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THE MYTH OF "NERVOUS FATIGUE"
Evelyn had been irritable, restless and tense for the past ten
years. Sleep was poor. Appetite had declined to the point
of making a meal an ordeal. There was a constant tightness
of the throat, pressure in the head, palpitations and gastric discomfort.
Overshadowing all complaints in importance and intensity
was "an awful fatigue, an exhaustion that starts right
when I get up in the morning and continues without letup
till late afternoon. Then it eases up and in the evening I feel
almost well."
In spite of this sustained suffering, "without letup/' Evelyn
managed to keep her job for years, supplementing her husband's
income. It was only in the past two years that the fatigue and
exhaustion became "unbearable." She resigned her position and
tended to her household and her young son. "But in taking care
of my home I have to drag myself all morning and the greater
part of the afternoon. I am exhausted most of the day.**
E Examiner
P Patient
E: You have attended classes for several months. Has your
condition improved during these months?
P: It has. I sleep well, and my appetite is much better. The
pressure in the head has hardly bothered me lately, and the
pain in the abdomen is getting less and less. But I am still
fatigued. In the morning I have to drag myself and can hardly
keep on my feet. Then I take lunch, and right after I have finished
eating I am all exhausted, my eyes droop and I have to
lie down for an hour or so.
E: You say that you are "all exhausted/' May I ask you what
precisely you mean when you use the word "exhaustion?"

318 MENTAL HEALTH THROUGH WILL-TRAINING
P: Why, I am all in. I have no pep and must force myself
to do the simplest thing.
E: Look here, Evelyn, an exhaustion that has lasted for years,
day after day, even hour after hour, ought to have finally reduced
you to a physical wreck. Your muscles should have
shrunk, your face should by now look gaunt and haggard.
Instead, you maintained your weight, your complexion is blooming,
and your capacity for working is equal to the task of taking
care of house, family and social activities. Several months ago
when sleep was poor and appetite scant your claim to be exhausted
might have been logical. But with a good appetite
and sound sleep it is difficult to think that you are suffering
from a state of exhaustion.
P: I don't understand it myself, but it is a fact that I feel
tired and weary all the time, except in late afternoon and evening.
E: You say you "feel tired and weary all the time." I do not
deny that. You alone are competent to state how you feel. What
interests rne is whether your so-called fatigue is a mere subjective
feeling or an actual and objective condition, whether you
merely feel tired or actually are tired. You seem to be puzzled
by the sharp distinction and I shall try to be more specific.
You understand that if somebody says he feels guilty that does
not necessarily mean he is guilty. And if somebody feels feverish
that does by no means establish the objective fact that he
has fever. These examples will prove to you that a subjective
feeling does not necessarily point to an objective condition. And
if you say you "feel tired and weary all the time," I shall ask
you whether you consider your tiredness a subjective feeling or
an objective condition?
P: All I know is I am miserable all day. I wake up in the
morning, and the fatigue is there the moment I open my eyes.
E: You told me, Evelyn, that for the past few months your
sleep has been good. Suppose you awoke this morning after a
good night's rest. Would you nevertheless have felt fatigued
immediately after awakening?

