The Project Gutenberg EBook of Outwitting Our Nerves by Josephine A. Jackson and Helen M. Salisbury This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org Title: Outwitting Our Nerves A Primer of Psychotherapy Author: Josephine A. Jackson and Helen M. Salisbury Release Date: February 8, 2005 [EBook #14980] Language: English Character set encoding: ISO-8859-1 *** START OF THIS PROJECT GUTENBERG EBOOK OUTWITTING OUR NERVES *** Produced by Rick Niles, Ronald Holder and the PG Online Distributed Proofreading Team. OUTWITTING OUR NERVES A PRIMER OF PSYCHOTHERAPY BY JOSEPHINE A. JACKSON, M.D. HELEN M. SALISBURY NEW YORK THE CENTURY CO. 1922 1921, by THE CENTURY CO. PRINTED IN U.S.A. TO MARY PATTERSON MANLY A LOVER OF TRUTH FOREWORD "Your trouble is nervous. There is nothing we can cut out and there is nothing we can give medicine for." With these words a young college student was dismissed from one of our great diagnostic clinics. The physician was right. In a nervous disorder there is nothing to cut out and there is nothing to give medicine for. Nevertheless there is something to be done,—something which is as definite and scientific as a prescription or a surgical operation. Psychotherapy, which is treatment by the mental measures of psycho-analysis and re-education, is an established procedure in the scientific world to-day. Nervous disorders are now curable, as has been proved by the clinical results in scores of cases from civil life, under treatment by Freud, Janet, Prince, Sidis, DuBois, and others; and in thousands of cases of war neuroses as reported by Smith and Pear, Eder, MacCurdy, and other military observers. These army experts have shown that shell-shock in war is the same as nervousness in civil life and that both may be cured by psycho-analysis and re-education. For more than a decade, in handling nervous cases, I have made use of the findings of recognized authorities on psychopathology. Truths have been applied in a special way, with the features of re-education so emphasized that my home has been called a psychological boarding-school. As the alumni have gone back to the game of life with no haunting memories of usual sanatorium methods, but with the equipment of a fuller self-knowledge and sense of power, they have sent back a call for some word that shall extend this helpful message to a larger circle. There has come, too, a demand for a book which shall give accurate and up-to-date information to those physicians who are eager for light on the subject of nervous disorders, and especially for knowledge of the significant contributions of Sigmund Freud, but who are too busy to devote time to highly technical volumes outside their own specialties. This need for a simple, comprehensive presentation of the Freudian principles I have attempted to meet in this primer of psychotherapy, providing enough of biological and psychological background to make them intelligible, and enough application and illustration to make them useful to the general practitioner or the average layman. JOSEPHINE A. JACKSON. Pasadena, California, 1921. CONTENTS PART I: THE STRANGE WAYS OF NERVES CHAPTER I PAGE In which most of us plead guilty to the charge of "nerves." Nervous Folk 3 CHAPTER II In which we learn what "nerves" are not and get a hint of what they are. The Drama of Nerves 10 PART II: "HOW THE WHEELS GO ROUND" CHAPTER III In which we find a goodly inheritance. The Story of the Instincts 33 CHAPTER IV In which we learn more about ourselves. The Story of the Instincts (Continued) 51 CHAPTER V In which we look below the surface and discover a veritable wonderland. The Subconscious Mind 77 CHAPTER VI In which we learn why it pays to be cheerful. Body and Mind 118 CHAPTER VII In which we go to the root of the matter. The Real Trouble 141 PART III: THE MASTERY OF "NERVES" CHAPTER VIII In which we pick up the clue. The Way Out 183 CHAPTER IX In which we discover new stores of energy and relearn the truth about fatigue. That Tired Feeling 219 CHAPTER X In which the ban is lifted. Dietary Taboos 250 CHAPTER XI In which we learn an old trick. The Bugaboo of Constipation 278 CHAPTER XII In which handicaps are dropped. A Woman's Ills 300 CHAPTER XIII In which we lose our dread of night. That Interesting Insomnia 322 CHAPTER XIV In which we raise our thresholds. Feeling Our Feelings 333 CHAPTER XV In which we learn discrimination. Choosing Our Emotions 359 CHAPTER XVI In which we find new use for our steam. Finding Vent in Sublimation 379 Glossary 386 Bibliography 390 Index 393 OUTWITTING OUR NERVES CHAPTER I In Which Most of Us Plead Guilty to the Charge of "Nerves." NERVOUS FOLK Who's Who Whenever the subject of "nerves" is mentioned most people begin trying to prove an alibi. The man who is nervous and knows that he is nervous, realizes that he needs help, but the man who has as yet felt no lack of stability in himself is quite likely to be impatient with that whole class of people who are liable to nervous breakdown. It is therefore well to remind ourselves at once that the line between the so-called "normal" and the nervous is an exceedingly fine one. "Nervous invalids and well people are indistinguishable both in theory and in practice," [1] and "after all we are most of us more or less neurasthenic." [2] The fact is that everybody is a possible neurotic. Putnam: Human Motives, p. 117. DuBois: Physic Treatment of Nervous Disorders, p. 172. So, as we think about nervous folk and begin to recognize our friends and relatives in this class, it may be that some [1] [2] of us will unexpectedly find ourselves looking in the mirror. Some of our lifelong habits may turn out to be nervous tricks. At any rate, it behooves us to be careful about throwing stones, for most of us live in houses that are at least part glass. The Earmarks Am I "Like Folks"? Before we begin to talk about the real sufferer from "nerves," the nervous invalid, let us look for some of the earmarks that are often found on the supposedly well person. All of these signs are deviations from the normal and are sure indications of nervousness. The test question for each individual is this: "Am I 