Psychotherapy

Two French observers believe that they have proved the sense of olfaction to be nine times more acute in women than in men.

So far as the present paper might serve in evidence, I should be inclined to say that the sense of smell was keener in women than in men, but as to this there is extreme diversity of opinion and the whole question awaits further investigation.47

Dread of the Dark.—The discipline suggested with regard to overcoming the dread of heights must be applied to any of these dreads if patients are to be made comfortable. They can form the opposite habit and by refusing to yield to their fears can do much to lessen them. Nearly everyone who is unaccustomed to sleeping in a dark house alone has dreads that come over him when he first tries to do it. Every noise is exaggerated in significance and the creaking of stairs and rattling windows and doors and the wind through the trees are all made significant of something quite other than what they are. Nearly everyone knows, however, that this can be overcome simply by refusing to pay any attention to the idle fears that come over us as a consequence of the tension due to loneliness, and after a time, sleeping in a strange room and a strange house in the dark is not a difficult matter. It is harder for some people to accomplish than others, but it is impossible for none. Here is the lesson that all the sufferers from dreads must learn. Gradually, quietly, persistently, they must resist the dreads that come over them, must deliberately, without excitement, do the opposite to that suggested by their apprehension, until habits are formed that enable them to accomplish without discomfort what was before a source of even serious ill-feeling.

The dread of darkness that so many people have is usually supposed to be cowardice. It is not, however, in most cases, but is due to idiosyncrasy or to certain special physical factors in the environment. If children have been brought up so that when they were small a light has been constantly shining in their eyes, even though only a dim light, it will often be difficult to accustom them to be quite comfortable in the dark. Much depends on habit in this matter. I have known men, who, when they came from Ireland, feared the darkness of the coal mines very much and their dread was increased by the awful horror of possible ghostly appearances, since so many accidents had taken place where they worked. After some years, however, they were quite placid about it and would calmly go into the mine as fire bosses at three and four in the morning, long before others were to go in, examining absolutely dark passages by the mile, with no human being near them and with the creaking of the pillars, the dripping of water, the rumbling of the sides and the occasional fall of a small particle from the roof, besides the noises of rats to add to the disturbing factors. Like going up on a high building, one may get entirely accustomed to it so as scarcely to notice it at all.

When the fear is allowed to take hold of one, however, and no effort is made to overcome it, it may prove quite seriously disturbing. The unaccustomed, however, means more than anything else in this matter. Sometimes, indeed, people have a dread of the dark that seems to be inborn and that apparently cannot be overcome, that, like the fear of cats or of lightning, may be quite beyond rational control. Hobbes, the English philosopher, was so perturbed by darkness that he kept a light in his bedroom all night. I know this to be the case in a clergyman who had been quite undisturbed about darkness until he was awakened one night by a burglar. He demanded "who's there?" and received as answer without further parley a bullet that fortunately struck only the head of the bed, but so close that it singed him. The burglar escaped, but the clergyman was never afterwards able to sleep without a light. Rousseau, the French philosopher, was also much afraid of darkness. Ordinarily it is presumed that superstition has something to do with this fear and that the victim of it has ghosts in mind or at least dreads spirit manifestations. Neither Hobbes nor Rousseau, however, was likely to be timorous about ghostly visitants. It was with them a physical idiosyncrasy.

Associated with dread of darkness is the fear of finding some one in a dark room whose presence may startle us. Sir Samuel Romilly, famous for his labors for the reform of the English criminal law, and who must be considered one of the great humanitarians of the nineteenth century, had this dread to an acute degree. It went so far that whenever he slept in a strange place he carefully examined all the possible hiding-places in the room and in wardrobes or closets connected with it and, as a last precaution, never failed to look under the bed. He did this even when he was in his own house.48 This, however, is not so unusual, even among men, as might be thought. Most women who sleep alone want to investigate under the bed and in a hotel closets and wardrobes and even bureau drawers are likely to be examined. Habit in this regard may make one quite miserable and over-solicitous. I have had patients whose sleep was seriously disturbed by the remembrance that they had not looked under the bed and who feared to get up and light a light to do so lest there should be someone there. Indeed, the idea of putting their feet on the floor before the light had come to reassure them seemed quite out of the question.

Dreads Connected with Water.—Strange as it may seem, water constitutes a source of dread for some people. We have the records of it in the peculiarities of great men and it is not unusual to meet it in common life. Dropping water is a source of disturbance for most people. It is quite impossible for the majority of men and women to go on writing or reading with any comfort if water is dropping near them. Dropping water, when one is trying to go to sleep, is one of the worst of awakeners. The Chinese are said to put people to death in horrible torture by having a drop of water fall at regular intervals on their heads. Robert Boyle, the great father of chemistry and a very sensible man in many ways, is said to have been thrown into convulsions by the sound of water dropping from a faucet. The splashing of water on some people is a poignant source of torture. I have had a woman patient who could not go to services where there was a sprinkling of water, for it seriously disturbed her and gave her a sense of depression that would not be overcome for some time. Peter the Great, though the father of the Russian navy, and though he passed many years of his life in Holland, used to shudder at the sight of water, and if, when out driving, his carriage passed near a stream or over a bridge, he would close the windows and be overtaken with terror that brought the perspiration out all over him.

