In recent years the attention of physicians has been called to the

fact that many people are made profoundly miserable by an

unconquerable tendency to doubt about nearly everything that has

happened to them, or is happening, or is about to happen. This is not

a new phenomenon, but introspection has emphasized it, leisure gives

more opportunity for it, and so physicians hear more of it now than

they did in the past. Thi
doubting tendency sometimes makes serious

inroads on the peace of mind of sufferers from it because they cannot

make up their minds to do things, even to take exercise, to eat as

they should in quantity or quality, and to share the ordinary

life around them sufficiently to get such diversion of mind as will

keep their physical functions normal. The state used to be described

as a neurasthenia (nervous weakness), but in recent years has come

better to be designated as in the class of psychasthenias (lack of

mental energy). It is always a mental trouble in the sense that it is

difficult for these patients to make up their minds about things, yet

it is not a mental disease in the ordinary sense of the term, and

these people are often eminently sane and thoroughly intellectual when

their attention has been once profoundly attracted. They may even,

under favorable circumstances, be active and useful helpers in great

causes, yet there is always to be observed in them a certain

noteworthy difference in mentality from the normal. The physician can

do more for an affection of this kind than is usually thought, and he

is probably the only one who can thoroughly appreciate and sympathize

and, therefore, be helpful in the condition.

Sufferers are often laughed at by their friends and relatives and are

likely to be the subjects of at least a little ridicule if they take

their troubles to their physician. As a matter of fact, however,

doubting is a typical case for psychotherapeutics and not only can

much be done for its relief, but it can be kept from disturbing the

general health, which it is prone to do if neglected, and by mental

discipline and acquired habits of self-control, the doubting habit may

be almost completely eradicated.

Exaggeration of Ordinary State of Mind.--The first thing absolutely

necessary to impress upon the minds of these victims of their own

doubts is that their condition is by no means unique, it is not even

very singular, but is only an exaggeration of that hesitancy and

tendency to put off making decisions that practically every person

finds in a lifelong experience. This frame of mind is rather

cultivated by education and by a large accumulation of knowledge. The

less one knows the easier it is to come to decisions about difficult

problems and to form conclusions without hesitancy. The young man will

decide anything under the sun, and a few other things besides, almost

without a moment's hesitation, and after but slight consideration.

Twenty years later he looks back and wonders how he did it, and having

done it, how he succeeded in turning the practical conclusions to

which he came to advantage. The scholar is eminently a doubter and a

hesitater, and we recognize that he loses certain of the qualities

that would make him a practical man of affairs, though he gains so

much more that broadens and deepens life's significance that there can

be no doubt about the value of his liberal education.

"Hamlet" is just the story of one of these doubters and hesitaters. He

saw his duty clearly and that duty was imperative. In spite of

cumulative evidence, however, he refused to go on to the performance

of that duty, urging to himself now one and now another reason of

delay, until finally he wonders whether it would not be worth the

while to take his own life, rather than try any longer to solve the

problems that lie around him demanding solution. When he finally does

something, his hand is forced and circumstances have so arranged

themselves that instead of one clean-cut punishment for a great crime,

there is the tragedy that involves six lives, including his own. The

play seems to involve such exceptional characters and to be written

around such an unusual set of circumstances that it might be thought

that it would prove uninteresting for men and women generally.

As a matter of fact, however, "Hamlet" is the most popular of

Shakespeare's plays and probably the most popular play, both for

readers and auditors, that was ever written. There are commentaries by

the hundred on it in nearly every modern language. Men have been more

interested in this figment of Shakespeare's imagination than in any

man that ever lived. Caesar and Napoleon have not attracted so much

attention. Only Homer and Dante have been perhaps more written about

than Hamlet.

