Nervousness and Its Influence on Character : Part 1

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

(Page 6 of 13)

There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability.

So much has been written on this subject by myself and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to repeat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view.

The two questions referred to above are these: The woman who consults you says, "I am nervous. I did not use to be. What can I do to overcome it?" Once well again, she asks you, - and the query is common enough from the thoughtful, - "What can I do to keep my girls from being nervous?"

Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symptomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant? Remark also that this is not one of the feebler sisters who accept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and incapacities which now she feels.

She wants to be helped, and will help you to help her. You have an active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes power. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either mental or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily disturbed by a sad tale or a startling newspaper-paragraph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely.

She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her as it once did not. Her sense of moral proportion becomes impaired. Trifles grow large to her; the grasshopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble? What made her, as she says, good for nothing? I have, of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness, - a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness.

If she is at the worst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist.

Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly ballasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call "shock" is at times and in some people capable of inflicting very lasting evil in the way of nervousness.

We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote organs and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us; and which is in proportion disastrous if the person on whom it falls is by temperament excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleepless, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage.

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.