Doctor and Patient

by S. Weir Mitchell

The woman in the situation I have described has probably a variety of symptoms on which her condition causes her to dwell. A great many of them are of little practical moment. If she is irresolute and weak, she yields where she should not, and finds for inactivity or for fears ample excuses in the state of her own feelings. An unwholesome crop of disabilities grows out of these conditions. It then becomes the business of her physician to tell her what is real, what is unreal, what must be respected, what must be overcome or fought. She has acquired within herself a host of enemies. Some are strong, some are feeble. The hour for absolute trust has arrived, and she must now believe in her adviser, or, if she cannot, she must acquire one in whom her belief will be entire and unquestioning.

Let us take an illustration. Such a woman is apt enough to suffer from vertigo or giddiness. "If I walk out," she says, "I become giddy. I am rarely free from this unless I am in bed, and it terrifies me." You know in this case that she is still strong enough to exercise in moderation. You say, "Walk so much daily. When you fall we will think about stopping. Talk to some one when you go out; have a friend with you, but walk." She must believe you to succeed. This is a form of faith-cure which has other illustrations. You tell her that she must disregard her own feelings. She credits you with knowing, and so wins her fight.

There is a sense of fatigue which at some time she should learn to treat with disrespect, especially when disuse of her powers has made their exercise difficult, and yet when returning health makes it wise to employ them. To think, and at last to feel sure that she cannot walk is fatal. And above all, and at all times, close attention to her own motions is a great evil. We cannot swallow a pill because we think of what, as regards the larger morsels of food, we do automatically. Moreover, attention intensifies fatigue. Walk a mile, carefully willing each leg-motion, and you will be tired. The same evil results of attention are observed in disease as regards other functions over which we seem in health to be without direct power of control.

"Mind-cure," so called, has, in some shape, its legitimate sphere in the hands of men who know their profession. It is not rare to find among nervous women a few in whom you can cause a variety of odd symptoms by pressing on a tender spine and suggesting to the woman that now she is going to feel certain pains in breast, head, or limbs. Nervous women have, more or less, a like capacity to create or intensify pains and aches, but when a woman is assured that she only seems to have such ailments she is apt, if she be one kind of woman, to be vexed. These dreamed pains—I hardly know what else to call them—are, to her, real enough. If she be another kind of woman, if she believes you, she sets herself to disregard these aches and to escape their results by ceasing to attend to them. You may call this mind-cure or what you will, but it succeeds. Now and then you meet with cases in which, from sudden shock or accident, a woman is led to manufacture a whole train of disabling symptoms, and if in these instances you can convince her that she is well and can walk, eat, etc., like others, you make one of those singular cures which at times fall to the luck of mind-or faith-cures when the patient has not had the happy fortune to meet with a physician who is intelligent, sagacious as to character, and has the courage of his opinions. I could relate many such cases if this were the place to do so, but all I desire here is to win the well woman and the nervously-sick woman to the side of the physician. If she flies from him to seek aid from the ignorant fanatic, she may, in rare cases, get what her trained adviser ought to give her and she be willing to use, while in unskilful hands she runs sad risks of having her too morbid attention riveted to her many symptoms; for to think too much about their disorders is, on the whole, one of the worst things which can happen to man or woman, and wholesome self-attention is difficult, nay, impossible, to command without help from a personally-uninterested mind outside of oneself.

I cannot leave this subject without a further word of solemn warning. In my youth we had mesmerism with its cures, then we had and have spiritualism with its like pretensions. From time to time we have had faith-cures. They come and they go, and have no stable life. The evil they do lives after them in the many mental wrecks they leave. When the charlatan Newton was ordering every class of the sick to get well, I was called upon to see case after case of the most calamitous results on mind and body. Now and then he had the luck to meet some one who was merely idea-sick,—a class of cases we know well. Then he made a cure which would have been as easy to me as to him. I made much inquiry, but could never find a case of organic disease with distinct tissue-changes which he had cured. A man with hopeless rheumatic alterations of joints was made to walk a few steps without crutches. This he did at sore cost of pain, and then came to me to tell me his tale with a new set of crutches, the healer having kept the old set as evidence of the cure. And now we have the mind-cure, Christian science and the like,—a muddle of mystical statements, backed by a medley of the many half-examined facts, which show the influence of mental and moral states over certain forms of disorder. The rarity of these makes them to be suspected. Hardly any have the solid base of a thorough medical study, and we lose sight of them at the moment of cure and learn nothing as to their future.

