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UNIVERSITY OF CALIFORNIA^ SAN DIEGO




3 1822 02686 0247



WAR-TIME NERVES
HERBERT J. HALL



UNIVERSITY OF CALIFORNIA SAN DIEGO



3 1822 02686 0247



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WAR-TIME NERVES

THE UNTROUBLED MIND

MOONRISE — A BOOK OF POEMS



WAR-TIME NERVES



WAR-TIME NERVES



BY



HERBERT J. HALL, M.D.




BOSTON AND NEW YORK
HOUGHTON MIFFLIN COMPANY

QTbt 3Riber0itie l^vtae CambriDgf
1918



COPYRIGHT, I91S, BY HERBERT J. HALL
ALL RIGHTS RESERVED

Published September iqi8



Master of Masters,
O maker of heroes,
Thunder the brave,
Irresistible message :-
'Life is worth Living
Through every grain of it.
From the foundations
To the last edge
Of the cornerstone, death.''

W. E. HENLEY



NOTE

These papers made their first appearance in the "Bdlman
and are now published in book form with the permission
of the editor.



CONTENTS

I. War-Time Nerves . . . . i

II. A Change OF System ... 9

III. Moods AND Obsessions ... 18

IV. Practical Patience . . . .27
V. Recalled to Life .... 34

VI. Waiting 4'

VII. Justification 48

VIII. The Middle Course. ... 56

IX. Medical Partnership ... 64

X. Truth-Telling in Medicine . 72

XI. A Way Out 80

XII. The Medicine of THE Spirit . 92

XIII. Symbols 103

XIV. Sleep 112



I

WAR-TIME NERVES

He whom a dream hath possessed knoweth no more of doubting.
For mist and the blowing of winds and the mouthing of words he

scorns;
Not the sinuous speech of schools he hears, but a knightly

shouting,
And never comes darkness down, yet he greeteth a million

morns.

He whom a dream hath possessed knoweth no more of roaming;
All roads and the flowing of waves and the speediest flight he

knows,
But wherever his feet are set, his soul is forever homing,
And going, he comes, and coming, he heareth a call and goes.

Shaemas O Sheel

What is the war doing to the mind and heart;
to the nerves of the Nation? I can answer
only as one obliged to stay at home and who
looks out from an obscure corner upon the
great world conflict. It is possible that such a
viewpoint may have its own special value and
interest.

A boy of nineteen goes into aviation because
he likes it and "because it does not matter if
a few boys are killed off in practice — that will



WAR-TIME NERVES



leave the older men for their larger work."
This is not fatalism, it is not the discouraged
cry of a man tired of life, neither is it patriot-
ism in the narrow sense. It is good-will, good
sportsmanship, the new nerve of the Nation.
It is more still. These boys, many of them sons
of rich men, are accustomed to luxury and
comfort — too much accustomed. They are
deliberately and in great numbers choosing
danger, privation, and death as something
better than what they were having. Why?
Not entirely from love of the game, we may be
sure, although that element is strong.

The individual and the war, or in relation
to the war, offers a most absorbing study.
How do men go into it and why, and what is
the reaction upon those who stay at home?
This much is sure: those who go and all of us
who are affected are simplifying life, not com-
plicating it any more. We shall all know our-
selves better, we shall understand better why
we do anything, and we are more likely to be
direct and effective in every way.



WAR-TIME NERVES



When a man denies himself all he has held
valuable and presents himself naked, so to
speak, before the great god of war, more than
he probably knows has happened. I am not
going to idealize and imagine character changes
which are not true. Every man will approach
his service from a different angle and the per-
sonal result will be different in each individual.
But with the eyes of the physician I have seen
into the lives of a number of men who have
enlisted or who have been drafted, who have
come back from service or who are waiting
to go. 1 have also studied somewhat the lives
of people who stay at home. It is all, or mostly
all, good; and the greatest change is in simpli-
fication and a new idealism. We no longer need
so many things to make us happy. There is
in the air a sense of relief even in the face of
dread and danger. But simplification in itself
would not be so valuable if it did not leave
room for and make possible certain great
positive virtues.

