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In recent years the attention of physicians has been called to the
fact that many people are made profoundly miserable by an
unconquerable tendency to doubt about nearly everything that has
happened to them, or is happening, or is about to happen. This is not
a new phenomenon, but introspection has emphasized it, leisure gives
more opportunity for it, and so physicians hear more of it now than
they did in the past. This doubting tendency sometimes makes serious
inroads on the peace of mind of sufferers from it because they cannot
make up their minds to do things, even to take exercise, to eat as
they should in quantity or quality, and to share the ordinary
life around them sufficiently to get such diversion of mind as will
keep their physical functions normal. The state used to be described
as a neurasthenia (nervous weakness), but in recent years has come
better to be designated as in the class of psychasthenias (lack of
mental energy). It is always a mental trouble in the sense that it is
difficult for these patients to make up their minds about things, yet
it is not a mental disease in the ordinary sense of the term, and
these people are often eminently sane and thoroughly intellectual when
their attention has been once profoundly attracted. They may even,
under favorable circumstances, be active and useful helpers in great
causes, yet there is always to be observed in them a certain
noteworthy difference in mentality from the normal. The physician can
do more for an affection of this kind than is usually thought, and he
is probably the only one who can thoroughly appreciate and sympathize
and, therefore, be helpful in the condition.

Sufferers are often laughed at by their friends and relatives and are
likely to be the subjects of at least a little ridicule if they take
their troubles to their physician. As a matter of fact, however,
doubting is a typical case for psychotherapeutics and not only can
much be done for its relief, but it can be kept from disturbing the
general health, which it is prone to do if neglected, and by mental
discipline and acquired habits of self-control, the doubting habit may
be almost completely eradicated.

Exaggeration of Ordinary State of Mind.--The first thing absolutely
necessary to impress upon the minds of these victims of their own
doubts is that their condition is by no means unique, it is not even
very singular, but is only an exaggeration of that hesitancy and
tendency to put off making decisions that practically every person
finds in a lifelong experience. This frame of mind is rather
cultivated by education and by a large accumulation of knowledge. The
less one knows the easier it is to come to decisions about difficult
problems and to form conclusions without hesitancy. The young man will
decide anything under the sun, and a few other things besides, almost
without a moment's hesitation, and after but slight consideration.
Twenty years later he looks back and wonders how he did it, and having
done it, how he succeeded in turning the practical conclusions to
which he came to advantage. The scholar is eminently a doubter and a
hesitater, and we recognize that he loses certain of the qualities
that would make him a practical man of affairs, though he gains so
much more that broadens and deepens life's significance that there can
be no doubt about the value of his liberal education.

"Hamlet" is just the story of one of these doubters and hesitaters. He
saw his duty clearly and that duty was imperative. In spite of
cumulative evidence, however, he refused to go on to the performance
of that duty, urging to himself now one and now another reason of
delay, until finally he wonders whether it would not be worth the
while to take his own life, rather than try any longer to solve the
problems that lie around him demanding solution. When he finally does
something, his hand is forced and circumstances have so arranged
themselves that instead of one clean-cut punishment for a great crime,
there is the tragedy that involves six lives, including his own. The
play seems to involve such exceptional characters and to be written
around such an unusual set of circumstances that it might be thought
that it would prove uninteresting for men and women generally.
As a matter of fact, however, "Hamlet" is the most popular of
Shakespeare's plays and probably the most popular play, both for
readers and auditors, that was ever written. There are commentaries by
the hundred on it in nearly every modern language. Men have been more
interested in this figment of Shakespeare's imagination than in any
man that ever lived. Caesar and Napoleon have not attracted so much
attention. Only Homer and Dante have been perhaps more written about
than Hamlet.

