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Occupation Of Mind

Two classes of patients frequently apply to physicians for relief from
various discomforts. They are, first, people who have no regular
occupation and who often are in what is supposed to be the happy
position of being able to do just what they please. The second class
consists of those who take their occupations too seriously, so that
they never get away from them and, as a consequence, disturb their
physical functions. The feelings that these two classes complain
of--for, when analyzed, their symptoms prove really to be
uncomfortable feelings--can usually be "bothered" away and, if not
entirely forgotten, made to disappear when the patients become deeply
interested in something other than their usual occupation. The first
class of patients needs occupation of mind; the second needs diversion
of mind, and that subject will be taken up in another chapter.

Uncomfortable Sensations, Their Location and Causes.--These pains and
aches, as patients call them, though it is well to remember that they
are only discomforts, senses of unequal pressure, of constriction, or
perhaps only unusual feelings, or consciousness of sensation, may
occur in every part of the body. Perhaps they are most commonly
complained of in the head. Many of the so-called headaches that are
more or less continuous consist of these senses of pressure or of
constriction over a particular part of the skull. Sometimes there may
be a sense of pressure at the back of the eyes. Very often there is a
feeling of heaviness at the back of the head that makes the patient
feel as if relief would come if the head were allowed to drop forward
and if sleep could be thus obtained. Every other portion of the head,
however, even within the cavities, may have some of these
uncomfortable sensations. In some persons, there is a tightness in the
throat. In others, there is a feeling of fullness of one cheek and the
dread that they may not be able to use it properly in talking.
Sometimes the uncomfortable feeling is within the nose. Not
infrequently the discomfort is in the ear.

All of these may be due to local conditions which need to be
corrected, but in most cases nothing is found locally, or at most
there is some functional disturbance so slight that, though it is
shared by a great many people in our climate, others do not complain
of it at all. It seems evident, therefore, that the discomfort must
result from the sensitiveness of the individual emphasizing the
significance of some slight disturbance.

Every portion of the body may suffer from these discomforts. The upper
part of the back, especially below the base of the neck, is a favorite
location in men, and particularly in those who bend over a desk. The
lower part of the back is affected in such men as tailors and cutters
who stoop incessantly at their work. In women, the lower part of the
back is likely to suffer, and this is usually attributed to genital
conditions, but constipation may play quite as large a role as the
genital organs. Some of the stooping occupations of women, at the
sewing machine or dressmaking, or even harder occupations, as
sweeping, washing, and the like, may also be responsible. The
commonest source of discomfort is, perhaps, the upper left-hand
quadrant of the abdomen. This seems to be due to the distention of the
stomach, either by gas or by liquid. Vague discomforts may occur
around the umbilicus, often due to the presence of gas, with or
without borborygmi.

Generally the local condition is only an occasion, and the real cause
of the complaint is the lack of occupation of mind and consequent
concentration of attention on any organ whose function happens to be
disturbed sufficiently to make one conscious of its action.

Lack of Occupation.--For all of these cases the most important
therapeutic factor is occupation of mind and diversion of attention.
In our time, social conditions allow a large number of people to have
very little occupation. For instance, many women of the well-to-do
classes have absolutely nothing that they must do. Various phases of
this are discussed in previous sections.

As a rule, it is useless to try to relieve these discomforts by
anodynes. Many an opium habit has been formed by a turning to opium in
such cases. The coal tar products are greatly abused here, for they do
not bring relief to queer feelings nor to a sense of pressure or
discomfort; they rather add to depression. What they are efficacious
for is acute pain. The coal tar products relieve even toothache or
neuralgia, as well as a real headache, but I have had patients tell me
over and over again that the continuous headaches from which they
suffered were not relieved in the slightest degree by phenacetin or
acetanilid. Occasionally one hears of hyoscine or hyoscyamus suggested
for these conditions, but they are quite as useless and as much
contraindicated as opium or the coal tar products. As a rule, these
headaches are relieved by lying down; they disappear during sleep. The
real indication for treatment, however, is found in the fact that all
of these vague discomforts are much better or even disappear when the
patient is intensely occupied, or at least pleasurably engaged.

