Our Nerves

12. Chapter XII

In which handicaps are dropped

A WOMAN'S ILLS

"THE FEMALE OF THE SPECIES"

If ever there was a man who wished himself a woman, he has hidden away the desire within the recesses of his own heart. But one does not have to wait long to hear a member of the female sex exclaim with evident emotion, "Oh, dear, I wish I had been born a man!" It is probable that if these same women were given the chance to transform themselves overnight, they would hesitate long when it actually came to the point. The joys of being a woman are real joys. However, in too many cases these joys seem hardly to compensate for the discomforts of the feminine organism. It is the body that drags. Painful menstrual periods, the dreaded "change of life," various "female troubles" with a number of pregnancies scattered along between, make some of the daughters of Eve feel that they spend a good deal of their lives paying a penalty merely for being women. Brought up to believe themselves heirs to a curse laid on the first woman, they accept their discomforts with resignation and try to make the best of a bad business.

"Since the War." Nothing is quite the same since the war. Among other things we have learned that many of our so-called handicaps were nothing but illusions,--base libels on the female body. Under the stern necessity of war the women of the world discovered that they could stand up under jobs which have until now been considered quite beyond their powers. Society girls, who were used to coddling themselves, found a new joy in hard and continuous work; middle-aged women, who were supposed to be at the time of life when little could be expected of them, quite forgot themselves in service. Ambulance drivers, nurses, welfare workers, farmerettes, Red-Cross workers, street-car conductors and "bell-boys," revealed to themselves and to the world unsuspected powers of endurance in a woman's body. Although some of the heavier occupations still seem to be "man's work," better fitted for a man's sturdier body, we know now that many of these disabilities were merely a matter of tradition and of faulty training.

There still remains, however, a goodly number of women who are continuously or periodically below par because of some form of feminine disability. Some of these women are suffering from real physical handicaps, but many of them need to be told that they are disabled not by reason of being women but by reason of being nervous women.

"Nerves" Again. Despite the organic disturbances which may beset the reproductive organs, and despite the havoc wrought by venereal diseases, it may be said with absolute assurance that the majority of feminine ills are the result neither of the natural frailty of the female body, nor even of man's infringement of the social law, but are the direct result of false suggestion and of false attitudes toward the facts of the reproductive life. The trouble is less a difficulty with the reproductive organs than a difficulty with the reproductive instinct. "Something wrong" with the instinct is translated by the subconscious mind into "something wrong" with the related generative organs, and converted into a physical pain.

That this relation has always been dimly felt is shown by the fact that the early Greeks called nervous disorders hysteria, from the Greek word for womb. It is only lately, however, that the blame has been put in the right place and the trouble traced to the instinct rather than to the organs of reproduction.

Why Women Are Nervous. Although women hold no monopoly, it must be conceded that they are particularly prone to "nerves." The reason is not hard to find. Since the leading factor in a neurosis is a disturbance of the insistent instinct of reproduction, a disturbance usually based on repression, then any class of persons in whom the instinct is particularly repressed would, in the very nature of the case, be particularly liable to nervousness.

No one who thoroughly knows human nature would attempt to deny that woman is as strongly endowed as man with the great urge toward the perpetuation of the race, or that she has had to repress the instinct more severely than has man. The man insists on knowing that the children he provides for are his own children. Whatever the degree of his own fidelity, he must be sure that his wife is true to him. Thus has grown up the insistence that, no matter what man does, woman, if she is to be counted respectable, shall control the urge of the instinct and live up to the requirements of continence set for her by society.

Unfortunately, however, there is more often blind repression than rational control. The measures taken to prevent a girl's becoming a tom-boy are measures of sex-repression quite as much as of sex-differentiation. Over-reaction of sensitive little souls to lessons in modesty often causes distortion of normal sex-development. Ignorance concerning the phenomena of life is commended as innocence, while it really implies a sex-curiosity which has been too severely repressed. The young woman blushes at thoughts of love, while the young man is filled with a sense of dignity. We smile at the picture of "Miss Philura's" confusion as she hesitatingly sends up to her Creator a petition for the much-desired boon of a husband. But really, why shouldn't she want one? Many a young woman, in order to deaden her senses to the unsuspected lure of the reproductive instinct by what is really an awkward attempt at sublimation, makes a fetish of dress and social position and considers only the marriage of convenience; or, on the other hand, she scorns men altogether and throws herself into a "career."

