It is, then, important to foresee the tendency of phobias, and to accustom one's self to the point of view that the worst possible harm, for example from contamination by ordinary objects, is no worse than mental unbalance, and that the probable consequences thereof (nil) are infinitely preferable.
Even with regard to more tangible fears, as of elevators, fires, tunnels, thunder-storms, and the like, a certain tranquility may be gradually attained by a similar philosophy. Suppose instead of dwelling on the possibility of frightful disaster the sufferer practices saying: "The worst that can happen to me is no worse than for me to let these fears gradually lessen my sphere of operations till I finally shut myself up in my chamber and become a confirmed hypochondriac." One should also remember that many another shares his fears, but shows no sign because he keeps a "stiff upper lip," an example he will do well to follow, not only for his own eventual comfort, but for the sake of his influence on others, particularly on those younger than himself. The pursuance of this line of thought may result in the former coward seeking instead of avoiding, opportunities to ride in elevators and tunnels, and even to occupy an inside seat at the theatre, just to try his new-found power, and to rejoice in doing as others do instead of being set apart as a hopeless crank.
These fears bear directly on the question of hypochondria. We have already seen how the sphere of the hypochondriac is narrowed. His work and his play are alike impeded by his fear of drafts, of wet feet, of loud noises, of palpitation, of exhaustion, of pain, and eventually of serious disease. Is he insane? Not so long as he can carry out a line of conduct consistent with his station and surroundings.
It is remarkable how many obsessions we may harbor without causing us to swerve from our accustomed line of conduct. Whatever our thoughts, our conduct may be such that we attract little attention beyond the passing observation that we are a little odd. We may break down, it is true, under the double load we carry, but we are in little danger of insanity. Those established in the conviction that they cannot stand noises or other sources of discomfort, rarely reach the point of a certain poor old lady who used to wander from clinic to clinic, able to think of nothing else, and to talk of nothing else, than the ringing in her ears, and to attend to no other business than efforts for its relief. She was counselled again and again that since nothing was to be found in the ears she should endeavor to reconcile herself to the inevitable, and turn her thoughts in other directions. Unfortunately, she had become peculiarly adept in the detection of disagreeable sights, sounds, and other sources of irritation, and had for a long term of years practiced quite the opposite of control. She had hitherto either insisted on discontinuance of all sources of irritation, fled their neighborhood, or put on blue glasses and stopped her ears with cotton. When, finally, her sharpened sense caught the sound of her own circulation, she could think of nothing but this unavoidable source of discomfort, which was prepared to follow her to the uttermost parts of the earth.
A well-known author has said that the difference between sanity and insanity depends only on the power to conceal the emotions. While this definition will hardly pass in law or medicine, it surely offers food for thought. Suppose for a moment that we were dominated by the impulse to externalize all our thoughts and all our emotions, there would be some basis for the common, but inaccurate, saying that everyone is insane.
This brings us to a form of insanity which the obsessive may well bear in mind, namely, that known as manic-depressive. This disorder, in its typical form, is shown by recurring outbursts of uncontrollable mental and physical activity (mania), alternating with attacks of profound depression (melancholia). This form of insanity represents the inability to control an extreme degree of the varied moods to which we all are subject. Long before the modern classification of mental disorders, Burton, in his introduction to the "Anatomy of Melancholy," expressed this alternation of moods thus:
"When I go musing all alone,
Thinking of divers things foreknown,
When I build castles in the ayr,
Void of sorrow and void of feare,
Pleasing myself with phantasms sweet,
Me thinks the time runs very fleet.
All my joyes to this are folly,
Naught so sweet as melancholy.
"When I lie waking all alone,
Recounting what I have ill done,
My thoughts on me they tyrannize,
Feare and sorrow me surprise,
Whether I tarry still or go,
Me thinks the time moves very slow.
All my griefs to this are jolly,
Naught so sad as melancholy."
"I'll not change my life with any King,
I ravisht am: can the world bring
More joy, than still to laugh and smile,
In pleasant toyes time to beguile?
Do not, O do not trouble me,
So sweet content I feel and see.
All my joyes to this are folly,
None so divine as melancholy.
"I'll change my state with any wretch
Thou canst from goale or dunghill fetch:
My pain's past cure, another hell,
I may not in this torment dwell,
Now desperate I hate my life,
Lend me a halter or a knife;
All my griefs to this are jolly,
None so damn'd as melancholy."
The depressed stage of this disorder is commonly shown by retardation of thought and motion, the excited stage by pressure of activity and acceleration of thought. In the so-called "flight of ideas" words succeed each other with incredible rapidity, without goal idea, but each word suggesting the next by sound or other association, thus: