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+The Project Gutenberg EBook of Psychotherapy, by Hugo Münsterberg
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Psychotherapy
+
+Author: Hugo Münsterberg
+
+Release Date: September 27, 2007 [EBook #22775]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK PSYCHOTHERAPY ***
+
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+
+
+
+  PSYCHOTHERAPY
+
+  BY
+
+  HUGO MÜNSTERBERG
+
+  M.D., PH.D., LITT.D., LL.D.
+  PROFESSOR OF PSYCHOLOGY IN HARVARD UNIVERSITY
+
+
+  NEW YORK
+  MOFFAT, YARD AND COMPANY
+  1909
+
+
+  COPYRIGHT, 1909, BY
+  MOFFAT, YARD AND COMPANY
+
+  _All Rights Reserved_
+
+  Published, April, 1909
+  Second Printing, May, 1909
+
+
+       *       *       *       *       *
+
+
+  RECENT BOOKS BY THE SAME AUTHOR
+
+  Psychology and Life, Boston, 1899
+
+  Grundzüge der Psychologie, Leipzig, 1900
+
+  American Traits, Boston, 1902
+
+  Die Amerikaner, Berlin, 1904
+
+  Principles of Art Education, New York, 1905
+
+  The Eternal Life, Boston, 1905
+
+  Science and Idealism, Boston, 1906
+
+  Philosophie der Werte, Leipzig, 1907
+
+  On the Witness Stand, New York, 1908
+
+  Aus Deutsch-Amerika, Berlin, 1908
+
+  The Eternal Values, Boston, 1909
+
+
+       *       *       *       *       *
+
+
+  TO
+
+  MY FRIEND AND COLLEAGUE
+
+  DR. FRANZ PFAFF
+
+  PROFESSOR OF THERAPEUTICS IN
+  HARVARD UNIVERSITY
+
+
+       *       *       *       *       *
+
+
+PREFACE
+
+
+This volume on psychotherapy belongs to a series of books which I am
+writing to discuss for a wider public the practical applications of
+modern psychology. The first book, called "On the Witness Stand,"
+studied the relations of scientific psychology to crime and the law
+courts. This new book deals with the relations of psychology to
+medicine. Others discussing its relations to education, to social
+problems, to commerce and industry will follow soon.
+
+For popular treatment I divide applied psychology into such various,
+separated books because they naturally address very different audiences.
+That which interests the lawyer does not concern the physician, and
+again the school-teacher has his own sphere of interests. Moreover the
+different subjects demand a different treatment. The problems of
+psychology and law were almost entirely neglected. I was anxious to draw
+wide attention to this promising field and therefore I chose the form of
+loose popular essays without any aim towards systematic presentation of
+the subject. As to psychology and medicine almost the opposite situation
+prevails. There is perhaps too much talk afloat about psychotherapy, the
+widest circles cultivate the discussion, the magazines overflow with
+it. The duty of the scientific psychologist is accordingly not to stir
+up interest in this topic but to help in bringing this interest from
+mere gossip, vague mysticism, and medical amateurishness to a clear
+understanding of principles. What is needed in this time of faith cures
+of a hundred types is to deal with the whole circle of problems in a
+serious, systematic way and to emphasize the aspect of scientific
+psychological theory.
+
+Hence the whole first part of this book is an abstract discussion and
+its first chapters have not even any direct relation to disease. I am
+convinced that both physicians and ministers and all who are in
+practical contact with these important questions ought to be brought to
+such painstaking and perhaps fatiguing inquiry into principles before
+the facts are reached. To those who seek a discussion of life facts
+alone, the whole first part will of course appear to be a tedious way
+around; they may turn directly to the second and third parts.
+
+One word for my personal right to deal with these questions, as too much
+illegitimate psychotherapeutics is heard to-day. For me, the relation
+between psychology and medicine is not a chance chapter of my science to
+which I have turned simply in following up the various sides of applied
+psychology. And still less have I turned to it because it has become the
+fashion in recent years. On the contrary, it has been an important
+factor in all my work since my student days. I have been through five
+years of regular medical studies, three years in Leipzig and two years
+in Heidelberg; I have an M.D. degree from the University of Heidelberg.
+In my first year as docent in a German university twenty years ago, I
+gave throughout the winter semester before several hundred students a
+course in hypnotism and its medical application. It was probably the
+first university course on hypnotism given anywhere. Since that time I
+have never ceased to work psychotherapeutically in the psychological
+laboratory. Yet that must not be misunderstood. I have no clinic, and
+while by principle I have never hypnotized anyone for mere experiment's
+sake but always only for medical purposes, yet I adjust my practical
+work entirely to the interests of my scientific study. The limitations
+of my time force me to refuse the psychotherapeutic treatment of any
+case which has not a certain scientific interest for me, and of the many
+hundreds whom I have helped in the laboratory, no one ever had to pay
+anything. Thus my practical work has strictly the character of
+laboratory research.
+
+The chief aim of this book is twofold. It is a negative one: I want to
+counteract the misunderstandings which overflood the whole field,
+especially by the careless mixing of mental and moral influence. And a
+positive one: I want to strengthen the public feeling that the time has
+come when every physician should systematically study psychology, the
+normal in the college years and the abnormal in the medical school. This
+demand of medical education cannot be postponed any longer. The aim of
+the book is not to fight the Emmanuel Church Movement, or even
+Christian Science or any other psychotherapeutic tendency outside of the
+field of scientific medicine. I see the element of truth in all of them,
+but they ought to be symptoms of transition. Scientific medicine should
+take hold of psychotherapeutics now or a most deplorable disorganization
+will set in, the symptoms of which no one ought to overlook to-day.
+
+                                                       HUGO MÜNSTERBERG.
+
+  HARVARD UNIVERSITY, March 20, 1909.
+
+
+
+
+  CONTENTS
+
+
+  CHAPTER                                                             PAGE
+
+     I. INTRODUCTION                                                     1
+
+
+  PART I
+
+  THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
+
+    II. THE AIM OF PSYCHOLOGY                                            9
+
+   III. MIND AND BRAIN                                                  27
+
+    IV. PSYCHOLOGY AND MEDICINE                                         55
+
+     V. SUGGESTION AND HYPNOTISM                                        85
+
+    VI. THE PSYCHOLOGY OF THE SUBCONSCIOUS                             125
+
+
+  PART II
+
+  THE PRACTICAL WORK OF PSYCHOTHERAPY
+
+   VII. THE FIELD OF PSYCHOTHERAPY                                     158
+
+  VIII. THE GENERAL METHODS OF PSYCHOTHERAPY                           184
+
+    IX. THE SPECIAL METHODS OF PSYCHOTHERAPY                           212
+
+     X. THE MENTAL SYMPTOMS                                            239
+
+    XI. THE BODILY SYMPTOMS                                            297
+
+
+  PART III
+
+  THE PLACE OF PSYCHOTHERAPY
+
+   XII. PSYCHOTHERAPY AND THE CHURCH                                    319
+
+  XIII. PSYCHOTHERAPY AND THE PHYSICIAN                                347
+
+   XIV. PSYCHOTHERAPY AND THE COMMUNITY                                 370
+
+
+
+
+I
+
+INTRODUCTION
+
+
+Psychotherapy is the practice of treating the sick by influencing the
+mental life. It stands at the side of physicotherapy, which attempts to
+cure the sick by influencing the body, perhaps with drugs and medicines,
+or with electricity or baths or diet.
+
+Psychotherapy is sharply to be separated from psychiatry, the treatment
+of mental diseases. Of course to a certain degree, mental illness too,
+is open to mental treatment; but certainly many diseases of the mind lie
+entirely beyond the reach of psychotherapy, and on the other hand
+psychotherapy may be applied also to diseases which are not mental at
+all. That which binds all psychotherapeutic efforts together into unity
+is the method of treatment. The psychotherapist must always somehow set
+levers of the mind in motion and work through them towards the removal
+of the sufferer's ailment; but the disturbances to be treated may show
+the greatest possible variety and may belong to mind or body.
+
+Treatment of diseases by influence on the mind is as old as human
+history, but it has attained at various times very different degrees of
+importance. There is no lack of evidence that we have entered into a
+period in which an especial emphasis will be laid on the too long
+neglected psychical factor. This new movement is probably only in its
+beginning and the loudness with which it presents itself to-day is one
+of the many indications of its immaturity. Whether it will be a blessing
+or a danger, whether it will really lead forward in a lasting way, or
+whether it will soon demand a reaction, will probably depend in the
+first place on the soberness and thoroughness of the discussion. If the
+movement is carried on under the control of science, it may yield
+lasting results. If it keeps the features of dilettanteism and prefers
+association with the antiscientific tendencies, it is pre-destined to
+have a spasmodic character and ultimately to be harmful.
+
+The chaotic character of psychotherapy in this first decade of the
+twentieth century can be easily understood. It results from the fact
+that in our period one great wave of civilization is sinking and a new
+wave rising, while the one has not entirely disappeared and the other is
+still far from its height. The history of civilization has shown at all
+times a wavelike alternation between realism and idealism, that is,
+between an interest in that which is, and an interest in that which
+ought to be. In the realistic periods, the study of facts, especially of
+the facts of nature, is prevalent; in idealistic periods, history and
+literature appeal to the world. In realistic periods, technique enjoys
+its triumphs; in idealistic periods, art and religion prevail. Such a
+realistic movement lies behind us. It began with the incomparable
+development of physics, chemistry, and biology, in the middle of the
+last century, and it brought with it the achievements of modern
+engineering and medicine. We are still fully under the influence of this
+gigantic movement and its real achievements will never leave us; and yet
+this realistic wave is ebbing to-day and a new period of idealism is
+rising. If the signs are not deceitful, this new movement may reach its
+historical climax a few decades hence, when new leaders may give to the
+idealistic view of the world the same classical expression which Darwin
+and others gave to the receding naturalistic age. The signs are clear
+indeed that the days of idealistic philosophy and of art, and of
+religion, are approaching; that the world is tired of merely connecting
+facts without asking what their ultimate meaning is. The world dimly
+feels again that technical civilization alone cannot make life more
+worth living. The aim of the last generation was to explain the world;
+the aim of the next generation will be to interpret the world; the one
+was seeking laws, the other will seek ideals.
+
+Psychotherapy stands in the service of both; it is the last word of the
+passing naturalistic movement, and yet in another way it tries to be the
+first word of the coming idealistic movement; and because it is under
+the influence of both, it speaks sometimes the language of the one, and
+sometimes the language of the other. That brings about a confusion and a
+disorder which must be detrimental. To transform this vagueness into
+clear, distinct relations is the immediate duty of science.
+
+Indeed it may be said that psychotherapy is the last word of a
+naturalistic age, because psychotherapy finds its real stronghold in a
+systematic study of the mental laws, and such study of mental laws,
+psychology, must indeed be the ultimate outcome of a naturalistic view
+of the world. Realism begins with the analysis of lifeless nature,
+begins with the study of the stars and the stones, of masses and of
+atoms. At a higher level, it turns then to the living organism, studies
+plants and animals and even brings the human organism entirely under the
+point of view of natural law. When science has thus mastered the whole
+physical universe, it finally brings even the mental life of man under
+the naturalistic point of view, treats his inner experiences like any
+outer objects, tears them in pieces, analyzes them, and studies them as
+functions of the nervous system. A scientific psychology is thus reached
+which is the climax of realism, because it means that even the ideas and
+emotions and volitions of man are treated as natural phenomena, that
+their causes are sought and that their effects are determined, that
+their laws are found out. To apply this realistic knowledge of the mind
+in the interest of therapy is merely to use it in the same way in which
+the engineer uses his knowledge of physics, when he wants to harness
+outer nature. As that is possible only when theoretical science has
+reached a certain height of development, it can indeed be said that
+practical psychotherapy on a scientific basis can be considered almost
+as the ultimate point of a realistic movement; it cannot set in until
+psychology has reached high development, and psychology cannot set in
+unless biology has preceded it.
+
+There is no doubt that we are still far from this last phase of the
+realistic period. The practical application of scientific psychology is
+still a new problem. Experimental psychology began about twenty-five
+years ago; at that time there existed one psychological laboratory.
+To-day there is no university in the world which does not have a
+psychological workshop. But laboratories for applied psychology are only
+arising in these present days, and the systematic application of
+scientific psychology to education and law and industry and social life
+and medicine is almost at its beginning. While the height of the last
+realistic wave was in the period of the sixties, seventies, and
+eighties, of the last century, its last phase, the practical application
+of physiological psychology, including psychotherapy, is only at its
+commencement.
+
+But while this last great movement has not yet reached its end, the new
+idealistic movement to come has not yet reached a clear self-expression.
+A general philosophical interest can be felt, but a great philosophical
+synthesis seems still lacking. A new sense of duty can vaguely be felt,
+but great new tasks have not yet found common acknowledgment. Above all,
+the unshaped emotionalism of the masses has not yet been brought into
+any real contact with the new idealism which grows up on the higher
+level of scholarly thought. But it is evident, if a new great mood of
+idealism is to come, one of its popular forerunners must be the demand
+that the spirit is real in a higher sense than matter, that the mind
+controls the body, that faith can cure. In such unphilosophic crudeness,
+no definite thought is expressed, as everything would depend on the
+definition of spirit, of faith, of mind, of reality. Moreover, every
+inquiry would prove that the idealistic value of such statements as are
+afloat among the masses to-day is reached only by a juggling with words.
+That faith can cure appears to point towards the higher world, as the
+word faith has there the connotation of the faith in a religious sense;
+and yet the faith which really cures a digestive trouble, for instance,
+is the faith in the final overcoming of the intestinal disturbance, an
+idea which belongs evidently in the region of physiological psychology,
+but not in the region of the church. Yet, however clumsy such statements
+may be, they are surely controlled by the instinctive desire for a new
+idealistic order of our life, and the time will come when their
+unreasoning and unreasonable wisdom will be transformed into sound
+philosophy without losing its deepest impulse. The realistic conviction
+that even the mind is completely controlled by natural laws and the
+idealistic inspiration that the mind of man has in its freedom mastery
+over the body, are thus most curiously mixed in the popular
+psychotherapy of the day, and too few recognize that the real meaning of
+mind is an entirely different one in these two propositions.
+
+Of course the one or the other of these two elements prevails in the
+systematic treatises on the subject; the realistic one in those written
+by the psychiatrists, the idealistic one in those written by clergymen
+or Christian Scientists. The literature indeed is almost entirely
+supplied from these two quarters: and yet it is evident that neither the
+one nor the other party can give to the problem its most natural
+setting. The student of mental diseases naturally emphasizes the
+abnormal features of the situation, and thus brings the
+psychotherapeutic process too much into the neighborhood of pathology.
+Psychotherapy became in such hands essentially a study of hypnotism,
+with especial interest in its relation to hysteria and similar diseases.
+The much more essential relation of psychotherapy to the normal mental
+life, the relation of suggestion and hypnotism to the normal functions
+seemed too often neglected. Whoever wants to influence the mind in the
+interest of the patient, must in the first place be in intimate contact
+with psychology. On the other hand, the minister's spiritual interest
+brings the facts nearer to religion than they really are. That a
+suggestion to get rid of toothache, or to sleep the next night, is given
+by a minister, does not constitute it as a religious suggestion. If the
+belief in religion simply lies alongside of the belief in most trivial
+effects, and both are applied in the same way for curing the sick, it is
+evident that not the spiritual meaning of religion is responsible for
+the cure, but the psychological process of believing. But if that is the
+case, it is clear that here again the psychologist, and not the
+moralist, will give the correct account of the real process involved.
+In short, it is psychology, psychology in its scientific modern form,
+which has to furnish the basis for a full understanding of
+psychotherapy. From psychology it cannot be difficult to bridge over to
+the medical interests, on the one side, to the idealistic ones on the
+other side.
+
+Our task here is, therefore, to lay a broad psychological foundation. We
+must carefully inquire how the modern psychologist looks on mental life
+and how the inner experiences appear from such a psychological
+standpoint. The first chapters of this volume may appear like a long,
+tiresome way around before we come to our goal, the study of the
+psychotherapeutic agencies. And yet it is the only possible way to
+overcome the superficiality with which the discussion is too often
+carried on; we must understand exactly how the psychological analysis
+and explanation of the scientist differ from the popular point of view.
