WHY WORRY?
BY: GEORGE LINCOLN WALTON, M.D.
CONSULTING NEUROLOGIST TO THE MASSACHUSETTS GENERAL HOSPITAL
XIV.
THE FEAR OF BECOMING INSANE
We must be steadfast, Julian! Satan is very busy in all of us.
--IBSEN: Emperor and Galilean
 Few, perhaps, among the high-strung and delicately organized can truly say that this fear has never occurred to them. It affects even children, at an age when their minds are supposed to be taken up with the pleasures and pursuits appropriate to their years. This fear is generally dispelled by the serious occupations of life, but in certain cases it persists as an insistent and compelling thought.
It may give you some consolation to know that insanity results, in the majority of cases, from the physical disease of the brain, and that it is ordinarily unanticipated, unsuspected and uncredited by the patient. There is no more danger of insanity attacking the worrier and the delicate than the robust and the indifferent. In fact, the temperament which produces the faulty habits we are considering rarely culminates in insanity.
It seems worthwhile, however, to replace the vague fear of insanity with a knowledge of the variety of mental unbalance remotely threatening the person who lacks the desire or the will, to place a check upon these faulty habits of mind. We may thus, in the worrier whose fears have taken this direction, substitute effort for foreboding.
 It is our conduct rather than our thoughts that determines the question of insanity. The most practical definition of insanity I know is that of [Edward Charles] Spitzka, the gist of which is that a person is insane who can no longer correctly register impressions from the outside world, or can no longer act upon those impressions so as to formulate and carry out a line of conduct consistent with his age, education and station.
The banker may repeat the process of locking and unlocking, even to the point of doubting his own sensations, but he may still be able to formulate, and carry out, a line of conduct consistent with his position, though at the expense of intense mental suffering.
In the realm of morbid fears, the person obsessed with fear of contamination shows no sign of insanity in using tissue paper to turn the door-knob, or in avoiding objects that have been touched by others. Up to this point his phobia has led merely to eccentricity, but suppose his fear so far dominates him that he can no longer pursue his occupation for fear of handling tools or pen, and that he persistently refuses to eat through fear of poison, he has then reached the point where he can no longer formulate lines of conduct, and he is insane.
It is, then, important to foresee the tendency of phobias, and to accustom one's self to the point of view that the worst possible harm, for example from contamination by ordinary objects, is no worse than mental unbalance, and that the probable consequences thereof (nil) are infinitely preferable.
Even when we think about tangible fears, such as phobias about elevators, fires, tunnels, thunderstorms, and so on, some calm may be found by a similar philosophy.
Suppose instead of dwelling on the possibility of frightful disaster, we practice saying: "The worst that can happen to me is no worse than for me to let these fears gradually lessen my sphere of operations till I finally shut myself up in my room and become a confirmed hypochondriac." We should also remember that many others share his fears, but shows no sign because he keeps a "stiff upper lip," an example he will do well to follow, not only for his own eventual comfort, but for the sake of his influence on others, particularly on younger people. Following this line of thought may result in the former "coward" seeking instead of avoiding, opportunities to ride in elevators and tunnels, and even to occupy an inside seat at the theatre, just to try his new-found power, and to rejoice in doing as others do instead of being set apart as a hopeless crank.
These fears bear directly on the question of hypochondria. We have already
seen how the sphere of the hypochondriac is narrowed. His work and his play are alike impeded by his fear of drafts, of wet feet, of loud noises, of
palpitation, of exhaustion, of pain, and eventually of serious disease. Is he insane? Not so long as he can carry out a line of conduct consistent
with his station and surroundings.
It is remarkable how many obsessions we may harbor without causing us to
swerve from our accustomed line of conduct. Whatever our thoughts, our
conduct may be such that we attract little attention beyond the passing
the observation that we are a little odd. We may break down, it is true, under
the double load we carry, but we are in little danger of insanity. Those
established in the conviction that they cannot stand noises or other
sources of discomfort, rarely reach the point of a certain poor old lady
who used to wander from clinic to clinic, able to think of nothing else,
and to talk of nothing else, than the ringing in her ears, and to attend to
no other business than efforts for its relief. She was counseled again and
again that since nothing was to be found in the ears she should endeavor
to reconcile herself to the inevitable, and turn her thoughts in other
directions.
