Psychotherapy

Possibility of Diversion of Attention from Ills.—The necessity for diversion of attention from one's ills is best realized by considering what happens in the opposite direction. Headache, toothache, and many other uncomfortable feelings, especially discomfort associated with abdominal disturbances, can be entirely banished from the mind by pleasant association with friends, by an interesting play, by a game of cards, or, indeed, by almost anything that takes up the attention completely. It is well understood that the severer forms of pains can not be thus banished, but discomforts that make life miserable for the patient may be entirely relieved for the time being. If this power of mind to divert attention from the ills of the body means so much, it is not hard to understand that if this mental influence be directed in the other way, that is, to emphasize the ailment by attention to it, it will not be long before symptoms become quite unbearable.

Hobbies.—A hobby is the physical salvation for a man who wants to work hard, yet not become so absorbed in his work that it becomes an obsession. Unfortunately, it is not possible to create a hobby for a man or a woman in a short time. It must be a growth for many years until it has become a portion of one's life. It must, as far as possible, be something to which one turns with as much interest as to one's regular occupation, so that the time taken from it, even for the necessary vocation of life, is more or less resented. If a man has two occupations that are intensely interesting, then he gets the best possible rest. Otherwise it will be necessary in many cases for the physician to help him in the choice of another interest in life. It is not enough that there should be a vacation once a year, or a conventional day off on Sunday. There must be much more than this, deliberately planned and faithfully carried out.

Gladstone .—Men with hobbies have done some of the best of the world's work; busy for many hours every day, they have yet lived to be eighty and even ninety years of age, and have been industrious to the end. A typical example in our generation was Gladstone, the great English statesman. Few men had their minds occupied with more serious problems than he for nearly forty years of a busy existence. In spite of this, he found time to make a study of Greek literature and of ecclesiastical writers; He acquired even more authority perhaps in these subjects than in political science, doing the work of several men, yet he lived to be an extremely old man. He welcomed the opportunity to get away from one kind of work in order to devote himself to another, but this occupation of an entirely different set of brain cells gave those that had been previously at work opportunity for complete rest. Very probably, except at times of special crisis or stress of anxiety, his political problems did not disturb his studies of Greek literature, not because he insisted on keeping them away, but because this other interest was so absorbing that it required no special effort to occupy his mind completely with it.

Virchow .—For more than a year I lived close to the great German pathologist, Virchow, and found that his varied interests were probably the secret of his power to devote himself to work for many hours a day, take only a small amount of sleep and yet live healthily and happily for over eighty years. Frequently he did not leave the Prussian legislature until 1 a. m., or even later, and yet he seldom failed to be at his laboratory before 7:30 o'clock in the morning, though it was several miles from his home and took over half an hour to get there. Besides pathology, he was deeply interested in anthropology and in most of the biological sciences, and his favorite hobby was the practical care of the health of the city of Berlin. From the time when Berlin, just after the Franco-Prussian war, began to grow out of the half-million provincial town that it was, into the great world capital that it became, a transformation that took less than twenty years, Virchow had charge of the health of the men engaged on the sewer farms of the city. Berlin, unlike other great capitals, is not situated on a large stream that will carry off its excreta, and consequently a new problem in sewage disposal had to be met. The sewage was spread over fields outside the city and proved, as might be expected, a magnificent fertilizer. The whole cost of sewage disposal was recouped from the sale of the farm products.

Prophecies of dire disaster of many kinds were made when this system was first proposed. It was said that the men engaged on the farms would suffer from all sorts of disease, especially respiratory and intestinal diseases, that the farm products would be insanitary, and the whole plant would be such a disease producer for the city as to become a nuisance. Virchow was put in charge of the sanitary side of the project, and how well he fulfilled his obligations is shown by the statistics. The people who worked on the farms were healthier than the average inhabitants of Berlin, and were especially free from intestinal disease. Every phase of disease that occurred among the workers on the farms, and there were many thousands of them with their families, was reported to Virchow. Every night, the last thing before he went to bed, he looked over this report and if there were any suspicious cases, made arrangements for the prevention of the spread of disease.

This of itself might seem work enough for one man, but it was only a diversion for Virchow, turning his mind away from his other intellectual work completely during certain hours of the day. His visits to the farms, his planning for the prevention of the spread of disease, his deep interest in the reports and the constant improvement of conditions, instead of hampering his other intellectual activity by wasting brain force, probably proved restful by diverting the blood stream away to the cells that occupied themselves with this other and very different problem, and so proved a benefit, not an evil. Perhaps other men might not have had the store of nervous energy to enable them to carry on work in this way, but for those who have, this is the ideal arrangement. There are many others whose names might be mentioned here. John Bigelow and Pope Leo XIII are typical recent examples. Great workers are usually long livers, barring accident, and all of them have had variety of occupation.

