Chapter 7 - Neurasthenia

"Some of your hurts you have cured,

And the worst you still have survived;

But what torments of mind you endured

From evils which never arrived."

—Lowell.

Today, the need to eat forces even sensible people to live, and die, at a feverish rate. In earlier days the world was a more peaceful place, in which our forefathers were denied the chance of combining exercise with amusement dodging murderous taxis; knew not the blessings of "Bile Beans", nor the biliousness they blessed either; they did not fall victims to "advert-diseases"; and they left the waters beneath to the fishes, and the skies above to the birds.

Despite being sound trenchermen, who called their few ailments "humors" or "vapors" and knew what peace of mind meant. Sixty years ago there was one lunatic in every six hundred people; to-day there is one in every two hundred.

At the same time, the "neurasthenic temperament" is not altogether a modern product, for Plato described it with great precision, and declared such people to be "undesirable citizens" for his ideal republic.

Neurasthenia is due to exhaustion and poisoning of the nervous system, the chief symptoms of which is persistent neuro-muscular fatigue with general irritability. Its minor symptoms are almost as numerous as the various activities possible in mind and body.

The Predisposing Cause of neurasthenia is inherited nervous instability, but among nervous diseases, neurasthenia seems the least dependent on heredity, this factor playing a less important part than

Exciting Causes which are the sparks that fire explosive trains laid by the living, and often by the dead.

Worry in any form (especially when accompanied by excess of brain-work),

Accident-shock,

Sexual abuse,

Abuse of drink, drugs or tobacco,

Lack of exercise,

Exhausting diseases,

Menopause, and diseases of the womb,

"Society life",

Retirement,

are the commonest exciting causes of neurasthenia; hard brain-work, unless accompanied by worry, not being injurious.

The condition is more common in men than women (because of the more active part played by them in the struggle for existence), in cities than in the country, in mental than in manual workers, in the "idle rich", and in races which live feverishly, like the Americans. It is rare in old age.

Ambition, the seemingly never ending race for "success", the struggle to carry out projects beyond the reasonable capacity of one man, and the ceaseless work and worry with little sleep and no real rest which mark life to-day are responsible for this disease.

Competition has increased in all conditions of life; free course is given to ambition, individuals impose on their brains a work beyond their strength; and then comes care and perhaps reverse of fortune; and the nervous system, under the wear and tear of incessant excitation, at last becomes exhausted,

The basic symptom is an inability to stand a normal amount of mental or physical strain or stress, and shows itself in seven marked ways:

1. Muscular Fatigue, which is often most marked in the morning. The patient rises reluctantly, feeling as if he had not slept, is listless and "lazy", and can neither work nor play much without getting unduly tired. This weariness may pass off as the day wears on.

2. Backache is often constant and annoying. It may be a genuine pain, or a general discomfort, and may be felt anywhere in the back. Common places to feel this back pain is the nape of the neck and down the spine. The legs often "give way", and, in extreme cases, patients may believe they cannot stand, and become bed-ridden. Under sudden excitement, emotion, or in an emergency, they may walk again, becoming "miracles of healing". These spinal symptoms are common in neurasthenia following accident.

3. Headache is more often an abnormal sensation than an intense pain. Pulsations, feelings of distress, of lightness, fullness, heaviness and pressure are common, or a band may seem to be drawn tightly round the head across the forehead.

The sensations are usually located in the back of the head, and may be accompanied by dizziness, noises in the ears, or dimness of sight. There may be a feeling of unsteadiness when walking, or a sense of being in motion when at rest. The headache varies in intensity; it is worst in the morning, is increased by thinking, diminished after eating, often improves at night, and never keeps the patient awake.

4. Stomach and Bowel Disorders. The victim is indifferent to food, though dainties often tempt him, when he cannot face a square meal. He has a feeling of general well-being after a meal, but within an hour signs of imperfect digestion arise; he feels oppressed, and has flatulence. Later, there are flushes of heat, palpitation, drowsiness, and a craving for food. Constipation [pg 33] is usually obstinate, while diarrhœa may cause great weakness.

