Mental Influence In Dyspepsia And Indigestion
It is often said that this teaching as to the effect of the mind on
digestion and its eminent usefulness for the treatment of dyspeptic
conditions, is due to the attention that has been attracted to this
subject as a consequence of the prominence of Eddyism, New Thought,
Mental Healing, and the like. There are absolutely no good grounds for
any such assertion. Here in America, more than twenty-five years ago,
before th
our greatest medical clinician, Dr. Austin Flint, expressed himself
very emphatically with regard to mental influence over digestion, and
to solicitude of mind as one of the most frequent etiological factors
in dyspepsia.
Dr. Flint was thoroughly scientific in his medical observations, was
no seeker after notoriety, and he was reading his paper before the
older physicians of the period, and all of those who took part in that
first meeting of the New York Medical Association strove to make their
papers of scientific value. His words, then, must carry great weight:
Dyspepsia formerly prevailed chiefly among those who adopted, to a
greater or less extent, the foregoing maxims [the finicky rules of
dyspeptics which he deprecates and corrects as quoted later in this
chapter]. It was comparatively rare among those who did not live in
accordance with dietetic rules. The affection is much less prevalent
now than heretofore, because these maxims are much less in vogue.
The dyspeptics of the present day are chiefly those who undertake to
exemplify more or less of these maxims. It seems to me, therefore, a
fair inference, that dyspepsia may result from an attempt to
regulate diet by rules which have for their object the prevention of
the affection which they actually produce. It is to be added that an
important causative element involved in the practical adoption of
these rules is the attention thereby given to digestion. It is by
introspection and constant watchfulness of the functions of the
stomach, that the mind exerts a direct influence in the causation of
this affection.
Dietetic Rules of a Former Day.--In order to make definite just what
were the views of the olden times which he deprecates, he stated them
briefly and forcibly:
The views generally entertained, at the time to which I have
referred, largely by physicians and almost universally by
non-medical sanitarians, may be summed up in a few maxims as
follows: Eat only at stated periods, twice or thrice daily, and
never between meals, no matter how great may be the desire for food.
Never eat late in the evening or shortly before bedtime. In the
choice of articles of diet, carefully select those which reason and
personal experience have shown to be best digested; and never yield
to the weakness of eating any article of food simply because it is
acceptable to the palate. In order to avoid the temptation of
overeating, let the articles of food be coarse rather than
attractive, and eschew all the devices of the cuisine. Always leave
the table hungry. Study personal idiosyncrasies, and never indulge
in kinds of food which, although wholesome for most persons, are
injurious to a few who are peculiarly organized. With reference to
this last maxim, bear in mind that "what is one man's meat is
another man's poison." In order to secure, as effectually as
possible, a proper restriction in the quantity of food, it was
recommended by some physicians and to some extent practiced, that
every article be carefully weighed at meal times, and that a certain
quantity by weight be never exceeded. Vegetarianism or Grahamism was
advocated and practiced by many. Total abstinence from drink was
considered by a few as a good sanitary measure, compelling the body
to derive the needed fluids exclusively from fruits, vegetables, and
other solid articles of diet. Restriction in the amount of drink, as
far as practicable with regard to the power of endurance, was very
generally deemed important, so as not to dilute the gastric juice.
When to his question, "Do you regulate your diet," the patient
answered promptly and often emphatically in the affirmative, Dr. Flint
insisted always: "This is a good reason for your having dyspepsia; I
never knew a dyspeptic get well who undertook to regulate his diet."
When the patient asks then, "How am I to be guided," the reply is,
"Not by theoretical views of alimentation and indigestion, no matter
how much they appear to be in accord with physiological and
pathological doctrines, but by the appetite, the palate and common
sense." He then goes on to answer certain other objections that
patients are wont to urge, and says:
But the patient will be likely to say, "Am I not to be guided by my
own experience and avoid articles of food which I have found to
disagree with my digestion?" The answer is, that personal experience
in dietetics is extremely fallacious. An article of diet which may
cause inconvenience of indigestion to-day may be followed by a sense
of comfort and will be readily digested to-morrow. A variety of
circumstances may render the digestion of any article of food taken
at a particular meal labored or imperfect. As a rule articles
which agree with most persons do not disagree with any, except from
casual or accidental circumstances, and from the expectation, in the
mind of the patient, that they will disagree. Without denying that
there are dietetic idiosyncrasies, they are vastly fewer than is
generally supposed; and, in general, it is fair to regard supposed
idiosyncrasies as purely fanciful. Patients not infrequently cherish
supposed idiosyncrasies with gratification. The idea is gratifying
to egotism, as evidence that Providence has distinguished them from
the common herd by certain peculiarities of constitution.
Dietetic Instructions.--Finally Dr. Flint has a series of instructions
for those suffering from indigestion:
Do not adopt the rule of eating only at stated periods, twice or
thrice daily. Be governed in this respect by appetite; and eat
whenever there is a desire for food. Eat in the evenings or at
bedtime, if food be desired. Insomnia is often attributable to
hunger [italics ours]. In the choice of articles of diet, be
distrustful of past personal experience, and consider it to be a
trustworthy rule that those articles will be most likely to be
digested without inconvenience which are most acceptable to the
palate. As far as practicable, let the articles of diet be made
acceptable by good cooking. As a rule, the better articles of food
are cooked, the greater the comfort during digestion. Never leave
the table with an unsatisfied appetite. Be in no haste to suppose
that you are separated from the rest of mankind by dietetic
idiosyncrasies, and be distrustful of the dogma that another man's
meat is a poison to you. Do not undertake to estimate the amount of
food which you take. In this respect different persons differ very
widely, and there is no fixed standard of quantity, which is not to
be exceeded. Take animal and vegetable articles of diet in relative
proportions as indicated by instinct. In the quantity of drink,
follow nature's indication; namely, thirst. Experience shows
abundantly that, with a view of comfortable digestion, there need be
no restriction in the ingestion of liquids.
