UC-NRLF -jjt Fox - : JUST NERVES JUST NERVES BY AUSTEN FOX RIGGS, M.D. BOSTON AND NEW YORK HODGHTON MIFFLIN COMPANY 1922 COPYRIGHT, 1922, BY AUSTEN FOX R1GGS ALL RIGHTS RESERVED Vfc toerufec CAMBRIDGE . MASSACHUSETTS PRINTED IN THE U.S^. TO B. C. R. 496^0 CONTENTS INTRODUCTION, BY HENRY VAN DYKE 9 I. USED AND ABUSED WORDS 13 II. HUMAN BEHAVIOR 23 III. MODERN LIFE AND THE OVER-SENSITIVE 37 IV. CHILDHOOD TRAINING 55 V. COMMON-SENSE RULES 77 NOTE Acknowledgments are due to the editors of Menial Hy- giene for permission to reprint those parts of this book which appeared in the April, 1922, number of that journal. INTRODUCTION THIS is certainly a good book on a difficult subject a sane, modest, helpful, and encouraging book based on a true philosophy of life, verified and corrected on every page by the practical experience of a successful physician to nervous in- valids. Here is the point which Dr. Biggs makes clear in his booklet. Most of these in- valids are real, not imaginary, sufferers. But the cause of their suffering is not so much a nervous disease as it is a nervous disorder. The way to cure that is to re- establish the right order; the reasonable rule, the self-control which is the secret of spiritual and physical health. Of course medicine and hygiene are use- ful in keeping the organs of the body in good working condition, in counteracting the influence of poisonous germs, in stim- ulating the action of certain glands which 10 INTRODUCTION have gone to sleep and fallen down on their job. The wise physician prescribes his remedies according to his best judg- ment, taking his patient into his confidence about the effect which he wishes to pro- duce. The sensible patient accepts the judgment of his chosen doctor and takes the prescription hopefully and cheerfully, thereby adding immensely to the efficacy of the medicine which is exhibited. But back of all this, in nervous disor- ders, lies the soul " Vital spark of heavenly flame " and it is there, in that abode of person- ality, human and divine, that the decision between life and death must be made. Will you, or won't you, be well? That is the question which every nerv- ous sufferer must answer. You must answer it for yourself. Your enemies are fear and worry and vanity and laziness and self-indulgence. Your friends are courage and obedience and humility and INTRODUCTION 11 patience and the sense of duty and love and God. Live with your friends. Then your doctor can help you. This, as I understand it, is the meaning of the little book which Dr. Riggs has written out of his experience. It does not need any introduction; but I am glad to write one because I have known him since he was a very little boy, and I am sure that what he says is sound, and that he practices what he preaches to the good of all his patients. HENRY VAN DYKE JUST NERVES I USED AND ABUSED WORDS JUST NERVES USED AND ABUSED WORDS How often does one hear some unfortu- nate person's troubles tersely and some- what contemptuously summarized by the supercilious onlooker as "just nerves"! As though now that the doctors had been unable to find a serious physical disease, there was nothing left but to condemn the still obstinately remaining disorder as " purely imaginary." This popular prejudice against nervous disorders is, like most prejudices, based upon ignorance and misunderstanding; in this instance ignorance of the facts of human psychology and misunderstanding of the phenomena of human behavior. Much confusion has arisen in the lan- guage which deals with mental phenom- 16 JUST NERVES ena, especially during the last few years, so that before plunging into the subject of nervousness, I wish to define very briefly in just what sense I use certain much-used and much-abused terms. In the first place, psychology is often given, at least by implication, many mys- terious and confusing meanings. This is not surprising when one realizes that it is only during the last century that psychol- ogy has gradually emerged from the status of a pseudo-science, a sort of unim- portant tail of metaphysics, into recogni- tion for itself. In our generation its termi- nology has been mutilated and the pieces appropriated by dozens of semi-religious, semi-philosophical cults, false healing sys- tems, and well-meant but misguided floods of pseudo-scientific popular books, deal- ing with everything which has for the pub- lic the least element of mystery in it, from the action of the digestive organs to spiritism. Briefly, psychology is only a sort of in- USED AND ABUSED WORDS 17 elusive physiology. It deals with human behavior; with the response of man, the wise animal, Homo sapiens^ to his envi- ronment. Just as physiology deals with the reactions of his separate organs, and groups of organs to their extrinsic and in- trinsic environment, so psychology deals with the response to environment of man as a whole. The object of human psychol- ogy is plainly, then, to interpret human behavior and finally to predict what that behavior will be under given circum- stances. Mental hygiene may be considered a subdivision of psychology, one of its medi- cal branches. To be more definitive: it is the psychological branch of preventive medicine. It concerns itself with the ways and means, the rules and regulations necessary to normal behavior; that is, to normal response of the individual to his surroundings. Finally, to avoid confusion let us as- sume a definite meaning for environment. 18 JUST NERVES Let this term include everything not in- cluded under the term individual. In short, it is the world in which he "lives, moves, and has his being." It has its physi- cal as well as its mental aspects. To both of these aspects it is the individual's prob- lem to adjust himself. The physical ele- ments of environment, such as food, cloth- ing, and the avoidance of physical vio- lence and disease, are the business of phy- siology, of physiological medicine, of pre- ventive and physical hygiene, and are not therefore germane to our present subject. The mental elements of the environment, on the other hand, which are essentially the social elements, are very much our present concern. These are the elements which are definitely and specifically the business of mental hygiene. The social aspects are par excellence those to which man as a whole reacts in terms of behavior. There are, in the first place, such things or situations which seem to threaten or protect the integrity of his USED AND ABUSED WORDS 19 life as a whole, and which are to him markedly agreeable or disagreeable. The outstandingly important situations are, of course, made up of other people to whose lives he has to adapt himself, who, on the other hand, are adapting themselves to him. To ensure adequate and skillful ad- justment to these primarily social aspects of his surroundings, to prevent the acci-, dents and illnesses peculiar to maladjust- ment, in short, to help the individual to initiate and to maintain habits of normal and effective response, is the primary ob- ject of this psychological branch of pre- ventive medicine called mental hygiene. Among the most frequent and the most commonly misunderstood results of poor adjustment of man to his environment is the condition which we call " nervousness." Through simply applying a little of the knowledge already formulated by men- tal hygiene, a great many, probably all cases, of '" nervous breakdown " could be avoided. To cure this condition when once 20 JUST NERVES it is established is the concern of a special branch of medicine. To do this obviously requires a knowledge of the nature of the disorder on the part of the physician. But it is not quite so obvious that a similar, though far less