# Popular Science Monthly/Volume 79/October 1911/The Relative Importance of Mental Pain

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* THE RELATIVE IMPORTANCE OF MENTAL PAIN
By SMITH BAKER, M.D.
UTICA, N. Y.
IT is everywhere thought beneficent and just to recognize the demands of physical pain, and to furnish prompt and effective means for its relief. Let there be but the least significant crick or colic, the dullest ache, the most transitory throb, and it is almost universally considered uncivilized not to try to give the sufferer relief from such an intrusion upon his sense of comfort and safety.
When, however, we look at the other aspect of human suffering, the one that is much more closely intimate, and yet much less evident to observers—the psychical, the mind-and-heart side of mortal suffering—we come upon the interesting if not startling discovery that there has been, and still is, comparatively speaking, by far less attention given to the truly exceptional needs of this kind of suffering than to those of physical derivation, even though so frequently these latter are of the lower order and of the lesser significance.
Of course, it should not be inferred that the significance of mental pain has never been recognized, nor that useful attempts at amelioration have never been made. Quite a proportion of the work of the sympathetic and other helping classes has ordinarily been and is now in some way to comfort and encourage and otherwise mitigate and even cure, the mental distress of their fellows. Moreover, it can be joyfully conceded that the sick-room has always and everywhere been the scene of useful effort on the part of the more strictly professional classes, through sympathy and persuasion and cheering-up and every •other sort of constructive and kindly attention, to relieve the sufferer from everything which might add mental distress to his physical ailment. All this has been worthy, most useful, even though as yet it may be counted, chiefly as but a sort of foundation experience upon which real systems of relief shall be built, those which shall certainly be far more truly and widely successful than hap-hazard methods have hitherto proved.
But granting all this to be true and as praiseworthy as useful, it still should not appear to be far-fetched or intrusive once more to invoke still further consideration of the relative importance of mental pain, or confidently to express the hope that in the very near future the extent and depths of this shall come to be by far more adequately recognized and appreciated; and that the art of preventing and ameliorating this shall be considered as much a matter of simple duty, ​as has been or will continue to be the art of preventing and relieving pain that is distinctively physical.
But first, what is "mental pain," or "psychalgia," as it may better be called? What evidence have we that aside from some form of physical pain there is ever any such thing as "psychalgia," that is, something which can be more familiarly and supposably more clearly noted and described than heretofore, and consequently more satisfactorily dealt with? If present how are we to differentiate it, and thus be reasonably sure that we are not dealing with mere phantoms—something that is not fixable or definable, and not to be rationally handled in any way?
Probably no one can truthfully say that there is such a thing as mental pain who has himself never suffered from it, and at times when physical pain or distress has not been present to such a degree as to obscure or complicate self-observation, beyond differentiation. For, no matter how dire the psychalgia in the latter case, the suspicion must arise that it was but merely a quale—quality—of the physical condition, and so not susceptible of being considered as a distinctive kind of suffering at all. To be this and to be worthy of consideration as a true psychalgia, it ought at least to be capable of being consciously remembered as an experience by itself, dissociated somewhat clearly from every physical condition save that of general well-being, and in most cases, at least, of being referred back to certain causes, which, whether true or not, are consciously regarded by the sufferer as having been of distinctively mental origin.