MENTAL HEALTH THROUGH WILL-TRAINING 319
P: I feel fatigued immediately after I wake up in the morning
regardless of whether sleep was good or poor.
E: If this is true then it is established that you suffer from
the subjective feeling of tiredness and weariness, and not from
the objective condition of fatigue. I shall tell you why I can afford
to be so positive about my statement. You see, Evelyn,
soldiers after a long march, athletes after an exhausting race,
laborers after a strenuous effort, may sometimes be too tired to
fall asleep. But once they lapse into a sound sleep they invariably
and inevitably feel refreshed after awakening. These are examples
of extreme fatigue. Even in these utmost exertions sleep
eliminates fatigue with unquestioned certainty. In minor exertions,
mere rest without sleep will have the same effect. The
only exception to this rule is physical ailment, like an anemia or
tuberculosis. In these conditions, even a sound sleep may not do
away with fatigue. But with physically healthy persons, sleep
never fails to remove fatigue. If it is true that for several
months past you have enjoyed good sleep you have no reason
for being tired in the morning. To sleep means to rest the
muscles. How can your muscles be fatigued if they are rested?
P: I don't know what to say. The fact is that I am all in
no matter how well I slept. If you call that a subjective feeling
you must think it is mental. But I didn't even have time to
think about it. It is there the moment I wake up.
E: I do not know what precisely you mean when you use the
word "mental." Presumably you refer to the possibility that
you may have the thought of fatigue in your mind and instantly
feel the fatigue in your muscles* This instantaneous response
of the muscles to a thought seems to puzzle you. I do not see
why it should. You have certainly gone through similar experiences
hundreds of times. Remember the occasion, for instance,
when you were at a meeting and were called upon to make a
speech. Instantly, your heart began to palpitate, your face reddened,
your abdomen trembled and the knees shook. To use
your own words, you "didn't even have time to think" of the
speech; you merely heard your name called, and the muscles of

320 MENTAL HEALTH THROUGH WILL-TRAINING
your heart, abdomen and legs were thrown into violent tremors
"in no time." In the instance which I quoted the thought in
your mind which caused your muscles to shake was the fear of
not being able to deliver a well constructed address. It was a
fear, or you may call it a fear idea, or the idea of danger. Do
you understand now that if an idea strikes or occupies your
mind the muscles may respond with a violent reaction in a
fraction of a second?
P: I understand that. But when I get up in the morning
there is no idea of danger in my head.
E: The question is what you mean by danger. If you wish to
indicate that, in the morning, you are not trembling with the
fear of being killed or trapped or burned I shall fully agree
with you that no such idea may occupy your brain immediately
after awakening. But there are subtler forms of fears and
dangers. These subtle anxieties and apprehensions go by the
name of preoccupations. I happen to know from your own
account how readily you fall victim to such preoccupations. Let
me remind you, for instance, of the anguish you experience
whenever you expect visitors for the afternoon or the evening.
You fret and worry days in advance, anticipating some bungling
or clumsiness while performing the part of the hostess. You
know that when finally the much dreaded day arrives you feel
troubled and helpless "the very minute" you awaken. The day
stares you in the face as a threat, as an event fraught with
heavy responsibilities. You are without pep or zest. Your vitality
is at a low ebb. A heaviness seems to descend on your
limbs. Everything is done with effort. You have to drag yourself,
feel "all in," exhausted, lifeless, fatigued. Do you understand
that all of this is caused by your preoccupation, and that
the preoccupation is based on the idea of danger ?
P: It is true I am worrying my head off when I expect
guests. People are critical, and it is not easy to please them and
make them feel at home. But we don't have visitors every day,
and there is not a day when I feel relaxed. I am always tired.
E: I mentioned your preoccupation with your guests as an example
only. The example will demonstrate to you that a pre

MENTAL HEALTH THROUGH WILL-TRAINING 321
occupation of this kind is apt to produce, in a split second, a
condition in which you feel "all in," dragging, exhausted and listless.
Being a nervous patient you are always preoccupied with
your disability. This preoccupation is a kind of worry which
hardly ever leaves you. You are always on guard against something
untoward happening in some part of your body. Looking
back on your unhappy experiences of the past ten years you can
recall numerous instances in which you planned a social engagement,
a card game, a show, a trip and were stricken with
a severe head pressure or palpitations or abdominal pain or
numbness. The card game had to be interrupted, or you managed
painfully to go through with it in wretched agony. You
remember the frequent occasions when dinner parties had to
be cancelled because your throat suddenly "locked," and you
were afraid you might not be able to swallow or speak; or the
dances that had to be called off because a heaviness settled on
your legs so that you could hardly walk. It was observations
of this character that in time suggested to you that it was no use
planning. The unpredictable suddenness with which your symptoms
could make their appearance gave you no guarantee that
if you made a plan you could go through with it. Gradually the
inability to plan spread to the trivial chores of everyday life. You
set out to prepare a meal, and your eyes blurred. Or you decided
to darn your husband's socks, and the hands trembled. The
symptoms came without warning. They shot through your
body without cause, without provocation. To use your own
words, you "didn't even have time to think about them." I
may tell you that symptoms which shoot up so unexpectedly,
in a mere fraction of a second, are called "trigger symptoms."
They shoot forth with the rapidity of a bullet after the trigger
has been pulled. Their trigger character makes them appear
weird, mysterious, threatening. In essence, they suggest to you
that you have utterly lost control of your primitive bodily functions.
Having noticed time and again that your organs may go
on a rampage without warning you feel you cannot trust your
body. You must always be on the alert for some sudden disturbance.
You cannot plan with any assurance of carrying out

