[In the essay below, Gratto details the autobiographical, medical, and literary components of "Mind and Body."]

William Carlos Williams' short story "Mind and Body" takes a vignette about a woman who obviously fascinated Williams, melds it with the substance of a chapter from a highly popular medical book of the depression era, and illustrates in a very effective literary way the main elements of an important medical issue—the relationship of psychiatric medicine to general practice.

The case of Martha Darby, first mentioned by Williams in his essay "Jataqua," provides the general biographical outlines of a character whom Williams would subsequently develop into the central figure in "Mind and Body."

Intelligent, our girls are, their minds are whip-like, if they don't rot, as did Martha's, she who beat the record of all years at Cornell; was secretary to Altman; was graduated as a trained nurse and, what a volcano of energy! taught Greek in a school till she went mad at the slowness of the pupils—and married that marvelous little lame Irishman, Darby—who has the moods of a rose. What a woman! spending her life now as servitor to women in the Insane Hospital on Ward's Island—after being an inmate there herself—and recovering. What an energy wasted there! No place for it in the world save among the insane. Especially no place for it in the United States.

A decade later Martha Darby reemerges as Ingrid Yates in the short story "Mind and Body." Like Martha, Ingrid

had won a scholarship from a Brooklyn High School to Cornell where she majored in Latin, Greek and Logic, and again won a fellowship in Logic. The instructors retreated in disorder before her attacks till she quit the game and, needing money, went to teach Latin in a high school from which, after a month, she ran away. The slowness of her pupils drove her mad. From there she went to a New York business schools, graduated in no time and became private secretary to one of New York's leading merchants. . . .

Yates, she had met, incredibly, in an asylum where she had been confined after her breakdown. She had gone there of her own will to be cured and there she had decided to remain, to become a nurse to attend the insane. And there she had encountered Yates, the gentle-voiced and kindly nurse—employed in the care of male patients—as she was in the care of females. It had been a most happy marriage, she with her erratic voluble disposition, he with his placid mind.

In the short story, Ingrid is undergoing an examination because of intestinal pains for which the doctor has difficulty finding a cause. He is not alone in his diagnostic difficulty; other physicians before him have also apparently failed, as Ingrid admits, for the condition lacks a physiological basis:

"I know people think I am a nut. I was an epileptic as a child. I know I am a manic depressive. But doctors are mostly fools. I have been very sick. They say it is my imagination. What is that?"

Williams, in an essay written about 1931, [titled "Imaginations"], commented on the relationship of the body and the wits, referring somewhat favorably to "Dr. Clendening's book" on this subject. The reference is almost certainly to Logan Clendening's The Human Body, originally published in 1927. Clendening's book contains a chapter entitled "The Relations of Mind and Body" which deals, as does Williams' story of similar name, with the general issue of psychosomatic illness. Clendening notes that telling a patient that his illness is "imaginary" is "resented more than anything. The patient will insist, 'I can tell you this is not imaginary,' . . . and they are perfectly right."

The difficulty for the physician in dealing with such a patient is recognized by Clendening, who views cases such as Ingrid's as conversion reactions. Clendening notes that such cases represent psychological "adaptation of the patient to his life up to the time of. . . [the symptom's] . . . origin."

Williams' physician attending Ingrid initially proceeds essentially as Clendening suggests would be appropriate: "Tell me more of your life," he says. Ingrid has obviously encountered this line of questioning before, because after telling him about an operation eighteen years earlier she remarks, "I am compensating for my childhood now." There follows an outpouring of dialogue, which Ingrid dominates, as she rambles erratically for several pages in a manner typical of a person a clinical psychologist would diagnose as a hysterical personality. Finally she remarks, "Someone to tell our troubles to is what we need. I suppose I bore you with all I am saying today but I must talk. You must think I'm crazy."