+After studying in this spirit the foundation of psychotherapy, we shall
+carefully examine the practical work, its methods and its results, its
+possibilities and its limitations. We shall inquire finally into the
+place which it has to take, looking back upon its history, criticising
+the present status and outlining the development which has to set in for
+the future, if a haphazard zigzag movement is not to destroy this great
+agency for human welfare by transforming it into a source of
+superstition and bodily danger.
+
+
+
+
+PART I
+
+THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
+
+
+
+
+II
+
+THE AIM OF PSYCHOLOGY
+
+
+The only safe basis of psychotherapy is a thorough psychological
+knowledge of the human personality. Yet such a claim has no value until
+it is entirely clear what is meant by psychological knowledge. We can
+know man in many ways. Not every study of man's inner life is psychology
+and the careless mixing of different ways of dealing with man's inner
+life is largely responsible for the vagueness which characterizes the
+popular literature of psychotherapy. It is not enough to say that a
+statement is true or not true. It may be true under one aspect and
+entirely meaningless under another. For instance, a minister's
+discussion of man's energies may be full of deep truth and may be
+inspiring; and yet it may not contain the slightest contribution to a
+really psychological knowledge of those energies, and would mislead
+entirely the physician were he to base his treatment of human energies
+on such a religious interpretation.
+
+Can we not look from different standpoints even on any part of the
+outer world? I see before me the ocean with its excited waves splashing
+against the rocks and shore, I see the boats tossed on the stormy sea
+and I am fascinated by the new and ever new impulses of the tumultuous
+waves. The whole appears to me like one gigantic energy, like one great
+emotional expression, and I feel deeply how I understand this beautiful
+scenery in appreciating its unity and its meaning. Yet would I ever
+think that it is the only way to understand this turmoil of the waters
+before me? I know there is no unity and no emotion in the excited sea;
+each wave is composed of hundreds of thousands of single drops of water,
+and each drop composed of billions of atoms, and every movement results
+from mechanical laws under the influence of the pressing water and air.
+There is hydrogen and there is oxygen, and there is chloride of sodium,
+and the dark blue color is nothing but the reflection of billions of
+ether vibrations. But have I really to choose between two statements
+concerning the waves, one of which is valuable and the other not? On the
+contrary, both have fundamental value. If I take the attitude of
+appreciation, it would be absurd to say that this wave is composed of
+chemical elements which I do not see; and if I take the attitude of
+physical explanation, it would be equally absurd to deny that such
+elements are all of which the wave is made. From the one standpoint, the
+ocean is really excited; from the other standpoint, the molecules are
+moving according to the laws of hydrodynamics. If I want to understand
+the meaning of this scene every reminiscence of physics will lead me
+astray; if I want to calculate the movement of my boat, physics alone
+can help me.
+
+As long as we deal with outer nature, there is hardly a fear of
+confusing the various attitudes; but it becomes by far more complex when
+we deal with man and his inner life. We might abstract entirely from
+æsthetic appreciation or from moral valuation, we might take man just as
+an object of knowledge; and yet what we know about him may be entirely
+different in accordance with our special attitude. Each kind of
+knowledge may be entirely true, and yet true only from the particular
+standpoint. Let us consider two extremes. If I meet a friend and we
+enter into a talk, I try to understand his thoughts and to share his
+views. I agree or disagree with him; I sympathize with his feelings, I
+estimate his purposes. In short, he is for me a center of aims and
+intentions which I interpret: he comes in question for me as a self
+which has its meaning and has its unity. The more I am interested in his
+opinions, the more I feel in every utterance, in every gesture, the
+expression of his will and his purposes; their whole reality for me lies
+in the fact that they point to something which the speaker intends; his
+personality lies in his attitude towards the surroundings, towards the
+world. Yet I may take an entirely different relation to the same man. I
+may ask myself what processes are going on in his mind, what are the
+real contents of his consciousness, that is, what perceptions and memory
+pictures and imaginative ideas and feelings and emotions and judgments
+and volitions are really present in his consciousness. I watch him to
+find out, I observe his mental states, I do not ask whether I agree or
+disagree; his will is for me now not something which has a meaning, but
+simply something which occurs in his inner experience; his ideas now
+have for me no reference to something in the world, but they are simply
+contents of his consciousness; his memories now are for me not symbols
+of a past to which he refers, but they are present pictures in his mind;
+in short, what I now find is not a self which shows itself in its aims
+and purposes and attitudes, but a complex content of consciousness which
+is composed of numberless elements. I might say in the first place that
+my friend was to me a subject whom I tried to understand by interpreting
+his meaning, and in the second case, an object which I understand by
+describing its structure, its elements, and their connections.
+
+Both ways of looking on man are constantly needed. We might alternate
+between them in any experience. In the heat of argument, my friend will
+certainly be for me the subject with whose meanings I try to agree or
+disagree, whose emotions carry me away, whose ideas open the world to
+me. Yet in the next moment, I may notice that his ideas were shaped and
+determined by certain earlier experiences; that they linked themselves
+in memory according to certain laws of mental flow; that the vividness
+of his ideas made him overlook certain impressions of the surroundings;
+and that may turn my attention to an entirely different aspect of his
+inner life. His feelings and emotions, his volitions and judgments now
+have for me simply the character of processes which go on and which are
+observed, which coincide and which succeed each other, which fuse and
+overlap, and which are composed of smaller parts. My interest is now no
+longer in the meaning and intentions of this self, but it belongs to the
+structure and the connections in this system of mental facts. At first,
+I wanted to understand him by living with him, by participating in his
+attitudes, and by feeling with his will; now I want to understand him by
+examining all the processes which go on in his consciousness, by
+studying their make-up and their behavior, their elements and their
+laws. In one case I wanted to interpret the man, and finally to
+appreciate him; in the other case I wanted to describe his inner life,
+and finally to explain it. The man whose inner life I want to share I
+treat as a subject, the man whose inner life I want to describe and
+explain I treat as an object.
+
+I might express these two standpoints still otherwise. If my neighbor is
+to me a subject, for instance, in the midst of an ordinary conversation,
+he comes in question only with reference to his aims and meanings:
+whatever he utters has a purpose and end. I understand his inner life by
+taking a purposive point of view. On the other hand, the man whose inner
+life is to me an object can satisfy my interest only if I understand
+every particular happening in his mind from its preceding causes. I
+transform his whole life into a chain of causes and effects. My
+standpoint is thus a causal one. No doubt in our daily life, our
+purposive interest and our causal interest may intertwine at any moment.
+I may sympathize with the hopes and fears of my neighbor in a purposive
+way, and may yet in the next moment consider from a causal standpoint
+how these emotions of his are perhaps affected by his fatigue or by some
+glasses of wine, or by a hereditary disposition, or by a suggestion; in
+short, at one time I look out for the meaning of the emotion as a part
+of the expression of a self, and at another time for the structure and
+appearance of the emotion as a part of a causal chain of events. In both
+directions I can go on with entire consistency, and there cannot be any
+part of inner experience which cannot be fully brought under either
+point of view. How far we have a right to mix the two standpoints in
+practical life, we shall carefully examine; but it is clear that if we
+want to understand the true meaning of the study of inner life, we have
+no longer any right carelessly to mix the two standpoints without being
+conscious of their fundamental difference. We must understand exactly
+what the aim of the one and of the other is, and where each has its
+particular value; science certainly has no right to throw together such
+different views of life. And now this may be said at once: the causal
+view only is the view of psychology; the purposive view lies outside of
+psychology.
+
+Such a separation does not at all aim to indicate that the one view is
+more important than the other, or that the one has more scientific
+dignity than the other; both yield us truth, and both may be carried
+from the simplest and most trivial observations of daily life to the
+highest elaborations of scholarship. To those who are inclined to give
+all value and all credit only to the strictly psychological view, it may
+be replied at once that surely our most immediate life experience is
+carried on by the non-psychological attitude. If we love our family and
+like our friends, and deal with the man of the street, we are certainly
+moving in a world of purposive reality. We try to understand each other,
+to agree and to disagree, to be in sympathy and antipathy, without
+asking how those volitions and feelings and ideas of other people are
+built as mental structures, and from what causes they arose; we are
+satisfied to understand what they mean. In the same way with ourselves.
+We live our lives by hinging them on our aims and purposes and ideas,
+and do not ask ourselves what are the causes of our attitudes and of our
+thoughts.
+
+This purposive view has in no respect to disappear if we move on from
+our personal intercourse to a scholarly study of reality. The historian,
+for instance, who tries to understand the will relations of humanity, is
+the more the true historian the more he sticks to this purposive view of
+man. The truth which he seeks is to interpret the personalities, to
+understand them through their attitudes, to make their will living once
+more, and to link it by agreement and disagreement, by love and hate,
+with the will of friends and enemies, groups and parties, nations and
+mankind. It is only a loose popular way of speaking, if this purposive
+analysis of a character is often called psychological. In a stricter
+sense of the word, it is not psychological. If the historian really were
+to take the psychological attitude, he would make of history simply a
+social psychology, seeking the laws of the social mind, and treating the
+individual, the hero, and the leader, merely as the crossing-point of
+psychological law. For such a psychological view the mental life of the
+hero would not be more important or more interesting than the mental
+life of a scoundrel, and the psychology of the king would not draw his
+interest more than the psychology of the beggar. The historian has to
+shape all that from an entirely different standpoint: his scientific
+interest depends upon the importance of men's attitudes and actions, and
+such importance refers to the world of purposes.
+
+In the same way, we have to stick to the non-psychological point of view
+whenever man's life, his thoughts and feelings and volitions, are to be
+measured with reference to ideals; that is in ethics and æsthetics and
+logic, sciences which ask whether the volitions are good or bad, whether
+the feelings are valuable or worthless, whether the thoughts are true or
+false. The psychologist does not care; just as the botanist is
+interested in the weed as much as in the flower, the psychologist is
+interested in the causal connections of the most heinous crime not less
+than in those of the noblest deed, in the structure of the most absurd
+error not less than in that of the maturest wisdom. Truth, beauty, and
+morality are thus expressions of the self in its purposive aspect.
+
+We can go one step further. Those who narrowly seek every truth only in
+the scientific understanding, ought to be reminded that this seeking for
+causal connections is itself, after all, only a life experience which as
+such is not of causal but of purposive character. "Life is bigger than
+thought." In the immediate reality of our purposive life we aim towards
+mastering the world by a causal understanding, and for this end we
+create science; but this aim itself is then a purpose and not an object.
+The first act is thus for us, the thinkers, not a part of the causal
+events, but a purposive intention towards an ideal. Therefore, our
+purposes have the first right; they represent the fundamental reality;
+the value of causal connections and thus of all scientific and
+psychological explanation, depends on the value of the purpose. Causal
+truth can be only the second word; the first word remains to purposive
+truth. From this point of view we may understand why there is no
+conflict between the most consistent causal explanation of mental life
+on the one side, and an idealistic view of life on the other side; yes,
+we can see that the fullest emphasis on a scientific psychology--which
+is necessarily realistic and, to a certain degree, materialistic--is
+fully embedded in an idealistic philosophy of life, and that without
+conflict. And we shall see how this consistency in sharply separating
+the psychological view from the non-psychological, secures much greater
+safety for true idealism than the inconsistent popular mixing of the
+two principles, where scientific psychology is constantly encroached
+upon by demands of faith and religion, and where faith and religion seem
+constantly in danger of being overturned by new discoveries in
+physiological psychology. We may, indeed, remove from the start the
+mistaken fear that a consistent causal aspect of life leads to injustice
+to the higher aims and ideal purposes of mankind. If we want to have
+psychology,--and that means if we want to consider the mental life in a
+system of causes and effects,--we must proceed without prejudices, and
+without side-thoughts.
+
+From a psychological standpoint our own mental life and that of our
+neighbor, that of the man and that of the child, that of the normal and
+that of the insane, that of the human being and that of the animal, are
+to be considered as a series of mental objects. They are to be analyzed,
+and to be described, and to be classified and to be explained, just as
+we deal with the physical objects in the outer world. How are these
+objects of the psychologist different from the objects of the physicist,
+from the pebbles on the way and the stars in the sky? There is only one
+fundamental difference and all other differences result from it. Those
+outer objects which we call physical, are objects for everybody. The
+star which I see is conceived as the same star which you see, the table
+which I touch is the table which you may grasp, too. But every psychical
+object is an object for one particular person only. My visual impression
+of the star, that is, my optical perception, is a content of my own
+consciousness only, and your impression of the star can be a content of
+your consciousness only. We both may mean the same by our ideas, but I
+can never have your perception and you can never have my perception. My
+ideas are enclosed in my mind. I may awaken in your mind ideas which
+have the same purpose and meaning, but they are new copies in your mind.
+We both may be angry, but your anger can never be my anger, and your
+volitions can never enter my mind. Every possible psychical fact thus
+exists in one consciousness only, while every physical fact exists for
+every possible consciousness.
+
+The psychologist's final task is to explain the appearance and
+disappearance, the connections and sequences of these mental objects,
+the contents of consciousness. But before he can start on explanation of
+the facts, he has to describe them, and describing means analyzing them
+into their elements and fixating those elements and their combinations
+for an exact report. Such descriptive work is in a way preparatory for
+the further task of real explanation; yet it is in itself important,
+complicated, and difficult. Of course, it may be easy to separate the
+complex content into some big groups of facts, to point out that this is
+a memory idea and this an imaginative idea and the other an abstract
+idea, and this a perception and that a feeling, this an emotion and that
+a volition. But such clumsy first discrimination does not go further,
+perhaps, than does the naturalist's, who tells us that this is a
+mountain and that a tree, this a pond and that a bird. The real
+description would demand, of course, an exact measurement of the height
+of the mountain and the geological analysis of its structure, or an
+exact classification of the tree and the bird, with a complete
+description of their organs, and in each organ the various tissues have
+to be described, and in each tissue the various cells, and the
+microscopist goes further and describes the structure of the cell.
+Certainly in the same way the psychologist has to go on to resolve every
+one of those complex structures; he has to examine the mental tissues
+and the mental cells of which a volition or a memory idea or a
+perception are composed. And while he cannot use a microscope for these
+mental elements, yet his studies may cause elements to appear which the
+naïve observation remains entirely unaware of.
+
+Perhaps he finds in his consciousness the perception of the table before
+him which lingers for a little while in his mind. He finds no difficulty
+in analyzing it into color sensations and tactual sensations; and yet he
+is aware of so much more in it. The table, for instance, has form for
+him and he may find that these form perceptions involve the sensations
+of the eye movements which he makes from one corner of the table to the
+other; he may find that if the idea lasts in him, he becomes aware of
+the time by sensations of tension; he finds that in his perception of
+the table lies an idea of its use, and he discovers that that is made up
+of elements which are partly memory reproductions of earlier
+impressions, partly sensations of movement impulses; he also finds that
+the table feels smooth, and he discovers by his analysis that this
+impression of smoothness results from a special combination of tactual
+sensations and movement sensations; and again those movement sensations
+he analyzes further into sensations of muscle contraction and sensations
+of pressure in the joints and sensations of tension in the tendons.
+Before a zoölogist has completed his description of a bird in the
+landscape, he has given account of hundreds of thousands of things; but
+before the psychologist would complete the enumeration of the mental
+elements which enter into the seeing of the table, he would have to give
+account of by far more psychical elements. Every point in the surface of
+the table has its own light value, perhaps different in its quality and
+intensity and saturation, in its hue and tint and shade from the next
+one, and at whatever point of the table's edge our attention is
+directed, each one involves numberless shades in the vividness of all
+the other points and numberless mental relations of space perception
+among the various parts of the table. In the thorough analysis of the
+describing psychologist, every single idea, and in the same way, every
+single emotion or feeling or judgment becomes complex like a living
+organism, an aggregate of thousands of mental tissues, and yet made up
+from "the stuff that dreams are made of."
+
+But there is one particular difficulty which makes the psychological
+description so much harder than that of the physicist, and which gives
+rise to many disagreements and discussions in psychological literature.
+The psychologist has not only to tear the complex into pieces and thus
+to seek the elements, but he has to fixate those elements for the
+purpose of communication, as, of course, a scientific description
+demands that he be able to give account to others of what he
+experiences. The physicist has no difficulty whatever in that line
+because, as we saw, the world of physical things is the world which all
+men are sharing together. Every element which I find in it, I can show
+to every other person, and if I cannot show that particular thing,
+because I cannot yet carry the mountain to another place, then I can at
+least measure it, as we share those standards of space. Thus natural
+science has in its objective measurements the possibility of describing
+every part of the physical world. The psychical world, on the other
+hand, is as we saw, the world which is private property. Every effort at
+description is thus entirely in vain as long as our mental facts cannot
+somehow be linked with physical happenings. If I say that I have in my
+mind sweetness or sourness, or bitterness or saltness, I cannot carry
+any understanding to anyone else and therefore cannot give any
+description until I have agreed that I mean by sweetness the sensation
+which sugar gives me, and by saltness the sensation of salt. The sugar
+and salt I can point out to my neighbor and only in that way I
+understand what he means if he says that he tastes salt and sweet;
+otherwise I should have no means whatever to discriminate whether that
+which he calls a sweet taste sensation is not just what I call headache.