Shakespeare has emphasized the condition of Hamlet by showing us an

eminently well educated man. His deep interest in literature, and

especially in dramatic literature and all that relates to the stage,

can be appreciated very readily from his speech to the players. No one

but a man of profound critical ability and deep intellectual interests

could have so summed up the actors' relation to the drama. Of course,

this is Shakespeare himself talking and unthinking people have said

that this was a purple patch fastened on the play because it gave the

author an opportunity to express his views with regard to actors and

their ways. Instead of that, it is of the very essence of the

development of Hamlet's character and shows us the scholarly amateur

who knows so much about many things that he has become quite unable to

make up his mind about the practical problems that lie before him.

James Russell Lowell says that Shakespeare sent Hamlet to Wittenberg,

though Wittenberg was not founded until centuries after Hamlet

existed--and Shakespeare probably knew that very well--because

Wittenberg in Shakespeare's time, on account of its connection with

Luther and the religious revolt in Germany, had the widespread repute

of occupying men's minds with doubts about many of the things that had

been deemed perfectly settled before, and its popular reputation

serves to give an added hint as to the character of Hamlet as the

dramatist saw it.

Once those who are perturbed by doubts learn that the reason for the

universal human interest in Hamlet is that there is a large capacity

for doubt of self in every man and woman, that we all put off making

decisions whenever possible, sometimes refuse to open letters when

they come if we fear that they will contain some disturbing news, put

off writing letters because we have to state ideas definitely,

apparently hope that the day and the night will bring us counsel and

that somehow the decision will be made for us without the trouble of

making up our minds, then they lose their sense of discouragement over

their condition and appreciate that they are suffering only from an

exaggeration, probably temporary and quite eradicable, of a state of

mind that comes to practically every human being.

This is the important thing, because on it can be founded the only

really hopeful therapy of the condition. Doubting is a habit that may

be increased by yielding to it, but that can be diminished to a very

great extent by constant discipline, which refuses to permit doubts

and hesitancy and bravely makes decisions, even though there may be

the feeling that they may prove to be wrong.

Extent of Affection.--If such discipline is not instituted, then the

lengths to which the doubting hesitant habit may go are almost

incredible. I have had patients tell me that they doubted about nearly

everything in the past. A very dear friend once confided to me that it

was always a source of bother to him that he was not quite sure

whether he was married or not. His marriage I knew had been a public

ceremonial, and he had led his bride down the aisle to the strains of

the "Wedding March" in quite conventional style, but he was hesitant

of speech, especially under excitement, and he was not sure that he

had ever said "I will" to the question of the clergyman, for there was

a constriction at his throat at the moment and he could utter no

sound. The absence of any audible sound from the groom is not so

unusual as to attract attention and, of course, his intention and his

bodily presence and everything else gave the assent without the

necessity for the word, but he could not get out of his mind the

thought that possibly he was not married and at times it gave him

poignant discomfort. He was a thoroughly intelligent man, a teacher

and a writer, with no abnormalities that attracted attention, and his

tendency to doubt was only known to very near friends who laughed at

it and had no idea at all of the annoyance that it often gave its

unfortunate victim.

I have a clergyman friend who has had some serious scruples with

regard to his ordination. He is a Catholic priest and at a certain

part of the ceremonial of ordination it is considered necessary for

the candidate for orders to touch at the same moment the paten, the

small metal plate on which the Host is placed, and the chalice. This

clergyman is not sure that he had done this simultaneously. As a rule,

great care is exercised in seeing that all the details of the

ordination ceremonies are carried out very exactly and as there are a

number of attendants on the altar whose duty it is to see that the

absolutely necessary details are properly fulfilled, it is quite

improbable that any mistake in this matter was made. The young

clergyman, however, had not made an act of conscious attention at the

moment when he was supposed to do this, and consequently he could not

be sure afterwards whether he had done it or not. He thought of it as

the very essence of his ordination and he feared that all his

subsequent acts as a clergyman might be impaired by this negligence.