By way of attempt at elucidation of this requirement, let us consider instances where the psychalgia, instead of being an exclusive experience, is apparently the direct consequence of personal shock and stress, and where primarily there are various wide-spread physical changes, especially in the sphere of metabolism, all of which must be included in any truly scientific consideration of the subject. To the sufferer himself these physical changes are of little importance, except as they are explained to him as possible sources of his mental distress. To him, it is his mind that is distressed, not his body: for the time being, all his regard is monopolized by his psychalgia, and if not told otherwise, he may not even suspect that anything but his mind is or ever will be affected by the causal event. If he be introspective and at the same time analytic enough, he will chiefly or exclusively note that his mental horizon has become painfully restricted; that his ideation is being painfully overworked along some certain narrow lines: that his emotions are all suffused with pain, even paradoxically when little or in nowise disturbed; and that his outlook upon the future is simply too painful to be invited or prolonged. In fact, it becomes evident that all the pain which the sufferer experiences is referred to his mind ​as something distinct from his body, and is there, and only there, to be met, handled and helped, if possible. "Give me relief from this awful feeling of inadequacy—from the pain that accompanies every thought—from the dark that clouds all the future. Please do this, and I will be well," is the cry: and to the sufferer this is all there is that can be described or helped.
Of course, psychalgia may accompany or succeed every form of physical distress imaginable; but even here, it is characterized by the very same consciousness of intellectual inadequacy and underrating, of emotional unrest instability and depression, as well as persistent vision of future blackness, as elsewhere; and has corresponding need to be regarded and dealt with, so far as possible, as distinctive from the physical distress present.
With these leading characteristics of psychalgia in mind, suppose, by way of still further helpful elucidation, we investigate and follow the course ordinarily taken by a case of so-called "traumatic neurosis." Here there are, especially at first, clearly outlined localities in the. organism whence waves of purely physical distress emanate, whose origin can not be accurately referred except to their organic source. But in time these come to be associated with certain other waves of pain, whose localization is not so apparent, either to the sufferer or to the investigator. In fact, eventually a large proportion of the suffering of the patient is seen to consist in pains which have no locality outside the selfhood that has been so direly and so deeply insulted by the injury. Often, too, because of supposed blundering on the part of his own self, or rebellion at "fate" through consideration of his present predicament in connection with previous experiences, or of vengeance against the objective cause of his present trouble, or of fear of possible untoward consequences, or of changes in intellectual strength and acuteness, emotional tone, will-power, self-control or self-direction, there comes additionally an abiding, ever-deepening sense of degradation, which eventually enshrouds him in distress that seems as coextensive as consciousness itself and as intense as imagination could possibly picture. Surely, if we have no means of absolutely differentiating the psychical from the physical pain—the psychalgia from the neuralgia—we are nevertheless not precluded from recognizing such differences at the focal points of the two kinds of distress, as to lead us rightly to deny that these may possibly require very different kinds of estimation, for the highest good of the sufferer. In fact, while splints and plasters and lotions and doses may succeed admirably in relieving the physical consequences of physical trauma, it should not be forgotten that the accompanying psychical trauma is of another order, and has very different needs, as to both estimation and remedy; and this, no matter how clear may be our notions as to the physical distress, or how this may contribute simultaneously to psychical distress, as well.
​Or, take a case of developing melancholia, where again the physical and the mental seem to vie with each other in the slide downward into abject misery. Here the defective metabolism, the choked secretory and excretory functions, the muscular weakness, and all the rest, are sufficient in a way to explain the mental condition as represented by its own peculiar slowness, weakness and distress. But however much and clearly these may "explain" to the observer, they most certainly do not constitute the pain which is really suffered—the morbid self-consciousness, the overwhelming depression, the fear of self-destruction, the dissociation from the rest of humanity—in fact, the poignant psychalgia, for which only personal experience can afford correct knowledge or provide the data for anything like a correct description. To all such, psychalgia is a definite, horrid fact, not to be mistaken for any other fact in the universe.
Take again the perplexing development and especially the slow systematization of the inner experiences of the youthful hebephrenic, or paranoid. Beginning with scarcely recognized perversions of one or more sense functionings, or with weakening or perversion of the more elaborate perceptional or ideational activities, the victim duly comes to the point where everything persistently clusters about his inner self, progressively to lead on to perplexity or danger or failure, with all the poignant mental distress that naturally belongs therewith; so great distress in fact, that long before such a state of self-monopolizing is reached, there is a period during which mental pain is so predominant that often some sort of real physical pain may be welcomed as chiefly beneficent. Surely, no one can suppose that the weakness, the muddlings, the suspicions, the fears, the antipathies and antagonisms, the imperative insistences and explosions of such an one, can be confounded with any sort of physical pain whatever. Here, as before, psychalgia is felt to be a fact, distinctive, dominating and determinative.