+Where no such direct relation for a physical thing is known, description
+of the mental element would remain impossible. Of course, every
+perception of the outer world, all our seeing and hearing, and touching
+and tasting, offers us at once such definite connection between the
+inner experience and a piece of the physical universe. Our own organism
+is also such a piece of physical nature: just as I describe my tasting
+or touching, I may describe the perception of my arms and legs or my
+inner organs. Thus everything which is material of perception gives us a
+handle for a real psychological description. Psychology usually calls
+the elements of these perceptions sensations. Whatever is composed of
+sensations is thus describable.
+
+On the other hand, no other way of description is open. If there were
+mental states which are composed of other elements than sensations, they
+would necessarily remain indescribable; we could not grasp them because
+they would not have any definite relation to the common physical world.
+We might say, for instance, that our mental content is made up of
+sensations and feelings, but if such feelings were really entirely
+different from sensations, they would have to remain for all time
+mysterious and unknown. We could not compare notes. The feeling which I
+call joy may feel just like the one which you call despair. The
+consistent development of modern psychology and its emancipation from
+vagueness and superficial analysis became possible only through the fact
+that such recourse to indescribable elements has become unnecessary.
+Modern psychology has been able to demonstrate more and more that the
+same elements which constitute our perceptions are also the elements of
+the other contents of consciousness. In other words modern psychology
+has recognized that the volitions and emotions and feelings and
+judgments, and the whole stream of inner life, are made up of
+sensations. Millions of sensations in all degrees of vividness and
+clearness, of intensity and fusion, in endless manifoldness of rhythms
+and relations constitute their whole content. It is a discovery quite
+similar to the one which chemistry made when it found that the same
+elements which are part of the inorganic substances are also the only
+possible elements of the organic world.
+
+From a strictly psychological standpoint, the ideas and the not-ideas
+contain thus nothing but sensations. Their grouping, their shading,
+their combination, their succession decide whether we have before us a
+perception or an imagination, a volition or an emotion. What are we
+ourselves then for the psychologist? Evidently we ourselves belong also
+to the inner experiences which we know; and psychology has succeeded in
+analyzing this idea of our own self just in the same way as it analyzes
+our idea of the moon. In this analysis, psychology finds its idea of the
+self as a content of consciousness crystallized about the sensations
+from the body. Every one of our bodily activities is represented in our
+consciousness by movement sensations, and these sensations form the core
+of the complex aggregate which develops into the idea of ourselves.
+Organic sensations from our inner organs, pain sensations and pleasure
+sensations fuse with the movement sensations, and the whole complex
+shapes itself slowly into the idea of the personality of the self in
+contrast to the idea of other personalities. We ourselves are for
+ourselves a complex combination of sensations; and yet all our feelings
+and emotions and volitions are only a part of it. Psychology thus
+necessarily considers those experiences of feeling and will and
+character simply as changes in the midst of that central experience of
+personality which is itself made up of bodily sensations. Each bit of
+will and emotion must be decomposed into its finest elements. There is
+no passing mood, and no floating half-thought in our mind, no dream and
+no intuition, no slightest change of attention, no instinct and desire
+which cannot be analyzed thus into its sensation elements or rather
+which must not be analyzed, if we are to describe it at all, and that
+means if we are to give a psychological account. Psychology is endlessly
+far from this ideal to-day. It has been claimed, not without justice,
+that psychology has reached to-day only the level which physics attained
+in the seventeenth century; but psychology must insist that its ideal
+lies in this direction. No one takes a real psychological view of the
+human mind who does not understand this endless complexity of the
+material, and who does not see that even the simplest mental state
+practically presents a most complex problem to scientific analysis. The
+physician who really aims towards scientifically exact influence on the
+human mind has reached the first step of his preparation as soon as he
+understands that the content of consciousness is composed of hundreds
+of thousands of elements. To treat the mind as if there were only a few
+large pieces, one thing called memory and one thing called will and one
+called emotion and so on, is as if a surgeon were to perform an
+operation, knowing that there are arms and legs, but not knowing the
+ramifications of the nerves and blood-vessels which his knife may
+injure. Yet the description of these complex facts is only the beginning
+of psychology. We saw that the real aim is their explanation.
+
+
+
+
+III
+
+MIND AND BRAIN
+
+
+The central aim of the psychologist must be to explain the mental facts.
+It is not sufficient to describe the procession of mental experiences in
+us, we must understand the causes which determine that now this and now
+that appears and disappears, and appears just in this combination of
+elements. The astronomer is not satisfied with describing the stars, he
+wants to explain their movements and to determine which movements are to
+be expected. The psychologist, like the naturalist, aims towards
+explanation, and it is this demand which forces him to look from the
+psychical facts to the physical ones, from the mind to the brain. He is
+under an illusion if he fancies that he can explain mental facts by
+themselves. The purposive mind has its connection in itself, the causal
+psychological mind demands for its connection the body. To understand
+this necessity is the first step towards understanding the relation of
+mind and brain.
+
+The psychologist's problem of explanation is in one way entirely
+different from that of the physicist. The physicist finds a world of an
+unlimited number of atoms which are ultimately conceived as all alike,
+but each one in a different place, and all the changes in the universe,
+the movements of the stars, the waves of the ocean, are to be explained
+by the causal connections of the movements of these atoms. The
+psychologist, on the other hand, finds an endless manifoldness of
+elements which are not in space, and which have no space form whatever.
+My will is neither triangular nor oval; my emotion is neither shorter
+than five feet nor longer; my memory image of a melody has no thickness
+and no tallness; my contents of consciousness are as such not in space;
+their elements cannot pass through any space movements like the atoms of
+the physicist. Instead of it, the psychical atoms, the sensations, have
+different qualities, are blue and green, and cold and warm, and sweet
+and sour, and toothache and headache. The changes which go on in such a
+system are thus not changes of position and movements, but changes in
+kind and strength and vividness and fusion; and exactly such changes are
+the processes which the psychologist wants to explain. He wants to make
+us understand why this idea grows up and the other fades away, why this
+impression stands out with clearness as an attended object while the
+other lacks vividness and disappears, why this volition grows out of
+that emotion, why this feeling leads to this imaginative thought.
+
+The first step towards such explanation is, of course, in psychology, as
+in all other sciences, the careful observation of regularities. It
+quickly leads us to formulate some general laws. Psychology has known,
+for instance, for two thousand years, that if we have perceived two
+things together, and later we see the one again, the new perception
+brings us a memory image of the other thing. If we saw a man's face and
+heard at the same time his name, seeing his face may later awaken in us
+the memory of his name, or the hearing of his name may later awaken in
+us a reproduced memory image of his face. On such a basis, for instance,
+we formulate some general laws of association of ideas, and as soon as
+we have such laws laid down, we consider the appearance of such a memory
+image by association as sufficiently explained. We feel that it gives us
+sufficient basis to predict that in the future this idea will stir up in
+us the other idea. Psychology has formulated plenty of such general
+statements, and they serve well for a first orientation.
+
+Yet can this ever be considered as a last word of scientific explanation
+of psychical facts? Can psychology really in this way reach an ideal
+similar to that of scientific astronomy or chemistry? Would the
+scientist of nature ever be satisfied with this kind of explanation,
+which is nothing but generalization of certain sequences? Does not the
+explanation of the naturalist contain an entirely different element? He
+does not merely want to say that this effect has sometimes been observed
+and that there is thus probability that it will come again, when similar
+causes are given. No, the physicist wants to understand those
+connections of cause and effect as necessary ones. He tries to find
+sequences which cannot be otherwise because they cannot be thought in
+any other way. Therefore he is not satisfied with complex regularities,
+but analyzes them until he can bring them down to simple physical
+connections, and these physical connections finally to mechanical
+processes, which realize for us logical necessities. That matter lasts
+and cannot disappear is such a presupposition, which comes to us with
+the necessity of logical thinking. We simply cannot think it otherwise.
+And the whole idea of natural science is to conceive the physical
+universe in such a way that all changes in the outer world can be
+understood as the movements of its parts in accordance with such
+necessary physical axioms. If we knew all the atoms of the present
+status of the universe, and we knew every present movement of every
+atom, we should be able to foresee the position of every atom in the
+next moment and in the following moment and in all following moments,
+and all that by the necessary continuation of the substance and its
+energies. That alone is the background of all special physical inquiry,
+and we rely on the special laws of physics and chemistry, because we
+trust that this universe, as a whole, could be ultimately understood as
+such a system of necessary changes in the positions of the lasting
+atoms.
+
+For the psychologist there is no hope of finding such necessity in the
+mental processes. The point is not that psychology is to-day too far
+removed from the fulfillment of such an ideal, the point is rather that
+such an ideal would be meaningless for the psychologist. His materials,
+the psychical contents of consciousness, are by their nature unfit to
+enter into such necessary connections; they cannot do it because they
+cannot last. The physical object, we saw, is the object which is common
+property, which we all feel in common, which must thus exist for all
+time. The things in nature may burn down or decay, but no atom of them
+can ever disappear from the universe, each must enter into new and ever
+new combinations and last through all changes. The psychical thing, on
+the other hand, can exist only for the one immediate experience. Every
+sensation which enters into my ideas or volitions or emotions is a new
+creation of the instant which cannot last; each one flashes up and is
+lost with the moment's experience. My will to-day may have the same aim
+as my will of yesterday, but as psychical object, my will to-day is a
+new will, is a new creation in every pulse beat of my life. I must will
+it again, I cannot store it up. And my joy of to-day can never be as
+psychical fact the same joy which I may have to-morrow. Mental objects
+as such, as psychological material, are not destined to last. It has no
+meaning whatever to think of their being kept over until another time.
+It is a coarse materialism to conceive the mental contents like pebbles
+which may remain on the road from one day to another. Our ideas and
+feelings are mental appearances which have their existence in the act of
+the one experience; each new experience must be an entirely new
+creation.
+
+If I remember my last year's perception, I do not dig it out from an
+under-mind, in which it was stored up and buried, but I create an
+entirely new memory picture, just as I may make to-day a speech which
+says the same thing which I said last year, and yet my action of
+speaking is not last year's speech movement. It is a new action, and the
+movement did not lie over somewhere during the interval. Mental life is
+produced anew in every moment. When the first experience is gone and the
+second comes, nothing of the stuff from which the first was made still
+has existence in the content of consciousness. By this fact it becomes
+entirely impossible ever to conceive necessary connections in the sense
+of physical necessity in the world of consciousness. The one idea may
+bring to me another idea by association, but as long as I consider both
+strictly as mental facts, I can never understand why this association
+happens, I can never grasp the real mechanism of the connection, I can
+never see necessity between the disappearance of the one and the
+appearance of the other. It remains a mystery which does not justify any
+expectation that the same sequence will result again. Whatever belongs
+to the psychical world can never be linked by a real insight into
+necessity. Causality there remains an empty name without promise of a
+real explanation.
+
+Only when we have recognized this fundamental difficulty in the efforts
+for psychological explanation, can we understand the way which modern
+psychology has taken most successfully. The end of this way is simply
+this: every psychical fact is to be thought of as an accompaniment of a
+physical process and the necessary connections of these physical
+processes determine, then, the connections of the mental facts. Indeed
+this has become the method of modern psychology. It has brought about
+the intimate relation between psychology and the physiology of the
+brain, and has given us, as foundation, the theory of psychophysical
+parallelism; the theory that there is no psychical process without a
+parallel brain process. But the real center of the theory lies indeed in
+the fact which we discussed; it lies in the fact that we cannot have any
+explanation of mental states as such at all, if we do not link them with
+physical processes.
+
+Is it necessary to express again the assurance that such statements of a
+parallelism between mind and brain in no way interfere with an
+idealistic view of inner life? Have we not seen clearly enough that
+these mental facts which are conceived parallel to physiological brain
+processes do not represent the immediate reality of our inner life, that
+our life reality is purposive and as such outside of all causal
+explanation, and that we have to take a special, almost artificial,
+point of view to consider inner life at all as objects, as contents of
+consciousness, and thus as psychological material? But since we have
+seen that for certain purposes such a point of view is necessary, as
+soon as we have taken it we must be consistent. Our inner life in its
+purposive reality has therefore nothing to do with brain processes, but
+if we are on the psychological track and consider man as a system of
+psychological phenomena, then to be sure, we must see that our only
+possible interest lies in the finding of necessary causal connections.
+But these cannot be found otherwise than by linking the mental facts
+with the physical ones, the psychological material with the processes of
+the brain.
+
+Of course, that mental experience stands in intimate relations to the
+body is a knowledge which does not wait for such philosophical
+arguments. That mind and body come in contact is a conviction which goes
+with every single sense perception. I see and hear because light and
+sound stimulate my sense organs, and the sense organs stimulate my
+brain. The explanation of perception through causes in the physical
+system seems the more natural as it is evident that in such cases there
+are no psychical causes which might have brought forward the perception.
+If I suddenly hear bells ringing, there was on the mental side nothing
+preceding which could be responsible for my sound perception. And the
+same holds true if the physical source lies in my own body, if perhaps
+my tooth begins to ache, although no expectation preceded it.
+
+In the same way it seems a matter of course that mind and body are
+connected wherever an action is performed. I have the will to grasp for
+the book before me, and obediently my arm performs the movement; the
+muscles contract themselves, the whole physical apparatus comes into
+motion through the preceding mental fact. The same holds true where no
+special will act arouses the muscles. If a thought is in my mind and it
+discharges itself in appropriate words, those words are after all as
+physical facts the movements of lips and tongue and vocal cords and
+chest; in short, a whole system of physical responses has set in through
+a mental experience. But the same thought may be the starting-point for
+many other bodily changes; it may make me blush, and that means that
+large groups of blood-vessels become dilated; or I may get pale, the
+blood-vessels are contracted. Or I may cry, the lachrymal gland is
+working; or it may spoil my appetite, the membranes of my stomach cease
+to produce; or my muscles may tremble, or my skin may perspire; in
+short, my whole organism may resound with mental excitement which some
+words may set up.
+
+But it is not only the impression of outer stimuli and the expression of
+inner thoughts in which mind and body come together. Daily life teaches
+us, for instance, how our mental states are dependent upon most various
+bodily influences. If the temperature of the blood is raised in fever,
+the mental processes may go over into far-reaching confusion; if hashish
+is smoked, the mind wanders to paradise, and a few glasses of wine may
+give a new mental optimism and exuberance; a cup of tea may make us
+sociable, a dose of bromide may annihilate the irritation of our mind,
+and when we inhale ether, the whole content of consciousness fades away.
+In every one of these cases, the body received the chemical substance,
+the blood absorbed and carried it to the brain, and the change in the
+brain was accompanied by a change in the mental behavior. Even ordinary
+sleep at night presents itself surely as a bodily state--the fatigued
+brain cells demand their rest, and yet at the same time the whole mental
+life becomes entirely changed. It is not difficult to carry over such
+observations of daily life to the more exact studies of the
+psychological laboratory and to examine with the subtle means of the
+psychological experiment the mental variations which occur with changes
+of physical conditions. We might feel, without instruments, that our
+ideas pass on more easily after a few cups of strong coffee, but the
+laboratory may measure that with its exact methods and study in
+thousandth parts of a second, the quickening or retarding in the flow of
+ideas. Every subjective illusion is then excluded, our electrical
+clocks, which measure the rapidity of mental action and of thought
+association, will show then beyond doubt how every change in the
+organism influences the processes of the mind. Bodily fatigue and
+indigestion, physical health and blood circulation, everything,
+influence our mental make-up. In the same way it is the laboratory
+experiment which shows by the subtlest means that every mental state
+produces bodily effects where we ordinarily ignore them. As soon as we
+apply the equipment of the psychological workshop, it is easy to show
+that even the slightest feeling may have its influence on the pulse and
+the respiration, on the blood circulation and on the glands; or, that
+our thoughts give impulse to our muscles and move our organs when we
+ourselves are entirely unaware of it.