Shakespeare has emphasized the condition of Hamlet by showing us an
eminently well educated man. His deep interest in literature, and
especially in dramatic literature and all that relates to the stage,
can be appreciated very readily from his speech to the players. No one
but a man of profound critical ability and deep intellectual interests
could have so summed up the actors' relation to the drama. Of course,
this is Shakespeare himself talking and unthinking people have said
that this was a purple patch fastened on the play because it gave the
author an opportunity to express his views with regard to actors and
their ways. Instead of that, it is of the very essence of the
development of Hamlet's character and shows us the scholarly amateur
who knows so much about many things that he has become quite unable to
make up his mind about the practical problems that lie before him.
James Russell Lowell says that Shakespeare sent Hamlet to Wittenberg,
though Wittenberg was not founded until centuries after Hamlet
existed--and Shakespeare probably knew that very well--because
Wittenberg in Shakespeare's time, on account of its connection with
Luther and the religious revolt in Germany, had the widespread repute
of occupying men's minds with doubts about many of the things that had
been deemed perfectly settled before, and its popular reputation
serves to give an added hint as to the character of Hamlet as the
dramatist saw it.

Once those who are perturbed by doubts learn that the reason for the
universal human interest in Hamlet is that there is a large capacity
for doubt of self in every man and woman, that we all put off making
decisions whenever possible, sometimes refuse to open letters when
they come if we fear that they will contain some disturbing news, put
off writing letters because we have to state ideas definitely,
apparently hope that the day and the night will bring us counsel and
that somehow the decision will be made for us without the trouble of
making up our minds, then they lose their sense of discouragement over
their condition and appreciate that they are suffering only from an
exaggeration, probably temporary and quite eradicable, of a state of
mind that comes to practically every human being.

This is the important thing, because on it can be founded the only
really hopeful therapy of the condition. Doubting is a habit that may
be increased by yielding to it, but that can be diminished to a very
great extent by constant discipline, which refuses to permit doubts
and hesitancy and bravely makes decisions, even though there may be
the feeling that they may prove to be wrong.

Extent of Affection.--If such discipline is not instituted, then the
lengths to which the doubting hesitant habit may go are almost
incredible. I have had patients tell me that they doubted about nearly
everything in the past. A very dear friend once confided to me that it
was always a source of bother to him that he was not quite sure
whether he was married or not. His marriage I knew had been a public
ceremonial, and he had led his bride down the aisle to the strains of
the "Wedding March" in quite conventional style, but he was hesitant
of speech, especially under excitement, and he was not sure that he
had ever said "I will" to the question of the clergyman, for there was
a constriction at his throat at the moment and he could utter no
sound. The absence of any audible sound from the groom is not so
unusual as to attract attention and, of course, his intention and his
bodily presence and everything else gave the assent without the
necessity for the word, but he could not get out of his mind the
thought that possibly he was not married and at times it gave him
poignant discomfort. He was a thoroughly intelligent man, a teacher
and a writer, with no abnormalities that attracted attention, and his
tendency to doubt was only known to very near friends who laughed at
it and had no idea at all of the annoyance that it often gave its
unfortunate victim.

I have a clergyman friend who has had some serious scruples with
regard to his ordination. He is a Catholic priest and at a certain
part of the ceremonial of ordination it is considered necessary for
the candidate for orders to touch at the same moment the paten, the
small metal plate on which the Host is placed, and the chalice. This
clergyman is not sure that he had done this simultaneously. As a rule,
great care is exercised in seeing that all the details of the
ordination ceremonies are carried out very exactly and as there are a
number of attendants on the altar whose duty it is to see that the
absolutely necessary details are properly fulfilled, it is quite
improbable that any mistake in this matter was made. The young
clergyman, however, had not made an act of conscious attention at the
moment when he was supposed to do this, and consequently he could not
be sure afterwards whether he had done it or not. He thought of it as
the very essence of his ordination and he feared that all his
subsequent acts as a clergyman might be impaired by this negligence.