This leads logically to the consideration of the by far largest group of psychalgias, those derived from the so-called "border-land" cases on the one hand, and from the great number of persons who in no ordinary sense are "cases" at all, on the other.
Abnormal psychology has yet an imperative need to be studied as never before, and this notwithstanding the far-reaching revelations and suggestions of more recent investigators. In this undertaking, introspective psychology, prosecuted by the right kind of self-observers, can become of such profound use, that almost everything as yet discovered may turn out to have been introductory, to say the most. Probably, there is no one who has been trained to properly look in upon himself, who does not have more or less frequent attacks of psychalgia so clearly defined, that were they accurately observed and recorded, a key would be furnished whereby not only the problem of his own morbidity could ​be solved, but also a standard could be established whereto similar morbid experiences of others could be profitably compared.
From cases of border-land psychalgia we often get descriptive phrases which throw light upon the intensity of the suffering, and leave no doubt as to its reality, as well. One of the most frequent of these phrases is, "Oh, I am so lonely—(or fearful, or depressed, or weak, etc.)—this unceasing, day after day, year after year, loneliness—etc." Here, as much as anything, for want of the simple instruction that as the "uniqueness" of any given individual must always carry with it a fundamental detachment from every other individuality, so must necessarily a natural loneliness reside forever in the substratum of every one's consciousness, and must normally or abnormally emerge only as endurable pathos, on the one hand, or as dire pain on the other, the sufferer necessarily goes on day by day accumulating a feeling of outof-the-world-ness which in time gets to be so painful, that the all of life may and often does come to be subordinated to it, entirely beyond self-emancipation. Surely, it were not humane, to say nothing of its not being good sense, or scientific, simply to ignore or scout the evidence of, or to jeer at, or malign, or to continue to misunderstand the distinctive importance of such a condition of suffering as this.
Again, there is the expression, "Just show me how I can have a little bit of happiness, even for an hour, and I'll bless you as never before," and all the changes rung on this, everywhere and everywhen. For purposes of truth it must be conceded that a reasonable amount of frequently recurring happiness together with the ever-present feeling that such experiences are truly prophetic of the future, is simply a basic necessity to the perpetuity of a reasonable state of well-being; and this in spite of Carlyle's demand: "By what act of Parliament was it decreed that Thou shouldst be Happy?" The simple fact is, that all energizing, all hoping, all accomplishing which does not have an inspiring element of happiness in more or less conscious suffusion, is not satisfactory, but the reverse; and this, notwithstanding so much seems directly to the contrary. Happiness of some kind—positively ecstatic, mildly expectant, a glowing interest, realistic energizing, comforting self-consciousness, vision of growing possessions, personal ease, enlargement of the family circle, faith that sees heavenly things—happiness of some kind, is the motive force of human life; and once let the enjoyable self-tone be lowered unduly for any length of time, or its rightful possessor be too frequently or too permanently cheated or denied, and he ceases at just this point to be fully what he ought to be either by divine right or by natural law. And the consciousness of all such cessation of fullwell-being—how many degrees of psychalgia are included therein! And how wide-spread too is just this same consciousness of every other form of unhappiness, with never a respite, and with no encouraging prospect.
