" Some of your hurts you have cured,
And the worst you still have survived ;
But what torments of mind you endured
From evils which never arrived."
TO-DAY, the need to eat forces even sensible
men to live and die at a feverish rate.
In bygone days the world was a peaceful
place, in which our forefathers were denied the chance
of combining exercise with amusement dodging
murderous taxis ; knew not the blessings of " Bile
Beans ", nor the biliousness they blessed either ; they
did not fall victims to " advert-diseases " ; and they
left the waters beneath to the fishes, and the skies
above to the birds.
Withal they were sound trenchermen, who called
their few ailments " humours " or " vapours " and
knew what peace of mind meant. Sixty years ago
there was one lunatic in every six hundred people ;
to-day there is one in every two hundred.
At the same time, the " neurasthenic temperament "
is not altogether a modern product, for Plato described
it with great precision, and declared such people to be
" undesirable citizens " for his ideal republic.
Neurasthenia is due to exhaustion and poisoning of
the nervous system, the chief symptoms of which is
persistent neuro-muscular fatigue with general irrita-
bility. Its minor symptoms are almost as numerous
as the various activities possible in mind and body.
The Predisposing Cause of neurasthenia is inherited
nervous instability, but among nervous diseases,
neurasthenia seems the least dependent on heredity,
this factor playing a less important part than
Exciting Causes which are the sparks that fire
explosive trains laid by the living, and often by the
Worry in any form (especially when accompanied
by excess of brain-work),
Abuse of drink, drugs or tobacco,
Lack of exercise,
Menopause, and diseases of the womb,
" Society life ",
are the commonest exciting causes of neurasthenia ;
hard brain-work, unless accompanied by worry, not
The disease is more common in men than women
(because of the more active part played by them in the
struggle for existence), in cities than in the country,
in mental than in manual workers, in the " idle rich ",
and in races which live feverishly, like the Americans.
It is rare in old age.
Ambition, the race for " success ", the struggle to
carry out projects beyond the reasonable capacity
of one man, and the ceaseless work and worry with
little sleep and no real rest which mark life to-day are
responsible for this disease.
Competition has increased in all conditions of life ;
free course is given to ambition, individuals impose on
their brains a work beyond their strength ; and then
comes care and perhaps reverse of fortune ; and the
nervous system, under the wear and tear of incessant
excitation, at last becomes exhausted.
82 EPILEPSY, HYSTERIA, NEURASTHENIA
The basic symptom is an inability to stand a normal
amount of mental or physical strain, and shows itself
in seven marked ways :
1. Muscular Fatigue, which is often most marked
in the morning. The patient rises reluctantly, feeling
as if he had not slept, is listless and " lazy ", and can
neither work nor play much without getting unduly
tired. This weariness may pass off as the day wears on.
2. Backache is often constant and annoying. It
may be a pain, or a general discomfort, and may be
felt anywhere in the back, the nape of the neck and
down the spine being common places. The legs often
" give way ", and, in severe cases, patients believe
they cannot stand, and become bed-ridden. Under
sudden excitement they may walk again, becoming
" miracles of healing ". These spinal symptoms are
common in neurasthenia following accident.
3. Headache is more often an abnormal sensation
than an intense pain. Pulsations, feelings of distress,
of lightness, fullness, heaviness and pressure are
common, or a band may seem to be drawn tightly round
the head across the forehead.
The sensations are usually located in the back of
the head, and may be accompanied by dizziness,
noises in the ears, or dimness of sight. There may be a
feeling of unsteadiness when walking, or a sense of
being in motion when at rest. The headache varies
in intensity ; it is worst in the morning, is increased
by thinking, diminished after eating, often improves
at night, and never keeps the patient awake.
4. Stomach and Bowel Disorders. The victim is
indifferent to food, though dainties often tempt him,
when he cannot face a square meal. He has a feeling
of general well-being after a meal, but within an hour
signs of imperfect digestion arise ; he feels oppressed,
and has flatulence. Later, there are flushes of heat,
palpitation, drowsiness, and a craving for food. Con-
stipation is usually obstinate, while diarrhoea may
cause great weakness.