Dread of Death.—The fear of death is one of the dreads that bothers young as well as old, and, curiously enough, as its inevitable approach becomes more certain, men are prone to dread it more. Long ago Sophocles said:

None cleave to life so fondly as the old,

—and this has remained true for all the centuries since. A young man is quite ready to throw his life away, but the old man hesitates and even in the midst of suffering, if it is not absolutely continuous, craves that death shall not come. Sophocles' great rival, the elder Greek dramatic poet AEschylus, had said:

How far from just the hate men bear to death

Which comes as safeguard against many ills,

—but his message was only for those with the character to face the worst. One may reason with the dread of death, however, and patients can be given motives from philosophy, literature, religion and experience that will help to relieve, though it will not entirely cure them. Shakespeare said in "Julius Caesar":

Cowards die many times before their deaths.

The valiant never taste of death but once,

—and people may be aroused to appreciate this.

Fear of Early Death .—Many fear that if they have shown symptoms of delicacy of constitution at some time in life or suffered severely from some serious disease, that they are not likely to live long and, above all, that they are almost sure not to be able to accomplish anything worth while in life. The old proverb is "a healthy mind in a healthy body." This is, however, the ideal. There are very few ideals realized in life. Just because a man has a weak body is no argument at all that his mind may be weak and some of the world's finest work has been accomplished by men whose bodies were always delicate. Metchnikoff is the apostle of old age to our generation, but it is he, also, who has pointed out that many distinguished workers in science, in poetry, in art, men who have left a precious heritage in succeeding generations, were delicate all their lives. He cites such typical examples as Fresnel, the great French physicist; Giacomo Leopardi, the distinguished Italian poet; Weber and Schumann, the great German musicians, and Chopin, the Polish composer and pianist, all of whom did work that the world would not willingly miss, in spite of delicacy of health and weakness of body which shortened their lives. Intellectual power is not dependent on bodily energy and accomplishment is not a question of years of work, but intensity of work.

It would not be difficult to add many other names to those mentioned by Metchnikoff. Naturally his thoughts recurred to men of distinction on the Continent, but in English-speaking countries we have a number of typical examples of strong minds doing fine work in weak bodies. Robert Louis Stevenson is the best remembered by our generation. Elizabeth Barrett Browning, delicate all of her life, a neurasthenic during the precious adolescent years that are supposed to mean so much for future accomplishment, always an invalid to some degree at least, did some of the best work that was given to any woman to do during the nineteenth century. J. Addington Symonds, the historian of the Renaissance and of Italian literature, is another striking example of a man who had to do his work under great physical difficulties, yet who left a long bookshelf of large volumes after him as the product of the hours that he could cheat from caring for his health. Henry Harland, whose recent death all too young was a blow to the English-speaking world, is another striking example. The names of such men and women and their stories must be made familiar to people who are themselves delicate in health and who fear for their future and, above all, are despondent about the possibility of ever doing anything worth while.

Dread of Insanity.—People who have relatives who are already sufferers from such severe forms of insanity as require asylum treatment are often likely to be much disturbed over the possibility that they themselves should become insane. Of course, there is no doubt but that these people are much more liable to suffer from insanity than others, but their worrying over the matter is sure to do them harm rather than good. There are quite enough sources of worry in life without the additional one of dread of a future event that may not occur, and this must be made as clear to them as possible. The people who have no obligations on them, who have nothing to do that they feel they have to do, are especially likely to suffer from such obsessions. The best possible relief for them is afforded, not by the effort not to worry about their dread, which usually has exactly the opposite effect and emphasizes their fear by the constant effort which they make to put it aside, but by getting something else to interest them. This must not be merely a passing interest, if possible, but a serious attraction of some kind that fully occupies the mind. A hobby is an excellent thing for this, but alas! a hobby must be cultivated for many years, as a rule, to become powerful enough to bring relief in such serious matters.

Occasionally the thought of the insane asylum or the sight of an institution of this kind passed even at a distance in the train is enough to give some people a fit of depression that may last for some time. The thought of going to visit their ailing relatives is enough to make them even more depressed. I have sometimes found that in chosen cases, especially among women and those of sympathetic disposition, the apparently heroic remedy of making them visit their relatives in the asylum was excellent for them. It is the usual rule for people who are themselves sane to consider that it is the greatest hardship of asylum confinement for the patients to be associated with those whom they recognize to be insane. Exactly the opposite effect is the usual result. To be among people, many of whom are more irrational than themselves and some of whom are quite beside themselves, proves a stimulus and an encouragement. Contentment has been defined by a cynic as the feeling that things might be worse.

