The word is a very old one and means a little sharp stone, as if in trying to make progress the scrupulous found themselves hindered by having to walk over little sharp stones which so disturbed them that they were hampered in getting on. Above all, scruples put them into a state of mind where they hesitate as to whether they can go on at all or not.

The subject of scruples was very thoroughly worked out and carefully described by the older spiritual writers centuries ago. They wrote elaborate treatises on it, while it was not until our own time that physicians by their careful study of corresponding conditions entirely apart from religion came to appreciate that these conditions of the spiritual life were only expressions of a rather common set of tendencies altogether independent of religion. They are p.r.o.ne to develop in people with certain physical and mental characteristics who are possessed of dispositions and nervous systems particularly likely to be the subject of these hesitancies and doubts and difficulties for which there is very little basis in actuality.

The whole chapter of phobias and the other chapter on obsessions and the third on what the French call _la folie du doute_, the doubting mania in our modern textbooks of neurology, are really so many chapters in the {221} literature of scruples of the old time, now transferred to the textbooks on functional nervous diseases. Some nervous people who are religiously inclined get into a very disturbed state of mind from the fear that they may commit sin almost unknown to themselves or that they may be in sin unawaredly and cut off from their Creator, and they become extremely miserable as a consequence.

This is, after all, a very familiar picture to the neurologist accustomed to see patients suffering from functional nervous diseases.

I have patients who suffer quite as much from the dread of dirt as these scrupulous people do from the dread of sin. Women often suffer from this dread of dirt--misophobia is the scientific name derived from the Greek--to an exaggerated degree. A woman patient of mine makes it extremely uncomfortable for the conductors on the street cars because, for fear of contaminating her hands, she dreads to touch the handle bars by which she could mount or descend easily. This adds greatly to the risks she takes every time she boards a car. She is constantly washing her hands to get the dirt off, so that in cold weather she sets up severe skin irritations and makes herself very uncomfortable. I have a male patient who would not touch the handle of my door for the world, and whom successive maids have come to know very well because he stands outside the outer door and has to have that as well as the inner door opened for him. He has said to me over and over again, "Doctor, don't ask me to shake hands with you, because you shake hands with so many people." I have seen him standing outside of a large department store with the temperature around zero, waiting for some one to open the door so that he might slip in without touching it. Nor are such states {222} of mind confined to the uneducated; on the contrary, they are commonest among those who have a good education and are quite sensible in other things.

Obsessions were originally described as super-religious states of mind in which some idea a.s.sumed a terrorizing character. The victims of them dread that they might commit some awful crime and as a consequence were profoundly miserable. Instead of being confined to religion, such mental states are quite common in conditions altogether apart from religious feelings. Women read of a mother killing her child in some awful way or perhaps accidentally poisoning it or burning it badly with some escharotic external application. They become obsessed with the idea that they may do something of this kind and fear that they may not be able to resist the suggestion. Medical literature is full of such cases. A typical case is described by Tangi in his textbook on insanity:

"A young married woman suffered from nervous exhaustion after her first childbirth. She watched day by day her husband cutting up meat for his parrots with a pair of scissors, and the action filled her with disgust which later increased to positive horror. Thus a repulsive obsession was produced and this in turn engendered the morbid suggestion to cut the tongue of her dearly loved child in the same way. The fear that she would not be able to resist this suggestion made the suggestion more vivid and the idea more imperative, causing an agonizing struggle each time."

Then there are accounts, some of them most poignant, from Catholic patients of my own, who were sure that sometime while in the midst of their devotions or even at the very reception of the sacraments they would {223} blaspheme. They are people who fear that every pious act of theirs may just expose them to the risk of committing some awful sacrilege.

Almost needless to say such states have nothing at all to do with religion, and when similar conditions occur among the religious minded, they must be attributed to the general neurotic condition and not to the incidental religious tendencies. The doubting mania occurs among the religious minded when they keep on fearing that they have not done something that they should do. Some of these individuals get into a profoundly miserable and disturbed state of mind, but that must not be blamed on religion.