5. Sleeplessness. Some patients go to sleep with little difficulty, but after a while wake suddenly, in a state of excitement that seems to hang on despite efforts to remain calm, and only at an early hour in the morning do they sleep again. Other patients go to bed certain they will not be able sleep, and are kept awake by incessant cogitation, their minds being harassed by a rapid flow of images, ideas and memories. In some cases the person is calm, his mind is at rest, yet he cannot sleep.

6. Circulatory Disturbances. More blood flows to an organ at work than to one at rest. In health we do not notice these changes, but in neurasthenia these internal tides are exaggerated as rushes of blood to the head, flushings of various parts, and coldness of hands and feet.

Heart palpitation is alarming but not dangerous, and the distended blood-vessels of the ears may set up vibrations in the drum, so that at night when the head is on the pillow, every beat of the heart is heard as a thump, which banishes sleep, and works the victim into a state of high tension. A pain in the chest, arms and elbows is often felt, limbs may swell (shown by the tightness of rings, collars, etc.) while the hands and feet are usually moist and clammy. The patient may have to empty the bladder every half-hour. Disorders of menstruation are common.

7. Mental Fatigue. Hundreds of pages would be needed to describe all the symptoms due to mental fatigue, the morbid belief that the victim has a fatal disease being very common, though his "disease" rarely makes him lie up; in the day he works, at night describes his symptoms to the home circle.

The inability of most men to apply themselves steadfastly to any one set of ideas is seen in the immense [pg 34] popularity of music halls, cinemas, and short-story magazines, which offer a change of interest every few minutes.

In normal people there is a slight consciousness of mental processes, but the mind rarely watches itself work; the neurasthenic is unable to concentrate, and gets charged with inconstancy and shiftlessness.

His ideas are restive, continuous thought is impossible, and when talking he has to be "brought back to the point" many times. Memory and attention flag, and he listens to a long conversation, or reads pages of a book without grasping its import, and consequently he readily "forgets" what in reality he never laboured to learn. Trembling of limbs is common.

He lacks initiative, and whatever course he is forced to take—after much indecision—he is convinced, a moment later, it would have been wiser to have taken the opposite one.

All his acts are done inattentively. He goes to his room for something, but has forgotten what when he gets there; later, he wonders if he locked the drawer, and goes back to see. At night he gets up to make sure he bolted the door, put out the gas, and damped the fire.

Regret for the past, dissatisfaction with the present, and anxiety for the future are plagues common to most people, but they become acute in a neurasthenic, who reproaches himself with past shortcomings of no moment, infuriates himself over to-day's trivialities, and frets himself over evils yet unborn.

Such a patient is often greatly upset by a trifle, yet little affected by a real shock, which by its very severity arouses his reactive faculties which lay dormant and left him at the mercy of the minor event. He will fret over a farthing increase in the price of a loaf, but if his bank fails he sets manfully to.

Duty that should be done to-day he leaves to be shirked to-morrow; he is easily discouraged, timid, and vacillating. Extremely self-conscious, he thinks himself the observed of all observers. If others are indifferent toward him, he is depressed; if interested, they have some deep motive; if grave, he has annoyed them; if gay, they are laughing at him; the truth, that they are minding their own business, never occurs to him, and if it did, the thought that other people were not interested in him, would only vex him.

He is extremely irritable (slight noises make him start violently), childishly unreasonable, wants to be left alone, rejects efforts to rouse him, but is disappointed if such efforts be not made, broods, and fears insanity. The true melancholic is convinced he himself is to blame for his misery; it is a just punishment for some unpardonable sin, and there is no hope for him in this world or the next. The neurasthenic, on the contrary, ascribes his distress to every conceivable cause save his own personal hygienic errors.

A neurasthenic, if epileptic, fears a fit will occur at an untoward moment. He dreads confined or, maybe, open spaces, or being in a crowd. When he reaches an open space (after walking miles through tortuous byways in an endeavour to avoid it) he becomes paralysed by an undefinable fear, and stops, or gets near to the wall.