Removal of Solicitude as a Remedial Measure.--Many dyspeptics have no
subject that they occupy themselves with more seriously than their
digestion, and they thus divert blood needed for digestive purposes as
well as nervous energy that would help in it from the stomach to the
brain, in order to exercise surveillance over the process. As has been
well said, "Probably much more than half of the indigestion is really
above the neck." This does not mean that there are not cases that need
definite stomachic treatment, or even that patients who have succeeded
in functionally disturbing their digestion by thinking over much about
it, will not need gastric remedies.
The explanation of the many fads and remedies that cure indigestion,
real or supposed, is exactly this tendency of the suggestive influence
of such remedial measures to lessen the patient's solicitude about
digestion. Any change in diet that carries with it the persuasion that
for any reason digestion ought to be better, will, because of this,
make digestion better. Any habit of taking warm or cold water before
meals, or of chewing in a particular way, or of taking a particular
kind of food different from what is usually taken--exclusively cereal,
uncooked, largely fruit, vegetarian, etc.--will lift the concentration
of attention on the digestive process, and so give the stomach a
chance to do its work without interference from the brain.
Du Bois has quoted some striking testimony in this matter from Baras,
who wrote on the "Gastralgias and Nervous Affections of the Stomach
and the Intestines" as early as 1820. Baras had himself been a
sufferer from gastric discomfort, fullness after eating,
eructations of gas, constipation, and general depression. He consulted
most of the distinguished medical practitioners of his time. With one
exception they were convinced that he was a sufferer from chronic
gastro-enteritis. They added more and more to his concern about his
stomach, and furnished him with numerous sources of autosuggestion. In
spite of all that they did for him, his condition grew worse and
worse, he lost in weight, and was sure that his case was hopeless. He
was cured in a single day. His daughter was attacked with consumption,
and "in the moment my attention," says Baras, "was centered entirely
upon my child, I thought no more of myself, and I was cured."
Brain Workers and Indigestion.--Perhaps the best proof of how
necessary it is that people should not continue to occupy their
intellect seriously during the time when digestion is going on, is to
be found in the frequency with which complaints of indigestion occur
in literary folk. The complaints are heard most from literary folk
because they are more likely to tell their stories. They have their
work, and thoughts of it, always with them. So there is a constant
call for nervous and mental activity and for much blood in the brain
tissues. This subtracts from the nervous energy necessary for
digestion, and makes it impossible to conduct it with that perfection
which comes naturally to people who banish all other thoughts and keep
their minds free for the pleasures of the table and social intercourse
at meal time.
Nervous indigestion is so common among literary folk, teachers and
scientific workers, that various causes have been suggested for it.
Dr. George Gould, in his "Biographic Clinics," calls attention to it
and suggests that the cause is probably the need of properly fitted
spectacles. In our own time, when we are much more careful in the
matter of eyeglasses, and when most writers and professors wear
scientifically adapted glasses, the complaints still continue. The
reason is evidently something associated with the almost continuous
work that they do. Such people, too, are much more self-conscious than
others. They think more about their digestion and what they eat. They
often think that they differ from other people and have special
idiosyncrasies for food. These thoughts are sure to culminate in
nervous indigestion.
Food Faddists.--Literary folk and people who live the intellectual
life are very prone to take up with fads of various kinds and find
surcease from their sorrows in all sorts of out of the way dietaries,
modes of eating, food limitations and specializations. They constitute
a majority of the food faddists. Some of them--sure that they should
not eat meat--are strenuous vegetarians. Others confine themselves
entirely to food the life of which has not been completely destroyed
by cooking. They are fruit faddists, nut faddists, milk-product
faddists, and the like. Some of them try to persuade the world that it
eats too much; others that it eats too frequently. Some of them take
but a single real meal a day and have apologies for the other meals.
All want to lead people to their particular mode of life, as if all
the world had been wrong until they came to set it right. Some want
the rest of the world to chew seventy-times-seven before they swallow
and to adopt other exaggerations of attention to eating that are quite
contrary to instinct, the most precious guide that we have in the
matter of food choice and food consumption.
These intellectuals are always improved by their fads, no matter what
they may be. The reason is apparent. Their original digestive
disturbance was due to over-occupation with intellectual work. Then
they began to worry about their digestion and feared that nearly
everything they ate would disagree with them. This fear and solicitude
still further interfered with digestion. Next they acquired the new
fad. They became persuaded that they could eat certain things in
certain ways. They no longer disturb their digestion by anxiety about
it, but, on the contrary, help it by favorable suggestion. Now under
the new regime everything will surely go on well. Besides, they
usually learn the lesson of not doing intellectual work close to their
meals, and of spacing their work better. They learn to do a daily
stint of work and no more. One of the fads that goes with most food
fashions is abundant outdoor air. This always does good. Between the
favorable mental influence, the lessened work, especially just after
meals, and the increased outdoor air they get better and then they
attribute it all to their special fad about food. The "cure" is due
to psychotherapy and common sense, and not in any way to the special
fad.
Worry.--Worry of any kind will have the same effect as the
over-attention of the literary man or teacher to his work. Anyone who
brings his business home with him is likely to suffer and, unless he
has a superabundant supply of energy, will impair his digestive
function as a consequence of attempting to do business after dinner,
perhaps also stealing some of it in before and during breakfast.
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