Empty Hands. Miss Y., a fine woman of middle age, suffering from extreme fatigue could neither sleep nor eat. She could only weep. She had spent her life taking care of an invalid girl who had recently died. Now her hands were empty. Like many a mother whose family has grown up, she had no outlet for her mothering instinct, and her sense of impotency expressed itself in the only way it knew how,—through her body. As there is never any lack of unselfish work to be done, or of people who need mothering, she soon found herself and learned how to sublimate her energy in useful activities.
Defying Nature. One young man from Wyoming had felt himself obliged to give up his business because he could neither work nor eat. It soon cropped out that he and his wife had decided that they must not
have any children. With a better understanding of the great forces which they were defying, his strength and his appetite came back and he went back to work, rejoicing.
Left-over Habits. Often a state of fatigue is the result of a carried-over habit. One of my patients, a young girl, had several years before been operated on for exophthalmic goiter. This is a disease of the thyroid gland, and is characterized by rapid heart, extreme fatigue, and numerous other symptoms. Although this girl's goiter had been removed, the symptoms still persisted. She could not walk nor do even a little work, like wiping a few dishes. I took her down on the beach, let her feel her own pulse and mine and then ran with her on the sand. Again I let her feel our pulses and discover for herself that hers had quickened no more than was normal and had slowed down as soon as mine. After a few such lessons, she was convinced that her symptoms were reverberations for which there was no longer any physical cause.
Another young girl, Miss L., had had a similar operation for goiter six years before. Since that time she had been virtually bedridden. During the first meal she had at my house her sister sat by her couch because she must not be left alone. By the second meal the sister had gone, and Miss L. ate at the table with the other guests. That night she managed to crawl upstairs,
with a good deal of assistance and with great terror at the probable results of such an effort. After that, she walked up-stairs alone whenever she had occasion to go to her room. Her heart will always be a little rapid and her body will never be very strong, but she now lives a helpful happy life at home and among her friends.
In cases like this the exaggeration proves the counterfeit. Nobody could have been so down and out physically without dying. The exaggeration secures attention and gives the little satisfaction to the natural desires which are denied expression, and which gain an outlet through habit along the lines previously worn by the real disease. Many a person is still suffering from an old pain or an old disability whose cause has long since disappeared, but which is stamped on the mind and believed in as a present reality. Since the sensation is as real as ever, it is sometimes very hard to believe that it is not legitimate, but if the person is intelligent, a little explanation and re-education usually suffices.
Twenty Years an Invalid. Mr. S., from Ohio, had spent much of his time for twenty years going from one sanatorium to another. There was scarcely a health resort in the country with which he was not familiar. The day he came to me he felt himself completely exhausted by the two-block walk from the car.
He explained that he could scarcely listen to what I was saying because his brain was so fagged that concentration was impossible. When asked to read a book, he dramatically exclaimed, "Books and I have parted company!" I set him to work reading "Dear Enemy" but it was not a week before he was devouring the deeper books on psychology, in complete forgetfulness of the pains in his head. Playing golf and walking at least six miles every day, he rejoiced in a new sense of strength in his body, which for twenty years he had considered "used up." He is now doing a man-sized job in the business and philanthropic life of his home city.
Brain-fag. This feeling of brain-fag is one of the commonest nervous symptoms; and almost always it is supposed to be the result of intellectual overwork. Some people who easily accept the idea that physical work cannot cause nervous breakdown can scarcely give up the deep-rooted notion that intense mental work is harmful. Intellectual effort does give rise to fatigue in exactly the same way as does physical exertion, but the body takes care of the waste products of the one just as it does those of the other. Du Bois says that out of all his nervous cases he has not found one which can be traced to intellectual overwork. I can say the same thing, and I know no case in all the literature of the subject whose symptoms I can believe to