Religion And Health

CHAPTER XIII
DREADS

The most fruitful source of neurotic affections and especially of what have come to be termed in recent years the psychoneuroses, those disturbances of nerve function due to an unfortunate state of mind, are the dreads or, as they have been called, the fear thoughts of mankind. Men as well as women develop, in the sense of fostering, often almost unconsciously to themselves, a dread of the ulterior significance of some symptom, or feeling, or disturbance of function, which serves to make them extremely uncomfortable. The physical sensation which they experience and which is the basis and the source of the dread may be only a quite normal physiological feeling common to all humanity, heightened by overattention to it, but the fearsome state of mind will cause it to assume the significance of a definite symptom of some serious disease or, what may be worse, an indefinite symptom of some impending affection which, in the opinion of the sufferer, may be as yet too inchoate for the physician to recognize its real significance.

It is not a question of an imaginary ill, as a rule, and there is but seldom a real hallucination or creation by the fantasy out of nothing, of the ailment from which these people suffer, but there is an exaggeration of some slight or at least comparatively insignificant feeling to an extent that makes it assume a serious aspect. This inhibits normal function, lessens appetite and exercise, at times even disturbs sleep, and so brings about some at least of the ailments that are dreaded.

Not infrequently these dreads are very vague. People wake in the morning with a sense of depression and the feeling that something is hanging over them. As a result they feel out of sorts, their appetite for breakfast is blunted and they begin the day very badly just because of this incubus of vague disturbance of mind. Almost anything that happens during the day will emphasize their depression; as a consequence lunch may be skimped, they do not get out as they should, and a vicious circle of influences is begun. Perhaps they eat rather heartily for dinner and then fall asleep in their chair afterwards over the evening paper, and then find that when they go to bed they do not sleep promptly as they expected to. They worry over it, feeling there must be something the matter with them, since they cannot sleep lying down though they could sleep so well in the chair, and if there should be a repetition of these feelings the next day, it is easy to understand how a psychoneurosis would be started which might easily, if eating and outing and exercise were to continue to be neglected, develop into a serious condition. Many a case of nervous breakdown has a beginning as simple as this, and people of nervous temperament must be constantly on guard against it.

Such patients—and they are much more common than might be thought and they have been with us for thousands of years, for Plato describes some of them and the oldest prescription in the world is a fumigation that was directed to curing just such a neurotic condition—need to have faith in themselves and faith in their Maker and to stop hesitating and doubting and thinking and dreading. I have known men, but particularly women, who had been suffering in this way, become converted so that they took up the practice of religion which they had neglected before and proceeded to get immensely better. Of course, there are any number of hypochondriacs among people who profess religion, but they are the exceptions which prove the rule that fewer people who have a real sense of religion and who take it seriously as a guide of life suffer from dreads and the symptoms which result from them than are to be found among the people who have given up the belief and practice of their religion. This is particularly true of those who belong to the old orthodox forms of religion which require self-denial and self-control as part of the practice of religious duties. As we have shown in the chapter on Nervous Diseases the Quakers, the strict Methodists, the Roman Catholics, the Orthodox Jews, get their reward for their submission to their religion even in this world by lessened solicitude about themselves. Indeed there is nothing that is more likely to dispel dreads than an abiding sense of religion. If a man or a woman is convinced that there is a Providence that oversees human life as well as the universe, in Whom "we live and move and have our being" and of Whose infinite knowledge and power we can have no doubt, the unreasonableness of dreads comes home to him. The man who prays every morning, "Thy will be done on earth as it is in heaven", must have the feeling that His will will be accomplished, and that is all that any of us can ask for. Somehow that is for the best, though we may not be able to see just how. "If not a sparrow falls to the ground but your Heavenly Father knoweth", and if, as the Master said, "Are not five sparrows sold for two farthings and not one of them is forgotten before God? But even the very hairs of your head are all numbered. Fear not therefore: you are of more value than many sparrows", surely the believer will keep himself at least from being overworried by dreads. His disposition may be such that he cannot dispose of them entirely, but at least the best source of consolation and strength is to be found in that strong faith for which there are so many strengthening expressions against the fears and dreads of life to be found in the sacred writings.

