Historical remedies for the 'riot of the emotions': when fear was the most potent menopausal pathogen

“ There is nothing remarkable in the fact that the cessation of menstruation and ovulation, after functional activity of an average period of time varying from thirty to thirty-five years, is sometimes attended by a series of disturbances of a local and constitutional character. The changes of functional activity under these conditions are in analogy to the course and constitution of nature as observed in connection with dentition, puberty, and other epochs in human life.
The physiology of the menopause is a subject extremely difficult of investigation. ”

“ DATE OF CESSATION OF MENSTRUATION, AND DURATION OF THE CHANGE OF LIFE.—The function of ovulation, as far as we know, ceases with the discontinuance of menstruation, although immature ova still exist in the ovaries. The date of natural cessation of menstruation and ovulation is variable in different women. It is difficult to determine an average date, because the menopause may be gradually ushered in, and then women are apt to interpret any genital hemorrhage as menstruation. In certain cases the menstrual flow may cease between the ages of thirty and forty years, or even at an earlier period. ”

“ Menstruation, which is the evidence of sexual maturity, is a monthly hemorrhage from the uterus which escapes through the vagina, normally recurring throughout the entire child-bearing period, except during pregnancy and lactation. The duration of this child-bearing period, or sexual activity, is about thirty years and continues from puberty to the menopause. ”

“ The menopause, also termed the climacteric and the change of life, marks the permanent cessation of menstruation and of sexual activity. It occurs ordinarily between the ages of forty and fifty; the majority of women stop menstruating at their forty-sixth year. The menopause has occurred as early as the twenty-fifth year, and as late as the eightieth or ninetieth year. ”

“ The menopause is the final cessation of menstruation. The age at which it occurs is dependent upon a great variety of conditions—nationality, climate, mode of life, constitutional and local diseases. In the northern countries of Europe the menopause is said to appear later than in the southern ”

“ The critical periods of life, when a profound revolution is overturning the endocrine equilibrium, puberty, pregnancy, and the menopause, are the periods of most frequent occurrence of insanity, when mental instability reveals endocrine instability (Dementia praecox, pregnancy psychosis, menopause neurosis) . Actual insanity need not be the only manifestation. ”

“ These various symptoms become apparent at the very outset of the menopause, when the oncoming entire cessation of menstruation is already foreshadowed by irregularity in the periods, gradual diminution in the quantity of the flow, and variations in the number of days during which the flow on each occasion persists.
The manifestations of the menopause are in fact so striking, that from ancient times down to the present day a widespread belief has prevailed that especial danger to a woman’s life is threatened by 572the climacteric age. ”

“ And the next most striking feature was that the prominent symptoms of the menopause are preeminently reflex or the functional diseases of the nervous system.
Tilt believes that single women suffer less than other women at the time of the menopause. He further writes: "As at puberty, from the ignorance in which it is still thought right to leave young women, so at the change of life, women often suffer from ignorance of what may occur, or from exaggerated notions of the perils which await them. ”

“ Why women are not prepared to meet the climacteric—The fear that unnerves many—Error of views concerning "Change of Life"—Correct teaching stated—Influence of medical literature—Three periods in a woman's life—Relation of early habits to later aches and ills—The menopause—Conditions which influence the period of the climacteric—The age at-which it usually appears—Effects of heredity—Childless women—Mothers of large families—Effects of different occupations—Excesses. ”

“ As the young girl is taught to fear the menstrual period, so the older woman is taught to dread the time when the periods shall cease. Despite the general enlightenment of this day and age, the menopause or "change of life" is all too frequently feared as a "critical period" in a woman's life, a time of distressing physical sensations and even of danger to mental balance.
As a matter of fact, the menopause is a physiological process which should be accomplished with as little mental and physical disturbance as accompanies the establishment of puberty. ”

“ The actual atrophy of the ovaries, uterus, external genitals and the breasts can, of course, not be prevented, but that atrophy is a slow and gradual process, and is not in itself the cause of the various distressing symptoms that we have enumerated.
The treatment of the menopause, if the symptoms are at all disagreeable, or distressing, should be in the hands of a competent physician. A little wholesome advice may be more efficient than gallons of medicine and bushels of pills. In general the woman [132] should try to lead as calm and peaceful a life as possible. ”

“ This must be insisted upon, for, at the present time, unfavorable suggestion with regard to the menopause is the universal rule. Women look for the worst from it, and their expectation makes conditions less tolerable than they really are. Most women dread it as if it were the beginning of the end of life, the first descent into old age, while it is often the dawn of a larger and broader life free from sexual and other irritations, and with better possibilities of accomplishment. ”

