The patient often feels, and takes comfort in feeling, that his temporary outbursts of fretfulness and impatience are understood by his friends, as having no consonance with the real feelings of his heart. A much respected patient, of whose sickness I have many pleasant recollections, was one day speaking to me of his sister in the highest terms of eulogy. “Yet,” said he, “I scold at her, but I have no business to do it. However, she understands it. She knows that I am nervous, and that I am sometimes hardly myself and she forgives it all.”
Let me not be understood to mean that all the notions and caprices of the sick are to be yielded to as a matter of course. I only object to an useless and injudicious warfare with them. There should always be firmness exercised in the management of the sick, but there should be no struggle with them from mere pride of opinion, or a desire for authority, or from want of a proper charity for their mental weakness. They should never be directly opposed, except it be distinctly and manifestly for their good.
One very common mistake in the mental management of some chronic cases remains to be noticed. I refer to those cases in which the nervous system is so deranged, as to produce a variety of sensations of a deceptive character. Such patients are generally laughed at as hypochondriacs, and they are told by their friends, and sometimes even by physicians, that these sensations are wholly imaginary. This is not so. Some of their notions about them are mere imaginations, it is true; but the sensations themselves are, to some extent at least, real. Imagination may magnify them, but it does not ordinarily create them. The wrong ground which is so often taken in regard to such patients, sometimes essentially retards their recovery. They feel that they are trifled with, and they have but little confidence in the judgment of those who deny that their sensations are real, and therefore have but little if any in the remedies which they administer to them. Besides, the mind of the patient is disturbed continually by the disputes and consequent ill feeling which such differences of opinion necessarily engender, and this of course has a tendency to aggravate the diseased condition.
As an illustration of these remarks, I will mention a single case. The patient, who had long been an invalid, had, among a great variety of sensations, a burning, twinging, sometimes a pulling sensation, in the region of the stomach. Her notion about it was that there was a cancer there, that really pulled, and burned, and twinged. She had been assured again and again that there was no cancer there, but so little credit had been given to her account of her sensations by those who had told her so, that she had on her part given little credit to their knowledge of her case. I immediately told her that I had no doubt that the nerves in that part of the body were the seat of the sensations she described, but that she was wrong in the disease which she fancied to be the cause of those sensations. By taking this plain and obviously proper ground with her as to the nature of her case, making the true distinction between what was real and what was imagined, she was induced to give up the imaginary notion that was weighing down her spirits. This view of her case, so consonant with the faithful report of her own sensations from day to day, commended itself to her common sense, and by inspiring confidence and hope, did quite as much for her recovery as any other remedial means that were used.
Among the great variety of topics which have suggested themselves in connection with the subject of this chapter I have selected those, the discussion and illustration of which would most interest and profit the general reader. There are two topics, however, of this character which require so extended a notice, that I shall devote to each of them a separate chapter. I refer to insanity, and the influence of hope in the treatment of disease.
In concluding this chapter I remark, that the subject of it demands of medical men a more distinct and thorough attention than it commonly receives. The physician should be something more than a mere doser of the body. Mental influences are among the most important of our appliances in the cure of disease. The physician, therefore, in fulfilling his high vocation, should not only have a full knowledge of mental philosophy, but he should aim to acquire a practical skill in applying its principles to all the ever varying phases, which the mind presents in its connection with disease. The possession of this skill is one of the most valuable endowments of the medical art.
FOOTNOTES:
[38] This chapter, and the chapter on Truth in our Intercourse with the Sick, appeared some years since in the New Englander.
[39] It is often difficult to determine definitely what are the real sentiments of phrenologists on this subject. But that some of them, if not actually and fully materialists, are very near it, there is no sort of doubt, if language is to be understood as used by them in the same way that it ordinarily is. They not only strip man of all the elements of moral character, and consider him, as one of them expresses it, as ‘a bundle of instincts,’ thus making him but a brute of a higher order; but the material organization is exalted in their view above all those spiritual qualities or powers, which they seem to consider either as attached to it, or resulting from it, or at least as being in no sense independent of it. If this be not materialism, it comes very near to it.