In recent years the attention of physicians has been called to the fact that many people are made profoundly miserable by an unconquerable tendency to doubt about nearly everything that has happened to them, or is happening, or is about to happen. This is not a new phenomenon, but introspection has emphasized it, leisure gives more opportunity for it, and so physicians hear more of it now than they did in the past. This doubting tendency sometimes makes serious inroads on the peace of mind of sufferers from it because they cannot make up their minds to do things, even to take exercise, to eat as {733} they should in quantity or quality, and to share the ordinary life around them sufficiently to get such diversion of mind as will keep their physical functions normal. The state used to be described as a neurasthenia (nervous weakness), but in recent years has come better to be designated as in the class of psychasthenias (lack of mental energy). It is always a mental trouble in the sense that it is difficult for these patients to make up their minds about things, yet it is not a mental disease in the ordinary sense of the term, and these people are often eminently sane and thoroughly intellectual when their attention has been once profoundly attracted. They may even, under favorable circumstances, be active and useful helpers in great causes, yet there is always to be observed in them a certain noteworthy difference in mentality from the normal. The physician can do more for an affection of this kind than is usually thought, and he is probably the only one who can thoroughly appreciate and sympathize and, therefore, be helpful in the condition.

Sufferers are often laughed at by their friends and relatives and are likely to be the subjects of at least a little ridicule if they take their troubles to their physician. As a matter of fact, however, doubting is a typical case for psychotherapeutics and not only can much be done for its relief, but it can be kept from disturbing the general health, which it is prone to do if neglected, and by mental discipline and acquired habits of self-control, the doubting habit may be almost completely eradicated.

Exaggeration of Ordinary State of Mind.—The first thing absolutely necessary to impress upon the minds of these victims of their own doubts is that their condition is by no means unique, it is not even very singular, but is only an exaggeration of that hesitancy and tendency to put off making decisions that practically every person finds in a lifelong experience. This frame of mind is rather cultivated by education and by a large accumulation of knowledge. The less one knows the easier it is to come to decisions about difficult problems and to form conclusions without hesitancy. The young man will decide anything under the sun, and a few other things besides, almost without a moment's hesitation, and after but slight consideration. Twenty years later he looks back and wonders how he did it, and having done it, how he succeeded in turning the practical conclusions to which he came to advantage. The scholar is eminently a doubter and a hesitater, and we recognize that he loses certain of the qualities that would make him a practical man of affairs, though he gains so much more that broadens and deepens life's significance that there can be no doubt about the value of his liberal education.

"Hamlet" is just the story of one of these doubters and hesitaters. He saw his duty clearly and that duty was imperative. In spite of cumulative evidence, however, he refused to go on to the performance of that duty, urging to himself now one and now another reason of delay, until finally he wonders whether it would not be worth the while to take his own life, rather than try any longer to solve the problems that lie around him demanding solution. When he finally does something, his hand is forced and circumstances have so arranged themselves that instead of one clean-cut punishment for a great crime, there is the tragedy that involves six lives, including his own. The play seems to involve such exceptional characters and to be written around such an unusual set of circumstances that it might be thought {734} that it would prove uninteresting for men and women generally. As a matter of fact, however, "Hamlet" is the most popular of Shakespeare's plays and probably the most popular play, both for readers and auditors, that was ever written. There are commentaries by the hundred on it in nearly every modern language. Men have been more interested in this figment of Shakespeare's imagination than in any man that ever lived. Caesar and Napoleon have not attracted so much attention. Only Homer and Dante have been perhaps more written about than Hamlet.

Shakespeare has emphasized the condition of Hamlet by showing us an eminently well educated man. His deep interest in literature, and especially in dramatic literature and all that relates to the stage, can be appreciated very readily from his speech to the players. No one but a man of profound critical ability and deep intellectual interests could have so summed up the actors' relation to the drama. Of course, this is Shakespeare himself talking and unthinking people have said that this was a purple patch fastened on the play because it gave the author an opportunity to express his views with regard to actors and their ways. Instead of that, it is of the very essence of the development of Hamlet's character and shows us the scholarly amateur who knows so much about many things that he has become quite unable to make up his mind about the practical problems that lie before him. James Russell Lowell says that Shakespeare sent Hamlet to Wittenberg, though Wittenberg was not founded until centuries after Hamlet existed—and Shakespeare probably knew that very well—because Wittenberg in Shakespeare's time, on account of its connection with Luther and the religious revolt in Germany, had the widespread repute of occupying men's minds with doubts about many of the things that had been deemed perfectly settled before, and its popular reputation serves to give an added hint as to the character of Hamlet as the dramatist saw it.

Once those who are perturbed by doubts learn that the reason for the universal human interest in Hamlet is that there is a large capacity for doubt of self in every man and woman, that we all put off making decisions whenever possible, sometimes refuse to open letters when they come if we fear that they will contain some disturbing news, put off writing letters because we have to state ideas definitely, apparently hope that the day and the night will bring us counsel and that somehow the decision will be made for us without the trouble of making up our minds, then they lose their sense of discouragement over their condition and appreciate that they are suffering only from an exaggeration, probably temporary and quite eradicable, of a state of mind that comes to practically every human being.

