"I've got to, or I'll go mad; "is an expression or state of mind very often found in the Orient, and especially amongst the American and European single-folk in China. "Got to what? "you ask. The answer to this question is mutable, and yet at the same time it is the basis of "Nerves" in the Orient. Japan, the Philippines and India are productive of Oriental Nerves, but they are not countries for exploitation and so do not lend personal aggrandizement as does China. The various physiological and psychological problems concerned with life in China have assumed increasing importance in recent years, because of the penetration of Occidental agents of commerce and education. The question of the ability of the newcomer to withstand the foreign environment is one of no small moment in the readjustment of the population and the evolution in industrial expansion that is going on.

Although modern science has greatly improved the sanitary conditions in the Orient and enriched our knowledge of tropical medicine, it cannot be said to have greatly advanced our understanding of psychology in the Far East. The tendency to irritability, nervous debility and other concomitant psychoneuroses so frequently developed by a longer or shorter period in these regions, is not so much due to the effects of the climate and physiological functioning as that in the main it has a psychological origin. With reasonable care, it is as easy to keep physically well in China as in Europe or America.

These psychoneuroses, or "Oriental Nerves," are one and all the resnlt of a conflict in the patient's mind. This conflict according to Freud is carried on between the desires created by the repressed libido or subconscious urges, and the demands of the cultural enviroment of the individual.

Prison neuroses, for example, are invariably due to the mental conflict between the ego urge of the prisoner who desires release and the pressure of the cultural standards which resulted in his incarceration. The ensuing neurosis or, if severe, psychosis, is a flight from reality and an endeavour on the part of the individual to substitute a self- produced product of psychic phantasy, for the unbearable reality that he is actually a convict and confined.

War neuroses, otherwise known as "shell shock," are due to the conflict between the self-preservation urge in the soldier and the self immolation urge. The resulting neurosis, or "shell shock," is again a flight from reality. The soldier unconsciously fears that he may develop into a coward, and the flight into sickness, with the resulting symptom of a phobia, is developed with the aim of removing him from the front, where his fear of betraying cowardice might overpower him, to a posi tion of safety in the rear, where his fear of cowardice would not be put to so severe a test.

Curiously enough, this type of neurosis, contrary to general belief, does not take place in men who are cowards; the true cowards run, desert or turn traitors. The neurosis, on the other hand, takes place in men of definite moral standards; they are those who are in mortal terror of becoming afraid, of showing cowardice. So great is their fear of this happening, that they become victims of compulsion neurosis, in that they develop a highly organised phobia or fear. These phobias are a secondary defense against the emotional substitute type of obsess sions. The phobia is developed to prevent the appearance of fear. This is the mechanism seen in the forms known as agoraphobia, or the fear of being alone in a large open space, and claustrophobia, or the dread of being shut up in a confined space.

There is a fairly definite neurosis or mental condition, which for convenience sake we have named Oriental Nerves, that one encounters in China. This form of distress is a result of a psychic atmosphere that beggars description; and to be adequately appreciated it must be experienced.

Is the atmosphere a happy or an unhapy one? That is the question to be considered. If the situation is one replete with contentment, then none but a criticizing iconoclast would offer comment. If, on the other hand, it is one characterized by avoidable discontent, the cause of this discontent becomes a matter of justifiable investigation.

Discontent may be due to reality or it may be due to phantasy. The end product, irrespective of the cause, is the same - it is unhappiness. Grief at receiving a telegram to the effect that one's sweetheart has been killed in a motor accident is exactly as poignant if the message be delivered as a result of a blunder in initials or name made by the telegraph company, as if it be a true report of the tragedy.

If the situation of psychic upsettedness be due to material facts, it would be reasonable to assume a consensus of opinion centering upon certain conditions that could be held to be responsible. But, if, contrariwise, the widest of antipodal diversion is found, it will then be meet to contemplate the immaterial or purely mental causes for the distress.

The material phases of life that might upon superficial examination be held to be responsible for Oriental Nerves may be classified in the order of their importance under such subtitles as the climate, the food, the economic situation, and the people.

As to the climate; one finds every type of climate imaginable in China, and yet in all these different climates, which vary from that found in the Riviera or Southern California to the dense fogs of London or the sticky weather of New Orleans, one still finds cases of Oriental Nerves. As a proof of the fact that the climate cannot be judged to be the cause of this neurosis, it can be stated that many temporary residents thoroughly enjoy the prevailing weather. Their memories of the moonlit evenings, the silvery fog, the gorgeously green fields, the glinting rain scenes, are among their most cherished reveries.

