So much, as we have said, is written in recent years with regard to prostatic symptoms that a body of unfavorable suggestion has been created. This must be neutralized as far as possible by calling the attention of patients who have initial symptoms of vesical disturbance to the ease with which mental influences act upon the urinary functions. Solicitude and anxiety will add to symptoms and may even bring about their continuance when the original, local and passing condition which has caused them has ceased. Very often if the patient's mind can be properly disposed a marked relief of symptoms will follow, especially if, at the same time, remedial measures of other kinds are employed to lessen the irritation that is being set up. While prostatism seems to be due to such purely mechanical difficulties that mental influences can mean very little, the history of the therapeutics of the condition for the last twenty years shows us clearly that if strong mental influences are aroused they bring so much relief that many patients consider themselves cured. This psychotherapy will not do away with the necessity for operation in many cases, but it will cure many of the sufferers from milder symptoms and will in not a few cases bring such relief as will prepare the patients to undergo operation, if it should be necessary, with more assurance of favorable results.
CHAPTER II
SEXUAL NEUROSES
Anything that disturbs the sexual sphere in either sex, no matter how trivial it may be, becomes a source of worry and depression quite beyond its real importance. It is not unusual for men and women to become so worried over some trifling affection of their sexual organs that they become convinced that serious pathological conditions are developing and that there is little hope of anything like a complete cure. This is particularly true of young patients, but holds also for those of older years. Slight discomforts are exaggerated into nagging aches and pains which produce extreme depression of spirits.
It is important, then, for the physician to recognize this and to treat the patient's mind by reassurance while conducting whatever other therapeutics may be required. There is danger always in these cases of either making too little or too much of the affection. If too much is made of it, an unfavorable influence is produced in the patient's mind and the discouragement leads to so much inhibition or even actual physical disturbance that the affection will not improve. If too little is made of it, patients get discouraged and are prone to think that the physician does not understand their cases. Then they go to the advertising specialist in men's diseases who works upon their fears and makes them feel much worse than before, though in the end he may lift the cloud of anxiety from their minds and pretend to have cured them. He always leaves them, however, with the impression that something serious has been the matter, and this acts as a nightmare and a source of dread in after time.
In men the unfavorable suggestions occur particularly as a consequence of affections of the external organs. In women the same suggestions are likely to make themselves felt with regard to the internal genital organs. We all recognize the exaggeration of feeling and even physical reaction that takes place with regard to slight sexual ailments in the male, because it is easy to recognize just exactly what pathological conditions are present and how trivial they may be and yet produce serious depression and all kinds of symptoms, reflexly referred to many other organs. There is a tendency to listen to the complaints from women more seriously because the actual pathological condition cannot be determined and there is always the fear that some serious affection may be at work. It must not be forgotten, however, that the complaints of pains and aches, the disturbance of sleep, of digestion and of the intestinal function, the mental and physical lassitude and the over-reaction to irritation which occur in both sexes as a consequence of sexual affections may be due entirely to mental solicitude and not to any real pathological change.
Trivial Afflictions—Varicocele.—It is curious what a little thing will sometimes set off the explosion of a train of sexual symptoms. Every physician has probably had some young man come to him with the look and the tone that there was something the matter that he knew was serious and would affect all his after life. The patient then goes on to say that he wants to know all and is brave enough to face it, and, though he has lost sleep for two or three nights and is not looking well for the present moment because his health has been disturbed by the loss of sleep, still he has the strength to know the worst and it is to be told him and he will bravely battle on in spite of the suffering that must come. Or he will submit to a serious operation if it is necessary for his relief. With a prelude like this, the inexperienced physician might expect strangulated hernia or some preliminary symptoms of brain tumor, but what he usually finds is a varicocele, and a small one at that. By chance the patient has discovered it and slept none the following night, went round in an agony of dread next day meaning to go to a physician, but too fearful to be told the worst, losing another night's sleep and then finally coming to a friend to be told all the ill that is in store for him.
There is no need for alarm in these cases; they merely illustrate the role of the mind disturbing the body. Nearly one-fourth of the male world carries its [{474}] varicocele around with it and never bothers about it. A few sensitive individuals are annoyed by a sense of weight and a feeling of distention from congestion in connection with it. In a few, because of special pathological conditions or congenital defects, the varicocele becomes so large that it has to be supported by a special bandage. In people who ride horseback, in athletes, and those who indulge in severe exercise, this sort of a bandage may be necessary or at least may make the wearer more comfortable even in slighter forms of the affection. Severe cases may be much relieved by it.
On first discovery of his varicocele nearly every young man, because of concentration of attention on it, is so much annoyed that he thinks he must wear a bandage. After a time, however, he often finds that the bandage itself is a source of more annoyance than the varicocele, and then he learns to forget it and its feelings—and that is all about it.
I have dwelt on this succession of events that takes place so often with regard to varicocele, because it is typical of the effect that an affection of the sexual organs has upon the mind. It exerts an unfavorable influence entirely disproportionate to the physical cause that is at work. If, as sometimes happens, a young man hesitates to confide in some one capable of undeceiving him with regard to the supposed significance of his affection, he may work himself into a decided nervous condition and lose much weight before he discovers his mistake. This physical running down confirms his exaggerated notion of the significance of the affection. He is sure that it constitutes the reason why he is losing weight and declining in health and he rather congratulates himself on the fact that he discovered the cause so shortly before the serious effects began.