War, even to those at home, is such an all-



WAR-TIME NERVES



pervading, penetrating matter. It gets into
the most sluggish blood, it activates the most
torpid brain, it makes men alive, it makes
them think. They think not in petty detail
any more, but in large directness. They think
of war, yes, and how to win it ; but they think
also of life. When life is so cheap it somehow
becomes more interesting, demands explana-
tions and understandings which we have been
too indolent or too confused to make.

I am not forgetting my medical viewpoint,
but medicine is enlarging its borders. Medical
men are permitted to think of vital things now-
adays, for it has become evident that matters
of philosophy and of religion have their direct
influence upon the body. It has also become
evident that there is a hygiene of the spirit
quite as important as that of the body.

We do not talk about it much at home, the
men who are going into service do not talk
about it; but out of this great simplification
is coming a new strength and directness of
religious belief — a new vision. The boy who



WAR-TIME NERVES 5

sails on a collier or a destroyer, who sees the
world and its distant ports, who stands his
watch in the early morning when the sea
changes from black to gray and from gray to
blue, is seeing and learning something besides
navigation and geography, is spying for some-
thing bigger than the periscope of the lurking
submarine. He is accepting cold and danger,
he is leaving behind all the absorbing diversity
of city life for a purpose greater even than war.
He is coming face to face with himself, and he
finds that self alone and unsupported before
the great mystery, the mystery of life and
death. Shall we not call it the mystery of
God? The boy has his duties to perform, but
they are simple, straightforward; drill and
routine have made them almost mechanical.
The one thing that is real is the great mystery.
"Why am 1 here?" he asks himself; "what
about the morning and the evening with their
wonder of sky and sea? What does it mean?"
We cannot answer these age-old questions. The
boy alone with the sea cannot answer them;



WAR-TIME NERVES



but by the very simplification of his Hfe, by
the ehmination of all else, he will be nearer
to an adequate answer. He will answer par-
tially and in his own way by his life, which
will be broader and bigger, by his spirit, which
will be richer and more generous.

Perhaps the boy will realize that the creeds
and philosophies are far from sufficient to
meet the growing needs of his spirit. The
greatness of the questions will bring to him a
sense of their importance. He may see that
he must make some tentative answer; that
he must say in effect, " I do not know. But
by the very wonder and beauty of life I know
that there is something behind it, some vital
being into whose hands I commend my spirit."
And then there may come a sense of nearness
to the God of the sea, the God so much greater
than battles, so much greater than human life,
so much greater than the roar of guns and the
clash of angry steel. Nearness and glad de-
pendence, that is enough — that is religion —
that is the great simplification, the great good



WAR-TIME NERVES



experience that the war may bring to the indi-
vidual, to the boy alone under the stars.

If something like this conception comes to
the soldier and the stay-at-home, we shall leave
behind us much that has made life cheap and
mean and purposeless. There will be a new
nervous health, a new quality of manhood that
will be the source of finer and more beautiful
life upon the earth.

I am going to borrow now part of Lord
Dunsany's preface to "The Last Book of
Wonder" — these are the words of a man who
has seen actual warfare and who finds some-
thing good in it: —

" I do not know where 1 may be when this
preface is read. As I write it in August, 1916,
I am at Ebrington Barracks, Londonderry,
recovering from a slight wound. But it does
not matter greatly where 1 am; my dreams are
here before you amongst the following pages;
and writing in a day when life is cheap, dreams
seem to me all the dearer, the only things that
survive.



8 WAR-TIME NERVES

"Just now the civilization of Europe seems
almost to have ceased, and nothing seems to
grow in her torn fields but death, yet this is
only for a while and dreams will come back
again and bloom as of old, all the more ra-
diantly for this terrible ploughing, as the
flowers will bloom again where the trenches
are and the primroses shelter in shell holes for
many seasons, when weeping Liberty has come
home to Flanders.

"And now I will write nothing further about
war, but offer you these books of dreams from
Europe as one throws things of value, if only
to one's self, at the last moment out of a
burning house."



II

A CHANGE OF SYSTEM

"Sir," I said one evening to Doctor Sangrado, "I call Heaven
to witness on the spot, that I have never saved a patient, one
would think they died out of spite." . . . "If you will take a
hint, sir," replied I, "we had better change our system."

