5. Fundamental in the symptoms of neurasthenia is fear. This fear takes two main forms. First, the worry over the life situation in general, that is to say, fear concerning business; fear concerning the health and prosperity of the household; fear that magnifies anything that has even the faintest possibility of being direful into something that is almost sure to happen and be disastrous. This constant worry over the possibilities of the future is both a cause of neurasthenia and a symptom, in that once a neurasthenic state is established, the liability to worry becomes greatly increased.
Second, there is a special form of worry called by the old authors hypochondriacism, which essentially is fear about one's own health. The hypochondriac magnifies every flutter of his heart into heart disease, every stitch in his side into pleurisy, every cough into tuberculosis, every pain in the abdomen into cancer of the stomach, every headache into the possibility of brain tumor or insanity. He turns his gaze inward upon himself, and by so doing becomes aware of a host of sensations that otherwise stream along unnoticed. Our vision was meant for the environment, for the world in which we live, since the bodily processes go on best unnoticed. The little fugitive pains and aches; the little changes in respiration; the rumblings and movements of the gastro-intestinal tract have no essential meaning in the majority of cases, but once they are watched with apprehension and anxiety, they multiply extraordinarily in number and intensity. One of the cardinal groups of symptoms in a neurasthenic is this fear of serious bodily disease for which he seeks examination and advice constantly. Naturally enough, he becomes the choicest prey for the charlatan, the faker, or perhaps ranks second to the victim of venereal or sexual disease. The faker usually assures him that he has the disorders he fears and then proceeds to cure him by his own expensive and marvelous course of treatment.
What has been sketched here is merely the outside of neurasthenia. Back of it as causative are matters we shall deal with in detail later on in relation to the housewife,—matters like innate temperament, bad training, liability to worry, wounded pride, failure, desire for sympathy, monotony of life, boredom, unhappiness, pessimism of outlook, over-æsthetic tastes, unfulfilled and thwarted desires, secret jealousy, passions and longings, fear of death, sex problems and difficulties and doubt; matters like recent illness, childbirth, poverty, overwork, wrong sex habits, lack of fresh air, etc.
Fundamentally neurasthenia is a deënergization. By this is meant that either there is an actual reduction in the energy of the body (as after a sickness, pregnancy, etc.) or else something impedes the discharge of energy. This latter is usually an emotional matter, or arises from some thought, some life situation of a depressing kind.
It is necessary and important that we consider these two aspects of our subject a little closer, not so much as regards the housewife, but over the wider field of the human being.
The human being, like every living thing, is an instrument for the building up and discharge of energy. He takes in food, the food is digested (made over into certain substances) and these are built up into the tissues,—and then their energy is discharged as heat and as motion. The heat is the body temperature, the motion is the movement of the human body in all the marvelous variety of which it is capable. In other words, the discharge of energy is the play of our childhood and of our later years; it is the skill and strength of our arms, the cleverness of our hands, the fleetness of our feet, the joyous vigor of our love-making, the embrace; it is the noble purpose, the long, hard-fought battles of any kind. It is all that is summed up in desire, purpose, and achievement.
Now all these things may be impeded by actual reduction of energy, as in tuberculosis, cancer, or in the lassitude of convalescence. In addition there are emotions, feelings, thoughts that energize,—that create vigor and strength of body and mind. Joy rouses the spirit; one dances, laughs, sings, shouts; or the more quiet type of person takes up work with zeal and renewed energy. Hope brings with it an eagerness for the battle, a zest for work. The glow of pride that comes with praise is a stimulus of great power and enlarges the scope of the personality. The feeling that comes with successful effort, with rewarded effort, is a new birth of purpose and will. And whatever arouses the fighting spirit, which in the last analysis is based on anger, achieves the same end.
There are deënergizing emotions and experiences as well, things that suddenly rob the victim of strength and purpose. Fear of a certain type is one of these things, as when one's knees knock together, the limbs become as it were without the control of the will, the heart flutters, and the voice is hoarse and weak. Fear of sickness, fear of death, either for one's self or some beloved one, may completely deënergize the strongest man. Then there is hope deferred, and disappointment, the frustration of desire and purpose, helplessness before insult and injustice, blame merited or unmerited, the feeling of failure and inevitable disaster. There is the unhappy life situation,—the mistaken marriage, the disillusionment of betrayed love, the dashing of parental pride. The profoundest deënergization of life may come from a failure of interest in one's work, a boredom due to monotony, a dropping out of enthusiasm from the mere failure of new stimuli, as occurs with loneliness. Any or all of these factors may bring about a neurasthenic, deënergized state with lowering of the functions of mind and body. We shall discover how this comes about farther on.
What part does a subconscious personality take in all this and in further symptoms? Is there a subconsciousness, and what is it?
In answer, the majority of modern psychologists and psychopathologists affirm the existence of a subconscious personality. One needs only mention James, Janet, Ribot, McDougall, Freud, Prince, out of a host of writers. Whether they are right or not, or whether we now deal with a new fashion in mental science, this can be affirmed—that every human being is a pot boiling with desires, passions, lusts, wishes, purposes, ideas, and emotions, some of which he clearly recognizes and clearly admits, and some of which he does not clearly recognize and which he would deny.