Trivial Doubts.--It is not alone with regard to important things,

however, that people may doubt and are disturbed by doubts, but with

regard to every trivial thing in life, if they permit the habit to

grow on them. Doubting is, after all, one of the phobias, that is to

say, it is the fear that something may happen if the decision they

make is wrong, that causes people to hesitate so much. There is a

tendency in all of us which, if undisciplined, may make us put off the

doing of things until the last moment. It is easy to resolve the night

before that we will do certain things the next day, but when the next

day comes we find excuses to put them off. I have already suggested as

a symptom that some people put off the opening of letters. There are

probably more who do this than anyone has any idea of. Delay in

answering letters is probably much more often due to hesitancy of

decision than to actual laziness. We doubt as to what we should say

about certain things, and we do not care to take the trouble of making

up our minds, and we fear if we do make up our minds it may be wrong,

so we adjourn the whole matter to another time and keep on adjourning

it. Many people are quite ready to confess that they do not do things

until they have to, though few are ready to acknowledge that it is due

to hesitancy or doubting about themselves and their decisions.

Of course, the man who doubts whether he has locked the door of his

house after he gets to bed can only satisfy himself by getting up and

actually investigating the state of affairs. Then there is the man who

doubts whether he has locked his safe at the office. He may get his

doubts just as he reaches the foot of the elevator and then if he is

wise he will go back and determine the matter. If he is wise with

experience he will also deliberately determine while he is there

whether the office window is closed and locked and will make a

conscious act when he comes out as to the locking of the office door.

If he does not do all this he will have further doubts on the way up

town and at his home during the evening which will make the doing of

anything else a matter of discomfort and he will spoil the restfulness

of his after-dinner hours. Some men conquer their first doubt, make

their way home only to be beset by so many doubts that at the end of

an hour they go back to their office and determine whether the safe is

locked or not. Finding it locked they may forget to notice other

things about the office and then they will surely have doubts about

these, and they may have to go back again and see about them.

Then there is the man who doubts whether he posted a letter or if he

did post it, who doubts whether it found its way down to the bottom of

the mail box, or whether it may not have caught on a projecting screw

or bolt or some portion of the upper part of the box and so fail of

collection; he may go back several times to determine this. Doubts

about even more trivial matters than this, however, annoy some people.

I have known widows on whom the responsibility of managing the

financial affairs of the household had been thrown for the first time

after their husbands' death, who constantly doubted whether they could

afford to spend this or that, though they were regularly saving money

from their income. Over and over again they would have to go over all

their recent expenditures to decide whether they could afford certain

expenses. Such little things as the sort of paper to use in their

correspondence, the wages they paid their servants, the amount of

waste in the food in the household, all aroused in them doubts and set

them to calculating once more just what was the relation of their

income to expenditure, all to no purpose, for they would have the same

doubts the next week or month.

Then there are people who doubt whether their friends really think

anything of them. They think that though they treat them courteously

this may be only common politeness and they may really resent their

wasting their time when they call on them. They hesitate to ask these

people to do things for them, though over and over again the friends

may have shown their willingness and, above all, by asking favors of

them in turn, may have shown that they were quite willing to put

themselves under obligations. They doubt about their charities. They

wonder whether they may really not be doing more harm than good,

though they have investigated the cases or have had them investigated

and the object of their charity may have been proved to be quite

deserving. They hesitate about the acquisition of new friends, and

doubt whether they should give them any confidence and whether the

confidences that they have received from them are not really baits.

This is, of course, a verging on suspicion as well as hesitancy and

doubt, but the stories of how these people try to conquer themselves,

yet have to make decision after decision, each one requiring time and

a certain resolution of mind, are quite pitiable. It gets worse

rather than better unless a definite discipline of opposition and

control is organized.

What ordinary people do habitually and easily and without any effort

of mind, these people must waste time and mental energy over so that

it is extremely difficult for them to accomplish anything. Training of

mind, as of hand, consists in making certain actions so habitual that

they are accomplished quite automatically. If we have decided that we

are to get up at a certain hour we get up at that hour and do not have

to make up our minds about it again, though this is one of the actions

in which we all have the most lapses and the most need of renewal of

resolution and habit. We make up our mind what we are going to eat and

gradually acquire the habit of eating a certain quantity and a certain

variety at meals and then we do not have to make up our minds about it

every time. We go out, to do whatever must be done in our occupation

quite automatically and there is no need of wasting mental energy over

decisions about it. It is this that the doubter cannot do. He or she

calls every trifling act before the supreme court of last decision,

the bar of intellect, to decide whether it is worth while doing,

whether it is to be done or not, how it is to be done, and then there

is a doubt whether after it is done it may not prove to be quite the

wrong thing to have done. This adds so much to the friction of life

that all the surplus energy is used up in the settling of trivial

matters, and nothing worth while is accomplished.

