If poverty exists, then one may inquire into the amount of work done, the character of the home, the opportunities for recreation and recuperation.  All or any of the factors I have mentioned in previous chapters may be critical, and the moil and turmoil of a crowded tenement home may be responsible.  That such conditions do not break all women down does not prove that they do not break some women down, women with finer sensibilities, or lesser endurance (which often go together).  The most depressing problems are met among the poor, the cases where one can see no way out because the social machinery is inadequate to care for its victims.

What is one to do when one meets a poor woman with three or four or more children, living in a crowded way, overworked, racked in her nerves by her fears, worries, and the disagreeable in her life, drudging from morning till night, yearning for better things, despairing of getting them, tormented by desires and ambitions that must be thwarted?  “What right has a poor woman anyway to desires above her station, and why does not she resign herself to her lot?” ask the comfortable.  Unfortunately philosophy and resignation are difficult even for philosophers and saints, and much more so for the aspiring woman.  And our American civilization preaches “Strive, Strive!” too constantly for much philosophy and resignation of an effective kind to be found.

One must give tonics, prescribe rest, try to get social agencies interested, obtain vacations and convalescent care, etc.  Can one purge a woman of futile longings and strivings, rid her of natural fears and even of absurd fears?  It can be done to a limited degree, if the patient has intelligence and if one gives liberally of one’s time and sympathy.  But unfortunately the consulting room for the poor is in the crowded clinic, the thronged dispensary, and how is the overworked physician to give the time and energy necessary?

For the time required is the least requirement.  To deal adequately with the neurasthenic is to have unending sympathy and patience and an energy that is limitless.  Without such energy or endurance the physician either slumps to a prescriber of tonics and sedatives, a dispenser of such stale advice as “Don’t worry” and “You need a rest”, or else himself gives out.

In dealing with the cases in the better-to-do and the rich, one has more weapons in the armamentarium.  The worry is more futile here, more ridiculous, and one can attack it vigorously.  Usually it is not overwork in these cases; it is monotony, boredom, discontent with something or other, a vicious circle of depressing thoughts and emotions, some difficulty in the sex life, some reaction against the husband, a rebellion of a weak, futile kind against life, maladjustment of a temperament to a situation.

Some difficulties, even when ascertained and clearly understood, are insurmountable.  “The truth shall make ye free” is true only in the very largest sense.  Some temperaments are inborn, and are as unchangeable as the nose on one’s face.  In such cases the ordinary physical therapeutics help the acute symptoms that flare up now and then, and that is as much as one may expect.