'like folks'?" To be normal and to be well is to be "like folks." Can the average man stand this or that? If he can, then you are not normal if you cannot. Do the people around you eat the thing that upsets you? If they do, ten chances to one your trouble is not a physical idiosyncrasy, but a nervous habit. In bodily matters, at least, it is a good thing to be one of the crowd. Many people who would resent being called anything but normal—in general—are not at all loth to be thought "different," when it comes to particulars. Are there not many of us who are at small pains to hide the fact that we "didn't sleep a wink last night," or that we "can't stand" a ticking clock or a crowing rooster? We sometimes consider it a mark of distinction to have a delicate appetite and to have to choose our food with care. If we are frank with ourselves, some of us will have to admit that our own ailments seem interesting, while the other person's ills are "merely nervous" or imaginary or abnormal. After all, a good many of us will have to plead guilty to the charge of nervousness. We have only to read the endless advertisements of cathartics and "internal baths," or to check up the quantity of laxatives sold at any drug store, to realize the wide-spread bondage to that great bugaboo constipation. He who is constipated can hardly prove an alibi to "nerves." Then there are the school-teachers and others who are worn out at the end of each year's work, hardly able to hold on until vacation; and the people who can't manage their tempers; and those who are upset over trifles; and those who are dissatisfied with life. To a certain degree, at least, all of these are nervous persons. The list grows. Half-Power Engines. These people are all supposed to be well. They keep going—by fits and starts—and as they are used to running on three cylinders, with frequent stops for repairs, they accept this rate of living as a matter of course, never realizing that they might be sixty horse-power engines, instead of their little thirty or forty. For this large and neglected class of people psychotherapy has a stimulating message, and for them many of the following pages have been written. The Real Sufferers. These so-called normal people are merely on the fringe of nervousness, on the border line between normality and disease. Beyond them there exists a great company of those whose lives have been literally wrecked by "nerves." Their work interrupted or given up for good, their minds harassed by doubts and fears, their bodies incapacitated, they crowd the sanatoria and the health resorts in a vain search for health. From New England to Florida they seek, and on to Colorado and California, and perhaps to Hawaii and the Orient, thinking by rest and change to pull themselves together and become whole again. There are thousands of these people—lawyers, preachers, teachers, mothers, social workers, business and professional folk of all sorts, the kind of persons the world needs most —laid off for months or years of treatment, on account of some kind of nervous disorder. Various Types of Nervousness. The psychoneuroses are of many forms. [3] To some people "nerves" means nervous prostration, breakdown, fatigue, weakness, insomnia, the blues, upset stomach, or unsteady heart,—all signs of so-called neurasthenia or nerve-weakness. To others the word "nerves" calls up memories of strange, emotional storms that seem to rise out of nowhere, to sweep the sky clear of everything else, and to pass as they came, leaving the victim and the family equally mystified as to their meaning. These strange alterations of personality are but one manifestation of hysteria, that myriad-faced disorder which is able to mimic so successfully the symptoms of almost every known disease, from tumors and fevers to paralysis and blindness. The technical term for nervousness is psycho-neurosis—disease of the psyche. There are certain "real neuroses" such as paralysis and spinal-cord disease, which involve an organic impairment of nerve-tissue. However, as this book deals only with psychic disturbance, we shall, throughout, use the term neuroses and psycho-neuroses indiscriminately, to denote nervous or functional disorders. To still other people nervous trouble means fear,—just terrible fear without object or meaning or reason (anxiety neuroses); or a definite fear of some harmless object (phobia); or a strange, persistent, recurrent idea, quite foreign to the personality and beyond the reach of reason (obsession); or an insistent desire to perform some absurd act (compulsion); or perhaps, a deadly and pall-like depression (the blues). As a matter of fact, the neuroses include all these varieties, and various shades and combinations of each. There are, however, certain mental characteristics which recur with surprising regularity in most of the various phases— dissatisfaction, lack of confidence, a sense of being alone and shut in to oneself, doubt, anxiety, fear, worry, self- depreciation, lack of interest in outside affairs, pessimism, fixed belief in one's powerlessness, along whatever line it may be. Underneath all these differing forms of nervousness are the same mechanisms and the same kind of difficulty. To understand one is to understand all, and to understand normal people as well; for in the last analysis we are one and all built on the same lines and governed by the same laws. The only difference is, that, as Jung says, "the nervous person [3] falls ill of the conflicts with which the well person battles successfully." Summary Since at least seventy-five per cent. of all the people who apply to physicians for help are nervous patients; and since these thousands of patients are not among the mental incompetents, but are as a rule among the highly organized, conscientious folk who have most to contribute to the leadership of the world, it is obviously of vital importance to society that its citizens should be taught how to solve their inner conflicts and keep well. In this strategic period of reconstruction, the world that is being remodeled cannot afford to lose one leader because of an unnecessary breakdown. There