5. Sleeplessness. Some patients go to sleep
readily, but after some instants wake suddenly, in a
state of excitement that persists despite their efforts
to calm themselves, and only at an early hour in the
morning do they sleep again. Other patients go to
bed with the conviction they will not sleep, and are
kept awake by incessant cogitation, their minds being
harassed by a rapid flow of images, ideas and memories.
In some cases the person is calm, his mind is at rest,
yet he cannot sleep.
6. Circulatory Disturbances. More blood flows to
an organ at work than to one at rest. In health we do
not notice these changes, but in neurasthenia these
internal tides are exaggerated as rushes of blood to
the head, flushings of various parts, and coldness of
hands and feet.
Heart palpitation is alarming but not dangerous,
and the distended blood-vessels of the ears may set
up vibrations in the drum, so that at night when the
head is on the pillow, every beat of the heart is heard
as a thump, which banishes sleep, and works the victim
into a state of high tension. A pain in the chest,
arms and elbows is often felt, limbs may swell
(shown by the tightness of rings, collars, etc.) while
the hands and feet are usually moist and clammy.
The patient may have to empty the bladder every
half-hour. Disorders of menstruation are common.
7. Mental Fatigue. Hundreds of pages would be
needed to describe all the symptoms due to mental
fatigue, the morbid belief that the victim has a fatal
disease being very common, though his " disease "
rarely makes him lie up ; in the day he works, at night
describes his symptoms to the home circle.
The inability of most men to apply themselves
steadfastly to any one set of ideas is seen in the immense
34 EPILEPSY, HYSTERIA, NEURASTHENIA
popularity of music halls, cinemas, and short-story
magazines, which offer a change of interest every few
In normal people there is a slight consciousness of
mental processes, but the mind rarely watches itself
work ; the neurasthenic is unable to concentrate, and
gets charged with inconstancy and shiftlessness.
His ideas are restive, continuous thought is
impossible, and when talking he has to be " brought
back to the point " many times. Memory and atten-
tion flag, and he listens to a long conversation, or reads
pages of a book without grasping its import, and
consequently he readily " forgets " what in reality
he never laboured to learn. Trembling of limbs is
He lacks initiative, and whatever course he is forced
to take after much indecision he is convinced, a
moment later, it would have been wiser to have taken
the opposite one.
All his acts are done inattentively. He goes to
his room for something, but has forgotten what when he
gets there ; later, he wonders if he locked the drawer,
and goes back to see. At night he gets up to make
sure he bolted the door, put out the gas, and damped
Regret for the past, dissatisfaction with the present,
and anxiety for the future are plagues common to
most people, but they become acute in a neurasthenic,
who reproaches himself with past shortcomings of no
moment, infuriates himself over to-day's trivialities,
and frets himself over evils yet unborn.
Such a patient is often greatly upset by a trifle,
yet little affected by a real shock, which by its very
severity arouses his reactive faculties which lay
dormant and left him at the mercy of the minor event.
He will fret over a farthing increase in the price of a
loaf, but if his bank fails he sets manfully to.
Duty that should be done to-day he leaves to be
shirked to-morrow ; he is easily discouraged, timid,
and vacillating. Extremely self-conscious, he thinks
himself the observed of all observers. If others are
indifferent toward him, he is depressed ; if interested,
they have some deep motive ; if grave, he has annoyed
them ; if gay, they are laughing at him ; the truth,
that they are minding their own business, never
occurs to him, and if it did, the thought that other
people were not interested in him, would only vex
He is extremely irritable (slight noises make him
start violently), childishly unreasonable, wants to
be left alone, rejects efforts to rouse him, but is
disappointed if such efforts be not made, broods, and
fears insanity. The true melancholic is convinced
he himself is to blame for his misery ; it is a just
punishment for some unpardonable sin, and there is
no hope for him in this world or the next. The
neurasthenic, on the contrary, ascribes his distress
to every conceivable cause save his own personal
A neurasthenic, if epileptic, fears a fit will occur
at an untoward moment. He dreads confined or,
maybe, open spaces, or being in a crowd. When he
reaches an open space (after walking miles through
tortuous byways in an endeavour to avoid it) he
becomes paralysed by an undefinable fear, and stops,
or gets near to the wall.