The books on mind-cure are calculated to make much and serious evil. I have read them with care, and have always risen from them with the sense of confusion which one would have if desired to study a pattern from the back of a piece of embroidery. There is, however, a class of minds which delight in the fogs of mystery, and, when a book puzzles them, accept this as evidence of depth of thought. I have been bewildered at times by the positiveness and reasoning folly of the insane, and I think most trained intelligences will feel that books like these mystical volumes require an amount of care and thinking to avoid bewilderment of which the mass of men and women are not possessed. In a few years they will be the rarely read and dusty volumes, hid away in libraries, and consulted only by those who undertake the sad task of writing the history of credulity. Their creed will die with them, and what is best of it and true will continue to be used by the thoughtful physician, as it has been in all ages. But, meanwhile, it is doing much harm and little good. Every neurologist sees already some of its consequences, and I, myself, have over and over had to undo some of the evil it had done.

Our nervous woman is well. Slowly, very slowly, she has won flesh and color, which means gain in quality and quantity of blood. By degrees, too, she has been able to return to the habits and endurances of health. And now she asks that other question, "I have daughters who are yet young, but how shall I guard them against nervousness?" and again puts forward this single complex symptom in disregard of the states of body which usually accompany it, and are to us matters quite as grave. She knows well that the mass of women are by physiological nature more liable to be nervous than are men. It is a sad drawback in the face of the duties of life, that a very little emotional disturbance will suffice to overcome the woman as it does not do the man, and that the same disease which makes him irritable makes her nervous. Says Romanes, in an admirable and impartial article on the mental differences of men and women, "She is pre-eminent for affection, sympathy, devotion, self-denial, modesty, long-suffering or patience under pain, disappointment, and adversity, for reverence, veneration, religious feeling, and general morality." I accept his statement to add that these very virtues do many of them lead to the automatic development of emotion, which, in its excesses and its uncontrolled states, is the parent of much of the nervousness not due to the enfeeblement of disease.[5]

[Footnote 5: Journal of Popular Science, July, 1887.]

With the intellectual differences between man and woman I have here little to do. That there is difference, both quantitative and in a measure qualitative, I believe, nor do I think any educational change in generations of women will ever set her, as to certain mental and moral qualifications, as an equal beside the man. It would be as impossible as to make him morally and physically, by any educational or other training, what the woman now is, his true superior in much that is as high, and as valuable as any mental capacities he may possess; nor does my creed involve for woman any refusal of the loftiest educational attainments. I would only insist on selection and certain limitations as to age of training and methods of work, concerning which I shall by and by have something more to say. Neither would I forbid to her any profession or mode of livelihood. This is a human right. I do not mean to discuss it here either as citizen or physician; but, as man, I like to state for my fellow-man that there are careers now sought and won and followed by her which for him inevitably lessen her true attractiveness, and to my mind make her less fit to be the "friendly lover and the loving friend."[7] Æsthetic and other sacrifices in this direction are, however, her business, not mine, and do not influence my practical judgments as to what freedom to act is or should be hers in common with men. For most men, when she seizes the apple, she drops the rose. I am a little afraid that Mrs. Lynn Linton is right as to this, but it took some courage to say what she said,[6] and she looks at the matter from a more practical point of view, and deserves to be read at length rather than quoted in fragments.

[Footnote 6: One would like to know how many women truly want the suffrage, and how, when it was won, the earnest anti-tariff wife would construe the marriage service in the face of the husband's belief in high tariff. The indirect influence of women in politics is worth a thought. We felt it sorely in 1861, and thence on to the war's end, and to-day it is the woman who is making the general prohibition laws probable. For ill or good she is still a power in the state.]