Trivial Doubts.--It is not alone with regard to important things,
however, that people may doubt and are disturbed by doubts, but with
regard to every trivial thing in life, if they permit the habit to
grow on them. Doubting is, after all, one of the phobias, that is to
say, it is the fear that something may happen if the decision they
make is wrong, that causes people to hesitate so much. There is a
tendency in all of us which, if undisciplined, may make us put off the
doing of things until the last moment. It is easy to resolve the night
before that we will do certain things the next day, but when the next
day comes we find excuses to put them off. I have already suggested as
a symptom that some people put off the opening of letters. There are
probably more who do this than anyone has any idea of. Delay in
answering letters is probably much more often due to hesitancy of
decision than to actual laziness. We doubt as to what we should say
about certain things, and we do not care to take the trouble of making
up our minds, and we fear if we do make up our minds it may be wrong,
so we adjourn the whole matter to another time and keep on adjourning
it. Many people are quite ready to confess that they do not do things
until they have to, though few are ready to acknowledge that it is due
to hesitancy or doubting about themselves and their decisions.

Of course, the man who doubts whether he has locked the door of his
house after he gets to bed can only satisfy himself by getting up and
actually investigating the state of affairs. Then there is the man who
doubts whether he has locked his safe at the office. He may get his
doubts just as he reaches the foot of the elevator and then if he is
wise he will go back and determine the matter. If he is wise with
experience he will also deliberately determine while he is there
whether the office window is closed and locked and will make a
conscious act when he comes out as to the locking of the office door.
If he does not do all this he will have further doubts on the way up
town and at his home during the evening which will make the doing of
anything else a matter of discomfort and he will spoil the restfulness
of his after-dinner hours. Some men conquer their first doubt, make
their way home only to be beset by so many doubts that at the end of
an hour they go back to their office and determine whether the safe is
locked or not. Finding it locked they may forget to notice other
things about the office and then they will surely have doubts about
these, and they may have to go back again and see about them.

Then there is the man who doubts whether he posted a letter or if he
did post it, who doubts whether it found its way down to the bottom of
the mail box, or whether it may not have caught on a projecting screw
or bolt or some portion of the upper part of the box and so fail of
collection; he may go back several times to determine this. Doubts
about even more trivial matters than this, however, annoy some people.
I have known widows on whom the responsibility of managing the
financial affairs of the household had been thrown for the first time
after their husbands' death, who constantly doubted whether they could
afford to spend this or that, though they were regularly saving money
from their income. Over and over again they would have to go over all
their recent expenditures to decide whether they could afford certain
expenses. Such little things as the sort of paper to use in their
correspondence, the wages they paid their servants, the amount of
waste in the food in the household, all aroused in them doubts and set
them to calculating once more just what was the relation of their
income to expenditure, all to no purpose, for they would have the same
doubts the next week or month.

Then there are people who doubt whether their friends really think
anything of them. They think that though they treat them courteously
this may be only common politeness and they may really resent their
wasting their time when they call on them. They hesitate to ask these
people to do things for them, though over and over again the friends
may have shown their willingness and, above all, by asking favors of
them in turn, may have shown that they were quite willing to put
themselves under obligations. They doubt about their charities. They
wonder whether they may really not be doing more harm than good,
though they have investigated the cases or have had them investigated
and the object of their charity may have been proved to be quite
deserving. They hesitate about the acquisition of new friends, and
doubt whether they should give them any confidence and whether the
confidences that they have received from them are not really baits.
This is, of course, a verging on suspicion as well as hesitancy and
doubt, but the stories of how these people try to conquer themselves,
yet have to make decision after decision, each one requiring time and
a certain resolution of mind, are quite pitiable. It gets worse
rather than better unless a definite discipline of opposition and
control is organized.

What ordinary people do habitually and easily and without any effort
of mind, these people must waste time and mental energy over so that
it is extremely difficult for them to accomplish anything. Training of
mind, as of hand, consists in making certain actions so habitual that
they are accomplished quite automatically. If we have decided that we
are to get up at a certain hour we get up at that hour and do not have
to make up our minds about it again, though this is one of the actions
in which we all have the most lapses and the most need of renewal of
resolution and habit. We make up our mind what we are going to eat and
gradually acquire the habit of eating a certain quantity and a certain
variety at meals and then we do not have to make up our minds about it
every time. We go out, to do whatever must be done in our occupation
quite automatically and there is no need of wasting mental energy over
decisions about it. It is this that the doubter cannot do. He or she
calls every trifling act before the supreme court of last decision,
the bar of intellect, to decide whether it is worth while doing,
whether it is to be done or not, how it is to be done, and then there
is a doubt whether after it is done it may not prove to be quite the
wrong thing to have done. This adds so much to the friction of life
that all the surplus energy is used up in the settling of trivial
matters, and nothing worth while is accomplished.