How many striking sentences there are in the Scriptures to help against these solicitudes: "And which of you with taking thought can add to his stature one cubit? If ye then be not able to do that thing which is least, why take ye thought for the rest?" How one is tempted to quote others of the expressions in that same wonderful chapter of Luke (XII). "The life is more than the meat and the body is more than raiment. Consider the ravens; for they neither sow nor reap; which neither have storehouse nor barn; and God feedeth them; how much more are ye better than the fowls. But rather seek ye the kingdom of God; and all these things shall be added unto you. Fear not, little flock; for it is your Father's good pleasure to give you a kingdom." All over the Scriptures are passages that are meant to be fear-dispelling and that have been for many men and women in many generations. For fear is often the state of man unless he has something to cling to. "Fear not, I am with thee."… "Fear ye not, nor be afraid, have I not told thee."… "Fear not, I am the first and the last, for I the Lord thy God will hold thy right hand, saying to thee fear not, I will help thee."

Scientists have recognized that religion and science were coördinate factors for the neutralization of the dreads that disturb humanity. Professor H. D. Seeley, who was for many years professor of geography, geology and mineralogy at Kings College, London, and who was a distinguished Fellow of most of the important English scientific societies, the Royal, Linnean, Geological, Zoological and Geographical, stated in his little work, "Factors in Life", his views as regards the place of religion in dissipating the fear thoughts of life, and places it side by side with science itself in this respect. He said:

"To the religious neither life nor death has terrors, and in freeing existence from its greater anxieties the influence of Religion works on the same foundation of moral efforts as Science. The sciences are the sisters of Religion in that they unfold something of the laws by which the universe is governed, and by which man's life is directed. They are thus far the stepping-stones of faith. And those who have learned that health is the reward which man may gain by moral discipline, that mental vigour may be augmented by the wise (or moral) use of food, and that education is the systematic exercise of moral responsibility in any or all the affairs of life, may find that in the practice and pursuit of the truths of Science they are conscious of a religious education which is a light to the feet. Such matters are factors in life, which may educate us in a reverent appreciation of religious truth and divine government of the world."

Many physicians of large experience have recognized the value of an abiding religious faith as a remedy for many of these dreads and doubts which so pester mankind and make so many people suffer even from physical symptoms that seem surely to have only material causes as their basis because they so hamper the will to live. Sir Dyce Duckworth, the distinguished English physician, once wrote to a friend:

"What is always needed is a reverent study and a full acknowledgment of God as a Father and as the great 'All in All.' In my experience the only solution of all our difficulties is to maintain a humble, child-like faith and a confident trust in the perfect love of God, who 'knows whereof we are made, and remembers that we are but dust.'

"With that and perfect love, there need be no fear, and all will come right in His own time. That is the faith to live by and to die with, and the happiest people (and the happiest of the dying) are those who hold firm by that faith.

"This is my experience after much thought, much knowledge of human nature, and not a little study of all the difficulties you relate to me."

But it must not be thought that these dreads cause only the trivial instances of nervous breakdown in which people never very capable give way before the strenuous call of commercial life in the large cities of our time. Nor must it be thought that education is dispelling them. Some idea of the important role that dreads may play in the production of human ills that seem to be very serious and that often prove quite incapacitating for mental and physical work, even in men of fine abilities and proven powers, may be gathered from what happened during the recent Great War. The Allied nations had to maintain some fifty thousand beds behind the lines for the accommodation of patients suffering from functional nervous affections really founded on dreads. At the beginning these cases were misunderstood, and they were unfortunately called "shell shock" because they seemed so serious that it was thought that they were due to some concussion of the nervous system, that is, some shaking up of its elements that made it impossible for it to function normally, even though there were no external signs of injury. After a time, however, it came to be appreciated that the great majority of these patients were suffering from major hysteria due to loss of control over the nervous system as a consequence of the almost inevitable dreads which developed in the awful conditions of warfare in the trenches, with its terrifying sights and sounds, and with the intense strain put upon the nervous system because of the demands made upon physical energy almost to the point of exhaustion.

After loss of sleep and irregular eating, wet feet for days at a time, exposure to the inclemencies of the weather and then having to withstand an enemy attack, often at dawn after a fearsome barrage had been laid down on them for hours, it is no wonder that in many cases men's nervous control did give way. They were not cowards, they were not malingerers; on the contrary they were often brave men who had volunteered for the service, giving up important positions at home to take up the defense of their country; and yet after a time their dreads dominated them and they suffered from all sorts of symptoms. Some of them could not see, a number could not hear; some could not use their legs, and some could not employ their arms properly; some walked with a limp, some had tremor that made their usefulness as soldiers absolutely at an end. Nearly all of them had a series of complaints which they wanted to detail in all their minuteness to every physician who came near. Their stories of what had happened were mainly untrue or utter exaggerations of the actual events, and yet these men were not liars and they were not the doddering idiots that they sometimes seemed to be; they were just fellow mortals who meant to do their best, and who had been affected in this way because they were asked to stand what was beyond their strength of soul to withstand.

