298 PSYCHOTHERAPY : SCIENTIFIC AND RELIGIOUS chap.
her mother, and above all was very resentful at what she considered the injustice of having been forbidden to swim. By listening to the mother's troubles, the doctor was able to relieve the maternal tension to some extent, and also to persuade the mother to stop nagging at the girl about her tics. He also allowed the girl to go swimming. Following this there was a considerable improvement of the tics. This case is suggestive of psychological difficulties expressing themselves through pathways made possible by the chorea.
One of the points stressed by Winnicott247 (pp. 76-88), who has an excellent understanding of children, is the importance of trying to differentiate the true rheumatic from the nervous child, from the point of view of treatment. The rheumatic child needs prolonged rest, whereas the nervous child is much better when allowed to be active. Thus it seems certain that rheumatism in children should be a fertile field for the psychotherapist, for so many problems of a nervous nature are to be found in these children, and it seems reasonable to assume that where it is possible to alleviate the nervousness, this may have a favourable effect on the rheumatic processes.
What the ultimate relationship of the nervous constitution is to rheumatoid arthritis, it is not possible to say. The possibilities are, that emotional strain, especially in conjunction with fatigue, may lower resistance. There may also be a common constitutional basis, accounting for both nervousness and joint disease occurring in the same person. The investigation is very interesting in showing the importance of social and psychological factors in this disease.
Headaches may have a psychological origin. They are not infrequent in anxiety states, depressive states, worry and similar disorders, where they usually take the