+
+Again we may turn in another direction. Pathology shows us how every
+physical disablement of the brain is accompanied by mental processes.
+If the blood supply to the brain is cut off, we faint; a blow on the
+head may wipe out the memory of the preceding hours, and a hemorrhage in
+the brain, the bursting of a blood vessel which destroys groups of brain
+cells, produces serious defects in the mental content. A tumor in the
+brain may completely change the personality; the bodily disease of
+certain convolutions in the brain brings with it the loss of the power
+of speech; paralysis of the brain dissolves the whole mental
+personality. Physical inhibition in the growth of the brain involves, on
+the mental side, feeble-mindedness and idiocy. Of course, all this is
+not sufficient to bring out a definite parallelism between special
+mental functions and special physical processes, as the phenomena are
+extremely complex. If a patient who has suffered from a mental
+disturbance dies, and his brain is examined, there is no simple
+correlation before us. It may be difficult to diagnose exactly the
+mental symptoms. If we have heard that the man was unable to read, we do
+not know from that what really happened in his brain. He may not have
+read because he did not see the words, or because the letters were
+confusing, or because he had lost memory for the meaning, or because he
+had lost the impulse to speak the words, or because he felt unable to
+turn his attention, or because the impulse to read aloud was not carried
+out by his organism, or because an inner voice told him that it is a sin
+to read, or for many similar reasons; and yet each one represents
+psychologically an entirely different situation. On the other hand, on
+the physical side, the destruction is probably not confined to one
+particular spot. Complications have crept over to other places or the
+disturbance in one part works as inhibitory influence on other brain
+parts, or a tumor may press on a far-removed part, or the disturbance
+may be one which cannot be examined with our present microscopic means.
+In short, we have always a complex mental situation and a complex
+physical one, and to find definite correlations may be possible only by
+the comparison of very many cases.
+
+Other methods, however, may supplement the pathological one. The
+comparative anatomist shows us that the development of the central
+nervous system in the kingdom of animals goes parallel to the
+development of the mental functions, and that it is not only a question
+of progress along all lines. Any special function of the mind may have
+in certain animal groups an especially high development, and we see
+certain parts correspondingly developed. The dog has certainly a keener
+sense of smell than the man--the part of the brain which is in direct
+connection with the olfactory nerve is correspondingly much bulkier in
+the dog's brain than in the human organism. Here too, of course,
+research may be carried to the subtlest details and the microscope has
+to tell the full story. Not the differences in the big structure, but
+the microscopical differences in the brain cells of special parts are to
+be held responsible. But comparison may not be confined to the various
+species of animals; it may refer not less to the various stages of man.
+The genetic psychologist knows how the child's mind develops in a
+regular rhythm, one mental function after another, how the first days
+and first weeks and first months in the infant's life have their
+characteristic mental possibilities, and no mental function can be
+anticipated there. The new-born child can taste milk, but cannot hear
+music. The anatomist shows us that correspondingly only certain nervous
+tracts have the anatomical equipment by which they become ready for
+functioning. Most of the tracts at first lack the so-called medullar
+sheath, and from month to month new paths are provided with this
+physical equipment.
+
+Finally we have the experiment of the physiologist. His vivisectional
+experiments, for instance, demonstrate that the electrical stimulation
+of a definite spot on the surface of a dog's brain produces movements
+which we should ordinarily take as expressions of mental states,
+movements of the front legs or of the tail, movements of barking or
+whining. On the other hand, the dog becomes unable to fulfill the mental
+impulses if certain definite parts of his brain are destroyed. The
+physiologist may show from the monkey down to the pigeon, to the frog,
+to the ant, to the worm, how the behavior of animals is changed as soon
+as certain groups of nervous elements are extirpated. It is the mental
+emotional character of the pigeon which is changed when the physiologist
+cuts off parts of his brain. In short, stimulation and destruction
+demonstrate, by experiments which supplement each other, that mental
+functions correspond to brain functions.
+
+There is thus no lack of demonstration from all quarters that mental
+facts and brain processes belong together; and yet, however much we may
+cumulate such popular and scientific observations, they would never by
+themselves admit of the sweeping generalization that there cannot be any
+mental state which is not accompanied by a process in the central
+nervous system. Someone might say, to be sure, the perceptions and
+memory images, the volitions and instincts and impulses, have their
+physiological basis, but there remain after all acts of attention, or
+decisions, or subtle feelings, or flights of imagination, which are
+independent of any brain action. Here, indeed, observation cannot settle
+such a general principle. Its real hold lies in the fact with which we
+started: there is no causal connection in the mental states as such. If
+we want to understand mental facts as such in a chain, of causal events,
+we have first to conceive them as parallel to physical events. The
+principle of psychophysical parallelism, that is, the principle that
+every psychical process accompanies a physiological change is thus not a
+mere result of observation. It is simply a postulate. Every science
+begins with postulates and only that which fulfills such postulates has
+the dignity of truth in the midst of that scientific realm. The
+astronomer cannot find by observation that there is no star the
+movements of which are not the effects of foregoing causes. He knows it
+beforehand, he demands it, he does not recognize any movement as
+understood until he has found the causes, he presupposes that such
+causes exist, that no star moves simply by a magic power, and that
+nowhere in the astronomical universe is the chain of causality broken.
+He postulates it, and where he does not discover the causes, he is sure
+that he has not solved the real problem.
+
+In the same way the psychologist who aims towards explanation of mental
+facts must postulate that there cannot be any mental state which is not
+an accompaniment of a physical brain process, and is as such connected
+through physical means with the preceding and the following events in
+the psychophysical system. Only when such a general framework of theory
+is built up by a logical postulate, is the way open to make use of all
+those observations of the laboratory and of the clinic, of the zoölogist
+and of the anatomist. It is the theory which has to give the right
+setting to those scattered observations. However far we may be from
+being able to point to the special brain process which lies at the
+bottom of the higher mental state, we know beforehand that there is no
+shadow of an idea, no fringe of a feeling, no suggestion of a desire
+which does not correspond to definite processes in the brain. The
+details may and must be material for diverging theories, but the
+conflict of such hypothetical opinions has nothing to do with the
+certainty of the underlying conviction that if we knew the whole truth,
+we should recognize every single mental happening as parallel to
+physical processes in the nervous system. To explain mental facts means
+to think them as parallel to the brain processes which have their own
+causal connections in the physical world.
+
+We started, for instance, from the old observation that two impressions
+which come to our mind at the same time have a tendency to reawaken one
+another; and we saw that psychology was well able to formulate these
+facts in general statements of the association of ideas. But we realized
+that that in itself is not really explanation. If the odor which we
+smell awakes in us the name of a chemical substance, and if we now bring
+this under the general heading of association of ideas, an explanation
+is not really given by it. That smell sensation itself is not really
+understood as a cause of those sound sensations of the word. We have no
+insight into the connection of those two happenings. But the situation
+is entirely changed, if we consider the smell effect from the point of
+view of the parallelistic theory. Now the association of facts would
+indicate that we got the first two impressions together, because two
+brain processes were going on at the same time. My nose brought me the
+smell stimulus, my ear gave me the sound stimulus, each going on in a
+particular center, or, to express it in a simplified schematic way, each
+reaching particular brain cells, and the excitement of these brain cells
+being accompanied by the particular sensations. The physiologist has
+many possibilities of conceiving the further stages of the process, in
+order to satisfy the demand of explanation. He may say the excitement of
+each of these two brain cells, the one in the olfactory center, the
+other in the auditory center, irradiates in all directions through the
+fine branches of the brain fibers. Each cell has relations to every
+other cell in the brain; thus there is also one connecting path between
+those two cells which were stimulated at once. Now if the two ends of an
+anatomical path are excited at the same time, the path itself becomes
+changed. The connecting way becomes a path of least resistance, and that
+means that if, in future, one of the two brain cells becomes excited
+again, the overflow of the nervous excitement will not now go on easily
+in all directions, but only just along that one channel which leads to
+that other brain cell. A theory like this explains in real explanatory
+terms, in ways which physics and chemistry can demonstrate as necessary,
+that any excitement of the odor cell runs over into the sound cell and
+vice versa. In short, the psychological association of ideas, which we
+should simply have to accept as inexplainable fact, is thus transformed
+into a connection which we understand as necessary; and the fact is
+really explained.
+
+This simple scheme of the physiology of association for a hundred years
+has given a most decided impulse to the progress of psychology. As the
+association process can so easily be expressed in physiological terms,
+the aim was prevalent to understand the interplay of mental life more
+and more as the result of association. The underlying thought of this
+whole association psychology was thus a conviction that whenever two
+mental experiences occur together, either of them keeps the tendency to
+reawaken the other at a later time. Through the endless combination
+which life's impressions awaken in the mind from the first hour after
+birth, the whole stream of memory images and thoughts and aims and
+imaginations is thus to be explained.
+
+The whole theory of physiological associationism works evidently with
+two factors. First, there are millions of brain cells of which each one
+may have its particular quality of sensation, and second, each brain
+cell may work with any degree of energy, to which the intensity of the
+sensation would correspond. If I distinguish ten thousand different
+pitches of tone, they would be located in ten thousand different cell
+groups, each one connected through a special fiber with a special string
+in the ear. And each of these tones may be loud or faint, corresponding
+to the amount of excitement in the particular cell group. Every other
+variation must then result from the millionfold connections between
+these brain cells. Indeed, the brain furnishes all possibilities for
+such a theory. We know how every brain cell resolves itself into
+tree-like branch systems which can take up excitements from all sides,
+and how it can carry its own excitement through long connecting fibers
+to distant places, and how the endings of these fibers clasp into the
+branches of the next cell, allowing the propagation of excitement from
+cell to cell. We know further how large spheres of the brain are
+confined to cells of particular function, that for instance cells which
+serve visual sensations are in the rear part of the brain hemispheres,
+and so on. Finally we know how millions of connecting fibers represent
+paths in all directions, allowing very well a coöperation by association
+between the most distant parts of the brain. The theories found their
+richest development, when it was recognized that large spheres of our
+brain centers evidently do not serve at all merely sensory states, but
+that their cells have as their function only the intermediating between
+different sensory centers. Such so-called association centers are thus
+like complex switchboards between the various mental centers. Their own
+activity is not accompanied by any mental content, but has only the
+function of regulating transmission of the excitement from the one to
+the other. Above all their operation would make it possible that through
+associative processes, the wonderful complexity of our trains of thought
+may be reached.
+
+Yet even the highest development of the association theories did not
+seem to do justice to the whole richness of the inner life. We may well
+understand through those association processes that a rich supply of
+memory pictures is at our disposal, that ideas stream plentifully to our
+minds and enter into new and ever new combinations. But that alone is
+not an account of our inner experience. If there is anything essential
+for inner life, it is the attention which gives emphasis to certain
+states and neglects others. And that means that certain mental contents
+are growing not only in strength but in vividness and clearness, and
+that others are losing their vividness, are inhibited and suppressed.
+Here were always the real difficulties of the association theories; they
+seemed so entirely unable to explain from their own means why certain
+states become foremost in our minds and others fade away, why some have
+the power to grow and others are neglected. These facts of attention and
+vividness, inhibition and fading, worked almost as a temptation to give
+up the physiological explanation altogether and to rely on some mystical
+power, some mental influence which could pull and push the ideas without
+any interference and help from the side of the brain. Yet since we have
+seen that the truth of psychophysical parallelism has the meaning of a
+postulate which we cannot escape unless we want to give up explanation
+altogether, it is evident that such falling back into un-physiological
+agencies would be just as inconsistent as if the naturalist should posit
+miracles in the midst of chemistry or astronomy. If the facts which
+cluster about attention cannot be understood by the simple scheme of
+associationism, the demand must be for a better physiological theory.
+
+The development of physiological psychology in recent years has indeed
+shown the way to such a wider theory, which furnishes the physiological
+accompaniment also for those experiences of attention and vividness
+which form the weakness of associationism. This new development has come
+up with the growing insight that the brain's mental functions are
+related not only to the sensory impressions, but at the same time to the
+motor expressions. The older view, still prevalent to-day in popular
+writings, made the brain the reservoir of physical stimuli, which come
+from the sense organs to the cortex of the brain hemispheres. There the
+perceptions arose and through associative interplay the memory pictures
+and the ideas of action and the feelings arose, and the whole inner life
+was thus bound up with the processes in these sensorial spheres. When
+the mind had done its work, finally an impulse was sent to some motor
+apparatus in the brain which then sent off the impulse to some acting
+muscles. That whole motor part was thus a kind of appendix to the brain
+process. The psychical life had nothing to do with it but to give the
+command for its action. The process in the motor part thus began when
+the mental proceeding was completed. But it became clear that this view
+was only the outgrowth of the strong interest which physiology took in
+the sense processes. If a neutral fair account of the brain actions is
+attempted, there can hardly be doubt that this whole sensorial view of
+the brain is only half of the story and that the motor half has exactly
+the same right to consideration. The cortex of the brain, the functions
+of which are accompanied by mental processes, is always and everywhere
+not only the recipient of sensory stimuli but at the same time the
+starting point of motor impulses. That which is centripetal, leading to
+the cortex, is therefore not more important for the central process than
+that which is centrifugal, leading from the cortex. The cortex is the
+apparatus of transmission between the incoming and the outgoing
+currents, between the excitements which run to the brain and the
+discharges which go from the brain, and the mental accompaniments are
+thus accompaniments of these transmission processes. If the channels of
+discharge are closed and the transmission is thus impossible, a blockade
+must result at the central station and the accompanying mental processes
+must be entirely different from those which happen there when the
+channels of discharge are wide open. Here too all the special theories
+are still in the midst of tumultuous discord. Yet this new emphasis on
+the motor side of the psychical process seems to influence modern
+psychology more and more.
+
+Nobody can deny that first of all this is the necessary outcome of a
+biological view of the brain. What else can be the brain's function in
+the midst of nature than the transforming of impressions into
+expressions, stimuli into actions? It is the great apparatus by which
+the organism steadily adjusts itself to the surroundings. There would be
+no use whatever biologically in a brain which had connections with the
+sense organs, but which had no connections with the muscular system, and
+on the other hand, a brain which had motor nerves and muscular
+adjustment would be entirely useless if it had not sensory nerves and
+sense organs connected with it. In the one case the world would be
+experienced, but no response would be possible; in the other case, the
+means for response would be given, but no adjustment could set in
+because no experience of the surroundings would be possible. Adjustment
+every moment demands the relation of the brain in both directions.
+Through the sensory nerves the brain receives; through the motor nerves
+the brain directs, and this whole arc from the sense organs through the
+sensory nerves, through the brain, through the motor nerves and finally
+to the muscles, is one unified apparatus of which no part can be thought
+away. The brain in itself would be just as useless for the organism as
+the heart would be without the arteries and veins.
+
+We must keep this intimate and necessary relation between the sensory
+and motor parts constantly in view, and must understand that there
+cannot be any sensory process which does not go over into motor
+response. Then only the ways are open to develop physiological views
+which give a physical basis to the processes of attention and vividness
+and inhibition, just as well as to the processes of memory and
+association. Such motor theories take many forms. Perhaps we shall most
+quickly bring the most essential factors together, if we say that full
+vividness belongs only to those sensations for which the channels of
+motor discharge are open, while those are inhibited for which the
+channels of discharge are closed; and any channel of discharge is
+closed, if action is proceeding in the opposite channel. If I open my
+hand, the motor paths which lead to closing my fist are blocked; and if
+I close my fist, the channels which lead to the opening of the hand are
+closed. Now if only those ideas are vivid which find the channels open,
+it is clear that all the ideas which would lead to the opposite action
+have no chance for development; they remain inhibited, and just this
+relation between the vividness of certain ideas and inhibition for those
+ideas which lead to the opposite action is the characteristic of the
+process of attention.
+
+From such a point of view, the total mental life can be brought into the
+psychophysical scheme. We now have not two variable factors, but three,
+namely, the qualities of the elements, the intensities of the elements,
+and, as a third, the vividness of the elements. The quality corresponds,
+as we saw in the association theory, to the local position and
+connection of the brain cells; the intensity corresponds to the energy
+of the excitement; and the vividness, we may add now, corresponds to the
+relation to motor channels. The whole mental life thus becomes the
+accompaniment of a steady process of transmitting impressions and
+memories into reactions. That every experience involves millions of such
+elements we saw when we spoke of the description of mental life. The
+effort to explain mental life shows us now that this millionfold
+manifoldness belongs to a system of reactions of which all parts are in
+steady correlation: a moving equilibrium of unlimited complexity. Surely
+no one can reduce this wonderful manifoldness to those clumsy concepts
+with which popular psychology is reporting the story of the mind and its
+relations to the brain.
