CHAPTER X

HISTORIES OF SOME SEVERE CASES

The cases that follow represent mainly the severe types of nervousness in the housewife. To every case that comes to the neurologist there are a hundred that explain their symptoms as "stomach trouble", "backache", etc., who remain well enough to carry on, and who think their pains and aches inevitably wrapped with the lot of woman.

It will be seen, upon reading these cases, that a rather pessimistic att.i.tude is taken toward some of them. It would be nice to present a series of cases all of which recovered, and it would be easy to do that by picking the cases. Such a series would be optimistic in its trend; it would however have the small demerit of being false to life. Though the majority of women suffering from nervousness may be relieved or cured, a number cannot be essentially benefited. Some of them have temperaments utterly incompatible with matrimony, others have husbands of the incorrigible type, others have life situations to change which would make it necessary to change society. Therefore in these cases all a doctor can do is to _relieve symptoms_, relieve some of the distress and rest content with that.

I am essentially neither pessimist nor optimist in the presentation of these cases, nor do I seek to present the man or woman's case with prejudice. In life a realistic att.i.tude is the best, for if we were to remove much of the sentimental self-deception at present so prevalent, huge reforms would occur almost overnight. Sentimentality decorates and disguises all kinds of horridness and makes us feel kindly toward evil.

Strip it away, and we would immediately break down the evil.

There is always this danger in presenting "cases" to a lay public, that symptoms are suggested to a great many people. How deeply suggestible the ma.s.s of people can be is only appreciated when one sees the result of public health lectures and books. Many persons tend to develop all the symptoms they hear of, from pains and aches to mental failure. Even in the medical schools this is so, and every medical teacher is consulted each year by students who feel sure they have the diseases he has described.

So in presenting the following cases symptoms will be largely omitted.

What will be presented is history and to a certain extent treatment.

That part of treatment which is strictly medical can only be indicated.

It may be said that in obtaining the intimate history of a woman a difficulty is met with in the natural reluctance to telling what often seems to the patient painful and unnecessary details. To some people it seems inconceivable that fears, pains and aches, sleeplessness, etc., can arise out of difficulties like the monotony of housework, temperament, or troubles with the husband. Furthermore, though some women understand well enough the source of their conflicts, they are ashamed to tell and rest mainly on the surface of their symptoms. To obtain the truth it is necessary to see the patient over and over again, to get somewhat closer to her. This is especially easy to do after the physician has to a certain extent relieved the patient. In other words, except in the cases where the woman is quite prepared to tell of her intimate difficulties, it is best to go slowly from the medical to the social-psychological point of view.

Case I. The overworked, under-rested type of housewife.

Mrs. A.J., thirty years old, is a woman of American birth and ancestry.

Her parents were poor, her father being a mechanic in a factory town of Ma.s.sachusetts. She had several brothers and sisters, all of whom reached maturity and most of whom married.

Before marriage she was a salesgirl in a department store, worked fairly hard for rather small pay, but was strong, jolly, liked dancing and amus.e.m.e.nts, liked men and had her girl friends.

At the age of twenty-two she married a mechanic of twenty-four, a good, sober, steady man, devoted to her and very domestic. Unfortunately he was not very well for some time following a pneumonia in the third year of their marriage. They drew upon all their savings and fell seriously in debt. This meant borrowing and scrimping for several years,--a fact which had great bearing on the wife's illness later.

They had three children, born the twelfth month, the third year, and the fourth year after marriage. After the first child the mother was very well, nursed the baby successfully, and the little family flourished. Then came the unfortunate illness of the husband, which threw him out of work for six months, during which time they lived on an allowance from his union, his savings, and finally ran into debt. This greatly grieved the man and depressed the woman, but both bore up well under it until the birth of the second child, when their circ.u.mstances forced them to move to a poorer apartment. The wife was delivered by a dispensary physician, who did his duty well but allowed the woman, who protested she felt well, to get up and care for her husband and baby much earlier than she should have done.

The nursing of this baby was more difficult. The mother's b.r.e.a.s.t.s did not seem to be nearly as active as in the previous case. The baby cried a great deal and needed attention a good part of the night. The husband was unable to help as he had previously done and the fatigue of the care of child and man brought a condition where the woman was tired all the time. Still she bore up well, though when the summer came she greatly missed the little two weeks' vacation that she and her husband had yearly taken together from the days of their courtship.

The husband recovered, but his strength came back very slowly. He went to work as soon as possible but worked only part time for six months. At night he came home utterly exhausted and could not help his wife at all.