Young men are not so often taught to repress, but neither are they taught to swing their vital energies into altruistic channels through sublimation. Since the woman of his class will not marry him until he has money, the young man too often satisfies his undirected instincts in a commercial way. The statistics of venereal diseases prove that here, as elsewhere, goods subject to barter are subject to contamination. In a late marriage, too often a contaminated body accompanies the material possessions which the standards of society have demanded of a husband.

But the woman pays in still other coin for the repressions arising from faulty childhood training. Unable to find expression for herself either in marriage or in devotion to work, because some old childish repression is still denying all outlet to her legitimate desire, she frequently falls into a neurosis; or if she escapes a real breakdown, she gives expression to unsatisfied longings in some isolated nervous symptoms which in many cases center about the organs of generation. There then results any one of the various functional disturbances which are only too often mistaken for organic disease. What is needed in cases like this is not a gynecologist nor a surgeon, but a psycho-pathologist--or perhaps only a grasp of the facts. Let us look at the more common of these disturbances in order to gain an understanding of the situation.

THE MENSTRUAL PERIOD

Potential Motherhood. Among the normal phenomena of a woman's life is the recurring cycle of potential motherhood. Every three or four weeks a new ovum or egg matures in the ovary and undergoes certain chemical changes, which send into the blood a substance called a hormone. This hormone is a messenger, stimulating the mucous membrane of the womb into making its velvet pile longer and softer, and its nutrient juices more abundant in readiness for the ovum.

The same stimulus causes the whole organism to make ready for a new life. As in hunger, the chemistry of the body produces the muscle-tension that is felt as a craving for food, so this recurring chemical stimulus produces a definite craving in body and mind. This craving brings about an increased irritability or sensitiveness to stimuli which may result either in a joyous or a fretful mood.

During sleep the social inhibitions are felt less distinctly and the sleeper dreams love-dreams woven from messages coming up from all the minute nerve-endings in the expectant reproductive organs. But if no germ-cell travels up the womb-canal and tube to meet and impregnate the ovum, the womb-lining rejects the egg as chemically unfit. All the furbishings are loosened from the walls and slowly cast out, constituting the menstrual flow. The phenomenon as a whole is a physiological function and should be accompanied by a sense of well-being and comfort as is the exercise of any other function, such as digestion or muscular activity. Only too often, however, it is dreaded as an unmitigated disaster, a time for giving up work or fun and going to bed with a hot-water bottle until "the worst is over." Let us see how this perversion comes about.

Why Menstruation Is Painful. What sort of atmosphere is created for the young girl as she attains puberty? Most girls get their first inkling of the menstrual period from the periodic "sick spells" of mother or sister. This knowledge comes without conscious thought and is a direct observation of the subconscious mind, which records impressions with the accuracy and completeness of a photographic plate. Hearing the talk about a "sick-time" and observing the signs of "cramps" among older friends, the young girl's subconscious mind plays up to the suggestion and recoils with fear from the newly experienced sensations in the maturing organs of reproduction.

This recoil of fear interferes with the circulation in the functioning organs, just as fear blanches the face or hinders digestion. There is several times as much blood in the stomach when it is full of food as there is between meals, but we do not for this reason fancy that we have a pain after each meal. There is more blood in the generative organs during their functioning, but this means pain only when fear ties up the circulation and causes undue congestion. Fear acts further on the sturdy muscle of the womb, tying it up into just such knots as we feel in the esophagus when we say that we have a lump in the throat. It is safe to say that ninety-five cases of painful menstruation out of every hundred are caused by fear and by the expectation of pain. The cysts and tumors responsible for pain are so rare as to be fairly negligible, when compared with these other causes.

Dr. Clelia Duel Mosher of Stanford University has for many years carried on careful investigations among the students of the university. After describing in detail certain physical exercises which she has found of value, she continues:

But more important even than this is an alteration of the morbid attitude of women themselves toward this function; and almost equally essential is a fundamental change in the habit of mind on our part as physicians; for do we not tend to translate too much, the whole of a woman's life into terms of menstruation? If every young girl were taught that menstruation is not normally a "bad time" and that pain or incapacity at that period is as discreditable and unnecessary as bad breath due to decaying teeth, we might almost look for a revolution in the physical life of women.... In my experience the traditional treatment of rest in bed, directing the attention solely to the sex-zone of the body, and the accepted theory that it is an inevitable illness while at the same time the mind is without occupation, produces a morbid attitude and favors the development and exaggeration of whatever symptoms there may be.[56]

[Footnote 56: Clelia Duel Mosher: Health and the Woman Movement, pp. 25, 26, 19.]