He fears trains, theatres, churches, social gatherings,
or the office.
Other victims fear knives, canals, firearms, gas,
high places, and railway tracks, when the basic fear
is of suicide. Many patients have sudden impulses
on which the attention is focussed with abnormal
intensity to perform useless, eccentric, or even
criminal actions ; to count objects, to touch lamp-
36 EPILEPSY, HYSTERIA, NEURASTHENIA
posts, to continually reiterate certain words, and
The victim is fully aware that there are no grounds
for his panic or impulse, but though his reason ridicules,
it cannot disperse, his fear, and the wretched man
finds relief in sleep alone, which adds to his woes by
being a coy lover.
An almost invariable stage is that wherein the
patient studies a patent-medicine advertisement and
finds that a disease, or collection of diseases, is the
root of his troubles. This alarms but interests him ;
he studies other advertisements, sends for pamphlets,
and so becomes familiar with a few medical terms.
He then takes a " treatment ", and talks of his
" complaint " and how he " diagnosed "it. He has
He borrows a book on anatomy from the public
library to discover in what part of the body his
ailment is located.
He draws up (or copies) a special diet -sheet, and
talks of " proteids ", notices a slight cloudiness in his
urine, and underlines " The Uric- Acid Diathesis " in
one of his pamphlets. Then his heart bumps, he
diagnoses anew, and so goes on, usually ending by
taking phosphorus for his " brain fag ". Then he
finds he has a disease unknown to the faculty, which
discovery interests him as intensely as it irritates his
This prince of pessimists has a conviction that,
compared with him, Job was a happy man, and that
he will go insane. He does not know that it is only
when there are flaws in the brain from inheritance
or organic disease that mental worry leads to lunacy ;
a sound brain never becomes unhinged from intellectual
Books and friends are daily questioned about his
" diseases ", and in spite of reassuring replies, he
continues to doubt, re-question and cross-examine
endlessly, feeding his hopes on the same assurances,
consoling himself with the same sympathies, and
worrying himself with the same fears.
Other folk may be " nervy ", he is seriously ill ;
he knows it because he feels it. He expects the
greatest consideration himself, denies it to others,
and then complains he is " misunderstood ".
" Every symptom becomes magnified ; the trifling
ache or pain, the trivial flatulence, the disinclination
or mere hesitation of the bowels to adhere to a strict
schedule, all minor events such as occur to the majority
of healthy men from time to time unheeded, come
to be of vast importance to the psychasthenic
He keeps a record of hourly changes in his condition,
and pesters his family doctor to death. He goes from
physician to physician, from hospital to hospital.
Having been induced by his friends to see a specialist,
he bores that good man who knows him all too well
with a minute description of his symptoms, presenting
for inspection carefully preserved prescriptions, urinary
examination records, differential blood counts, and the
like. Coming away with precious advice, he feels he
omitted to describe all his symptoms, begins to doubt
if the specialist really understands his case, and so the
pitiful farce goes on for years.
The extraordinary fact is that while he is suffering
(sic) from cancer, or heart disease, or Bright's disease,
and spasmodically from minor affections like tuber-
culosis, arterio-sclerosis, and liver-fluke, he is probably
running a successful business. While making money
he forgets his ills ; the moment his attention is diverted
from the " root of evil " he proceeds to further
" diagnosis ".
In the end, he makes a pleasant hobby of his
imaginary maladies, trying each patent nostrum, and
giving herbalists, electric-belt men, Christian Scientists,
and dozens of other weird " specialists " a chance to
Sexual Neurasthenia occurs chiefly in young men
given to self -abuse or sexual excesses. Erections and
emissions are frequent, first at night with amorous
dreams, then in the day as a result of sexual thoughts ;
weakness and pain in the back follow, and the sexual
act may become impossible. The patient usually
studies a quack advertisement, and passes into the
hands of men who make a living by bleeding such
wretches dry. Cold baths and the treatment outlined
in Chapter IX will cure him.
Course and Outlook. Neurasthenia is very curable.
If the cause be removed, and vigorous treatment
instituted, the victim may be well in a couple of
months, but in most cases there are obstacles to
radical treatment, and the disease drags on indefinitely.