What these people need is occupation that really catches their
interest and takes attention from themselves. One of the most striking
expressions of this truth that we have comes from the poor, sad, mad
poet, Cowper:

Absence of occupation is not rest;
A mind quite vacant is a mind distressed.

And surely poor Cowper, himself the victim of depression, saved from
himself only by the suggestion that he should put into poetic form the
thoughts that came so abundantly to him, could well understand the
depth of wisdom in his couplet. The story of Cowper's life is enough
of itself to encourage physician and patient to persevere in the
effort to lift depression by occupation, since the fruits of that
occupation may prove so valuable.

Mental Short-Circuit.--The minds of these people must do something,
and since there is nothing really occupying for them to do, in a very
expressive modern phrase, they are doing their possessors. As we
suggest elsewhere, the nearest simile is that of the short-circuiting
of a dynamo. Mental energy is exerted harmfully within the machine
instead of in doing work.

See what happens in these cases when by some chance the women, or the
men, who complain almost constantly are suddenly deprived of the means
which enabled them to live an aimless life. The physician often has
patients who have been in affluence but after a financial panic are in
straitened circumstances. It is interesting to note what an excellent
tonic effect, in younger people always, in older people very often,
the change of life has on these chronic valetudinarians. Sometimes
this is attributed to the simpler life which they lead when poorer,
occasionally to the lack of responsibility, or other similar reason.
Nearly always it is easy to see that the real cause of the improvement
in health is the occupation of mind with serious interests outside of

Regulation of Life.--In the matter of occupation, and especially
occupation of mind, the formation of habits and the training of the
will are extremely important. In his book on "The Education of the
Will," which was so popular that it went through over thirty editions
in France, M. Jules Payot [Footnote 25] emphasizes the necessity for
deliberately arranging the details of life so that time shall not hang
heavily on the hands, he reverts to certain rules of life of the old
religious orders, and to the habits advised by spiritual directors. He
counsels that every one should make an examination of the day's
happenings at the end of it, in order to see just where the failures
lay and in what accomplishment was made. At the end of this
old-fashioned examination of conscience, he counsels that a set of
resolutions for the next day be made and an arrangement of work for
various times, so that even more may be accomplished.

[Footnote 25: English translation by Dr. Smith Ely Jelliffe.
New York, 1909.]

M. Payot further suggests that a certain time be given up to
reflection, or as he calls it, meditation, on the significance of life
and on the consideration whether something valuable is being made of
it. Without this he insists that it is easy to let one's self slip
into habits of life in which absolutely nothing is accomplished for
self or others. If there is no real accomplishment, then pleasure soon
palls, because pleasure has a place only as an interval in the midst
of labor and as a relief from effort. These reversions to the old
modes of life and thought of the monastic communities show how little
of real advance there is in life, and what excellent conclusions
serious men came to even in the distant past. Certainly for many of
the leisure class in modern times only the use of periods of
reflection and the examination of results obtained will serve to
prevent that utter waste of time which leads to the intense
dissatisfaction that is often reflected in the general health.

Thought for Others.--After forgetfulness of self, the most important
factor in psychotherapeutics is thoughtfulness for others. Ordinary
diversions are quite insufficient to occupy most people. One must have
a serious occupation that appeals deeply, and then diversions of mind
will be useful for purposes of recreation. Pleasure, so-called, if
pursued not as an interruption from work but for its own sake and
without serious occupation, palls, and after a time its votaries find
life is scarcely worth living. The pursuit of pleasure as the sole
interest of life is one of the most fruitful resources of depression,
discouragement and neurotic symptoms with which modern physicians are
brought in contact. The only way to be sure of having compelling
interests is to be so much occupied with other people that one forgets

