Treatment of the Individual Cases : Part 1

The Nervous Housewife
by Abraham Myerson, M.D.

(Page 12 of 14)

It is obvious that what is largely a problem of the times cannot be wholly considered as an individual problem. Yet individual cases do yield to treatment (to use the slang of medicine) or at least a large proportion do. The minor cases in point of symptoms are very frequently the most stubborn, since neither the patient nor the family are willing to concede that to alter the life situation is as important as the taking of medicine.

Most housewives are nervous, both in their own eyes and in those of their husbands, yet rightly they are not regarded as sick. They are uncomfortable, even unhappy, and the way out seems impossible to find. I believe that even with things as they are, adjustments are possible that can help the average woman. It is conceded that where the life situation involves an unalterable factor, relief or help may be unobtainable.

It is necessary first of all to rule out physical disease. To do this means a thorough physical study. By doing this a considerable number of women will be immensely helped. Flat feet, varicose veins, injuries to the organs of generation, eye strain, relaxed gastro-intestinal tract, and the major diseases, - these must be remembered as factors that may determine nervousness.

With this question settled, let us assume that there is no such difficulty or it has been remedied, and we have next to consider the life situation of the patient. Here we enter into a difficult place, where knowledge of life and understanding of men and women, as well as tact, are the essentials.

It is necessary to remedy whatever bad hygienic habits exist. A rich woman may have settled down to a deënergizing life, with too much time in bed, too many matinées, too many late nights, too many bonbons, etc. Aside from the psychical injuries that such a life produces, it is bad for "the nerves" in its effects upon digestion, bodily tone, and the sources of mood. On some simple detail of life, some unfortunate habit, the whole structure of misery may rest.

I always keep in mind an incident of some years ago when I lived in a small town in Massachusetts. For some reason our furnace threw coal gas into the house in such a way as nearly to poison us. The landlord sent several plumbers down, and one after the other suggested drastic remedies, - a new chimney, a new furnace, etc. Finally the landlord and I investigated for ourselves. At the bottom of the chimney we found an inconspicuous loose brick which allowed air to enter the chimney beneath the entrance of the pipe from the stove. We got ten cents' worth of lime and fastened the brick in firmly. A complete cure, where the specialists had failed.

So there often exists some drain on the energy and strength of the woman which may be simple and easily changed, and yet is critical in its significance and importance.

An overdomestic woman may stick too closely to the house; an underdomestic one may go too often to movies and suffer the fatigue of mind and body that comes from over-indulgence in this most popular indoor sport. Carelessness about the eating and the care of the bowel functions may have started a vicious chain of things leading through irritability and fatigue into neurasthenia. We say human beings are all the same, but the range of individual susceptibility to trouble is such that a difficulty not important to most people will raise havoc with others who are in most ways perfectly normal.

Look then for the bad hygiene! Look for the evils of the sedentary life Look for the root of the trouble in lack of exercise, poor habits of eating, insufficient air, disturbed sleep! Search for physical difficulties before inquiring into the psychical life.

If poverty exists, then one may inquire into the amount of work done, the character of the home, the opportunities for recreation and recuperation. All or any of the factors I have mentioned in previous chapters may be critical, and the moil and turmoil of a crowded tenement home may be responsible. That such conditions do not break all women down does not prove that they do not break some women down, women with finer sensibilities, or lesser endurance (which often go together). The most depressing problems are met among the poor, the cases where one can see no way out because the social machinery is inadequate to care for its victims.

What is one to do when one meets a poor woman with three or four or more children, living in a crowded way, overworked, racked in her nerves by her fears, worries, and the disagreeable in her life, drudging from morning till night, yearning for better things, despairing of getting them, tormented by desires and ambitions that must be thwarted? "What right has a poor woman anyway to desires above her station, and why does not she resign herself to her lot?" ask the comfortable. Unfortunately philosophy and resignation are difficult even for philosophers and saints, and much more so for the aspiring woman. And our American civilization preaches "Strive, Strive!" too constantly for much philosophy and resignation of an effective kind to be found.

One must give tonics, prescribe rest, try to get social agencies interested, obtain vacations and convalescent care, etc. Can one purge a woman of futile longings and strivings, rid her of natural fears and even of absurd fears? It can be done to a limited degree, if the patient has intelligence and if one gives liberally of one's time and sympathy. But unfortunately the consulting room for the poor is in the crowded clinic, the thronged dispensary, and how is the overworked physician to give the time and energy necessary?

For the time required is the least requirement. To deal adequately with the neurasthenic is to have unending sympathy and patience and an energy that is limitless. Without such energy or endurance the physician either slumps to a prescriber of tonics and sedatives, a dispenser of such stale advice as "Don't worry" and "You need a rest", or else himself gives out.

In dealing with the cases in the better-to-do and the rich, one has more weapons in the armamentarium. The worry is more futile here, more ridiculous, and one can attack it vigorously. Usually it is not overwork in these cases; it is monotony, boredom, discontent with something or other, a vicious circle of depressing thoughts and emotions, some difficulty in the sex life, some reaction against the husband, a rebellion of a weak, futile kind against life, maladjustment of a temperament to a situation.

Some difficulties, even when ascertained and clearly understood, are insurmountable. "The truth shall make ye free" is true only in the very largest sense. Some temperaments are inborn, and are as unchangeable as the nose on one's face. In such cases the ordinary physical therapeutics help the acute symptoms that flare up now and then, and that is as much as one may expect.

Boston
Little, Brown, And Company
1920