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.





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