Religion And Health

by James J. Walsh

After loss of sleep and irregular eating, wet feet for days at a time, exposure to the inclemencies of the weather and then having to withstand an enemy attack, often at dawn after a fearsome barrage had been laid down on them for hours, it is no wonder that in many cases men's nervous control did give way. They were not cowards, they were not malingerers; on the contrary they were often brave men who had volunteered for the service, giving up important positions at home to take up the defense of their country; and yet after a time their dreads dominated them and they suffered from all sorts of symptoms. Some of them could not see, a number could not hear; some could not use their legs, and some could not employ their arms properly; some walked with a limp, some had tremor that made their usefulness as soldiers absolutely at an end. Nearly all of them had a series of complaints which they wanted to detail in all their minuteness to every physician who came near. Their stories of what had happened were mainly untrue or utter exaggerations of the actual events, and yet these men were not liars and they were not the doddering idiots that they sometimes [{241}] seemed to be; they were just fellow mortals who meant to do their best, and who had been affected in this way because they were asked to stand what was beyond their strength of soul to withstand.

The educated suffered more than the uneducated. There were four times as many "shell shock" cases among the officers of the British army in proportion to their number as there were among the privates. Neither ambition nor nobility nor any artificial distinction of any kind seemed to make any difference, for all classes and conditions of men came down with it. Its frequence can be very well judged from the fact that one third of all the dismissions from the British army, not counting the wounded, was for "shell shock", which of course should be called by its proper name of major hysteria. One seventh of all the dismissions, if the wounded were included, was for this reason. It had been the custom to think before the war that only a comparatively few men, mostly those of a certain feministic appearance and delicacy of constitution, were likely to suffer from hysteria. It was found, however, that college graduates who stood at the head of their classes, athletes who held records, broad-shouldered, healthy men who had been considered to be the very acme of common sense, men who were supposed to be without a nerve in their make-up, all these proved to have "nerves"; and when the war "got on their nerves", they suffered from the complaints which we have mentioned and many others, including pains and discomforts of all kinds, and inabilities and incapacities, motor and sensory as well as of the memory, of the mind or the will.

This recent significant experience will give some idea of how potent dreads may be in the production of [{242}] symptoms which seem surely to be due to physical rather than merely mental conditions. Most people would probably be inclined to think that in so far as dreads produced diseases by the exaggeration of minor symptoms, at most scarcely more than mental conditions of discomfort would result from them. What are called the psychoneuroses, that is, the neurotic affections dependent on the state of mind, may simulate almost any of the organic conditions and may seem to be serious diseases. Through the creation of unfortunate habits, they may give rise to a great many rather severe physical symptoms. The war neuroses emphasized this for us. Inability to use limbs, either legs or arms, is quite common in connection with them; disturbances of sensation, such as defective hearing and eyesight, or even what seems to be complete blindness and deafness, may develop. Tremors are quite common, and pains and aches in connection with the disabilities of the limbs are extremely frequent.

A very usual experience is to find that a patient has as a preliminary suffered some injury. This may not be very severe, but it is enough to cause the sufferer to spare the limb that is affected; and unfortunately physicians sometimes put a limb with a minor affection in plaster of Paris or in a splint for a time. The patient's own solicitude with regard to the hurt may cause almost as effective splinting of it as a plaster cast or wooden slat and a bandage. Whenever this happens, the unused muscles lose some of their nutrition. This is due partly to the fact that the circulation is interfered with because the active contraction of muscles, especially of the legs, is depended on by nature to help the venous or return circulation by bringing about compression of the veins. The valves in the veins are so arranged that when the [{243}] veins are compressed and the blood thus pressed out of them, it cannot move away from the heart but is impelled onward toward the heart. Besides, the sending down of nervous impulses for the active use of muscles increases the size of the arteries to the part by direct action on their walls, and whenever there is failure to send impulses down, the arteries do not carry as much blood as usual, and the nutrition of the part suffers as a result.