Clendening notes that patients whose illnesses are essentially psychosomatic are likely to find relief only from "regular physicians who devote themselves to rational psychotherapy," rather than from a "dreary round of specialists or mechanists," or from the average physician, whose psychiatric training is inadequate to the problem:

"The reason for this attitude of mind lies largely in the training of the average physician. All his professional life he is urged to look upon diseases from a mechanistic view-point. Therefore when a patient with many symptoms and no signs appears, he is apt to think that, no matter if you do call it hysteria or neurasthenia, still there must be some obscure infection, or some derangement of a ductless gland, or some metabolic disorder temporarily beyond his powers of demonstration. When the patient's complaints become so absolutely unreasonable as to force him to the conviction that no physical basis for them exists, the spiritual equipment of the average practitioner is inadequate to a sympathetic interpretation."

The patient, on the other hand, does, in fact, experience symptoms like those of actual disease, Clendening notes. Furthermore, the patient is unaware of the psychological adaptiveness of the illness, "totally unconscious of the steps by which he got sick," and thus essentially incurable in a normal medical sense.

The dilemma of a patient who can't accept the psychosomatic nature of her illness, and the doctor, who suspects it, but by training and temperament still perhaps seeks an organic cause is well illustrated in "Mind and Body." Ingrid ultimately insists on a physical examination. The doctor agrees. He

carefully palpatated her abdomen but could find nothing at all. . . . Her heart action was even and regular. Only flushed cheeks, the suggestively maniacal eyes, the quiver of the small muscles of her face, her trembling fingers told her stress. She awaited my verdict in silence. I could find nothing. "Yes," she said, "only two men have found the exact spot, and she pointed to a place in her right iliac quadrant. One was a young doctor at the Post Graduate Hospital who has become famous since then, and another was the surgeon who operated on me the first time. The rest just feel around the abdomen as you have done."

The doctor responds rather absurdly with a reference to an ancient medical belief, "But do not forget, I said in my own defense, that there is a place in the abdomen of major hysteria which if it is pressed upon will definitely bring on a convulsive attack."

A short discussion of this comment ensues, but the doctor quickly stops any further speculation with a diagnosis of exactly the sort Clendening abhorred: "I believe you are suffering merely—but that is quite enough—from what Llewelyn C. Barker calls—I have forgotten the term—what we used to call mucuous colitis." He explains the condition briefly, but the explanation in actuality is vague and uninformative. Furthermore, Ingrid apparently does not choose to hear it, presumably because she cannot psychologically endure the loss of her illness, anyway. At any rate, after the doctor takes her to the bus stop she remarks, "Well, you haven't told me what is the matter with me. What is it? Don't tell me I am nervous?" The doctor responds remarkably:

"There has never been an anatomic basis discovered for an opinion in cases like yours . . . until recently. Apparently the cause was laid down in the germ plasma when you were created. . . . "

"The anatomic basis of your condition . . . seems to have been detected in a new study called capiilaroscopy, a study of the microscopic terminal blood vessels. In people of your type these terminal loops between the arteries and the veins are long and gracile. They are frail, expand and contract easily, it is the cause of all the unstable nervous phenomena, you see."

Ingrid is now satisfied. "Yes, I can feel it often, she agreed. The blood goes into my face or into my brain. I often want to run and scream out, it is so hard for me to stand it."

The doctor begins to elaborate, but the arrival of Ingrid's bus mercifully interrupts this curbstone diagnosis the doctor is improvising.

Dr. Clendening, in his chapter on "The Relations of the Mind and Body" has outlined the difficulties for both patient and doctor when a physician who is untrained in psychiatric medicine encounters a patient who presents a psychosomatic disorder. Dr. Williams, in his story "Mind and Body," has effectively illustrated those difficulties.

Williams, of course, may have been dealing ironically with the issue. He did not fully agree with Clendening, who had embraced Freudian thought in a way Williams never would. Thus, while Williams' general practitioner in "Mind and Body" may have been inadequate by Clendening's standards to work Ingrid through her psychologically based conversion reaction, he obviously was ultimately perceptive enough to recognize a psychosomatic issue when he saw one. He did not rashly strip away Ingrid's defense mechanism. He recognized that Ingrid was rather hysterical, to be sure, but that she was also functional and in no apparent danger. The doctor could not cure Ingrid, and maybe she didn't need curing. At any rate, true to the Hippocratic oath, the doctor did the patient no harm.