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CHAPTER XII
NERVOUS DISEASE

Just as with regard to insanity, there is a very common impression that religion increases the amount of nervous disease in the world and is responsible for a great deal of what has been called hysteria. Not a few who think they have a right to an opinion in this matter, and some of them are physicians—though usually they are rather young—are quite ready to assert that religion is a fruitful source of nervous symptoms and very often of rather serious nervous conditions. We saw in the chapter on Insanity how false is the prevalent impression as to religion producing tendencies to insanity, though of course a great many insane people have religious delusions. It is very much the same with nervous diseases. Many nervous people pay a certain amount of attention to religion, and not a few of them cling to straws of hope that they may be able to overcome their neurotic tendencies by superficial attention to prayer or to some practices of religion which they seem to look upon about in the same light as patent medicines recommended for the cure of nervous diseases. People who are deeply religious, however, very seldom suffer from nervous affections, and they have in their religion the most beneficent of helpful resources, if by nature, that is, by heredity or unfortunate development, they have neurotic tendencies.

So far from religion increasing nervous disease, then, it has exactly the opposite effect. We have a number of testimonies to this purport from prominent neurologists, many of whom were themselves not believers in religion but who recognized its influence for good over others. Such expressions are to be found in the writings of men of every nationality. Not infrequently, in spite of their own religious affiliations, they acknowledge what a profound influence certain forms of religion have over certain people. These testimonies have been multiplying in our medical literature in recent years, because apparently physicians have come to appreciate by contrast the influence for good of religion over some of their patients, since they see so many sufferers from nervous diseases who have not this source of consolation to which to recur.

In America we have a number of such testimonies. In his "Self Help for Nervous Women", Doctor John K. Mitchell of Philadelphia, who may be taken to represent in this matter the Philadelphia School of Neurologists, to which his father lent such distinction, said:

"It is certainly true that considering as examples two such separated forms of religious belief as the Orthodox Jews and the strict Roman Catholics, one does not see as many patients from them as might be expected from their numbers, especially when it is remembered that Jews as a whole are very nervous people and that the Roman Catholic includes in this country among its members numbers of the most emotional race in the world.

"Of only one sect can I recall no example. It is not in my memory that a professing Quaker ever came into my hands to be treated for nervousness. If the opinion I have already stated so often is correct, namely that want of control of the emotions and the overexpression of the feelings are prime causes of nervousness, then the fact that discipline of the emotions is a lesson early and constantly taught by the Friends would help to account for the infrequency of this disorder among them and adds emphasis to the belief in such a causation."

In writing a "Textbook of Psychotherapy"⁸ eight years ago one of the appendices was devoted to the relations between religion and psychotherapy. One of the paragraphs, written for physicians, and I may say that it has been read by many thousands of them, puts my own opinion on the dual subject of the nexus between religion, insanity and nervous disease, as succinctly as I can hope to put it. There is no doubt that an abiding sense of religion does much for people in the midst of their ailments and, above all, keeps them from developing those symptoms due to nervous worry and solicitude which so often are more annoying to the patient than the actual sufferings he or she may have to bear. While religion is often said to predispose to certain mental troubles, it is now well appreciated by psychiatrists that it is not religion that has the tendency to disturb the mind, but a disequilibrated mind has the tendency to exaggerate out of all reason its interest in anything that it takes up seriously. Whether the object of the attention be business, or pleasure, or sexuality, or religion, the unbalanced mind pays too much attention to it, becomes too exclusively occupied with it, and this overindulgence helps to form a vicious circle of unfavorable influence.

While many people in their insanity, then, show exaggerated interest in religion, this is only like other exaggerated interests of the disequilibrated, and religion itself is not the cause but only a coincidence in the matter.

Some who are interested particularly in this subject, on reading this will at once revert to the fact that scruples are extremely common among the religiously inclined and that these are, after all, as a rule, only nervous symptoms which are surely fostered by religion. To say this, however, is to misapprehend the real meaning of scruples. The word is a very old one and means a little sharp stone, as if in trying to make progress the scrupulous found themselves hindered by having to walk over little sharp stones which so disturbed them that they were hampered in getting on. Above all, scruples put them into a state of mind where they hesitate as to whether they can go on at all or not.