extensive, knowledge on the part of the prospective patient himself is required to prevent and will prevent these conditions from developing. This knowledge fortunately need not be as full nor as detailed as that required of the physician to cure; and equally fortu- nately it is true that such sufficient knowl- edge exists, and that furthermore it is available to any one of moderate educa- tion and intelligence. It only needs adop- tion by the thinking public, especially by parents, to cut down the incidence of nervousness to an enormous degree. Mental Hygiene is as yet very young, but as it grows older it will grow wiser; it will offer more and more of its knowl- edge in usable form and there will be less and less necessity for nervousness, fewer USED AND ABUSED WORDS 21 and fewer nervous breakdowns. Even now, it offers enough to enable us to say that nervous breakdowns are not only curable, but are distinctly preventable dis- orders. Now, as to nervousness itself: As I have already intimated, this condition is the result of imperfect response on the part of the victim to the social aspects of his surroundings. I now wish to add most emphatically that " nervousness " is not a disease, but is a disorder. It is not a dis- ease of the nerves or brain or of any other part of the body. It is not " auto-intoxi- cation." It is not " weakness of the nerves," nor exhaustion, nor fatigue, nor a perquisite of the idle rich. It is none of these things. In other words, I want to make it quite clear that it is purely and simply the result of maladjustment on the part of an otherwise perfectly sound, es- sentially normal person, and that there- fore it is both curable and furthermore avoidable. 22 JUST NERVES The mentally and physically unfit ob- viously cannot respond normally to their surroundings. They are inadequate. They constitute an entirely different problem. In them we often find an exhibition of wonderful courage, resulting often in the most glorious victories the triumphs of the handicapped. Appealing as these cases are, we must leave them to an- other chapter of the subject, for just now we are dealing only with nervous- ness, and this is not inadequacy but inefficiency. Our problem is the most hope- ful problem of all, for we have the splen- did prospect of complete cure, of absolute prevention of future failures of adjust- ment, of the maintenance of complete use- fulness, of the saving of a vast amount of misery and suffering, not to speak of thou- sands of dollars' worth of wasted energy and talent; for we are dealing with good, sound, undamaged material, handicapped by mismanagement only. n JBTCJMAN BEHAVIOR II HUMAN BEHAVIOR NERVOUSNESS is largely a personal prob- lem, a question of personal reactions, and the answer can best be summarized in the phrase, "Know thyself." There is no mystical implication in this phrase as I use it. It means simply, definitely and specifically that self-knowledge, psycholo- gically and ethically, is the best assurance against nervous breakdowns. Some gen- eral impersonal understanding of normal psychology in short, of human behavior as a whole is manifestly the necessary foundation for this essential self-knowl- edge, and it is likewise the basis of mental hygiene. Human psychology, as I have already said, resolves itself into a study of the re- sponses of man as a whole to his environ- ment. Roughly speaking, there are three 26 JUST NERVES types or kinds of response into which human behavior can be divided: reflex instinctive, and acquired. In the first place, we are each one of us born with a psychophysical apparatus which responds in its various parts re- flexly to changes in its surroundings. A reflex has to do with the adjustment of a part of the body to some stimulus. For instance, let an irritating substance be. applied to the mucous membrane of the nose. It responds reflexly, and the re- sponse is a sneeze. Various organs and groups of organs in our bodies respond similarly by change of function to the varying stimuli which are brought in con- tact with them. The stomach responds to the presence of food, and varies its func- tion according to the nature of the food present. The pupil of the eye contracts to the stimulus of bright light, and dilates in the dark. The respiratory and circulatory organs respond reflexly to the quality of the air we breathe, on the one hand, and HUMAN BEHAVIOR 27 the varying demands of the body for oxy- gen, on the other. But the human apparatus has other in- herent dynamic tendencies, which are, to all intents and purposes, highly com- pounded reflexes, involving not parts of the body, but the whole individual. When these are set in motion by the appropriate stimuli, the whole individual responds as a unit, and this we call instinctive action. Instinctive action is always accompanied by its appropriate emotion. Indeed, an emotion is an intrinsic and inseparable part of its instinct. Conversely, one may say that an instinct depends absolutely on its emotion for its dynamic force. An in- stinct is no more and no less than an in- born tendency to react in a certain pre- determined manner to certain conditions or stimuli. For example, an infant, if hungry, reacts in a certain predetermined, characteristic way in response to food; also, if the desire for food is frustrated, we can safely predict that he will react in- 28 JUST NERVES stinctively in another perfectly specific and definite manner. One instinctive reac- tion being frustrated, another, usually that of pugnacity, takes its place; much energy is mobilized and expressed, and in the expression we recognize that instinct's own appropriate emotion in this case, rage. As another example, consider what happens extrinsically and intrinsically when the cat sees her hereditary enemy, the dog. The response is immediate, spe- cific, and effectual. She presents a picture of mobilized energy. The mobilization is, furthermore, absolutely appropriate for the purpose, namely, escape. The extrin- sic signs of this status are stiffened mus- cles, rigid legs, arched back, erect tail, and bristling hair. Intrinsically there are other signs. The heart is beating rapidly, send- ing a greatly increased amount of blood to the muscles, and to all other organs of lo- comotion. That blood, furthermore, car- ries to the motor apparatus increased HUMAN BEHAVIOR 29 quantities of readily oxidizable material from the internal, so-called ductless glands. The digestive organs, not being needed for the emergency, are in a state of temporary paralysis put temporarily out of business, so to speak. All of these internal as well as external changes are part and parcel of the emotion of fear. The cat undoubtedly feels the emotion as an irresistible impulse which, with re- markable swiftness, impels her to escape. Presumably without thought, as mechani- cally as a gun is discharged by a pull on the trigger, the cat at the sight of the dog runs. Should she meet an unclimbable fence, the instinct of escape will immedi- ately be replaced by the instinct of pugna- city and quite as inevitably wiH she turn with rage to fight her pursuer. Thus, if one studies the behavior of ani- mals, one sees instinctive action in its pure, unaltered form, especially in wild animals. For instance, a loud noise to most animals is the adequate stimulus to set in motion 30 JUST NERVES the instinct of escape, and tHe emotion fear, which is an essential part of this in- stinct, literally lends wings to the animal's flight. The third variety of action in human be- havior is that of acquired modes of re- sponse. These are largely modifications of instinctive reactions. These modifica- tions are brought about by training the in- telligence and