“ If an occasional body is not quite able to regulate the chemical readjustment, we may have to administer the glands of some other animal, but in the majority of cases, the body, unhampered by an extra burden of fear, is quite able to make its own adjustments. The hot flash passes in a moment, if not prolonged by emotion or if not converted into a habit by attention.
One source of trouble in the menopause is that it comes at a time in a woman's life when she is likely to have too much leisure. In no way can a woman so easily handicap her body at this time as by stopping work and being afraid. ”

“ When fear causes the blood to bound through veins and arteries, or languidly to move the palsied mechanism, destroy the fear, and the system regains its equilibrium; anodynes, counter-irritants, or depletion can never reduce inflammation like the Truth of being. Faith, or belief, is a poor equivalent for science; we must understand man metaphysically, before we can control him aright, physically. Ignorance, coupled with a smattering of metaphysical learning, is a shocking bore ”

“ In considering the changes that take place in the female reproductive organs at this period of life, we must distinguish between the proper period of the climacteric, with its various manifestations antecedent to and associated with the irregularity and ultimate cessation of menstruation, from the condition of old age in which menstruation has actually and completely ceased, in which the menopause has been fully accomplished, and in which the changes of senescence have set in at once in the organs of the reproductive system and in the organism as a whole. ”

“ An ovary belated after the fortieth year of life atrophies, and menopause symptoms will often ensue in the course of a few months after the operation. The retention of an ovary minimizes the menopause disturbances, and they are never so acute and prominent under these conditions as they are when an acute menopause is induced by the sudden and complete removal of all ovarian tissue. ”

“ There is reason to believe that whatever good effects follow the practice of leaving a belated ovary (that is, an ovary divorced from the uterus and left in the pelvis) , they are temporary, for in the course of a few years the ovarian tissue disappears and the patients experience the usual symptoms of the menopause. It is possible that the rate of atrophy of the secreting tissue of a belated ovary depends on the age at which a patient is submitted to hysterectomy. ”

“ The disturbance of the vascular system gives rise to flashes of heat and cold and often to profuse perspiration. Certain of the symptoms of the menopause can be compared rather strikingly with those of Graves' disease and have been attributed to the disturbance of the external secretion of the ovaries which are now known to act as ductless glands as well as genital organs. ”

“ Disturbances in the circulation of the eye and its appendages are frequently associated with the menopause. The writer recalls a case where for years there was headache with intense congestion of the palpebral and bulbar conjunctiva, with a fulness and pressure on the orbits at each menstrual period, all these symptoms disappearing with the cessation of the menses. The most striking examples of the influence of the menses on the eyesight are those where the flow has been suddenly checked. ”

“ Interference with the action of the voluntary muscles and intestinal peristalsis by the deposition of adipose tissue in the abdominal walls and omentum, diminution of the intestinal secretions as the result of profuse perspirations and critical discharges, are etiological factors frequently referable to the menopause. Alterations in the innervation of the intestinal walls are probably productive of conditions which tend to constipation. The nature of the changes in the functions of the abdominal sympathetic nervous system during the menopause is a matter of pure speculation. ”

“ What we know of the endocrine factors in heredity leads us to suppose that it is the mating of one marked endocrine insufficiency with another that is often responsible for the inherited tendency to feeble-mindedness and insanity. The effect of the hormone system upon the vegetative apparatus may create the more obscure insanities and quasi-insanities. The direct action of the internal secretions upon the brain cells, producing a sort of hair trigger situation within them, may cause the explosive discharges from them which appear as overpowering impulses or uncontrollable conduct. ”

“ If, at the time of the menarche, there were severe nervous manifestations, or heart troubles of a serious kind, 579the passage of the menopause may be expected to give rise to neuropathic affections and to cardiac disturbances in a similar manner.
The woman’s state of general health is likewise of importance in determining whether the course of the menopause will be favourable or unfavourable. Perfectly healthy women, with a quiescent temperament, and in favourable circumstances of life, will pass most easily through the climacteric period without disturbance of their general condition. ”

“ Prostitutes who continue the active pursuit of their profession until the climacteric age, have at this time much to suffer. Women who have had difficult deliveries, or several miscarriages, or severe puerperal illnesses—and indeed, speaking generally, 580those women who have been subject to any kind of disease of the reproductive organs—are apt to suffer from serious disturbances of the general health during the climacteric period.
The mode in which the cessation of menstruation takes place, is also causally connected with the easy or difficult course of the menopause. ”

“ In other words, in women whose nervous system is an unstable one, and in those with hereditary predisposition to the occurrence of cardiac disorder, the changes that take place in the reproductive organs both during the menarche and during the menopause, are likely during these vital phases to arouse reflex disturbances of the cardiac functions. ”

