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HISTORIES OF SOME SEVERE CASES

The cases that follow represent mainly the severe types of nervousness in the housewife. To every case that comes to the neurologist there are a hundred that explain their symptoms as “stomach trouble”, “backache”, etc., who remain well enough to carry on, and who think their pains and aches inevitably wrapped with the lot of woman.

It will be seen, upon reading these cases, that a rather pessimistic attitude is taken toward some of them. It would be nice to present a series of cases all of which recovered, and it would be easy to do that by picking the cases. Such a series would be optimistic in its trend; it would however have the small demerit of being false to life. Though the majority of women suffering from nervousness may be relieved or cured, a number cannot be essentially benefited. Some of them have temperaments utterly incompatible with matrimony, others have husbands of the incorrigible type, others have life situations to change which would make it necessary to change society. Therefore in these cases all a doctor can do is to relieve symptoms, relieve some of the distress and rest content with that.

I am essentially neither pessimist nor optimist in the presentation of these cases, nor do I seek to present the man or woman’s case with prejudice. In life a realistic attitude is the best, for if we were to remove much of the sentimental self-deception at present so prevalent, huge reforms would occur almost overnight. Sentimentality decorates and disguises all kinds of horridness and makes us feel kindly toward evil. Strip it away, and we would immediately break down the evil.

There is always this danger in presenting “cases” to a lay public, that symptoms are suggested to a great many people. How deeply suggestible the mass of people can be is only appreciated when one sees the result of public health lectures and books. Many persons tend to develop all the symptoms they hear of, from pains and aches to mental failure. Even in the medical schools this is so, and every medical teacher is consulted each year by students who feel sure they have the diseases he has described.

So in presenting the following cases symptoms will be largely omitted. What will be presented is history and to a certain extent treatment. That part of treatment which is strictly medical can only be indicated.

It may be said that in obtaining the intimate history of a woman a difficulty is met with in the natural reluctance to telling what often seems to the patient painful and unnecessary details. To some people it seems inconceivable that fears, pains and aches, sleeplessness, etc., can arise out of difficulties like the monotony of housework, temperament, or troubles with the husband. Furthermore, though some women understand well enough the source of their conflicts, they are ashamed to tell and rest mainly on the surface of their symptoms. To obtain the truth it is necessary to see the patient over and over again, to get somewhat closer to her. This is especially easy to do after the physician has to a certain extent relieved the patient. In other words, except in the cases where the woman is quite prepared to tell of her intimate difficulties, it is best to go slowly from the medical to the social-psychological point of view.

Case I. The overworked, under-rested type of housewife.

Mrs. A.J., thirty years old, is a woman of American birth and ancestry. Her parents were poor, her father being a mechanic in a factory town of Massachusetts. She had several brothers and sisters, all of whom reached maturity and most of whom married.

Before marriage she was a salesgirl in a department store, worked fairly hard for rather small pay, but was strong, jolly, liked dancing and amusements, liked men and had her girl friends.

At the age of twenty-two she married a mechanic of twenty-four, a good, sober, steady man, devoted to her and very domestic. Unfortunately he was not very well for some time following a pneumonia in the third year of their marriage. They drew upon all their savings and fell seriously in debt. This meant borrowing and scrimping for several years, a fact which had great bearing on the wife’s illness later.

They had three children, born the twelfth month, the third year, and the fourth year after marriage. After the first child the mother was very well, nursed the baby successfully, and the little family flourished. Then came the unfortunate illness of the husband, which threw him out of work for six months, during which time they lived on an allowance from his union, his savings, and finally ran into debt. This greatly grieved the man and depressed the woman, but both bore up well under it until the birth of the second child, when their circumstances forced them to move to a poorer apartment. The wife was delivered by a dispensary physician, who did his duty well but allowed the woman, who protested she felt well, to get up and care for her husband and baby much earlier than she should have done.

The nursing of this baby was more difficult. The mother’s breasts did not seem to be nearly as active as in the previous case. The baby cried a great deal and needed attention a good part of the night. The husband was unable to help as he had previously done and the fatigue of the care of child and man brought a condition where the woman was tired all the time. Still she bore up well, though when the summer came she greatly missed the little two weeks’ vacation that she and her husband had yearly taken together from the days of their courtship.

The husband recovered, but his strength came back very slowly. He went to work as soon as possible but worked only part time for six months. At night he came home utterly exhausted and could not help his wife at all.

