Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

In the religious communities of women, particularly, it has seemed to us that the occurrence of Graves' disease (the affection is three times more frequent in women than in men) in a Superior should always be the signal for relieving her of the responsible duties of her position. This action is quite as necessary for the patient's own health as for the peace and happiness of the community. The disease may exist in a [{247}] latent form and only develop strikingly after the assumption of the serious responsibilities of the position of Superior. When, however, the eyes are prominent, the pulse rapid, and the goitre, or swelling of the front of the throat, characteristic of the disease, is present, there are practically always mental symptoms that make it extremely inadvisable for her continuance in a position of serious responsibility. Professor Church of Chicago (Professor of Nervous and Mental Diseases and of Medical Jurisprudence, in the Northwestern University Medical School), in the last edition of his book on Nervous and Mental Diseases, [Footnote 5] has this to say with regard to the mental disturbances of Graves' disease:

[Footnote 5: Nervous and Mental Diseases. Church and Peterson, 4th edition. Saunders, Phila., Pa., 1903.]

"From the beginning, and often for a long period antecedent to the appearance of cardiac symptoms, the subjects of Graves' disease present a considerable mental erethism. There is an indefinable and tormenting agitation, marked by mental and motor restlessness and an imperative and impulsive tendency to be doing. Their emotions are too readily excited, and they are unusually impressionable and irritable, reacting in an exaggerated manner to all the incidents of daily life. In more pronounced cases they become voluble and manifest the greatest mobility of ideas, but have no persistent concentration of logical order. Their affections are likely to undergo modifications, and they become irascible, fault-finding, inconsiderate, ungrateful, and hard to live with. In some instances this disturbance of mentation carries them over the border into active mania, marked, perchance, by delusions of fear, due to the cardiac symptoms of sensations of heat. Insomnia is often added and the fitful sleep is disturbed by horrifying dreams that are likely to be projected into the waking moments and woven into delusions which are usually unsystematised, and constantly changing, furnishing the analogue of the motor restlessness. Hallucinations of sight and hearing are not uncommon.

"The mental perturbance only rarely reaches the degree of actual mania, and then is, perhaps, equally dependent upon numerous other causes acting in a neurotic individual. But [{248}] a condition of abnormal mental stimulation is characteristic of the malady, and is as important an index as any of the cardinal triad." [Footnote 6]

[Footnote 6: Of physical symptoms, namely, the rapid heart, the prominent eyes, and the enlargement of the thyroid gland in the neck.]

Dr. Church considers, then, that the mental symptoms of the disease are as important a concomitant, and as little likely to be absent in any given case, as are any of the three or four well-known physical symptoms characteristic of the disease. Under these circumstances the necessity for the exercise of care in permitting such a patient to continue in the office of Superior must be manifest. It is a question not for religious authorities to decide but for physicians, and they are to be experts in mental diseases. There are many physicians who have had experience with cases in which Graves' disease has been a source of unfortunate conditions in religious life, owing to the failure to understand the relations of the physical affection to mental disturbances. At times unfortunate consequences follow that are irretrievable in the destruction of vocations and the impairment of the religious spirit in communities.

As a rule it may be said that the development of serious disease is almost sure to incapacitate a Superior from fulfilling the functions of office. This is true, however, not only for physical disease but for the so-called neuroses. These are maladies which have their basis in some disturbance of the physical constitution, though this is not always easy to find. We prefer to speak of them as neuroses rather than neurasthenia, because this latter name has somehow come to have an unwelcome sound and to carry with it the idea of imaginary rather than real ailments. A true neurasthenic, however, is supremely to be pitied.

It has often been noticed that such individuals, while perfectly capable of judging properly for others, are not able to form right judgments with regard to their own conditions. This principle, however, should not be taken as a rule, and it must not be forgotten that neurasthenics are often the subjects of compulsory ideas—so-called obsessions, in which they are not entirely responsible for actions performed. At such [{249}] times they are prone to be irritated by very trivial faults, and what is worse, to exaggerate slight defects into serious infractions of rule or of obedience. With regard to such persons, therefore, constant care has to be exercised to control their statements by those of others and not to take them at their full value without due substantiation. In this matter the subject is quite as likely to suffer as the Superior, and information obtained from them should not be acted upon without consultation with others who know the details of the case.

As a rule neurasthenic individuals become, as is well known, worse as far as the mental condition is concerned when they are asked to assume new responsibilities. This physical side of the choice of Superiors, and of those to be elected by members of the community, should always receive due attention, though sometimes it is entirely lost sight of. Not a few communities, however, have suffered in their usefulness and in the fulfilment of the design of their institute by the selection of Superiors whose neurotic conditions sometimes seemed to proclaim a high degree of piety, which was, however, rather emotional than practical. The physician's view of some of these cases would add materially to the knowledge of the character of such individuals.

It should in general be very clear that the development of any serious nervous disease, which is not likely to be cured by ordinary remedies or which requires freedom from responsibility as the first requisite for improvement, should be the signal for consideration as to a change of Superiors. Physicians see much more of the evil that may be worked in this way, and realise the true significance of what is often a sad state of affairs, much better than those who have not the secret of the cause of the unfortunate condition. It is almost needless to say that the question of obedience to some one whose responsibility is not complete, but is influenced by neurotic disturbance, becomes an extremely difficult problem for the subject, and one in which there is apt to be the feeling that it was not the original intention of his obligation of obedience to bind him under such circumstances.