will, which are as conspicu- ous by their absence among animals as they are by their presence in man. For instance, we learn that is, we ac- quire the habit to respond in certain conventional ways to the presence of tempting viands. If acting instinctively and without acquired control, we should respond to the smell and sight of food by simply devouring it, and if interfered with, we should as simply fly into a rage and fight. Furthermore, we learn to mod- ify our instinctive actions by intelligent control, not only for the purpose of sub- stituting some opposite action more ap- HUMAN BEHAVIOR 31 propriate to the occasion, such as doing the right and intelligent thing, even though fear, let us say, bids us run away, but we train the very instincts themselves to greater perfection of action. We may become skillful fighters if need arise, as well as self-forgetful and reasonably self- sacrificing citizens. There are two important elements which profoundly affect human behavior and which vary greatly in strength in any given individual. The first of these is temperament. This is a qualifying char- acteristic. Briefly described, it is a ten- dency to be over-sensitive or under-sensi- tive to such items in the environment as usually produce in any one markedly, painful or markedly pleasurable sensa- tions and emotions. Over-sensitiveness to one's own emotions and sensations natu- rally leads to over-valuation of their sig- nificance and importance, which of course directly affects behavior. If a sensation or 32 JUST NERVES an emotion is valued as a very disagree- able one, and almost intolerable in itself, one's thoughts and efforts are naturally bent on getting rid of it or modifying it. If, for instance, one is over- sensitive to the disagreeableness of fear and fear it- self is therefore over-valued, it is treated as an item to be avoided at all costs and life is accordingly modified, consciously or unconsciously. The other element which is difficult to define, and which I shall not even attempt to describe, but which must be reckoned with as of the greatest importance in hu- man behavior, is that which we call spiritual. It expresses itself more or less concretely in ideals^ These ideals are fre- quently in conflict with our instinctive de- mands, and this conflict, through its inter- ference with the realization of ideals through action, constitutes the fundamen- tal problem of human conduct. On the one hand, animals, without the power of choice, presumably without HUMAN BEHAVIOR 33 spiritual impulses, are impelled in any sit- uation by whatever happens to be the in- stinct or instincts aroused by the then present environmental stimuli. They do not preside over the conflict of instincts nor presumably is there any conflict between the strongest instinctive impulse and some ideal demand. They are frankly and simply subject to their instincts and their behavior is proportionately simple and di- rect. A cat, when she sees her enemy, the dog, feels the emotion of fear which puts all of her machinery of flight into action. Unless the expression of this instinct is blocked by an insuperable obstacle, her flight continues until the emotional force is exhausted. If the flight is blocked, the instinct of escape is immediately replaced by the newly aroused instinct of pugna- city, and she quite as inevitably fights. But all of this presumably without choice or without reason. On the other hand, the human being presides over the conflict of his own in- 34 JUST NERVES stincts, felt by him as a conflict of emotions. He presides over this conflict with intelli- gence and with a consciousness of the power and necessity of choice. This would be a comparatively simple process if it consisted merely of choosing which in- stinct was to have expression ; or if it were only a matter of choosing which was the most expedient manner of obeying that instinct; whether hiding, running, or " playing 'possum " would satisfy the sit- uation. The strongest instinct would al- ways win, and it would be merely a mat- ter of adding intelligent planning to in- stinctive action to make that action more effective. However, fortunately or unfor- tunately the other great element which I mentioned comes in with its demands namely, the spiritual. The ideal of service and self-sacrifice may demand of a man, whose instincts would drive him simply and quickly away from danger, that he shall stand fast and neither hide nor " play 'possum," but sacrifice himself without HUMAN BEHAVIOR 35 recompense of any sort, except the spirit- ual, even to complete self-destruction. It is when intelligence and will are used, to realize an ideal through an action which is contrary to instinctive demands, that ani- mal behavior rises to the dignity of human conduct. To keep instinctive forces under the intelligent control of the will, in order to realize through these very forces our ideals that is to live a civilized life, a happy life, and furthermore a healthy life. Ill MODERN LIFE AND THE OVER-SENSITIVE Ill MODERN LIFE AND THE OVER-SENSITIVE THE inherent instinctive outfit of man, it is safe to assume, is very much the same, very little altered since history began. He is very much the same animal as he has al- ways been. He has the same reflexes, the same instincts, the same primary emotions, and probably very much the same intelli- gence as he has always had. In short, dur- ing the history of civilization this original outfit all of these fundamental inherent elements has presumably been changed but little. But his environment that has changed enormously and with great rapidity. The mode of life in a single gen- eration has often changed from that of primitive man fighting for survival in a frontier wilderness to the highly civilized and complex existence of city life. 40 JUST NERVES The physical elements of man's envi- ronment, it is true, have changed greatly during the progress of history, but these changes are not of a kind to tax his adap- tation severely. To be free from the hard- ships of hunger and cold and exhaustion ; to be warm, well-fed and well-housed, and no longer subject to exhausting physical strains, requires a very little and a very simple sort of adaptation. But the social complexity, the multiplication of tempt- ing opportunities that such physical changes imply these do tax his power of intelligent adaptation. The social factors have undergone an enormous change, from primitive simplicity to their present complexity and rapidity, and it is this rather than the physical change which makes adaptation difficult. Physical com- fort and safety, it would seem, have been won through multiplying the mental jmd moral risks. Ease of communication by rapid tran- sit, telephone, telegraph, labor-saving de- LIFE AND THE OVER-SENSITIVE 41 vices, and all sorts of time and space anni- hilators, are the things which, in my opinion, are largely responsible for our difficulties of adjustment. These labor- and time-saving devices are highly benefi- cial in themselves as labor-saving de- vices. They broaden one's horizon, multi- ply one's opportunities, and are capable of saving much energy and of conserving leisure, if wisely used. Only when they are used as leisure-killers, only when we allow them to tempt us into trying to do three things at once, making two blades of grass grow where only one grew before; only when we use them to accomplish the im- possible, to crowd a life's work into a few years are they harmful ; but then they become the very instruments of the Devil. Think of the difference between the mental processes of the modern business man and those of his old-fashioned proto- type of the nineteenth century. In that golden and primitive past, whole