322 MENTAL HEALTH THROUGH WILL-TRAINING
your decisions. But if you are deprived of the power to plan,
your day is carried on without accomplishment. Moreover, without
planning, you miss that singular joy of looking ahead to
accomplishments. The joyous trembling of watchful anticipation is
taken from your daily routine. Life becomes a never-ending
drabness and drudgery. It is this type of life that you look forward
to when you awaken in the morning. In a flash, before
you had "time to think about it," the dismal dreariness of your
existence stares at you. Again one of those empty days with
no plans, no decisions, no accomplishments. You become
discouraged, disgusted with the dead monotony that is in store
for you, and it is the self-disgust that robs your tissues of their
vitality. There is no vigor, zest or incentive with which to
start out on the daily routine. Your body is devoid of stimulation;
it feels uninspired, flabby, limp. This feeling of limpness
you call "fatigue." You will now understand why towards
evening your vitality returns and why, after supper, you "feel
almost well." There is nothing left for planning after supper,
no drabness to be anticipated, no drudgery to be performed in
self-disgust. The dreadful day is gone or going. Nothing is
expected of you any more. You breathe freely now, and your
vitality returns. Do you realize now that what you call "fatigue"
is nothing but a psychological reaction to the anticipated and
dreaded boredom of daily existence? Do you understand that
the tiredness of which you complain is not in your muscles but
in your mind?
P: You are right, doctor. I realize now that everything you
say is exactly as I feel it. My mornings are dreadful. I have
nothing to look forward to. I can't plan; I am afraid to plan.
You are right, doctor, but why was I never told what is wrong
with me? I have seen all kinds of physicians, and the one
told me I was suffering from nervous exhaustion, another said
my energy was running down, and I should take it easy. One
blamed it on my thyroid gland; another told me I had a poor
constitution and he couldn't do anything about it. I was warned
not to overwork, was told to take long periods of rest, to go on
trips and vacations. If you say that my trouble is nothing but

MENTAL HEALTH THROUGH WILL-TRAINING 323
boredom and disgust why did nobody tell me that before?
It would have spared me ten years suffering, and I could have
saved thousands of dollars spent on cures, sanitariums and trips.
E: It is painful for me to answer this question. I do not
like to be critical of what other men think or believe. Unfortunately,
there are superstitions that refuse to die. One of them,
very preposterous and pernicious, is the myth of nervous fatigue
or nervous exhaustion. All I can tell you is that, in 1880, a New
York physician formulated the absurd theory that a group
of patients whom he called "neurasthenics" suffered from a state
of nervous exhaustion.* How uncritical this man was is evident
from the fact that he did not hesitate to make unwarranted and
extravagant claims, for instance, that the "disease runs in families,"
that it is due to inheritance, that it has its origin in the
spine, that it is typically American and, hence, proposed to call
it "American Nervousness." Somehow this fanciful idea spread
all over the globe and is still widely accepted today as a message
of scientific truth. I cannot tell why a theory of this kind has
been permitted to figure in textbooks and to be practiced on
hapless sufferers. All I can state is that superstitions are born
easily but die with difficulty. I do not blame you for feeling
resentful of the unnecessary hardship that was imposed on you
during ten long years of anguish. But resentment will not help
you. It will only serve to whip up your emotions and throw
an additional load on your nervous system. What you need is
re-education. You must learn to reject as untrue all the silly
notions that were crammed into your head and to accept the
explanation which I gave you. Up to now, with the thought of
exhaustion in your brain, you were afraid to move, to work,
to tax your "weak" muscles. I take it for granted that henceforth
you will throw to the winds all this drivel about nerve
exhaustion and will not hesitate to tax your muscles to your
heart's delight.
P: You told me that before, and I made every effort to accept
your view. On many mornings I jumped out of bed with-
*George M. Beard, A Practical Treatise on Nervous Exhaustion
(Neurasthenia), New York, 1880, William Wood.