Gil Bias

The war holds tremendous possibilities for
the men and women who are available for serv-
ice or who can work at home in some useful
capacity. I want to say a word, not so much
for those who are actually sick and disabled,
as for those who for some more or less obscure
reason cannot keep up with the procession of
life. In these days of accomplishment there
is a sharpened and painful contrast between
the active and the passive, the effective and
the ineffective. The so-called nervous invalid
or the constitutionally feeble find that the war,
far from simplifying, actually complicates ex-
istence. They cannot understand why they
are unequal to the emergency.



10 WAR-TIME NERVES

The medical department is weeding out of
the service man after man who is apparently
well, but who, according to test and in the
light of previous personal history, does not
measure quite up to the physical or nervous
standard. I know a young woman who wants
to go abroad to work among the poor and the
refugees. She has spirit enough, a wise head
and a warm heart, but she lacks physical and
nervous stamina. She ought rather to stay at
home under medical treatment until her body
is the best that it can be. She will surely find
some smaller but useful work to do here. Shall
we call her a failure; shall she call herself a fail-
ure? Her situation is typical of hundreds who
are failing in the ordinary sense of large ac-
complishment.

Unquestionably it is the business of such
people to use every known means for full recov-
ery. They will find the medical profession
ready and eager to help them. But medicine
has its great limitations; often enough it is
impossible to restore full power. Then we



A CHANGE OF SYSTEM ii

must not depend upon medical treatment of
the usual sort. When drugs and surgery, rest
and hygiene, have done their utmost and have
failed, it is time for a change of system, it is
time for the cure of readjustment and of new
understanding.

As a physician I have had my share of diflfi-
culty with physical defects and deficiencies,
and with those nameless conditions of the
body which defy medical aid for years. But
I am optimistic because I know that a very
real cure is almost always possible even though
some of the physical limitations remain. By
this cure I mean a readjustment of life; an
adaptation to limitations which brings balance
and the greatest possible degree of physical
efficiency. I say to my discouraged and doubt-
ful patient, " Success is not measured by what
you accomplish, but by what you are." If
you are the brave, generous soul you ought
to be, accomplishment is a secondary matter;
it may be expressed in terms of character and
of social relationship as well as in terms of



12 WAR-TIME NERVES

work. Without character behind it, even work
is barren and will ultimately fail. With char-
acter, material accomplishment will inevitably
follow as far as strength will allow. In any
event, the value will be there; you yourself
are part of the world's treasure. The success-
ful man, the essentially well man, is the one who
has done the best he can with his equipment.
It is never wise or fair to compare the work
of individuals, for we can rarely, if ever, know
just what material there was to start with —
to work with. Yet a great deal of discontent
and unhappiness come from such comparisons.
The girl who cannot go to France is likely to be
unhappy, and so, nervously as well as physi-
cally ill, if she does not see that here in America
the loyalty and patience and courage for which
she stands may have their immense value, may
help win the war really — for there are plenty
of people to accomplish the actual service if
they are backed by the character and the en-
thusiasm, the whole-hearted support, of those
who stay at home.



A CHANGE OF SYSTEM 13

Such a cure is, of course, not so easy as it
sounds. The sense of failure is a heavy weight
not to be shaken off and disposed of with a few
fine phrases. Yet there is a cure for apparent
failure. It is the realization of the fact that
many, many times there has really been no
actual failure, but only an inability to reach
preconceived ideals. There is no comfort here
for the insincere, for the essentially ineffective.
To do their best with what they have to work
with is the business of brave souls struggling
against odds in a stern and darkened world.
But since there is no absolute standard of
accomplishment, but only a requirement of
quality, there need be no despair in the hearts
of those who are ill or poorly endowed.

Here, then, is a kind of medicine, a new sys-
tem, that does not pretend to cure what can-
not be cured, but which turns failure into suc-
cess and apparent defeat into victory. We
must not neglect the body; there are reme-
dies to cure many of its ills. But when these
remedies fail there is a medicine of the spirit —



14 WAR-TIME NERVES

more potent, more desperately needed than
any salt or tincture known to man.