Yet mere flippant excitement and superficial entertainment is
nothing but a cheap counterfeit of what is needed. Voluntary effort
is needed, and this is the field where the psychotherapist must put
in his most intelligent effort. There is no one for whom there is
not a chance for work in our social fabric. The prescription of work
has not only to be adjusted to the abilities, the knowledge, and
social conditions, but has to be chosen in such a way that it is
full of associations and ultimately of joyful emotions. Useless work
can never confer the greatest benefits; mere physical exercises are
therefore psychophysically not as valuable as real sport, while
physically, of course, the regulated exercises may be far superior
to the haphazard work in sport. To solve picture puzzles, even if
they absorb the attention for a week, can never have the same effect
as a real interest in a human puzzle. There is a chance for social
work for every woman and every man, work which can well be chosen in
full adjustment to the personal preference and likings. Not
everybody is fit for charity work, and those who are may be entirely
unfitted for work in the interest of the beautification of the town.
Only it has to be work; mere automobiling to charity places or
talking in meetings on problems which have not been studied will, of
course, be merely another form of the disorganizing superficiality.
The hysterical lady on Fifth Avenue and the psychasthenic old maid
in the New England country town both simply have to learn to do
useful work with a concentrated effort and a high purpose. From a
long experience I have to confess that I have seen that this
unsentimental remedy is the safest and most important prescription
in the prescription book of the psychotherapist.

Care of Children.--Probably the most important therapeutic factor in
the cure of the ills which come to unoccupied women is the finding of
some occupation that will absorb their hearts as well as their
intellects, that is, satisfy their feelings as well as appeal to their
intelligence. That very acute observer and kenner of her sex, Mrs. St.
Leger Harrison, who is Charles Kingsley's daughter and writes under
the pseudonym of "Lucas Malet," said in "Sir Richard Calmady": "Feed
their hearts and the rest of the mechanism runs easy. I have known
disease to develop in a perfectly healthy woman simply because the
heart was starved." For most women the only thing that will entirely
satisfy the heart or keep it from hunger is children. Fortunately an
interest in other people's children can, under certain circumstances,
be almost as satisfying as in one's own.

Interest in Others.--Probably the best possible occupation that a
childless woman can have is the care of others. Charity in one form or
another satisfies the emotions as well as creates interest and gives
varied occupations. Even the frequent disillusions that are
encountered in charity work only add variety to the experience,
and do not discourage those who have the real charity instinct. For
women particularly, as we have said, some charity that brings them
much in contact with children is the surest preventive of
over-occupation with themselves and over-emphasis on their feelings
and sufferings. Many a woman in our large cities owes her freedom from
the neurotic symptoms to which her sisters are subject, to her
interest in tuberculous children. There is just enough of suffering to
arouse all the pity of the visitor, without so much of anguish as
would deter the more delicate from being interested in the work.

Touch with Real Suffering,--For patients who think they have much to
suffer, yet whose complaints are all of subjective feelings of
oppression and depression, there is no better remedy than to come in
touch with real suffering. I have known not a few neurotic young
women, who were preparing for themselves years of suffering by
over-attention to little pains and aches, saved to a life of
usefulness and even happiness by having to nurse near relatives
through the last stages of fatal cancer. When these neurotic persons
are brought intimately in touch with real suffering, have their
sympathies aroused, and see how well human nature can bear pain when
it has to, and yet not be impatient, nor wish to end it all, then a
renewed life comes over them and they cease to be preoccupied with

Sympathy as a Remedy.--In former days, when hospitals were not so
well provided and trained nurses non-existent, all forms of suffering
had a wider appeal and aroused more active sympathy than at present.
It is true that patients, in both hospitals and homes, suffered from
the lack of trained nursing, and that was an even greater
disadvantage. But it is, nevertheless, too bad that more actual touch
with suffering does not come to people now, for nothing is so sure to
make little ills disappear as the sympathy aroused by the sight of
real suffering. Certainly, our cancer cases might well be a strong
therapeutic factor for many of the neurotic ills of the world. They
are, of course, deterrent to many people. It would seem to add
needlessly to human suffering for some of the delicate to have to be
in contact with what is one of the most awful afflictions that flesh
is heir to. If death and suffering were not inevitable, we might try
to save people from the suffering which sympathy entails. But there is
no avoiding them; soon or late they are sure to come to everyone. The
upbuilding of character, consequent upon intimacy with them, is of
great value, and really brings so much of contentment to people who
are over-worried about little things that it is worth while to recall
how valuable this sympathy for suffering is in psychotherapy.

