Indigestion And Unfavorable States Of Mind





Indigestion is the characteristic disease of our time. There are few

men or women over thirty who have not suffered from it. The working

classes are spared the most, but with the frequent suggestions in the

newspapers and the introspection which has become so common,

indigestion is often complained of even among them. Sedentary

occupations, involving mental work and little physical effort, seem

especially to predispose to some form of indigestion. Few of those who

live what is called the intellectual life escape suffering from some

of its symptoms. Not infrequently men have been hale and hearty

specimens of muscular manhood when they took up some profession which

compels them to be indoors, yet before long, they begin to complain of

discomfort after eating, of tendencies to constipation, of headaches,

of depression, of incapacity for mental effort after meals, and all

these symptoms are attributed to the almost universal disease,

indigestion.



It is possible for the general attitude of mind to have a great effect

on digestive processes, and the symptom-complex which is called

indigestion, or dyspepsia, is probably much more dependent on the mind

than on any other factor. In many cases it is primarily due to

over-concentration of attention on digestion. In others it is due to

over-occupation with business, worry, or serious thought at times when

the digestive processes need all the energy. In many cases so-called

dyspepsia is due to an unfavorable state of mind toward digestive

processes in general, because of unfavorable auto-suggestion.

Normally, stomachic sensations reach our consciousness only under

special circumstances. When, however, much attention is paid to them,

even the slight sensations that occur with normal digestion may rise

above the threshold of consciousness and become subjects of

solicitude. If they do so, then the increased attention likely to be

paid to them surely interferes with function and changes what may be

merely physiological into pathological processes.





Disease Suggestions.--An unfortunate state of the public mind with

regard to indigestion in general has been cultivated by many

publications on the subject. People dread its occurrence, and fear

that the first sign of discomfort in their gastric region is a signal

of the beginning of a progressive affection. They fear the worst, and

the consequence is a reaction quite out of proportion to the gravity

of the ailment. So much has been said particularly of mistakes in diet

that just as soon as they feel, or often rather think they feel, the

first symptom of beginning dyspepsia they begin to study how to modify

their diet so as to prevent its progress. They begin to eliminate

various supposedly indigestible foods. Usually among the first things

that are greatly reduced in quantity, or are entirely eliminated, are

the fats and certain of the starchy vegetables. Because of expressions

heard and read as to its harmfulness, the fearful ones also are

usually timorous about taking fluid at meal times. As this is about

the only time when they are likely to take fluid, unless it be summer,

they soon suffer for lack of it. Eating only food that leaves

little residue and taking insufficient fluid leads to constipation.

This reacts still further to disturb digestion, and to interfere with

appetite.



This leads to further reduction in the amount and variety of food,

with the consequence that insufficient nutrition to supply energy for

bodily needs is taken. The digestive system gives up to the body as

much as it possibly can, not only of the food materials to be

consumed, but of its own substance. Thus it weakens its own vitality,

with a lessening of appetite and of digestive power. Hence, a vicious

circle of change is instituted, the consequences of which are easy to

see. After a time the patient is taking only the blandest foods,

constipation has become an important element in the case, and the mind

is constantly occupied with solicitude over the digestion and the

choice of materials at meals.





Contrary Suggestion and Digestion.--Hudson, in "The Law of Mental

Medicine," insisted on the necessity for not suggesting to children

the possibility of indigestion of various substances, for that is

almost sure to disturb digestive functions. Children sometimes hear

the remark that father or mother cannot take a certain article of food

because it disagrees with them. The imitative faculty of the child is

sure to be aroused, with the consequence that this particular food is

not eaten with relish nor given a fair show for digestion, and will be

the source of some stomach disturbance. Not infrequently substances

thus spoken of are among those that are especially likely to do

children good, such as milk or eggs, or occasionally butter. The harm

done by the remark may, therefore, even be serious, for these foods

should constitute a large proportion of the child's diet. Indeed, an

excellent prophylactic in the matter of indigestion is to prevent as

far as possible all conversation at table about the indigestibility of

food. Unfortunately, this has, in late years particularly, become a

favorite subject of table conversation.





Transferred Feelings.--Professor Cohnheim called attention to the fact

that many uncomfortable feelings are likely to be mistranslated

because they are referred to organs with which there is nothing wrong.

