The Symptoms of Neurasthenia.—The symptoms are essentially those of chronic fatigue, which has become exaggerated and pathologic. They may be classified as sensory, motor, psychic, and somatic. The sensory symptoms first noticed are those of generalized fatigue, with such localized sensations as headache, backache, and limbache. The motor symptoms are muscular fatigue, muscular weakness, and muscular exhaustion on slight exertion. The psychic symptoms are manifested by a diminution in the capacity for sustained mental effort and the spontaneity of thought and exhaustion after slight mental effort. The somatic symptoms show themselves in atony of the digestive tract and the circulatory apparatus, with disturbances of the secretions.
Headache is one of the most common symptoms of localized fatigue, and, associated with this, may be a sense of constriction about the head, and there may be either a sense of lightness or fulness of the head.
A woman who is chronically tired loses all her personal vigor, force, aggressiveness, and, above all, will power. Associated with this lack of will power are hesitation, indecision, a marked irritability, and timidity. Neurasthenic patients are subject to spontaneous attacks of fear, causeless in origin, and generalized in character. These attacks may be accompanied by pallor of the face and palpitation of the heart, just as in normal fear. The tired woman is a cross woman. The irritability shows marked impairment of the power of inhibition.
The Rational Treatment of Neurasthenia.—First of all, there must be a removal of the cause which has produced it. There are two distinct classes of cases—the overworked and the idle. The first class, and the most important to the world, are the overworked. We may have to deal with the intellectually overworked, in which the mental overwork was combined with financial anxieties, domestic difficulties, or lack of success in their work, or the cause may have been the tremendous responsibilities of their positions, which involved the lives or fortunes of many people. Added to this great strain and overwork, has been a lack of proper intervals for rest, recreation, and sleep, and the body has become a storehouse for various toxins, and so is suffering from both acute and chronic poisoning.
This class of patients must have the most rigid rest treatment, such as was prescribed by Weir Mitchell years ago. It is most important that the patient should be removed from her old surroundings; if this is not possible, she should be isolated on the top floor of the house with a good nurse. The room selected must be bright and cheerful, with plenty of sunshine and fresh air; a window should be open practically all the time, for oxygen and sunshine are two of the best restoratives. The diet must be easily digested and very nutritious. The patient should be urged not to use her mind at all. Carefully selected short stories may be read aloud by the nurse; the reading should not be continued for more than half an hour at a time.
A great deal may be done to eliminate these toxins from the system by the proper use of electric-light baths, followed by the shampoo and the percussion douche; massage with salt water, salt rubs, and electricity.
In most cases a month of this absolute rest is as long as is beneficial to the patient. And for most of them the sea-shore is the best. There should be enough going on to be diverting without being overtaxing, and a climate should be selected which is warm enough for the patient to live out-of-doors. There should be short walks, drives, sails, etc., and this outdoor life, with a contemplation of nature, is the most powerful restorative. The grandeur of nature, whether it is the mighty forests, with their refreshing shade and quiet, or even stretched in a hammock watching the sky and trees, or the constant surging of the vast sea, bringing rest in its unceasing restlessness, with the ships sailing lazily along, until the whole fades away in the distant horizon. In the vastness of the universe, the ego becomes contemptibly unimportant and insignificant.
After several months spent in this way the body has gotten rid of its toxins, nerves and muscles are rested, and through the soothing influence of nature the neurasthenic is gradually trained back to a healthier habit of thought and a more rational frame of mind. There is substituted for the morbid emotional complex a feeling of pleasure and energy. Reason and judgment reassert their sway; outdoor life quickens the perceptions, and forms tranquilizing memory pictures on the brain that return later to solace and refresh the individual.
There is another, and a very large class, of cases among women of leisure who have suffered all their lives from a lack of a vocation; they have nothing to think of except themselves. They do not know what it is to be quite well; they travel from one part of the country to another, and from one country to another, but they never rise above a certain level of invalidism. They are self centered, and what they need is the work cure. In the majority of cases, before these patients can be restored to health, powerful habits must be eradicated, new interests in others must be supplied to supplant the most intense egotism, new paths must be hewn out in the brain, the will must be recreated, and character can only be imparted by those who possess it.