As to the food; this depends upon the standards to which one has been bred. Needless to comment, to the woman reared in the lap of luxury, whose merest gastronomic whim was at once granted in terms of Delmonico dishes, Rector entr6es, Shanley sherbets or Poodle-Dog puddings, the food obtainable in China might be seriously handicapped in comparison. But in terms of reality the conditions are above the most exacting criticism.

The efforts and attainments of the Chinese cooks, the delightful tea, the local luscious fruit, the crisp vegetables, the tender chickens and fresh fish, actually offer marketing conditions for the most elaborate menu. There are many in China who are completely contented with the food, whether native or foreign. Hence this item can be eliminated from the etiology of Oriental Nerves.

Another factor that might be investigated in order to see if it could be held responsible for the neuroses is the economic situation. This is easily disposed of, for, as a matter of fact, one can live in China better and more economically than in any city in the United States.

What can we say about the Chinese people as a cause of Oriental Nerves? Their customs and habits may lend the proper environment for the neurosis, but in reality there is a considerable range of variation in the personal coefficients of the Chinese people. Even though they were perfect, there would still be Occidentals who would complain.

Business in China is not conducted on the same systematic (we might say efficient) lines as it is in Western lands. If business were conducted in China on the same efficient lines as in America, there probably would be no cause for Occidentals going to the Far East. There are numerous hindiances and delays and vexations, which many unwise Occidentals criticize and find fault with. This results in a definite dampening of morale, for these methods which have been in vogue for some two or three thousand years cannot or will not be changed just because the new arrival finds fault with them. The Oriental, and especially the Chinese attitude, is (more or less) never to do to-day what can be put off until the morrow. Chinese are accustomed to taking time to come to decisions, in fact, business is done over the teacup rather than the telephone as in America, and friendship plays an important part; all of which is extremely taxing to the nerves of the modern rushing Occidentals.

The feeling of being under constant observation and the desire to maintain the prestige that the Occidentals feel their position or their nationality demands are important factors in helping to bring about the psychological condition conducive of Oriental Nerves.

In regard to this matter of being under constant observation anyone who is at all familiar with Oriental habits, well knows that almost his every act is discussed by the natives about him, and his character and temperament are gauged to a nicety. It would be an eye-opener to many foreigners if they could see themselves as their Chinese neighbours see them. Although the foreigners may never learn the natives real opinion about them, they always have the feeling that they are living in the public eye, and as most Occidentals are not accustomed to this, it naturally produces a strain on the nerves which at first they are not likely to realize.

The responsibility placed upon the Occidentals in the interior of China is often colossal. It is not so much the amount of power which is entrusted to them, as the feeling that many times they are the final courts of appeal in matters relating to their missionary or business work; that there are few to whom they can go for helpful counsel; and, worst of all, it is the knowledge of the political situation in China to-day, where there is frequently no power behind them to support their authority, that brings about the psychoneurotic mind. The man in charge of a school, mission station or business well knows that if any unusual situation arises he has to handle it himself and see that his injunctions are carried out, with little hope of outside assistance. The man in a responsible position in America knows well enough that there is always the law back of him and the police force to appeal to if necessity should arise, but in China, to appeal to the law, such as it is today, or to seek police assistance, is in most cases only to make the matter worse. One never knows, too, in China, when these extraordinary situations may arise, and hence many people come to be always on the look-out for them. Naturally, such individuals tend to become hypersensitive and phobic, or, what is more common, superlatively egotistical.

The Occidental, especially the American and Britisher, on going to China finds himself in a totally foreign moral environment with a radically divergent system of sexual and personal ethics, which he is not usually prepared to combat. The Occidental is prone to say that the Oriental has a lower code of morals and to excuse himself thereby. But, judging from the foreigner's own code, how does the Occidental stand I Be that as it may, the possibilities for the stimulation and gratffication of the sexual side of the psychic Occidental are more numerous in the Orient, and the continued flaunting of the erotic makes its impression on the mind of the Occidental. If he evades it, it callouses his nature, if he succumbs to its wiles, it erodes him; either of which may throw him into a morbid mentality.

Many of the Occidental single-folk in China are away from home for the first time. They may be in the Orient seeking surcease from a disappointed romance, or they may have just wanted to get away from the humdrum of their home town. Whatever it may be, they feel that nobody cares ; and so why should they I Their new environment only augments the reasons for self-contempt, for in most cases there is no one near to whom they can confide. The Occidentals in China are not especially strict in seeing that their fellows observe the more rigid conventions of society, and it is just as Kipling says: "There ain't no ten commandments , and a man can rai8e a thirst." If the young men stay out too late at night, no one but missionaries are unduly shocked. This is to such great extent the ultratolerant attitude of the populace, that it gradually breaks down the morale of the strongest man.

