There is quite an array of evidence that neurasthenia which has entered upon a hypochondriacal stage or complication with or without a strong hysterical admixture, is curable by sudden impressions in the form of a shock, or more gradually by frequent repetitions of an impression. Such cases, as I have shown above, occur most commonly in the stage when what may be considered the essential pathological disturbances of function have run their course and have left the patient in a state of mental disturbance which indicated that the patient’s recovery depends entirely upon her volition.
But there is none, and so far nothing has succeeded in arousing it. Persuasion is as useless and irritating, as argument would be in a case of insanity with a fixed illusion. The resemblance between this and the state of mind of a hypochondriacal neurasthenic is very close. She cannot move nor thick. Exhaustion overcomes her and keeps her its victim for years, when suddenly the scene changes, and a few days or weeks suffice to restore the patient to activity. In one instance it is attributed to medical, in another to “mind cure,” in a third to “Christian science;” in still other cases massage has done it, in others again “magnetic influence,” in others the very powerful factor necessity.
It is certain that cases of this kind, produced by sudden effects on the mind of a predisposed person, are also cured by such effects. Whatever the visible form of these effects may be -whether that of “Christian science,” joy, grief or absolute inexorable necessity, there is always to be noticed a certain force and condition involving the modern idea of suggestion, which comes to the patient in an irresistible degree and now sets the function of the will in motion again.
Experience teaches that it is by no means a matter of indifference which of these forms of effect are brought into action. In one case it is the professional Christian scientist’s method, in another the almost brutal exertion of a person’s will combined with some physical force. In either case the patient is aroused from his inertia, and discovers his powers of mental and bodily ability to act.
A deplorable result is that recoveries after such effects are attributed in the popular mind to supernatural causes. That such is not the case may be gathered form instances occurring in very sensible and intelligent patients, whose reason is scarcely ever so far disturbed and weakened that they do not resent the proposition of trying, e.g., Christian science or mind cure.
Nevertheless, it is the mind cure which the intelligent patient needs quite as much as the ignorant and superstitious person; the difference is only the form in which the influencing force is applied. While in one case it is obedience to the candidly expressed instructions of the physician, in the other case the result is the to mystification. In either case it is the powerful stimulus of hope and aroused confidence that recovery will be realized.
The definition of suggestion does not fully cover the meaning, because the influence employed is greater than mere suggestion. The physician’s plan of action should be straightforward assurance of recovery, a direct appeal to hope, and an unceasing endeavor to arouse the self-reliance of the patient, not so much by verbal exhortations as by a manner and department from which the patient learns more readily than from words what is expected. If the attitude of the physician is appreciated, and seconded by the relatives and attendants, a favorable result is much more certain to follow.
Hypnotism is not advisable. There are now existing ancient neurasthenic invalids dating from the times of spiritualism when they were famous “mediums.” Hypnotism weakness the will and nervous endurance, and produces a predisposition to emotional nervousness with an intractable erotic admixture. The suggestions sought to be instilled into a hypnotized patient amount to nothing. The mental influence of mystical treatment administered while the patients is awake is much more powerful in awaking hope and confidence than the uncertain effects of an abnormal state like that of hypnotism.
Mystification, again, though sometimes unavoidable with the best intention, is less powerful than direct and intelligible encouragement. While resort to mystification should be shunned by reputable physicians, the question arises as to what shall be done with the many who, from lack of intelligence or education, are entirely beyond the reach of honest common sense, and who will persist in mystifying themselves, who remain neurasthenic invalids in spite of the best regulations of the physician, and who do not recover unless their encouragement follows some mystical formalities which alone arouse their “faith” and finally their confidence and will-power.
For the present there is no way out of the dilemma but to submit such patients to the suggestive methods of what is popularly known as mind cure and Christian science. In doing so, physicians should use their influence as far as possible in selecting the most honest persons of this class.
DISCUSSION.
JAMES C. WOOD, M.D.: I have nothing but words of praise for Dr. Wesselhoeft’s excellent paper. It is very evident that the author’s inspiration came not from books but from actual contact with neurasthenic subjects, for the impress of originality is most conspicuous. It is a production which could only come from one of experience and from a reasoner. I consider it a most valuable contribution to the literature of that now most interesting subject, “neurasthenia”.
The doctor, in his paper, has sometimes used the term “neurasthenia” instead of “neurasthenia.” The first of these means, according to Thomas, great nervous power or excitement; the second, nervous debility. I taken it from the context that the subject dealt with is neurasthenia. To the average mind there exists what seems to me a needless confusion regarding the terms, nervous prostration, hysteria and hystero-neurosis. As I understand these terms they define distinct conditions, though there is a frequent blending the one with the other.
The term nervous prostration, which is a synonym of neurasthenia, defines itself; the term hysteria should be restricted to those general neuroses characterized particularly by psychical manifestations, though not infrequently by motor, sensory, secretory, vasomotor and reflex derangements as well; while the term hysteroneurosis implies the uterine origin of symptoms manifesting themselves in organs remote from the uterus without structural changes in such organs, being the direct result of reflex nervous influence starting from the uterus. The last term does not occur in the paper under discussion. From the standpoint of a gynecologist I think that this is misleading.
Let us see why and how it is that these three conditions (I will not call them diseases) are so frequently associated. I think that all will admit the frequent occurrence in woman of reflex symptoms, the result of pelvic lesions. An irritation staring form the pelvis is conveyed to the genito-spinal centre, thence to any or all organs with which this centre communicates. The organ oftener involved than any other is the stomach. This is shown by the frequent occurrence of nausea and vomiting following conception.
The nervous system may have been previously involved, but oftener it becomes so only after the nutrition is depraved, which, sooner or later, occurs if the pelvic lesion is not removed. The depraved blood fails to supply the nerve centres with that which they need to sustain them, and they become anaemic. Prostration is but a subjective manifestation of the anaemia, and it varies in degree from a slight indisposition to the most abject helplessness.
If, then, nervous prostration may have its beginning in a pelvic lesion, is it possible for a pelvic lesion to be inaugurated by systemic disturbances? Personally, I believe that it is, and offer this explanation as the modus operandi by which such a lesion is induced: Marked circulatory changes nearly always attend nervous prostration. The circulation is presided over by the vaso-motor system, and wear and repair depend upon the proper regulation of this system. If it becomes disturbed, the bloodvessels dilate or contract unduly, with resulting local hyperaemia or local anaemia, as the case maybe.
The climacteric flushes are the result of such disturbance. The alternate coldness and heat of the extremities, so often associated with rectal and uterine lesions, is another familiar illustration. If the brain is involved, either insomnia or drowsiness occur, depending upon whether the brain is anaemic or hyperaemic. Flatulence, gastralgia, and nervous dyspepsia result when the stomach is similarly affected. The womb and the ovaries, because of the periodical congestion imposed upon them, are oftener implicated by these unnatural circulatory disturbances than any of the pelvic organs, and in time also become unduly hyperaemic or anaemic, as the case may be.