I have spoken of this phase of occupation as if it referred only to
women. There are many men of whom one may well say that they need more
human sympathy in their lives and that if they had it their supposed
ills would drop from them, or seem so slight as to be quite
negligible. Over and over again, I have seen men who had become too
occupied with themselves lose their pains and aches in an interest in
some real charity. Charity, however, not philanthropy, is the secret.
The sitting on a board of trustees of a charitable institution may
mean little though even this usually has its good effect; but close
contact with the poor, intimate personal relations with other human
beings who are in suffering, are quite as necessary for men
over-occupied with themselves as for women.

Care of the Incurable.--Mother Lathrop (Hawthorne's daughter) in her
cancer work prefers not to take patients suffering from incurable
cancer into the homes that she has for them, if they can in any way be
cared for reasonably at their own home. Of course, the main reason is
because there is so much of cancer in the community (one in thirty of
the population now die of it), that it is impossible to take care of
all the cases that apply for admission. Another excellent reason is
that it would be too bad to take out of a home the opportunity for
self-discipline that is afforded by the care of one of these patients,
when it does not inflict an intolerable burden on someone already
overworked. As a rule, the effect of attendance on such a patient does
so much for character upbuilding, and for a proper realization of
values in life, that trivial things fall into their right places.
Anyone who has seen the development of character, And the growth in
amenity of disposition of those who bear such a burden with patience,
will realize just what is meant by the expressions used.

Finding Mental Occupation.--For many of his patients the physician
simply must find occupation of mind. Not a little racking of brain is
needed for this, until experience helps. One form of occupation of
mind that seemed quite unpromising at first, but that has in a number
of cases proved of value, is the committing to memory of passages in
verse. A generation ago it was quite common for people to have their
memories stored with fine passages from authors which they could
repeat literally. Latin verse particularly was learned by the school
boys of fifty years ago. Frenchmen know their classical poets, and
some of the Italians also know theirs with wonderful fidelity. It is
said that, even in his advanced years, Pope Leo XIII could repeat long
passages of Dante and often found a relief from pressing cares of
state in the ponderings of the great thoughts recalled by the verses.
I have known half a dozen Italian clergymen who could from memory
follow up a line of Dante, taken anywhere in the poet's writings, with
the rest of the passage.

Such well-stored memories furnished much more abundant food for
thought to their possessors than do those of the modern time. Our
modern system of education has done away, to a great extent, with
learning by heart, but as one of those educated under the older system
and who is still able to recall many passages from Pope, or
Goldsmith's "Deserted Village," or "The Traveler," or from Virgil or
Horace, I feel sure that this is a serious mistake. In some cases I
have deliberately tried to make up for it by having people, even well
on in years, settle down to memory lessons again. Under disorders of
memory I suggest the use of this practice as a valuable training which
serves first to dispel the idea that memory is failing when it is only
lack of attention and of concentration of mind that is at fault, and
secondly, because after a time there can be observed an actual
improvement of the memory faculty. Here I would insist on its value as
an occupation of mind for those who lack some serious interests. I
have found it to be ever so much better as a diversion than reading or
the theater. If the interest in it can be awakened, it represents a
valuable adjunct in the treatment of some rather difficult cases of
mental short-circuiting. Lord Chesterfield, in one of his letters,
suggested to his son that even very brief periods during the
day--those that are ordinarily used for the fulfillment of bodily
necessities--might be employed to store the memory with valuable
quotations, great thoughts greatly expressed, and this should be
recalled. After a little practice not near so much time is required
for memory work as might be imagined, and the effects are excellent.

Much of this may seem too trivial for the physician to occupy himself
with and quite apart from his duties as a practitioner of medical
science. But it must not be forgotten that medical science is as yet
quite imperfect and the practice of medicine is an art. What we have
to do, is to treat individual patients rather than cure cases, for
that is why medicine is a profession. Each affected individual who
comes to us is quite different from any other. In spite of our
grouping them under certain heads, the diseases of the race are as
distinct from one another as the features of the individuals affected.

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