the natural recuperative powers of the system can begin their work. The historic popularity of opium, and of late of the coal-tar products (phenacetine and acetanilide), in the beginning of an acute illness, is largely based on the power which they possess of dulling pain, relieving disturbances of the blood-balance, and soothing bodily and mental excitement.

Fever-panic or pain-panic, like a banking panic, though it has a genuine and substantial basis, can be dealt with and relieved much more readily after checking excessive degrees of distrust and excitement. An opiate will relieve this physical pain-panic, just as a strong mental impression will relieve the fright-paralysis and emotional panic which often accompany it, and thus give a clearer field and a breathing s.p.a.ce for the more slowly acting recuperative powers of nature to a.s.sert their influence and get control of the situation.

_But neither of them will cure._ The utmost that they can do is to give a breathing spell, a lull in the storm, which the rallying powers of the body, if present, can take advantage of. If the latter, however, be not adequate to the situation, the disease will progress to serious or even fatal termination, just as certainly as if no such influence had been exerted, and often at an accelerated rate. In fact, our dependence upon opiates and mental influence have been both a characteristic and a cause of the Dark Ages of medicine. The more we depended upon these, the more content we were to remain in ignorance of the real causes of disease, whether bodily or mental.

The second physical effect produced by mental influence is probably the most important of all, and that is _the extent to which it induces the patient to follow good advice_. We as physicians would be the last to underestimate the importance of the confidence of our patients. But we know perfectly well that our retention of that confidence will depend almost entirely upon the extent to which we can justify it; that its princ.i.p.al value to us lies in the extent to which it will insure prompt obedience to our orders, and intelligent and loyal cooperation with us in our fight against disease. The man who would depend upon the confidence of his patients as a means of healing, would soon find himself without practice. We know by the bitterest of experience that no matter how absolute and boundless the confidence of our patients may be in our ability to heal them, no matter how much they may express themselves as cheered and encouraged by our presence, ninety-nine per cent of the chance of their recovery depends upon the gravity of the disease, the vigor of their powers of resistance, and our skill and intelligence in combating the one and a.s.sisting the other.

Valuable and helpful as courage and confidence in the sick-room are, they are but a broken reed which will pierce the hand of him who leans upon it too heavily, be he patient or physician. We can all recall, as among our saddest and most heart-breaking experiences, the cases of fatal disease, which were well-nigh hopeless from the start, and yet in which the sufferers expressed, and maintained to the last moments of conscious speech, a bright and pathetically absolute confidence in our powers of healing, based upon our success in some previous case, or upon their own irrepressible hopefulness.

Even the deadliest and most serious of infectious diseases, consumption, has--as is well known--as one of its prominent symptoms an irrepressible hopefulness and confidence that they will get well, on the part of a considerable percentage of its victims. This has even been formally designated in the cla.s.sical medical treatises as the "_Spes Phthisica_,"

or "Consumptive Hope." But these hopeful consumptives die just as surely as the depressed ones; in fact, if anything, in a little larger proportion. It well ill.u.s.trates the other side of the s.h.i.+eld of hope and confidence, the danger of unwavering expectancy, in that it is chiefly those who are early alarmed and turn vigorously to fight the disease under intelligent medical direction, who make the recoveries. Too serene a courage, too profound a confidence in occult forces, is only a form of fatalism and a very dangerous one.

Broadly speaking, mental states in the sick-room are a pretty fair index--I don't mind saying, product--of bodily states. Hopefulness and confidence are usually favorable signs, for the reason that they are most likely to be displayed by individuals who, although they may be seriously ill, are of good physique, have high resisting power, and will make a successful fight against the disease. So, roughly speaking, courage and hopefulness are good omens, on purely physical grounds.

But these are only rough indications of probabilities, not reliable signs; and as a rule we are but little affected by either the hopes or the fears of our patients in making up our estimate of their chances.

The only mental symptom that weighs heavily with us is indifference.

