Mental States Of Disappointment

Quite apart from these serious ailments, however, there are passing

phases of depression that come to nearly everyone after adult life is

reached that are likely to be somewhat more frequent as years go on,

but that are not entirely unknown even in early years. They are more

likely to come to those who feel that life has been somewhat of a

failure and that they have accomplished very little in spite of all

that they have tried to do. Not infrequently they come, however, to

those who in the estimation of other people have made a magnificent

success of life. The rich man, after he has made his fortune, unless

he continues to engross himself with some time-taking and

interest-claiming work, may be the subject of repeated attacks of

mental depression. Social leaders among women who begin to feel

something of the emptiness of social striving, after they have made

what is called a success in society and at the time when they are the

envy of many on the social ladder below them, are particularly likely

to be subject to attacks of "the blues." The only men and women who

are free from them to a great extent, and even they not absolutely,

are those who are busily engaged with some occupation not entirely

selfish in which they can see that what they are doing is

accomplishing something for the people around them.

Very often an attack of depression is ushered in by some small

disappointment. As a rule, however, this is not the causative factor

but is only an occasion which makes manifest the depressed state that

has existed for some time and that now declares itself openly. In the

same way only a slight occasion is necessary apparently to dispel

clouds that hang over a person in the milder attacks of depression,

because, for some time before, relief has been preparing itself and a

livelier phase of existence has been gradually coming on. Relief can

be promised with absolute assurance, but freedom from relapse cannot

be assured and the only true source of consolation that is helpful is

the frank recognition of the fact that these are successive phases of

existence quite as likely to be periodic as certain physical facts in

life. Depression is likely to be a little more manifest in the morning

than at other times, partly because the interests of the day have not

yet come to occupy the mind, but mainly because the physical life as

indicated by the pulse and the temperature is lower during the morning

hours than in the afternoon and evening. Just as soon as people

realize the physical nature of certain dispositional changes they give

much less depressive significance to them.

Occupation of Mind.--The most important feature of the treatment of

depression of mind is to secure somehow such occupation as will catch

the attention and arouse the interest. This is not always an easy

matter. How effective it is, however, can be best judged from what one

notes of the effect of such things as physical pain or great

solicitude for someone else besides themselves. I have known a mother,

whose fits of "the blues" were getting deeper and the intervals

growing shorter to be roused from her condition when all means had

failed by the elopement of a daughter who had been partly pushed into

leaving because things had become so unpleasant around home

during her mother's depression, and any change seemed welcome. On the

other hand, I had a doctor friend who felt quite alarmed about his

growing depression and who even had some fears lest, if it continued

to deepen, he might commit suicide. He was completely lifted out of

his increasing depression by the occurrence of pneumonia in his boy of

sixteen. The pneumonia did not end by crisis but by lysis and for

weeks he had very little sleep. He confessed that the intense

preoccupation of mind had completely driven away his blues and had

even done much to relieve him of various digestive symptoms to which

he had previously attributed his depression.

Again and again I have known men who, in the midst of prosperity,

found life dull and rather hard to bear, and who just as soon as a

crisis in their affairs compelled them to pay attention to other

things than themselves and the state of their feelings, grew better

mentally and physically. It seems almost a contradiction in terms to

say that it is the man of little occupation, as a rule, or at least of

occupations that are not insistent, who is likely to be troubled with

insomnia, while the very busy man, especially the man busy not about

one or two narrow interests, but about a number, is seldom so

bothered. Nothing contributes more to the depression of mind than loss

of sleep or supposed loss of sleep. Even women who, while living in

ease and comfort, had much to complain of as regards depression, often

lose entirely their tendencies to "the blues" or have fits of them at

much longer intervals, when necessity compels them either to earn

their own living or, at least, to occupy themselves much more with

absolutely necessary duties.