Pre-Menstrual Discomfort. If it be objected that women often feel badly for a day or two before the period begins, before they know that it is due, and that this feeling of discomfort could not be caused by fear and expectation, it is easy to reply that the subconscious mind knows perfectly what is happening within the body. The emotion of fear, working within the subconscious, is able to translate all the varying bodily sensations into feelings of distress without any knowledge on the part of the conscious mind.

Sometimes before the period begins, a girl feels blue and upset for a day or two, a sign that the instinct is getting discouraged. The whole body is saying, "Get ready, get ready," but it has gotten ready many times before, and to no purpose. Unsatisfied striving brings discouragement. What reaches consciousness is a feeling of pessimism and a general dissatisfaction with life as a whole. If, instead of giving in to the blues or going to bed and predicting a pain, the girl finds other outlets for her energy, she finds that after all, her instinct may be satisfied in indirect ways and that she has strangely come into a new supply of vim.

The Purpose of the Pain. Although suggestion is behind all nervous symptoms, there is a deeper reason for the disturbance. When an unhealthy suggestion is seized and acted upon, it is because some unsatisfied part of the personality sees in it a chance for accomplishing its own ends. The pre-menstrual period is the blooming-time, the mating-time, the springtime of the organism. That means eminently a time for coming into notice, that one's charms may attract the desired complement. But if the rightfully insistent instinctive desires are held in check by unnatural repressions and misapplied social restrictions, the starved instinct can obtain expression only by a concealment of purpose. The disguise assumed is often one of indifference or positive distaste for the allurements of the other sex. But, as we know, an instinctive desire will not be denied. In this case, the misguided instinct which has been given the suggestion that menstruation means illness, fits this conception into the scheme of things and obtains notice in a roundabout way by the attention given to the invalid.

The Treatment. To find that the symptom has a purpose rather than a cause gives the indication for the treatment. Judicious neglect causes the symptom to cease by defeating its very purpose,--that of drawing attention to itself. The person who never mentions her discomfort, thinks about it as little as possible, and goes about her business as usual, is likely to find her trouble gone before she realizes it.[57]

[Footnote 57: Violent exercise at this time is unwise, but continuing one's usual activity helps the circulation and keeps the mind from centering on the affected part. The physiological congestion is unduly intensified by standing; therefore all employments should afford facilities for the woman to sit at least part of the time while continuing work.]

A little explanation gives the patient insight into the workings of her own mind, and usually causes the pain to disappear in short order. Astonished, indeed, and filled with gratitude have been some of my young-women patients who had all their lives been unable to plan any work or social engagements for the time of this functioning. Many of them were the worst kind of doubters when they were told that to go to bed and center their attention on the generative organs only made the muscles tighten up and the circulation congest. They could not conceive themselves up and around, pursuing their normal life during such a time. However, as they have found by experience that this point of view is not an optimistic dream, they have broken up the confidence-game which their subconscious had been playing on them, and have gone on their way rejoicing.

There was one young girl, a doctor's daughter, who suffered continuously from pain in the abdomen, and from back-pain which increased so greatly at the time of the menses that she was in the habit of going to bed for several days, to be waited on with solicitous care by her family. In an attempt to cure the trouble she had undergone an operation to suspend the uterus, but the pain had continued as before. When she came to me, I explained to her that there was no physical difficulty and that her trouble was wholly nervous. I made her play tennis every day and she had just finished a game when her period came on. She stayed up for luncheon, went for a walk in the afternoon, ate her dinner with the family, and behaved like other people. Her mother telephoned that evening and when I told her what her daughter had been doing, she gasped in astonishment. She had difficulty in believing that the new order was not miracle but simply the working out of natural law. Since that time her daughter has had no more trouble.

The Ounce of Prevention. If young girls had wiser counselors in their mothers and physicians, the misconception would never occur, and such an indirect outlet would not be needed; the organic sensations incident to puberty and the recurring menstrual period would have something of the significance of the annunciation to Mary, bringing wonder and a sense of well-being.

When your little daughter arrives at maturity, give her a joyous initiation into the noble order of women. She will welcome the new function as a badge of womanhood and as a harbinger of wonderful things to come.

A girl of fifteen came under my care to be helped out of a mood of increasing depression and uneasiness. Her glance was furtive, yet anxiously expectant. Tears came unbidden as she sat alone or fingered the keys of the piano. Tactful questioning elicited no response as to reasons for her unhappiness. Opportunities for giving confidence were not accepted. At a chance moment our talk drifted to the subject of menstruation. "Your periods are regular and easy; and do you know what they are for?" Then I painted for her a picture of the preparations that are made throughout the whole organism, for the germ-cell that comes each month and has in it all the possibilities of a new little life.

