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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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