“ It is easy to understand how the rarer recurrence of menstruation, the occasional profuse losses of blood, the complete suppression of menstruation, the conditions peculiar to the climacteric period of stasis and congestive hyperaemia of the brain, are competent, more especially in hereditarily predisposed persons, to give rise to the development of psychoses; whilst in those already suffering from mental disorder, the menopause will be likely to bring about an aggravation in their symptoms. ”

“ The influence on the development of neurotic fear of certain phases of life, such as puberty and the period of menopause, when the production of libido is materially heightened, belongs here too. In some conditions of excitement we may observe the mixture of anxiety and libido and the final substitution of anxiety for libido. These facts give us a twofold impression, first that we are concerned with an accumulation of libido, which is diverted from its normal channel, second that we are working with somatic processes. Just how anxiety originates from the libido we do not know ”

“ This task is successfully solved in the case of the individual neurotic, and we are confident of finding a similar solution in the case of races.
In the second place we cannot help noticing that the sense of guilt contains much of the nature of anxiety; without hesitation it may be described as “conscience phobia.” But fear points to unconscious sources; The psychology of the neuroses taught us that when wish feelings undergo repression their libido becomes transformed into anxiety. ”

“ Finally the last case, the origin of anxiety neurosis through a severe illness, overwork, exhaustive nursing, etc., in addition to the efficacy of coitus interruptus readily permits a free interpretation. Through deviation the psyche becomes here insufficient for the subjugation of the somatic sexual excitement, a task which continuously devolves upon it. We know how deeply the libido can sink under the same conditions, and we have here a nice example of a neurosis which although not of a sexual etiology still evinces a sexual mechanism. ”

“ In the corresponding attack of anxiety of our neurosis we have before us the dyspnoea, the palpitation, etc., of the coitus in an isolated and aggravated manner.
It can still be asked why the nervous system merges into a peculiar affective state of anxiety under the circumstances of psychic inadequacy for the subjugation of the sexual excitement? A hint to the answer is as follows: The psyche merges into the affect of fear when it perceives itself unable to adjust an externally approaching task (danger) by corresponding reaction ”

“ And then, as I stood more and more decidedly for the significance of sexuality in the causation of the neuroses, Breuer was the first to show me those reactions of unwilling rejection, with which it was my lot to become so familiar later on, but which I had then not yet recognized as my unavoidable destiny.
The fact that a grossly sexual, tender or inimical, transference occurs in every treatment of a neurosis, although this was neither desired nor induced by either party, has, for me, always seemed to be the most unshakable proof that the forces of the neuroses originate in the sexual life. ”

“ Menopause is not a disorder but a natural condition of aging that involves changes in hormone levels in the body. Menopause in women can cause intermittent periods of strong anxiety, chronic nervousness, depression, irritability, lack of confidence, and headaches. Physical symptoms include hot flashes, sweating, and palpitations. Male menopause is increasingly being recognized by doctors; symptoms most frequently appear when a man {108} is in his fifties. Emotional symptoms may involve anxiety and depression; physical symptoms include hot flashes, sweating, fatigue, and insomnia. ”

“ Worried, fearful, anxious, self-pitying, excitable, or melancholy, the nervous person proves that whatever else a neurosis may be, it is, in essence, a riot of the emotions.
There is small wonder that a riot at the heart of the empire should lead to insurrection in every province of the personality. It is only for the purpose of discussion that we can separate feeling from thinking and doing. Every thought and every act has in it something of all three elements. An emotion is not an isolated phenomenon ”

“ Anything which arouses the fear instinct in the inhibitory or paralyzing stages will necessarily give rise to psychopathic functional psychosis or neurosis. The fear instinct and the impulse of self-preservation, inherent in all life, are the alpha and omega of psychopathic maladies. ”

“ He came to the same conclusion as I that the etiology of neurosis is to be found in fear, which alone forms the basis of psychopathic neurosis. All other factors, social, professional, sexual, religious, repressions, conflicts are only occasions of the disease. [172] It is fear, and fear alone that forms the pathology of the psychopathic neurotic symptom complex.
A young lady was afflicted with ornithophobia, fear of birds, fear of chickens. The sight of a chicken set her into a panic. The patient is very timid, and this timidity can be traced to her early childhood. ”

“ In other types of psychopathic affections the patient is entirely unaware of the whole situation, he is engrossed by the symptoms which he regards as the sum and substance of his trouble; the fear is entirely subconscious. Frights, scares, dread of sickness, instructions associated with fear of the mysterious and unseen, injunctions with fear of punishment or failure in moral standards, enforcement of social customs with dread of failure and degradation,—all go to the cultivation of the fear instinct which in later life becomes manifested as functional psychosis or neurosis. ”

