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Disabilities

33. OBSESSIONAL NEUROSIS*

IT is difficult to remember a time when my life wasfree from problems. - It was, however, when I went to my public school that they began to crowd upon me.The life there bewildered me. The conventions weredifferent from anything I had met previously, and Icould not make companions easily. There were otherswho were duffers at games, but they did not have the difficulties I encountered. I would lie awake at nightconvinced that I had left an essential word out of anessay I had prepared. It was not satisfactory to tellmyself that I could add it in the morning. It was notthat that bothered me. It was that if I did not writeit there and then some dreadful harm, though I did notknow what, would overwhelm me. I was far too scaredto go and see, though I felt I ought to. And it was

always the same in the morning-the mistake I hadbelieved I had made -wasn’t there. Then there were

religious doubts. Nobody else seemed unduly worriedby the sermons in chapel. I was. They seemed toforetell doom. I became absorbed in the Bible ; notfor any specific religious reason, but to convince myselfthat the fears I had were unfounded. The worst of itwas that I had no sooner .convinced myself than somefresh fear arose. .

It was a good school with good teachers, but I washorrified by the tales I heard, -and no wonder I lostweight. I was taken to various doctors who soundedme and reassured my parents, but who knew nothing ofthe torments I suffered. There was one pet subject-maths. Here at any rate there was no doubt. Twoand two made four, and (a + b)2 did make a2 + 2ab + b2.There were a host of other excitements. Complicatedproblems of squares, and divisions. Even Pythagoraswas- almost, though not quite, beyond doubt. Thetrouble- was that while I doubted my own conclusions,and was quite certain I had sinned against the HolyGhost, -1 was absolutely clear that my elders must becorrect, and to doubt them only made my crimes worse.

After many different doctors had been consulted

I went into a private bank, and here my mathematicalresearches had full play. My dexterity with figuresfully compensated for the purgatory I had been throughbecause of my clumsiness with balls, and my doubtsseemed to disappear. I rapidly advanced, my opinionwas actually welcomed, and by the time I was thirtyI had become a partner. --

During my twenties three events or opinions shapedthemselves. The first was that the doubts were spread-ing. - They always involved myself and my own safety.The second was that I was clearly very different fromothers as regards the fair sex. No woman appealed tome, and I was definitely frightened of any womanwhom I believed was attractive to others. Nor had I

any homosexual feelings. But-and this is the thirdpoint-in following the family tradition to help in clubwork, which always terrified me, I found that the moreI took to distasteful responsibility the calmer I becamein mind. I even Volunteered to lecture, partly from asense of duty, partly because I had an inkling that the verystress of preparing and giving lectures would relieve

my turmoil of mind. From this developed my interest inpolitics, and I was able to devote time to our local affairs.But although these external interests were, I am sure,ameliorative, the way in which my fears spread andbecame affected by sex was quite alarming. What wouldhappen if I accidentally touched a woman’s hand withmy own ’? My friends laughed’ at my convention ofwearing gloves all the time, little knowing what thisportended. I knew there were " sexual " words, thoughI could never remember anv of them. But -the fear

Retold by the patient’s doctor.

that I might write a " sexual " word by mistake meantthat I had constantly to open and reopen envelopes.For some mysterious reason the fear about sex was

specially strong in the presence of money or cheques,and I developed a ritual for the signing of cheques whichamused my confidential clerk.Awful as this sexual obsession became, it was to some

extent my salvation. Before I was thirty I had neverbreathed a word of my internal worry to a doctor. Ihad consulted a great many, because my doubts includeddoubts about disease. I know it is silly to believe thatany cough portends consumption, but it was as real tome as the certainty during the night that I had mademistakes at school. I got flickerings before my eyes.I am not exaggerating when I say that at - times I wasconvinced that I was,- not going, but actually blind.Then as rapidly the sensation-or perhaps I ought tosay belief-would vanish. I know it is absurd to believethat if, when I use a public urinal, water splashes onmy trousers or shoes I may be harmed ; I can only saythat theidea did for the time being convince me.