+
+It may seem that such a psychological view of inner life annihilates
+that which we feel as the most essential characteristic of our inner
+experience, its unity and its freedom. In one sense that is certainly
+true. In the real life which we live and fight through, where our duties
+and our happiness lie, we know a unity and freedom of our personality
+which psychology must destroy. Of course that does not mean that
+psychology denies the truth of that freedom and unity. Moreover it would
+condemn itself if it were to deny that which gives meaning to the
+endeavors of our life and thus also to every search for truth.
+Psychology claims only that we must abstract from it, when we take the
+psychological standpoint towards life. Freedom of our real life means
+that we must know ourselves in the midst of our life work as guided by
+aims and obligations, and that in this purposive existence of ourselves
+we do not feel ourselves as determined by causes. I will the fulfillment
+of my ideals only because I will them. That this will itself may be the
+effect of foregoing causes is an aspect which does not belong to my
+naïve experience. Our freedom means that in our real life our will is
+not related to causes, that the point of view of causality is thus
+meaningless for the value of our achievements. And the other man's will
+too comes in question for us as something to be interpreted and to be
+appreciated, but not to be explained by connection with causes. As long
+as we move in this sphere of purposive interest, we are free and deal
+with free selves; but if in the midst of these free aims, the will
+arises to consider the actions of others and of ourselves from the
+standpoint of causality, then we have ourselves decided to enter a new
+sphere in which it would be meaningless to seek for any will which is
+not determined by causes. As soon as we have chosen the psychological
+standpoint and are in the midst of the work of causal reconstruction,
+any will which is not understood as determined by causes is simply an
+unsolved problem. In the midst of a causal construction, absence of
+causes would never mean real freedom.
+
+In that purposive world of immediate life experience, we also are
+unities inasmuch as we ourselves know us as the same in every new will
+of ours. We remain identical with ourselves because every purpose is
+posited in the midst of, and bound up with, the general purpose of
+ourselves. And in this internal unity of meaning, nothing breaks
+ourselves into pieces, and the whole manifold of experience is thus
+expressed by a personality which knows itself in its purposive unity.
+But this unity again is denied by our own intention as soon as we decide
+to take the causal view of inner life. The purposive unity must now
+transform itself into an endless complexity, and our own self becomes a
+composite of hundreds of thousands of elements.
+
+On the other hand, all this does not mean that psychology cannot have
+its own consistent conception of the mind's unity and freedom. Our
+psychological mind is a unity because its manifold is a system in which
+all parts hang together. A change in any one part involves changes in
+the whole system. The interrelation, to be sure, is not a strictly
+psychical one, for we have seen that the causal connection as such
+appears at the physical side. But, inasmuch as there is no psychical
+process which does not belong to a physiological one, the
+interconnection of the mental facts is complete and involves the
+totality of neural processes of which after all a small part only has
+its psychological record. We might compare those hundreds of millions of
+neurons in each brain with the hundreds of millions of individuals who
+make up the population of the nations, and the psychical accompaniment
+we might compare with the written historical record of mankind. The
+written records themselves have no direct interconnection, they are only
+accompaniments of what happens in these millions of men. And again only
+the higher layer of the neurons in the population sees its doings
+recorded in the annals of history; and yet whatever those leaders of
+action and thought and emotion may achieve is dependent upon and working
+on the actions of those millions of subcortical population neurons. The
+historical record has its unity through the interrelation of all parts
+of historical mankind.
+
+But after all the psychologist has no less a right to speak of freedom.
+Of course his freedom cannot mean exemption from causality. Whatever
+happens in the psychological system must be perfectly determined by the
+foregoing causes. But the psychologist has good reason to discriminate
+between those actions which result from the normal psychophysical
+factors and such actions as result from broken machinery. If the brain
+is poisoned by alcohol or in fever, if an infectious disease has
+destroyed the brain cells, action is no longer the outcome of the
+normal coöperation of the organs, and even those clusters of neural
+activities which are accompanied by the consciousness of the own
+personality lose their control of the motor outcome. The man in delirium
+or paralysis acts without causal connection with his past; the action
+is, therefore, not the product of his whole personality, and the
+psychologist is justified in calling the man unfree. But, whenever the
+motor response results from the undisturbed coöperation of the normal
+brain parts, then the inherited equipment and the whole experience and
+the whole training, the acquired habits and the acquired inhibitions
+will count in bringing about the reaction. This is the psychological
+freedom of man. The unity of an interconnected composite and the freedom
+of causal determination through normal coöperation of all its parts
+characterize the only personality which the psychologist has to
+recognize.
+
+
+
+
+IV
+
+PSYCHOLOGY AND MEDICINE
+
+
+We are now ready to take the first step towards an examination of the
+problem of curing suffering mankind. So far we have spoken only of the
+meaning of psychology, of its principles and of its fundamental theories
+as to mind and brain. We have moved in an entirely theoretical sphere.
+Now we approach a field in which everything is controlled by a practical
+aim, the treatment of the sick. Yet our discussion of psychology should
+have brought us much nearer to the point where we can enter this realm
+of medicine. Everything depends on the right point of entrance. That an
+influence on the inner life of man may be beneficial for his health is a
+commonplace truth to-day for everybody. Every serious discussion of the
+question has to consider which influences are appropriate, and in which
+cases of illness the influence on inner life is advisable. The popular
+treatises usually start this chapter by speaking of the "mental and
+moral" factors; and this coupling of mental influences and moral
+influences characterizes large parts of the discussions of the Christian
+Scientists and the Christian half-scientists. Yet we must insist that
+the right entrance to psychotherapy is missed if the difference between
+morality and mentality is not clearly recognized from the beginning. The
+confusion of the two harms every statement. To avoid such a fundamental
+mistake, we had to take the long way around and to examine carefully
+what psychology really means and what it does not mean.
+
+We know now that inner life can be looked on from two entirely different
+standpoints: a purposive one and a causal one, and we have seen that
+these two ways of looking on inner life bring about entirely different
+aspects of man's inner experience, serve different aims, and stand in
+different relations to the immediate needs of our real life. We know
+that the one, the causal aspect, belongs to psychology, while the
+non-psychological, the purposive aspect, belongs to our immediate mutual
+understanding in the walks of life. If the physician is to make use of
+inner experience in the interests of overcoming sickness, he must first
+decide whether to take the causal or the purposive point of view in
+dealing with the patient's mind. This problem is too carelessly ignored
+and through that neglect arises much of the popular confusion. Of course
+just this carelessness becomes in some ways the ground for apparent
+strength for many a superstition and prejudice. If the doors of the
+causal mind and of the purposive mind are both open, and the spectator
+does not notice that there are two, any trick on thought and reason can
+easily be played. Whatever cannot pass through the causal door slips in
+through the other, and whatever does not go in through the door of
+purpose marches through the entrance of causality. With such methods
+anything can be proved, and the most unscrupulous doctrines can be
+nicely demonstrated. If we are to avoid such logical smuggling, we must
+see clearly which attitude towards mental life belongs properly to the
+domain of psychotherapy.
+
+But what we have discussed now leaves little doubt as to the necessary
+decision. The physician is interested in the mental life with the aim of
+producing a certain effect, namely, that of health. Thus the mental life
+of the whole personality comes in question for him as belonging to a
+chain of causes and effects; whichever levers he may move, everything is
+to be a cause which, in accordance with causal laws, is to produce a
+certain change. Inner life is thus, in the interests of medical
+treatment, necessarily a part of a causal system. This means the
+standpoint of scientific psychology is the only adequate one. The
+purposive view of inner life ought not to be in question when the
+patient enters the doctor's office.
+
+To characterize the difference, it may be said at once that it is a
+purposive view which belongs to the minister. If the minister says to
+his despairing parishioner, "Be courageous, my friend, and be faithful,"
+nothing but a strictly purposive view gives meaning to the situation.
+The word friend indicates it, that one subject of will approaches
+another subject of will, with the intention of sympathy and
+understanding of the attitude of the other; and the advice to be
+courageous and faithful means an appeal which has its whole meaning in
+the relation to aims and ends. The speaker and the hearer are both
+moving in a sphere of will relations, purposes and ideals, sin and
+virtue, hope and belief. To take the other extreme: if the neurasthenic
+in his state of depression and in his feeling of inability seeks relief
+from the nerve specialist, he too may say: "My friend, be courageous and
+faithful," yet his words have an entirely different purpose. They are
+not appeals to a common interest of belief; they are subtle tools with
+which to touch and to change certain psychophysical processes, certain
+states in mind and brain; there each word is a sound which awakens
+certain mental associations, and these associations are expected to be
+causes of certain effects and these effects are to inhibit those
+disturbing states of emotional depression. If a few grains of sodium
+bromide were to produce the same effect, they would be just as welcome.
+The whole consideration moves in a sphere in which only physiological
+and psychological processes are happening. Thus the physician may work
+with the ideas of religious belief, but those ideas are then no longer
+religious values but natural psychophysical material, which is to be
+applied whenever it appears as the right means to secure a certain
+effect.
+
+On the other hand the minister also knows, of course, that every word
+which he speaks has its psychological effect, but he abstracts from that
+entirely, as his belief should appeal directly to the struggling will of
+the man. As minister, he is thus not a psychologist. He works with
+moral means; the physician, with causal means. The view which the doctor
+has to take of the man before him is therefore thoroughly psychological;
+whereas that of the religious friend is thoroughly unpsychological, or
+better, apsychological. Indeed it is misleading, or at least demands a
+special kind of definition, if people say that the minister has to be a
+good psychologist. It is just as misleading as the claim, which we hear
+so often, that for instance Shakespeare was a great psychologist. No,
+the poet deals with human beings from the purposive standpoint of life
+and the mere resolving of complex purposes into parts of purposes is not
+psychology in the technical sense of the term. The poet makes us
+understand the inner life, but he does not describe or explain it; he
+makes us feel with other people, but he does not make those feelings
+causally understood. The realistic novelists sometimes undertake this
+psychological task, but they are then on the borderland of literature,
+the analysis of their heroes becomes then a psychological one.
+Shakespeare understood human beings better than anyone and therefore the
+men and women whom his imagination created are so fully lifelike that
+the psychologist may feel justified in using them as material for his
+psychological analysis, but Shakespeare himself did not enter into that
+psychological dissection; he kept the purposive point of view. In the
+same way certainly the minister--the same holds true for the lawyer or
+the tradesman or anyone who enters into practical dealings with his
+neighbor--may resolve complex attitudes of will into their components,
+but each part still remains a will attitude which has to be understood
+and to be interpreted and to be appreciated, while the psychologist
+would take every one of those parts as a conscious content to be
+described and to be explained. But here we abstract from the purposive
+relations. Our attention belongs now to the doctor's dealing with man;
+for him cause and effect are the only vehicles of connection. Thus he
+has to exclude the purposive interpretation of inner life and has to
+understand every factor involved from a psychological point of view: his
+psychotherapy must be thoroughly applied psychology.
+
+The day of applied psychology is only dawning. The situation is indeed
+surprising. The last three or four decades have given to the world at
+last a really scientific study of psychology, a study not unworthy of
+being compared with that of physics or chemistry or biology. In the
+center of the whole movement stood the psychological laboratory with its
+equipment for the most subtle analysis and explanatory investigation of
+mental phenomena. The first psychological laboratory was created in
+Leipzig, Germany, in 1878. It became the parent institution for
+laboratories in all countries. At present, America alone has more than
+fifty psychological laboratories, many of them large institutions
+equipped with precious instruments for the study of ideas and emotions,
+memories and feelings, sensations and actions. Still more rapid than
+this external growth of the laboratory psychology was the inner growth
+of the experimental method. It began with simple experiments on
+sensations and impulses, and it seemed as if it would remain impossible
+to attack with the experimental scheme the higher and more complex
+psychical structures. But just as in physics and chemistry the triumphal
+march of the experimental method could not be stopped, one part of the
+psychological field after another was conquered. Attention and memory,
+association and inhibition, emotion and volition, judgment and feeling
+all became subjected to the scientific scheme of experiment. And that
+was all supplemented by the progress of physiological psychology,
+pathological psychology, child psychology, animal psychology. In this
+way the last decades created a science which of course was by principle
+a continuation of the old psychology, but yet which had good reason to
+designate itself as a "new" psychology.
+
+But in this whole development, until yesterday, the curious fact
+remained that it was going on without any narrow contact with practical
+life; it was a science for the scientist and measured by its practical
+achievements in daily life, it seemed barren and unproductive.
+Psychology was studied as palæontology and Sanscrit were studied,
+without any direct relation to the life which surrounds us. And yet
+after all it deals with the mental facts which have to enter into every
+one of our practical deeds, if we are to consider mental life from a
+psychological point of view. The psychologists were certainly not to be
+blamed for sticking to their theoretical interests. More than that,
+they were certainly justified in their reluctance, as everything was in
+the making, and incomplete theories can easily do more harm than good.
+But slowly a certain consolidation has set in; large sets of facts have
+been secured, and psychology seems better prepared to become serviceable
+to the practical tasks. On the other hand, it has been noticeable for
+some time that not a few of the psychological results have gone over
+into unprofessional hands and have been thrown on the market places and
+have been brought into many a home where no one knew how to deal with
+them rightly. Thus the need seems urgent that the psychologists give up
+their over-reserved attitude and recognize it as their duty to serve the
+needs of the community.
+
+It is not sufficient for that end, simply to take odds and ends of
+psychology and to hand them over to anyone who can see some use for
+them. We must have a systematic scientific work done for the special
+purpose of adjusting psychological knowledge to the definite practical
+tasks and of examining the psychological facts with that practical end
+in view. A science must be developed which is related to psychology as
+engineering is related to physics and chemistry. Just as the
+technological laboratories of the engineer bring out many new problems
+which the physicist would never have approached, in the same way we may
+expect that special institutions for applied psychology will shape the
+psychological inquiry in a new way.
+
+Such a new science of applied psychology of course has before it a
+field just as large and manifold as the field of technology, where
+physical engineering, chemical engineering, mechanical engineering, and
+electrical engineering and so on are separated. Such a future
+psychological technology would deal, for instance, with
+psychopedagogical problems. There belongs everything which refers to the
+psychology of memory or attention, of discipline, of fatigue, of habit,
+of imitation or effort; in short, all those mental factors which have to
+be considered whenever the schoolchild is looked on from a causal point
+of view. Further there is the psycholegal field where the memory and the
+perceptions, the suggestibility and the emotions of the witness are to
+be studied, where the psychological conditions which lead to crime, the
+means to tap the hidden thoughts of the criminal, the inhibitions for
+the prevention of crime, the mental effects of punishment and similar
+causal processes must be determined. There are the psychoscientific
+problems referring to psychological influences on the observations and
+judgments and discriminations of the scholar who watches the stars or
+who translates an inscription. There are the psychoæsthetic problems
+where the task is to examine causally the factors which lead to the
+agreeable effects of beautiful surroundings, and from the height of the
+psychology of æsthetics in painting and sculpture, the inquiry may go to
+the psychology of the pleasant effects in dress-making or cooking. There
+are the large groups of psychotechnical problems where the effort refers
+to the application of psychology in securing the best conditions for
+labor and industry and commerce. It leads from the mental effects of
+signals or the mental fatigue in mills to the secrets of advertisements
+and salesmanship. There are especially important psychodiagnostical
+studies where the aim is to determine the individual differences of man
+by experimental methods and to make use of them for the selection of the
+right man for the right place. There are psychosocial problems where we
+examine the psychological factors which have to enter into public
+movements, into social reforms, into legislation and into politics. In
+this way new and ever new groups may be added; every time the central
+thought is: how far can causal psychological knowledge help us to reach
+a certain end? Together with these forms of applied psychology, we find
+the psychomedical problems; here belongs everything which allows the
+application of causal psychology in the interests of health.