Provision of Occupation.--It is a hard matter to create such

occupation of mind as will be satisfactory. Patients have to be tried

by various suggestions. The tendency to periodic fits of depression

deep enough to be called to the physician's attention is much more

noticeable in recent years than it used to be, and seems to me at

least to bear a corresponding ratio to the decrease of home life. Home

duties usually mean joys and of late there has been a neglect of the

joys of life while seeking its pleasures. Certain phases of city life

are responsible for much dissatisfaction with existence and depression

of spirits. Most of the women who live in apartment hotels have

practically no serious occupation of mind. They need not get up if

they do not feel quite right or quite rested--and who after the age of

forty ever does feel quite all right in the morning hours unless sleep

has been in the open air? Nothing is so likely to start a day of

depression than failure to get up promptly, lounging around with forty

winks here and there, reading in bed, and the like. If breakfast is

taken in bed, then some reading indulged in, and then some sleeping,

and only an hour or two of dawdling around comes before lunch, that

meal is not properly enjoyed and the afternoon is started badly;

unless there is some special diversion of mind depression is almost

sure to get the upper hand.

Place of Children in Psychotherapy.--Where there are children the

interests are much more urgent and there is little time for such

preoccupation with self as gives one "that tired feeling." We are very

interesting to ourselves, but just as soon as we have no other subject

to occupy us than ourselves we soon grow very tired of the subject.

Children are the best interest that one can think of, for women

particularly. When they have none of their own an interest in orphan

asylums, in day nurseries, in various children's institutions,

and, above all, in the adoption of a child, will do more than anything

else to relieve the tendency to blues. Of late years the adoption of

children has been much less frequent than used to be the case in

childless families, and doctors see the result in mental depression.

Children are a great care, but they are a great blessing to women, and

while the present trend of social life eliminates them as far as

possible, this elimination, beginning with their relegation to nurses

when they are infants, to nursemaids as they grow a little older, and

then to the kindergarten up to six years of age, far from adding to

comfort rather increases the discomfort of many mothers. Nature takes

her revenge. The reason why the mothers of past generations could

stand the suffering that they must have borne with patience before

gynecology developed to relieve them, was that they had their children

around them, and their minds and their hearts and their hands were so

full that they had no time to think of themselves, to brood over their

ills, and consequently these troubled them much less than would

otherwise have been the case.

Delicate mothers really interested in their children undoubtedly

suffer very little compared to delicate women who are alone in life,

and what is thus true of the mother is true also of those who have the

care of children. It is not alone a satisfaction of the maternal

instinct, but it is an occupation of mind and heart with cares for

little ones. Other people's children serve just as good a therapeutic

purpose, if only their necessities are imposed on the attendant. The

reason why women in religious orders have such happy peaceful lives

and are happier in spite of a routine of life that would seem to be

fatal to happiness, is that their minds are filled with the interests

of others, every moment of their time is occupied, and, above all,

they have to care for children, the ailing, the poor, sometimes the

vicious, who make many demands on them, many calls on their sympathies

and keep them from thinking about themselves.

Occupation with Living Things.--After occupation with human beings

the most important therapeutic factor against periods of depression is

occupation with living things of various kinds. Horseback riding is an

excellent remedy for the blues and the outside of a horse in the old

axiom is literally very good for the inside of man or woman. There is

a sympathy between man and animal that in itself means much, but the

most important element is the absolute impossibility of preoccupation

with oneself and one's little troubles and worries while one is trying

to manage a somewhat restive animal. If the horse, however, is old and

very quiet--so that one can throw the reins on his neck and allow him

to jog on for himself, then horseback riding may mean very little.

Where the care of the animal is entirely taken off the rider's

shoulders by a groom who brings him to a particular place and takes

him afterwards, then, also, much of the benefit of horseback riding is

lost. Care for other animals as well as the horse is of great service

and especially is this true if the owners feel the duty of exercising

the animals. Many a downhearted person finds that to take an animal

out for a stroll will do much to lift the clouds of depression.

With the disappearance of children from the families of the

better-to-do classes, pet dogs have grown in favor mainly because of

this influence. They awaken sympathies and so keep people from

thinking too much about themselves, For many an elderly woman who is

alone in the world her dogs or her cats or a combination of both

are the best possible remedies for depression. At times it will be

found necessary to prescribe them. There is no better way to get an

elderly person to go out at certain times than to have them feel that

their pets need exercise.

Garden Cures.--After animals the next best thing is the care of a

garden. Here once more human sympathies with living things are aroused

and it is easier to cultivate a forgetfulness of self while

cultivating flowers and plants. Growing plants do not arouse the

interest that growing animals do, but still they have advantages over

things that do not vary, and their growth is a subject of day-to-day

interest and the effect on them of vicissitudes of the weather arouses

feelings of solicitude which help to dissipate the little insistent

cares for self that depress. The care of a garden is the very best

thing for the "pottering old." Younger people are too impatient to get

much benefit out of a garden, but after middle life many an hour of

depression will be saved in the care of plants.