This sad state of mind in people who have no religion at all is extremely familiar to the neurologist, and it has no necessary connection with religious practice or religious belief. I have a patient who has been coming to me for many years now from a city in the Middle West; he is a broker, and every time there is a panic in the money market I am almost sure to see him. Whenever he gets very much disturbed over business matters, as is likely to happen in panic times, he develops a very striking _folie du doute_, or doubting mania. He will take a letter to a post box and go back three or four times, first to see if by chance he did not drop it on the way, secondly to be sure that it did not get caught in the slot; then, if the letter is important, he will go back to see if perchance there may not be some bolts or other obstructions at the top of the box that may catch it and delay its collection. I have even known him to wait for some time at the post box to see if the postman might not possibly drop it when he came to collect the mail. But then he does other things just as foolish. Occasionally he will {224} get home from his office and suddenly have the feeling that he forgot to lock his safe.

He will go back and then get part way up town when he is overcome by the fear that he may not have locked the door after him as he came out. At times when his _folie du doute_ is at its worst, he has been known to go back three or four times to close windows or for some other trivial reason. When he is in reasonably good condition there is very little of this state of mind manifest, but he can make himself supremely miserable when the obsession is on him.

It is often said that the declaration by the Church of the idea of possession by the devil rather encouraged the development of certain mental and nervous states and thus fostered neurotic manifestations of many kinds. This whole question of the possibility of direct diabolic influence over mankind, that is, of some evil spirit deeply influencing certain human beings, is yet a matter that is not nearly so settled as a great many physicians who have not been following scientific work in allied lines seem to think. So distinguished a scientist as Alfred Russel Wallace, the co-discoverer with Darwin of the theory of natural selection, had the feeling that spirits interfered much more in human affairs than a great many people were willing to admit, and that the evil spirits probably could, under certain circ.u.mstances, deeply affect individuals. Professor Barrett of Trinity College, Dublin, is even more outspoken in what he has to say in this regard, and now there is a very general feeling among those who have investigated spiritistic phenomena most carefully that if spirits do actually communicate directly with men, it is commonly not the spirits who claim to do the communicating who are actually present. Almost needless to say any such conclusion as this would, {225} if maintained, throw even scientists back to the old idea of diabolism, which the Church, on the strength of many centuries of experience, still teaches.

One thing is perfectly sure: that if overzeal on the part of certain ecclesiastics rather encouraged neurotic manifestations because of the alluringly suggestive quality of the thought of diabolic possession, they did no more than physicians did in more modern times by their suggestive methods in the study of hysteria. A great French neurologist of to-day has pointed out that major hysteria as studied by French neurologists of a generation ago has practically disappeared, or occurs very rarely in our day because it is no longer unconsciously suggested to patients by physicians that these major symptoms are being looked for. Overzeal in medicine raised up a whole series of symptoms that had no existence except in the heated imagination of their patients under the influence of strong suggestion.

Another extremely interesting phase of this subject is that in the old days many of the sensible ecclesiastics and some of the civil authorities came to recognize that people supposed to be possessed of evil spirits could be cured of their condition not infrequently by roundly whipping them. Sir Thomas More particularly called attention to how much good could be effected in this way. In writing an article on "Psychoneurosis and the War" (International Clinics, Volume II, Series 29) I called attention to this in a paragraph that may be helpful in the understanding of the discussion of diabolic influence.

It has been the custom for many years now, indeed for more than a generation, to think that the old-fashioned methods of treating many of the psychoneuroses by {226} punishment and the infliction of pain were founded on an entirely wrong principle. Sir Thomas More, for instance, tells the story of a number of folk in his time who suffered from rather serious complaints; some of them were dumb and some deaf, and some thought they could not see, and others could not walk. He says that some people considered them possessed of the devil, and that it was the presence of this very undesirable spirit that hampered their activities in various ways and made it impossible for them to use their powers properly. The description of the cases makes it very clear that he is referring to hysterical conditions of various kinds and the sequel as to the successful treatment which he says was frequently employed on them more than confirms the inference of hysteria and demonstrates the very definite hysterical character of the affection. Many a physician down through the ages has been inclined to think that these people were possessed of a bad spirit of some kind, even though he might not be quite ready to think that a personal devil had taken hold of them and was seriously hampering their functions. We recognize that the real trouble is with their own spirit, to which may be applied whatever epithets come to mind, and no one will think them exaggerations; this spirit has lost its control of their activities, rendering them incapable of exercising their functions properly.