Sir James Paget once expressed all the realities of the situation of

many of these people in a few terse phrases. It is probably the best

explanation of its kind that we have and it deserves to be in the

notebook and often before the mind of physicians who treat neurotic

patients. Sir James said: "The patient says 'She cannot'; her friends

say 'She will not'; the truth is she cannot will."

The expression, of course, applies to many other phases of so-called

nervous disease besides doubting and especially to the psychasthenias.

It represents, indeed, the keynote of many of these puzzling

affections. The fact that it was uttered more than half a century ago

shows how much better these affections were understood two generations

before ours than we are likely to think, and how well physicians then

got to the heart of them. From this to the re-education of will, that

mental discipline and relearning of self-control which constitutes the

essence of the treatment of them, is but a short step.

Prophylaxis.--Serious Occupation.--Of course, the real way out of

the trouble is to have to do certain important things that occupy the

mind and require the doing of many other things as subsidiaries which

must be accomplished in order to carry out the greater resolution. Men

who have important affairs on their hands seldom are bothered by

doubts and hesitancy. Women who have not much to do make mountains out

of the molehills of their little occupations and every trifle must be

adjudged. The larger interests must be cultivated, the smaller ones

must be turned over to the automaton which every one of us can develop

in our persons if we only set about it resolutely. Each thing that

comes up must be settled at once and action must replace

contemplation. The Hamlet in us all must be put down and resolution

must not be allowed to be sicklied over with the pale cast of thought.

We must do things and not think about them too much. The

doubters can learn this lesson. They will never be entirely without

hesitancy, but they can remove many of their difficulties, and live to

accomplish much in spite of their make-up.

Physical Treatment.--The physical treatment of the doubting state

consists, of course, in bringing the individual's physical condition

as near as possible up to the normal. When the state occurs in people

who are under weight its betterment is rather easy. The special

feature of the physical condition that needs seeing to is an ample

supply of fresh air. People who live in ill-ventilated places, or who

do not get out into the air enough, are almost sure to suffer from the

tendency to avoid the making of decisions. The man of decision usually

is a vigorous outdoor-air individual. Even the perfectly healthy man

who has been in the house for some reason for days together gets into

a state of mind where the making of decisions becomes objectionable.

He wants to push things away from him. In individuals who already have

a natural tendency this way this is greatly exaggerated by

confinement. Arrangements must be made, therefore, that will ensure

getting out for some time, not once but twice every day. The regular

making of decisions for this purpose is of itself a good mental

discipline. It must not be omitted even for rain or snow, unless there

are additional reasons of some kind. An abundance of fresh air in the

sleeping-room is extremely important and must be secured.

Mental Treatment.--The mental treatment consists in diversion of mind.

Usually the doubters have no interests that appeal to them deeply and

in which they have to make prompt regular decisions. If possible,

these must be secured. They must form habits of doing things regularly

and of making up their minds to do them, and then not have to repeat

the adjudication and resolution. In recent years people realize, quite

apart from its religious significance, the value of what older

religious writers called examination of conscience. Regularly before

they go to sleep these people must be told to call up what they have

done during the day and to note their faults in the matter of putting

off doing things and making decisions slowly. They must, however, not

only realize their faults, but they must make up their mind to correct

them during the following day. They must not leave the arrangement of

what they shall do next day to chance, but must decide just how and

when they shall do things and then, as far as possible, keep to this

program. The program must, of course, be sensible and considerate.

This preliminary arrangement can be made to mean much more than might

be thought. Some people thus learn to correct entirely their tendency

to doubt whether they should do things or not and lessen greatly the

difficulties they have in making decisions.