days would be consumed in the completion of 42 JUST NERVES an only moderately important business transaction. A good bit of friendly inter- course and social entertainment, much that was gracious in manner and speech, form to the point of elaboration, were consid- ered assets in those courtly olden days. Such time-consuming processes were part and parcel of the old-time merchant's busi- ness activity. There probably was no such thing as the chronically tired business man, for everything he did was comfortably packed about and upholstered with little pleasant, healthful things that took time. Compare the old-fashioned picture with what we are familiar with in the modern business man's office. He arrives by rapid transit, elevated, automobile, or what- not, or even by airplane, at a huge noisy structure which he enters, joining a crowded, hurrying stream of other preoc- cupied speed maniacs. Having taken not more than perhaps a hundred steps since breakfast, he is shot upward at a terrific rate, probably in an express elevator, and LIFE AND THE OVER-SENSITIVE 43 is hastily ejected at the twentieth story within a half-dozen steps of his office. There, if his organization is " up-to-date," he will find things already started, per- haps going full tilt. His mail is already opened, even sorted for him. He does not waste the fraction of a minute between shedding his hat and coat and beginning to dictate his replies and give his orders. Even while dictating, he will hold not one but several conversations of importance on the telephone, and before finishing these it is more than likely that he will be starting a third activity of some sort, such as interviewing a client. In short, he does probably in an hour, of what to him is an ordinary business day, as much as the old-fashioned chap did in a week. Does he leave the office any earlier because of this wonderful speed? Does he gain leisure? No, indeed; he stays just as long or longer, but he makes more money. It hardly needs scientific argument to prove which type of life means longevity, 44 JUST NERVES let alone contentment, happiness, and health. I do not mean to imply that the modern citizen is less intelligent or is less wise than his forefathers. On the contrary, I believe that the problem is far more hopeful, for I am sure that he is just as wise, just as intelligent, and has all the wisdom of his forefathers' accumulated experience to draw on, if only he would. But I think it is clear without argument that, be he wiser or less wise, his modern environment calls for the exercise of greater wisdom, for greater adaptability, than was necessary a century or more ago. Obviously there is greater speed, greater emotional strain, a greater tendency to let quantity of effort spoil the quality of life. In short, the great wealth of opportunity is fraught with the danger of a greatly increased temptation to unwisdom. Yet it is true that normal, evenly bal- anced people that is, the great majority of people can and do most successfully LIFE AND THE OVER-SENSITIVE 45 adapt themselves to these entirely extra- ordinary factors of modern life. But to the inherently over-sensitive individuals this present environment of ours offers in- creasingly tempting dangers and pitfalls. For the hypersensitive, more emotional person tends to ou^r-react, especially to things which normally produce mark- edly painful or markedly pleasurable emotions in most of us, and especially to avoid such things as produce markedly painful reactions. Thus the behavior of a certain minority of people tends to be im- pulsive, emotional, instinctive. It tends," therefore, to be unplanned, hurried, in- complete and superficial, and clashes with the strident, speedful world of the pres- ent. Instead of guiding themselves wisely among the environmental difficulties, they succumb to its temptations and dangers. These over-sensitive and over-emotional people tend to act according to how they feel, and then to apply judgment and will only when it is practically too late. 46 JUST NERVES Wishes and fears tend to distort thoughts. We all tend to believe rather what we wish were true than what is true. But when this characteristic is exagger- ated, perhaps chiefly through lack of training, it obviously makes for poor ad- justment to the world as it is, and malad- justment leads directly to malcontent^ Malcontent frequently expresses itself in the pseudo-philosophies and cults which describe the world, not as it is, but as they wish it were. The nihilist and anarchist, the parlor Bolshevik, the cubist, and the free love doctrinaire are examples of essentially maladjusted and discontented people. They imagine a world which in each case shall contain the element which they most crave personally, and a world also which shall be free from the obstacles to achieve- ment and obstructions to self-expression which they have found most difficult, and most annoying. A world of commerce without money, capital, or labor, without LIFE AND THE OVER-SENSITIVE 47 management or competition. A social world without laws or customs. A world, in short, without those restrictions and ne- cessities to which they have found adjust- ment difficult, and which they wrongly blame for their own mediocrity or lack of success. A world where their weaknesses shall be assets, where their supposed strengths shall make them leaders without competition or effort. These people are essentially neuras- thenic; that is, they are nervous. If they could be given self-knowledge, it would cure all of them, and they would then find contentment and happiness in accepting their world as it is as the basic starting- point for good work, as the raw material out of which to forge success* As an example of how ignorance of the essentials of a problem in personal adjust- ment leads to a poor solution, war neurosis is most instructive. (This condition, by the way, is often misnamed shell shock, for the shock of a near-by exploding shell is 48 JUST NERVES only very rarely associated with~the be- ginning of the disorder.) A man, usually somewhat hypersensitive to his own emo- tions, often with an essentially timid per- sonality, finds himself in a position of ex- treme danger, or if not actually in the po- sition of danger, on his way toward it. His ideals of honor, of service, and of loyalty push him onward toward the goal from which his instinct of self-preserva- tion, through the emotion of fear, is doing its best to hold him back. Through mis- conception he has learned to consider fear as synonymous with cowardice. His own essential self-esteem excludes cowardice from his idea of self. Indeed, as a matter of fact, he knows he is not a coward. Therefore, it is impossible for him in the face of this prejudice to recognize or ac- knowledge the presence of fear. Fear, however, is what every normal man must feel when in danger, and, furthermore, this emotion, like all emotions, is not just a mental state, but is actually also a bodily LIFE AND THE OVER-SENSITIVE 49 state, a state of mobilization of bodily forces, a state of preparation for immedi- ate flight, and it has very marked and no- ticeable physical signs. Among these are a rapid and often irregular heart, tremor of the muscles, a dry mouth and disturb- ances of the stomach and intestines. He cannot help being disturbed by these phys- ical disorders, which, largely because they are neither understood nor recognized, be- come exaggerated. They finally consti- tute a bodily condition which becomes the innocent focus of his fear. Fear of break- ing down physically he can recognize and can acknowledge without prejudice to his character. He can with spiritual safety be afraid that his physical condition