When a man is sick, unable to meet the
ordinary requirements of life, and yet has no
evident or organic physical illness, we say he
has nervous prostration. We are apt to shrug
our shoulders when we speak of this affliction
because we associate it with certain feeble and
fussy women who have been known on occa-
sion to pick up their skirts and run as fast as
any one. More often than not, such a judg-
ment is unjust, wholly unfair to the idler who
might perhaps for a short spurt do a lot of hard
work, but who would soon enough give out and
go down in a heap.

There are diseases the doctors do not or
cannot name; not dangerous to life, perhaps,
but interfering with the proper working of the
body. There are partly understood unbalances
and disturbances which were once called fanci-
ful or imaginative, but which now are known
to be real and out of the patient's control. We
have literally no right to say that a man is



A CHANGE OF SYSTEM 15

making or pretending feebleness until every
possible means of restoration has been tried,
until every investigation has been made; and
then, half the time, we shall be wrong if we
blame him for his illness.

As the years go by, medical men are learn-
ing better how to deal with these poorly de-
fined illnesses. They are learning that one
weak organ affects all the others and may
interfere even with the proper working of
the mind itself. They are learning that poor
nourishment, with feeble muscles and badly
poised body, may affect the proper action of
even normal organs. They are learning that
fear and misconception, the effort of the mind
to protect itself against real or fancied harm,
may produce states of great exhaustion. And
they are finding ways to remedy these defects.

Of course, there are a few nervous individ-
uals who "enjoy poor health." They should
be criticized and ridiculed, urged and com-
manded, re-educated, until they reform. There
is no excuse for the real idler. In my observa-



i6 WAR-TIME NERVES

tion, however, the professional invalids are
very few — an almost negligible number, es-
pecially in these war-times when the spirit of
work and service is in the air. We must be
very slow and careful in our judgment lest
we do a serious harm.

Perhaps the hardest part of a nervous illness
is the almost inevitable misunderstanding.
Not only is the patient looked upon with
suspicion, but he suspects himself of being a
shirker. If he is not considered a fraud and
made the subject of ridicule, he is too much
pitied; too much pampered, and so, spoiled.
Perhaps somewhere there is a nervous invalid
who is fully understood and fairly managed.
It would be a pleasure to find him.

The reason for these unhappy misunder-
standings is not far to seek. What we call
nervous prostration seems to involve the per-
sonality. The patient is depressed; there are
times when he sees no light in the sun and
no beauty in the moon. He is querulous and
fault-finding, so gains a bad reputation. Per-



A CHANGE OF SYSTEM 17

haps he becomes erratic and irresponsible,
impulsive and thoughtless. All this list of
bad qualities, and much more, may be the
unhappy burden of the neurasthenic. Some-
times we find a nervous patient who is perfectly
even and sweet-tempered. I generally suspect
such a patient of duplicity, and I am not sur-
prised when he says something behind my
back that he would not say openly. Safety
and sanity lie somewhere between these ex-
tremes.

I shall try in the next chapters to suggest
some practical ways and means whereby the
unfortunate victim of lowered vitality may
find his way back to a tolerable, if not a happy,
life.



Ill

MOODS AND OBSESSIONS

For what has he whose will sees clear
To do with doubt and faith and fear,

Swift hopes and slow despondencies?

His heart is equal with the sea's
And with the sea-wind's, and his ear

Is level to the speech of these,
And his soul communes and takes cheer

With the actual earth's equalities,
Air, light, and night, hills, winds, and streams,
And seeks not strength from strengthless dreams.

Swinburne

We criticize the slothfulness of the nervous
invalid and have small patience with his whims
and his erratic habits. Is there any excuse for
a grown man who is afraid to go into a room
full of people, or who is afraid to go out in the
good sunlight lest he have a stroke of apoplexy?
Does any one suppose that such painful obses-
sions are agreeable? It is true that after a
while the observance of unnecessary caution
and the assumption of absurd protective meas-
ures do give a strange relief to suffering, and
so may be carried out selfishly without regard
for the comfort of others.



MOODS AND OBSESSIONS 19

We must not proceed to call these people
cranks and punish them with ridicule, or
attempt to break their wills and make them
conform to the comfortable social traditions.
Sometimes, perhaps, we can and should do just
this; but more often the result is suffering and
rebellion with the substitution of worse habits
or the intensification of the old conditions.