​And then, there is "disappointment "—in love, in business, in politics, in health, in preparation for life, in church affiliation, in children; disappointment in man's sense of honor, in woman's high soul, in the constancy of friends, in all ambitious prospects—for which we so glibly say, "show thyself a man," or "wait patiently on the Lord "—and think that we have said it all; and so we probably have, until we, in turn, direfully find ourselves learning very differently, through what our would-be friends call just our "own doing." Then, how different does pooh-poohed disappointment seem; how revelational, too, in that now we can see how others did actually suffer while we were regarding them as merely "weak" and consequently as but "poor things," at best. Kor does it matter really, if "one has brought it all on one's self "; indeed, all the more should we see how much does this but add to his distress, and how much does it have to do in prolonging and deepening this indefinitely; indeed, until it may most unexpectedly result in such permanent registerings, as may quite absolutely unfit him for any further useful accomplishment in life. For, first and last and all the time, it must be remembered that the outcome of psychalgia, unless acting upon exceptional constitutions, is unfitness for even the commonplaces of life. Of course, the exceptionally endowed individuality reacts differently, at least for a time, and for the most part, constructively; but the common cry of the victim of mental pain is, "I no longer can do as I once could; I'm not really fit for anything now "; and his subsequent life is apt only too conclusively to prove the correctness of his cry, and the predictive fear which accompanies it.
Morbid "self-consciousness," too,—how wide, vague, mysterious is this, yet how fearfully painful, especially when subject to misunderstanding, neglect, or brutality. Shall any one say that here is something that is not a source distinctively of the most interfering if not destructive kind of psychalgia? Try to get a definite appreciation of the flashy personal commotions, the wide-spread vaso-motor reactions, the stagefright, the unaccountable antipathies and fears and obfuscations and general overwhelmings, that such a one suffers from; try to get a clear vision of all the futile efforts of intellect and feeling and will to ward off and overcome these; try to get a fellow-feeling of all that this means to the personality which would be something and do something and feel something like other people; and then see if it be possible to regard mental pain as less significant than physical pain, either distinctly, or side by side. Certainly, no one who has never suffered the pangs of morbid self-consciousness should stupidly deny their existence; for there are many, many people who go through life virtually conscious of nothing else, in any vividly continuing sense. With every glimpse of their own bodies, with every movement, with every contact with others, with every thought of planning or doing anything, with all their hop ​and realizations, there is such a tormenting intrusion of painful selfhood upon consciousness, that a desperate fight for place and favor, or even for existence, is always on, and the issue seldom if ever comfortably assured. Such people, in no sense technically "insane," are yet so burdened with a veritable soul-pain, that it is only a "kind providence" which for the time being keeps them from becoming unbalanced—a providence, however, which may yet some time call very loudly to any one who happens to be at hand, to come to its help against this "mighty" scourge, and all the indecisive conflicts which are part and parcel of it.
Undertaking now a yet closer study of this widely prevailing sickness of soul, expressed in so many morbid variations of consciousness, it does not take long to come upon the truth that probably the greater proportion of these cases are primarily owing to the fact that the personality itself has never from the first been properly harmonized, that is, has never become thoroughly enough blended in the course of its development to avoid remaining other than a veritable storm-center of all the ragings of emotion and ideation and volition, which are here as incalculable as they are pain-producing. Whether this unblending is due to such disparities and tendencies in the several ancestral lines as do not admit of continuously close relationship and coordination, even in distinct individuals, or whether the course of "bringing-up" from birth onward has been such as never to overcome the natural heterogeneity of the personal elements, probably common to the genesis of every human being, does not matter. The outcome, a heterogeneous or imperfectly blended or ununified personality, may almost everywhere be discovered as constituting at least a very natural soil in which rank psychalgias may easily generate and grow and forever plague and choke the possessor quite beyond description. To stand on the brink of a seething surging crater, whose sulphurous fumes never cease to stifle, and whose eruptions are always immanent and frequently realized, might afford some sort of parallel to the position occupied by some of the more deeply afflicted of these cases; only, the man by the crater might possibly recede from his danger at will; while no Prometheus was ever chained more absolutely beyond self-help to his Caucasian rock, or was more horribly subject to tormenting insults both from without and from within, than is the one who finds himself inseparable from the miseries of the species of psychalgia that are chiefly due to heterogeneity, or to this in combination with all the imperfections of our natural growth and conventional breeding.