will in- terfere with his carrying out his ideal of service. In short, he can recognize a fear of failure from bodily causes over which he has no control, whereas, in his igno- rance, he cannot acknowledge that he is afraid of being killed or horribly maimed. The emotional state becomes ever more 50 JUST NERVES tense, its physical symptoms more marked, until they dominate the picture, and he is actually disabled by disordered or para- lyzed bodily function. The deadlock of the conflict between his ideal of service and his instinct of escape is incidentally broken by the condition produced by the emotion, for that condition makes it physically im- possible for him to go on, and much against his will he is ordered to the rear a case of " shell shock." Had he known that fear is the one oc- casion and the only occasion for courage, and that it is not synonymous with cow- ardice ; had he had sufficient knowledge of his own psychology to have recognized fear as part of the normal and universal reaction of any human being to danger, and that courage is the spirit in which one does things in the face of fear his prob- lem would have been a very simple one; namely, whether or not he could do his duty, even in spite of being filled with fear. He might have had probably LIFE AND THE OVER-SENSITIVE 51 would have had a short but decisive moral struggle, but he would have brought his will to bear upon a clean-cut, soluble problem, and he would undoubtedly have gone through successfully. The same is exactly true of the more complicated neuroses of ordinary civil life. Knowledge of the factors of the problem of adjustment is the first step and the ab- solutely essential step toward a successful solution ; and, as in war neurosis, given the requisite knowledge, we can be quite sure of finding the strong desire, the will to get well, ready to apply itself to the problem as soon as the latter can be made clear and definitive* IV CHILDHOOD TRAINING IV CHILDHOOD TRAINING To prevent the occurrence of "nervous- ness" is, then, obviously the problem of preventing maladjustment. Whether tender-mindedness is acquired by early contagion from nervous elders, by lack of training as in a spoiled child, or is partly inherited, may be left as an academic ques- tion. However this and other elements that make for nervousness may arise, it is the business of Mental Hygiene to recog- nize these elements as early as may be, so that, being recognized, they may be trained from being liabilities to being assets. The time for this recognition and training is in childhood, for it is then that the seed of nervousness is sown. I believe that the following are the most important of these elements which tend toward nervousness on the one hand and 56 JUST NERVES are particularly amenable to training on the other. The temperamental tendency to being over-sensitive to the markedly painful or markedly pleasant emotions and sensa- tions is perhaps the most common and fundamental element which, if unrecog- nized and uncorrected, makes for later nervous breakdowns. This element is recognizable even in the early months of life. Whether it be inherited in part or in whole, or merely acquired by circum- stances, is not important to our present discussion. That it is recognizable in very young children is most important, for this fact presents one of the earliest and most hopeful opportunities for training. All of us, especially when we are chil- dren, are sensitive to our own emotions to a greater or less extent and are especially appreciative of the pleasurable emotions. But a certain proportion of children are otter-sensitive to emotions, particularly to painful emotions. They give physical evi- CHILDHOOD TRAINING 57 dence of this extra sensibility by over-re- acting physically to correction, disappro- val, and punishment. They show the over- reaction most often not only in being over- prone to weep, but also in disturbances of digestion and circulation. They may lose their appetites, their bowels may become disturbed, or they may even react emo- tionally to painful situations by an attack of vomiting. On the side of circulation, they are the children who blush and blanch easily. They may also show an over-excitability of their kidneys and sweat glands. In short, they perspire too easily under ex- citement, cry too easily, and likewise their overactive kidneys, under the same cir- cumstances, may lead to one of the most embarrassing accidents of childhood. Too often this latter unavoidable accident meets with severe and unjust punishment. On the mental side they show a greater dependence than normal on praise and ap- proval and especially an exaggerated sen- 58 JUST NERVES sitiveness to disapproval. They show the latter by avoiding conflict with authority as much as possible, either by exagger- atedly good behavior or by deception and lying. Their repulsion to the disagreeable whether it have to do with the touch of a disagreeable surface or substance or a disagreeable taste, or with being too easily and too markedly influenced to avoidance of such things as may arouse in them a painful emotion, such as fear is evident and conspicuous. These signs of the over-sensitive tem- perament, as I say, are easily recognized in early childhood and call for definite training. Usually they are noticed but rarely are they understood, and often quite the wrong training is applied. Pun- ishments are made too drastic ; or the par- ents sedulously plan to avoid all discipline wherever possible and so to arrange the environment for the child as to avoid wherever possible the production of fear or any other disagreeable reaction. Both CHILDHOOD TRAINING 59 of these extremes are apt to lead to the same result, namely, an increase in the sensitiveness, a further accentuation of the very handicap which they are intended to remove. On the other hand, the training should have in view the distinct object of mould- ing the sensitiveness itself into a useful force. The first steps of this training are to give the child a true valuation to tol- erance of the disagreeable, and to help him to a realization of the naturalness and nor- mality of the emotion of, let us say, fear, which only needs a little courage to com- bat it. At the same time, an appreciation of the necessity and importance of adapt- ing himself to the needs of his play-fellows can be aroused through stimulating his in- terest in team-play which makes a good basis for normal courage. For instance, instead of telling a child that he is silly to be afraid to go into the dark room, that there is nothing there to hurt him, that he ought not to be afraid, or that he is a baby 60 JUST NERVES to be afraid, he should be told that of course he is afraid, that lots of other chil- dren are afraid of the dark, even though there is nothing to be afraid of. He should be shown that being afraid is one of those disagreeable things that we can get over by not thinking too much of it, and that, at all events, he is of course going into the dark room to get the game or book he wants, because he wants it. He can thus be shown, by the actual demonstration of going into the dark room and getting the desired game in spite of fear, in the first place how harmless that little fear of his really is, and in the second how compara- tively easy and fully worth while it was to get the game. A little victory, but lots of fun when won. Every effort should be made, in other words, to accentuate the importance and desirability, the satisfac- tion and fun, in free objective action in spite of, rather than because of, sensitive- ness. Every effort should be made to make the interest in doing things and the results CHILDHOOD TRAINING 61 of doing things