The psychological study of disease is still, alas! a very young and immature science. We have been held so long in the thrall of the materialistic delusion of having to look for bacilli and other micro-organisms behind all diseases that we have almost wholly neglected the psychic factor in disease. It now seems that these psychic factors play the chief role in the so-called “nervous” diseases, whereas all the other “causes,” namely, the predisposition, heredity, infection, etc., it now turns out, do play a certain role, not an unimportant one, it is true, but yet a secondary one. The influence of emotional disturbance upon these diseases has only recently received careful study.

We have learned that psychic causes may play a great role in the occurrence and the prevention of disease. We may confidently assert that without the presence of a psychic component which invokes the disease hardly a single case of nervous disease could occur. Paradoxical as this may sound it is nearer the truth than the orthodox teachings of our day. For who does not recollect times in his childhood when he longed to be sick that he might not have to go to school, and that he might at the same time [Pg 126]be petted and indulged by his parents? A little of this infantilism persists with us throughout life. Hysterics especially are distinguished by the infantilism of their thoughts, their feelings, and their ideas. This being so, we must agree with Bleuler when he asserts that the most common cause of hysteria is the desire to take refuge in disease. It will be of interest here to reproduce Bleuler’s report of one of his cases (from his book on “affectivity, suggestibility, and paranoia,” published by Karl Marhold in 1906).

“A paterfamilias suffers an injury in a railway accident. How terrible it would be if he were so disabled that he could no longer provide for his family and if he had to go through life that way, suffering all the time, and half the time unable to work! How much better it would be if he were dead or wholly disabled. His attorney informs him that his annual earnings equal the interest on 80,000 francs, and that he could bring an action for that amount—a sum which would insure his family against want for the rest of their lives. Are there not indications enough that he will need this sum? Isn’t it a fact that he is already suffering from insomnia? Work fatigues him—his head aches—railway journeys make him apprehensive and even cause attacks of anxiety; how helpful it would be, nay, how absolutely necessary it would be, to prove that he is very sick and to get that 80,000 francs! And now the traumatic neurosis or psychosis is [Pg 127]established, and will in all probability not be curable until the lawsuit is satisfactorily settled.” Bleuler does not mince matters but roundly asserts that in this case the wish caused the neurosis. Would it be proper to call these people malingerers? By no means! For, naturally, all these wishes are not clearly known to these individuals; they suffer in good faith. The wish emanates from unconscious levels. Consciousness vehemently resents any imputation of the thought of simulation. Such invalids usually protest vehemently their desire to be well. “How happy would I be if only I had my health! Then I would gladly dispense with damages!”

Here I should like to report two cases from my own experience which serve to illustrate the refuge in disease even better than the case described by the distinguished Swiss psychiatrist. The first was a very sick woman who had been bed-ridden for six years. No organic malady could be discovered. The diagnosis was hysteria. The deeper cause of her malady was as follows: Her husband was a coarse, brutal fellow, continually upbraiding her for something or other and raising fearful rows; but when she was sick his whole nature underwent a change. Then he became amiable, affectionate and attentive. As soon as she was well he became the old, unendurable, domestic tyrant. Finally, there was nothing for this delicate, weak woman to do but to take refuge in disease. [Pg 128]Her limbs used to tremble and refuse their function, so that she had to stay in bed or be rolled about in an invalid chair. All the skill of her physicians—and she had the best the metropolis had to offer—proved unavailing. Naturally the cure of such a case is hardly possible unless one can remove the cause for the refuge in disease. In this case this solution was out of the question, and so the woman goes on enjoying the blessed fruits of her invalidism, complainingly but not unhappily, exulting within, but miserable without.

Our everyday life furnishes numerous petty examples of refuge in disease: the nervous wife who breaks out in a hysterical crying spell if her husband reproaches her; the schoolboy who complains of headache when he cannot get his lessons done; the husband who gets pains in the stomach every time his wife makes life unbearable;—they all take refuge in disease as a means of escape from their persecutor. How often is this phenomenon observed among soldiers, for whom a few days of illness means the most delightful change! In these cases even the most experienced military physicians............