Pain and Its Consequences : Part 3

Doctor and Patient
by S. Weir Mitchell, M.D.

(Page 6 of 9)

I am sure, too, that a part of it lies in the readiness with which many physicians give sedatives, and their failure to feel the vast moral responsibilities of their position. But, whatever be the cause or causes, it is well in the hour of ease to learn beforehand the risks which come of too easy and too frequent appeals to agents which benumb the nerves.

When people are first given opium, it is apt to be the friend of the night and the foe of the morrow. Repeated often enough, it loses power to constipate and distress. It still soothes pain. It still gives sleep. At last it seems to be in a measure a tonic for those who take it. But after a while it does some other things less agreeable. The mind and memory suffer, but far more surely the moral nature is altered. The woman becomes indifferent, her affections dull, her sense of duty hopelessly weakened. Watchful, cunning, suspicious, deceitful, - a thief, if need be, to get the valued opiate, - she stops at nothing. It would seem as if it were a drug which directly affected the conscience. At last, before this one craving, all ties in life are slight and bind her not. Insensible to shame and dead to affection, she is happy if the alcohol habit be not added to her disorder, for if she cannot get the one drug she longs for, the other will serve her at need.

There is a popular idea that opium gives pleasant dreams, and that it takes us away into the land of poetry, to which it is supposed to have conducted Coleridge and De Quincey. As a matter of fact, there are but few persons who get more out of opium than relief of pain, sense of comfort, and next day's remorses. The opium dream is not for all. I have known only four or five cases of habitual and distinct opium dreamers. There was more of Coleridge than of opium in "Kubla Khan," and more of De Quincey than of the juice of poppies in the "Vision of Sudden Death." When it came to the telling of these immortal dreams, we may well suspect that the narrative gained in the literary appeal from the poet opium-drunk to the poet sober.

It is, I fancy, well known to physicians that opium may act on an individual differently at different times. In the case of one well known to me it usually causes sleep, and no longer gives rise to nausea the next day, as it once did. Although it leaves him sufficiently wretched, and he has taken it but rarely, the drug occasionally keeps him wide awake and delightfully indifferent to the passage of time. The striking hours are heard, and that is all. There is none of the ennui of insomnia. This effect of morphia is rare with him. He may have taken morphia a dozen times in his life to ease acute pain, but only twice has it made him thus wakeful.

On these nights he saw an endless succession of visions, which he did not forget, as one does common dreams. Nearly all of the hallucinations were of the most amusing character, and were often long and connected series of ludicrous situations, over which he wondered, as he lay next day, a victim to the secondary miseries due to the soothing dose of the night before. This is one of the tricks which drugs play, and is not a thing to be anticipated. The drug is the same; the man varies, and with his variations arise peculiarities in the effects of remedies.

The excess sometimes attained in the use of opiates is almost past belief. I have seen a mere girl of seventeen years take at one dose thirty grains of morphia, and I know of a woman who took for years ninety grains a day, and ruined a weak husband, a man of small means, by the costliness of her habit.

The causes of the torment, which the cessation of the use of morphia brings about, are interesting. Agonizing pains show that the nerves, long muffled, have become more acutely sensitive than they were before the fatal drug was first employed. A host of lesser troubles - insomnia, pain, and indigestion - attend the cure. I know nothing more pitiful than such an ordeal, and, despite the most watchful care, I have seen it end more than once in suicide. When one has watched a woman from whom opium has been taken away, even with skilful tenderness, roll in agony on the floor, rend her garments, tear out her hair, or pass into a state of hysterical mania, the physician is made to feel that no suffering for which she took the drug can have been as bad as the results to which it leads.

The capacity to suffer, which comes on as we remove the poison, is almost inconceivable. It lasts long, and is the true difficulty in the way of forming anew habits of wholesome endurance. The physician who imagines that his case is well, because he has enabled an opium-taker to eat, sleep, and be comfortable without use of the sedative, can have seen little of the future of such people. The oversensitiveness to pain persists for months, and is a constant temptation. The moral and mental habits formed under opium - the irresolution, the recklessness, the want of shame, in a word, the general failure of all that is womanly - need something more than time to cure. But I am not preaching to the woman just set free from this bondage to sin, and speak of her only to emphasize the horror with which I would wish to inspire the well, who yet may come some day to be the suffering.

If there be one set of women more liable than another to become victims of morphia or chloral, it is the wives of physicians. Every winter I see four or five, and always it is true that the habit has arisen out of the effort of the husband to attend medically on his wife. Physicians make good husbands, and this is in part due to the fact that their knowledge of the difficulties of feminine life causes them to be more thoughtfully tender, and more charitable as concerns the effects upon women of certain inevitable conditions as to which the layman is ignorant or indifferent. But the very fulness of the husband's appreciation of a woman's drawbacks and little moral ailments, the outcome of her womanhood, becomes dangerous when he ventures to be her medical caretaker. What he coolly decides in another's case, he cannot in hers. How can he see her suffer and not give her of the abundance of relief in his hands? She is quick to know and to profit by this, and so the worst comes of it.

"It is easy for you to sit by in your strength and see me suffer," said a woman once to me. She was on the verge of the morphia habit, and I was trying to break it off abruptly. I felt, as any gentle-hearted man must feel, the sting and hurt of her words. Next day she said to me, "Of course you were right. I used to talk that way to B - - , and he never could stand it." He was her husband and a physician. She got well easily.

I do not believe that most women who sin in this way slip into it either quite so ignorantly and so unwarned as they would have you to suppose. Nearly always there is a time when some one - the physician, a friend, or their own reason - bids them pause, reflect, and choose.

"Alas I for thee, if thou from thine own soul dost turn and flee.
Better the house and company of pain;
Better distress;
Better the stones of strife, the bread with tears;
Humiliation and despair and fears;
All, all the heart can suffer, the soul know,
Rather than with the bestial train to go,
With base rejoicings, ignorant of woe."

About the Author

Silas Weir Mitchell was an American physician and writer. He studied at the University of Pennsylvania in that city, and received the degree of M.D. at Jefferson Medical College in 1850. During the Civil War he had charge of nervous injuries and maladies at Turners Lane Hospital, Philadelphia, and at the close of the war became a specialist in neurology.