always stronger and more enticing than the abnormal and introspec- tive interests that the child may have in his own emotional reactions. Such training, for instance, is quite cap- able of turning timidity into habitual courage, sympathetic pain into the profes- sional understanding and practical pur- posive sympathy of the genuine physician or nurse. Such training can transmute sensitiveness to color or sensitiveness to sound into intelligent appreciation and thus make of it the professional under- standing of the successful artist or musi- cian. One can turn this sensitiveness by such training into useful objective appre- ciation of the physical and social environ- ment, including the needs of others. Thus a liability can be turned into an asset. y The second element making for ner- vousness, which is, as you will see, largely dependent on the first, is disturbance of the balance of instincts. By this I mean an over-prominence, an over-irritability of 62 JUST NERVES one or more of the instincts over the others. Usually this also is recognizable in very early life and the temperamental sensitiveness just described is always as- sociated with it. Indeed, it is the instinc- tive force which gives sensitiveness specific form. Usually the instincts of self-preserva- tion, escape and pugnacity, one, some- times both of them, with their respective emotions of fear and anger, are the mov- ing forces in the second element making for maladaptation. This specific sort of sensitiveness is indeed easy to recognize at an early stage. Who cannot recognize even in infancy the markedly timid or the markedly pugnacious personality in a child? The timid, shrinking child and the irritable, pugnacious child, subject to fits of temper, are too well known both physi- cally and mentally to need further de- scription. The former I think is more apt to be headed for nervousness than the lat- ter, though even the latter, if he be of CHILDHOOD TRAINING 63 sensitive temperament, is a neurotic risk. The training of this element, if not easy, is certainly plain. The child must be taught to acknowledge the presence of the emotion, whether it be anger or fear or whatever. He must learn to treat it, not as an enemy, but as a natural part of him- self. He must not be taught to deny its existence or to make-believe through re- pression that it does not exist. He must be taught to say to himself, "I am mad, or I am afraid, but I can do as I choose " ; and he must be held responsible for that choice. Gradually his interest in growing up to be an effective actor, an effective performer of acts of which he approves, must be built up. Coincidentally good- natured contempt for his own emotions should be established; that is, contempt for the painful element in emotion and sensation. To be a "good sport" rather than a slave of fear or anger must be made an understandable and, furthermore, an attractive proposition. To make disci- 64 JUST NERVES pline seem always to be self-discipline rather than superimposed, I believe to be an important point. Punishment as far as possible, perhaps always, should be to the child as much as possible an obviously in- evitable result of his own action rather than the outgiving of the judgment, backed up by the power, of that superior being, his parent. The parent should stand to him rather as a wise friend, whose judgment he believes in and wants to fol- low, than as the strong arm that carries out a little understood law. I believe these rules hold good no matter what over-active instinct we are dealing with, whether it be the instinct of escape, of pugnacity, or even the sex instinct/Our object is to train the child to guide the energies and impulses supplied him by his instincts, not to deny nor suppress them, and above all not to be subject or slave to them.) In short, the ob- ject of training is to make a civilized citi- zen out of a little, perhaps overly strong, animal. CHILDHOOD TRAINING 65 The third item in the personal equation which needs recognition and calls for training appears later in life than the first two. It has to do with difficulty in reali- zation of the spiritual element where either ideals are unformed or fail in ade- quate expression because of instinctive or temperamental obstacles. For lack of a better term I will call this character fault or weakness. The signs of this tendency are absent from the physical point of view, except perhaps in the matter of those in- definite signs of facial expression and form which we rightly or wrongly attrib- ute to strength or weakness of character, such as the " square " jaw, the " loose " lip, or the " wavering " eye. The element, how- ever, can be definitely recognized by a comparison of the individual's behavior with his professed ideals, and by noting a prominent feature which is always there, namely, unreliability. People with sensi- tive temperaments and unbalance of in- stincts always remind me of an electrical G3 JUST NERVES apparatus which is suffering from a ten- dency to short circuit. A person with character faults, on the other hand, re- sembles an electrical apparatus where the wires just fail to make connection and the current of energy from the ideal to the ap- paratus of expression fails to get through. They know theoretically what is right, they are not moral idiots, but they fail to make good their ideals in action with any reliability. The training of this tendency takes perhaps more tact, more delicacy of touch, and more sympathy than do all the others, for it calls for practical moral training, and by this I do not mean continual pun- ishments nor old-fashioned "moral sua- sion," which no doubt has its place, nor picturing in lurid colors the "way of the transgressor." It consists rather in show- ing the adolescent child how his technique has failed, just where a little determina- tion would have made the connection; in showing the practical advantages of regu- CHILDHOOD TRAINING 67 larfty both physical and mental, the effi- ciencies to be attained by a planned life, the ease to be gained by the momentum of regular habits, and last but not least the fundamental necessity to him of content- ment above comfort, of happiness above pleasure; and finally in proving that these can be attained only by running the ordi- nary ideals of life straight through the in- stinctive apparatus to practical everyday action. There is a fourth type of disorder which tends to nervousness which is important enough to afford a separate classification. The human young, unlike the young of the other animals, tend to develop irregu- larly. The intellectual side of a child may develop far ahead of the physical and even of the moral. This irregularity is not hard to recognize, especially not by the proud parent who is only too ready to acknowl- edge precocity of intellect in his own off- spring. Unfortunately, only too often the 68 JUST NERVES proud parent, instead of turning such a child's energies more toward the develop- ment of those elements which are lagging behind, namely, the physical, will, in his pride and delight in the child's cleverness, push his already over-developed intellect to further precocity. In extreme cases the "infant phenomenon" is developed, who rarely if ever escapes an even more serious breakdown than common nervousness. Obviously the training of such a child should be aimed toward balancing his de- velopment by increasing his physical strength and well-being. Out-of-door games and exercises and interest in nature studies should be emphasized, rather than progress in mathematics; woodcraft rather than Latin. All of this can be done without any undue neglect of the purely intellectual development. Indeed, it would surely