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Mental Healing In Gynecology





All physicians are convinced of the good that has been done by the
extension of the application of surgery to women's diseases during the
pest generation. On the other hand, there are probably very few,
except the ultra-specialists, who are not quite sure that there has
been too much surgery in gynecology, and that many a woman has been
operated on without sufficient reason and without definite
indications. In suitable cases surgery is sometimes life-saving and is
often the only means of relief for suffering that is seriously
disturbing the general conditions and is making life unbearable. Its
very possibilities of good, however, have led to abuses. From the
abuse of a thing, the old Latins used to say, no argument against its
proper use can be derived, and this is eminently true of gynecological
surgery. It will not belittle the great benefit that operative work
has been to state how much of auxiliary good may be accomplished by
the use of psychotherapy in gynecology.

Many a woman who is operated on is benefited only for the time being,
and her old symptoms return after a time. Dr. Goodell, one of our
first great gynecologists, used to warn his students insistently that
women had many organs outside of the pelvis. The individuality in
gynecology is extremely important. Some women suffer what they
describe as excruciating pain or unbearable torture from pathological
conditions that other women do not notice at all. Very often these
women either have no real interest in life and are so self-centered
that they emphasize their feelings by dwelling on them, or else their
attention has been attracted to some sensation not necessarily
pathologic and then by concentration of mind on it they so disturb
vasomotor conditions and the nutrition of nerves that the condition
does become a veritable torture and apparently demands surgical
intervention. It is possible to cause a hyperemia in the skin by
thinking about certain portions of it, and the genital organs are
particularly prone to be influenced by mental states. If for any
reason a woman gets her mind on her genital tract and becomes
persuaded that there is a pathological condition in it, symptoms will
develop until an operation seems inevitable. But the operation will
bring relief only for a while, and then her mind will find something
else to dwell on and produce similar symptoms.



Place of Psychotherapy.--To fail to try to sway the mind by all the
methods and auxiliaries outlined in the earlier chapters of this work
before suggesting an operation to a woman is to neglect a most
important means for relief in many gynecological cases. There is
scarcely any pathological condition from which women may suffer that
does not become worse as the result of the depressing influence of
much thinking about it, and that is not made better by a change in
their mind that makes them realize the possibility of being well
again. The most important preliminary to operation is the promise of
complete relief through surgery. The acme of suggestion is reached in
the preparation for operation with its constant encouragement and then
the congratulations after the operation. Then come the weeks of
convalescence during which the same strong suggestion is constantly at
work making the patient sure that she must be better. All this serves
to add tone to the system, invigorates the appetite and puts patients
in the best possible mental attitude to bring about a favorable
result. Indeed, the ten or fifteen pounds in weight that such patients
gain during their convalescence, especially when they have been under
weight before, is often the most beneficial result of their hospital
experience.

If the same patients had been given the same promise that they would
surely be cured, and then had been removed from depressing home
influences and bothersome trials and labors, and been told that what
they needed for complete recovery was to gain in weight; if they had
then been visited by friends who congratulated them on the fact that
now at least they were going to be better and their symptoms were
going to disappear, and if they had gained the fifteen pounds that
came in convalescence after their operation, most of them would have
recovered quite as completely as by the operation from many of their
vague gynecological difficulties. This is, of course, true only of
cases where there are not very definite indications for surgical
intervention. But in a certain number the symptoms are so vague that
operation is decided upon rather with the hope than the assurance of
benefit; and it is particularly in these that psychotherapy is useful
and must be given a thorough trial.


Pain Relief .--It is often set down as a maxim of gynecologic
practice, that pain which cannot be relieved except by recourse to
dangerous or habit-forming drugs is an indication for operation. Pain,
however, is a relative matter and, as we have shown in the chapter on
Pain, its intensity depends not a little on the patient's attitude of
mind towards it. When there is discouragement and depression, pain
becomes insufferable, and what was borne quite well at the beginning
may now prove intolerable. Whenever occupation of mind can be secured,
however, pain is diminished in intensity.


Reputed Remedies and Suggestion.--Probably the most striking indirect
testimony to the value of mental influence and especially of
frequently repeated suggestion in gynecology is found in the recent
history of various much-advertised remedies that have been sold in
enormous quantities for all the ills of women. The composition of
these remedies is not, as is popularly supposed, a great mystery. They
have all been analyzed and their ingredients are well known. As a
rule, they contain only simple tonic drugs that have absolutely no
specific effect on the genital organs, but that are stimulating to the
general system. There has been much surprise at the definite evidence
furnished by expert investigators, that the principal ingredient
in most of them--certainly their most active element--is the alcohol
they contain, which, until the passage of the pure food and drug law,
was in such considerable quantities that practically each
tablespoonful of these favorite remedies for women was equal to half
an ounce of whisky. No wonder that this gave an immediate sense of
well-being which rose in most of those unused to alcohol to a feeling
of exaltation. The patient was sure beyond contradiction that she
could feel the effects of the medicine! Of the after effects, the less
said the better, but there is no doubt that many women acquired the
alcohol habit through indulgence in these nostrums.