The result of this confidential talk may seem fanciful to any one but an eye-witness. We had only a week's association, but the depression ceased, the furtive look and deprecatory manner were replaced by a joyous buoyancy. In a few weeks the thin neck and awkward body rounded out into the symmetry which usually precedes the establishment of puberty, but which was delayed in this case until the unconscious conflict resolved itself.

In the Large. Looked at from any angle, this subject is an important one. There are involved not only the physical comfort and convenience of the sufferers themselves, but also the economic prospects of women as a whole. If women are to demand equal opportunity and equal pay, they must be able to do equal work without periodic times of illness. When employers of women tell us that they regularly have to hire extra help because some of their workers lose time each month, we realize how great is the aggregate of economic waste, a waste which would assuredly be justified if the health of the country's womanhood were really involved, but which is inefficient and unnecessary when caused merely by ignorant tradition. "Up to standard every day of every week," is a slogan quite within the range of possibility for all but the seriously ill. When reduced to their lowest terms, the inconveniences of this function are not great and are not too dear a price to pay for the possibilities of motherhood.

THE "CHANGE OF LIFE"

Another Phantom Peril. As the young girl is taught to fear the menstrual period, so the older woman is taught to dread the time when the periods shall cease. Despite the general enlightenment of this day and age, the menopause or "change of life" is all too frequently feared as a "critical period" in a woman's life, a time of distressing physical sensations and even of danger to mental balance.

As a matter of fact, the menopause is a physiological process which should be accomplished with as little mental and physical disturbance as accompanies the establishment of puberty. The same internal secretion is concerned in both. When the function of ovulation ceases the body has to find a new way to dispose of the internal secretion of the ovary. Its presence in the blood is the cause of the sudden dilatation of the blood-vessels that is known as the "hot flash."

The matter is altogether a problem of chemistry, with the necessity for a new adjustment among the glands of internal secretion. The body easily manages this if left to itself, but is greatly interfered with by the wrong suggestion and emotion. We have already seen how quickly emotion affects all secretions and how easily the adrenal and thyroid glands are influenced by fear. This is the root of the trouble in many cases of difficult "change." If an occasional body is not quite able to regulate the chemical readjustment, we may have to administer the glands of some other animal, but in the majority of cases, the body, unhampered by an extra burden of fear, is quite able to make its own adjustments. The hot flash passes in a moment, if not prolonged by emotion or if not converted into a habit by attention.

One source of trouble in the menopause is that it comes at a time in a woman's life when she is likely to have too much leisure. In no way can a woman so easily handicap her body at this time as by stopping work and being afraid. Those women who have to go on as usual find themselves past the change almost before they know it,--unless they consider themselves abused, and worry over the necessity for working through such a "critical time."

Three Rules. Here are a few pointers which have have been of help to a number of women:

1 Remember that this is a physiological process and therefore abundantly safeguarded by Nature. If you don't expect trouble you will not be likely to find it.

2 Remember that the sweating and flushing are made worse by notice.

3 Do everything in your power to keep from the public the knowledge that you are no longer a potential mother. If you are past forty, do not mop your face or gasp for breath or carry a fan to the theater! Shun attention and fear, and you will be surprised at the ease with which the "change" is effected.

Nature's Last Chance. While we are on the subject of the middle-aged woman, it may be well to mention a phenomenon sometimes noticed in the early forties. Often an "old maid" who has considered herself settled for life in her bachelor estate, suddenly takes to herself a husband. (I use the verb advisedly!) Mothers who have thought their child-bearing days long past sometimes find themselves pregnant. "The child of her old age" is not an uncommon occurrence. Unmarried women who have "kept straight" all their lives sometimes go down before temptation at this late time. There is a reason. It is as though Nature were making a last desperate attempt to produce another life before it is too late, speeding up all the internal secretions and flashing insistent messages throughout the whole organism.

It may help some woman who feels herself inexplicably impelled toward the male sex to know that she is not being "tempted by the devil" but merely driven by the insistent chemicals within her body. She is likely to rationalize and tell herself that it is too bad for a worth-while person like herself to leave no progeny behind her; or she may say, as one of my patients did when contemplating running away with another woman's husband,--that she could make that man so much happier than his wife did, and that she really owed it to him as well as to herself. When a woman knows what is the matter with her, it makes it easier to bide her time and wait for the demands of Nature to subside. Chemicals may not be so romantic as love, but neither are they so melodramatic!

