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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,

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

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

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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