Egoism, moral cowardice, and sexual excess play
a part in much neurasthenia, but relatives must not
forget, in their indignation at these laxities, that the
patient really is ill ; it is unkind, unjust and useless
to tell an ailing man the unpalatable truth that it
is his own fault.
" Diseased nature oftentimes breaks forth
In strange eruptions ; . . . "
" King Henry IV."
HYSTERIA, recorded in legend and law, in
manuscript and marble, in folk-lore and
chronicle, right from history's dawn, is still
a puzzle of personality, and only equalled by syphilis
in the protean nature of its manifestations.
The sacred books of the East said delayed menstrua-
tion due to a devil was its cause ; the thrashing-out
of the devil its cure. Chinese legends describe it, and
its symptoms were ascribed by the Inquisition to
witchcraft and sorcery.
Old Egyptian papyri tell how to dislodge the devil
from the stomach, and there were hysteria specialists
in 450 B.C. All old theories fix on the womb as the
seat of the disease. The name hysteria is the Greek
word for womb, and 97 per cent of patients are
A few of the very numerous modern theories may be
The unconscious (or the subconscious) and the
conscious are only parts of one whole. Our
" conscious " activities are those which have developed
late in the history of the race, and which develop
comparatively late in the history of the individual.
The " conscious " is the product of the racial education
of the " unconscious " ; the first is the man, the
40 EPILEPSY, HYSTERIA, NEURASTHENIA
modern, the civilized ; the last is the child, the
primitive, the savage. Between the two there is no
gulf fixed, and the Oxford metaphysician need not go
to Timbuctoo to seek a superstitious savage ; he
may find one within himself.
In hysteria, Janet says, the field of consciousness is
narrowed, and the patient lives through subconscious
experiences, which she forgets when she again " comes
to ". She journeys back into the past, back a few
years individually, back centuries or aeons racially,
and becomes a savage child again.
Normally, when anything goes wrong, or we suffer
from excessive emotion, we give vent to our feelings
by tears, abuse, anger, or impulsive action ; in some
way we " hit back ", and relieve ourselves of the
feeling of oppression. Then we forget, which heals
the sore, and closes the experience.
If, at the moment, we bottle up our emotions, they
obtrude later at inconvenient times until we " get
them off our mind " by confiding in some one, when we
get peace of mind. Open confession is good for the
soul, and it is better to " cry your eyes out " than to
" eat your heart out ".
There are some experiences, however, to which we
cannot react by anger or confidence, and so we imprison
our emotions, and try to obtain peace of mind by
forgetting the irritation.
Freud thinks perverted sex ideas are thus repressed,
and cause hysteria by coming into conflict with the
normal sex life. If these old sores can be laid bare
by psycho-analysis, and the mental abscess drained
by confession and contrition, cure follows.
The biologists consider hysteria as an adult childish-
ness, a primitive mode of dodging difficulties. Victims
cannot live up to the complicated emotional standard
of modern life, and so act on a standard which to us
seems natural only in children and uncivilized races.
Savill gives the following differences between
neurasthenia and hysteria :
Sex - - Both sexes equally.
Age Any age.
Mental Intellectual weak-
peculiarities ness ; bad memory
Overwork ; dyspep-
sia ; accident ;
Course - Fairly even.
97 per cent females.
First attack before
age of 25.
Deficient will power.
Want of control
Emotional upset or
from hour to hour.
Mental Mental exhaustion ;
Symptoms unable to study ;
restless ; sad ;
irritable ; not
equal to amuse-
f ment. May be
General Occasional giddiness ;
Symptoms fainting rare ; con-
vulsions ; head-
ache ; backache ;
sleeplessness ; no
loss of feeling.
Termina- Lasts weeks
Flushing ; convul-
sions and fainting
common ; no
attacks ; local
hy peraesthesia .
Lasts lifetime in
Hysteria is a disease of youth, usually ceasing at
the climacteric. Social, financial and domestic worries
42 EPILEPSY, HYSTERIA, NEURASTHENIA
are exciting causes, a happy marriage often curing,
and an unhappy one greatly aggravating the complaint.