​Speaking of "soul-sickness," brings to mind the subject of "religion" in all its bearing upon the consciousness of well-being or ill-being, and the profound interest, comparable to the acknowledged importance of the subject, thus insured. Formerly, certain classes of people at some particular times in their lives would come more or less unexpectedly to a more or less vivid and painful view of their sinful selves; then, perhaps for a longer or shorter period, would go through a series of spasms and stresses of conviction and renunciation and pleading and aspiration; but would in time "come out" of it all so victoriously, that usually forever after God was felt to be so good and so near that "salvation" and the "joy in the Lord" thereof were more or less fully assured forevermore. Along with these fortunately "converted" people, still other classes also have quite naturally experienced such a sufficient "assurance" of their "call," that they have quite uninterruptedly found ample solace for their untoward depression and apprehension, whenever needed. Thus, heretofore, many people have actually found, that when attacks of mental pain came on, they could go unreservedly to the "fount of all mercy" and find what to themselves, at least, was satisfactory relief. Indeed, whatever criticism may be justifiable with respect to religious dogmas and institutions, it certainly is not wise to forget that the human personality everywhere has recognized and does still recognize a supreme worth in its religious consciousness, and has found and still finds its profounder weal or woe in the spirit of religion and the practical exercises inspired by this. Woe indeed is it when religious fears and apprehensions and the general gloom arising from an abiding sense of detachment and loss, comes to pervade all the soul-life and simultaneously sees no or little relief. Joy indeed, too, when relief does come, or when the general religious temperament or atmosphere or experience begets the "joy that abides," in true realization of the Source that is Infinite! It does not do for even the most clearsighted materialist any more than it does for the most devoted metaphysician, to forget that this deepest-sounding and farthest-reaching of all vital experiences may through mental or other pain come to be but a mere travesty of the real life, or that such abject misery and this only may irretrievably "damn" the subject long before the pains of future perdition are possible. "Hell on earth" is not a figure of speech to very many people; it expresses exactly the sufferings of those who are the victims of the sort of psychalgia which is owing to perversions and failure in their religious life.
A concrete case of associated mental and physical distress, occasioned by a succession of experiences certainly not very common, will serve to make plain not only the comparative significance of the more intimate kind of experience, in a way that can not be mistaken, but also somewhat to elucidate the blundering and inefficiency to which sufferers of ​psychalgia are, let us hope unwittingly, everywhere subjected, chiefly because of failure to recognize its distinctive characteristics and needs.
The lady had reached middle life before anything other than unrealized motherhood had noticeably hindered or marred her fortunes. Then domestic troubles, loss of property, major operations came to shock and strain her in quick succession; but even these had she surmounted bravely and successfully; only, however, to develop in time the insidiously undermining of muscular control and all that goes with it, known as "Parkinson's disease." After this had reached an observable stage, it was evident that she had before her, not alone many long years of suffering from her tired painful ever-pulling muscles, for which there was no known cure, but likewise an ever-increasing danger from intercurring diseases and accidents, which could only be averted by constant care. But worse, much worse than all this, there was the horrible prospect that through it all her intellect was to remain as clear and the sensibilities as keen as ever, and that until the very last she must necessarily be the cruelly enforced observer of the entire course of most fiendish progressive physical decline. In fact, pain of body and pain of mind were to be in closest concomitance throughout. Already she had been partially apprised of the nature and cause of her disease; yet had evidently allowed herself to expect a more or less positive denial of this. But the facts were unquestionably against every view save that of unqualified affirmation—to be softened, however, as much as intelligent sympathy, general hopefulness, and patient care could make possible. Especially was it thought additionally desirable to endeavor to instruct and encourage her in the art of keeping her mind as rightly occupied on matters outside herself as possible; and also by suggesting a variety of means for combating the awful waves of depression and despair which had already begun to pass over her battered feelings and were sure to come with increased force, later on. After a month or so of this, during which time she had gradually become more fully acquainted with the true nature of the fight that was before her, as well as with a number of really useful measures for temporary relief of changing symptoms, especially those evidencing the "sick-soul" which would undoubtedly be the ground of some of the most poignant of her sufferings, she seemed vastly better prepared for her prospective ordeal, in that she had seemingly conceived and adopted the large and comforting assurance, that come what would, she would "make the best of it," and persistently remain all she possibly could be to the relatives and friends in whose circle she was to live.