DREADS OF MEN OF GENIUS

The insane are particularly prone to suffer from dreads, so that some people argue from their dreads to the thought of insanity. It is quite a mistake, however, to think of dreads as necessarily connected with insanity in any way. They are irrational though they will commonly be found to be dependent on some special physical condition. This is usually some exaggeration of attention to a sensation natural enough in itself but disturbing when dwelt on to such a degree that it produces a much greater reaction in these individuals than in other people. These dreads have existed in all sorts of people. It is said that they are more frequent in the highly intellectual, especially in the class known as geniuses, and they are often said to represent the definite evidence of a relationship between genius and insanity. I have always felt, however, that they are quite as common among ordinary people who have no genius and no signs of it as among the so-called geniuses. They are not so much spoken of by ordinary people, however, because they are rather ashamed of them. Genius, on the contrary, is quite willing, as a rule, to exploit its peculiarities for the benefit of the public, or what is even more true, its peculiarities are remembered and commented on as details of history.

With this in mind the following paragraph from Dr. Dorland's book on "The Ages of Mental Virility"49 deserves to be recalled. He has gathered a number of examples that are very interesting:

Fear has played an important rôle in the development of the antipathies of the great—fear that was often groundless in its origin and inexplicable in its manifestation. The unaccountable fear of dogs is not so common as ailurophobia, although it is said that De Musset cordially detested them, and Goethe despised them, notwithstanding, forsooth, he kept a tame snake. Much more frequent is the fear of spiders, centipedes, and other insects. Charles Kingsley, thorough naturalist though he was, entertained an unconquerable horror of spiders, even the common house spider; Turenne became weak when he saw a spider; while the author of the "Turkish Spy" once asserted that he would far prefer, with sword in hand, "to face a lion in his desert lair than to have a spider crawl over him in the dark." Lord Lauderdale, on the contrary, while declaring that the mewing of a cat was "sweeter to him than any music," had a most intense dislike for the flute and the bag-pipe; and Dr. Johnson was so fond of his cats that he would personally buy oysters for them, his servants being too proud to do so.

There are curious contradictions to be found in these matters. Montaigne confesses that he did his best writing and was in the best humor for keeping at his Essays while stroking his favorite cat with his left hand, his other being occupied with his writing. This would be seriously disturbing to many people, but apparently occupied certain distracting sensory tendencies and enabled him to concentrate his mental energies. To many people the very thought of doing anything like this would put all ideas for writing out of their mind. Other of Montaigne's peculiarities are quite as interesting. He always refused to sit down with thirteen at table, his liking for odd numbers was so great that he made all sorts of excuses in order not to use even numbers and his aversion for Friday made the quota of work that he could do on that day much less than any other day of the week.

OBSESSIONS

There are many curious obsessions that disturb people and that are often extremely difficult of explanation even by themselves. Dr. Johnson, one of the most sensible men in many ways in his time in England, could not, it is said, pass a post on the street without touching it. At least if he did so he felt that somehow he had omitted to do something that he ought to have done and it would make him uncomfortable. There are many people who have some idea that it is lucky to touch posts as they pass along and the number of people who do things like this is larger than might be imagined. Many people put themselves out of the way in order to avoid letting a post come between the person with whom they are walking and themselves because it is said to be unlucky. Most of them will laugh at it, but still they continue the practice in spite of the bother it may occasion them. Occasionally there is some incident in their past life which accounts for such obsessions, though the patients themselves are occasionally not quite conscious of them. Dr. Boris Sidis tells the story of a man who could not take a car with an odd number. Psycho-analysis showed that he had once seen a child run down by an odd-numbered car.

In such cases there has been a long series of suggestions that have created a dominant state of mind. The only way to overcome this when it becomes a serious annoyance is to undo the influence of the suggestions by a continued series of counter-suggestions, and by such discipline of mind as will prevent the former suggestion from exerting itself. The cure can be accomplished in this way, though, as a rule, the patient will need the help of someone else.

FORGOTTEN FRIGHTS AND DREADS

Dreads founded on terrifying or seriously disturbing incidents of the past, the details of which at times have gone out of the patient's mind, are not infrequent. It is probable that many of the unreasoning dreads have some such foundation and occasionally, if patients' memories are carefully searched, the whole story can be reconstructed. All that is needed, as a rule, is to get the patients interested in conjunction with the physician in tracing the origin of their affliction and not infrequently an interesting story will turn up. Hypnosis used to be considered of great value for such reconstructions, but unfortunately patients then become so suggestible that it is often difficult to decide how much of what is brought out by questioning is due to the suggestive quality that cannot well be kept out of questions, and how much to a true redintegration of memory.