I am not referring now to the testiness of the
selfish and the habit-bound who must manage
everything or make some one pay the penalty;
but rather to those unhappy souls who, with-
out wish to cause trouble to themselves or any
one else, have become the victims of obses-
sions and superstitions which threaten to
wreck all happiness.

We are beginning to realize that such con-
ditions as I have mentioned, and worse, may
come about in perfectly natural and inevitable
ways. Certainly it is rare to find a person who
does not possess in some degree the possibili-
ties of nervous trouble, or who can claim to
be wholly free from the fads and foibles that



20 WAR-TIME NERVES

we associate with the nervous invalid. We
have only to examine our own experiences to
understand how morbid fears and suggestions
may arise and dominate. With a little self-
study we shall realize that we are all of us full
of the suggestions and superstitions that are
the beginnings of fear.

Now, fear has a way of growing in some
minds. It is like fire that gets in between par-
titions in a house and smoulders away until
finally it breaks out and is hard to control.
There are a few people who may be subject to
all sorts of nervous shocks, but who never
suffer fear in any great degree. There are
others, suggestible or temporarily sensitive,
who become easy prey to fear — fear which
may smoulder from childhood only to break
out at some remote, unexpected time. Some-
times we can trace nervousness and unfortu-
nate habits to old or new fear and the conscious
or unconscious effort of the victim to protect
himself from evil. Often no such connection
is evident, though we suspect its existence.



MOODS AND OBSESSIONS 21

Many complex and mysterious cases of hys-
teria and nervous disease are apparently due
to hidden fear. Serious nervous illness has
been cured by the removal of fear — by a
reasonable explanation and reassurance —
even after the original misconception has been
buried under a host of irrelevant symptoms.

We must not assume at once that the dis-
covery of the cause of unreasonable apprehen-
sion will make relief easy. Often enough there
are accompanying states of mind which must
be overcome by complete re-education, and
conditions of the body itself which must first
be righted.

It has always seemed to me that the attempt
to cure a nervous illness by elimination of a
single fear is a futile business — something
like catching a few rats in a trap while the
breeding-place in the cellar goes without
attention. Great relief comes, of course, when
a dominant fear or anxiety is conquered; but
there will always be cause for fear in the world.
The fearful and timid attitude of mind must



22 WAR-TIME NERVES

be changed for one of steadiness and courage
— a lifelong task for most of us, but one which
will amply repay all effort. Once beyond a
certain point and we shall be affected only by
necessary and legitimate anxieties. But until
that point is reached we shall be unhappy and
perhaps ill with fear.

In the average case of nervous exhaustion,
accompanied by moods and obsessions, we
may rarely hope for permanent and complete
relief from physical or medical measures alone.
I am apt to say to my patients who ask relief
from obsessive thoughts and from sleepless
nights of trouble: " 1 can do nothing until you
give me a cleaner, simpler background for my
work. Now everything is confusion and prej-
udice; moreover, you are still too near to your
moods to see them clearly and to meet them
fairly, or to ignore them successfully."

Before there can be anything beyond a
transient and unreliable calmness and happi-
ness, there must be a purpose in life and a
striving for fulfillment that carries all before



MOODS AND OBSESSIONS 23

it, that dominates to the virtual exclusion of
fear. Primal purpose is a vague thing to talk
about or to understand. Doubtless it varies
from time to time in form and in evidence. It is
almost sure to be confused with some lesser
purpose. Perhaps we may find an understand-
ing of the greater through the less. The fine,
strong purpose and inspiration which we see in
the loves of men and of women will serve well
for example. In true love we have a purpose
sufficient, to overcome obstacles for the attain-
ment of its desire. The obstacles are heart-
rending enough at times, but they do not de-
stroy the affection; rather do they heighten it.
Finally, the lover, if he is of the right sort,
loves on even if he fails of his object and is
denied forever the surrender and embrace of
his love. Deep as it is beyond most other im-
pulses and desires, love itself springs from a
deeper source, and that source is wrapped up
in the final significance, the final justification
of life.
We know a primal purpose best by its work-



24 WAR-TIME NERVES

ing, by the sense of obligation in us which will


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