Soon after this, however, she fell in with a member of a coterie of "faith curists," who assured her that she had no need to go through all that had been hinted, if not predicted, but could most certainly be "cured" simply by prayer, if only she would allow them to take her ​in hand. Doomed as she otherwise rightly thought herself to be, one can not very consistently blame her for avidly grasping at the promised salvation, given with such assurance, even if from no matter how really unknowing a source. Submitting both honestly and unreservedly to the efforts of the "prayer circle," she seemed to "get better from the first," and, some two months later, it was noted that she could actually carry herself with somewhat better step, with a brighter face, and most of all, with the absolutely unembarrassed confidence that "before long she would be entirely well"; for "God can do anything, as you see." One could not be entirely dishonest in feeling much of the gladness with which she was congratulated upon her improvement, or in expressing the hope that this would continue indefinitely; yet, within, one could not help anticipating none the less clearly the fateful day of abject sadness and despair which would surely come to her, when she had all too pathetically found herself disillusioned and her physical disease quite perceptibly advanced, as well. One could indeed feel glad that she had had this much respite from her mental distress; but when one thought upon what ignorance of the facts, upon what fanciful assurances, upon what perversion of the highest offices of even present-day possibilities, her temporary release from suffering had been founded, one at least wondered if the temporary "gain" would in the long run be worth the irretrievable loss of confidence, true faith, and reasonable hope that was sure to ensue. Better, it seemed, that she should have patiently continued from the first without deviation in the persistent course of mind and soul cultivation and strengthening which had been marked out, or better still which might have been marked out, had some one more capable been her adviser, than to have experienced a but specious exaltation for a season, only to fall into the direst slough of despond, suspicion, digust and what-not, as she in due season must and did. From this awful jolt in her mental life she had better have been saved, so it seems even yet. Although what a thought significantly follows; if only she could have been given the comfort without such a train of miserable consequence! After spending several weeks or months with this sort of people, and, more consequentially, after having given them all her little savings as well, and then found them mostly "uninterested" afterwards, she returned to her home where for more than seven years she divided the slow days and tortured nights between all the horrors of the deceived, the disillusioned, the despairing, on the one hand, and the bravest endeavors imaginable to endure patiently everything, and likewise not to become too rebellious against God and humanity, on the other. And during this period what a transformation physically, was hers. Slowly, step by step, ordinary communication with every one came to be cut off; while all their sayings, doings, feelings and entire lives yet remained as patent to her as before. Then eventually came the hour when not a ​smile, nor a finger clasp, nor a syllable could she give, in token of her recognition of the life about her. For a couple of years or longer the only expression possible was through her clear eyes, which always seemed to be automatically trying their best to tell how truly their owner responded, really if not voluntarily, to every effort to communicate with or to help or sustain her imprisoned spirit. Once in a while an explosion of meaningless laughter, so unlike the laughter of her former self, would startle one with its unexpectedness as well as quality, but would carry little or no meaning, as only exceptionally would there be any such response to the pleasantries (which it was remembered she formerly rejoiced in) as would suggest that impression and expression had remained very closely associable. Indeed, it was obvious enough that she had now become only a bundle of impressionable tissues, organs and centers, never so keen as now, never so liable to insult, never so pitiable; simply—was now practically helpless in body—yet absolutely as active in mind as ever. Not disembodied, but body-burdened, was her soul to continue through all these months, to see on, hear on, taste on, feel on, think on, hope or fear on, rebel or acquiesce on, love or hate on—but always to be increasingly conscious of the body that was dying, dying, yet ever alive to ache, to hinder, to endanger! With Dante how truly could she have said,
I did not die and I alive remained not.
