Psychotherapy. James Joseph Walsh
it should be followed by at least half an hour of pleasant occupation that does not call for serious mental work. This may not be possible for every one, and many will complain that this is asking too much in our busy time. We physicians are not here to make the nice customs of medicine courtesy to great kings of finance or to the busy tyrants of the professions, but to tell them what we think should be done in order that nature may not be abused. Men should be advised to take their luncheon in some building different from that in which their offices are located, or, if they eat in the same building, to go out on the street for a while before the meal. In the old days men used to call on one another in order to transact business, and these little trips were often made just before or after luncheons.
Now the telephone and the messenger boy have done away with this, with a great saving of time, but with an increase of intensity of labor that makes for nervous exhaustion. Luncheon clubs are excellent things when men do not talk shop, but they have one fatal defect. Almost invariably they lack simplicity of menu, and, because of the variety supplied and the example of others, there is a tendency to eat to excess. A game of billiards after eating is often excellent, because, when standing, digestion is accomplished with more comfort than when seated. A walk after the lighter midday meal is a good thing, though the old saw said "after dinner sit a while," but that was in reference to the largest meal of the day, and may still hold good for the evening meal, which is likely to be the heaviest one.
Women's Lunch.—Women are very likely to take their mid-day meal, when it is their luncheon, very irregularly. If they have to get it for themselves they are likely to be satisfied with almost anything. If they get it outside the house they are likely to take it rather late, so that if they have breakfast before eight o'clock, this putting off of the next meal causes some disturbance of the economy. When the stomach gets to be empty, either there is a tendency to swallow air, or there is a rumbling sense of fullness that disturbs the appetite, or the appetite itself is capricious, and a headache develops. How many headaches are due to missed meals it would be hard to say, but this is one of the most fruitful causes of the ordinary passing headache. Delicate women, and especially those who work, are likely not to eat enough luncheon. All the details with regard to this meal must be known or the physician will find it hard to get rid of many neurotic symptoms, particularly in working women. The same thing is true for the so-called society woman, since she is likely to have a late breakfast and then skip her mid-day meal. This is permissible if she is so stout as to be able to spare it, but it is all wrong if she is thin and needs every ounce of weight.
Nature of the Noon Meal.—During the last two generations fashion, custom and the increasing demands of business have pushed the hour of taking the principal meal farther and farther away from mid-day. There are, however, cases in which it seems better that the principal meal should be taken in accordance with the old custom, about noon time. For tuberculous patients this is especially important. They often have fever in the afternoon that seriously disturbs appetite. They may eat with comfort and relish a couple of hours before the fever is due. For delicate persons, especially those who have not much appetite for breakfast and who can not be persuaded to eat a sufficient amount early in the morning, a hearty meal at noon is almost a necessity. They should be shown how low their nutrition is during working hours. Their principal meal of the day before was taken between six and seven o'clock. They have had a light breakfast, a meager lunch, and naturally have little reserve force during the afternoon hours. As a consequence they become overtired, this lessens the appetite, they do not eat properly, and, above all, they do not digest as well as they would if their last good meal were not so far away. They are suffering from inanition, and, as is well known, starving people cannot be allowed to eat heartily, because their stomachs have not enough vitality to digest well.
It is often difficult to change the hour of taking the principal meal, but in special cases this can be done with decided advantage. I have seen such a change make all the difference between slow recuperation from bad colds, and have seen it of the greatest possible importance in tuberculosis. The very changing of the hour will sometimes suggestively react to make the patient eat more heartily than usual, the day is broken up better, the reaction against the morning discouragement comes earlier, and the patient's general condition improves. Many people rest better at night if their principal meal is taken at the middle of the day.
CHAPTER V
THE LEISURE HOURS
Then comes the return from business. Here once more the ordinary method of getting on a crowded train, standing up to be pushed and jammed, to have all sorts of unpleasant things happen, to have the pessimism of one's nature stirred to its depths by the utter disregard for women, the heedless rush of men, the roughness of railroad employees, and the general lack of humanity that characterizes the evening rush from business in a large city, is eminently unsuitable as a preparation for dinner; while a calm walk of three to five miles is ideal. To walk home will probably take twenty minutes or half an hour longer, but not more than this—and it avoids the undesirable features of the usual method.
Gymnastics.—Occasionally one finds that men rush through the last hour of business in order to spend an hour in a gymnasium. Often this is quite undesirable. Exercise within doors, taken in a routine manner and merely for the sake of exercise, with no diversion of mind, is eminently unsuitable for the busy man. What he needs is air much more than exercise. Walking out of doors is the very best thing for him. If he walks at a rapid pace, swinging his arms a little freely and carrying a cane in one hand and perhaps a book in the other, because this exercises his fingers and keeps him from having any unpleasant congestion of the hands when they hang down, then the exercise is almost ideal. Owing to the novelty of it, and the interest that a new occupation arouses, great benefit will at first be derived from the gymnasium. Very often, too, the cold plunge after the exercise does more good than the exercise itself. The plunge is real fun, especially when taken with many others, but the exercise itself is likely to degenerate into the sorriest kind of a task. If the man who walks home will take a bath before dinner, the temperature of the water being made suitable to him and the reaction that comes to his particular nature, there is no need of anything else, and there is nothing better that he could do. The walk must be varied. The course must not always be through the same streets. Occasionally it should even lead one to see some monument or new building, or to go out of the way with a friend, so that variety is introduced.
Work at Home.—There are men who in busy times take some of their work home with them. This is a mistake. And though it is the custom to tell the doctor that they cannot do otherwise, it is practically always a bit of self-deception. When the case is properly put before them, they realize, if they already have any neurotic symptoms, that to continue home work will be a serious risk. Most men who carry business home with them, easily get into the habit of pushing certain details away from them during the day with the idea that they will have more time for that in the evening. They do a certain amount of dawdling over their work. If they really resolved to finish work during business hours they could do it, and do it better than during the evening at home. Six hours of work is about all that a man ought to do with his intellect at high pressure. This should be pretty well divided into two periods of three hours each, with an interval of an hour to an hour and a half between. The nearer a man can come to this arrangement the better for him, and the better, also, for his affairs. If he has assumed obligations that require more of his time and attention than this, he is trying to do too much.
After-Dinner Hours.—The evening hours and their proper occupation are important for the business man, or for anyone who is much occupied during the day. The temptation to let the work of the day run over into the evening must be overcome at all costs, or it will prove serious for the health of most men. It is important as far as possible to get something completely different for men to do at night. Many men settle down to the reading of a newspaper or of a magazine or novel. While this does very well under some circumstances, reading does not provide diversion whenever there is serious worry or solicitude over business matters. A man may think that he is occupying himself with the newspaper, but we all know very well that business cares intrude, that business troubles are often doubled by reading about others. The reading of novels does well for a while, but the serious-minded man tires of them and then, while they may occupy a couple of hours, they have exactly the same objection as the newspaper. A genuine diversion