During the next year both children were sick, first with scarlet fever and then with whooping cough. The mother did most of the nursing, though by this time the father was able to help and did. The necessary expenses so depleted the family treasury that when the summer came neither could afford to go away.

Both noticed that the mother was getting more irritable than was natural to her. She went out very seldom and her youthful good looks had largely been replaced by a sharp-featured anxiety. Though she carried on faithfully she had to rest frequently and at night tossed restlessly, though greatly fatigued.

She became pregnant again, much to her dismay and to the great regret of her husband. At times she thought of abortion, but only in a desperate way. The last few months of her term were in the very hot months of the year and she was very uncomfortable. However, she was delivered safely, got up in a week to help in the care of her other two children and to get the house into shape again. Her milk was fairly plentiful, despite her fatigue and “jumpy nerves.” Unfortunately at this time, when they had accumulated a little surplus and she was looking forward to better clothes for her family and more comforts, the plant at which her husband was employed suspended operations because of some “high finance” mix-up. Coming at this time, the news struck terror into her heart; she broke down, became “hysterical” i.e. had an emotional outburst. This passed away, but now she was sleepless, had no appetite, complained of headache and great fatigue.

Though she was assured that the plant would reopen soon (in fact it soon did), she made little progress. That she was suffering from a psychoneurosis was evident; what remained was to bring about treatment.

This was done by enlisting a development of recent days, the Social Service agencies. Out of the old-time charity has come a fine successor, social service; out of the amateurish, self-consciously gracious and sweet Lady Bountiful has come the social worker. Unfortunately social service has not yet dropped the name “Charity”, perhaps has not been able to do so, largely because the well-to-do from whom the money must come like to think of themselves as charitable, rather than as the beneficiaries of the social system giving to the unfortunates of that system.

Let me say one more word about social service and the social worker, though I feel that a volume of praise would be more fitting. The social worker has become an indispensable part of the hospital organization, an investigator to bring in facts, a social adjuster to bring about cure. For a hospital to be without a social service department is to confess itself behind the times and inefficient.

Briefly, this is what was done for this family.

Their prejudices against social aid were removed by emphasizing that they were not recipients of charity. The husband was allowed to pay, or arrange to pay, for a six weeks’ stay in the country for the mother and the new baby. The home for this purpose was found by the agency and was that of a kindly elderly couple who took the woman into their hearts as well as over their threshold. The social worker arranged with a nursing organization to send a worker to the man’s house each day to clean up the home while the children stayed in a nursery. One way or another the husband and children were made comfortable, and the wife came back from her stay, made over, eager to get back to her work.

It is obvious that in such a case as this the physician is largely diagnostician and director, the actual treatment consisting in getting a selfish and inert social system to help out one of its victims. That a sick man should be left to sink or swim, though he has previously been industrious and a good member of society, is injustice and social inefficiency. That a woman, under such circumstances, should be left with the entire burden on her hands is part of the stupidity and cruelty of society.

How avert such a thing? For one thing do away with the name “Charity” in relief work, and find some system by which industry will adequately care for its victims. What system will do that? I fear it may be called socialistic to suggest that some of the fifteen billions spent last year on luxuries might better be shifted to social amelioration. The record in automobile production would be more pleasing if it did not mean a shift from real social wealth to individual luxury.

Case II. The over-rich, purposeless woman.

This type is of course the direct opposite of the woman in Case I and represents the kind of woman usually held up as most commonly afflicted with “nervousness.” “If she really had something to do,” say the critics, “she would not be nervous.”

This is fundamentally true of her, though not true of the majority of women whom we have discussed. It seems difficult to believe that hard work and worry may bring the same results as idleness and dissatisfaction, but it is true that both deënergize the organism, the body and mind, and so are kindred evils. What’s the matter with the poor is their poverty, while the matter with the rich is their wealth.

Mrs. A. De L. is of middle-class people whose parents lived beyond their means and educated their only daughter to do the same. Here is one of the anomalies of life: bitterly aware of their folly, the extravagant and struggling deliberately push their children into the same road. Mrs. De L. learned early that the chief objects of life in general were to keep up appearances and kill time; that as a means to success a woman must get a rich husband and keep beautiful. Being an intelligent girl and pretty she managed to get the rich husband, and settled down to the rich housewife’s neurosis.