+
+It might be answered that this demand for a strictly causal point of
+view can hardly be fulfilled, because, if I am acting,--it may be in the
+interest of education or law or technique or medicine,--I must always
+have an end in view and to select such an end belongs after all to my
+system of purposes. If I am a teacher and have to deal with children,
+then it may be said that after all, my knowledge of causal psychology
+cannot help me if I am uncertain for which ideals I want to educate
+these children. Psychology can tell me that I need these means, if I
+want to reach certain effects, but I cannot find out by psychology which
+effects are desirable. Psychology may tell me how to make a good
+business man or a good scholar or a good soldier out of my boy, but
+whether I want him to become a soldier or a merchant I must decide for
+myself with reference to general aims, and that leads me back to the
+purposive view of life. Such argument is entirely correct. Yes, it is
+evident that it is in full harmony with our whole understanding of the
+purpose of psychology. We saw that psychology with its causal treatment
+of man's mind does not express the immediate reality, but is a certain
+reconstruction which allows a calculation of certain effects. Thus it is
+itself a system existing for a subject who has certain ends in view. The
+whole causal view of man is thus a tool in the service of the purposive
+man. This is the reason why it is indeed utterly absurd to think that
+psychology can ever help us to determine which end we ought to reach.
+
+In education, for instance, very many different ends might be reached;
+psychology cannot decide anything. The decision as to the aims of
+education must be made by ethics, which indeed takes not a causal but a
+purposive attitude. Only after ethics has selected the aim, psychology
+can teach us how to reach it. Of course this principle must hold for the
+physician too. All his causal dealing with the mind presupposes that he
+has selected a certain end in harmony with his purpose. The only
+difference is that, in the case of the physician, there can be no
+possible doubt as to the desirable end; what he aims at is a matter of
+course, namely, the health of the patient. To desire the health of the
+sufferer is thus itself a function which belongs entirely to the
+purposive view of the world, and only in the interest of this purpose
+does the physician apply his knowledge of psychology or of the causal
+sciences of physics, physiology, and chemistry. Indeed only with this
+limitation have we the right to say that the psychotherapist takes the
+causal,--and that means the psychological,--view of his patient. As far
+as he decides to take care of the health of his patient, this decision
+itself belongs to the purposive world and to his moral system. The
+physician is thus ultimately just like the minister and just like anyone
+who deals with his neighbor, a purposive worker; but while the minister,
+for instance, remains on this purposive track, the physician puts a
+causal system into the service of his purpose. He knows the end, and his
+whole aim is to apply his causal knowledge of the physical and psychical
+world to the one accepted end of restoring the health of the patient. He
+has to ask thus in general: what has psychology to-day to offer which
+can be applied in the interests of medicine?
+
+It would be an inexcusable narrowness to confine that chapter of applied
+psychology which is to deal with the psychomedical problems to the work
+of psychotherapy. Medicine involves diagnosis of illness as well as
+therapeutics. Between the recognition and the treatment of the illness
+lies the observation of its development and all this is preceded by
+steps towards the prevention of illness. In every one of these regions,
+psychology may be serviceable. Psychotherapy is thus only one special
+part of psychomedicine. But the situation becomes still more complex by
+the fact that the illness to be treated or the disturbance to be removed
+may stand in different relations to the psychophysical processes. The
+illness may be a disturbance in the psychophysical brain parts, or it
+may belong to other brain parts which are only in an indirect way under
+the influence of mental states or which are themselves indirectly
+producing changes in the mental life. And finally the disturbance may
+exist outside of the brain in any part of the body, and yet again
+through the medium of brain and nervous system it may produce effects in
+the mind or be open to the influence of the mind. Thus we have entirely
+different groups of medical interests and it would be superficial to
+ignore the differences.
+
+Both psychodiagnostic and psychotherapeutic studies must be devoted to
+cases in which the mind itself is abnormal, further to cases in which
+the normal minds registers the abnormalities in other parts of the body,
+and finally to cases in which the normal mind influences abnormal
+processes in the body. These latter two cases have to be subdivided into
+those where the bodily disturbance still lies in the brain parts and
+those where it lies outside of the brain. But the situation becomes
+still more complex by the mutual relations of those various processes.
+The impulse to take morphine injections may have reached the character
+of a mental obsession and thus represent an abnormality of the mind, but
+yielding to it produces at the same time disturbances in the whole body
+which thus become again external sources for abnormal experiences in
+otherwise normal layers of the mind.
+
+Of course the interest of the psychologist as such remains always
+related to the psychological factor, but the relation of the
+psychological factor itself to the total disturbance may be of most
+different character. If I diagnose or treat the fixed idea of a
+psychasthenic, the psychological factor itself represents the
+disturbance. On the other hand, if I study the pain sensations of a
+patient who suffers from a disease of the spinal cord, then the
+sensations themselves, the only psychological factor in the case, are
+only indications of a disease which belongs to an entirely different
+physical region; the mind itself is normal. Or, on the other hand, if I
+try to educate a sufferer from locomotor ataxia to develop his walking
+by building up in his mind new motor ideas to regulate his coördinated
+movements, the mind again is entirely normal but the physician needs his
+psychology on account of the influence which the mind has on the bodily
+system. Again, we must insist that psychomedicine covers this whole
+ground. Wherever a psychical factor enters into the calculations of the
+physician either by reason of its own abnormality or by its relation as
+effect or as cause to a diseased part of the body in the brain or
+without, there we have a psychomedical task, and as far as it is
+therapeutic, we have psychotherapy.
+
+The psychodiagnostic research lies outside of the compass of our book,
+but we cannot emphasize sufficiently the great importance which belongs
+to that work. Moreover, just in the field of psychodiagnostics, the
+methods of the modern experimental psychological laboratory are most
+promising and successful. Let us not forget that we deal with such
+psychological factors even when we test the functions of eye and ear and
+skin and nose by examining the sensations and perceptions. The oculist
+who analyzes the color sensations of a patient and the aurist who finds
+defects in the hearing of the musical scale and discovers that certain
+pitches cannot be discriminated, is certainly dealing, for diagnostic
+purposes, with the material that the psychological laboratory has sifted
+and studied. Even that sensation symptom which enters into so many
+diseases, the sensation of pain, belongs certainly within the compass of
+the psychologist and it is only to be regretted that the systematic
+study of the pain sensations, mostly for evident practical reasons, has
+been much neglected in the psychological laboratory.
+
+The psychologists have been at work all the more eagerly in the fields
+of association and memory, attention and emotion, habit and volition,
+distraction and fatigue. Here subtle methods have been elaborated,
+methods which surely common sense cannot supply, and which showed
+differences of mental behavior with the exactitude with which the
+microscope reveals the hidden differences of form. If physicians are
+slow in accepting the help which the psychological laboratory can
+furnish, it may be in good harmony with the desirable conservative
+policy in medicine, but finally the time must come when this
+instinctive resistance against new methods will be overcome. The recent
+attachment of psychological laboratories to certain leading psychiatric
+clinics is a most promising symptom. Yet the diagnostic studies with the
+means of the psychological laboratory cannot be confined to the cases of
+mental disease. The mild abnormalities of the mind, and especially the
+nervous disturbances which exist outside the field of insanity, demand
+this support of psychology much more. And even the normal personality
+will be more safely protected from disease and from social dangers for
+its mental constitution if the resources of experimental psychology are
+employed. The more we know of the psychological constitution of the
+individual, the more we can foresee the development which is to be hoped
+for or feared and which may be encouraged or retarded.
+
+The psychologist may determine, for instance, the degree of attention
+with its resistance against distracting stimuli, the power of memory
+under various conditions and on various material, the mental
+excitability and power of discrimination, the quickness and correctness
+of perception, the chains of associations, the rapidity of the
+associative process for various groups, the types of reaction, the
+forming of habits and their persistence, the conditions of fatigue and
+of exhaustion, the emotional expressions and the emotional stability,
+the time needed for recreation and the resistance against drugs, the
+degree of suggestibility and the power of inhibition: and every result
+in any of these lines may contribute to the diagnosis and prognosis of
+cases. The chronoscope here measures the reaction times and association
+times in thousandths of a second; the kymograph, by the help of the
+sphygmograph, writes the record of the pulse and its changes in
+emotional states, while the pneumograph records the variations of
+breathing, and the plethysmograph shows the changes in the filling of
+blood vessels in the limbs which is immediately related to the blood
+supply of the brain. Here belongs also the ergograph, which gives the
+exact record of muscular work with all the influences of will and
+attention and fatigue, the automatograph which writes the involuntary
+movements, especially also the galvanoscope which may register the
+influence of ideas and emotions on the glands of the skin, and thus lead
+to an analysis of repressed mental states, and hundreds of other
+instruments which are used in the psychological laboratory.
+
+Yet it would be misleading to think only of complex apparatus when
+experimental psychology is in question. An experiment is given whenever
+the observation is made under conditions which are artificially
+introduced for the purpose of the observation. Thus there is no need of
+the physical instrument. If I bring a spoonful of soup to my mouth at
+dinner and I become interested in the combination of warmth sensation
+and touch sensation and taste sensation and smell sensation, then I have
+performed an experiment if I take one more spoonful of soup just for the
+purpose of the observation. The physician too may carry out important
+psychological experiments, without needing the outfit of a real
+laboratory. Association experiments, for instance, promise to become of
+steadily growing importance. To make them serviceable to the problems of
+his office, nothing but a subtle psychological understanding is needed,
+inasmuch as any routine work schematically applied to every case alike
+would be utterly useless. Give your man perhaps a hundred words and let
+him speak the very first word which comes to his mind when he hears the
+given ones. You call rose, and he may say red or flower or lily or
+thorn; you call frog and he may answer pond or turtle or green or jump,
+and if you choose your hundred words with psychological insight, his
+hundred answers will allow a full view of his mental make-up. This is an
+experiment which does not require any instruments at all but a man's
+subtle analysis of the replies. That is not seldom sufficient to secure
+the diagnosis of complex mental variations. The method yields still more
+if the time for such a reply is measured, but there again not the costly
+chronoscope of the laboratory is indispensable; a simple stop watch
+which gives the fifths of a second would be fully sufficient for all
+practical purposes. From such simple facts of the mental inventory the
+association experiments may lead to complex questions which slowly may
+disentangle the confused ideas, for instance, of a dementia præcox, and
+thus lead to subtle differential diagnosis.
+
+The psychological laboratory alone can also elaborate the methods of
+studying, for instance, the feeble-minded with all the individual
+variations. New and ever new methods have been tried; the memory was
+tested by reading and repeating figures or letters, or colored papers
+were shown or cardboards of different forms or nonsense syllables, and
+the powers of remembering were studied. Or the accuracy of arm movements
+was examined, or the quickness of understanding associated words, or the
+success in planning a complex movement like throwing a ball at a target,
+or the tapping of a key in the rhythm of a metronome, or the
+discrimination and recognition of the pieces in the game of dominoes and
+many another scheme. The laboratory has to analyze the conditions for
+such methods and the psychologist has to prepare the means for the use
+of the physician, just as the chemist has to prepare the sleeping
+powders. In a similar way the laboratory may furnish means to analyze
+the mental disturbances by a comparison with the experimental results of
+artificial influences, for instance, of over-fatigue or half-sleep, of
+drugs or alcohol, of poisons and emotional excitements. The
+psychological resolving of the mental symptoms may of course, in the
+same way, furnish the diagnosis where the mental variation is only a
+distant effect of a bodily ailment. The changes in the emotions, for
+instance, may lead to the recognition of a heart disease; lack of
+attention may be a hint of the overgrowth of the adenoids; irritability
+or apathy or delirious character of the mental behavior may indicate
+whether uræmic acid is in the system or an infectious disease: anæmia
+and undernutrition may be diagnosed and the psychology of fever demands
+too a much closer analysis with the means of the psychological
+laboratory than it has received so far.
+
+We have not spoken as yet about those psychological methods which
+themselves introduce abnormal mental states like hypnotism, and which
+also not seldom are only means for diagnostic purposes. The hypnotic
+state may bring to memory forgotten experiences of which the
+physiological effects may have lasted in the brain and which may have
+brought injury to the psychophysical system. Hypnotic inquiry can thus
+lead to the recognition of the first causes in many hysterical states
+and where hypnotism is not the best adjusted tool, a certain dreamlike
+staring may be more effective. We have to return to much of that later
+in full detail because just for instance in hysteria, the clear
+recognition of the sources and of the character of the disease may at
+the same time prove to be in itself the right starting point for
+curative treatment.
+
+We have spoken so far only about the relations of psychology and
+medicine from the point of view of diagnosis; the relations from the
+point of view of therapy will make up the second part of this book. We
+shall describe the methods and the results, the possibilities and the
+limitations with manifold detail. That is the chief topic of this
+volume. All that is needed to prepare for this principal problem is on
+the one side a preparatory clearing up of some fundamental conceptions,
+especially of those two which have played the chief rôle in the whole
+discussion, namely the subconscious and suggestion. And on the other
+side, we may consider at first some fundamental discriminations which
+steadily influence the inquiries and controversies in the field. I think
+of the difference between normal and abnormal mental states, between
+psychical and physical facts in psychotherapy, between functional and
+organic diseases, and to return to our starting point, between mental
+and moral influences.
+
+Every curative effort presupposes that the normal state of health has
+been lost and that a diseased state has set in. Yet the mental analysis
+suggests still less than the bodily inquiry, just where the normal
+functioning is really lost. It would be easy to draw a demarcation line
+if the pathology of the mind introduced any mental features which are
+unknown in our normal existence, but the opposite is true. No mental
+disease introduces elements which do not occur in the sphere of health.
+A degenerated brain cell looks differently under the microscope from a
+normal one, but the ideas of a paranoiac, the emotion of a maniac, the
+volition of a hysteric, the memory idea of a paralytic is each in its
+own structure not different from such elements in any one of us. The
+total change lies thus only in the proportion; there is too much or too
+little of it. The pathological mental life is like a caricature of a
+face--each feature is contained, as in the ordinary portrait, but the
+proportion is distorted, there is too much or too little of chin or of
+nose. But who can indicate exactly the point where the distortion of the
+features constitutes a caricature? Every grotesque change in the
+relations ruins the healthy state: what makes us sure that the harmony
+of health is spoiled?
+
+Certainly we cannot settle it by mere statistics. The norm never means
+merely a majority. Even if the overwhelmingly larger part of mankind
+suffered from phthisis, the few who were free from it would be
+recognized as well and all the others would be considered ill. In mental
+life still more, no one ought to propose that the exceptional function
+is the symptom of disease. The few persons who never had a dream in
+their lives differ much in their mental experience from the large
+majority and yet their peculiarity is certainly not a symptom which
+needs curative treatment. The only real test of health is the
+serviceableness to the needs of life. We have an unhealthy state of the
+personality before us wherever the equilibrium of the human functions is
+disturbed in a way which diminishes the chances of existence, and the
+seriousness of the ailment depends upon the degree of this diminishing
+power. Seen from a strictly psychological point of view, we must expect
+thus a broad borderland region between the entirely normal well-balanced
+mental life and that unbalanced disorder of functions which really
+interferes with the chance for self-protection and effectiveness. That
+the melancholic who declines to take any nourishment, or the paranoiac
+who misjudges his surroundings, is unable to secure by his own energies
+the safety of his life cannot be doubted. The balance is completely
+destroyed and the will and the intellect of the physician and of the
+nurse must be substituted for his own mental powers, if his life is to
+be prolonged at all. But the misjudgment and the depression of the
+insane are only an exaggeration of that which may occur in any man.
+
+There are therefore thousands of steps which lead from the normal error
+or regret to the destructive disturbance. Everyone knows persons whose
+pessimistic temperament makes them inclined to an over-frequent
+depression, or others whose silly disposition brings out constantly
+those emotional tendencies which the maniac shows in an exaggerated
+degree. The stupid mind shows those lacks of association and connection
+which reach their maximum degree in the mind of the idiot. We know from
+daily life the timid, undecided man who cannot come to a will impulse;
+the hasty man who rushes towards decisions; the inattentive man who can
+never focus his consciousness; and the overattentive man who can never
+dismiss any subject; the indifferent man on whom nothing produces
+evident impression and feeling; the over-sensitive man who reacts on
+slight impressions with exaggerated emotion; and yet every one of such
+and a thousand similar variations, needs only the projection on a larger
+scale to demonstrate a mental life which is self-destructive. The silly
+girl and the stupid boy, the man who has the blues and the reckless
+creature, are certainly worse equipped for the struggles of existence
+than those who are intellectually and emotionally and volitionally
+well-balanced. They will take wrong steps in life, they may be
+unsuccessful, their stupidity may lead them to the poorhouse, their
+recklessness may lead them to the penitentiary. And yet we do not speak
+of them as patients because their disproportionate mental features may
+be sufficiently corrected by other mental states which are perhaps more
+strongly developed.