There is a very widespread tradition, which has found its way into medical literature especially, that the fervent practice of religion in women has a very definite tendency to make them neurotic.

Particularly when religious devotion is a.s.sociated with mortification and fasting, it is supposed to be serious in its effects. It is the custom to make references to such pious women as St. Catherine {227} of Siena and St. Theresa of Spain as typically exemplifying this neuroticizing tendency.

Any one who really knows the lives of either of these women will not be likely to think that they were neurotic in any proper sense of that word at all. Both of them were not weak but had immensely strong characters, veritable towers of strength in supremely difficult times, supporting not only their own heavy burdens but helping others around them to bear theirs. Of Catherine of Siena, Swinburne, the English poet, surely not a sanctimonious person, whose sentimentality might lead to admiration for the hysterical bizarre, but who had studied her career because so many incidents in her life have been the subject of great paintings by a number of the greatest painters of Italy, said:

"Then in her sacred saving hands She took the sorrows of the lands, With maiden palms she lifted up The sick time's blood-embittered cup, And in her virgin garment furled The faint limbs of a wounded world.

Clothed with calm love and clear desire.

She went forth in her soul's attire, A missive fire."

The great hospital at Siena was rebuilt in honor of Catherine shortly after her death because of the fact that she had spent many years of her comparatively brief life there; she died at thirty-two in personal service of all kinds to the patients suffering from every manner of disease, even leprosy, who were in the inst.i.tution. (The lepers were housed apart from the others.) She placated so many feuds among the n.o.ble families of Siena, feuds that were the cause of as many murders as the worst {228} of our own in Kentucky, that she was asked to be the envoy of peace when cities were at war, and it was she who eventually by her influence brought the Popes back from Avignon to Rome and thus put an end to the great disorders in the Italian peninsula.

St. Theresa, the great Spanish mystic of the sixteenth century, the other "horrible example," held up even by some neurologists, of hysterical tendencies due to religion and mortification, proves, when studied in real life, to have been at least as great and strong a character as Catherine of Siena. She well deserves the name of saint as a leader in unselfishness, but besides she had a fine sense of humor. That is what neurotic people lack above all--a sense of humor.

All sorts of distinguished men in the Spain of her time--and in the sixteenth century Spain was by far the greatest country in Europe, her sovereigns ruling most of Europe and the greater part of America, and the nation gave birth to great art, literature, architecture and philosophy--turned to consult St. Theresa in their difficulties. She wrote a series of books that have been republished in every cultured language in Europe at least once a century ever since, and our own generation has been sedulous in the study of Theresa's writings. No less than a dozen lives of her have been written in English in the twentieth century. This Spanish lady who died three hundred and fifty years ago is still a very living force in the world.

Owing to the special conditions under which much of my work is accomplished, I am brought in contact with a great many religious women every year. For some twenty years I have spent some days each summer with groups of religious communities where large numbers were a.s.sembled for special intellectual and spiritual work. The {229} mother superior has often consulted me with regard to some of her daughters who had special nervous manifestations, but it is a never-ending source of surprise to find how few of them suffer from the nervous symptoms so common in our time. Considering the fact that they spend their lives very largely indoors, that they live on very simple food--and sometimes I have been inclined to think with scarcely enough nor sufficient variety to make them capable of the amount and demanding nature of work they have to do--fewer of them suffer from nervous symptoms or affections than women of the same cla.s.s who are living at home and on whom the demands are not nearly so strenuous.

Their religious duties, instead of being in any way a drain on their nerve force, though I have often heard it said that teachers ought not to be required to give quite so much time to their religious duties, represent a reservoir of energy from which they draw strength and above all placidity of mind and consequent power to accomplish more than would otherwise be the case.