Necessity for Diversity of Occupation.—Even for those of lesser intellectual capacity, it is advisable to have, in a lower order of intellectual occupation, two very different things in which there is intense interest. The blasé attitude in which the individual finds no interest in anything and nothing worth doing, makes it impossible to secure such relaxation as will give relief from worry. So long as nothing happens to call for special resistive vitality, such people may go on nursing their unhappiness. It is from this class, however, that the suicides come. The mind becomes occupied with the worries that it cannot get away from, sleep is interfered with; the worries become an obsession, and brain exhaustion results. It is usually said that suicides are insane, and to this extent certainly the expression is true. Certain brain cells have so long been occupied with a particular subject, because the mind has no other interest to divert attention and blood supply to other portions, that these cells are overborne and become utterly beyond the control of reason and will.

Intervals in Work.—The old university rule of long ago was that no one should do more than two hours of intellectual work continuously at the same subject. Certain of the monastic orders required scholars and students to take a break from an intellectual occupation for a measured interval at least every two hours. The modern business man, and even the literary man or reporter, would think this preposterous. The rule is, however, founded on good common sense, for it relieves the tension and keeps conditions of strain from inveterating themselves in such a way as to do harm.

As a matter of fact, better work is accomplished if it is done in two-hour intervals, with a break of fifteen minutes to a half-hour between, than if the attempt is made to work longer. This may not be true for certain forms of creative literary work, where, when the mood is on, it is easier to finish things than if a break occurs, but these are exceptional cases, and even here there may be serious abuse. Many of the men who work late at night eventually get into habits that seriously impair their sleep. This system of rest prevents such a strain from being put upon the physical organs underlying attention as will prevent them from promptly relaxing when the call upon them has ceased.

There are, of course, men for whom no such rules as these seem to be needed, because they apparently thrive on work. These are exceptions, however, that prove the rule. They will usually be found on investigation to have been men who lived very simply and permitted themselves very little excitement. There is great danger in imitating them because most of them had a superabundant vitality which expressed itself in longevity as well as in a noteworthy capacity for work. They had superabundant brain power to run their business (even though it was deeply intellectual), but then, too, these men were careful not to throw extra burdens upon their digestive organs, nor to abuse stimulants, nor to permit a regular routine of work to be disturbed. When symptoms of nerve weakness begin to show themselves, even the exceptional men must be warned of the danger. The causes of the exhaustion of nervous vitality should be pointed out, and an improvement of habits insisted upon.

Amusement and the Mind.—The theater, as it is at the present time, affords very little opportunity for mental relaxation. Most of our theatricals are mere show that occupies the eye but does not seriously catch the attention, especially after a certain number of types of these performances have been attended. The humor of the comedians of our musical comedy may, for a certain number of people, mean something as a diversion of mind, but it does not last. Unfortunately, practically all their humor runs along the same line, most of it is extremely superficial, much of it is borrowed and wears signs of its origin, not a little of it is mere horse-play, which may divert children but not grown men, and so the theater as a mental relaxation has lost nearly all of its effect. Other diversions are sometimes more hopeful. For baseball enthusiasts, attendance at a game may be such a complete occupation of mind as to furnish thorough relaxation.

The kind of work that provides mental relaxation for others often proves exhausting to those who do it. Humorists, especially those who have to grind out paragraphs or columns of humor every day or every week, are usually melancholy men. The story of Grimaldi illustrates how serious may be the effect of work that seems mere play if pursued too singly. This humorist on one occasion consulted a specialist in mental diseases, for certain symptoms of nervous breakdown and depression that were causing him much annoyance and even more solicitude. The specialist believed in diversion of mind, and, having been to see Grimaldi the night before and enjoyed him hugely, though he did not recognize him off the stage, counseled him to go and see that humorist and have his "blue devils" banished for good. "If Grimaldi won't cure you of your depression," he added, "I don't know anything that will." "My God!" the humorist said, "then don't leave me in despair. Man, I am Grimaldi!"

Sports.—Unfortunately in our modern life we have to a great extent lost the idea of sport. The conventional make-shifts of life in a camp that is really a luxurious country house, or on a luxurious yacht, do not replace the complete diversions that came with real camping, hunting, fishing, sailing and the like. People now go to the country, but take the city with them. They live in country hotels and make five changes of clothing in the day, if not more. If men are interested in hunting and fishing and can go into the forest (unfortunately even the Adirondacks can scarcely be so designated now and we have to go into the Canadian wilderness to get away from the pall of regular life and civilization), complete recreation is secured. This makes a real vacation which does not mean absolute freedom of mind, but freedom from other cares so that one may with complete absorption apply himself to something different. During the year sports for grown-ups are difficult to obtain. Some men continue well on in middle life to play tennis, hand-ball, and certain other games, O fortunati nimium, that make the best kind of diversion. Fortunately, in recent years golf has become a favorite and for many makes a genuine diversion.