During the next year both children were sick, first with scarlet fever and then with whooping cough. The mother did most of the nursing, though by this time the father was able to help and did. The necessary expenses so depleted the family treasury that when the summer came neither could afford to go away.

Both noticed that the mother was getting more irritable than was natural to her. She went out very seldom and her youthful good looks had largely been replaced by a sharp-featured anxiety. Though she carried on faithfully she had to rest frequently and at night tossed restlessly, though greatly fatigued.

She became pregnant again, much to her dismay and to the great regret of her husband. At times she thought of abortion, but only in a desperate way. The last few months of her term were in the very hot months of the year and she was very uncomfortable. However, she was delivered safely, got up in a week to help in the care of her other two children and to get the house into shape again. Her milk was fairly plentiful, despite her fatigue and "jumpy nerves." Unfortunately at this time, when they had acc.u.mulated a little surplus and she was looking forward to better clothes for her family and more comforts, the plant at which her husband was employed suspended operations because of some "high finance" mix-up. Coming at this time, the news struck terror into her heart; she broke down, became "hysterical" _i.e._ had an emotional outburst. This pa.s.sed away, but now she was sleepless, had no appet.i.te, complained of headache and great fatigue.

Though she was a.s.sured that the plant would reopen soon (in fact it soon did), she made little progress. That she was suffering from a psychoneurosis was evident; what remained was to bring about treatment.

This was done by enlisting a development of recent days,--the Social Service agencies. Out of the old-time charity has come a fine successor, social service; out of the amateurish, self-consciously gracious and sweet Lady Bountiful has come the social worker. Unfortunately social service has not yet dropped the name "Charity", perhaps has not been able to do so, largely because the well-to-do from whom the money must come like to think of themselves as charitable, rather than as the beneficiaries of the social system giving to the unfortunates of that system.

Let me say one more word about social service and the social worker, though I feel that a volume of praise would be more fitting. The social worker has become an indispensable part of the hospital organization, an investigator to bring in facts, a social adjuster to bring about cure.

For a hospital to be without a social service department is to confess itself behind the times and inefficient.

Briefly, this is what was done for this family.

Their prejudices against social aid were removed by emphasizing that they were not recipients of charity. The husband was allowed to pay, or arrange to pay, for a six weeks' stay in the country for the mother and the new baby. The home for this purpose was found by the agency and was that of a kindly elderly couple who took the woman into their hearts as well as over their threshold. The social worker arranged with a nursing organization to send a worker to the man's house each day to clean up the home while the children stayed in a nursery. One way or another the husband and children were made comfortable, and the wife came back from her stay, made over, eager to get back to her work.

It is obvious that in such a case as this the physician is largely diagnostician and director, the actual treatment consisting in getting a selfish and inert social system to help out one of its victims. That a sick man should be left to sink or swim, though he has previously been industrious and a good member of society, is injustice and social inefficiency. That a woman, under such circ.u.mstances, should be left with the entire burden on her hands is part of the stupidity and cruelty of society.

How avert such a thing? For one thing do away with the name "Charity" in relief work,--and find some system by which industry will adequately care for its victims. What system will do that? I fear it may be called socialistic to suggest that some of the fifteen billions spent last year on luxuries might better be shifted to social amelioration. The record in automobile production would be more pleasing if it did not mean a shift from real social wealth to individual luxury.

Case II. The over-rich, purposeless woman.

This type is of course the direct opposite of the woman in Case I and represents the kind of woman usually held up as most commonly afflicted with "nervousness." "If she really had something to do," say the critics, "she would not be nervous."

This is fundamentally true of her, though not true of the majority of women whom we have discussed. It seems difficult to believe that hard work and worry may bring the same results as idleness and dissatisfaction, but it is true that both deenergize the organism, the body and mind, and so are kindred evils. What's the matter with the poor is their poverty, while the matter with the rich is their wealth.

Mrs. A. De L. is of middle-cla.s.s people whose parents lived beyond their means and educated their only daughter to do the same. Here is one of the anomalies of life: bitterly aware of their folly, the extravagant and struggling deliberately push their children into the same road. Mrs.

De L. learned early that the chief objects of life in general were to keep up appearances and kill time; that as a means to success a woman must get a rich husband and keep beautiful. Being an intelligent girl and pretty she managed to get the rich husband,--and settled down to the rich housewife's neurosis.