“ I said, that Superstition was the child of Fear, and Fear the child of Ignorance; and you might expect me to say antithetically, that Science was the child of Courage, and Courage the child of Knowledge.
But these genealogies—like most metaphors—do not fit exactly, as you may see for yourselves.
If fear be the child of ignorance, ignorance is also the child of fear; the two react on, and produce each other. The more men dread Nature, the less they wish to know about her. Why pry into her awful secrets? It is dangerous ”

“ When, however, menorrhagia is a symptom of some serious progressive condition, psychotherapy will do harm rather than good. I have known women whose menstruation was stopped and then recurred and even became profuse reassured that this was only a symptom of the menopause when it was the first symptom of a cancer. In such cases there must be no temporizing or reassurance, but a careful determination of the actual condition must be made and immediate operation done if it seems necessary. ”

“ The widespread belief among the laity that hemorrhage at the time of the menopause is a normal condition, and that if left alone it will stop in the course of a few years, is most erroneous and fatal. On this altar of ignorance thousands of women sacrifice their lives every year. The case-book of any gynecologist will testify to the truth of this statement. The following three cases will serve to illustrate different types of hemorrhage in cancer patients, in no one of which did the patient even suspect that she was suffering from anything more serious than the "vagaries of the menopause." ”

“ Fear, worry, anger, envy, jealousy, and other negative thoughts, reflect themselves most disastrously in the human system. Fear has paralyzed nerve centers, and turned the hair white over night. A mother's milk has been poisoned by a fit of anger. Fear and Hate—father and son—have produced insanity, idiocy, paralysis, cholerina, jaundice, sudden decay of teeth, fatal anaemia, skin diseases, erysipelas, and eczema. Epidemics owe their rapid spread and heavy death rate to Fear and Ignorance. Epidemics may kill their dozens—Fear kills its thousands. ”

“ Since adrenalin is the starter of the whole process, and since McDougal has defined emotion as the feeling aspect of an instinct, just as an instinct may be defined as the motor aspect of an emotion, the adrenals as emotion-genetic, and instinct-genetic, play a part in the most profound processes of the subconscious and unconscious.
THE MECHANISM OF FEAR We may therefore visualize a mechanism of fear. An instant excess of adrenalin occurs in the blood of, say, a cat when it is alarmed by the sight of a dog. In that cat, at the image of its hereditary enemy, certain brain cells vibrate. ”

“ This holds specially true of nervous cases, and particularly of psychopathic patients, who are dominated by the impulse of self-preservation and the fear instinct. The fears and worries keep the patient awake, and the subconscious fears become emphasized by concentration of attention, monotony, limitation of field of consciousness, limitation of voluntary movements, and other factors favorable to dissociation and the induction of the hypnoidal state, in which the patient becomes sensitive to the awakening of the fear instinct, with all its horrible fear suggestions. ”

“ That man is unconscious of his fear, neither changes its effects on the body nor the mental fact; ignorance of the cause, or approach of disease, not in the least militates against its mental origin. More or less fear accompanies all ignorance; who that understands the power of mind over body, its impelling force, and how controlled, and this very ignorance, like walking in darkness on the edge of a precipice, is an ever-present involuntary fear. ”

“ These superadded physical symptoms can be readily relieved by directions for rational living and then the genuine menopause symptoms may be so diminished as to be scarcely noticeable. It is impossible for the ordinary human being to stay much in the house, to lie down a large part of the time, eat irregularly and let the bowels become sluggish without having many symptoms of depression. ”

“ Puberty or the period of development extends over several years, so the menopause or period of atrophy extends over a period of from three to five years. If a woman relaxes and allows32 the changes to proceed naturally she need have no cause to worry, but she must remember that rest from continual strain is necessary during this period. Freedom from care, relaxation of physical and mental effort, regular periods of complete rest once or twice a day, a reduction of the diet and regulation of the bowels should be the first principles of treatment. ”

“ The treatment of the menopause should be directed to the maintenance of the general bodily and mental health. The diet should be carefully regulated. Too much nutritious food should be forbidden. Purgatives should be administered whenever necessary. The woman should have plenty of fresh air and the proper amount of exercise. ”

“ At the first signs of hemorrhages or excessive flow, a woman should place herself under the care of a gynecologist (specialist in the diseases of woman) , just as a pregnant woman is under the care of a physician until she is entirely free from the dangers of childbirth.
Women have heretofore looked to this period with dread, on account of the consequences which neglect has caused. It need not be dreaded for assuring word comes from prominent physicians who have made this special period a study, that the natural symptoms of the Menopause do not portend loss of life, reason or health. ”