This is the important thing, because on it can be founded the only really hopeful therapy of the condition. Doubting is a habit that may be increased by yielding to it, but that can be diminished to a very great extent by constant discipline, which refuses to permit doubts and hesitancy and bravely makes decisions, even though there may be the feeling that they may prove to be wrong.

Extent of Affection.—If such discipline is not instituted, then the lengths to which the doubting hesitant habit may go are almost incredible. I have had patients tell me that they doubted about nearly everything in the past. A very dear friend once confided to me that it was always a source of bother {735} to him that he was not quite sure whether he was married or not. His marriage I knew had been a public ceremonial, and he had led his bride down the aisle to the strains of the "Wedding March" in quite conventional style, but he was hesitant of speech, especially under excitement, and he was not sure that he had ever said "I will" to the question of the clergyman, for there was a constriction at his throat at the moment and he could utter no sound. The absence of any audible sound from the groom is not so unusual as to attract attention and, of course, his intention and his bodily presence and everything else gave the assent without the necessity for the word, but he could not get out of his mind the thought that possibly he was not married and at times it gave him poignant discomfort. He was a thoroughly intelligent man, a teacher and a writer, with no abnormalities that attracted attention, and his tendency to doubt was only known to very near friends who laughed at it and had no idea at all of the annoyance that it often gave its unfortunate victim.

I have a clergyman friend who has had some serious scruples with regard to his ordination. He is a Catholic priest and at a certain part of the ceremonial of ordination it is considered necessary for the candidate for orders to touch at the same moment the paten, the small metal plate on which the Host is placed, and the chalice. This clergyman is not sure that he had done this simultaneously. As a rule, great care is exercised in seeing that all the details of the ordination ceremonies are carried out very exactly and as there are a number of attendants on the altar whose duty it is to see that the absolutely necessary details are properly fulfilled, it is quite improbable that any mistake in this matter was made. The young clergyman, however, had not made an act of conscious attention at the moment when he was supposed to do this, and consequently he could not be sure afterwards whether he had done it or not. He thought of it as the very essence of his ordination and he feared that all his subsequent acts as a clergyman might be impaired by this negligence.

Trivial Doubts.—It is not alone with regard to important things, however, that people may doubt and are disturbed by doubts, but with regard to every trivial thing in life, if they permit the habit to grow on them. Doubting is, after all, one of the phobias, that is to say, it is the fear that something may happen if the decision they make is wrong, that causes people to hesitate so much. There is a tendency in all of us which, if undisciplined, may make us put off the doing of things until the last moment. It is easy to resolve the night before that we will do certain things the next day, but when the next day comes we find excuses to put them off. I have already suggested as a symptom that some people put off the opening of letters. There are probably more who do this than anyone has any idea of. Delay in answering letters is probably much more often due to hesitancy of decision than to actual laziness. We doubt as to what we should say about certain things, and we do not care to take the trouble of making up our minds, and we fear if we do make up our minds it may be wrong, so we adjourn the whole matter to another time and keep on adjourning it. Many people are quite ready to confess that they do not do things until they have to, though few are ready to acknowledge that it is due to hesitancy or doubting about themselves and their decisions.{736}

Of course, the man who doubts whether he has locked the door of his house after he gets to bed can only satisfy himself by getting up and actually investigating the state of affairs. Then there is the man who doubts whether he has locked his safe at the office. He may get his doubts just as he reaches the foot of the elevator and then if he is wise he will go back and determine the matter. If he is wise with experience he will also deliberately determine while he is there whether the office window is closed and locked and will make a conscious act when he comes out as to the locking of the office door. If he does not do all this he will have further doubts on the way up town and at his home during the evening which will make the doing of anything else a matter of discomfort and he will spoil the restfulness of his after-dinner hours. Some men conquer their first doubt, make their way home only to be beset by so many doubts that at the end of an hour they go back to their office and determine whether the safe is locked or not. Finding it locked they may forget to notice other things about the office and then they will surely have doubts about these, and they may have to go back again and see about them.

Then there is the man who doubts whether he posted a letter or if he did post it, who doubts whether it found its way down to the bottom of the mail box, or whether it may not have caught on a projecting screw or bolt or some portion of the upper part of the box and so fail of collection; he may go back several times to determine this. Doubts about even more trivial matters than this, however, annoy some people. I have known widows on whom the responsibility of managing the financial affairs of the household had been thrown for the first time after their husbands' death, who constantly doubted whether they could afford to spend this or that, though they were regularly saving money from their income. Over and over again they would have to go over all their recent expenditures to decide whether they could afford certain expenses. Such little things as the sort of paper to use in their correspondence, the wages they paid their servants, the amount of waste in the food in the household, all aroused in them doubts and set them to calculating once more just what was the relation of their income to expenditure, all to no purpose, for they would have the same doubts the next week or month.