The educated suffered more than the uneducated. There were four times as many "shell shock" cases among the officers of the British army in proportion to their number as there were among the privates. Neither ambition nor nobility nor any artificial distinction of any kind seemed to make any difference, for all classes and conditions of men came down with it. Its frequence can be very well judged from the fact that one third of all the dismissions from the British army, not counting the wounded, was for "shell shock", which of course should be called by its proper name of major hysteria. One seventh of all the dismissions, if the wounded were included, was for this reason. It had been the custom to think before the war that only a comparatively few men, mostly those of a certain feministic appearance and delicacy of constitution, were likely to suffer from hysteria. It was found, however, that college graduates who stood at the head of their classes, athletes who held records, broad-shouldered, healthy men who had been considered to be the very acme of common sense, men who were supposed to be without a nerve in their make-up, all these proved to have "nerves"; and when the war "got on their nerves", they suffered from the complaints which we have mentioned and many others, including pains and discomforts of all kinds, and inabilities and incapacities, motor and sensory as well as of the memory, of the mind or the will.

This recent significant experience will give some idea of how potent dreads may be in the production of symptoms which seem surely to be due to physical rather than merely mental conditions. Most people would probably be inclined to think that in so far as dreads produced diseases by the exaggeration of minor symptoms, at most scarcely more than mental conditions of discomfort would result from them. What are called the psychoneuroses, that is, the neurotic affections dependent on the state of mind, may simulate almost any of the organic conditions and may seem to be serious diseases. Through the creation of unfortunate habits, they may give rise to a great many rather severe physical symptoms. The war neuroses emphasized this for us. Inability to use limbs, either legs or arms, is quite common in connection with them; disturbances of sensation, such as defective hearing and eyesight, or even what seems to be complete blindness and deafness, may develop. Tremors are quite common, and pains and aches in connection with the disabilities of the limbs are extremely frequent.

A very usual experience is to find that a patient has as a preliminary suffered some injury. This may not be very severe, but it is enough to cause the sufferer to spare the limb that is affected; and unfortunately physicians sometimes put a limb with a minor affection in plaster of Paris or in a splint for a time. The patient's own solicitude with regard to the hurt may cause almost as effective splinting of it as a plaster cast or wooden slat and a bandage. Whenever this happens, the unused muscles lose some of their nutrition. This is due partly to the fact that the circulation is interfered with because the active contraction of muscles, especially of the legs, is depended on by nature to help the venous or return circulation by bringing about compression of the veins. The valves in the veins are so arranged that when the veins are compressed and the blood thus pressed out of them, it cannot move away from the heart but is impelled onward toward the heart. Besides, the sending down of nervous impulses for the active use of muscles increases the size of the arteries to the part by direct action on their walls, and whenever there is failure to send impulses down, the arteries do not carry as much blood as usual, and the nutrition of the part suffers as a result.

If this inactive state of the muscles continues for a few days, they will become somewhat flaccid, and after a week or more will actually begin to decrease in size. As a consequence of this, they cannot be used to as good advantage as before, and use of them sets up an achy condition as soon as the limb is set free for use, whether it has been splinted by the physician or by the patient's mind. If the patient is still solicitous, he notices this condition of pain and concludes that it means that the muscles are not yet in the condition of health where they should be used, and he puts on the splints, metaphorical or literal, once more. The muscles grow more flaccid and eventually atrophic as a consequence, until sometimes there will be a difference of more than an inch in the girth of two limbs at the same point, and this atrophy may proceed much farther. It seems almost impossible to believe that men and women could thus make a limb useless, but this is actually what happens rather frequently. The effects of the original injury will pass off in a few days, but the effects of the disuse of the limb may remain for months or even years because of the disturbance of circulation and of nerve impulse. It is probable that the nerves themselves have a trophic or nutritional—that is, vitalizing—influence upon muscles. Some physiologists actually talk of there being trophic fibers in the nerves, though it would seem more reasonable to think that the nerve trophic effect comes from the modification of the circulation to the part.