The subject of scruples was very thoroughly worked out and carefully described by the older spiritual writers centuries ago. They wrote elaborate treatises on it, while it was not until our own time that physicians by their careful study of corresponding conditions entirely apart from religion came to appreciate that these conditions of the spiritual life were only expressions of a rather common set of tendencies altogether independent of religion. They are prone to develop in people with certain physical and mental characteristics who are possessed of dispositions and nervous systems particularly likely to be the subject of these hesitancies and doubts and difficulties for which there is very little basis in actuality.

The whole chapter of phobias and the other chapter on obsessions and the third on what the French call la folie du doute, the doubting mania in our modern textbooks of neurology, are really so many chapters in the literature of scruples of the old time, now transferred to the textbooks on functional nervous diseases. Some nervous people who are religiously inclined get into a very disturbed state of mind from the fear that they may commit sin almost unknown to themselves or that they may be in sin unawaredly and cut off from their Creator, and they become extremely miserable as a consequence. This is, after all, a very familiar picture to the neurologist accustomed to see patients suffering from functional nervous diseases. I have patients who suffer quite as much from the dread of dirt as these scrupulous people do from the dread of sin. Women often suffer from this dread of dirt—misophobia is the scientific name derived from the Greek—to an exaggerated degree. A woman patient of mine makes it extremely uncomfortable for the conductors on the street cars because, for fear of contaminating her hands, she dreads to touch the handle bars by which she could mount or descend easily. This adds greatly to the risks she takes every time she boards a car. She is constantly washing her hands to get the dirt off, so that in cold weather she sets up severe skin irritations and makes herself very uncomfortable. I have a male patient who would not touch the handle of my door for the world, and whom successive maids have come to know very well because he stands outside the outer door and has to have that as well as the inner door opened for him. He has said to me over and over again, "Doctor, don't ask me to shake hands with you, because you shake hands with so many people." I have seen him standing outside of a large department store with the temperature around zero, waiting for some one to open the door so that he might slip in without touching it. Nor are such states of mind confined to the uneducated; on the contrary, they are commonest among those who have a good education and are quite sensible in other things.

Obsessions were originally described as super-religious states of mind in which some idea assumed a terrorizing character. The victims of them dread that they might commit some awful crime and as a consequence were profoundly miserable. Instead of being confined to religion, such mental states are quite common in conditions altogether apart from religious feelings. Women read of a mother killing her child in some awful way or perhaps accidentally poisoning it or burning it badly with some escharotic external application. They become obsessed with the idea that they may do something of this kind and fear that they may not be able to resist the suggestion. Medical literature is full of such cases. A typical case is described by Tangi in his textbook on insanity:

"A young married woman suffered from nervous exhaustion after her first childbirth. She watched day by day her husband cutting up meat for his parrots with a pair of scissors, and the action filled her with disgust which later increased to positive horror. Thus a repulsive obsession was produced and this in turn engendered the morbid suggestion to cut the tongue of her dearly loved child in the same way. The fear that she would not be able to resist this suggestion made the suggestion more vivid and the idea more imperative, causing an agonizing struggle each time."

Then there are accounts, some of them most poignant, from Catholic patients of my own, who were sure that sometime while in the midst of their devotions or even at the very reception of the sacraments they would blaspheme. They are people who fear that every pious act of theirs may just expose them to the risk of committing some awful sacrilege.

Almost needless to say such states have nothing at all to do with religion, and when similar conditions occur among the religious minded, they must be attributed to the general neurotic condition and not to the incidental religious tendencies. The doubting mania occurs among the religious minded when they keep on fearing that they have not done something that they should do. Some of these individuals get into a profoundly miserable and disturbed state of mind, but that must not be blamed on religion.

