As man is made up of a sum total of many loose parts with the well balanced adjustment of the same to be normal, apprehensiveness of his uncertain state engenders self- consciousness and throws into a chaotic state the numerous component parts in the psyche. This proves to be alarming to him and he accumulates many and varied erroneous ideas regarding his many parts. He continues to dwell and ponder in this fashion until he builds in his mind the symptoms of nearly every known ailment or disease. Enlarging on his morbid sensations and physical ailments he ignores the fact that his difficulty lies in the state of his mind.
Some of the accompanying physical symptoms are: headache, characterized by sensation of pressure or a band-like sensation around the head; sweating of the hands and the feet, sometimes of the axillae and face; epigastric pulsations due either to gas in the stomach or from excitement and physical exertion; tremors of the extremities and photophobia due to the dilatation of the pupils. Spinal irritation or sensation of heat, pain and weakness. An added physical aspect to a neurasthenic is his underweight with flabby muscles. The skin is sallow with an anxious expression and dilated pupils. Acne may be present from faulty elimination. A coated tongue and an offensive breath are commonly present. The cold clammy hands and feet are ofttimes cyanotic, suggestive of hypotension and a low tension pulse. Organic disorders may accompany or predispose the train of neurasthenic symptoms. It is well to examine physically every case to avoid confusion.
Mentally, there is insomnia of a worrisome type. He worries because he cannot sleep and does not sleep because he worries. Forgetfulness is undoubtedly due to the fact that the imagination did not sufficiently register on the memory centers because of the inattention from fatigue. Pessimism runs as an undercurrent through the symptoms with fits of irritability. Fear and apprehension intermingle to increase his difficulties. Being too absorbed in his personal problems he lacks decision.
The causes of neurasthenia are multitudinous. Jeliffe and White in Nervous and Mental Diseases stress the importance of masturbation. They consider it essentially an auto-erotic phenomenon. When this habit begins with puberty to an excessive degree there is danger of the physiological and developmental level in this period of life to remain the same throughout adult life. Normally there are transitional stages in the placement of sex interest. The first is the infantile period — the period of self–discovery when it becomes aware of such a thing as sex instinct. When the child fondles its genitalia erethism is focalized upon the organs. The young life then emerges from this auto-erotic period by placing his interest on members of his family most like himself of the same sex. Passing from this homosexual period he enters the one of puberty where a critical and highly important change ensues. From youth into manhood, love instincts are given out to the opposite sex, outside of his family.
The consequences are readily seen should the psycho-sexual development be stayed or fixed at any of the intermediate points. This seems to be the function of excessive masturbation to fix the narcissistic or homosexual periods. The individual then becomes too much occupied with himself and fails to deal sufficiently with the outer world interests. He becomes a misfit in adult life. Sensing this he loses self-esteem and sinks deeper into self-isolation. Then follows a deficient energy output but an excessive or inadequate discharge of energy is present in the physical sphere.
Francis W. Sinkler in the latest edition of the Cyclopedia of Medicine, edited by Piersol, briefly drops this subject of sex etiology by a short paragraph ending by saying: “It is generally considered that no temporary or permanent injury results from onanism, unless the act is accompanied by, or causes the development of, anxiety”.
It may be well not to stress any one of these viewpoints at the exclusion of the other, for certainly the onanist tends to become an introvert or self-centered and furthermore when confronted by a new business venture or starting on the uncertain course on the sea of matrimony he becomes greatly embarrassed, worrisome and apprehensive.
We should not ignore other causative factors inducing drain on the nerve energy; strain as excess activity, lack of proper amount of rest, the monotonous drudgery of a vocation without a vacation; prolonged mental stress, surgical operations, accidents; worry and anxiety of long duration.
Sinkler mentions heredity. The neurotic and psychotic ancestors are likely to give their offspring unstable nervous system or lowered nervous tone. He also mentions environment such as association with abnormal parents, the lack of self-restraint, the dissipation of nerve energy in vicious habits.
Now passing on to anxiety neurosis, which is an excessive excitation of discharge of energy. True to the name, all the symptoms are grouped about the cardinal symptom– anxiety. At first one might think it is of psychic origin. However, it arises from the physiological plane and attaches itself to an idea or ideas or without ideation. In this, it is different from fear which is related to and activated by some definite external object or some abstract idea entertained in the mind.
The etiology in anxiety neurosis, which is an excessive excitation of discharge of energy. True to the name, all the symptoms are grouped about the cardinal symptom– anxiety. At first one might think it is of psychic origin. However, it arises from the physiological plane and attaches itself to an idea or ideas or without ideation. In this, it is different from fear which is related to and activated by some definite external object or some abstract idea entertained in the mind.
The etiology in anxiety neurosis is fully as interesting as in neurasthenia. It is worth while here to quote Freud: “In some cases of anxiety neurosis, no etiology can readily be ascertained. It is noteworthy that in such cases it is seldom difficult to demonstrate a marked hereditary taint.” Then he continued to say where the assumption of the neurosis is acquired, sometimes after laborious examination the etiology is based upon a series of injuries and influences from sexual life. He even goes so far as to set aside all cases of a doubtful or different etiology so preponderately demonstrated is sexual etiology of anxiety neurosis. To deal precisely with this etiological problem, the sex life and habit must be thoroughly gone in to. In the case of marital relations, it will be a problem situation shared equally by male and female.
The symptom group of anxiety neurosis is accompanied by a physiological disturbances of palpitation, sometimes pseudo- angina pectoris, disturbances of respiration, profuse perspiration, trembling and shaking, dizziness, diarrhoea and vasomotor changes.
In commenting on the borderline mental disorders, one readily recognize no distinctive types or syndromes unless it is in the psychopathic constitutional group. Many cases may present an admixture such as anxiety-neurasthenic, hysteroneurasthenic.
TREATMENT.
This is probably one of the major problems confronting the general medical profession, all the more so from the fact that the concept of mental troubles is rapidly changing. It is known that there is such a thing as purely disordered mental mechanism independent of any apparent physical basis; in other words, there may be a severe mental disorder prior to any physical alternation. We are gradually removing the old idea that there must be organic tissue changes to produce symptoms of any character.
The physicians viewpoint and attitude must truthfully be related to the situation at hand. His personality, tact, knowledge as well as skill will be on trial. He should have a friendly and dependable attitude. Ridicule, commands, deception, argument, has no place in the technique. If he is emotionally inclined, let him recondition himself! Sympathy and scolding will be entirely out of place, and the chances are the patient has had a generous amount of both from relatives and friends.
It is first necessary to make a friendly contact to elicit and command the confidence of the patient. It is well to be passive and receptive, but at the same time deeply interested. Encourage the sufferer to unload all of his or her troubles. Quietly lead them along should they hesitate and only interrupt to set them right on their course should they wander from the matter in hand. All this time there will be ample opportunity to judge the patients attitude whether friendly or cold, irritable, antagonistic, suspicious, aggressive, shrinking or indifferent. Observation of his posture and his facial expression will give some impression as to the success in his personal response.
From here it will be impossible to be specific in outlining treatment. Every case must be adjudged and treated on its own merits. In other words, individualization is always before our minds eye. Should the afflicted one be seriously concerned about his abdominal or cardiac condition, attempt should be made promptly to discover if any real cause for anxiety exists. It may be advisable to make a complete physical examination. This will be a means of establishing rapport and a basis for further therapeutic procedure. Sometimes the patient will be engrossed in expounding his social or religious situation; then, possibly, it would be out of the question for a physical checkup. This can be deferred easily to the time of the second, or even the third, visit.