OTHER TROUBLES

"Speaking of Operations." Physicians are often called upon to diagnose some such vague symptom as pain in the abdomen, back and head; ache in the legs; constipation, or loss of appetite. Since the patient is very insistent that something shall be done, the physician may be driven to operate, even when he has an uneasy feeling that the trouble is "merely nervous." Sixty per cent. of the operations on women are necessitated by the results of gonorrheal infection. Next in frequency up to recent date, have been operations for nervous symptoms which could in no way be reached by the knife. Only too often a nerve-specialist hears the tale of an operation which was supposed to cure a certain pain but which left it worse rather than better. It is a pleasure to see some of these pains disappear under a little re-education, but one cannot help wishing that the re-education had come before the knife instead of after it.

A skilled surgeon can cut almost anything out of a person's body, but he cannot cut out an instinct. It sometimes takes great skill to determine whether the trouble is an organic affection or a functional disturbance caused by the misdirected instinct of reproduction. Often, however, the clinical pictures are so different as to leave no room for doubt, provided the diagnostician has his eyes open and is not over-persuaded by the importunity of the poor neurotic, who insists that the surgeon shall remove her appendix, her gall-bladder, her genital organs, and her tonsils, and who finally comes back that he may have a whack at the operation scar.

The Bearing of Children. A number of years ago I became acquainted with a charming young married woman who had all her life recoiled with fear from the phenomena of sex. She had been afraid of menstruation and of marriage, and had at this time almost a phobia for pregnancy and childbirth. Before long she came to me in terror, telling me that she had become pregnant. I explained to her that pregnancy is the time when most women are at their best, that the nausea which is often troublesome in the beginning is caused merely by a mixing of messages from the autonomic nerves, which refer new sensations in the womb to the more usual center of activity in the stomach; and that after the body has become accustomed to these sensations, most women experience a greater sense of well-being and peace than at any other time in life. We had a conversation or two on the subject and everything seemed to go well for a while.

As it happened, this young woman and her husband came to call on me one afternoon just before the baby was expected. During the visit she began to show signs of being in labor. Again she was in terror. Again I explained the phenomena of labor, telling her that the womb-contractions are caused by the presence in the blood of a chemical secretion (hormone) which continues its good work as long as there is a state of confidence, but which sometimes stops under fear or apprehension. I explained that these womb-efforts are a peristaltic movement, a contraction of the upper muscles and a letting go of the purse-string muscle at the mouth of the womb, and that fear only tends to tie up this purse-string muscle, making a difficult process out of one which was intended by Nature to be much more simple. She seemed to understand and to lose a good deal of her fright.

About six o'clock the couple went home on the street car from the upper end of Pasadena to the far end of Los Angeles. The next morning I had a jubilant telephone message from the happy father, announcing that the boy-baby had arrived at midnight and that, wonderful to relate, he had come without the mother's experiencing any pain whatever.

I give this account for what it is worth, without of course contending that labor could always be as easy as this. It happened that this girl was a normal, healthy woman and that there were no complications of any kind in the process of childbirth. A right attitude of mind could not have corrected any physical difficulty, but it did seem to help her let go of her fear, which would of itself have caused long and painful labor.

A patient once told me that when her first baby came, she happened to be out in the country where she had to call in a doctor whom she did not know. He was an uncouth sort of fellow who inspired fear rather than confidence. She soon found that labor stopped whenever he came into the room, and started again when he went out. She had the good sense to send him out and complete her labor with only the help of her mother. Unfortunate is the obstetrician who does not know how to inspire a feeling of confidence in his patients. Even childbirth may be mightily helped or hindered by the mother's state of mind.

SUMMARY

A woman's body has more stability than she knows. It is sometimes out of order, but it is more often misunderstood; usually it is an unobtrusive and satisfactory instrument, quite fit for its daily tasks. The average woman is really well put together. We hear about the ones who have difficulty, but not about the great majority who do not. We notice the few who are upset during the menopause, and forget all the others. To be comfortable and efficient most of the time is, after all, merely to be "like folks."

The special functions which Nature has been perfecting in a woman's body are as a rule, easily carried through unless complicated by false ideas or by fear.

If the woman who has no organic difficulty but who still finds herself handicapped by her body, will cease being either resigned to her languishing lot or envious of her stalwart brothers; if instead she will set out to learn how to be efficient as a woman, she will find that many of her ills are not the blunders of an inefficient Creator, but are home-made products, which quickly vanish in the light of understanding.