Intellectual Occupations.--It might be expected that intellectual

occupations would serve to brush away "the blues" for educated people.

They are perfectly capable of doing so, but they must be of the kind

that grip attention and must be undertaken seriously, usually with an

appeal quite apart from mere cultural interests. Hobbies of various

kinds, especially the making of collections, even of such trivial

things as stamps, will often serve the purpose of distraction from

gloomier thoughts. Unfortunately, a hobby cannot be created all at

once and usually does not take a strong enough hold to be available

for mental therapeutic purposes unless it was acquired when the person

was comparatively young and has been indulged in for many years.

Reading and study utterly fail unless there is some end in view apart

from the reading and study itself. The reading of novels and

newspapers is particularly likely to be a failure. The gloomier

thoughts obtrude themselves in the midst of the reading and very often

what is read proves suggestive of melancholic thoughts and all the

time the mind and the person are not occupied seriously enough to push

away the state of depression which exists. The mind must be

interested, not merely occupied superficially, or the depression will


It might be thought that the reading of books that concerned human

suffering might have a similar appeal to that to be obtained from real

touch with human suffering. This is true to a certain extent when the

books concern real and not fictitious suffering. For this reason the

trials and hardships of travelers at the North and South poles or in

the heart of tropical Africa--Nansen and Peary and Stanley and

Livingston--have all been excellent therapeutic agents. The stories of

mountain climbers have something of the same effect. Adventures in

Alaska and in the Far North, especially, come in the same category.

Novels, however, even though they use the same material, soon fail to

have a corresponding effect. Even when the novel does touch the

emotions deeply it is prone to make the reader forget the suffering

around him and does not prove a good diversion from his own feelings.

In his play, "The Night Asylum," Maxim Gorky, the Russian novelist and

playwright, brings this out very well. One of his characters, a young

scrubwoman, wears her fingers to the bone during the day for a

miserable pittance and sleeps in a squalid night lodging house, yet

this comparatively young creature, crouched near the only light

in the room, sheds tears over the imaginary sufferings of the

fictitious people that she reads about, while the real human suffering

around her fails entirely to arouse her sympathy or affect her

emotions, except to anger her if lodgers come in between her and the

light or when the complaints made by some of those who are suffering

around her annoy and distract her from her reading.

In younger folks, study, provided there is some definite object to be

attained by it, is often helpful. Correspondence schools are of value

by setting a definite purpose before the mind. In a number of cases I

have found that the suggestion to make translations from a foreign

language when the patient knew that language even tolerably well,

afforded excellent relief from that over-occupation with self which

was the real cause of the depression. There are many people who know

enough French to be able to translate fairly well and there are many

articles and books a translation of which may at least be submitted to

editors and often proves available for publication. To have some such

end as this in view is of itself one of the best means that can be

provided for these people to relieve their tendency to depression.

Occasionally even the suggestion to write stories may prove helpful.

One hesitates to add to the number of story-writers in this country,

but it may be remembered as a last resort. I know at least two people

saved from themselves by even a very moderate success as writers of

short stories.

Consolation from History.--Perhaps the most serious thing about

depression is the feeling of those afflicted by it that they are

singular in this respect and that other people who seem gay never have

depressed states. There is probably no one who has not periods of

depression. They may not be very deep and "the blues" may be only of

a light tinge, but they are there. The higher the intelligence, as a

rule, the more tendency there is to feelings of discouragement and

depression at intervals when one is not occupied. Those who have the

artistic temperament and the striving after the expression of the

beautiful as they see it, whether it be in art or in letters or in the

betterment of humanity, usually suffer more than others because they

realize poignantly their failure to reach their ideals. This is well

illustrated by the experience of writers and artists. As a rule, most

men and women look forward to the completion of any intellectual work

with confidence that after it is finished they will have a period of

rest and peace. Commonly just the opposite is true. The completion of

any work leaves one with a sense of dissatisfaction with what has been

done, for no man of real intelligence ever thinks that he has so

realized his ideals as to be satisfied, and only the foolishly

conceited fail to feel the many defects that there are in their work.

There is abundance of evidence, however, that it is not alone artists

and writers who thus feel the hollowness of life and the tears there

are in things. Many of the men who have accomplished great things in

science and in politics have been prone to times of depression.