be just the right kind of intellectual development for the physically backward child to turn his interest and reasoning power toward the phenomena of nature and his own growing physical prowess. CHILDHOOD TRAINING 69 When the physical development is ob- viously ahead of the intellectual, which is easily discovered by the child having to study harder and getting poorer results than the average usually to the unrea- sonable despair of his parents then the intellectual and moral side of the individu- ality call for development; but this can be done only gradually, not suddenly. Regularity of life in these cases is particu- larly important. The child should be taught to guide the instinctive forces into purposive channels by gradually introduc- ing simple objective, purposive, mental effort in relation to outdoor play and ex- ercise, of which such a child is probably al- ready fond. More important than even constructive play is constructive work, both mental and manual, and for such children the educational value of physics, mathematics, and, above all, of manual training, cannot be over-estimated. Grad- ually to stimulate interest in achievement, gradually to arouse curiosity in the 70 JUST NERVES " why " of the things which the child up to then has merely taken animal pleasure in, by stimulating interest in nature and nature's laws, and gradually working through biology to other sciences, is gently to lead intellectual development on apace, till it matches the physical. When the moral element lags behind, the same method of treatment should be employed as I have roughly outlined as appropriate for character faults. But we should be especially careful not to harden by constant and severe disapproval. We should try in every way to accentuate our appreciation and approval wherever we can find even a slight excuse for it, in something well done and for a good pur- pose. You can always depend upon it that the child will react toward and will be attracted to the pleasurable emotions aroused by approval and praise, as read- ily, at least, as he reacts away from the pain of displeasure and disapproval. In short, we must show the child who is back- CHILDHOOD TRAINING 71 ward in moral development that it pays to be good, and to do this we must praise every good point; and, on the other hand, disapproval, when we show it, must be shown only for a purpose and not because we are angry. It is only through utmost patience and always sympathetic effort that we can hope to make social adapta- tion seem a worth-while process and a ne- cessity to the morally backward child. To make moral response habitual and reliable must be not only a labor of love, but one of unwavering faith and patience. Modern life, especially the life of the well-to-do, is in many ways poor training, very poor mental hygiene, for the growing child. It presents too much superimposed entertainment. This entertainment, fur- thermore, has excitement rather than healthful pleasure as its main objective. Movies and theater parties might be all very well, but are they? They might be opportunities for constructive and in- 73 JUST NERVES structive play, innocent amusement and interest, but usually they are not. In the first place, such entertainments are far too frequent in the average child's life, and in the second place, they result in nine cases out of ten, not in interest, but excitement. Coupled with dances lasting to all hours of the night they constitute an active men- ace to the child's mental health. The re- sult is that most melancholy sight of mod- ern times the over-old, blase young- ster who demands there shall and must be "something doing" every moment. Through no fault of his own, he has de- veloped within him an abnormal appetite for excitement, on the one hand, and, on the other, a pretty complete ignorance of the real pleasures of play; and unless he is a very evenly balanced, stable, indi- vidual he is fairly on his way to become a neurotic. Public playgrounds, child ath- letics, and games where the real pleasure of play comes from the successful exercise of energy, make for health and stability, CHILDHOOD TRAINING 73 and not only balance work, but keep the appetite for work, for achievement, alive; whereas movies and modern superimposed entertainment, with just excitement as an unacknowledged goal, make for unbal- ance, discontent, and nervousness. A modern child, especially a girl, is dangerously apt to skip from the mental and social age of twelve almost overnight to that of eighteen. This forcing process of modern social life suddenly ejects her from innocent childhood into the status of a society woman. She skips, and thus loses utterly those wonderful years of natural fun, of growth of interest, of development of character, of the gradual unfolding of the knowledge of life; those wonderful "teens," which should be lived joyously and as slowly as may be. These should be the years of the most valuable formative training, and too often nowadays are they exploded out of existence by the forced high tension of the modern regime. These years should be guarded, should be utilized 74 JUST NERVES for our children's gradual growth and development, and if they are so utilized they will cheat the nerve specialist of many of his cases. I have dealt with Mental Hygiene only where it touches my subject, Nervous- ness, its causes and prevention. I have spoken of the knowledge already extant, which if applied would in my opinion pre- vent nervousness. Much of this knowl- edge you will see is quite obvious, long known, not original nor exciting. True, but that probably is the very reason it has not been applied. No doubt much of it is tob ordinary or too obvious to invite at- tention, and no doubt has therefore been neglected. Most often nervousness has its begin- nings in childhood ; therefore it is in child- hood that preventive training should be applied. Obvious, but none the less true. The recognizable symptoms of poten- tial nervousness are : CHILDHOOD TRAINING 75 1. Sensitiveness to the disagreeable and painful. 2. Overbalance of one or more instincts. 3. Faults in application of intelligence and ideal to instinctive forces (character faults) ; and lastly, 4. Uneyenness in the relative develop- ment of the physical, mental, and moral sides during growth. One or more of these is always the fundamental cause of that maladaptation called nervousness. It is obvious, I trust, that early recognition is not only neces- sary but possible to all. Obvious or not, it is the truth. If these tendencies should be and can be recognized, to overcome their influence, it is only necessary to train the child ac- cordingly and this then becomes largely a matter of applying common sense to a clean-cut, formulated problem. To this end all of us, especially parents and teach- ers, need only a mere working knowledge of everyday psychology. It is a simple 76 JUST NERVES matter to apply such knowledge in the form of mental hygiene, to the upbringing of our children as well as to the ordering of our own lives. V COMMON-SENSE RULES COMMON-SENSE RULES To avoid " nervous breakdowns " in adult life it is only necessary to maintain one's mental and moral efficiency. This can be made a simple, straightforward matter by following a few more or less simple and common-sense rules. These rules can be readily deduced from everyday psychol- ogy and common experience. If adopted and applied steadily, they will prove be- yond a doubt that " nervousness " can be avoided. Here follow a few such practical sug- gestions, more or less formulated specifics against becoming "nervous": 1. Neither run away from emotions nor yet fight them. Accept them as the well- springs of all action. They are your auto- matically mobilized energies, and you may, within very wide limits, do with 80 JUST NERVES them what you choose. You may, fur- thermore, do what you choose, again within broad limits, in the way, in the manner, in which you choose to do it. By doing what you choose, in the way you choose, you force these energies into the channels of your choice. It is like guiding spirited horses you guide, they obey, not their own impulses, but your will. A sim- ple suggestion, but, if followed, it leads one safely away from the dangers of sen- sitiveness and unbalance of instinct. 