Whenever muscles have to be increased in size or won back from an atrophic condition, the individual to whom they belong must go through a period of soreness and tenderness in those muscles which often is very hard to bear. The young fellow who, after a rather relaxed summer, begins training for the football team in the fall, knows how sore and tender his muscles have become. After the first day or two of training, each time he wakes up at night he turns over in bed with the feeling that every bit of him is full of tenderness. Any number of people under similar circumstances are inclined to think that they must have caught cold. They usually reason thus: "I got into a perspiration and sat down for a while and then took cold, and that is the reason for all this painful condition that has developed."

That word "cold" is as unfortunate as "shell shock." There is no such thing as taking cold. We catch infections, but much more frequently in fall and spring than in winter. The young man who is in training usually pays no attention to such unfavorable suggestions or dreads, since he knows that he must take his medicine of further hard exercise until he has hardened and developed his muscles and then, instead of their causing discomfort, nothing in the world gives him so much satisfaction as their active exercise.

Older people, however, and especially those who have what may be called a "dready" disposition, do not call their muscle discomfort soreness and tenderness; they speak of pains and aches. The very words carry a suggestion of evil with them, and above all they carry with them an inhibitory suggestion which keeps muscles from being used normally. If, then, certain older people get an injury, even though it may not be very serious, so long as it causes them to give up the use of a limb for a while, or sets them to using the muscles of it a little differently from before, a psychoneurosis on the basis of a dread, but with the physical basis of somewhat atrophied muscles to keep it up, may develop and persist for weeks and months and even years. As a consequence of this state—much more of the mind than the body—men may walk lame or be very awkward in the use of one arm, or they may have a little stoop, or they may dread very much the using of some group of muscles. Such conditions occasionally occur in the neck or in various parts of the back, and especially in the lumbar region, with strikingly visible effects.

It might seem impossible that such conditions should develop and persist for any length of time in sensible and above all intelligent people, and yet I suppose that every physician's case book contains a number of examples. After he has been in practice for ten years or more this will surely be true, if he has had much to do with nervous patients. One of the most distinguished scientists that we had in this country, possessed of one of the finest intellects of our generation, thoroughly sensible and noted for his executive ability, suffered from a slight attack of sciatica, to which he had been predisposed by some unusual work in connection with a heavy fall of snow when he had to go out and do the shoveling himself, since labor was not available. He never quite got over it. For some time he carried two crutches because he had so little confidence in putting down the foot on that side, after having spared it for a while. Then for several years he carried a single crutch. In the meantime he was examined by half a dozen of the best physicians in the country, who could find nothing the matter with him except that disuse had rendered the muscles of that leg slightly atrophic, and he would have to push through a period of soreness and tenderness while exercising them. He carried a cane ever afterwards, walked a little lame and favored that leg.

Persistent sciaticas of this kind and lumbagoes are much more common than they are thought. It was a case of this kind, undoubtedly, that brought about Bernheim's interest in hypnotism at Nancy and initiated that wave of attention to hypnotism at the end of the nineteenth century which did so much harm. A patient who had suffered from sciatica for some years and walked a little lame as a consequence came under Bernheim's care, and he tried without success every therapeutic resource at his command to make him better. Finally his patient gave up calling on him, completely discouraged. He had gone to a great many physicians before Bernheim, and all of them had failed to do him any effectual good. They could relieve his discomfort for a while, but when he stopped taking drugs, that returned and his limb could be used no better than before.

Some months after Bernheim missed the patient from his clinic he met him on the street one day, walking perfectly straight without his cane and evidently entirely well. He was so much interested that he stopped to ask what had cured him. The patient told him he had gone around to Liebault, who, almost alone in Europe, was still practicing hypnotism, for the practice had been greatly discredited by certain exposures in England shortly after the middle of the century. Bernheim, who had ignored Liebault's work before, now took an interest in it and found of course that hypnotism—or indeed, though Bernheim did not know that, anything else that would give these patients the confidence to push through a period of tenderness and soreness in regaining the use of their muscles—would cure them. The incident began that period of reawakened interest in hypnotism which now constitutes such a ludicrous series of events in the medicine of the end of the nineteenth century.