Virchow told me there were moments when life seemed very empty to him

and that he had to shake off feelings of depression in order to be

able to go on with his work. At one time in the sixth decade of his

life he suffered considerably from what we would now call neurasthenic

symptoms, gave up his medical work and spent a long time with

Schliemann in the Troad. His presence was valuable to the excavator in

his work at Troy, and the change gave Virchow back his health.

Even more striking is what we know of Von Moltke, who seemed in many

ways to have an ideally happy life. He had had the fulfillment of all

his desires or, at least, the fruition of all his hopes, and the

successful accomplishment of what he worked for beyond what is usually

given to man. He had come to be one of the most highly respected men

of Europe and was the subject of veneration on the part of his own

German people and of intimate affection from his sovereign, who loaded

him with honors. He was a man who had probably no enemies and many,

many firm friends. It was said that "he could keep silence in eleven

languages" and so he had avoided most of the pitfalls of life. His

domestic life was ideally happy and his letters to his wife for over

fifty years read like those of a lover, before all his great battles

his last thought and written word was for her, after them his first

thought and message was for her. In spite of this, towards the end of

his life, when the question of reincarnation was a subject of

discussion in Berlin and it was brought particularly to his attention,

he declared that looking back on his career, in spite of all its good

fortune, there seemed to him to be so many chances in life, so many

possible sources of failure, so many springs of discouragement, that

he would prefer not to have to live again. Surely, if anyone, he might

be expected to be ready to take the chances of re-incarnation after

such happy experiences of life, yet he was not. Such an expression

could only come from a man who had looked depression often in the

face, who had shaken off the blue devils and who knew that even the

joy of success was followed by the gloom of uncertainty as to the

future and solicitude as to the real significance of accomplishment.

Literature and Life.--We have many examples of this tendency to

depression that come to the literary man in the lives and letters of

distinguished writers that have been published so frequently in recent

years. Perhaps one of the most striking is to be found in the life of

Robert Bulwer Lytton, the second Lord Lytton, so well known as a

diplomatist in European circles and throughout the English-speaking

world as a poet, under the pen name of "Owen Meredith." [Footnote

51] It might be thought that Lytton would be one of the men safely

harbored from storms of depression and discouragement, for his life

seemed ideally situated to enable him to get the best out of himself

without worry or dissipation of energy in occupation with mere

personal matters. His father had made a distinguished success as a

literary man and a politician, had been raised to the peerage and the

son began life with every possible advantage. He made a distinguished

success in literature so that he even converted his father to praise

him and as a diplomatist he occupied nearly every important post in

English diplomacy and had hosts of friends all over the world.

[Footnote 51: Personal and Literary Letters of Lord Lytton,

edited by Lady Betty Balfour. New York, 1909.]

It is all the more surprising, then, to have many passages in his

letters refer to periodic attacks of depression. He says, for

instance, "My physical temperament has a great tendency to beget blue

devils and when those imps lay siege to my soul they recall those

words of Schopenhauer's and say to me 'thou art the man.'" Perhaps the

price that the artistic temperament pays for the satisfaction that it

gets out of life in other directions is this occasional tendency

to depression because achievement does not equal aspiration. Certainly

the price often seems excessive to those who have to pay it. In the

same letter to his daughter, Lytton continues:

When my blue devils are cast out, and I recover sanity of spirits,

then I say to myself just what you say to me in your letter--that

the main thing is not to do but to be; that the work of a man is

rather in what he is than in what he does; that one may be a very

fine poet yet a very poor creature; that my life has at least been a

very full one, rich in varied experiences, touching the world at

many points; that had I devoted it exclusively to the cultivation of

one gift, though that the best, I might have become a poet as great

at least as any of my contemporaries, but that this is by no means

certain to me for my natural inclination to, and unfitness for, all

the practical side of life are so great that I might just as likely

have lapsed into a mere dreamer; that the discipline of active life

and forced contact with the world has been specially good for me,

perhaps providential, and that what I have gained from it as a man

may be more than compensation for whatever I may have lost by it as

an artist.