Illusory as was this sense of well-being, it sufficed in many cases to
relieve women of discomfort that had become so serious, to their minds
at least, that they feared an operation would be necessary.
Undoubtedly many of the testimonials given to such remedies are
founded on actual experiences of this kind in which patients were sure
that they were cured of serious ills. Where alcohol is not the chief
ingredient of these remedies, some other tonic stimulant is employed,
and it has proved sufficient to make the patients feel, or at least
suggest to themselves, that they must be better. This has given them
courage to take more exercise and get more out into the air, and
consequently relieves them of many physical symptoms that had
developed because they thought they were the subjects of some serious
ailment and must be solicitously careful of their health. The idea of
care for the health in many persons' minds seems to be to do as little
as possible of external, useful work and to occupy themselves
principally with their internal concerns. They stay in the house too
much and in so doing disturb nearly every physical function. Perfectly
well people, if confined with nothing to interest them, become
short-circuited on themselves and develop all sorts of symptoms,
physical and mental.


The Mind as a Factor in Gynecological Affections.--A gynecologic
incident of any kind may become to many women such a center of
attention that it is impossible for them to distract their minds from
it, and every symptom or feeling that can by any stretch of thought be
connected with the genital system becomes greatly exaggerated. Young
women, whose menstruation has been perfectly regular, may have it
disturbed by fright, grief, a change of environment, getting the feet
wet, or something of that kind. At immediately succeeding periods
their fear of bad effects will of itself influence unfavorably the
conditions in their genital system. They have always had more or less
discomfort, but now this discomfort becomes difficult to bear because
of the fear that there may be further serious consequences of the
disturbing incident in their menstrual life. It occupies all their
attention; instead of deliberately trying to disregard it, they fear
that, if they should do so, they would be allowing some progressive
condition to gain a hold on them which would lead to serious results.

One is apt to see this condition in young married women who have had a
miscarriage in their first pregnancy and who fear that there will be
serious results from it. If they have been much disturbed by the
miscarriage, they may lose in weight, and then a number of subjective
symptoms in their genital life will appear. Though their menstruation
appears regularly, lasts the usual time, and is neither more scanty
nor more profuse than before, and though their physical
conditions are normal as ever, they suffer from bearing down pains and
feelings and backache just before menstruation begins; their ovarian
regions become sensitive and, if they are constipated, their right
ovarian region is likely to become tender, and they develop a set of
symptoms that seems to call for surgical interference. If, however,
they are put in conditions where they have some other occupation
besides themselves and their ills, it is surprising how the case will
clear up. They gain in weight, their subjective symptoms disappear and
especially they lose the persuasion, so common among them, that any
betterment of their symptoms is due to their getting used to the
pathological condition present and not to any real improvement of it.


Treatment.--In the treatment of gynecological conditions such as are
not necessarily indications for operation, the most important
consideration is to reassure the patient's mind and secure the
discipline of self-control. If patients are under weight this
condition must be corrected. If they are in an unfortunate environment
it must be modified, as far as possible. If they are without
occupation this must be provided for them. Dominant ideas and morbid
auto-suggestion must be overcome--not always an easy task, yet always
possible if patience, tact, and skill are exercised. They must be made
to realize that the women of the past, before the development of
modern gynecology, not only lived useful lives without any of the
modern gynecological operations, but that most of them were quite
happy in so doing. Even though many of them had physical symptoms, the
lack of unfavorable suggestion as to the significance of these
prevented mental exaggeration, and morbid dwelling on them was not
allowed to produce such a deterioration of the physical condition as
to emphasize the pathological conditions. This does not mean that
women may not have to be operated on, and, when that is necessary, the
operation should be determined on and performed with no more delay
than is proper to put the patients into suitable physical condition.
But many operations that are undertaken without definite indications
merely because the women complain, and it is hoped that an operation
will somehow prove of relief, would be replaced with much more final
satisfaction and relief by properly directed psychotherapy.

There are many minor pathological conditions such as slight cystic
enlargements, hyperemias with tenderness, slight displacements of the
ovary, slight dislocations of the uterus or twistings of it that can
often be successfully treated the same way. After all, what is
considered the normal condition of the feminine internal organs is
only an average reached from observation and many deviations from this
average cannot be considered abnormal. Many a woman living practically
without symptoms, or certainly without such symptoms as to justify an
operation, has pathological conditions of her internal organs worse
than those for which operations are sometimes suggested because
over-sensitive women complain of their symptoms. The rule must be
first to relieve the over-sensitiveness and then to determine whether
an operation is necessary or not. Pain alone, unless it is of a
disabling character or reacts upon the physical health, is not a
sufficient indication for operation.





Next: Psychic States In Menstruation

Previous: Coccygodynia



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