Other victims fear knives, canals, firearms, gas, high places, and railway tracks, when the basic fear is of suicide. Many patients have sudden impulses—on which the attention is focussed with abnormal intensity—to perform useless, eccentric, or even criminal actions; to count objects, to touch lamp-posts, [pg 36] to continually reiterate certain words, and so on.

The victim is fully aware that there are no grounds for his panic or impulse, but though his reason ridicules, it cannot disperse, his fear, and the wretched man finds relief in sleep alone, which adds to his woes by being a coy lover.

An almost invariable stage is that wherein the patient studies a patent-medicine advertisement and finds that a disease, or collection of diseases, is the root of his troubles. This alarms but interests him; he studies other advertisements, sends for pamphlets, and so becomes familiar with a few medical terms. He then takes a "treatment", and talks of his "complaint" and how he "diagnosed" it. He has become hypochondriac.

He borrows a book on anatomy from the public library to discover in what part of the body his ailment is located.

He draws up (or copies) a special diet-sheet, and talks of "proteids", notices a slight cloudiness in his urine, and underlines "The Uric-Acid Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses anew, and so goes on, usually ending by taking phosphorus for his "brain fag". Then he finds he has a disease unknown to the faculty, which discovery interests him as intensely as it irritates his unfortunate friends.

This prince of pessimists has a conviction that, compared with him, Job was a happy man, and that he will go insane. He does not know that it is only when there are flaws in the brain from inheritance or organic disease that mental worry leads to lunacy; a sound brain never becomes unhinged from intellectual stress alone.

Books and friends are daily questioned about his "diseases", and in spite of reassuring replies, he [pg 37] continues to doubt, re-question and cross-examine endlessly, feeding his hopes on the same assurances, consoling himself with the same sympathies, and worrying himself with the same fears.

Other folk may be "nervy", he is seriously ill; he knows it because he feels it. He expects the greatest consideration himself, denies it to others, and then complains he is "misunderstood".

"Every symptom becomes magnified; the trifling ache or pain, the trivial flatulence, the disinclination or mere hesitation of the bowels to adhere to a strict schedule, all minor events such as occur to the majority of healthy men from time to time unheeded, come to be of vast importance to the psychasthenic individual."

He keeps a record of hourly changes in his condition, and pesters his family doctor to death. He goes from physician to physician, from hospital to hospital. Having been induced by his friends to see a specialist, he bores that good man—who knows him all too well—with a minute description of his symptoms, presenting for inspection carefully preserved prescriptions, urinary examination records, differential blood counts, and the like. Coming away with precious advice, he feels he omitted to describe all his symptoms, begins to doubt if the specialist really understands his case, and so the pitiful farce goes on—for years.

The extraordinary fact is that while he is suffering (sic) from cancer, or heart disease, or Bright's disease, and spasmodically from minor affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is probably running a successful business. While making money he forgets his ills; the moment his attention is diverted from the "root of evil" he proceeds to further "diagnosis".

In the end, he makes a pleasant hobby of his imaginary maladies, trying each patent nostrum, and [pg 38] giving herbalists, electric-belt men, Christian Scientists, and dozens of other weird "specialists" a chance to cure him.

Sexual Neurasthenia occurs chiefly in young men given to self-abuse or sexual excesses. Erections and emissions are frequent, first at night with amorous dreams, then in the day as a result of sexual thoughts; weakness and pain in the back follow, and the sexual act may become impossible. The patient usually studies a quack advertisement, and passes into the hands of men who make a living by bleeding such wretches dry. Cold baths and the treatment outlined in Chapter IX will cure him.

Course and Outlook. Neurasthenia is very curable. If the cause be removed, and vigorous treatment instituted, the victim may be well in a couple of months, but in most cases there are obstacles to radical treatment, and the disease drags on indefinitely.

Egoism, moral cowardice, and sexual excess play a part in much neurasthenia, but relatives must not forget, in their indignation at these laxities, that the patient really IS ill; it is unkind, unjust and useless to tell an ailing man the unpalatable truth that it is his own fault.

EPILEPSY, HYSTERIA, AND NEURASTHENIA

THEIR CAUSES, SYMPTOMS, & TREATMENT

NEURASTHENIA