is greater need than ever for people who can keep at their tasks without long enforced rests; people who can think deeply and continuously without brain-fag; people who can concentrate all their powers on the work in hand without wasting time or energy on unnecessary aches and pains; people whose bodies are kept up to the top notch of vitality by well-digested food, well-slept sleep, well-forgotten fatigue, and well-used reserve energy. That such a state of affairs is no Utopian dream, but is merely a matter of knowing how, will appear more clearly in later chapters. CHAPTER II In which we learn what "nerves" are not, and get a hint of what they are THE DRAMA OF NERVES An Exploded Theory "Nerves" not Nerves. Pick up any newspaper, turn over a few pages, and you will be sure to come to an advertisement something like this: Tired man, your nerves are sick! They need rest and a tonic to restore their worn-out depleted cells! No wonder people have believed this kind of thing. It has been dinned into their ears for many years. They have read it with their breakfast coffee and gazed at it in the street cars and even heard it from their family physicians, until it has become part and parcel of their thinking; yet all the time the fundamental idea has been false, and now, at last, the theory is exploded. So far as the modern laboratory can discover, the nerves of the most confirmed neurotic are perfectly healthy. They are not starved, nor depleted, nor exhausted; the fat-sheath is not wanting, there is no inflammation, there is nothing lacking in the cell itself, and there is no accumulation of fatigue products. Paradoxical as it may sound, there is nothing the matter with a nervous person's nerves. The faithful messengers have borne the blame for so long that their name has gotten itself woven into the very language as symbolic of disease. When we speak of nervous prostration, neurasthenia, neuroses, nervousness, and "nerves" we mean that body and mind are behaving badly because of functional disorder. These terms are good enough as figures of speech, so long as we are not fooled by them; but accepting them in their literal sense has been a costly procedure. Thanks to the investigations of physiologist and psychologist, usually combined in the person of a physician, "nervousness" has been found to be not an organic disease but a functional one. This is a very important distinction, for an organic disease implies impairment of the tissues of the organ, while a functional disorder means only a disturbance of its action. In a purely nervous disorder there seems to be no trouble with what the nerves and organs are, but only with what they do; it is behavior and not tissue that is at fault. Of course, in real life, things are seldom as clear-cut as they are in books, and so it happens that often there is a combination of organic and functional disease that is puzzling even to a skilled diagnostician. The first essential is a diagnosis as to whether it be an organic disease, with accompanying nervous symptoms, or a functional disturbance complicated by some minor organic trouble. If the main cause is organic, only physical means can cure it, but if the trouble is functional, no amount of medicine or surgery, diet or rest, will touch it; yet the symptoms are so similar and the dividing line is so elusive, that great skill is sometimes required to determine whether a given symptom points to a disturbance of physical tissue or only to behavior. If the physician is sometimes fooled, how much more the sufferer himself! Nausea from a healthy stomach is just as sickening as nausea from a diseased one. A fainting-spell is equally uncomfortable, whether it come from an impaired heart or simply from one that is behaving badly for the moment. It must be remembered that in functional nervousness the trouble is very real. The organs are really "acting up." Sometimes it is the brain that misbehaves instead of the stomach or heart. In that case it often reports all kinds of pains that have no origin outside of the brain. Pain, of course, is perceived only by the brain. Cut the telegraph wire, the nerve, and no amount of injury to the finger can cause pain. It is equally true that a misbehaving brain can report sensations that have no external cause, that have not come in through the regular channel along the nerve. The pain feels just the same, is every bit as uncomfortable as though its cause were external. Sometimes, instead of reporting false pains, the brain misbehaves in other ways. It seems to lose its power to decide, to concentrate, or to remember. Then the patient is almost sure to fancy himself going insane. But insanity is a physical disease, implying changes or toxins in the brain cells. Functional disorders tell another story. Their cause is different, even though the picture they present is often a close copy of an organic disease. Distorted Pictures. It should not be thought, however, that the symptoms of functional and organic troubles are identical. Hysteria and neurasthenia closely simulate every imaginable physical disease, but they do not exactly parallel any one of them. It may take a skilled eye to discover the differences, but differences there are. Functional troubles usually show a near-picture of organic disease, with just enough contradictory or inconsistent features to furnish a clue as to their real nature. For this reason it is important that the treatment of the disease be solely the province of the physician; for only the carefully trained in all the requirements of diagnosis can differentiate the pseudo from the real, the innocuous from the disastrous. False or nervous neuritis may feel like real neuritis (the result of poisons in the blood), but it gives itself away when it localizes itself in parts of the body where there is no nerve trunk. The exhaustion of neurasthenia sometimes seems extreme enough to be the result of a dangerous physical condition; but when this exhaustion disappears as if by magic under the proper kind of treatment, we know that the trouble cannot be in the body. Let it be said, then, with all the emphasis we can