Whenever this function is hampered in any way, there are many

uncomfortable feelings associated with the digestion of food. The

custom has been to refer the origin of all these to the stomach.

Cohnheim thinks that it is much more likely that they really originate

in the intestines, though the rule has been to take the patient's

feelings as an indication and to treat the stomach. It is not an

unreasonable thing for patients to be deceived as to the exact

location of discomfort. Even in so acute a process as toothache it is

possible to mistake the particular tooth that is giving trouble, and,

as dentists know, a perfectly quiescent tooth is sometimes blamed for

pain that is coming from another. Fillings have been removed, teeth

have been treated, good teeth have been extracted, because patients

insisted on the significance of their feelings in such cases. The

stomach must not always be blamed. Sometimes the only source of

supposed gastric discomfort is the constipation present which is

usually easy to relieve.





Gastric Reflexes.--While the mind may serve to disturb digestion and

produce gastric discomfort by over-attention, there are many reflexes

that center in the digestive tract, the origin of which may be in

distant organs. Fright often produces a sensation as of cold at the

pit of the stomach. Looking down from a height has the same effect in

some persons. Discordant noises have the same effect on people

of sensitive hearing and certain reactions to touch may be similarly

reflected. There are a number of affections which produce

uncomfortable reflex sensations in the gastric region. This is the

hypochondrium of the olden time. Whenever feelings were complained of,

for which there was no actual basis in the hypochondriac region, it

came to be spoken of as hypochondriasis, a word that has an innuendo

of imaginativeness about it. Dr. Head's studies with regard to the

transfer of sensations from one portion of the body to the other, show

us that there is a good physical reason in reflexes for many of these

complaints. An explanation of this to patients will often relieve

their minds greatly and make their discomfort seem much less serious.

Dr. Head said:



With orchitis or prostatitis, we also occasionally find that the

patient complains of a pain at the epigastrium, representing the

stomach area. This is put down to hypochondriasis and if it occurs

in a woman as a consequence of ovaritis, she is said to be

hysterical. But this phenomena is no more "hysterical," whatever

that may mean, than is the reference of the pain and the tenderness

of an aching tooth to the back of the head or the shoulder.

[Transfers which have been observed actually to take place.]



This is the phenomenon I have been accustomed to call

"generalization" of visceral pain and tenderness, and is of such

common occurrence as to form a very important factor in the clinical

picture of many diseases.



The order in which generalization takes place, leads one to speak of

the relative "specific resistance" of the centers for the sensory

impulses from various organs. No very definite rule can be laid down

to govern every case, but each case must be considered on its

merits. However, the area which appears most easily on a woman, as a

secondary affection, is the tenth dorsal; then, perhaps the sixth

dorsal, or inframammary, and then the various gastric areas,

beginning first with the ensiform or seventh dorsal. In a man the

tenth dorsal appears rather less readily while the ensiform appears

with great ease.



Affections of other organs within the abdomen may produce like

reflexes. A chronic appendicitis, for instance, will often be

reflected in the stomach area. So will the presence of gallstones, or

of disturbances of the biliary mucosa. Loose kidney often produces

stomach reflexes. Any disturbance of the intestinal function will

produce gastric irritation and inhibition of digestion. Most of the

other primary conditions are more serious. Often the patient is aware

of their existence, and it is a relief to him to find that the stomach

symptoms are not the index of further pathological development, but

only reflex conditions. This of itself does much to make the condition

more bearable.



Patients who are suffering from symptoms of indigestion often have

areas of their skin surface that are at least very sensitive, if not

actually tender. They feel the pressure of their clothing over a

particular portion of the body, usually on the left side of the

abdomen somewhat above, though at times also below the umbilicus.

Though not painful, as a rule, it is decidedly uncomfortable and

produces a constant desire to loosen the clothing, or lift it from the

part. Mere loosening, it is soon found, does no good, because the

clothing continues to touch the skin and it is not the constriction or

pressure but the contact that produces the discomfort. Sometimes there

is a distinct lesion of the stomach. This cutaneous hyperasthesia may,

indeed, rise to the height of extreme tenderness in cases of gastric

ulcer, or the like. But there is no doubt that a certain amount

of this sensation is present with all functional disturbances of the

stomach and that the reflex sensitiveness of superficial nerves is

only what might be expected from what we now know of this subject.