Her husband was old-fashioned despite his rather new wealth, and they had two children, a large modern American family. Though he allowed her to have servants he insisted that she manage their household, which she did with rebellion for a short time, and then rather quickly broke away from it by turning over the household to a housekeeper. This brought about the silent disapproval of her husband, who let her “have her own way”, as he said, “because it’s the fashion nowadays.”

She became a seeker of pleasure and sensation, drifting from one type of amusement to the other in an intricately mixed coöperation and rivalry with members of her set. She followed every fad that infests staid old Boston, from the esoteric to the erotic. She became an accomplished dancer, ran her own car, followed the races, went to art exhibitions, subscribed to courses of lectures of which she would attend the first, dabbled in new religions, became enthusiastic: about social work for a month or two, and became a professional at bridge. Summers she rested by chasing pleasure and flirting with male habitués of fashionable summer resorts; part of the winter she recuperated at Palm Beach, where she vied for the leadership of her set with her dearest enemy.

Her husband financed all her ventures with a disillusioned shrug of his shoulders. As she entered the thirties she became intensely dissatisfied with herself and her life, tried to get back to active supervision of her home but found herself in the way, though her children were greatly pleased and her husband sceptical. The need of excitement and change persisted; gradually an intense boredom came over her. Her interest in life was dulled and she began a mad search for some sensation that would take away the distressing self-reproach and dissatisfaction. Shortly after this she lost the power to sleep and had a host of symptoms which need not be detailed here.

The medical treatment was first to restore sleep. I may say that this is a first step of great importance, no matter how the sleeplessness originates. For even if an idea or a disturbing emotion is its cause, the sleeplessness may become a habit and needs energetic attention.

With this done, attention was paid to the social situation, the life habits. It was pointed out that all the philosophies of life were based on simple living and work, and that all the wise men from the beginning of the written word to our own times have shown the futility of seeking pleasure. It was shown that to be a sensation seeker was to court boredom and apathy, and that these had deënergized her.

For interest in the world is the great source of energy and the great marshaler of energy. From the child bored by lack of playmates, who brightens up at the sight of a woolly little dog, to the old and vigorous man who makes the mistake of resigning from work, this function of interest can be shown.

She was advised to get a fundamental, nonegoistic purpose, one that would rally both her emotions and her intelligence into service. Finally she was told bluntly that on these steps depended her health and that from now on any breakdown would be merely a confession of failure in reasonableness and purpose.

That she improved greatly and came back to her normal health I know. Whether she continued to remain well and how far she followed the advice given I cannot say. From the earliest time to this, necessity has been the main spur to purpose, and probably the lure of social competition drew the lady back to her old life. Experience, though the best teacher, seems to have the same need of repetition that all teaching does.

Case III. The physically sick woman who displays nervousness.

Though this is one of the most important of the types of nervous housewife the subject is essentially medical. We shall therefore not detail any case, but it is wise to reemphasize some facts.

There are bodily diseases of which the early and predominant symptoms are classed as “nervousness.” Hyperthyroidism, or Graves’ Disease, a condition in which there is overactivity of the thyroid gland and which is particularly prevalent among young women, is one of those diseases. In this condition excitability, irritability, emotional outbursts, fatigue, restlessness, digestive disorders, vasomotor disorders, appear before the characteristic symptoms do.

Neuro-syphilis is another such disease. This is an involvement of the nervous system by syphilis. One of the tragedies that distresses even hardened doctors is to find some fine woman who has acquired neuro-syphilis through her husband, though he himself may remain well. In the early stages this disease not only has neurasthenic symptoms but is very responsive to treatment, and thus the early diagnosis is of great importance.

What is known as reflex nervousness arises as a result of minor local conditions, such as astigmatism and other eye conditions, trouble with the nose and throat and trouble with the organs of generation. The latter is especially important in any consideration of nervousness in the housewife, particularly in the woman who has borne children. Frequently too the existence of hemorrhoids, resulting from constipation, acts to increase the irritability of a woman who is perhaps too modest to consult a physician regarding such trouble. Where such modesty exists (and it is found in the very women one would be apt to think were the very last to be swayed by it), then a competent woman physician should be consulted. With good women physicians and surgeons in every large community there is no reason for reluctance to be examined on the part of any woman.

Further details are not necessary. Enough has been said to emphasize the fact that the nervousness of the housewife is first a medical problem and then a social-psychological one.

Case IV. A case presenting bad hygiene as the essential factor.