This sad state of mind in people who have no religion at all is extremely familiar to the neurologist, and it has no necessary connection with religious practice or religious belief. I have a patient who has been coming to me for many years now from a city in the Middle West; he is a broker, and every time there is a panic in the money market I am almost sure to see him. Whenever he gets very much disturbed over business matters, as is likely to happen in panic times, he develops a very striking folie du doute, or doubting mania. He will take a letter to a post box and go back three or four times, first to see if by chance he did not drop it on the way, secondly to be sure that it did not get caught in the slot; then, if the letter is important, he will go back to see if perchance there may not be some bolts or other obstructions at the top of the box that may catch it and delay its collection. I have even known him to wait for some time at the post box to see if the postman might not possibly drop it when he came to collect the mail. But then he does other things just as foolish. Occasionally he will get home from his office and suddenly have the feeling that he forgot to lock his safe. He will go back and then get part way up town when he is overcome by the fear that he may not have locked the door after him as he came out. At times when his folie du doute is at its worst, he has been known to go back three or four times to close windows or for some other trivial reason. When he is in reasonably good condition there is very little of this state of mind manifest, but he can make himself supremely miserable when the obsession is on him.

It is often said that the declaration by the Church of the idea of possession by the devil rather encouraged the development of certain mental and nervous states and thus fostered neurotic manifestations of many kinds. This whole question of the possibility of direct diabolic influence over mankind, that is, of some evil spirit deeply influencing certain human beings, is yet a matter that is not nearly so settled as a great many physicians who have not been following scientific work in allied lines seem to think. So distinguished a scientist as Alfred Russel Wallace, the co-discoverer with Darwin of the theory of natural selection, had the feeling that spirits interfered much more in human affairs than a great many people were willing to admit, and that the evil spirits probably could, under certain circumstances, deeply affect individuals. Professor Barrett of Trinity College, Dublin, is even more outspoken in what he has to say in this regard, and now there is a very general feeling among those who have investigated spiritistic phenomena most carefully that if spirits do actually communicate directly with men, it is commonly not the spirits who claim to do the communicating who are actually present. Almost needless to say any such conclusion as this would, if maintained, throw even scientists back to the old idea of diabolism, which the Church, on the strength of many centuries of experience, still teaches.

One thing is perfectly sure: that if overzeal on the part of certain ecclesiastics rather encouraged neurotic manifestations because of the alluringly suggestive quality of the thought of diabolic possession, they did no more than physicians did in more modern times by their suggestive methods in the study of hysteria. A great French neurologist of to-day has pointed out that major hysteria as studied by French neurologists of a generation ago has practically disappeared, or occurs very rarely in our day because it is no longer unconsciously suggested to patients by physicians that these major symptoms are being looked for. Overzeal in medicine raised up a whole series of symptoms that had no existence except in the heated imagination of their patients under the influence of strong suggestion.

Another extremely interesting phase of this subject is that in the old days many of the sensible ecclesiastics and some of the civil authorities came to recognize that people supposed to be possessed of evil spirits could be cured of their condition not infrequently by roundly whipping them. Sir Thomas More particularly called attention to how much good could be effected in this way. In writing an article on "Psychoneurosis and the War" (International Clinics, Volume II, Series 29) I called attention to this in a paragraph that may be helpful in the understanding of the discussion of diabolic influence.

It has been the custom for many years now, indeed for more than a generation, to think that the old-fashioned methods of treating many of the psychoneuroses by punishment and the infliction of pain were founded on an entirely wrong principle. Sir Thomas More, for instance, tells the story of a number of folk in his time who suffered from rather serious complaints; some of them were dumb and some deaf, and some thought they could not see, and others could not walk. He says that some people considered them possessed of the devil, and that it was the presence of this very undesirable spirit that hampered their activities in various ways and made it impossible for them to use their powers properly. The description of the cases makes it very clear that he is referring to hysterical conditions of various kinds and the sequel as to the successful treatment which he says was frequently employed on them more than confirms the inference of hysteria and demonstrates the very definite hysterical character of the affection. Many a physician down through the ages has been inclined to think that these people were possessed of a bad spirit of some kind, even though he might not be quite ready to think that a personal devil had taken hold of them and was seriously hampering their functions. We recognize that the real trouble is with their own spirit, to which may be applied whatever epithets come to mind, and no one will think them exaggerations; this spirit has lost its control of their activities, rendering them incapable of exercising their functions properly.

There is a very widespread tradition, which has found its way into medical literature especially, that the fervent practice of religion in women has a very definite tendency to make them neurotic. Particularly when religious devotion is associated with mortification and fasting, it is supposed to be serious in its effects. It is the custom to make references to such pious women as St. Catherine of Siena and St. Theresa of Spain as typically exemplifying this neuroticizing tendency.