command, "nerves" are not physical. Laboratory investigation, contradictory symptoms, and response to treatment all bear witness to this fact. Whatever symptoms of disturbance there may be in pure nervousness, the nerves and organs can in no way be shown to be diseased. The Positive Side "Nerves" not Imaginary. "But," some one says, "how can healthy organs misbehave in this way? Something must be wrong. There must be some cause. If 'nerves' are not physical, what are they? They surely can't be imaginary." Most emphatically, they are real; nothing could be more maddening than to have some one suggest that our troubles are "mere imagination." No wonder such theories have been more popular with the patient's family than with the patient himself. Many years ago a physician put the whole truth into a few words: "The patient says, 'I cannot'; his friends say, 'He will not'; the doctor says, 'He cannot will.'" He tries, but in the circumstances he really cannot. The Man behind the Body. The trouble is real; the organs do "act up"; the nerves do carry the wrong messages. But the nerves are merely telegraph wires. They are not responsible for the messages that are given them to carry. Behind the wires is the operator, the man higher up, and upon him the responsibility falls. In functional troubles the body is working in a perfectly normal way, considering the perverted conditions. It is doing its work well, doing just what it is told, obeying its master. The troubles are not with the bodily machine but with the master. The man behind the body is in trouble and he really has no way of showing his pain except through his body. The trouble in nervous disorders is in the personality, the soul, the realm of ideas, and that is not your body, but you. Loss of appetite may mean either that the powers of the physical organism are busily engaged in combating some poison circulating in the blood, or that the ego is "up against" conditions for which it has "no stomach." Paralysis may be due to a hemorrhage into the brain tissues from a diseased blood vessel, or it may symbolize a sense of inadequacy and defeat. Exaggerated exhaustion, halting feet, stammering tongue, may give evidence of a disturbed ego rather than of a diseased brain. All Body and no Mind. At last we have begun to realize what we ought to have known all along,—that the body is not the whole man. The medical world for a long time has been in danger of forgetting or ignoring psychic suffering, while it has devoted itself to the treatment of physical disease. By way of condoning this fault it must be recognized that the five years of medical school have been all too short to learn what is needed of physiology and anatomy, histology, bacteriology, and the various other physical sciences. But at last the medical schools are realizing that they have been sending their graduates out only half-prepared—conversant with only one half of a patient, leaving them to fend for themselves in discovering the ways of the other half. Many an M.D. has gone a long way in this exploration. Native common sense, intuition, and careful study have enabled him to go beyond what he had learned in his text-books. But in the best universities the present-day student of medicine is now being given an insight into the ways of man as a whole—mind as well as body. The movement can hardly proceed too rapidly, and when it has had time to reach its goal, the day of the long-term sentence to nervousness will be past. In the meanwhile most physicians, lacking such knowledge and with the eye fixed largely on the body, have been pumping out the stomach, prescribing lengthy rest-cures, trying massage, diet, electricity, and surgical operations, in a vain attempt to cure a disease of the personality. Physical measures have been given a good trial, but few would contend that they have succeeded. Sometimes the patient has recovered—in time—but often, apparently, despite the treatment rather than because of it. Sometimes, in the hands of a man like Dr. S. Weir Mitchell, results seem good, until we realize that the same measures are ineffective when tried by other men, and that, after all, what has counted most has been the personality of the physician rather than his physical treatment. No wonder that most doctors have disliked nervous cases. To a man trained in all the exactness of the physical sciences, the apparent lawlessness and irresponsibility of the psychic side of the personality is especially repugnant. He is impatient of what he fails to comprehend. All Mind and no Body. This unsympathetic attitude, often only half conscious on the part of the regular practitioners, has led many thousands of people to follow will-o'-the-wisp cults, which pay no attention to the findings of science, but which emphasize a realization of man's spiritual nature. Many of these cults, founded largely on untruth or half-falsehood, have succeeded in cases where careful science has failed. Despite fearful blunders and execrable lack of discrimination in attempting to cure all the ills that flesh is heir to by methods that apply only to functional troubles, ignorant enthusiasts and quacks have sometimes cured nervous troubles where the conscientious medical man has had to acknowledge defeat. The Whole Man. But thinking people are not willing to desert science for cults that ignore the existence of these physical bodies. If they have found it unsatisfactory to be treated as if they were all body, they have also been unwilling to be treated as if they were all mind. They have been in a dilemma between two half-truths, even if they have not realized the dilemma. It has remained for modern psychotherapy to strike the balance—to treat the whole man. Solidly planted on the rock of the physical sciences, with its laboratories, physiological and psychological, and with a long record of investigation and treatment of pathological cases, it resembles the mind cure of earlier days or the assertions of Christian Science about as much as modern medicine resembles the old bloodletting, leeching practices of our forefathers. For the last quarter-century there have been scattered groups