Bad hygiene is something more than exposure to bad air, poor food, contaminated water, etc. It includes habits and times of eating, attention to the bowels, outdoor exercise, sleep, and in the marital state it includes the sexual indulgence.

The housewife under consideration, Mrs. T.F., aged twenty-eight, married five years, two children, complained mainly of headache, occasional dizziness, great irritability, and fatigue, so that quarrels with her husband were very common, though there seemed nothing to quarrel about. The family was not rich, but lived in a comfortable apartment; there were no serious financial burdens, the children were reasonably healthy and good, and the closest questioning revealed the husband as a kindly man who never took the initiative in quarrels but who was never able to keep silent under provocation. The couple was still in love and there seemed to be no essential incompatibility.

Questioned as to her habits, Mrs. F. said she did all her own housework except the washing and ironing and scrubbing. She had a little girl three times a week to take the baby out. Before marriage she had been a stenographer, but never earned high pay and had no love for her work. In fact she gave it up with relief and found housework with its disagreeable features much more to her taste than business. She had been of a placid, pleasant temperament and could not understand the change in her.

Since all this did not explain her symptoms, closer inquiry was made into her habits. She arose with her husband at seven-thirty, prepared his breakfast, sent the oldest child off to kindergarten and then had her own breakfast, which usually consisted of toast and coffee. At noon she had a very small piece of meat or an egg and a few potatoes with tea. At night she ate sparingly of the dinner, which usually was meat, potatoes, another vegetable, and a dessert. Her husband here stated that she ate at this meal less than the boy of four and a half.

Comparing her buxom figure with the diet a discrepancy was at once apparent. She then confessed with shame that she was a constant nibbler, eating a bit of this or that every half hour or so, and consequently never had an appetite. The food thus nibbled usually was either spicy or sweet, and she consumed quite a bit of candy. Her bowels moved infrequently and she always needed laxatives. In her spare time she felt rather “logy”, rarely went out, except now and then at night with her husband, and spent her leisure hours on the couch reading or nibbling.

This in itself would have quite explained much of her trouble. It has been pointed out that body and mind are not separable; that mental functions are based on the bodily functions, and that mood may rest on no more exalted cause then the condition of the bowels. But a more intimate questioning revealed sexual habits which are easily drifted into by people of an amorous turn of character and who are really fond of one another. These both husband and wife frankly said they had not meant to speak of, but with their disclosure it was evident that a good deal of importance was to be attached to them.

The correction of the life habits was of course the fundamental need. The young woman was instructed in detail as to diet, the care of the bowels and outdoor exercise. Since she was in perfect condition except for stoutness she could easily look for recovery, and as an added incentive the restoration of youthful good looks was held out as certain.

The sexual life was frankly discussed, and necessary restrictions were imposed. Both the husband and wife agreed willingly to the changes ordered and promised faithfully to carry out instructions.

The patient made a splendid recovery and very rapidly. Here was a deënergization dependent solely upon the sedentary life of the housewife and upon ignorance of sex hygiene. Here were quarreling and impending marital disaster removed by attention to details in living. Here was a complete proof that not only does a sound mind need a sound body, but that a sound marriage needs one as well.

Case V. The hyperæsthetic woman.

Mrs. J.F. is twenty-seven years of age. She was born in the United States, of middling well-to-do people. Her father was a gruff, hearty man, not in the least bit finicky, who really despised manners and the like, though he was conventional enough in his own way. Her mother was an old-fashioned housewife, fond of her home and family, in fact perhaps more attached to the former than the latter. She hated servants and got along without them (except for a day woman) until she became rather too old to do the work.

J.’s sister and two brothers were duplicates of the parents, hearty, stolid, and remarkably plain looking. J., the younger sister, though not the youngest in the family, was as different from her family as if she had sprung from another stock. She was slender, very pretty, with a quick, alert mind which jumped at conclusions, because labored analysis fatigued it. Above all, from the very start of life she was sensitive to a degree that perplexed her family, who were however intensely sympathetic because they adored her. This adoration arose from the fact that J. was brighter and prettier than most of her friends, and that her cleverness in many directions music, writing, talking, handiwork was the talk of their little group.

This sensitiveness arose from two main factors. First, an egoism fostered by the worship of her friends and the leadership of her group, an egoism which led her to regard as a sort of insult anything disagreeable. Accustomed to praise, the least criticism implied or outspoken cut like a knife; accustomed to being waited upon, she resented physical discomfort of the slightest kind. Second, there must also have been an actual physical sensitiveness to sights, sounds, smells, tastes, etc. that made her perceive what others failed to notice. This led to an artistry manifested by her nice work in music and decoration and also by an excessive displeasure at the inartistic.