Discomfort and Digestion.--Just as certain food materials disagree

because of the state of mind, so certain feelings in the gastric

region, even in the skin surface, sometimes disturb digestion and lead

to changes of the diet unwarranted by the condition. Patients conclude

that, if the skin is so tender, then the underlying organs, the

disturbance of which causes this tenderness, must be in a serious

condition. For these patients the explanation of the present state of

our knowledge as to reflex disturbance of sensory nerves will be of

therapeutic value. They must be taught that pain is reflected from one

nerve branch to another, and is not communicated by continuity of

tissue, or by sympathetic affection from the stomach mucous membrane

through the stomach wall, and then from the abdominal wall to the skin

surface. This knowledge will prove reassuring.





Division of Energy.--After this mental occupation with digestion

itself, which by consuming nervous energy lessens the amount available

for digestive purposes, probably the most common factor in the

production of indigestion is the concentration of mind on serious

subjects, while digestion is proceeding. An old English maxim is that

some people have not enough brains to run their liver and their

business. The liver in old-time pathology was considered the most

important of the abdominal organs and was taken by metathesis for them

all. Most of us have only a limited amount of vital energy and,

usually, we can accomplish only one thing well at a time. If we try to

do intellectual work while digestion is going on, both the

intellectual work and the digestion suffer. If we persist in

attempting to do both, we will surely disturb the digestive organs and

we may bring about grave neurotic disturbances in the central nervous

system. We may be able for a time to accomplish the two things at the

same time, but it will not be long before evil results will be seen.

Nervous, high-strung people should be reminded of Lincoln's anecdote

of the little steamboat on the Mississippi which had not steam enough

to blow its whistle and run its paddle wheels at the same time, so

that whenever the engineer wanted to blow the whistle he stopped the

boat.



Indeed, much of the indigestion that we see is due to this dissipation

of energy through the attempt to do two things at the same time. Those

who live the intellectual life are the most frequent sufferers.

Worries and anxieties that are allowed to trouble the mind during

digestion time are sure to disturb digestion eventually because they

use up energy that is needed for physical purposes.



A change of environment that takes us away from the ordinary cares of

life, is often sufficient to make all the difference between ease of

digestion and extremely uncomfortable dyspepsia. By worry the mind

apparently becomes short-circuited on itself and uses up a large

amount of the available energy in nervous impulses that do not find

their way outside the central nervous system at all, but are used in

disturbing associated nerve cells. Just as soon as a change of scene

and occupation calls for a different set of thoughts and other

feelings, energy is released for work outside the central nervous

system itself, digestion begins to improve, and in a comparatively

short time what seemed to be a serious gastric disturbance, disappears

almost completely.







Lack of Sleep Repair.--In my own experience one of the most

characteristic stigmata of these cases of indigestion which are due to

exhaustion through other channels of vital energy, is that they feel

much better in the evening than in the morning. They are, therefore,

tempted to stay up late and so do not get the necessary rest. Their

excuse for late hours is that they need recreation. To that excuse I

have no objection. They do need more recreation; they need more hours

during which their minds are absolutely free from business cares; but

these hours must not be taken from their sleep, for they need rest

even more than recreation.





Worries and Irritations During Meals.--The presence of worries or

irritation during meals or shortly after, as well as unfavorable

states of mind towards digestion itself, and occupation of mind with

serious affairs during digestion, are likely to be sources of serious

disturbance of digestion. A fright, a fit of anger, nagging,

irritation, or any disturbing emotions, may hamper digestion. An

experiment that is sometimes performed in the physiological laboratory

on the cat nicely illustrates this. If the laboratory cat is fed some

dainty that it likes, mixed with bismuth in order that its stomach and

intestines may be made opaque to the x-rays, and then be examined by

means of the fluoroscope, the peristaltic processes of digestion by

which food is mixed in the stomach, passed out into the intestines,

and by which intestinal digestion is stimulated, may be seen to go on

very interestingly. If, now, the cat is made to arch its back, and

manifest the usual signs of extreme irritation, the process of

digestion is interrupted, and will not be resumed till some time after

the cat quiets down. The lesson is obvious.





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