of physicians,—brilliant, patient pioneers,—who, recognizing man as spirit inhabiting body, have explored the realm of man's mind and charted its paths. These pioneers, beginning with Charcot, have been men of acknowledged scientific training and spirit, whose word must be respected and whose success in treating functional troubles stands out in sharp contrast to the fumblings of the average practitioner in this field. The results of their work have been positive, not negative. They have not merely asserted that nervous disorders are not physical; they have discovered what the trouble is and have found it to be discoverable and removable in almost every case, provided only that the right method is used. Ourselves and Our Bodies. If the statement that "nervous troubles are neither physical nor imaginary but a disease of the personality," sounds rather mystifying to the average person, it is only because the average person is not very conversant with his own inner life. We shall hope, later on, to find some definite guide-posts and landmarks which will help us feel more at home in this fascinating realm. At present, we are not attempting anything more than a suggestion of the itinerary which we shall follow. A book on physical hygiene can presuppose at least a rudimentary knowledge of heart and lungs and circulation, but a book on mental hygiene must begin at the beginning, and even before the beginning must clear away misconceptions and make clear certain fundamental principles. But the gist of the whole matter is this: in a neurosis, certain forces of the personality—instincts and their accompanying emotions—which ought to work harmoniously, having become tangled up with some erroneous ideas, have lost their power of coöperation and are working at cross purposes, leaving the individual mis-adapted to his environment, the prey of all sorts of mental and physical disturbances. The fact that the cause is mental while the result is often physical, should cause no surprise. In the physiological realm we are used to the idea that cause and effect are often widely separated. A headache may be caused by faulty eyes, or it may result from trouble in the intestines. In the same way, we should not be too much surprised if the cause of nervous troubles is found to be even more remote, provided there is some connecting link between cause and effect. The difficulty in this case is the apparent gulf between the realm of the spirit and the realm of the body. It is hard to see how an intangible thing like a thought can produce a pain in the arm or nausea in the stomach. Philosophers are still arguing concerning the nature of the relation between mind and body, but no one denies that the closest relation does exist. Every year science is learning that ideas count and that they count physically, as well as spiritually. Such Stuff as "Nerves" are Made Of. Dr. Tom A. Williams in the little composite volume "Psychotherapeutics" says that the neuroses are based not on inherently weak nervous constitutions but on ignorance and on false ideas. What, then, are some of these erroneous ideas, these misconceptions, that cause so much trouble? We shall want to examine them more carefully in later chapters, but we might glance now at a few examples of these popular bugaboos that need to be slain by the sword of cold, hard fact. Popular Misconceptions about the Body. 1 "Eight hours' sleep is essential to health. All insomnia is dangerous and is incompatible with health. Nervous insomnia leads to shattered nerves and ultimately to insanity." 2 "Overwork leads to nervous breakdown. Fatigue accumulates from day to day and necessitates a long rest for recuperation." 3 "A carefully planned diet is essential to health, especially for the nervous person. A variety of food, eaten at the same time, is harmful. Acid and milk—for example, oranges and milk—are difficult to digest. Sour stomach is a sign of indigestion." 4 "Modern life is so strenuous that our nerves cannot stand the strain." 5 "Brain work is very fatiguing. It causes brain-fag and exhaustion." 6 "Constipation is at the root of most physical ailments and is caused by eating the wrong kind of food." Some of these misconceptions are household words and are so all but universally believed that the thought that they can be challenged is enough to bewilder one. However, it is ideas like this that furnish the material out of which many a nervous trouble is made. Based on a half-knowledge of the human body, on logical conclusions from faulty premises, on hastily swallowed notions passed on from one person to another, they tend by the very power of an idea to work themselves out to fulfilment. The Power Behind Ideas Ideas Count. Ideas are not the lifeless things they may appear. They are not merely intellectual property that can be locked up and ignored at will, nor are they playthings that can be taken up or discarded according to the caprice of the moment. Ideas work themselves into the very fiber of our being. They are part of us and they do things. If they are true, in line with things as they are, they do things that are for our good, but if they are false, we often discover that they have an altogether unsuspected power for harm and are capable of astonishing results, results which have no apparent relation to the ideas responsible for them and which are, therefore, laid to physical causes. Thinking straight, then, becomes a hygienic as well as a moral duty. Ideas and Emotions. Ideas do not depend upon themselves for their driving-power. Life is not a cold intellectual process; it is a vivid experience, vibrant with feeling and emotion. It therefore happens that the experiences of life tend to bring ideas and emotions together and when an idea and an emotion get linked up together, they tend to stay together, especially if the emotion be intense or the experience is often repeated. The word emotion means outgoing motion, discharging force. This force is like live steam. An emotion is the driving part of an instinct. It is the dynamic force, the electric current which supplies the power for every thought and every action of a human