The mind of the Occidental is at first shocked, but gradually the blunting process begins, after seeing the degraded sociological state of China's majority. The universal use of child labour strikes the Westerner with great force at first sight. The great mass of China's population are i]literate working people, who are comfronted with the mysteries of life they, like so many other people, cannot comprehend, and are naturally susceptible to various kinds of beliefs which higher education usually dispels. Their conception of religion is something wrapped up in mystery and uncertainty, controlled by a conglomeration of ethnic belief The very hopelessness of these people, living from hand to mouth has a certain galling effect on the Occidental mind.

With all this array of facts before us, still to attribute Oriental Nerves to reality, to hold accountable the material situations encountered, would in itself be a flight into phantasy.

Psychologically there is a certain behaviour which may be regarded as motivated by the " flight from reality urge." This behaviour shows itself under well recognized conditions. For example, when the actual demands of life face an individual he can react in two divergent ways One way, the reality method, is to attack the problem at band bring to bear upon it all the conscious efforts of training and education and to dispose of the matter to the very best of one's capacity.

The other type of behaviour is that of flight from reality, which has been mentioned above. In this group is found the entire gamut of human frailty and neurotic symptoms; these range from quaint mannerisms at the one extreme to terminal psychotic dilapidation and suicide at the other.

The principle of the flight from reality is a simple one, but the protean character of its innumerable manifestations make it extremely difficult at times to recognize. It shows itself in such symptoms as sleepi - ness, feeling dopey," disinterestedness, lack of " pep," being bored, irritability, criticizing, disparagement of others, maintaining a perfect score in bridge-party attendance, incessant novel reading, excessive smoking, nightly moving - picture going, chronic cabaret attendance and the craze for daily dances. More marked activities are downright meanness and malicious gossip, which are compensations for an intense feeling of inferiority, by endeavouring to bring about trouble for others More serious symptoms are solitary tippling, drug addiction, and flights into illness, the psychoneuroses, such as the obsessions, compulsions hysteria and phobias. The culminating catastrophe is complete escape from reality in the shape of suicide.

The seriousness of the latter is owing to the fact that each suicide is an inherent homicide, hence a potential murderer at the same time Prior to committing the act of self-destruction each patient takes under the gravest consideration the question of killing the person who appears to them to be the most responsible for their plight. The determining factor as to whether the suicide goes alone to Eternity, or goes accom panied by a slave, the spirit of his murdered victim, may be settled pro or con upon the finest of intrapsychic discrimination.

The development of different symptoms which are etiologically a flight from reality are regularly brought about by the same mechanism They are compensations on the part of the organism for a repressed wish It is not germane to the issue that this repressed wish relates invariably and inexorably to unsated desires and mismanagement of the procreation instinct of the individual, in that no neurosis ever takes place in a person whose sexual life is normal.

To escape the unbearable ravages of ennui people condition them- selves to become dependent upon a certain kind of diversion, such as five - o'clock teas, large moving-picture productions amid lavish chair comforts and organ or orchestral accompaniments, theatre going, terminating in cabaret climaxes, and ball-room dancing.

Where they have been accustomed to avail themselves of these cultural compensations, and then suddenly find themselves bereft of the opportunity to secure them in the quantity or quality to which they have been accustomed in the large American cities, there comes to the surface a curious set of ready-at-hand neurotic symptoms.

These neurotic symptoms are all attempts of the personality to bring about an escape from the reality resulting from unsated desire The compensation by active participation in the social activities of Chicago, New York, Washington, or wherever you please, being denied, owing to transfer to China, others must be sought.

By trial and error, different substitutes one after the other are tried, discarded or settled upon.

The end held in view by those who really suffer from the efforts of transplantation from a metropolis to an Oriental home is a return to "civilization," as they usually express it.

In the general routine, this is a question of from two to seven years, the neurotic, however, regularly attempts to hasten this return by a flight into sickness, the mechanism of which is the unconscious production of the most bizarre symptoms. In that these symptom-productions are in the majority of cases motivated by the unconscious mind, they are philosophically exempt from the pale of criticism in terms of morality, malingering and other phraseology. They are matters of human conduct, and, as such, merit the deepest attention and most sympathetic understanding and handling.