My duties often bring me into contact with numbers of sisters during their hours of recreation, so-called, and I do not think that I have ever seen a happier, heartier group of people than they make during these periods of relaxation. I have always considered it a privilege to share recreation after dinner or supper with a dozen sisters when I am lecturing in one of the smaller towns, and we have often laughed so heartily together that I have sometimes wondered what the neighbors would think of us. People with a sense of humor like this are not likely to have hysterical tendencies. Nervousness is at bottom selfishness, and there is always a great deal of conceit in it.

Religious women are likely to be humble, and that means much in keeping them from various magnifications {230} of their ego which so often result in nervous and mental symptoms.

I have often ventured to say that I was quite sure that a religious house, especially where there were many young people, in which laughter came easily and was heard frequently during the times appropriate for it, was sure to be a place of real spirituality and happiness. I have often dared to remind them that the one place where one hears no real laughter, though sometimes sounds are made resembling it, is an insane asylum. People who are ready to laugh are usually eminently sane. Above all, they do not take themselves too seriously. It is taking one's self and one's feelings too seriously that is the root of a great deal of nervous and mental disturbance in this little world of ours. Certainly the discipline of heart and mind and body and the feeling of satisfaction from duty well done that comes in connection with that complete sacrifice of themselves in a great religious cause which members of religious orders make, so far from predisposing them to nervous disease has just exactly the opposite effect.

Nervous diseases, instead of being fostered or fomented by religion, are on the contrary repressed rather effectually and equilibrium given even to those in whom some hereditary elements might have proved disturbing. This does not mean that all the religious minded are free from nervous symptoms, and it must not be forgotten that not every one who says "Lord, Lord," gets into the kingdom of heaven, either on earth or hereafter, but religion must be counted as an a.s.set and not a liability in this matter. It will not overcome strong hereditary tendencies, and it will not help efficaciously those who do not submit to the discipline that true religious feeling entails, and of {231} course religion is not a panacea for the ills of mankind, though it must be counted a therapeutic adjuvant and not a nervous irritant.

Professor Foerster, whom one is tempted to quote because of the thoroughgoing thoughtfulness of his treatment of many of these subjects and his wise conservatism founded on that deep consideration, has discussed the question of repression of self in matters of purity as a possible source of nervous troubles of various kinds.

Freudianism, as it is called, which has attracted so much attention in recent years, would seem to suggest the conclusion that a great many of the nervous symptoms of humanity are due to the repression of s.e.x impulses. Foerster has pointed out that just the opposite is true, and that there never was a time when there was so little real self-repression and also never a time when there was so much functional nervous disease. He said:

"From this point of view there can be no doubt that the modern theory of 'living one's nature out' is largely responsible for the nervous degeneration of to-day, and that the widespread hysteria in modern life does not spring from those remnants of discipline and idealism which are still operative amongst us. One is compelled to ask indeed with astonishment, with what right Freud finds the dangers of repression so alarming in an age which is conspicuous for self-indulgence. In reality there has never been an age which was less influenced by the spirit of abnegation and repression than is our own. The present age is one of disintegration, in which natural instincts have largely broken away from their controlling higher ideals; if, therefore, it suffers to a peculiar degree from nervousness, one can hardly look for the cause in the fact that it const.i.tutes a high-water mark of control and {232} discipline. The precisely opposite conclusion would be nearer the mark."

Professor Foerster admits, however, that it is perfectly possible that people who have no good motive for self-repression and who suppress instincts only out of the merest human respect and cowardice as to results, may very well suffer some of the consequences that Freud has pointed out. He says:

"There is one point, however, in which one can entirely agree with Freud, or at any rate allow oneself, through him, to be led to the recognition of an important psychological and pedagogical truth.

There are to-day certain circles who cling to the old ethical tradition only through considerations of an outward description, as the result of a species of timidity which keeps them from breaking with respectable customs; and yet these people are, at the bottom of their hearts, believers in a view of life of a totally different description--one which attaches no value or meaning to self-mastery and self-denial."