life. Man is not a passive creature. The words that describe him are not passive words. Indeed, it is almost impossible to think about man at all except in terms of desire, impulse, purpose, action, energy. There are three things that may be done with energy: First, it may be frittered away, allowed to leak, to escape. Secondly, it may be locked up; this results usually in an explosion, a finding of destructive outlets. Finally, it may be harnessed, controlled, used in beneficent ways. Health and happiness depend upon which one of the three courses is taken. Character and Health Evidently, it is highly important to have a working knowledge of these emotions and instincts; important to know enough about them and their purpose to handle them rightly if they do not spontaneously work together for our best character and health. The problems of character and the problems of health so overlap that it is impossible to write a book about nervous disorders which does not at the same time deal with the principles of character-formation. The laws and mechanisms which govern the everyday life of the normal person are the same laws and mechanisms which make the nervous person ill. As Boris Sidis puts it, "The pathological is the normal out of place." The person who is master of himself, working together as a harmonious whole, is stronger in every way than the person whose forces are divided. Given a little self-knowledge, the nervous invalid often becomes one of the most successful members of society,—to use the word successful in the best sense. It Pays to Know. To be educated is to have the right idea and the right emotion in the right place. To be sure, some people have so well learned the secret of poise that they do not have to study the why nor the how. Intuition often far outruns knowledge. It would be foolish indeed to suggest that only the person versed in psychological lore is skilled in the art of living. Psychology is not life; it can make no claim to furnish the motive nor the power for successful living, for it is not faith, nor hope, nor love; but it tries to point the way and to help us fulfil conditions. There is no more reason why the average man should be unaware of the instincts or the subconscious mind, than that he should be ignorant of germs or of the need of fresh air. If it be argued that character and health are both inherently by-products of self-forgetful service, rather than of painstaking thought, we answer that this is true, but that there can be no self-forgetting when things have gone too far wrong. At such times it pays to look in, if we can do it intelligently, in order that we may the sooner get our eyes off ourselves and look out. The pursuit of self-knowledge is not a pleasurable pastime but simply a valuable means to an end. Knowing Our Machine Counting on Ourselves. Knowing our machine makes us better able to handle it. For, after all, each of us is, in many ways, very like a piece of marvelous and complicated machinery. For one thing, our minds, as well as our bodies, are subject to uniform laws upon which we can depend. We are not creatures of chaos; under certain conditions we can count on ourselves. Freedom does not mean freedom from the reign of law. It means that, to a certain extent, we can make use of the laws. Psychic laws are as susceptible to investigation, verification, and use as are any laws in the physical world. Each person is so much the center of his own life that it is very easy for him to fall into the way of thinking that he is different from all the rest of the world. It is a healthful experience for him to realize that every person he meets is made on the same principles, impelled by the same forces, and fighting much the same fight. Since the laws of the mental world are uniform, we can count on them as aids toward understanding other people and understanding ourselves. "Intelligent Scrutiny versus Morbid Introspection." It helps wonderfully to be able to look at ourselves in an objective, impersonal way. We are likely to be overcome by emotion, or swept by vague longings which seem to have no meaning and which, just because they are bound up so closely with our own ego, are not looked at but are merely felt. Unknown forces are within us, pulling us this way and that, until sometimes we who should be masters are helpless slaves. One great help toward mastery and one long step toward serenity is a working-knowledge of the causes and an impersonal interest in the phenomena going on within. Introspection is a morbid, emotional fixation on self, until it takes on this quality of objectivity. What Cabot calls the "sin of impersonality" is a grievous sin when directed toward another person, but most of us could stand a good deal of ingrowing impersonality without any harm. The fact that the human machine can run itself without a hitch in the majority of cases is witness to its inherent tendency toward health. People were living and living well through all the centuries before the science of psychology was formulated. But not with all people do things run so smoothly. There were demoniacs in Bible times and neurotics in the Middle Ages, as there are nervous invalids and half-well people to-day. Psychology has a real contribution to make, and in recent years its lessons have been put into language which the average man can understand. Psychology is not merely interested in abstract terms with long names. It is no longer absorbed merely in states of consciousness taken separately and analyzed abstractly. The newer functional psychology is increasingly interested in the study of real persons, their purposes and interests, what they feel and value, and how they may learn to realize their highest aspirations. It is about ordinary people, as they think and act, in the kitchen, on the street cars, at the bargain- counter, people in crowds and alone, mothers and their babies, little children at play, young girls with their lovers, and all the rest of human life. It is the science of you, and as such it can hardly help being interesting. While psychology deals with such topics as the subconscious mind, the instincts, the