Children's Diversions.—In recent years we have so interfered with the normal natural development of the child that there is need to emphasize certain details in this matter. The modern child is apt to be precociously occupied with books and adult interests, because he is brought so much into the foreground of family interests. True play for some city-bred children is almost an anomaly. Exercise and air they get. They are conducted solemnly to the park by a nursemaid, who is instructed to see that they do not play with other children unless quite as well dressed as they are themselves, and their dress is often so elaborate that it is quite impossible for them to think of any real play. There is absolutely no recreation for the child in this procedure: on the contrary, a new effort of will is required to walk with the stately propriety that is expected of it. Then the child is preoccupied with the thought of its clothes. Relaxation of mind is often quite out of the question, and yet we wonder why children are nervous and do not sleep well, why they have night terrors and do not digest their food properly, while all the time they are living unnatural lives that give no proper outlet for their energies and little diversion for their mind.

Games are important, but their true spirit has gone out in recent years. There are still a few young people who play for the sake of the sport, but everything now seems to be a preparation for some sort of contest. Only those are engaged in these contests and the preparation for them whose muscular development is such as to suggest that they will help to win. Winning, and not sport, has become the purpose of our games. This makes the participants worry about the games and associate them with dread of errors and ill chances. It is true that the interest for the contestants during the game is sufficient to make up for this and make the game valuable as relaxation; but those who need such relaxation most—the boys and girls who are underdeveloped muscularly—must sit and watch the contests, and this, after one has become accustomed to it, like newspaper reading and the theater, constitutes a poor apology for the complete relaxation of mind and diversion of brain-cell energy that used to come with sports when they were freely indulged, for the sake of the sport and not for the sake of winning.

CHAPTER VII

HABIT

Few people realize how powerful a factor for physical, as well as moral, good and evil is habit. The old expression that habit is second nature is amply illustrated in the most familiar experiences. The child, unable at the beginning to make any but the most ill-directed movements, learns during its first two years to make the most complex co-ordinated movements—first with difficulty, then with ease, and finally with such facility that there is no need for it to pay any but the most perfunctory attention to their execution. Walking requires the co-ordination of a large number of muscles so that the absolute position of every muscle in both the legs and in the trunk, at least as far as the shoulders, must be definitely known and their activity properly directed. Perhaps nothing brings out more clearly the difficulty of walking, though it depends on only one factor, the co-ordination of the two sides of the body, than the story of the Italian Tozzi twins. They were born with two heads and shoulders and with only one pair of legs. It was found that each head ruled the leg on its own side of the body. It was impossible for the creatures to walk. They lived to adolescent life, yet never succeeded in walking. The intimate association of the lower parts of their trunk and the long years of companionship of their brains, did not enable them to accomplish what seems to us so commonplace a co-ordination of movement as walking.

Formation of Habits.—The co-ordination of the two limbs is after all only a small portion of walking. The body must be held erect, the curve of the spine must be managed so that the center of gravity is kept well within the base, and gluteal and femoral and calf muscles must all be co-ordinated with one another. In a few months a child learns to do all this, and in a couple of years it executes all the co-ordinate motions with such certainty that walking becomes not only an easy matter but an absolutely unconscious accomplishment that can be carried on while the mind is occupied with something else or while it becomes so abstracted that surrounding objects are not noticed.

A far more difficult co-ordination is required for talking. It is only when we analyze how nicely adjusted must be every movement, in order to pronounce consonants and vowels properly and to combine them in various ways, that we realize how complex is the mechanism of talking. A difference of a hundredth of an inch in the movement of the tongue, or less than that in the movements of various muscles of the larynx, makes all the differences between clear articulation and a defect of speech. In the course of the years up to seven, the child learns this wonderful co-ordination apparently without difficulty, but really at the cost of constant well-directed effort. There is no time in human existence when the child really learns so much as during the first four years of its existence, even if it learns nothing else except to walk and to talk. The foolishness of obtruding other things, information and study of various kinds, on the child's attention at this time should be manifest.