+
+Further, inasmuch as human life just in its mental functions is related
+to its social surroundings, much must depend on the external conditions,
+whether the disproportion and abnormality has to be treated as
+pathological. The mind which may find perhaps its way under the most
+simple rural conditions would be unable to protect life under the
+complex conditions of a great city. The man who in certain surroundings
+may appear a crank has to be treated as a patient in a different set of
+life conditions. Wherever psychotherapeutic work is in question, perhaps
+nothing is more important than to keep steadily in mind this continuity
+between normal and abnormal mental features. The mental disturbance must
+constantly be looked upon as a change of proportions between functions
+which, as such, belong to every normal life. We have to train and to
+develop, and thus to reënforce, that which is too weak, and we have to
+drain off and to suppress and to inhibit that which is too strong.
+
+Yet just this functional view of disease must remind us strongly from
+the beginning that it would be utterly in vain to draw any demarcation
+line between psychical disturbances and physical ones. We have seen from
+the start that from the point of view of physiological psychology,
+there can be no psychical process without an accompanying physiological
+process in the brain. Every disturbance in mental actions is thus at the
+same time a disturbance in the equilibrium of nervous functions. Yet
+that alone would not exclude the possibility of considering some
+diseases, for instance, exclusively from the mental side, and we should
+be justified in doing so if those parts of the brain which are the seat
+of the mental processes could remain in the diseased state without
+influence on other parts of the nervous system and of the whole body. In
+such a case it would indeed be sufficient to consider the psychophysical
+disturbance from the psychological point of view only, that is, to speak
+of the disease as a disorder of intellect, of emotion or will, without
+thinking of changes in the brain cells. But such isolation does not
+exist in nature. Not only the bodily factors like nutrition and
+circulation and sexual functions have a thousandfold influence on the
+psychophysical processes, and these in turn change the vegetative
+functions of the body, but especially the other parts of the brain and
+nervous system can be affected in most different ways. If we want to
+consider whether a certain variation of the personality demands curative
+treatment, we certainly cannot confine ourselves to the mental
+variations. They are after all only parts of the whole group of changes
+in the organism and are thus symptoms of a disease which has to be
+studied in its totality. The mental symptoms alone may be relatively
+slight variations, which in themselves might be sufficiently balanced
+not to disturb the equilibrium of life, and yet they may be symptoms of
+a brain disturbance which as a whole must interfere with the safety of
+life. On the other hand, mental life may appear like a chaos and yet the
+disturbance may be the symptom of merely a slight brain affection and
+the treatment of the mental symptoms in their apparent severity would be
+a useless effort. The mental disturbance, for instance, of the
+intoxicated or the hashish smoker, even the delirium of the feverish,
+does not suggest a fight against the mental symptoms during the attack.
+
+On the whole, there is a far-reaching independence between the apparent
+mental variations and the seriousness of the brain affection. Light
+hysteric states may produce a strong absenting of the mind while severe
+epileptic conditions of the brain may be accompanied by very slight
+mental changes. Every neurasthenic state may play havoc with mental
+life, while grave brain destructions may only shade slightly the
+character or the intellect. To deal with the mental changes as if they
+belonged to a sphere by itself, to the soul which is well or ill through
+its own independent alterations without steadily relating the changes to
+the total organism, leads therefore necessarily to failure. The mind
+reflects only symptoms of the disease; the disease itself belongs always
+to the organism. Psychotherapy has suffered too much from the belief
+that the removal of mental symptoms is a cure of disease.
+
+Certainly the psychophysical symptoms may often stand in the foreground
+of the disease, and in that case it may be left to the special needs
+whether we deal with them as psychical or as physical changes. Even the
+patient may be made to see them in one or the other way in accordance
+with his special needs. To tell him that his brain cells are in disorder
+and that they can be cured will be the right thing for him who takes
+only the introspective view of his suffering and is in despair because
+his own will seems powerless to overcome those mental changes. For the
+next patient, the opposite may be wiser. The belief that his brain is
+ill may have induced him to give up effort of the will instead of
+helping along by steady self-suggestion. He will be helped more if he
+understands that his mind is working wrongly. But the full truth is that
+both mind and body are in disorder; the function of the disturbed brain
+cells accompanies the ineffective will, and to reënforce the will means
+to bring into equilibrium again the disturbed brain cells. For the
+psychotherapist the temptation of giving the attention to the mental
+symptoms only is strong. The more firmly the physician sticks to the
+standpoint of psychophysiology, the better he will see ailment and cure
+in their right proportion.
+
+This demand for the consideration of the whole personality, mind and
+body, ought not to be influenced by the popular separation between
+organic and functional diseases. If we call organic diseases of the mind
+those in which the mental disturbance is the accompaniment of a brain
+disturbance, and functional those in which no brain disturbance exists,
+we leave entirely the ground of modern psychology. As soon as we
+believe that the mind can be disturbed without a change in the functions
+of the brain, we give away all that which has brought scientific order
+into the study of psychological existence. Every mental disturbance
+corresponds to a disorder in the brain's functions. But there cannot be
+a change in the functions of the brain without a change in its
+structure. Thus we must claim that all those so-called functional
+disturbances like neurasthenia and hysteria, fixed ideas and obsessions,
+phobias and dissociations of the personality, as well as the typical
+insane states of the maniac or paranoiac have their basis in a
+pathological change of the anatomical structure of the brain. This
+postulate cannot be influenced by the fact that the microscope has been
+unable to detect the character of most of these changes.
+
+Of course all this does not exclude its being perfectly justifiable to
+separate those diseases for which a definite destruction of the brain
+parts can be detected, as in paralysis of the brain, from those where
+that is impossible. We may also expect that those disturbances in the
+brain which we cannot as yet make visible, may allow more easily an
+organic repair and thus a restoration to the normal functions. Just as a
+disjointed arm may be brought to function quickly again, a broken arm
+slowly, an amputated arm never, each brain cell too may suffer lesions
+which are reparable in different degrees. But it is evident that it
+remains then an entirely empirical question whether the invisible damage
+allows repair or not. We have no right to say that where the
+destruction cannot be seen under the microscope there is no organic
+change and the disturbance is therefore only a psychical one and can be
+removed by mental means. All changes are physical and experience has to
+decide whether they are accessible to psychological influences or not.
+States like epilepsy may not allow any recognition of definite brain
+destruction and are yet on the whole inaccessible to mental influence,
+while many a brain disturbance with visible alterations, resulting
+perhaps from anæmia or hyperæmia, may be caused to disappear. If on the
+other hand we say that we can cure with psychotherapeutic means only the
+functional brain diseases and define as functional simply those diseases
+which can be cured by such means, we move, of course, in the most
+obvious circle and yet just that is the too frequent fate of the
+discussions in certain quarters.
+
+Every psychical disturbance is organic inasmuch as it is based on a
+molecular change which deranges the function. Some of these changes are
+beyond restitution; some can be brought back to a well-working structure
+by strictly physical agencies like drugs or electricity; others can be
+repaired by physiological stimuli which reach directly the higher brain
+cells through the sense organs and which we call psychical under one
+aspect, but which certainly remain physiological influences from another
+aspect. And these psychophysiological influences of the spoken words or
+similar agencies are thus indeed for therapeutic effect entirely
+coördinated with the douche and the bath and the electric current and
+the opiate. It is a stimulation of certain brain cells, an inhibition of
+certain others: a subtle apparatus which must be handled with careful
+calculation of its microscopical causes and effects. That these words
+from an entirely different point of view may mean a moral appeal and
+have ethical value, point to moral and religious ideas and reënforce the
+spiritual personality, lies entirely outside of the psychotherapeutic
+calculation. As long as the curing of the patient is the aim, the faith
+in God is not more valuable than the faith in the physician and the
+moral appeal of no higher order than the influence through the galvanic
+current. They come in question only as means to an end and they are
+valuable only in so far as they reach the end. That they can be related
+to an entirely different series of purposes, to the system of our moral
+ideas, ought not to withdraw the attention of the psychotherapist from
+his only aim, to cure the patient. The highest moral appeal may be even
+a most unfit method of treatment and the religious emotion may just as
+well do harm as good from the point of view of the physician.
+Psychotherapy has suffered too much from the usual confusion of
+standpoints.
+
+
+
+
+V
+
+SUGGESTION AND HYPNOTISM
+
+
+Psychotherapy has now become for us the effort to repair the disturbed
+equilibrium of human functions by influencing the mental life. It is
+acknowledged on all sides that the most powerful of these influences is
+that of suggestion. This is an influence which is most easily
+misunderstood and which has most often become the starting point for
+misleading theories. Before we enter into the study of the practical
+effects of suggestion and the psychotherapeutic results, we must examine
+this tool in the hand of the psychotherapist from a purely psychological
+viewpoint. The patient may perhaps sometimes profit from suggestion the
+more, the less he understands about its nature, but the physician will
+always secure the better results, the more clearly he apprehends the
+working of this subtle tool. Of course, that does not mean that any
+psychology is able to explain the process of suggestion to a point where
+all difficulties are removed, but at least the mysteries can be removed
+and the effects can be linked with other well-known processes.
+
+Let us be clear from the start that suggestion is certainly nothing
+abnormal and exceptional, nothing which leads us away from our ordinary
+life, nothing which brings us nearer to the great riddles of the
+universe. There is no human life into which suggestion does not enter in
+a hundred forms. Family life and education, law and business, public
+life and politics, art and religion are carried by suggestion. A
+suggestion is, we might say at first, an idea which has a power in our
+mind to suppress the opposite idea. A suggestion is an idea which in
+itself is not different from other ideas, but the way in which it takes
+possession of the mind reduces the chances of any opposite ideas; it
+inhibits them. It is indeed the best result of any successful education,
+that the teachings have taken hold of the mind of the young in such a
+way that all the opposite tendencies and impulses and wishes do not come
+to development. The well-educated person does not need to participate in
+a struggle between good and bad motives, for that which has been
+impressed upon his mind does not allow the other side to come up at all.
+Our life would be crowded with inner conflicts if education had not
+secured for us from the start preponderance for the suggestions of our
+educators.
+
+The love of family and friends, of our country and our party are in the
+same way such suggestions. We may hear arguments for the other side,
+arguments which easily convince the man of the other party, but they do
+not appeal to us: they are emasculated before they enter our minds; they
+have no chance to overcome the resistance because suggestions stand in
+their way. No argument will overwhelm the suggestion which religion has
+settled in our inner life, and from this strongest suggestion which can
+stand against any temptation of life small psychological steps lead down
+to the little bits of suggestion with which our daily chance life is
+over-flooded. Every advertisement in the newspaper, every display in the
+shop-window, every warm intonation in the voice of our neighbor has its
+suggestive power, that is, it brings its content in such a way to our
+minds that the desire to do the opposite is weakened. We do buy the
+object that we do not need, and we do follow the advice which we ought
+to have reconsidered. And what would remain of art if it had not this
+power of suggestion by which it comes to us and wins the victory over
+every opposing idea? We believe the painter and we believe the novelist,
+if their technique is good. We do not remember that the inventions of
+their genius are contrary to our life experience; we feel sympathy with
+the hero and do not care in the least that he has no real life. The
+suggestion of art has inhibited in us every contrary idea.
+
+Such daily experience shows us that suggestive power may belong to
+different men in different degree. There are lawyers whose arguments and
+whose presentation open our mind, it seems, to any suggestion: while
+others leave us indifferent; we understand their idea, we follow their
+thoughts, and yet we remain accessible to opposite influences. There are
+teachers whose authority gives to every word such an impressiveness and
+dignity that every opposite thought disappears, while others throw out
+words which are forgotten. On the other hand, the readiness to accept
+suggestions is evidently also quite different with different
+individuals. From the most credulous to the stubborn, we have every
+degree of suggestibility, the one impressed by the suggestive power of
+any idea which is brought to his mind, the other always inclined to
+distrust and to look over to the opposite argument. Such a stubborn mind
+is indeed not only without inclination for suggestions, but it may
+develop even a negative suggestibility; whatever it receives awakens an
+instinctive impulse towards the opposite. Moreover we are all in
+different degrees suggestible at different times and under various
+conditions. Emotions reënforce our readiness to accept suggestions. Hope
+and fear, love and jealousy give to the impression and the idea a power
+to overwhelm the opposite idea, which otherwise might have influenced
+our deliberation. Fatigue and intoxicants increase suggestibility very
+strongly. To look out on a wider perspective, we may add at once that an
+artificial increase of suggestibility is all which constitutes the state
+of hypnotism.
+
+At first, however, we want to understand the ordinary process of
+suggestion in that normal form in which it enters into every hour of our
+life and into every relation of our social intercourse. But if we begin
+to examine the structure of the process, we can no longer be satisfied
+with the vague reference to ideas and their opposites. What does it mean
+after all if we speak of opposite ideas? Can we not entertain any ideas
+peacefully together in our consciousness? From a logical standpoint,
+ideas may contradict each other, but that refers to their meaning. As
+mere bits of psychological experience, I may have any ideas together in
+my consciousness. I can think summer and winter or day and night or
+right and left or black and white or love and hate in one embracing
+thought. As mere mental stuff, the one idea does not interfere with the
+other. On the other hand, this is evident: I cannot will to turn to the
+right and to turn to the left at the same time. There may be a wrangling
+between those two impulses, but as soon as my will stands for the one,
+the other is really excluded. Any action which I am starting to do thus
+crowds out the impulse to the opposed action.
+
+In the sphere of psychological facts, we have here indeed the only
+relation between two happenings which necessarily involves an
+opposition. We could never understand why one brain cell might not work
+together with any other brain cell, but we do understand that nature
+must provide for an apparatus by which the impulse to one action makes
+the impulse to the opposite action ineffective. There is no action which
+has not its definite opposite. The carrying out of any impulse involves
+the suppression of the contrary impulse, and the impulse not to do an
+action involves the suppression of the impulse to do it. When we spoke
+of the relations of mind and brain, we mentioned that such a corelation
+of mental centers indeed exists. Physiological experiments have
+demonstrated that the activity of those centers which stimulate a
+certain action reduce the excitability of those brain parts which awaken
+the antagonistic action. As far as the world of actions is concerned,
+the mechanism of the process of suggestion thus seems not inaccessible
+to a physiological understanding.
+
+Various ideas of movements to be carried out are struggling for control
+in the cortex of the brain. That is the normal status which precedes any
+decision. The channels of motor discharge are open for both
+possibilities; we may turn to the right or to the left. Then the play of
+associations begins. A larger and larger circle of ideas surrounds the
+idea of the one and of the other goal. Those ideas awaken emotions. On
+the one side may call our duty and on the other side our pleasure.
+Larger and larger parts of the central content of our consciousness, of
+our own personality, become involved; our principles and maxims, our
+memories, our hopes and fears, enter into the battle until deeper strata
+of the idea of ourselves enter into a firm association with the one
+side, reënforcing, perhaps, the idea of the goal at the right. This
+opens wide the channels of discharge for the movement to the right and
+inhibits thereby the excitability of the center which leads to the
+opposite action. The channel of discharge to the movement towards the
+left becomes closed, the idea of that movement fades away and becomes
+inhibited: we are moving towards the right. The outcome was the product
+of our total personality.
+
+But this result would have been different, if from the start the
+channels of discharge had not been equally open for both possible
+movements, and if thus the relative resistance to the impulse had not
+been equal on both sides. If, for instance, we had gone from the given
+point frequently to the left, as a result of the habit and training, the
+impulse to the left would have found less nervous resistance. The
+channels would have become widened by the repetition and the opposite
+channels would have been somewhat closed by the lack of use. Or if
+instead of such previous habit, we should see at the decisive moment
+others turning to the left, the impression would have become the
+starting point for a reaction of mere instinctive imitation. While we
+might not have followed that imitative impulse at once, yet the channels
+would have been widened, the discharge in the direction would have been
+prepared by it, the resistance would have been lowered and the chances
+for the opposite movement would have been decreased. Those people who
+moved to the left gave us by their action the same kind of an impulse
+which they would have furnished if they had begged us with words, or if
+they had ordered us to follow them with authoritative firmness. In each
+of these cases, the influence would have amounted to a suggestion.
