class="sidenote">The problem of the day.

There is no doubt that breakdowns constitute one of the most momentous problems of the day. We hear of them on all hands, in different guises and under various terms. Go into any company you like, and it is safe to say that before many minutes have passed matters of health will be under discussion, and oftentimes they are nerves or breakdowns in some form or other.

It is only natural, perhaps, that this should be so. Yet too frequently the only result of these aimless conversations is to accentuate suffering, instead of leading to the acquisition of any useful information which might help to relieve it. Unfortunately, the general public seems to have made up its mind that nervous disorders are an inevitable concomitant of modern life. They fear them just as they fear influenza, wondering who will be the next to be attacked.

Yet there is no comparison between the two complaints. For the one is due to a germ which pounces upon the good and the bad, the wise and the foolish, the thoughtful and the careless, with absolute impartiality; whilst the other is brought about by a number of conditions, all associated with our mode of life, for which we are responsible, and over which we have a vast amount of control.

Influenza comes like a bolt from the blue, attacking its victims with disconcerting suddenness. To be sure, breakdowns may appear, in many cases at least, to come in a fell swoop; but what seems so abrupt and unlooked for is usually the climax to a long-continued process of undermining, like the collapse of a house, which has succumbed to the ravages of time. Yet the events which have led up to it may have been spread over a large number of years.

Occasionally we hear of someone who has been disabled all of a sudden by some definite form of ailment, paralysis, cancer or heart disease, it may be. Such cases are, however, the exception, and they are not the breakdowns with which we are now concerned. In the great majority of instances “breaking down” is the final stage of a long process of “running down.” There is as much difference between the two classes of cases as between an engine which has come to a stop because a wheel has come off or a connecting-rod broken, and one that has become useless owing to neglect or prolonged wear and tear.

The period of running down may last for months or years, and it is characterised by various symptoms, physical and nervous. It is the former which are at the root of the matter, but the others predominate more and more, until, when the final breakdown occurs, they overwhelm the bodily symptoms altogether. On this account it is usually designated by terms expressing this nervous element: nervous exhaustion or debility, neurasthenia or simply nerves. Yet all these are only different phases or stages of the same complaint.

What, then, is the nature of this complaint? It is one that has suffered from much misapprehension, chiefly through the use of the term “nervous exhaustion.” This phrase has given rise to an impression in the lay mind that there is a limit to the nervous force with which human beings are endowed, as though each one started with a certain quantity which must come to an end sooner or later.

This idea is a fallacy, for nervous energy is in process of being manufactured every hour we live. And Nature stores up out of this supply a reserve from which we may draw in any emergency that may demand a special output.

This reserve fund is constantly varying. It is replenished during the hours of sleep, it is called upon during the period of wakefulness. Sometimes an extra call has to be made upon it. A woman may have her night’s rest broken, or she may even lose her sleep altogether for several nights in succession. Or a man may have a sudden stress of work which cannot be avoided. Then the reserve may be depleted, but that does not constitute a breakdown. If care is taken to ensure sufficient rest afterwards, the surplus is regained. It is only when a constant drain is put upon it that serious damage results.

And in many cases of breakdown the question of exhaustion plays no part. For most neurasthenics show no loss of energy; in fact, many of them exhibit an increased output. The crux of the whole matter is not exhaustion, but a loss of control over the nervous forces. This loss may show itself in two distinct ways. It may either prevent the energy from manifesting itself, or it may discharge it in a spasmodic manner.

One market-day, in a country town, there were two horses, both of which, so far as their utility was concerned, were equally inefficient. Yet neither were lacking in energy. The one was excitable, plunging about to the danger of the public, and in any direction except the right one. The other was, on the contrary, perfectly quiet, standing harnessed to a vehicle, but unable to move it. This animal had strength and nerve force in plenty, yet it was incapable of making use of it. For a drunken ostler had harnessed it the wrong way round, with its head towards the cart.

The same types can often be recognised in those who suffer from nervous breakdown. Some patients become fidgety and restless, rushing about from pillar to post, worrying their employees or their fellow-workers, and fussing around in the home until the rest of the household dreads the sight of them.

Others are precisely the opposite of this. They become moody and taciturn, or disinclined to meet their friends or take part in a conversation. A woman will sit by herself most of the time, not caring even to have her children about her. A man will have a difficulty in making up his mind not only on important points of business, but it may be on the most trivial matters. He begins to look at his work as stupidly as the aforesaid horse stared helplessly at the cart he was supposed to pull.

Where does the fault lie? Not in too much energy or too little, but in some derangement of the system, whereby the patient’s faculties either go astray or are rendered inert. And in order to discover the real source of the mischief, it is necessary to look, not at the climax, but farther back, through a long sequence of events which have been leading up to it.