Almost needless to say this obscuration of religious motives with the result of leaving the individual too much at the mercy of the merely physical without adequate principles for self-control is not the fault of religion but of its very opposite--irreligion. Foerster's words are all-important for the understanding of an important phase of the discussion of the cause and cure of nervous and psychic symptoms of various kinds which has attracted much more attention outside of medical circles than it deserves.

The danger of the absence of religious motives in the world, because of the persuasion that new discoveries are doing away with the necessity for faith, has also been emphasized by Professor Foerster, who said:

{233}

"Along with the disappearance of belief in a spiritual world arises the danger that even earnest and n.o.ble men and women will be influenced in their consideration of the deeper things of life by the newest and most tangible facts alone, and will be inaccessible to all arguments going beyond the scope of mere practical sense and expediency. It would appear as if the preponderance of an intellect directed towards external things destroyed not only belief in the invisible world in a religious sense, but also undermined the power of grasping the full value and reality of certain _imponderabilia_ in earthly life, and of understanding the deep-growing spiritual injuries which may proceed from apparently harmless and even outwardly beneficial things."

{234}

CHAPTER XIII

DREADS

The most fruitful source of neurotic affections and especially of what have come to be termed in recent years the psychoneuroses, those disturbances of nerve function due to an unfortunate state of mind, are the dreads or, as they have been called, the fear thoughts of mankind. Men as well as women develop, in the sense of fostering, often almost unconsciously to themselves, a dread of the ulterior significance of some symptom, or feeling, or disturbance of function, which serves to make them extremely uncomfortable. The physical sensation which they experience and which is the basis and the source of the dread may be only a quite normal physiological feeling common to all humanity, heightened by overattention to it, but the fearsome state of mind will cause it to a.s.sume the significance of a definite symptom of some serious disease or, what may be worse, an indefinite symptom of some impending affection which, in the opinion of the sufferer, may be as yet too inchoate for the physician to recognize its real significance.

It is not a question of an imaginary ill, as a rule, and there is but seldom a real hallucination or creation by the fantasy out of nothing, of the ailment from which these people suffer, but there is an exaggeration of some slight or at least comparatively insignificant feeling to {235} an extent that makes it a.s.sume a serious aspect. This inhibits normal function, lessens appet.i.te and exercise, at times even disturbs sleep, and so brings about some at least of the ailments that are dreaded.

Not infrequently these dreads are very vague. People wake in the morning with a sense of depression and the feeling that something is hanging over them. As a result they feel out of sorts, their appet.i.te for breakfast is blunted and they begin the day very badly just because of this incubus of vague disturbance of mind. Almost anything that happens during the day will emphasize their depression; as a consequence lunch may be skimped, they do not get out as they should, and a vicious circle of influences is begun. Perhaps they eat rather heartily for dinner and then fall asleep in their chair afterwards over the evening paper, and then find that when they go to bed they do not sleep promptly as they expected to. They worry over it, feeling there must be something the matter with them, since they cannot sleep lying down though they could sleep so well in the chair, and if there should be a repet.i.tion of these feelings the next day, it is easy to understand how a psychoneurosis would be started which might easily, if eating and outing and exercise were to continue to be neglected, develop into a serious condition. Many a case of nervous breakdown has a beginning as simple as this, and people of nervous temperament must be constantly on guard against it.

Such patients--and they are much more common than might be thought and they have been with us for thousands of years, for Plato describes some of them and the oldest prescription in the world is a fumigation that was directed to curing just such a neurotic condition--need to have faith in themselves and faith in their Maker and to stop {236} hesitating and doubting and thinking and dreading. I have known men, but particularly women, who had been suffering in this way, become converted so that they took up the practice of religion which they had neglected before and proceeded to get immensely better. Of course, there are any number of hypochondriacs among people who profess religion, but they are the exceptions which prove the rule that fewer people who have a real sense of religion and who take it seriously as a guide of life suffer from dreads and the symptoms which result from them than are to be found among the people who have given up the belief and practice of their religion. This is particularly true of those who belong to the old orthodox forms of religion which require self-denial and self-control as part of the practice of religious duties. As we have shown in the chapter on Nervous Diseases the Quakers, the strict Methodists, the Roman Catholics, the Orthodox Jews, get their reward for their submission to their religion even in this world by lessened solicitude about themselves. Indeed there is nothing that is more likely to dispel dreads than an abiding sense of religion. If a man or a woman is convinced that there is a Providence that oversees human life as well as the universe, in Whom "we live and move and have our being" and of Whose infinite knowledge and power we can have no doubt, the unreasonableness of dreads comes home to him.