With this training, experience, and natural temperament she should have married a rich collector of art products, who would have added her to his collection and cherished her as his most fragile possession. Instead, through the working of that strange law of contraries by which Nature strikes averages between extremes, she fell in love with a hulk of a man whose ideas on art were limited to calling a picture “pretty”, who loved sports and the pleasures of the table, and whose business motto was “Beat the other guy to it.” A successful man, troubled with few subtleties either of approach or conscience, he viewed the marriage relationship in the old-fashioned way and the new American indulgence. A man’s wife was to be given all the clothes she wanted, servants to help run the home, ought to bear two or three children, and love her indulgent husband. As for any real intimacy, he knew nothing of it. Kindly, self-indulgent, wife-indulgent, child-indulgent, ruthless in business, he may stand as something America has produced without any effort.

From the very first night J.’s world was shattered. We need not enter into details in this matter, but a woman of this type needs finesse in the initiation into marriage more than at any other time. Cave-man style outraged her every fiber, and the man was dumbfounded at her reaction. Though he tried to make amends his very effort and lack of understanding complicated matters.

Aside from this matter, which in the course of time became adjusted, so that though she rebelled desire arose in her, she found herself at odds with her husband’s tastes and conduct in little things. Though his table manners were good enough, the gusto of his eating annoyed her and took away her own appetite. When they went to a play together the coarse jokes and the plainly sensuous aroused his enthusiasm. He lacked subtlety and could not understand the “finer” things of life. As he grew settled in matrimony, which he enjoyed in spite of her nerves (which he took for granted as like a woman), he grew stouter and this irritated and jarred her.

She finally realized she no longer loved him. It is doubtful if she realized this before the birth of her first and only child. She lacked maternal feeling and rebelled with a bitter rebellion against the distortion of her figure that came with the pregnancy. The nursing ordered by the doctor and expected by all around her nearly drove her “wild”, she said, for she felt like a “cow”, a “female.” Indeed she reacted bitterly against the femaleness that marriage forced on her and hated the essential maleness of her husband. Her emotional reaction against nursing took away her milk, and finally the disgusted family doctor ordered the baby weaned and he was turned over to a servant.

She went back to her own life, determined to become a housewife, to see if she could not love her husband and her home. But everything he did irritated her, and everything in the house made her feel as in a “luxurious cage.” Yet she was by no means a feminist; she detested “noisy suffragettes”, thought women doctors and lawyers ridiculous, and had been brought up to regard marriage as indissoluble.

Gradually out of the conflict, the chilling fear that she had made a mistake which could not be rectified, the constant irritation and annoyances, the revolt against her own sex feeling and her life situation, arose the neurosis. It took the form mainly of sudden unaccountable fears with faint dizzy feelings. The family physician on the aside told me that it was “just a case of a damn fool woman with everybody too good to her.”

What constitutes a “damn fool” will include every person in the world, according to some one else. It seemed obvious to me that J. was not meant by nature to be a housewife or any kind of wife. Matrimonially she was a misfit, unless she met some man of a type like herself, though I doubt if any man could have pleased her. I doubt if her over-exacting taste would not rebel against the animal in life itself. For though the animal of life is essentially as fine as the human, certain types find it impossible to acknowledge it in themselves.

At any rate I advised separation for a time, six months at least. I told the woman her reaction to her husband was abnormal and finicky. She answered that she knew this but could not conceive of any change. We discussed the matter in all its ramifications, and though she and her husband agreed to the separation, I knew that he was determined to hold her to her contract. She improved somewhat but I believe that such a temperament is incompatible with marriage, at least to such a man. The outlook is therefore a poor one.

Case VI. The over-conscientious housewife, the seeker of perfection.

The woman whose history is to be discussed comes from a family of New England stock, i.e. the Anglo-Saxon strain modified by New England climate, diet, history, religion, and tradition into a distinct type. This type, often traditionally conservative and often extraordinarily radical, has this prevailing trait, standards of right and wrong are set up somehow or other, and a remarkably consistent effort is made to maintain these inflexibly. However, the hyperconscientious are not peculiarly New England alone; I have met Jewish women, Italians, French, Irish, and Negroes who showed the same loyalty to a self-imposed ideal.