Then there are people who doubt whether their friends really think anything of them. They think that though they treat them courteously this may be only common politeness and they may really resent their wasting their time when they call on them. They hesitate to ask these people to do things for them, though over and over again the friends may have shown their willingness and, above all, by asking favors of them in turn, may have shown that they were quite willing to put themselves under obligations. They doubt about their charities. They wonder whether they may really not be doing more harm than good, though they have investigated the cases or have had them investigated and the object of their charity may have been proved to be quite deserving. They hesitate about the acquisition of new friends, and doubt whether they should give them any confidence and whether the confidences that they have received from them are not really baits. This is, of course, a verging on suspicion as well as hesitancy and doubt, but the stories of how these people try to conquer themselves, yet have to make decision after decision, each one requiring time and a certain resolution of mind, are quite {737} pitiable. It gets worse rather than better unless a definite discipline of opposition and control is organized.

What ordinary people do habitually and easily and without any effort of mind, these people must waste time and mental energy over so that it is extremely difficult for them to accomplish anything. Training of mind, as of hand, consists in making certain actions so habitual that they are accomplished quite automatically. If we have decided that we are to get up at a certain hour we get up at that hour and do not have to make up our minds about it again, though this is one of the actions in which we all have the most lapses and the most need of renewal of resolution and habit. We make up our mind what we are going to eat and gradually acquire the habit of eating a certain quantity and a certain variety at meals and then we do not have to make up our minds about it every time. We go out, to do whatever must be done in our occupation quite automatically and there is no need of wasting mental energy over decisions about it. It is this that the doubter cannot do. He or she calls every trifling act before the supreme court of last decision, the bar of intellect, to decide whether it is worth while doing, whether it is to be done or not, how it is to be done, and then there is a doubt whether after it is done it may not prove to be quite the wrong thing to have done. This adds so much to the friction of life that all the surplus energy is used up in the settling of trivial matters, and nothing worth while is accomplished.

Sir James Paget once expressed all the realities of the situation of many of these people in a few terse phrases. It is probably the best explanation of its kind that we have and it deserves to be in the notebook and often before the mind of physicians who treat neurotic patients. Sir James said: "The patient says 'She cannot'; her friends say 'She will not'; the truth is she cannot will."

The expression, of course, applies to many other phases of so-called nervous disease besides doubting and especially to the psychasthenias. It represents, indeed, the keynote of many of these puzzling affections. The fact that it was uttered more than half a century ago shows how much better these affections were understood two generations before ours than we are likely to think, and how well physicians then got to the heart of them. From this to the re-education of will, that mental discipline and relearning of self-control which constitutes the essence of the treatment of them, is but a short step.

Prophylaxis.—Serious Occupation.—Of course, the real way out of the trouble is to have to do certain important things that occupy the mind and require the doing of many other things as subsidiaries which must be accomplished in order to carry out the greater resolution. Men who have important affairs on their hands seldom are bothered by doubts and hesitancy. Women who have not much to do make mountains out of the molehills of their little occupations and every trifle must be adjudged. The larger interests must be cultivated, the smaller ones must be turned over to the automaton which every one of us can develop in our persons if we only set about it resolutely. Each thing that comes up must be settled at once and action must replace contemplation. The Hamlet in us all must be put down and resolution must not be allowed to be sicklied over with the pale cast of thought. We must do {738} things and not think about them too much. The doubters can learn this lesson. They will never be entirely without hesitancy, but they can remove many of their difficulties, and live to accomplish much in spite of their make-up.

Physical Treatment.—The physical treatment of the doubting state consists, of course, in bringing the individual's physical condition as near as possible up to the normal. When the state occurs in people who are under weight its betterment is rather easy. The special feature of the physical condition that needs seeing to is an ample supply of fresh air. People who live in ill-ventilated places, or who do not get out into the air enough, are almost sure to suffer from the tendency to avoid the making of decisions. The man of decision usually is a vigorous outdoor-air individual. Even the perfectly healthy man who has been in the house for some reason for days together gets into a state of mind where the making of decisions becomes objectionable. He wants to push things away from him. In individuals who already have a natural tendency this way this is greatly exaggerated by confinement. Arrangements must be made, therefore, that will ensure getting out for some time, not once but twice every day. The regular making of decisions for this purpose is of itself a good mental discipline. It must not be omitted even for rain or snow, unless there are additional reasons of some kind. An abundance of fresh air in the sleeping-room is extremely important and must be secured.

Mental Treatment.—The mental treatment consists in diversion of mind. Usually the doubters have no interests that appeal to them deeply and in which they have to make prompt regular decisions. If possible, these must be secured. They must form habits of doing things regularly and of making up their minds to do them, and then not have to repeat the adjudication and resolution. In recent years people realize, quite apart from its religious significance, the value of what older religious writers called examination of conscience. Regularly before they go to sleep these people must be told to call up what they have done during the day and to note their faults in the matter of putting off doing things and making decisions slowly. They must, however, not only realize their faults, but they must make up their mind to correct them during the following day. They must not leave the arrangement of what they shall do next day to chance, but must decide just how and when they shall do things and then, as far as possible, keep to this program. The program must, of course, be sensible and considerate. This preliminary arrangement can be made to mean much more than might be thought. Some people thus learn to correct entirely their tendency to doubt whether they should do things or not and lessen greatly the difficulties they have in making decisions.