Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL OOMJIUXICATION. 27
tro-intestinal auto-intoxication, so called, heightened suggestibility. Moreover, indue
to faulty diet; bacterial modifications toxication by alcohol, haschish, or bacteof
the flora of the digestive tract; chronic rial products in the course of infections
diseases, etc; not forgetting the constitu- maj' affect the psyche in either or both of
tioually born tired individual. these ways. These are the symptomatic
From these considerations a clinician may psychasthenias and hysterias respectively,
know when he is dealing with more than a and are analogous, nosologically speaking,
simple neurasthenia, and thus can avoid to symtomatic hallucinations, disortentawasting
the patient's time and money on a tion and delusions seen in the fevers or exuseless
"rest cure, " which would not onh' haustion.
fail to ameliorate the psychasthenic symp- Another form, psychasthenic in tppe,
toms, but would aggravate the patient's false neurasthenia, unfortunately too corncondition
by isolating him from the stimuli mon, is that induced by the reaction pf the
of daily life, some of which are not inju- patient against some disappointment, disrious
to his mental state and should be util- grace or other psychic trauma. Initsesized
as a fulcrum to uplift his will power, sence this is what psychologists call a defer
which purpose they should be especially fen se reaction, and further analyzed is one
managed or at least arranged by the doctor, of the varieties of what Dupre (4) has
The successful psyc/iol/ierapy of psychas- termed mythomania, though of the types of
thenics is arduous, and often only relative- which he speaks none simulate neurasthely
successful. Any isolation imposed upon nia. The brilliant inventions of the conthese
patients is confined to certain situa- stitutional liar, or those of poetic fancy, do
tions and acts, or is a mere simplification not adapt themselves to so uninteresting a
of their life; and the ])rocedure is quite dif- role as that of a neurasthenic; they tend
ferenl to that used in hysteria to emphasize rather to assert themselves in a more posithe
suggestion, persuasion against, and re- tive manner than the negation of activity
education of the morbid trend. Xor is it entailed by the neurasthenic role. The apthe
isolation required by the neurasthenic, petite for distinction; the dislike of neglect
for whom the deprivation of jjhysiological determined to be fed, and having no means
stimuli is required to give rest to exhausted of satisfaction through exhibition of talent
neurones and induce an anabolic phase, or capacity to perform in some useful way;
Psychasthenics, on the contrary, require or from indolence or cowardice of disposiphysiological
stimuli in order to maintain tion, resorts to the extortion of sympathy
what Janet calls the "'ijsychological ten- by its perseverance in a suffering in which
sion. Of course, stimulation must be short the patient indeed comes to believe,
of exhaustion. One of their characteris- Sympathy or even praise removes deprestics
is to be able to bear themselves well sionor vacuity of mind, titillates the psyche,
during temporary stresses. A physical, .\ child who has learned to lean upon either
mental or moral strain when too long con- is a candidate for false neurasthenia of this
tinned, however, is sure to induce a psy- type when later in life some business or socliasthenic
crisis, a desire for movement, cial project miscarries. When a person is
feeling of unreality, expectant anxiety, or ruined or slighted, or when ambition fails,
obsessive doubt, or any of their numerous neurasthenia is often diagnosed and a rest
modifications. Of course etymologically cure imposed. Psychotherapy pure and
speaking, psychasthenia should be a form simple, is the true indication: for the state
of neurasthenia, but nosologies do not de- was not neurasthenia, but a palsy of will
pend upon etymology, else hysteria would and interest whose jwychogenesis is manibe
in a sad plight. I do not defend the fest in the fixed idea of a determination to
term psychasthenia, but merely accept it as lie down acquire thus the moral comfort to
a now pretty well recognized clinical auto- their vanity the misfortune itself did not
noniy, representing at least a clearly de- bring largely enough to satify it.
fined mode of reaction to environment dis- 'i'he personality of many a woman denied
played by certain individuals, often of neu- a legitimate field eventually shows itself in
ro])athic heredity. As such it is clearly chronic neurasthenia (sic). Her beautiful
differenliable from the picture of neurr>s- resignation at last gives her the eclat she
theuia, of which the dominant feature is has longcraved; she now has an object for
fatigue and easy fatiguability, as well as which she exists, and nurses that as caremany
physical symptoms not so usual in fully as her husband does his business or a
doui)ting madness and the other forms of naturalist his collection,
what we have agreed to term psychasthenia. .V remarkable case ( 5) of this kind has
It must be remembered that a truly neu- just come to the writer's notice. -It was
raslhenic condition may produce in certain that of a naval yeoman, who after rapid
individuals oljsessive manifestations and promotion of which he had reason to be
morbid fears and timidities, as well as a proud, utterly broke down on account of