Unconscious Regulation of Muscles .—What is thus prefigured in early life invades every activity in later years. The boy who learns to ride a bicycle must at first devote all his attention to it, but after a while rides it quite unconsciously, his muscles having learned by habit to accommodate themselves automatically to all the varying positions of his machine. Anything well learned by habit is never forgotten. How hard it is to learn to swim, yet, after years away from the practice of it, the art comes back at once. The same is true of skating, and of the nice adjustments of muscles required in various games. Such is the influence of habit in forming a second nature. It is no wonder that Reid, the Scotch philosopher, should have written:

As without instinct the infant could not live to become a man, so without habit man would remain an infant through life, and would be as helpless, as unhandy, as speechless, and as much a child in understanding at threescore as at three.

Commenting on this Prof. J. P. Gordy, in his "New Psychology,"25 says:

Strong as this statement seems, it is probably an understatement of the truth. Without habit, we should rather say, a man would be as helpless, as speechless, as unhandy at three-score as at birth. Habit is the architect that builds the feeble rudimentary powers of the child into the strong, developed powers of the full-grown man. If a child's vague, purposeless movements give place to definite movements performed for definite purposes, if his sensations become more definite, if his perceptions become clearer, if his memory becomes more accurate, if he reasons more and more correctly and logically, it is because of habit.

Law of Habit.—The law of habit is that every time we perform any action, mental or physical, or allow ourselves to be affected in any way, we have more proneness to, and greater facility in the performance of that action or in experiencing that affection under similar circumstances, than we had before. In the chapter on Tics, I call attention to the fact that all the curious gestures by which we are individualized, are due to the law of habit. It is infinitely amusing to watch a group of people and note the endlessly different habits of which they have become the victims. There are tricks of speech and tricks of gesture eminently characteristic and often quite laughably individualistic. We imitate, especially those of whom we think much. Sometimes it is only when a father's attention is called to them in his sons that he realizes the ludicrousness, or at least laughableness, of some of the things he does, and he proceeds to correct both generations of their faults.

PHYSICAL HABITS

Habit and Food.—Most of our likes and dislikes for food are neither physical nor physiological, but simply habitual. We have become accustomed to certain things, and so we like them. We are unaccustomed to them, and do not care for them. It is amusing when people put forward these lacks of habituation as if they were physiological idiosyncracies. Many thin people do not like butter and milk. The real reason for this is not any peculiarity of digestion, or any gastric incompatibility, at least in 99 cases out of every 100, but the mere fact that they are not habituated to their use. That is one of the reasons why they are thin. Our tastes for curious foreign foods are nearly all deliberately acquired. Not one in ten ordinary Americans likes olives or caviar when first tasted. Nearly every curious article of food is "caviar to the general" at first trial. Later it becomes impossible to understand how we could have had any objection to them. At times, even an actual craving for them asserts itself as a consequence of the habitual use, and then deprivation means positive discomfort.

Slow Eating.—One of the most valuable habits that a man can cultivate, but one of the most difficult to acquire in our time, is that of eating slowly. Most Americans bolt their food to a degree that would be quite appalling to them if they realized what they were doing. Pieces of potatoe as large as the end of the thumb are swallowed. Bread and milk may be eaten so hurriedly as to be as potent a source of digestive disturbance as fried onions. There seems no doubt from what we know of Fletcher's experience and Chittendan and Follin's studies that a man derives more nutrition from food that is masticated properly, that he can get along and do his work on less material and that, above all, there is not the same tendency for him to put on weight that is so common among people after reaching middle age.

Sir Andrew Clarke used to have his patients chew a definite number ol times on each bite—say thirty times. Even so great a man as Gladstone submitted to this rule and gradually learned to accustom himself to eating very slowly. Fletcher's system of chewing the food until it passes down the esophagus of itself without any swallowing effort is a better rule. It is a surprise to most people how unconsciously swallowing can be accomplished in this way and how little liquid is needed in order to prepare food to be swallowed. The formation of the habit, however, is not an easy one. Persistence and frequent reminders are needed, or else the beginnings of the habit are soon dissipated and old bolting habits reassert themselves.

Water Drinking.—In drinking, habit is as supreme as in eating. The majority of people who work outside and perform muscular labor crave and take an abundance of water. Many of those who live indoors, especially in steam-heated houses, may need it quite as much if not more, but get out of the habit of drinking water. As we need about three quarts of water per day for use in our economy, this no water habit often becomes a serious factor in the production of physiological disturbances. We have replaced water drinking and the milk drinking of the olden times by tea and coffee, and as these are stimulants, habits form very readily with regard to them. I have known people who were sure they would be miserable without their half-dozen cups of tea or coffee each day, and who actually would be miserable for a few days, when deprived of it. They were seriously impairing the efficiency of their nervous system by so much stimulation. Unfortunately, it is just those whose nervous systems have least stability, and are already the subjects of more stimulation by conscious introspection than is good for them, that are most likely to form the tea and coffee habits, and who are most harmed by them, though they find it hard to understand the reason therefor.