Frights in children may for a time be forgotten and yet the memory of them may come back, or a dread connected with them develop, that will make the patient profoundly miserable. One of my patients slipped and fell on a smooth steel plate at the head of a coal breaker and was only saved by good fortune from falling a long distance. This happened when he was a boy of ten. There were times when the memory of this recurred so vividly as to set him all atremble and he could not look down from a height without something of the feeling of goneness coming over him that he felt at the time of the accident. The calling of his attention to the fact that his memory probably exaggerated the danger he had been in as a boy led him to go back and have another look at the conditions in which he had fallen some thirty years before. He found that they were not so dangerous as he thought and that while he would have been scratched and his clothes would probably have been soiled and torn, he would not have been seriously injured. This has greatly diminished his dread of heights.

Various physical manifestations may be due to dreads which are often supposed to be the result of some physical process in the nervous system. Occasional fits of trembling, for instance, are, in sensitive people, due to more or less forgotten memories of dangers or frights. Occasionally even slight convulsive seizures may follow such recurrent dreads. Not a few of the cases of so-called hystero-epilepsy in the borderland between hysteria and epilepsy but always one or the other, are due to such mental states rather than to any physical conditions. Such incomplete memories are sometimes spoken of as subconscious. The word subconscious has been so much abused, however, that I prefer not to use it. The reminiscences have been obscured by an accumulation of other facts but may with an effort of attention and concentration of mind be recalled. Hypnosis, or the milder form of it spoken of as the hypnoidal state, may enable the patient to recall them more vividly by enabling him to concentrate his attention, but there are always risks that suggestion will vitiate the old story in these cases. With care all the details can usually be recalled and the patient is thus given renewed confidence in himself and his own powers and does not learn to lean on someone else in the process.

TREATMENT

The most important psychotherapeutic factor for the relief of the discomfort due to dreads is the knowledge that there are so many and such different varieties of them and that so many people suffer from them. Many of those afflicted are inclined to think that their cases are almost unique. To have them know that there are all forms and phases of these curious aversions is to make them laugh a little at their own because they laugh so readily at others, and it gives them new courage for the attempt to conquer them. The aversion cannot be entirely overcome, but it can be prevented from seriously influencing sleep or appetite or occupation. This is after all the important feature of the case from the standpoint of psychotherapy. Besides, patients are encouraged not only to take up, but, above all, to continue, the practice of that mental discipline and self-control which will enable them to lessen their natural aversion, if not to remove it entirely. I have many cases in which patients' aversions have been entirely overcome. Curiously enough, there are rather often relapses when the patients are run down in weight, or are in an irritable condition from worry or emotional stress, and then something of the former mental discipline has to be reinstituted to make them once more free from disturbance.

I have sometimes found that the recommendation to patients suffering from dreads to read Mary Wollstonecraft Shelley's "Frankenstein" has proved an excellent therapeutic agent. This is particularly true when the patients are women, for it is likely to bring them close to the sad lives of the Shelleys. The circumstances in which the book was written add to the appeal. "Frankenstein" itself is interesting, so that the mood created by this combination of interests is excellently therapeutic. It will be recalled that in "Frankenstein" the inventor seeking to make a man does make an automaton that is able to move and to talk, but that then haunts its inventor, demanding of him a soul. It proves a plague to him, but he cannot escape from it. Fly where he will his creation follows him and bothers the life out of him, killing a friend, strangling his bride, and making existence intolerable. The symbol is complete and to the point. The things that bother us in life are to a great extent of our own invention. The dreads that make so many people miserable are practically always without any groundwork in reality, figments of our imagination without the soul of real life, but capable, as was Frankenstein's monster, of making their creators intensely miserable and with them, to an even greater degree, their friends.

CHAPTER IV

HEREDITY

There are so many false and, indeed, from a scientific standpoint, utterly groundless notions with regard to heredity which, as a result of the popularization of science, have become widely diffused, that notions about inheritance are a most copious source of dreads and discouragement and even produce inhibition of resistive vitality against disease on the part of many patients. At first it seemed to me as though the subject should be treated in the chapter on Dreads. It is so much more important than the other dreads, however, and there are so many people with so many different notions as to the evil influence of heredity that it seems advisable to devote a special chapter to it in which to provide contrary suggestion. Many patients are constantly suggesting to themselves that, because they are suffering from certain symptoms due to real or supposed hereditary conditions, there is little or no hope of their recovery or of any effective relief. In the old days, when tuberculosis was considered to be hereditary, it was almost hopeless to try to rouse patients into a state of vital resistance to their disease because of this overhanging dread. Such a prepossession of mind must be overcome.