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

self.





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

self.



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

themselves.





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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