It is surprising to think of a man of this kind becoming so depressed

by the death of a son that all the world and the meaning of life took

on a somber hue for him. In 1871 Lord Lytton lost a young boy by a

very painful illness which had probably been more painful for

sympathetic onlookers than for the patient himself. The incident

proved sufficient, however, to make the father think that there could

not be a beneficent Providence ruling over the world. He felt sure

that somehow God's power must be shortened, if such suffering, for

which he could see no reason, had to be permitted. He was much

depressed after this and never was quite the same in his outlook upon

the world and the significance of life. It was easy to understand that

this was due rather to his character than his intellect, but it

illustrates forcibly how much a deeply intelligent man may be affected

by something that seems after all, only the course of nature.

It is sometimes surprising to find from the life stories of men how

often those who would be thought least likely to suffer from

periodical depression were victims of it. Few Americans in our time

have apparently had a more satisfying career than that of James

Russell Lowell, a successful author as a young man, then a successful

editor, a teacher whom his students appreciated very much, and in

later life the subject of many honors and such honors as provided him

with splendid opportunities for the exhibition of his special genius.

He would seem to be the last who should suffer from depression. His

post as Minister to Spain gave him an opportunity which he took

magnificently to study the great Spanish authors and to store up

material for writing about them. As Minister to England few men were

so popular. He was constantly in demand for occasional addresses and

his special style enabled him to respond to these demands with

brilliant success. Here in America no great occasion was complete

without Lowell. In spite of all this that would surely seem ample to

satisfy the aspirations of any man, Lowell was often depressed and

sometimes even talked about the possibility of suicide. Life seemed at

times very empty to him. The story of the lives of such men, if made

familiar to patients, proves a source of consolation, for it makes

them realize that they are not alone in their experiences, that

depression at some times is the lot of man, and that very few people

are without the sphere of its influence.

Depression an Incident, not a State.--This suggestion may, in the case

of some of those inclined to longer periods of depression, lead to

indulgence in the luxury of being depressed and so putting off the

doing of things. It must be pointed out, however, that just inasmuch

as depression has this effect it is pathological. It seems to be

natural to man to suffer from periods of discouragement and depression

which keep him from devoting himself too persistently to lines of work

that may be insignificant and make him take cognizance of the real

values of what he is doing. Depression, however, that continues after

the recognition of this takes place is morbid and must be actively

resisted. Just inasmuch as depression precedes and prepares patients

for a reaction, it is an incident in practically all lives. Indulged

in as a luxury, it is abnormal.

Suggestive Treatment--The most important thing for patients who suffer

from periodic depression is to make them understand that this state of

mind, far from being personal to them or very rare, or even uncommon,

is an extremely frequent experience of men and women. There are

certain men and a few women eminently occupied with the external life,

busy with many things, though often they are trivial enough, and even

when they are important, significant only in a financial or a social

way, but meaning nothing for the great realities of life, who seem

during their younger active years to escape the periodical attacks of

depression that come to most people and come almost without exception

to people who think seriously. Some of the best thoughts and

inspirations of men come to them as the result of the serious mood

that follows an attack of depression. A butterfly existence lacks

these sources of inspiration. Far from being objectionable then,

attacks of depression, if not allowed to proceed too far, and if kept

from paralyzing activity, prove to be intervals when life values are

seriously weighed and when a proper estimation of such values is come

to. Men are prone without such interruptions to get too interested in

trivial concerns that seem to them important because they are occupied

with them to the exclusion of other ideas, but that prove to be of no

real import when seen on the background of a certain hollowness that

there is in human life, if lived merely for its own sake.

The occurrence of periodical depression is a part of the mystery of

life and it affords us a better opportunity to get a little closer to

the heart of the mystery than almost anything else. It is out of such

periods that men have risen "on stepping-stones of their dead selves

to higher things" and have even risen to the highest that there is in

life. Geniuses have nearly always had deep periods of depression, but

in the midst of them have read new meanings into life and have read

the lessons of humanity in their own souls better than at any other

time. Depression throws a man back on himself and makes him think

deeper than in his mind--in what has been called his heart. "The

fascination of trifles obscures the good things in life" are words of

old-time wisdom and men are weaned from this by fits of depression

that are really moods of precious dissatisfaction with their work

inasmuch as it falls short of the best accomplishment. Without

periodic depression, apparently, a man never gets as close to the

heart of life as he otherwise would. Far from being an unwelcome

visitant, it should be rather welcome as a stimulus to the possibility

of further study of self and the realities of life.

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