This lady, Mrs. F.B., thirty-five years of age, with three children, was brought by her husband against her will. He declared that both she and he were on the verge of nervous prostration; that unless something was done he would start beating her, this last of course representing a type of humorous desperation that usually has a wish concealed in it. She was “worn to a frazzle”, always tired, sleepless, of capricious appetite, irritable, complaining, and yet absolutely refused to see a physician. She had taken tonics by the gallon, been overhauled by a dozen specialists, all of whom say, “nothing wrong of any importance yet she is a wreck and I am getting to be one.”

Her husband was a jolly looking personage from the Middle West, in a small business which kept his family comfortably. He looked domestic and admitted he was, which his wife corroborated. Evidently he was exasperated and worried as he gave the history of the case, with his wife now and then putting in a word: “Now, John, you are stretching things there; don’t believe him, Doctor; not so bad as all that,” etc.

She was a slender person, rather dowdily dressed as compared with her husband, with garments quite a little behind the prevailing mode. Her hair was unbecomingly put up, and it was evident that she disdained cosmetics of any kind, even the innocent rice powder. Her hands were quite unmanicured, though they were, of course, clean and neat. The hat was the simplest straw, home trimmed and neat, but a mere “lid” compared to the creations most women of her class were at the time wearing. That clothes were meant to be ornamental as well as useful was an attitude she completely rejected.

It turned out that life to her was an eternal housekeeping, from the beginning of the day to the end she was on the job. Though she had a maid this did not relieve her much, for she constantly fretted and fumed over the maid’s slackness. Everything had to be spotless all the time; she could not bear the disordered moments of bedtime, of the early morning hours, of wash day, of meal preparation, of the children’s room, etc. She was obsessed by cleanliness and order, and her exasperated efforts, her reaction to any untidiness kept her husband and children bound in a fear like her own, though they rebelled and scolded her for it.

“She’s always after the children,” said her husband. “She is crazy about them, but she has got them so they don’t dare call their soul their own. They don’t bring their playmates into the house largely because they know that mother, though she wants children to play, goes after them picking up and cleaning.”

This restlessness in the presence of disorder was accompanied by the effort to eradicate all vices, all discourtesies, all errors in manners from the children. She feared “bad habits” as she feared immorality. She thought that any rudeness might grow into a habit, must be broken early; any selfish manifestation might be the beginning of a gross selfishness, any lying or pilfering might be the beginning of a career of crime.

Here one might hold forth on the necessity for trial and error in children’s lives. They want to try things, they form little habits for a day, a week, a month which they discard after a while; they try out words and phrases, playing with them and then pass on to a new experiment. They are insatiable seekers of experience, untiring in their quest for experiment, and they learn thereby. Not every mickle grows into a muckle, and the supplanting of habits, the discarding of them as unsatisfactory, is as marked a phenomenon as the formation of habits.

So our patient allowed nothing for imperfections, experimental stages, developing tastes in her children. She was, however, hardest on herself, self-critical, scolded herself constantly because her house was never perfect, her work never done. She never had time to go out; she had become a veritable slave to a conscience that prodded her every time she read a book, took a nap, or went to a picture show.

It was not at first obvious either to her or her husband that her own ideal of cleanliness and perfection was responsible for her neurasthenia. If her “stomach was out of order ought she not have some stomach remedy; if her nerves were out of order would the doctor not prescribe a nerve tonic or a sedative?” The idea of a medicine for everything is still strong in the community and especially amongst dwellers in small towns, and represents a latent belief in magic.

In addition to such medicines as I thought the situation demanded, and to such advice as bore on her attitude to work and play, I hinted that dressing more fashionably might be of value. For the poorly dressed always have a feeling of inferiority in the presence of the better dressed, and this feeling is seriously disagreeable. To raise the ego-feeling one must remove feelings of inferiority, and here was a relatively simple situation. This woman really cared about clothes, admired them, but had got it into her head early in life that it was sinful to be vain about one’s looks. Though she had discarded the sin idea the notion lingered in the form of “unworthy of a sensible woman”, “extravagance”, etc. As she was painfully self-conscious in the presence of others as a result, this was a hidden reason for sticking to her home.

This woman had a really fine intelligence, wanted to be well and made a gallant effort to change her attitude. In this she succeeded, became as she put it more “careless of her things and more careful of her people.” Of course one cannot expect her ever to be anything but a fine housekeeper but she manages to be comfortable and has conquered an over-zealous conscience.