The man who prays every morning, "Thy will be done on earth as it is in heaven", must have the feeling that His will _will_ be accomplished, and that is all that any of us can ask for. Somehow that is for the best, though we may not be able to see just how. "If not a sparrow falls to the ground but your Heavenly Father knoweth", and if, as the Master said, "Are not five sparrows sold for two farthings and {237} not one of them is forgotten before G.o.d? But even the very hairs of your head are all numbered. Fear not therefore: you are of more value than many sparrows", surely the believer will keep himself at least from being overworried by dreads. His disposition may be such that he cannot dispose of them entirely, but at least the best source of consolation and strength is to be found in that strong faith for which there are so many strengthening expressions against the fears and dreads of life to be found in the sacred writings.

How many striking sentences there are in the Scriptures to help against these solicitudes: "And which of you with taking thought can add to his stature one cubit? If ye then be not able to do that thing which is least, why take ye thought for the rest?" How one is tempted to quote others of the expressions in that same wonderful chapter of Luke (XII). "The life is more than the meat and the body is more than raiment. Consider the ravens; for they neither sow nor reap; which neither have storehouse nor barn; and G.o.d feedeth them; how much more are ye better than the fowls. But rather seek ye the kingdom of G.o.d; and all these things shall be added unto you. Fear not, little flock; for it is your Father's good pleasure to give you a kingdom." All over the Scriptures are pa.s.sages that are meant to be fear-dispelling and that have been for many men and women in many generations. For fear is often the state of man unless he has something to cling to. "Fear not, I am with thee."... "Fear ye not, nor be afraid, have I not told thee."... "Fear not, I am the first and the last, for I the Lord thy G.o.d will hold thy right hand, saying to thee fear not, I will help thee."

Scientists have recognized that religion and science {238} were coordinate factors for the neutralization of the dreads that disturb humanity. Professor H. D. Seeley, who was for many years professor of geography, geology and mineralogy at Kings College, London, and who was a distinguished Fellow of most of the important English scientific societies, the Royal, Linnean, Geological, Zoological and Geographical, stated in his little work, "Factors in Life", his views as regards the place of religion in dissipating the fear thoughts of life, and places it side by side with science itself in this respect.

He said:

"To the religious neither life nor death has terrors, and in freeing existence from its greater anxieties the influence of Religion works on the same foundation of moral efforts as Science. The sciences are the sisters of Religion in that they unfold something of the laws by which the universe is governed, and by which man's life is directed.

They are thus far the stepping-stones of faith. And those who have learned that health is the reward which man may gain by moral discipline, that mental vigour may be augmented by the wise (or moral) use of food, and that education is the systematic exercise of moral responsibility in any or all the affairs of life, may find that in the practice and pursuit of the truths of Science they are conscious of a religious education which is a light to the feet.

Such matters are factors in life, which may educate us in a reverent appreciation of religious truth and divine government of the world."

Many physicians of large experience have recognized the value of an abiding religious faith as a remedy for many of these dreads and doubts which so pester mankind and make so many people suffer even from physical symptoms that seem surely to have only material causes as their basis because they so hamper the will to live. {239} Sir Dyce Duckworth, the distinguished English physician, once wrote to a friend:

"What is always needed is a reverent study and a full acknowledgment of G.o.d as a Father and as the great 'All in All.' In my experience the only solution of all our difficulties is to maintain a humble, child-like faith and a confident trust in the perfect love of G.o.d, who 'knows whereof we are made, and remembers that we are but dust.'

"With that and perfect love, there need be no fear, and all will come right in His own time. That is the faith to live by and to die with, and the happiest people (and the happiest of the dying) are those who hold firm by that faith.