If this inactive state of the muscles continues for a few days, they will become somewhat flaccid, and after a week or more will actually begin to decrease in size. As a consequence of this, they cannot be used to as good advantage as before, and use of them sets up an achy condition as soon as the limb is set free for use, whether it has been splinted by the physician or by the patient's mind. If the patient is still solicitous, he notices this condition of pain and concludes that it means that the muscles are not yet in the condition of health where they should be used, and he puts on the splints, metaphorical or literal, once more. The muscles grow more flaccid and eventually atrophic as a consequence, until sometimes there will be a difference of more than an inch in the girth of two limbs at the same point, and this atrophy may proceed much farther. It seems almost impossible to believe that men and women could thus make a limb useless, but this is actually what happens rather frequently. The effects of the original injury will pass off in a few days, but the effects of the disuse of the limb may remain for months or even years because of the disturbance of circulation and of nerve impulse. It is probable that the nerves themselves have a trophic or nutritional—that is, vitalizing—influence upon muscles. Some physiologists actually talk of there being [{244}] trophic fibers in the nerves, though it would seem more reasonable to think that the nerve trophic effect comes from the modification of the circulation to the part.

Whenever muscles have to be increased in size or won back from an atrophic condition, the individual to whom they belong must go through a period of soreness and tenderness in those muscles which often is very hard to bear. The young fellow who, after a rather relaxed summer, begins training for the football team in the fall, knows how sore and tender his muscles have become. After the first day or two of training, each time he wakes up at night he turns over in bed with the feeling that every bit of him is full of tenderness. Any number of people under similar circumstances are inclined to think that they must have caught cold. They usually reason thus: "I got into a perspiration and sat down for a while and then took cold, and that is the reason for all this painful condition that has developed."

That word "cold" is as unfortunate as "shell shock." There is no such thing as taking cold. We catch infections, but much more frequently in fall and spring than in winter. The young man who is in training usually pays no attention to such unfavorable suggestions or dreads, since he knows that he must take his medicine of further hard exercise until he has hardened and developed his muscles and then, instead of their causing discomfort, nothing in the world gives him so much satisfaction as their active exercise.

Older people, however, and especially those who have what may be called a "dready" disposition, do not call their muscle discomfort soreness and tenderness; they speak of pains and aches. The very words carry a suggestion of evil with them, and above all they carry with [{245}] them an inhibitory suggestion which keeps muscles from being used normally. If, then, certain older people get an injury, even though it may not be very serious, so long as it causes them to give up the use of a limb for a while, or sets them to using the muscles of it a little differently from before, a psychoneurosis on the basis of a dread, but with the physical basis of somewhat atrophied muscles to keep it up, may develop and persist for weeks and months and even years. As a consequence of this state—much more of the mind than the body—men may walk lame or be very awkward in the use of one arm, or they may have a little stoop, or they may dread very much the using of some group of muscles. Such conditions occasionally occur in the neck or in various parts of the back, and especially in the lumbar region, with strikingly visible effects.

It might seem impossible that such conditions should develop and persist for any length of time in sensible and above all intelligent people, and yet I suppose that every physician's case book contains a number of examples. After he has been in practice for ten years or more this will surely be true, if he has had much to do with nervous patients. One of the most distinguished scientists that we had in this country, possessed of one of the finest intellects of our generation, thoroughly sensible and noted for his executive ability, suffered from a slight attack of sciatica, to which he had been predisposed by some unusual work in connection with a heavy fall of snow when he had to go out and do the shoveling himself, since labor was not available. He never quite got over it. For some time he carried two crutches because he had so little confidence in putting down the foot on that side, after having spared it for a [{246}] while. Then for several years he carried a single crutch. In the meantime he was examined by half a dozen of the best physicians in the country, who could find nothing the matter with him except that disuse had rendered the muscles of that leg slightly atrophic, and he would have to push through a period of soreness and tenderness while exercising them. He carried a cane ever afterwards, walked a little lame and favored that leg.

Persistent sciaticas of this kind and lumbagoes are much more common than they are thought. It was a case of this kind, undoubtedly, that brought about Bernheim's interest in hypnotism at Nancy and initiated that wave of attention to hypnotism at the end of the nineteenth century which did so much harm. A patient who had suffered from sciatica for some years and walked a little lame as a consequence came under Bernheim's care, and he tried without success every therapeutic resource at his command to make him better. Finally his patient gave up calling on him, completely discouraged. He had gone to a great many physicians before Bernheim, and all of them had failed to do him any effectual good. They could relieve his discomfort for a while, but when he stopped taking drugs, that returned and his limb could be used no better than before.