Any one who really knows the lives of either of these women will not be likely to think that they were neurotic in any proper sense of that word at all. Both of them were not weak but had immensely strong characters, veritable towers of strength in supremely difficult times, supporting not only their own heavy burdens but helping others around them to bear theirs. Of Catherine of Siena, Swinburne, the English poet, surely not a sanctimonious person, whose sentimentality might lead to admiration for the hysterical bizarre, but who had studied her career because so many incidents in her life have been the subject of great paintings by a number of the greatest painters of Italy, said:

 
  "Then in her sacred saving hands
  She took the sorrows of the lands,
  With maiden palms she lifted up
  The sick time's blood-embittered cup,
  And in her virgin garment furled
  The faint limbs of a wounded world.
  Clothed with calm love and clear desire.
  She went forth in her soul's attire,
  A missive fire."
 

The great hospital at Siena was rebuilt in honor of Catherine shortly after her death because of the fact that she had spent many years of her comparatively brief life there; she died at thirty-two in personal service of all kinds to the patients suffering from every manner of disease, even leprosy, who were in the institution. (The lepers were housed apart from the others.) She placated so many feuds among the noble families of Siena, feuds that were the cause of as many murders as the worst of our own in Kentucky, that she was asked to be the envoy of peace when cities were at war, and it was she who eventually by her influence brought the Popes back from Avignon to Rome and thus put an end to the great disorders in the Italian peninsula.

St. Theresa, the great Spanish mystic of the sixteenth century, the other "horrible example," held up even by some neurologists, of hysterical tendencies due to religion and mortification, proves, when studied in real life, to have been at least as great and strong a character as Catherine of Siena. She well deserves the name of saint as a leader in unselfishness, but besides she had a fine sense of humor. That is what neurotic people lack above all—a sense of humor. All sorts of distinguished men in the Spain of her time—and in the sixteenth century Spain was by far the greatest country in Europe, her sovereigns ruling most of Europe and the greater part of America, and the nation gave birth to great art, literature, architecture and philosophy—turned to consult St. Theresa in their difficulties. She wrote a series of books that have been republished in every cultured language in Europe at least once a century ever since, and our own generation has been sedulous in the study of Theresa's writings. No less than a dozen lives of her have been written in English in the twentieth century. This Spanish lady who died three hundred and fifty years ago is still a very living force in the world.

Owing to the special conditions under which much of my work is accomplished, I am brought in contact with a great many religious women every year. For some twenty years I have spent some days each summer with groups of religious communities where large numbers were assembled for special intellectual and spiritual work. The mother superior has often consulted me with regard to some of her daughters who had special nervous manifestations, but it is a never-ending source of surprise to find how few of them suffer from the nervous symptoms so common in our time. Considering the fact that they spend their lives very largely indoors, that they live on very simple food—and sometimes I have been inclined to think with scarcely enough nor sufficient variety to make them capable of the amount and demanding nature of work they have to do—fewer of them suffer from nervous symptoms or affections than women of the same class who are living at home and on whom the demands are not nearly so strenuous. Their religious duties, instead of being in any way a drain on their nerve force, though I have often heard it said that teachers ought not to be required to give quite so much time to their religious duties, represent a reservoir of energy from which they draw strength and above all placidity of mind and consequent power to accomplish more than would otherwise be the case.

My duties often bring me into contact with numbers of sisters during their hours of recreation, so-called, and I do not think that I have ever seen a happier, heartier group of people than they make during these periods of relaxation. I have always considered it a privilege to share recreation after dinner or supper with a dozen sisters when I am lecturing in one of the smaller towns, and we have often laughed so heartily together that I have sometimes wondered what the neighbors would think of us. People with a sense of humor like this are not likely to have hysterical tendencies. Nervousness is at bottom selfishness, and there is always a great deal of conceit in it. Religious women are likely to be humble, and that means much in keeping them from various magnifications of their ego which so often result in nervous and mental symptoms.