324 MENTAL HEALTH THROUGH WILL-TRAINING
out paying attention to my fears. I ignored the heaviness in my
muscles and did my work, but it was certainly difficult. Your
assurance that the fatigue is in the brain and not in the muscles
helps me at times. But after I continue with my work for
awhile the thought strikes me that maybe the other doctors
were right when they warned me not to strain my muscles.
After ten years it seems not easy to shake off the fears.
E: You said you made every effort to accept my views about
fatigue. This is, of course, an exaggerated claim. I do not
expect anybody to make "every" effort in any endeavor. What
you mean is that you tried hard but did not succeed. But remember,
Evelyn, I never asked you to "accept my views." I
asked you to practice them. My view with regard to "nervous
fatigue" is that you can safely ignore it, that it is a bugaboo
and not a real danger. This view cannot be "accepted" and,
as it were, placed in your brain there to preside over your
actions. In order to make a view direct your action it must
be acquired, digested and absorbed through patient practice.
This is true of every sphere of life in which you wish to plant
views into the thoughts and brains of a person. In bringing
up your children you did not merely present them with lovely
notions and lofty principles, asking them to accept them. These
views had to be practiced, again and again, till finally they
were incorporated and lived and experienced and acted out
spontaneously. When you intended to make your boy adopt
the view of group responsibility you did not tell him to accept
your principle of group behavior. Instead, you told him not
to make noise in the presence of people. You urged him to
say "thank you" and "please." This you did for months and
years until finally the new habits took root. After ceaseless
practice your boy finally incorporated the view in his system,
made it part of his organism. The practice made the view
"sink in" and take its firm place in the brain from where it
then directed action. In this process of child training you influenced
your boy's muscles and through them established a
firm structure of habits. It was these good habits that represented
your view. You understand now that I asked you to

MENTAL HEALTH THROUGH WILL-TRAINING 325
practice my view, not merely to accept it. The continued practice
would have brought acceptance in its train. You will perhaps
remember what precisely I asked you to do. I told you
to jump out of bed and to go about your work, fatigue or no
fatigue. But I also warned you to avoid all actions that embody
the view of danger, I specifically instructed you not to look in
the mirror to watch your so-called fatigue in your anxious
features. I asked you to avoid the practice of touching the
muscles of your arms and legs to investigate the degree of
their flabbiness. I cautioned you not to sit down after a few
steps or a few manipulations. Most important, I enjoined you
not to complain about your fatigue, not to moan or sob, not
to ask for help or sympathy. If you had complied with these
instructions you would have established a new set of habits
of how to deal with this legendary thought of nervous fatigue.
The old habits of fear would have been crowded out of your
mind, and a new set of constructive trends would have settled
down or sunk into your brain. My view would then have
occupied and taken possession of your brain without any effort
on your part to accept or adopt it. If you say that "after ten
years it is not easy to shake off the fears" I shall advise you
that you had no business assuming that it might be easy. Mere
acceptance of a view is easy, but practicing it means sustained
application with endless trials and endless failures till finally
you score the ultimate success. You thought of merely accepting
a view. That would have been easy but ineffectual. What
I wanted you to do was to practice, i.e., to direct your muscles
to carry out my view. I presume that after tonight's interview
you will no longer entertain the unrealistic notion that mere
lip-service to a principle -will reestablish a new set of habits.
Practice alone will do that.