laws of habit, and association of ideas and suggestion, it is after all not so much an academic as a practical question. These forces govern the thought you are thinking at this moment, the way you will feel a half-hour from now, the mood you will be in to-morrow, the friends you will make and the profession you will choose, besides having a large share in the health or ill-health of your body in the meantime. Summary Perhaps it would be well before going farther to summarize what we have been saying. Here in a nutshell is the kernel of the subject: Disease may be caused by physical or by psychic forces. A "nervous" disorder is not a physical but a psychic disease. It is caused not by lack of energy but by misdirected energy; not by overwork or nerve-depletion, but by misconception, emotional conflict, repressed instincts, and buried memories. Seventy-five per cent. of all cases of ill- health are due to psychic causes, to disjointed thinking rather than to a disjointed spine. Wherefore, let us learn to think right. In outline form, the trouble in a neurosis may be stated something like this: Lack of adaptation to the social environment—caused by Lack of harmony within the personality—caused by Misdirected energy—caused by Inappropriate emotions—caused by Wrong ideas or ignorance. Working backward, the cure naturally would be: Right ideas—resulting in Appropriate emotions—resulting in Redirected energy—resulting in Harmony—resulting in Readjustment to the environment. If the reader is beginning to feel somewhat bewildered by these general statements, let him take heart. So far we have tried merely to suggest the outline of the whole problem, but we shall in the future be more specific. Nervous troubles, which seem so simple, are really involved with the whole mechanism of mental life and can in no way be understood except as these mechanisms are understood. We have hinted at some of the causes of "nerves," but we cannot give a real explanation until we explain the forces behind them. These forces may at first seem a bit abstract, or a bit remote from the main theme, but each is essential to the story of nerves and to the understanding of the more practical chapters in Part III. As in a Bernard Shaw play, the preface may be the most important part of this "drama of nerves." Nor is the figure too far-fetched, because, strange as it may seem, every neurosis is in essence a drama. It has its conflict, its villain, and its victim, its love-story, its practical joke, its climax, and its denouement. Sometimes the play goes on forever with no solution, but sometimes psychotherapy steps in as the fairy god-mother, to release the victim, outwit the villain, and bring about the live-happily-ever-after ending. PART II: "HOW THE WHEELS GO ROUND" CHAPTER III In which we find a goodly inheritance THE STORY OF THE INSTINCTS Each in His Own Tongue A fire mist and a planet, A crystal and a cell, A jelly-fish and a saurian, And caves where cavemen dwell; Then a sense of law and beauty, And a face turned from the clod; Some call it evolution And others call it God. [4] If we begin at the beginning, we have to go back a long way to get our start, for the roots of our family tree reach back over millions of years. "In the beginning—God." These first words of the book of Genesis must be, in spirit at least, the first words of any discussion of life. We know now, however, that when God made man, He did not complete His masterpiece at one sitting, but instead devised a plan by which the onward urge within and the environment without should act and interact until from countless adaptations a human being was made. William Herbert Carruth. As the late Dr. Putnam of Harvard University says, "We stand as the representative of a Creative Energy that expressed itself first in far simpler forms of life and finally in the form of human instincts." [5] And again: "The choices and decisions of the organisms whose lives prepared the way through eons of time for ours, present themselves to us as instincts." [6] Putnam: Human Motives, p. 32. Putnam: Human Motives, p. 18. Introducing the Instincts Back of Our Dispositions. What is it that makes the baby jump at a noise? What energizes a man when you tell him he is a liar? What makes a young girl blush when you look at her, or a youth begin to take pains with his necktie? [4] [5] [6] What makes men go to war or build tunnels or found hospitals or make love or save for a home? What makes a woman slave for her children, or give her life for them if need be? "Instinct" you say, and rightly. Back of every one of these well-known human tendencies is a specific instinct or group of instincts. The story of the life of man and the story of the mind of man must begin with the instincts. Indeed, any intelligent approach to human life, whether it be that of the mother, the teacher, the preacher, the social worker or the neurologist, leads back inevitably to the instincts as the starting-point of understanding. But what is instinct? We are apt to be a bit hazy on that point, as we are on any fundamental thing with which we intimately live. We reckon on these instinctive tendencies every hour of the day, but as we are not used to labeling them, it may help in the very beginning of our discussion to have a list before our eyes. Here, then, is a list of the fundamental tendencies of the human race and the emotions which drive them to fulfilment. THE SPECIFIC INSTINCTS AND THEIR EMOTIONS (AFTER MCDOUGALL) Instinct Emotion Nutritive Instinct Hunger Flight Fear Repulsion Disgust Curiosity Wonder Self-assertion Positive Self-feeling (Elation) Self-abasement Negative Self-feeling (Subjection) Gregariousness Emotion unnamed Acquisition Love of Possession Construction Emotion unnamed Pugnacity Anger Reproductive Instinct Emotion unnamed Parental Instinct Tender Emotion These are the fundamental tendencies or dispositions with which every human being is endowed as he comes into the world. Differing in degree in different individuals, they unite in varying proportions to form various kinds of dispositions, but are in greater or less degree the common property