* * *

I have had much experience of doctors. In earlydays I certainly told- them too little. Later I becamedissatisfied with the pat on the back-sometimestimorous " this chap will probably go mad but I can’ttell him so " ; sometimes overhearty

" I’ll dismiss himas soon as I can, he’s just a weakling." Suddenly inmy late thirties I developed a real symptom : albuminwas discovered in my urine. It turned out to be posturalalbuminuria, but the investigations led me to a very well-known physician, and he had the capacity for listeningto me as well as patting me. No wonder he was successful.He believed in my absurd worries. He solaced thoughhe did not cure. The discovery of albumin raised

my alarm about disease into panic, and the physicianand his psychologist friend had a terrible twelve monthswith me. They feared I might commit suicide. The

past was a roseate morning compared with the blacknessof what might be.

Gradually I recovered from the constant panic andresumed my political work. I had made two friendswho would stand beside me medically. The psycho-logist (I suppose I should say psychotherapist) has toldme that he wanted to dig into my past. We did not

get very far, and he always admits now that in my case(I was then over forty) the French proverb

"

guerirsouvent, soulager ..." was particularly apt. So it hasbeen for twenty years. My obsessions persist, but theshame has largely gone. They vary from week to week.But the psychotherapist is at hand. Sometimes I do notsee him for six weeks. Occasiona,lly-perhaps twice ayear-I have to see him four times in a fortnight’s badpatch. The knowledge that he is accessible if need beis my sheet anchor. By his persuasion I have admittedto two or three friends something of my difficulties.When I see him I have listed my main fears in a short-hand of my own, for exposure of my worries to the worldis a terrifying thought. He reassures me about them all.He admits that it is theoretically possible that I couldwrite blasphemous words, or enunciate lewd expressions,but says that in men of my temperament an internalcensorship exists that would prevent any such outwardexpression. He assures me (and this is not easy to believe)that many cases like mine are known. That in itself is

encouraging. It makes my private life and worries lessisolating. I often fear harrowing diseases, and hisassurance that Medicine can offer palliative measuresmeans a great deal. He emphasises that my disorder isa real thing, part of my nervous temperament.That this disorder is partly hereditary is not far to

seek. My family history of mental illness is a grizzly one.So far as I know I have never been mad, but for twelvemonths 20 years ago I must have been very nearly mad,

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and sometimes the terror has been grim. I am not a

Church-goer, but I am -very glad that I have time forpursuing worthy causes. The work I have put intothese has kept my terrors at bay. To prepare a new setof lectures, to put the sums spent on drink or footballpools in a fresh and arresting light, is for me enthrallingand sense-saving. And above all there is finance. Mathe-matics remains what it was at school-a fascinatinggame. In my political work I am always ready to makea speech on financial matters, though I like to thinkthat I only speak when I have something to say. Butwoe betide me if I do not express myself calmly andmodestly. For then there will be a week’s worrying overmy doubts or over my health. Samuel Johnson used to

repeat the Lord’s Prayer or Shakespeare to allay hisobsessions. Neither work in my case. But I will lieawake in the dark at night, seeing pages of Blue Booksor Whitaker’s Almanack, or civil estimates ; and as thefigures fall into place, and the right conclusion is drawn,the fear that I have contracted venereal disease or puta blasphemous word at the bottom of my grocer’s billfades and I fall asleep.

Medicine and the Law

Death from Disseminated Lupus ErythematosusAT an inquest in Manchester on June 21, the city

coroner denied a charge that there had been carelessnessin giving ultraviolet-light therapy to a woman withdisseminated lupus erythematosus who died of pneumonia.A verdict of death from natural causes was returned.The woman’s husband said that his wife had entered

hospital for treatment of a spinal disorder. Later shereceived sun-ray treatment as an outpatient ; afterthe sixth application she became very ill and developeda rash with itching and burning. He blamed the hospitalstaff for carelessness in putting the lamp too near andleaving it on too long.According to medical evidence, the patient had in

the past gained considerable relief from pain throughultraviolet light. After the sixth treatment there was

peeling of the skin at the front and back of the chest.There was a rash, but it did not cover the whole of thearea exposed ; later the rash extended’ to the face,forearms, and hands. For the rash to get worse aftera week or two was not characteristic of burning froman ultraviolet lamp. It was possible for lupus erythema-tosus to manifest itself as a result of ultraviolet-lighttherapy. With regard to this treatment, a small dosewas first applied to test skin-sensitivity ; and thedisease might have been expected to manifest itselfafter this test dose.A dermatologist testified that neither he nor his col-

leagues had ever seen lupus erythematosus developthrough exposure to ultraviolet light ; he was not pre-pared to say that there was any connexion betweenthis treatment and the onset of the disease ; nor was