This puts us on the lookout at once. So long as our patients have a sufficiently vivid and lively fear of impending death, we feel pretty sure that they are not seriously ill; but when they a.s.sure us dreamily that they "feel first-rate," forget to ask us how they are getting along, or become drowsily indifferent to the outlook for the future, then we redouble our vigilance, for we fear that we recognize the gradual approach of the Great Restbringer, the merciful drowsiness which in nine cases out of ten precedes and heralds the coming of the Long Sleep.

Lastly, the cases in which the sufferings of the patient are due chiefly to a morbid action of his or her imagination, are a small percentage of the total of the ills which come before us for relief. But, even of this small percentage, _only a very few are in perfect or even reasonably good physical health_. A large majority of even these neurasthenics, psychasthenics, imaginary invalids, and bodily or mental neurotics, have some physical disturbance, organic or functional, which is the chief cause of their troubles. And the important point is that our success in relieving these sufferers will depend upon our skill in ferreting out this physical basis, and the extent to which we can succeed in correcting or relieving it. We no longer ridicule or laugh at these unfortunates. On the contrary we pity them from the bottom of our hearts, because we know that their sufferings, however polarly remote they may be from endangering their lives in any way, and however imaginary in a purely material sense, are _to them_ real. Their happiness is destroyed and their efficiency is crippled just as genuinely and effectively as if they had a broken limb or a diseased heart.

We are now more and more firmly convinced that these patients, however ludicrously absurd their forebodings, are _really sick_, either bodily or mentally, and probably both. A perfectly healthy individual seldom imagines himself or herself to be ill. And as the list of so-called functional diseases--that is to say, those diseases in which no definite, objective mark of degeneration or decay in any tissue or organ can be discovered--are steadily and swiftly diminis.h.i.+ng under the scrutiny of the microscope and the methods of the laboratory, so these purely imaginary diseases, these "depressed mental states," these "essential morbid tendencies," are also rapidly diminis.h.i.+ng in number, as cases are more conscientiously and personally studied and worked out.

Even hysteria is no longer looked upon as sheer perversity on the part of the patient, but is patiently traced back, stage by stage, until if possible the primary "strangulated emotion" which caused it is discovered; and where this can be found the whole morbid tendency can often be relieved and reversed almost as if by magic.

To sum up: My contention is, that the direct influence of emotional states upon bodily organs and functions has been greatly exaggerated; that it is exceedingly doubtful whether, for instance, any individual in a reasonable condition of health was ever killed by an imaginary or even an emotional shock; that there is surprisingly little valid evidence that the hair of any human being turned white in a single night, or was completely shed within a few hours, under the influence of fright, terror, or grief; that the effects upon bodily functions and secretions, digestion, etc., produced by emotion, are due to secondary effects of the latter, diverting the energy of the body into other channels and disturbing the general balance of its forces and blood-supply; that the actual percentage of cases in which the imagination plays the chief, or even a dominant part, is small, probably not to exceed five or ten per cent; that a very considerable share of the influence of mental impressions in the cure of disease is due to the relief of mental panic, permitting the rallying of the recuperative powers of the body, and to the extent to which they produce the reform of bad physical habits or surroundings or conditions.

The most important element in the cure of disease by mental impression is _time_ plus the _vis medicatrix naturae_. The mental impression--suggestion, scolding, securing of confidence--diverts the attention of the patient until his own recuperative power and the intelligent correction of bad physical habits remedy his defect. Pure mental impression, however vivid, which is not followed up by improvement of the environment, or correction of bad physical habits, will be almost absolutely sterile. Faith without works is as dead in medicine as in religion. Mental influence is little more than an introduction committee to real treatment. Even the means used for producing mental impressions are physical,--impressions made upon some one of the five senses of the individual. In short, as Barker aptly puts it, "Every psychotherapy is also a physical therapy."

Furthermore, even mental worry, distress, or depression, in nine cases out of ten has a physical cause. To remedy conditions of mental stress by correcting the underpay, overwork, bad ventilation, or underfeeding on account of illness or death of the wage-earner of the family, is, of course, nothing but the most admirable common sense; but to call it the _mental_ treatment of disease is a mere juggling with words. "Take care of the body and the mind will take care of itself," is a maxim which will prove valid in actual practice nine times out of ten.