of us all. There flows through the life of every creature a steady stream of energy. Scientists have not been able to decide on a descriptive term for this all-important life-force. It has been variously called "libido," "vital impulse" or "élan vital," "the spirit of life," "hormé," and "creative energy." The chief business of this life-force seems to be the preservation and development of the individual and the preservation and development of the race. In the service of these two needs have grown up these habit-reactions which we call instincts. The first ten of our list belong under the heading of self- preservation and the last two under that of race-preservation. As hunger is the most urgent representative of the self- preservative group, and as reproduction and parental care make up the race-preservative group, some scientists refer all impulses to the two great instincts of nutrition and sex, using these words in the widest sense. However, it will be useful for our purpose to follow McDougall's classification and to examine individually the various tendencies of the two groups. In Debt to Our Ancestors. An instinct is the result of the experience of the race, laid in brain and nerve-cells ready for use. It is a gift from our ancestors, an inheritance from the education of the age-long line of beings who have gone before. In the struggle for existence, it has been necessary for the members of the race to feed themselves, to run away from danger, to fight, to herd together, to reproduce themselves, to care for their young, and to do various other things which make for the well-being or preservation of the race. The individuals that did these things at the right time survived and passed on to their offspring an inherited tendency to this kind of reaction. McDougall defines an instinct as "an inherited or innate psycho-physical disposition which determines its possessor to perceive or pay attention to objects of a certain class, to experience an emotional excitement of a particular quality upon perceiving such an object, and to act in regard to it in a particular manner, or at least to experience an impulse to such action." This is just what an instinct is, —an inherited disposition to notice, to feel, and to want to act in certain ways in certain situations. It is the something which makes us act when we cannot explain why, the something that goes deeper than reason, and that links us to all other human beings,—those who live to-day and those who have gone before. It is true that East is East and West is West, but the two do meet in the common foundation of our human nature. The likeness between men and between races is far greater and far more fundamental than the differences can ever be. Firing Up the Engine. Purpose is writ large across the face of an instinct, and that purpose is always toward action. Whenever a situation arises which demands instantaneous action, the instinct is the means of securing it. Planted within the creature is a tendency which makes it perceive and feel and act in the appropriate way. It will be noticed that there are three distinct parts to the process, corresponding to intellect, emotion, will. The initial intellectual part makes us sensitive to certain situations, makes us recognize an object as meaningful and significant, and waves the flag for the emotion; the emotion fires up the engine, pulls the levers all over the body that release its energy and get it ready for action, and pushes the button that calls into the mind an intense, almost irresistible desire or impulse to act. Once aroused, the emotion and the impulse are not to be changed. In man or beast, in savage or savant, the intense feeling, the marked bodily changes, and the yearning for action are identical and unchangeable. The brakes can be put on and the action suppressed, but in that case the end of the whole process is defeated. Could anything be plainer than that an instinct and its emotion were never intended to be aroused except in situations in which their characteristic action is to be desired? An emotion is the hot part of an instinct and exists solely for securing action. If all signs of the emotion are to be suppressed, all expression denied, why the emotion? But although the emotion and the impulse, once aroused, are beyond control, there is yet one part of the instinct that is meant to be controlled. The initial or receptive portion, that which notices a situation, recognizes it as significant, and sends in the signal for action, can be trained to discrimination. This is where reason comes in. If the situation calls for flight, fear is in order; if it calls for fight, anger is in order; if it calls for examination, wonder is in order; but if it calls for none of these things, reason should show some discrimination and refuse to call up the emotion. The Right of Way. There is a law that comes to the aid of reason in this dilemma and that is the "law of the common path." [7] By this is meant that man is capable of but one intense emotion at a time. No one can imagine himself strenuously making love while he is shaken by an agony of fear, or ravenously eating while he is in a passion of rage. The stronger emotion gets the right of way, obtains control of mental and bodily machinery, and leaves no room for opposite states. If the two emotions are not antagonistic, they may blend together to form a compound emotion, but if in the nature of the case such a blending is impossible, the weaker is for the time being forgotten in the intensity of the stronger. "The expulsive power of a new affection" is not merely a happy phrase; it is a fact in every day life. The problem, then, resolves itself into ways of making the desirable emotion the stronger, of learning how to form the habit of giving it the head start and the right of way. In our chapter on "Choosing the Emotions," we shall find that much depends on building up the right kind of sentiments, or the permanent organization of instincts around ideas. However, we must first look more closely at the separate instincts to acquaint ourselves with the purpose and the ways of each, and to disco...