قراءة كتاب Outwitting Our Nerves: A Primer of Psychotherapy
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Outwitting Our Nerves: A Primer of Psychotherapy
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