Unfortunately, she had become peculiarly adept in the detection
of disagreeable sights, sounds, and other sources of irritation, and had
for a long term of years practiced quite the opposite of control. She had
hitherto either insisted on discontinuance of all sources of irritation,
fled their neighborhood, or put on blue glasses and stopped her ears with
cotton. When, finally, her sharpened sense caught the sound of her own
circulation, she could think of nothing but this unavoidable source of
discomfort, which was prepared to follow her to the uttermost parts of the
earth.
A well-known author has said that the difference between sanity and
insanity depends only on the power to conceal emotions. While this
the definition will hardly pass in law or medicine, it surely offers food for
thought. Suppose for a moment that we were dominated by the impulse to
externalize all our thoughts and all our emotions, there would be some
basis for the common, but inaccurate, saying that everyone is insane.
This brings us to a form of insanity that the obsessive may well bear in
mind, namely, that known as manic-depressive [bi-polar].
This disorder, in its typical form, is shown by recurring outbursts of uncontrollable mental and
physical activity (mania), alternating with attacks of profound depression
(melancholia). This form of insanity represents the inability to control an
extreme degree of the varied moods to which we all are subject. Long before
the modern classification of mental disorders, Burton, in his introduction
to the "Anatomy of Melancholy," expressed this alternation of moods thus:
"When I go musing all alone,
Thinking of divers things foreknown,
When I build castles in the ayr,
Void of sorrow and void of feare,
Pleasing myself with phantasms sweet,
Me thinks the time runs very fleet.
All my joyes to this are folly,
Naught so sweet as melancholy.
"When I lie waking all alone,
Recounting what I have ill done,
My thoughts on me they tyrannize,
Feare and sorrow me surprise,
Whether I tarry still or go,
Me thinks the time moves very slow.
All my griefs to this are jolly,
Naught so sad as melancholy."
"I'll not change my life with any King,
I ravisht am: can the world bring
More joy, than still to laugh and smile,
In pleasant toyes time to beguile?
Do not, O do not trouble me,
So sweet content I feel and see.
All my joyes to this are folly,
None so divine as melancholy.
"I'll change my state
with any wretch
Thou canst from goale
or dunghill fetch:
My
pain's past cure, another hell,
I
may not in this torment dwell,
Now desperate I hate
my life,
Lend me a halter or a
knife;
All my griefs to this are jolly,
None so damn'd as melancholy."
The depressed stage of this disorder is commonly shown by retardation
of thought and motion, the excited stage by the pressure of activity and
acceleration of thought. In the so-called "flight of ideas" words succeed
each other with incredible rapidity, without a goal, but each word
suggesting the next by sound or other association, thus:
"Are you blue?"
"Blue, true blue, red white, and blue, one flag and one nation, one kingdom,
one king, no not one king, one president, we are going to have a president
first, cursed, the worst."
Who does not recognize the modest prototype of this elaborate rigmarole
chasing itself through his mind as he walks the street in a jaunty mood, and
who of us would not surprise and alarm his friends if he should suddenly
let go of his habitual control, express his every thought, and materialize his
every passing impulse to action? Who can doubt that the person who has
trained himself for years to repress his obsessions is less likely to
give way to this form of insanity than one who has never practiced such
training? Let us then endeavor to pursue "the even tenor of our way"
without giving way to the obsession that we must inflict our feelings upon
our associates. We may in this way maintain a mental balance that shall stand us in good stead in time of stress.
The autumnal tendency to melancholy is recognized by [Henry David] Thoreau. The characteristic suggestion of this nature-lover is that the melancholic go to the woods and study the symplocarpus foetidus (skunk cabbage), whose English name savors of contempt, but whose courage is such that it is already in the autumn jauntily thrusting forth its buds for the coming year.
An admirable reflection for the victim of moods, as for many another, is the old saying in which Abraham Lincoln is said to have taken peculiar comfort, namely, "This also will pass."
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