It is most common among the races we usually deem
" excitable ", the Slavs, Latin races and Jews, and is
often associated with anaemia and pelvic disorders.
Symptoms. Changeability of mood is striking.
" All is caprice. They love without measure those
they will soon hate without reason."
Sensationalism is manna to them. They must
occupy the limelight. Pains are magnified or manu-
factured to attract sympathy ; they pose as martyrs
refusing food at table, and eating sweets in their room,
or stealing down to the larder at night to the same
end. If mild measures fail, then self-mutilation, half-
hearted attempts at suicide, and baseless accusations
against others are brought into play to focus attention
Minor attacks usually commence with palpitation
and a " rising " in the stomach or a lump in the throat,
the globus hystericus, which the patient tries to dislodge
by repeated swallowing. This is followed by a feeling
of suffocation, the patient drags at her neck-band,
throws herself into a chair, pants for breath, calls for
help, and is generally in a state of great agitation.
She may tear her hair, wring her hands, laugh or
weep immoderately, and finally swoon. The recovery
is gradual, is accompanied by eructations of gas, and
a large quantity of pale, limpid, urine may be passed
Major attacks have attracted attention through all
ages, ancient statues showing the same poses as modern
photographs. The beginning stage which may last
a few moments or a few days is one of mental unrest,
the victim being irritable and depressed. In some
cases a warning aura then occurs ; clutchings at the
throat, or the globus hystericus, palpitation, dizziness,
sounds in the ears, spots dancing before the eyes, or
feelings of intense " tightness " as if the skin is about
to tear or the stomach to burst.
The victim throws herself on a chair or couch, from
which she slides to the floor, apparently senseless,
the head being thrown back, the arms extended, the
legs held straight and stiff. The face is that of a
dreamer, and the crucifix position is not uncommon.
This stage is a gigantic sexual stretch.
Next comes the convulsive stage, but the convulsions
are not the true jerky movements of epilepsy, but are
bilateral tossing, kicking, and rolling movements,
interspersed with various irregular passionate attitudes.
There is great alteration but not loss of consciousness.
The patient struggles with those about her, bites them,
but never her own tongue, shrieks and fights, but never
passes urine, throws things about, and arches the back
until the body rests on head and feet (opisthotonos).
The stretching and convulsive stages alternate, and
the attack lasts a long time, being stopped by pain or
by the departure of onlookers. During this stage the
face may reflect the various emotions passing through
the mind with a fidelity that would rouse the envy of
The patient gradually calms down, and a fit of tears
or a scream ends the attack, after which the worn-out
victim is depressed but not confused, though memory
for the events of the attack may only be partial. The
patient sometimes passes into the " dream state ",
described in Chapter II, for some hours or occasionally
for far longer ; these are the women described with
much gusto in the local Press as being in a trance
" the living dead ".
The victim of these attacks is suffering from a
disease, for she shows many temporary mental symp-
toms which could not possibly be feigned, while there is
often a genuine partial forgetfulness of the incidents
of an attack. She says she cannot help it ; candid
44 EPILEPSY, HYSTERIA, NEURASTHENIA
friends say she will not. The truth is that she cannot
will not to help it ; for though intelligence and memory
are often good and sometimes abnormal, the judgment
and will are always weak indecision, obstinacy, and
doubt being common.
Treatment. A thorough examination by a doctor is
absolutely essential, to prove that the patient is merely
hysterical, and not the victim of unrecognized organic
disease. In a few cases, skilled attention to some
minor ailment will result in an apparently miraculous
Many who habitually " go into hysterics ", are
merely grown-up " spoiled children ", and in all cases,
the basic factor is a lack of control and self -discipline.
Unfortunately, these tainted individuals who are
so exquisitely sensitive that any reproof brings floods
of tears, turn with mercurial rapidity from passionate
fury to passionate self-reproach, and assuage by
impassioned protestations of affection the distress
they have carelessly inflicted, and, as a consequence
of their momentary but undoubtedly sincere contrition,
escape blame and punishment.
Harmful sympathy is thus substituted for helpful
discipline, and the more stable members of the family
are often made slaves to the whims and caprices of the
The usual home treatment of the victim passes