It is my firm belief that the function of intelligence is to control instinct and emotion, and that temperament, if inborn, is not unchangeable, even at maturity. Once you convince a person that his or her symptoms are due to fear, worry, doubt, and rebellion you enlist the personal efforts to change.
A new philosophy of life must be presented. Less fussiness, less fear, more endurance, less reaction to the trifles of their life are necessary. The aimless drifter must be given a central purpose or taught to seek one; the dissatisfied and impatient must be asked, "Why should life give you all you want?" "What cannot be remedied must be endured!" What a wealth of wisdom in the proverb! One seeks to establish an ideal of fortitude, of patience, of fidelity to duty,—old-fashioned words, but serenity of spirit is their meaning. Suddenly to come face to face with one's self, to strip away the self-imposed disguise, to see clearly that jealousy, impatience, luxurious, and never satisfied tastes, a selfish and restless spirit, are back of ennui and fatigue, pains and aches of body and mind, is to step into a true self-understanding.
If a situation demands action, even drastic action, "surgical" action, then that action must be forthcoming, even though it hurts. To end doubt, perplexity, to cease being buffeted between hither and yon, is to end an intolerable life situation. I have in mind certain domestic situations, such as the effort to keep up in appearance and activity with those of more means and ability.
Sexual difficulties, so important and so common, demand the coöperation of the husband for remedy. He should be seen (for usually the wife consults the physician alone) and the situation gone over with him. Men are usually willing to help, willing to seek a way out. A neurasthenic wife is a sore trial to the patience and endurance of her husband and he is anxious enough to help cure her.
Where there is conflict of other kinds the situation is complicated by the intricacy of the factors. Financial difficulties especially wear down the patience and endurance of the partners, and the physician cannot prescribe a golden cure. In prosperous times there is less neurasthenia than in the unprosperous, just as there is less suicide.
Sometimes it is just one thing, one difficulty, over which the conflict rages. I have in mind two such cases, where one habit of the husband deënergized his wife by outraging her pride and love. When he was induced to yield on this point the wife came back to herself,—a highly strung, very efficient self.
In fact, the basis of treatment is the painstaking study of the individual woman and then the painstaking adjustment of that individual woman. It may mean the adjustment of the whole life situation to that housewife, or conversely the adjustment of the housewife to the life situation.
In many marital difficulties that one sees, not so much in practice as in contact with normal married couples, the trouble reminds one of the orang-outang in Kipling's story who had "too much Ego in his Cosmos." Marriage, to be successful, is based on a graceful recession of the ego in the cosmos of each of the partners. The prime difficulty is this; people do not like to recede the ego. And the worst offenders are the ones who are determined to stand up for the right, which usually is a disguised way of naming their desire.
One might speak of a thousand and one things that every man and every woman knows. One might speak of the death of love and the growth of irritation, the disappearance of sympathy,—these are the hopeless situations. But far more common and important, though less tragic, is the disappearance of the little attentions, the little love-making, the disappearance of good manners. Men are not the only or the worst offenders in this; the nervous housewife is very apt to be the scold and the nag. Perhaps the neurasthenia of the husband arises from his revolt against the incessant demands of his wife, but that's another story.
At any rate, there is what seems to be a cardinal point of difference between men and women, perhaps arising from some essential difference in make-up, perhaps in part due to difference in training. An essential need of the average American-trained woman is sympathy, constantly expressed, constantly manifested. The average man tends to become matter-of-fact, the average woman finds in matter-of-factness the death of love. She acts as if she believed that the little acts of love and sympathy are the more important as manifesting the real state of feeling, that the major duties were of less importance.