he prepared to say that the treatment had aggravatedthe disorder; in fact he would have expected suchtreatment to benefit the patient.A resident medical officer said that, when admitted after

heliotherapy, the patient had a rash over her face, acrossan area of the chest, and on parts of the hands ;it was itching and burning. The skin on the front ofthe chest was crusted and scaly ; the fingers were

similarly affected, and some areas were raw, red, andpainful; in the mouth were ulcers of the same nature.Necropsy showed that death was due to pneumoniafollowing disseminated lupus erythematosus.The coroner said that the medical evidence had

convinced him there had been no neglect or want ofcare on the part of the hospital staff. The treatmentgiven had been proper.

In England NowA Running Commentary by Peripatetic CorrespondentsIN Canterbury Cathedral the organ is on the screen.

From this high place, at the Festival Service -for theScience and Art of Healing on June 25, we saw doctorsas a splash of scarlet in the choir, nurses behind the altar,crisp as a border of clove pinks, choir-boys below us-tworows of nicely brushed heads-and priests fine as tapestry,far up the chancel. A stately procession moved roundand under us as the banners, the taperers, the precentor,the master of the choristers, the choir, the canons andpreachers, the bishop, and the dean with his two smallcope-bearers went down to receive the Lord-Lieutenantof Kent and the knights of St. John of Jerusalem, whosecloaks bore crosses like a Garter knight’s. " Sing aloudwith gladness," chanted the choir, standing by the westdoor; " sing and praise the God of Jacob. Come yewith music, strike ye the tabouret ; and bring ye thepleasant harp and psaltery." The organ answered theinvocation with the trumpet voluntary, and flawlesssinging began again rising into the arches with nodistorting echo. It was easy to hear Lord Webb-Johnsonreading the first lesson, not . merely because of thefamiliar words, " Honour a physician-" but becausehe paused long enough between each clause for the earto trap the sounds mumbled and twisted by the loud-speaker and translate them into speech. With his longeraddress Lord Moran could hardly speak so slowly, and,though well heard in the choir was lost to us in thegallery. Should not our cathedrals’ consider laying outsome of their building funds on first-class wirelessinstallations ? Perhaps we were badly placed for theCanterbury loudspeakers, but I have also heard, orfailed to hear, services in St. Paul’s and Southwark.St. Paul’s was easily the worst of the three. The bestsermon ever preached will fall on deaf ears if the deafeningis mechanical. ’

Later, in the Chapter House, the splendid archangels,preceded by a convincing- cherub, sailed up the steps toopen The Zeal of Thy House. Whether on the stage orin the hand, this play always turns out -to be even moreimpressive than one expected. It is hardly proper,nowadays, to do two different kinds of things well. - IfMiss Dorothy Sayers hadn’t given us Wimsey, should wefeel this recurrent astonishment over her - religiousplays ? * * *

I don’t yet know who got in at the election of sheriffsof the City of London today ; but my hat ! they deservedto. With the temperature in the 90’s the three candi-dates, in full topper-and-tails, supported by their heroicwives in Ascot attire, stood (surely with intervaIs- forrefreshment ?) all day in the porch of the Guildhall,facing south, well screened by surrounding buildingsfrom any breath of air. And as each of us voters,liverymen all, drove up in our limousine-or moreusually in the cabriolet sent to fetch us by the candidatemost confident of our support—candidates and wivesstepped forward to greet us and even smiled as theyshook our hand. It.nearly broke our heart, when wegot into the great cool hall that was temporarily thepolling station, to place our crosses against only two andknow that the third would have sweltered in vain. ’

* * *

My views on games took an abrupt change a day ortwo ago. It came to me that they could be regardedas art-a. robust and rhythmic form of art. I - mustfind out if anyone else has suggested this : perhapsBernard Shaw in Cashel Byron’s ’Profession; certainlynot Havelock Ellis, who " never wasted a momentover the superstition of games," and who said thatother people’s games " for me (have) no existencebecause they seem to me to be outside life." Surelythe same could be said of the ballet, or surrealist painting.One can’t get away from the idea that there may bean affectation or assumption of cultural and mentalsuperiority in thus despising those spontaneous mani-festations of rhythmic values and artistic sense of themass of mankind. It’s snobbery of a short-sighted kindthat doesn’t try to get behind the outward appearancesof things.