People living under Oriental conditions have often been advised to seek some form of recreation or to take up some hobby in order to recreate mind and body. But to those in the interior this counsel is somewhat difficult to follow. Whatever hobby or recreation a person takes up is found in many instances to he of a somewhat solitary nature and it is most difficult, especially for ladies, to get that change of scene or company which is so necessary for real recreation. There is the ever present feeling that one is surrounded by the swarming masses of China; a veritable sea which salts everything that falls into it, for China is the only country in which Jewish communities have entirely lost their identity and become absorbed into the general population. The Mohammedan communities which exist in considerable numbers within its borders are profoundly modified thereby. However friendly the Chinese may be, or however one may like them, the very awfulness of their dominance comes to have very often a bad effect on the Occidental, unless he or she takes frequent furloughs to other climes.

But," you say, "if the Orient wrecks a person's nerves, why the irresistable call of the East, that is so well known by the resident or transient visitor to China." That is just it; the very factors that appeal and entrance are the same that undermine the psychic being. What person has his ego so subservient to his will that having once tasted of power and prestige, or having been waited on hand and foot by a multitude of servants, can readjust himself to the democratic plebeian life of the West, and remain satisfied?

The man or woman who succeeds in China and avoids getting Oriental Nerves is the person who approaches the new enviroment with a spirit of cheerfulness and a charitable attitude towards the people with whom he or she plans to live and associate, which attitude is only gained through an understanding of the people. Men who have succeeded in China, and women who have remained the social attraction they are, are those who have worked with the current, while at the same time lending the full strength of their personalities and characters in helping to bring about better conditions.

Atrue understanding of a foreign people can only be gained through the personal contact of the native languages. The knowledge of the language of a people carries with it far more than many seem to realize. It affords a deeper understanding of the customs and institutions of the people and, more important still, a sympathy towards these customs and institutions, which it seems is difficult to acquire in any other way. Few Occidentals in China who speak Chinese express dissatisfaction or show symptoms of Oriental Nerves from living in China; in fact, most of them are real Chinese " boosters," even to the extent of being enthusiastic over the Chinese dietary. Furthermore, with a knowledge of the language, it is easier to appreciate the other man's viewpoint. Few, if any, are there who can interpret the enthusiasm and feeling on which one depends for genuine interest and sympathetic appreciation.

It is the consensus among Occidentals who know China that the Chinese business man is a very desirable person with wbom to trade, for the reasons that he respects his obligations, pays his bills, and is reasonable in the adjustment of disputes. He does not quibble over legal technicalities ; in fact, he is accustomed to the dictates of equity rather than to those of law. Customs and practice carry much weight with him, so that it is necessary to understand and respect the customs and practices of the country when doing business with the Chinese.

The customs among the Occidentals in China of indulging in afternoon teas, tennis, polo, riding, sport, and community celebration of national holidays are all valuable in forestalling Oriental Nerves. For those that do hard mental work, a short nap, if for only fifteen minutes after the noon meal, is of great value also. One custom or practice followed by some, and no doubt of inestimable value in the prevention of Oriental neurosis, is the institution of the morning tea in bed. The Occidental may first meet the observance of this custom on board the steamer going across the Pacific, or perhaps not until he is settled in an hotel or club in China. Getting up in the morning is perhaps the hardest work the Occidental does all day in his homeland, let alone in the Far East, and it should be set about diplomatically. In the Occident the day's ordeal is usually ushered in by a ruthless alarm, but the technique is different in the Orient. Enter the boy. "Good morning, Master. Tea " Window and blinds 4elicately adjusted. Silence and solitude, no suggestion that you should get up, no reason why you should not have another nap. Maybe you do, but the smell of buttered toast strengthens you for the effort of pouring out your tea. Such an aroma is better, after all, than the more stimulating coffee which will greet you later at the breakfast table. It does not preclude another snooze if the duties or pleasures of the night before seem to demand it, but does give one a suave serenity which eventually will lift one out of bed and ease one gently through the fatigues of assem - bling oneself for the arduous toil awaiting. It makes breakfast a much more likeable institution, too. For, as so often happens, the impromptu breakfast is fret with discord. The morning cup of tea gentles the disposition and starts the day off right.

Having thus rather painstakingly gone over the etiology and rather briefly the prevention of Oriental Nerves we will leave the undiscussed angles of this important malady to the consideration of the reader. Undoubtedly there are many kinks in this subject that may raise discussion or that have not been mentioned here, but no matter what may he said, it must be admitted nevertheless, that such a condition as Oriental Nerves does commonly exist.

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