Yet, to those who were closely about her, to the great world that but little more than heard about her, even to those who were under obligation to interpret as truthfully as possible, it may be doubted if any one ever got more than an inkling of the great mental anguish or even physical distress suffered by her, until she herself as pathetically as surely made it known. Assuredly, the manner and speech and life of the household and neighborhood did not evince much beyond commonplace understanding sympathy and effort. And as the most interested may now look back upon his own thought and care of her, how paltry, too, how inefficient, how bungling, compared with what it ought to have been or might have been, does it all now seem!
And so all had waited until, in spite of everything—in spite of the greatly augmented sensitiveness of impression, in spite of the locked-up systems of expression, in spite of slowly entombing fate, in spite of inner travail, pain and unhappiness—had waited until this most pathetic sufferer conceived and perseveringly gave to the world, what probably is absolutely unique in letters, and better than this, even, something which may possibly be so pondered by all who have to do with human suffering of any sort of the locked-in kind, that to the end of time the human heart universal shall be the better for her effort.
Imagine her then with but the slightest power of denoting her wishes, and this with uncountable bunglings and failures, sitting at her ​table, perhaps tied in her chair, with a series of baby alphabet-blocks before her. Her attendant opposite tries to make out what is wanted. Over and over again nothing is determined. Then it slowly dawns that she hopes to use these blocks to make known her wishes. Then, again, after weeks of trial, it is learned that she wishes to write a letter. But what a task is before her and her interpreter. Evidently, as it is not a commonplace communication that she wishes to make, the ordinary words and phrases must easily fail. But how difficult to be sure when the right letter or word or phrase is reached; even her simplest thoughts and feelings, to say nothing of the great determination in some way to succeed in more complicated expression, is so impossible. But slowly, with patience that should be crowned by all the Academies—slowly one by one, letters, words, phrases, sentences, even unto as many as eight note pages, and requiring as many as two full years or more to do it, was the precious revealing letter evolved—to be read in two minutes, to be forgotten—never! A letter so intime, so exceptional, so precious, that as a voice from the tomb did it come; as an appeal from the innermost soul of humanity, should it be received.
Nothing but the dire, infinite needs of the suffering soul of humanity's very self could justify the publication of such a communication; yet the justification is complete, when once we think of all the many selves that are everywhere suffering, if not from living entombments, then from death-in-life psychalgias, which if not physical are yet not the less horrible, and have similarly day by day through all time so absolutely to feel the great need of accurate recognition and efficient ministering.