Sir James Paget once expressed all the realities of the situation of
many of these people in a few terse phrases. It is probably the best
explanation of its kind that we have and it deserves to be in the
notebook and often before the mind of physicians who treat neurotic
patients. Sir James said: "The patient says 'She cannot'; her friends
say 'She will not'; the truth is she cannot will."

The expression, of course, applies to many other phases of so-called
nervous disease besides doubting and especially to the psychasthenias.
It represents, indeed, the keynote of many of these puzzling
affections. The fact that it was uttered more than half a century ago
shows how much better these affections were understood two generations
before ours than we are likely to think, and how well physicians then
got to the heart of them. From this to the re-education of will, that
mental discipline and relearning of self-control which constitutes the
essence of the treatment of them, is but a short step.

Prophylaxis.--Serious Occupation.--Of course, the real way out of
the trouble is to have to do certain important things that occupy the
mind and require the doing of many other things as subsidiaries which
must be accomplished in order to carry out the greater resolution. Men
who have important affairs on their hands seldom are bothered by
doubts and hesitancy. Women who have not much to do make mountains out
of the molehills of their little occupations and every trifle must be
adjudged. The larger interests must be cultivated, the smaller ones
must be turned over to the automaton which every one of us can develop
in our persons if we only set about it resolutely. Each thing that
comes up must be settled at once and action must replace
contemplation. The Hamlet in us all must be put down and resolution
must not be allowed to be sicklied over with the pale cast of thought.
We must do things and not think about them too much. The
doubters can learn this lesson. They will never be entirely without
hesitancy, but they can remove many of their difficulties, and live to
accomplish much in spite of their make-up.

Physical Treatment.--The physical treatment of the doubting state
consists, of course, in bringing the individual's physical condition
as near as possible up to the normal. When the state occurs in people
who are under weight its betterment is rather easy. The special
feature of the physical condition that needs seeing to is an ample
supply of fresh air. People who live in ill-ventilated places, or who
do not get out into the air enough, are almost sure to suffer from the
tendency to avoid the making of decisions. The man of decision usually
is a vigorous outdoor-air individual. Even the perfectly healthy man
who has been in the house for some reason for days together gets into
a state of mind where the making of decisions becomes objectionable.
He wants to push things away from him. In individuals who already have
a natural tendency this way this is greatly exaggerated by
confinement. Arrangements must be made, therefore, that will ensure
getting out for some time, not once but twice every day. The regular
making of decisions for this purpose is of itself a good mental
discipline. It must not be omitted even for rain or snow, unless there
are additional reasons of some kind. An abundance of fresh air in the
sleeping-room is extremely important and must be secured.

Mental Treatment.--The mental treatment consists in diversion of mind.
Usually the doubters have no interests that appeal to them deeply and
in which they have to make prompt regular decisions. If possible,
these must be secured. They must form habits of doing things regularly
and of making up their minds to do them, and then not have to repeat
the adjudication and resolution. In recent years people realize, quite
apart from its religious significance, the value of what older
religious writers called examination of conscience. Regularly before
they go to sleep these people must be told to call up what they have
done during the day and to note their faults in the matter of putting
off doing things and making decisions slowly. They must, however, not
only realize their faults, but they must make up their mind to correct
them during the following day. They must not leave the arrangement of
what they shall do next day to chance, but must decide just how and
when they shall do things and then, as far as possible, keep to this
program. The program must, of course, be sensible and considerate.
This preliminary arrangement can be made to mean much more than might
be thought. Some people thus learn to correct entirely their tendency
to doubt whether they should do things or not and lessen greatly the
difficulties they have in making decisions.

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