Such cases are by no means so uncommon as they might be thought. I have known the teacher of a high school to slip while coming out of school, fall on his knee, bruise it rather badly, and then have this bruised condition heal very well, only to develop in the course of a few weeks a distinct inability to use the muscles of that leg properly, until he had to walk with a marked limp. The circumference of the limb above the knee reduced distinctly in size, it suffered more from cold than did the other one; it perspired more freely; it was distinctly more sensitive to the touch, and it would seem as though there must be some serious underlying nervous condition. He passed through the hands of several specialists, including one who wanted to remove a cartilage in the knee joint which he said had been dislocated, and another who insisted that he was suffering from a neuritis of a branch of the sciatic nerve, and who wanted to inject water within the sheath of it or at least lay it bare and stretch it. Fortunately we persuaded him to join an athletic club and take more exercise than usual and above all exercise that limb. He had had massage and passive movements for it, but these are of very little service in these cases, because the nervous impulses must come down from above. It would almost seem as though the will sent down some of its own creative energy through the nerves which lead to the part. He is now entirely well, though he suffered for several years, and absolutely nothing was done for him except to make him eat better and make him push through a period of soreness and tenderness—he used to call them pains and aches before we explained the condition to him—until he had properly recovered the use of his limb.

On the other hand, I have known a good clergyman with a rather similar condition to this, who had bumped his shin bone not far below the knee and after recovery from that had developed a marked psychoneurosis in the muscles above the knee, refuse to be cured by any such simple procedure as merely exercising himself back to health. He could not bring himself to think that it was only his own lack of will power that had caused the condition to develop. Above all he needed something external to cure him. He finally went to a bone-setter, one of these old fellows who claim to be the seventh son of a seventh son, or something of that kind, possessed of marvelous hereditary power and instinctive intuition in the matter of setting bones right, and who cure nearly everything under the sun and a few other things besides by their supposed bone-setting processes. My clerical friend was sure that he had been cured by the bone-setter, but any physician would have told him that what had happened was that his faith in his healer had released his inhibition of his muscles and given him the confidence to go on and use them as they should be used,—that is, of course, as far as he possibly could at first. Then they were gradually restored to their former condition of health and strength. That is what happened, and he has had no recurrence. He is quite sure, however, that the trouble was a subluxation of his hip joint, which the bone-setter set right, thus allowing nervous impulses and the blood to flow properly through the part once more. His own will was the only obstacle and it was that alone that had to be overcome and used as a therapeutic agent.

These patients are the stock in trade of all sorts of irregular practitioners. Whenever they think anything is the matter with them they must be "cured"; they never get better of themselves. They need something or somebody to which to pin their faith. It is the hardest thing in the world to find out what is the matter with a man who has nothing the matter with him except a state of mind and its consequences in his physical condition. He must have his state of mind changed first of all, and usually he requires some rather strong suggestion for that purpose. What is likely to affect him most favorably is some novel or unusual method of treatment, or some new discovery in science recently applied to medicine, or some new method of healing, or some supposedly new invention or discovery in therapeutics. These patients are a veritable nuisance in medicine. It is the cures of them, made by all sorts of new-fangled remedies, which make it so difficult for physicians to judge whether a new remedy has a positive favorable physical effect or only a mental influence.

Very probably the best appreciation of the place of dreads in life and how much of good is accomplished by their neutralization can be obtained from the number of sufferers of all kinds who are cured by all sorts of new remedies which prove after a time to have no physical effect at all. We have discussed this subject of the remedies that have come and gone in medicine in the volume "Psychotherapy." It has been very well said that the most important chapter in the history of medicine is that of the cures that have failed. It illustrates very thoroughly how much influence the mind has over the body, and particularly how much dreads have meant for the production of symptoms which have been relieved whenever the patient had his dreads lifted, no matter what might be the agent to accomplish this purpose. Instead of decreasing, dreads have increased just in proportion as popular education has spread and more people have been able to read and receive unfavorable suggestions of all kinds. This has been particularly true with the diminution of the influence of religion over people's minds.

All sorts of religious substitutes which would give people enough confidence in themselves to enable them to throw off their dreads have gained vogue and have come to be very popular institutions in recent years. Dowie, who claimed he was Elijah returned to earth, and Schlatter, who said that he was divinely inspired to cure people, were as successful in the twentieth century as Greatrakes "the stroker," who said that the Holy Ghost appeared to him in a dream and told him to heal people, in the seventeenth. Metaphysical healing of all kinds has been successful, and spiritualistic healing and new thought and magnetic healing, with as little magnetism about it as Mesmer's famous battery which had no electricity,—all these have cured people. All sorts of healers are successful just because they lift the dreads and make people forget the inhibitions that they have been exercising over their functions. Indeed this state of fear thought is one of the most prolific sources of symptoms, or rather let us say of complaints, that medicine has to do with at all times, hence the importance of the chapter of the cures that have failed. Almost any religious feeling will be helpful in the matter, but an abiding sense of rational religion will save many people from being imposed on by all sorts of upstart theories and religious systems which base their claim to recognition on these cures of human beings.