I have often ventured to say that I was quite sure that a religious house, especially where there were many young people, in which laughter came easily and was heard frequently during the times appropriate for it, was sure to be a place of real spirituality and happiness. I have often dared to remind them that the one place where one hears no real laughter, though sometimes sounds are made resembling it, is an insane asylum. People who are ready to laugh are usually eminently sane. Above all, they do not take themselves too seriously. It is taking one's self and one's feelings too seriously that is the root of a great deal of nervous and mental disturbance in this little world of ours. Certainly the discipline of heart and mind and body and the feeling of satisfaction from duty well done that comes in connection with that complete sacrifice of themselves in a great religious cause which members of religious orders make, so far from predisposing them to nervous disease has just exactly the opposite effect.

Nervous diseases, instead of being fostered or fomented by religion, are on the contrary repressed rather effectually and equilibrium given even to those in whom some hereditary elements might have proved disturbing. This does not mean that all the religious minded are free from nervous symptoms, and it must not be forgotten that not every one who says "Lord, Lord," gets into the kingdom of heaven, either on earth or hereafter, but religion must be counted as an asset and not a liability in this matter. It will not overcome strong hereditary tendencies, and it will not help efficaciously those who do not submit to the discipline that true religious feeling entails, and of course religion is not a panacea for the ills of mankind, though it must be counted a therapeutic adjuvant and not a nervous irritant.

Professor Foerster, whom one is tempted to quote because of the thoroughgoing thoughtfulness of his treatment of many of these subjects and his wise conservatism founded on that deep consideration, has discussed the question of repression of self in matters of purity as a possible source of nervous troubles of various kinds. Freudianism, as it is called, which has attracted so much attention in recent years, would seem to suggest the conclusion that a great many of the nervous symptoms of humanity are due to the repression of sex impulses. Foerster has pointed out that just the opposite is true, and that there never was a time when there was so little real self-repression and also never a time when there was so much functional nervous disease. He said:

"From this point of view there can be no doubt that the modern theory of 'living one's nature out' is largely responsible for the nervous degeneration of to-day, and that the widespread hysteria in modern life does not spring from those remnants of discipline and idealism which are still operative amongst us. One is compelled to ask indeed with astonishment, with what right Freud finds the dangers of repression so alarming in an age which is conspicuous for self-indulgence. In reality there has never been an age which was less influenced by the spirit of abnegation and repression than is our own. The present age is one of disintegration, in which natural instincts have largely broken away from their controlling higher ideals; if, therefore, it suffers to a peculiar degree from nervousness, one can hardly look for the cause in the fact that it constitutes a high-water mark of control and discipline. The precisely opposite conclusion would be nearer the mark."

Professor Foerster admits, however, that it is perfectly possible that people who have no good motive for self-repression and who suppress instincts only out of the merest human respect and cowardice as to results, may very well suffer some of the consequences that Freud has pointed out. He says:

"There is one point, however, in which one can entirely agree with Freud, or at any rate allow oneself, through him, to be led to the recognition of an important psychological and pedagogical truth. There are to-day certain circles who cling to the old ethical tradition only through considerations of an outward description, as the result of a species of timidity which keeps them from breaking with respectable customs; and yet these people are, at the bottom of their hearts, believers in a view of life of a totally different description—one which attaches no value or meaning to self-mastery and self-denial."

Almost needless to say this obscuration of religious motives with the result of leaving the individual too much at the mercy of the merely physical without adequate principles for self-control is not the fault of religion but of its very opposite—irreligion. Foerster's words are all-important for the understanding of an important phase of the discussion of the cause and cure of nervous and psychic symptoms of various kinds which has attracted much more attention outside of medical circles than it deserves.

The danger of the absence of religious motives in the world, because of the persuasion that new discoveries are doing away with the necessity for faith, has also been emphasized by Professor Foerster, who said:

"Along with the disappearance of belief in a spiritual world arises the danger that even earnest and noble men and women will be influenced in their consideration of the deeper things of life by the newest and most tangible facts alone, and will be inaccessible to all arguments going beyond the scope of mere practical sense and expediency. It would appear as if the preponderance of an intellect directed towards external things destroyed not only belief in the invisible world in a religious sense, but also undermined the power of grasping the full value and reality of certain imponderabilia in earthly life, and of understanding the deep-growing spiritual injuries which may proceed from apparently harmless and even outwardly beneficial things."