Beginning our use of this letter at about its third page, she says, "While I look at the ceiling I see beyond and live in a world of thought and imagination. I take journeys, make visits, write letters—am like a live spirit in a dead body. Though I seem to be dead and irresponsive, I feel as if I were made on the principle of a toy jumping-jack, with some one pulling the string, holding my head back and mouth open. I must be a repulsive-looking object," she continues. "I must look like a fool, anyway." To one who had known her even when but partially well, and had noted her most delicately feminine appearance and ways, it is only too clear that observation of the successive steps of her progressive physical degradation was not among the least of the sources of her mental distress. "My throat and mouth are in dreadful condition. . . . My tongue refuses to work. My teeth all seem to be dying like the rest of my body. My tongue has grown short, I can hardly get it outside my mouth." No wonder that her next words are these: "I suppose books tell you these things I suffer and endure, but that little innocent word 'helpless' must be lived to know its meaning and misery. Add speechless, and the trifles of daily living become mountains of trial." And now ​hear the deeper revelation: "One is misjudged," she says, "misunderstood, called unreasonable, when, if I could explain, it would be the other fellow," And how full of suggestion for all: "This life of inaction and repression is full of misery. It is only with the thought of putting yourself in her place, can one get any idea of the awfulness of living in a body that refuses to do anything for you." Ah! that thought of putting yourself in her—in any one's place. What a field of enlightening, constructive imagination is here, always. "I never dreamed of such a combination of conditions and circumstances of physical suffering for one to endure," she continues. Nor was the mere fact of personal suffering all; for she so regretfully adds, "I drink my cup of poison every day, and give a portion to every one around. It is awful to live and be such a disagreeable burden. I am like a lead sinker around—[her husband's] neck. It would be easier if I felt sick and weak; but I feel all the springs of life and energy to be and do." And how the realization of soul-body anguish deepens as one reads further; "People think I am comfortable when I am quiet; but I can not be anything else. I can not move an inch, no matter how cramped I am, or how things hurt. My suffering is constant and its name is legion." Yet, in spite of all this, note how characteristically it was to be added to: "Father [her father-in-law, a fine old man who had constantly, lovingly cared for her all the days, for years] has gone home [i. e., died] and left me adrift on a sea of helplessness and silence. I suffer for want of him every day. He had grown into knowing my needs as no one else could. He was hand, feet and tongue for me. It was a sore trial to him, but he was ever sweet and patient. He filled a large place in the house, and it seems very empty without him. His was unquestioning trust, child-like faith, and so free from criticism of others. He was a lesson to us all. Oh, we felt so sure to trust him." How satisfactory in every way, that so much of this letter is devoted to such an appropriate tribute to devoted efficiency and kindliness. "When you were here in May you asked me to write you a letter. I wanted to tell you there was one in the mill, but that it grinds slowly." This was probably two years or longer before surprise at receiving it came. Going back to an earlier portion of the letter, written probably about the time of the asking for it, she says: "I dread spring and summer. If every day were a zero-blizzard, conditions would be easier to bear. When all the world is alive and stirring, it is harder to hibernate. In my corner, tied hand and foot and tongue, I am like a rat in a trap—the only thing left to do is to squeal "—a pathetic bit of the native humor which when she was well had ever irradiated her whole life.
Finally, to show how clearly appreciative she was, how inwardly responsive to even such poor desultory effort as was doled out (too often when most convenient, one fears), and especially to suggest how if a ​system of recognition and care more intelligent, much more devoted had been employed, so much more good could have been done, let the conventional veil of sacred personality be removed from the very beginnings of the letter, and thus complete the picture as contained in its entirety: "I can only thank you," she begins, "for all your generous thoughts and deeds." Carlyle's remorse at his meager treatment of his "poor Jeanie" comes deprecatingly to mind as one now reads this again. "You are say-well and do-well bound in one frame."—What one ought to have been and done, rather. "Your Christmas book came; it was full of words of comfort. I have written to you in thought many times; it requires heroic effort to make it real. The lovely flowers spoke of you many days after you were here. It will soon be time to think of your coining again—always good to see you, and have your presence."
Unquestionably this is too personal to be published except for one reason—the immeasurable reason for calling attention anew, and with all the emphasis possible, to the need of a more universal recognition of the thickly peopled realm of psychalgia—the mentally anguished, the sick-of-soul—as well as to the never-lessening need there is of finding ways and means for more successful amelioration of such suffering, and of applying these with an efficiency heretofore unattempted. How often has one in the presence of this unique sufferer, as has been the case in the presence of many another less distinctive, felt an utter unpreparedness for rendering the relief which instinctively one has felt to be needed. Yet note how she understood, magnified and appreciated what little one did attempt. Could one have been intelligent enough, skillful enough, sympathetic enough, and could those in more immediate association with her have been similarly endowed and prepared, what indeed might not have been done to relieve, if not the bodily suffering then the mind and heart suffering, which was ever so present and so insulting.