WHY WORRY? CHAPTER X
OCCUPATION NEUROSIS
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WHY WORRY?
BY: GEORGE LINCOLN WALTON, M.D.
CONSULTING NEUROLOGIST TO THE MASSACHUSETTS GENERAL HOSPITAL
Chapter X.
OCCUPATION NEUROSIS
"Be not ashamed, to be helped; for it is thy business to do thy duty like a soldier in the
assault on a town. How, then, if being lame thou canst not mount up on the battlement alone,
but with the help of another it is possible?
--Marcus Aurelius
The insistent and over-conscientious habit of mind plays so large a part in the so-called occupation neuroses that a brief discussion of their
nature may here be in place.
 The best-known form of this distressing malady is "writer's cramp." Upon this subject the proverbially dangerous little knowledge has been
already acquired; a fuller knowledge may give comfort rather than alarm, and may even lead to the avoidance of this and allied nervous disorders.
The term "writer's cramp" has unduly emphasized a feature, namely, the cramp, which is neither the most common nor the most troublesome among
the symptoms resulting from over-use of a part. In occupation neuroses, other than those produced by the use of the pen, pain, weakness, and numbness
are at least equally prominent, and even in writer's cramp the "neuralgic" form is common.
 The fact is generally realized that this type of disorder is particularly frequent among persons of nervous temperament. The reason is twofold, first, the resistance of such individuals is lower than that of the average person, and, second, their persistent habit of mind leads them to overdo. It is against this last factor that our efforts may be directed to some advantage.
I have in mind the case of a lady who complained of severe pain in the right arm with no apparent physical cause. The pain, at first appearing
only when the arm was placed in a certain position, finally became almost constant. She denied excessive use of the arm, but her husband stated
that she plied the needle to such an extent that it caused the family distress. This she indignantly denied, and fortified her position by the statement
that she only took short stitches! Further inquiry elicited the acknowledgment that she did so because she could no longer take long ones. [Sounds like something we today would call "carpal tunnel syndrome".]
This is a fair example of an occupation neurosis.
Some time ago, after long continued and over-conscientious effort to satisfy the requirements of an athletic instructor, I acquired what is
known as a "golf arm". Efforts at its relief were unavailing. A vigorous course of
massage only increased the pain. I finally asked a friend what
they did in England when a golf player suffered this annoyance.
He replied that no golf player ever did so; when it occurred among others the arm was placed in wool for three months, at the end of
which time a single movement of swinging the club was made; if this movement caused pain the treatment was renewed for another three months.
I did not suppose he intended the advice to be taken literally, but followed it, except as regarded the wool, and I verily believe that I should
otherwise have been experimenting with the treatment of golf arm to-day.
My friend's advice indicates the general experience with occupation neuroses including writer's cramp, for which every imaginable measure
has been tried, only to be replaced by protracted abstinence from the use of the pen. The attempt to use the left hand proves, as a rule, only
temporarily efficacious. The speedy appearance of symptoms in the left hand emphasizes the fact that it is tired brain, as well as the tired muscle,
that rebels.
The ranks of every profession, and of every trade, are daily depleted of the most promising among their members, whose zeal has outrun their
discretion; their over-worked brains and hands have succumbed under the incessant strain of tasks, often self-imposed.
It is hard, but essential, for the sufferer from an occupation neurosis to abandon frantic efforts at combining treatment with continuance of
labor. He must bring all his philosophy to bear on the temporary, but complete, abandonment of his chosen occupation, at whatever loss to himself or
others.
To avoid this contingency the over-conscientious worker will do well to modify his ambition, and lower his pride if needful, consoling himself
with the reflection that an occasional interruption of his labor, even at material loss, may be replaced by years of future usefulness. Cowper
says:
"Tis thus the understanding takes repose
In indolent vacuity of thought,
And rests, and is refreshed."
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