Her husband was old-fashioned despite his rather new wealth, and they had two children,--a large modern American family. Though he allowed her to have servants he insisted that she manage their household, which she did with rebellion for a short time, and then rather quickly broke away from it by turning over the household to a housekeeper. This brought about the silent disapproval of her husband, who let her "have her own way", as he said, "because it's the fashion nowadays."

She became a seeker of pleasure and sensation, drifting from one type of amus.e.m.e.nt to the other in an intricately mixed cooperation and rivalry with members of her set. She followed every fad that infests staid old Boston, from the esoteric to the erotic. She became an accomplished dancer, ran her own car, followed the races, went to art exhibitions, subscribed to courses of lectures of which she would attend the first, dabbled in new religions, became enthusiastic: about social work for a month or two,--and became a professional at bridge. Summers she rested by chasing pleasure and flirting with male _habitues_ of fashionable summer resorts; part of the winter she recuperated at Palm Beach, where she vied for the leadership of her set with her dearest enemy.

Her husband financed all her ventures with a disillusioned shrug of his shoulders. As she entered the thirties she became intensely dissatisfied with herself and her life, tried to get back to active supervision of her home but found herself in the way, though her children were greatly pleased and her husband sceptical. The need of excitement and change persisted; gradually an intense boredom came over her. Her interest in life was dulled and she began a mad search for some sensation that would take away the distressing self-reproach and dissatisfaction. Shortly after this she lost the power to sleep and had a host of symptoms which need not be detailed here.

The medical treatment was first to restore sleep. I may say that this is a first step of great importance, no matter how the sleeplessness originates. For even if an idea or a disturbing emotion is its cause, the sleeplessness may become a habit and needs energetic attention.

With this done, attention was paid to the social situation, the life habits. It was pointed out that all the philosophies of life were based on simple living and work, and that all the wise men from the beginning of the written word to our own times have shown the futility of seeking pleasure. It was shown that to be a sensation seeker was to court boredom and apathy, and that these had deenergized her.

For interest in the world is the great source of energy and the great marshaler of energy. From the child bored by lack of playmates, who brightens up at the sight of a woolly little dog, to the old and vigorous man who makes the mistake of resigning from work, this function of interest can be shown.

She was advised to get a fundamental, nonegoistic purpose, one that would rally both her emotions and her intelligence into service. Finally she was told bluntly that on these steps depended her health and that from now on any breakdown would be merely a confession of failure in reasonableness and purpose.

That she improved greatly and came back to her normal health I know.

Whether she continued to remain well and how far she followed the advice given I cannot say. From the earliest time to this, necessity has been the main spur to purpose, and probably the lure of social compet.i.tion drew the lady back to her old life. Experience, though the best teacher, seems to have the same need of repet.i.tion that all teaching does.

Case III. The physically sick woman who displays nervousness.

Though this is one of the most important of the types of nervous housewife the subject is essentially medical. We shall therefore not detail any case, but it is wise to reemphasize some facts.

There are bodily diseases of which the early and predominant symptoms are cla.s.sed as "nervousness." Hyperthyroidism, or Graves' Disease, a condition in which there is overactivity of the thyroid gland and which is particularly prevalent among young women, is one of those diseases.

In this condition excitability, irritability, emotional outbursts, fatigue, restlessness, digestive disorders, vasomotor disorders, appear before the characteristic symptoms do.

Neuro-syphilis is another such disease. This is an involvement of the nervous system by syphilis. One of the tragedies that distresses even hardened doctors is to find some fine woman who has acquired neuro-syphilis through her husband, though he himself may remain well.

In the early stages this disease not only has neurasthenic symptoms but is very responsive to treatment, and thus the early diagnosis is of great importance.

What is known as reflex nervousness arises as a result of minor local conditions, such as astigmatism and other eye conditions, trouble with the nose and throat and trouble with the organs of generation. The latter is especially important in any consideration of nervousness in the housewife, particularly in the woman who has borne children.

Frequently too the existence of hemorrhoids, resulting from constipation, acts to increase the irritability of a woman who is perhaps too modest to consult a physician regarding such trouble. Where such modesty exists (and it is found in the very women one would be apt to think were the very last to be swayed by it), then a competent woman physician should be consulted. With good women physicians and surgeons in every large community there is no reason for reluctance to be examined on the part of any woman.

Further details are not necessary. Enough has been said to emphasize the fact that the nervousness of the housewife is first a medical problem and then a social-psychological one.

Case IV. A case presenting bad hygiene as the essential factor.