2. Be efficient in what you do. First ap- prove the purpose of the act, then perform that act in a manner and with the means that are appropriate to its purpose. Effi- ciency or inefficiency is determined by the relation between effort expended and re- sult obtained. Obviously the result must be worth the effort. Nothing is worth do- ing that is not worth doing well, but " well " must include not only the attain- ment of the gross end in view, but it must also mean attainment without waste of COMMON-SENSE RULES 81 effort. Quality of effort appropriate to the end, skill rather than crude force, means efficiency. In short, do not drive your tacks with a sledgehammer. There is a better, less fatiguing way. Find out how easily you can do things well, and take pride in such skill. 8. Do one thing at a time. Only thus can we practice concentration. By con- centration I do not mean that violent over- dramatization of effort usually understood as concentration, but the gentle art of con- trolling the attention. This art consists almost entirely of many, oft-repeated, small acts of skillful selection. It is really no more than gently culling from the stream of thought that which is interesting and relevant to the object of the moment, and secondarily discarding all else. Above all, it is not a violent, sustained moral effort. 4. Make clean-cut practical decisions. To be clean-cut they must deal with prob- lems clearly stated and as free from emo- 82 JUST NERVES tional prejudice as may be. To be practi- cal they must deal with problems of pres- ent moment and relevancy, with probabil- ity rather than possibility, with the con- crete rather than the vague. Finally deci- sions must be valued, not as irrevocable oaths or unretractable contracts, but as mere decisions, subject to change in the face of new facts or additional knowledge. 5. Do not accept hurry as a necessary part of modern life. If hurry in any given case becomes necessary, it has become so solely because there has been a direful lack of plan, or because tardiness and procras- tination have spoiled the plan, or lastly be- cause one has tried to crowd two or more things into the temporal space of one. Quality of work, not quantity, spells suc- cess, and quality is destroyed by hurry. 6. The worst enemy of efficiency, as well as the best ally of nervousness, is worry. Worry is a complete circle of in- efficient thought whirling about a pivot of fear. To avoid it, consider first whether COMMON-SENSE RULES 83 the problem in hand is actually your busi- ness. If it is not, turn to something that is. If it is your business, decide next whether it be your business now. If it be your busi- ness and your business now, decide what is the wisest and most efficient thing to do about it. If you know, get busy and do it; if you do not know, if you lack knowledge, seek the knowledge you need and seek it now. Do these things, and in nine cases out of ten anxiety will not degenerate into worry. If the actual probabilities are so very bad that intense anxiety is un- avoidable, nevertheless, apply this me- chanical rule, and then assert your faith and your courage; realize that success for you, as for others, is always an approxi- mation of the ideal. Then rest your case on the determination that no matter how hard things may turn out to be, you will make the best of them and more than that no man can do. In short, common sense can put worry out of the running in most cases, but always faith is essential to real victory. 84 JUST NERVES 7. Keep work, play, rest, and exercise in their proper relative proportions; not only in the space of decades, but year by year, month by month, week by week, and day by day. Keep these items separated. Work when you work; play when you play ; and do nothing when you rest. Each item has its daily place, and a well- planned life is a life made up of well- planned days. Such a life absorbs emer- gencies without strain. 8. Shun the New England conscience. It is a form of egotism which makes a moral issue of every trivial thought or feeling. Its motive is self-defense, defense of self from the possibility of guilt or con- sciousness of moral error. It takes the ad- venture out of life, and fills it instead with endless petty, safety-first devices, clog- ging its machinery and warping it out of true. To live fully and with reasonable ease, one must take one's own fundamen- tal decency more or less for granted, and be willing to take at least ordinary chances COMMON-SENSE RULES 85 of being wrong. Soul-harrowing analyses to prove one's moral impeccability are merely expressions of nothing better than worry about self, and the same rules apply to this sort of worry as to all other sorts. 9. Energy is often wasted by a peculiar process which many people seem to think necessary before they can do anything, especially anything that promises to be difficult. I refer to a sort of " getting up steam," a kind of moral mobilization, an attitude of "girding up the loins," men- tally speaking, which is referred to by them as "making up their minds," or " getting ready " to do something. It is not a decision, but usually follows one as a sort of preliminary flourish before ac- tion. It is really only picking up a moral sledgehammer, and an imaginary one at that, when a practical decision has already cleared the way, and nothing remains to be done save to begin immediate action. When a decision has been reached, when something has to be done, waste no time in mobilizing extra energy, just do it. 86 JUST NERVES 10. Lastly, to avoid breaks in charac- ter, breaks between your ideals and your everyday actions, recognize that your problem is fundamentally the same as every one else's, no matter what your par- ticular job may be. This problem of ours, reduced to its common denominator, is to keep our ideal clear, to adopt purposes which shall serve these ideals, and lastly to make our ideals live in practical, pur- posive everyday action. To do this, it is first necessary to accept the material of life as plenty good enough for us, as defi- nitely our material, awaiting only our workmanship to be forged into success. This should be our method of making our dreams come true, of living up to our great illusion. Therefore, waste no time in kicking against the pricks. The " divine unrest" of ambition is a noble spur to better action, but the restlessness of dis- content is a miserable state of misunder- standing. Beware the contrary currents of anger, fear, and pride, but turn the COMMON-SENSE RULES 87 i strength of these currents into the chan- nels of your purposes. Do not criticize your part in the play, study it, understand it, and then play it, sick or well, rich or poor, with faith, with courage, and with proper grace. To follow these rules absolutely and to the letter is certainly somewhat beyond the power of human frailty, but to follow the spirit, to steer one's course by some such compass, is both possible and practi- cal. Thus, and only thus, can one main- tain a good, safe offing from the shoals and reefs of nervousness. 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