+Whether we watched the movements of other people or whether their words
+made an impression on us, in either case the way became prepared for a
+certain line of action and therefore the way for the opposite action
+became blocked. The final outcome was thus no longer an entirely free
+play of motor ideas, but there was a little inequality in play. The one
+had from the start a better chance, the other was from the start
+laboring under difficulties. The suggestion of actions is thus nothing
+but making use of the antagonistic character in the nervous paths which
+start from the motor centers. That all such phrases as the opening and
+the closing, the widening and blocking, of channels of discharge are
+only metaphors hardly needs special emphasis. Instead of such
+comparisons, we ought rather to think of chemical processes which offer
+various degrees of resistance to the propagation of the nervous
+excitement.
+
+We see from here the direction in which many psychotherapeutic efforts
+must lie, efforts which are entirely within the limits of the daily
+normal experience, and belong to the medical practice of every
+physician, yes, to the helpful influence of every man in practical life.
+The intemperate man may suffer from his inability to resist his desire
+for whiskey. The idea of his visit to the saloon finds the channels of
+discharge open. We argue with him, we tempt him by attractions which
+lead to other ways, we suggest to him that he spend those evening hours
+perhaps with friends or with books for which we awaken his interest; we
+do it as impressively as we can, we appeal to his friendly feeling for
+us; and if again the hour comes in which the desire for the artificial
+stimulation sets in with a motor impulse towards the bottle, the
+channels for discharge have now been blocked. The idea of the opposite
+action arises, it associates itself with the emotions which we stirred
+up in his mind, it associates itself with the respect for the adviser,
+and thus new clusters of thought reënforce that idea of action which we
+suggested, and this opposite line of action now finds a minimum
+resistance because our appeal has opened beforehand the gate. The desire
+for the book works itself out into action while the desire for the cup
+finds increased resistance.
+
+Just this is the kind of suggestion with which we correct faulty action
+everywhere in our social circle; and yet small steps lead on from here
+to the case where perhaps the desire for alcohol has reached that
+pathological intensity in which the equilibrium is entirely disturbed
+and cannot be repaired without suggestions of a much more powerful
+character, given in a state of artificially increased suggestibility--in
+hypnotism. The principle of opening certain channels of discharge for
+the purpose of closing the opposite channels remains in the extreme case
+the same as in the more ordinary cases. The impulse to drink is a
+positive one, but the principle is not different where the impulse is
+negative. A friend who comes from the quiet country may feel unable to
+pass the busy square of the city. The fear of an accident holds back his
+steps, he cannot give the impulse to walk through the crowded rush of
+vehicles. Now either by words of advice, by persuasion or by showing the
+way, we may apply our suggestion, we open the channels of discharge for
+the necessary movements and thus decrease the excitability of those
+centers in which nervous fear was playing. And again small steps lead
+from here to the case of the psychasthenic sufferer whose phobia does
+not allow him to cross any square and where reënforced suggestion has to
+break open the ways for the walking movement when the square is reached.
+
+Thus we are not far from a causal understanding of suggestive influences
+wherever actions are concerned, where movements are to be reënforced or
+to be suppressed and where antagonism of the motor paths is involved.
+But that does not seem to lead us nearer to the much larger group of
+states in which the whole suggestive process concerns apparently the
+interplay of ideas alone, where not actions but impressions are
+controlled by suggestion, where not impulses but thoughts are
+strengthened or inhibited. Here lies the real psychophysical problem
+which has been by far too much neglected in scientific psychology and
+has almost been hidden and made to disappear in the wonderful accounts
+of the hypnotists. But all those mysterious stories as to the
+achievements of suggestion cannot help so long as we do not understand
+the working of the process, and we shall have the better chance to
+understand it the more we keep away from the uncanny and mysterious
+results which refer to the most complex conditions, and rather seek to
+analyze the state in its simplest forms and compare it with other simple
+mental processes. The psychology of suggestion has suffered too much by
+the fascination which its most complex forms exert on a trivial
+curiosity.
+
+Yet the problem of suggestion in the field of ideas stands after all not
+isolated. Instead of connecting it with the weird reports of mystic
+influence from man to man, let us rather link it with the simple
+experience of attention. There is no pulse-beat of our life in which
+attention does not play its little rôle. But does not attention share
+with suggestion the characteristic feature that some contents of
+consciousness are reënforced and others are suppressed? This negative,
+this suppressing character of attention is not a chance by-product, it
+is most essential. There is no attention without it. If I am studying, I
+do not hear the conversation around me, and if I listen to the
+conversation, my studies in hand become inhibited. If I enjoy the play
+on the stage and give to it my full attention, my memories of the day's
+work are suppressed; if I think of the happenings of the day, I am not
+attentive to the play and hardly notice what is going on. The inhibited
+impression may often disappear entirely. While I am reading I am not at
+all aware of the tactual and muscular sensations in my legs, and if I am
+completely absorbed by my book, I may not even notice that the bell
+rings. In short, we have here as the most characteristic relation, just
+as in suggestion, the fact that one mental state becomes vivid, and that
+others are losing ground, become less vivid, are inhibited and perhaps
+disappear entirely.
+
+Of course, to point to the similarity between suggestion and attention
+is not a real explanation. It may be answered that attention simply
+offers the same difficulties once more. How can we explain in the
+attention process the fact that one idea, the one attended to, becomes
+vivid and that others evaporate? The difficulty evidently cannot be
+removed by simply saying that only one sensorial process can be
+developed in the brain at one time. The popular descriptions of
+attention easily make it appear as if such were the solution of the
+problem. If one sensorial brain part is intensely engaged, the remainder
+of the brain is condemned to a kind of inactivity. Yet such a dogma is
+hardly better than the old-fashioned one that the soul can have only one
+idea at a time. We know too well now that the psychophysical system is
+an extremely complex equilibrium of millions of elements. Thus every
+change must be explained with reference to this complex manifold. Above
+all, the facts simply contradict such an over-simple explanation,
+inasmuch as it is not at all true that only one content of consciousness
+can become vivid. Our attention does not focus upon one point at all but
+may illuminate a large field and thus give vividness to various complex
+groups. If I am thinking about a scientific problem, an abundance of
+reminiscences of previous reading and imaginative ideas of possible
+solutions, associative thoughts and conclusions are with equal vividness
+before my mind and the forthcoming thought may be influenced by this
+total combination. I have no right whatever to say that the idea of a
+certain solution excludes there in my mind the consideration of the
+books which I have read and of the discussions which I have heard.
+Emotions may be superadded. In short, a world of mental states may be
+held together by one act of attention. And new and ever new thoughts
+are shooting in, and all still find place there in the field attended
+to, while on the other hand my slight headache is inhibited and an
+appointment is forgotten. At a gay banquet, my attention may be given to
+the whole hall with all its color effects and its flowers, and to all
+that the table offers and to the music from the orchestra and to the
+jokes of my neighbors. It is not true that any one of those parts
+suppresses the vividness of the others, they seem rather to maintain and
+to help one another; and yet in the next moment, my neighbor may bring
+me news which absorbs my mind entirely and leaves no room for the
+flowers and the music and the meal. How far can psychology do justice to
+these characteristics of attention?
+
+There seems to be but one way. The attended-to idea does not exclude
+every other idea, but it does exclude the opposite idea, and opposite to
+each other is here again that pair of ideas which lead to opposite
+actions, to opposite psychophysical attitudes. We must remember here the
+psychomotor character of our brain processes which we so fully
+discussed. We recognized the fundamental truth that there is no
+sensorial state which is not at the same time the starting-point for
+motor reaction. We recognized that the brain is by its whole
+psychological development a great switchboard which transfers incoming
+currents into outgoing ones and that its biological meaning lies in the
+fact that it is the center piece of an arc which leads from the sense
+organs to the muscles. We cannot conceive of those relations as complex
+enough; we know, of course, that millions of nerve fibers lead from the
+periphery to the highest psychophysical apparatus in the cortex of the
+brain and that millions of fibers bring about the interrelation between
+these central stations, but we must never forget that millions of fibers
+also represent the outgoing paths and that they too lead down to lower
+central motor instruments which are again in numberless corelations. Any
+impression is thus a starting point for attitudes and reactions and it
+is an empty abstraction to consider it otherwise. An idea is never,
+psychophysically considered, the end of the process, it is always also a
+beginning. No external action may follow, but the mental impulse to such
+is nevertheless starting in the highest center.
+
+If we look at the landscape, every single spot of color, reaching a
+nerve fiber in our eye and finally a sensory cell in our brain, is there
+the starting point for an impulse to make an eye movement in the
+direction of the seen point. The eye may remain entirely quiet as the
+impulse to move to the right and to the left, to move up and to move
+down, may be equally strong, but those thousands of impulses work in the
+motor paths and only their equilibrium results in the suppression of the
+outer movement. With such motor scheme, we begin to understand the
+selective process in attention. An impression may be accompanied by
+other stimuli and associations, by thoughts and ideas, and thousands of
+sensory excitements may thus arise in the cortex, but only those have a
+chance for full vividness of development which coöperate in the motor
+action already started. Those impressions which would lead to the
+opposite actions have no chance because their motor paths are blocked
+and their own full development is dependent upon their possibility of
+expression. To close the path means to inhibit the idea which demands
+such action. We can attend to a hundred thoughts together, if they all
+lead to the same attitude and deed. We can look at the opera, can see
+every singer and every singer's gown, can listen to every word, can have
+the whole plot in mind, can hear the thousands of tones which come from
+the orchestra; and yet combine all that in one act of attention, because
+it all belongs to the same setting of our reactive apparatus. Whatever
+the one wants is wanted by the others. But if at the same time our
+neighbor speaks to us, we do not notice it; his words work as a stimulus
+which demands an entirely different motor setting as answer. Therefore
+the words remain unvivid and unnoticed.
+
+To attend means therefore to bring about a motor setting by which the
+object of attention finds open channels for discharge in action. Which
+particular action is needed in the state of attention cannot be
+doubtful. Attention demands those motor responses and those inner steps
+by which the object of attention shows itself more fully and more
+clearly. When we give attention to the picture we want to see more
+details, when we give attention to the problem we want to recognize more
+of the factors involved, when we give attention to the banquet we want
+to grasp more of the pleasurable features. This aim of attention
+involves that, as part of such reactions, the sense organs become
+adjusted; we fixate the eyeball, we listen, and in consequence the
+object itself becomes clearer, and through the easy passage into the
+motor channels the whole impression becomes vivid. At the same time, all
+those associations must be reënforced and become vivid too which lead to
+the same action. On the other hand, the opening of the one passageway
+closes the path to the opposite action and inhibits the impressions
+which would interfere with our interest. Every act of attention becomes,
+therefore, a complex distribution in the reënforcement and inhibition of
+mental states.
+
+Now let us come back to suggestion. It shares, we said, with attention,
+the power to reënforce and to inhibit. But if we examine what is
+involved in the suggestion of an idea, we find surely more than a mere
+turning of the attention towards one idea and turning the attention away
+from another idea. That which characterizes and constitutes suggestion
+is a belief in the idea, an acceptance of the idea as real and the
+dismissal of the opposite idea as unreal. Yes, we may say directly that
+it is meaningless to speak of suggesting an idea; we suggest either an
+action or, if no action is concerned, we suggest belief in an idea. If I
+suggest to the fearful man at twilight that the willow-tree trunk by the
+wayside is a man with a gun, I do not turn his attention to an abstract
+idea of a robber nor do I simply awaken the visual impression of one,
+but I make him believe that such an idea is there realized, that he
+really sees the person. If I suggest to him that he hears distant bells
+ringing or that he feels a slight headache, he may not be suggestible
+enough to accept it, but if he accepts it he is not simply attending to
+the idea which I propose but he is convinced of its real existence. The
+same holds true with the negative; if I suggest to him that the slight
+headache of which he complained has disappeared or that the smell which
+he noticed has stopped, I do not simply invite him to think of the
+absence of such sensations. It becomes for him a suggestion only if he
+becomes convinced that these disturbances have now become unreal. The
+same holds true for all those suggestions of ideas which belong to our
+practical life, the suggestions which art imprints on our minds, or
+which politics and religion impart. As long as we are under the
+suggestion of the novelist, we really believe in the existence of the
+heroine; we really believe in the validity of the political party
+principle; it is not an argument to which we simply give our attention,
+it becomes a suggestion only when the belief in its objective existence
+controls our minds. We may say in general that suggestions which are not
+suggestions of actions are without exception suggestions of belief.
+Actions and beliefs are the only possible material of any suggestion.
+
+Yet what else is a belief than a preparation for action? I may think of
+an object without preparing myself for any particular line of behavior.
+Here in the room I may think of rain or sunshine on the street as a mere
+idea, but to know that it now really rains or shines means something
+entirely different. It means a completely new setting in my present
+attitude, a setting by which I am prepared to act along the one or the
+other line, to take an umbrella or to take a straw hat, when I am to
+leave the house. I may think of the door of this room as locked or
+unlocked without transcending the mere sphere of imagination, but to
+believe that it is the one or the other means a new setting in my motor
+adjustments. If it is locked I know that I cannot leave the room without
+a key. Every belief means the preparation for a definite line of action
+and a new motor adjustment in the whole system of motor paths, an
+adjustment by which my actions in future will be switched off at once
+into particular paths. And there is theoretically no difference whether
+my belief refers to the proposition that the door is locked or that a
+God exists in Heaven.
+
+But if every belief is such a new motor setting, then we are evidently
+brought back to the mechanism which was essential for every suggestion
+of action on the one side and for every process of attention on the
+other side, namely, the mechanism of antagonistic movements. To prepare
+ourselves for one line of action means to close beforehand the channels
+of discharge for the opposite. The suggestible mind sees the man with a
+gun on the wayside because he is preparing himself in his expectation
+for the appropriate action; he is ready for the fight or ready to run
+away, and every line of the tree trunk is apperceived with reference to
+this motor setting. The smell, on the other hand, has disappeared under
+the influence of the suggestion because a new motor adjustment has set
+in, in which he is prepared to act as if there were no smell.
+
+The difference between suggestion and attention lies thus only in this:
+the motor response in attention aims towards a fuller clearness of the
+idea, for instance, by fixating, listening, observing, searching; while
+the motor response in suggestion aims towards the practical action in
+which the object of the idea is accepted as real. In attention, we
+change the object in making it clearer; in suggestion, we change
+ourselves in adapting ourselves to the new situation in which we
+believe. If you consider attention as a psychophysical process open to
+physiological explanation, you have surely no reason to seek anything
+mysterious in the process of suggestion; and no new principle is
+involved, if we come from the effect of the smallest suggestive hint to
+the complex and powerful suggestions which overwhelm the whole
+personality.
+
+The two great types of suggestion, the suggestion of actions and the
+suggestion of ideas, have now come nearer together since we have seen
+that the suggestion of ideas is really a suggestion of the practical
+acceptance of ideas, and that means, of a preparation towards a certain
+line of action. In the one case I suggest the idea of a certain action
+and this motor idea leads to the action itself, and in the other case I
+suggest a certain preparatory setting for action and that will lead to
+the appropriate action whenever the time for action comes. Every
+suggestion is thus ultimately a suggestion of activity. The most
+effective suggestion for an action results, of course, if both methods
+are combined, that is, if we suggest not only the will to perform the
+action, but at the same time the belief that the end of the action will
+be real. Suggestion reaches us usually from without. Yet there is again
+no new principle involved, when the new motor setting results from one's
+own associations and emotions. Then we speak of auto-suggestion. It is
+the same difference which exists between the attention called forth
+through an outer impression and the attention directed by our own will.
+Loud noise demands our attention, and even a whispered word may awaken
+associations which stir up the attention. In both cases the channels for
+adjustment become opened without our intention. But if we are expecting
+something of importance, if we start to watch a certain development and
+to find something which we seek, we open the channels by our own effort
+beforehand and produce our own settings thus through a voluntary
+attention. In this way suggestion too may start from without,--by a
+spoken word, by a movement, by a hint; or may start within us and may
+give us our caprices and our prejudices.
+
+We must not neglect one other feature of the suggestion. Not every
+proposition to action or to belief can be called a suggestion. Essential
+too remains the other side of it, the overcoming of the resistance. A
+mere request, "Please hand me the book on the table," or a mere
+communication, "It rains," may produce and will produce the fit motor
+response, the movement towards handing over the book or opening of the
+umbrella, and yet there may be no suggestive element involved. We have a
+right to speak of suggestion only if a resistance is to be broken down,
+that is, if the antagonistic impulse, or the motor setting for the
+antagonistic action is relatively strong. If I say to the boy, "Hand me
+the book," when he was anxious to hide the book from my eyes and thus
+had the wish not to hand it to me and the tone of my request overwhelmed
+his own intention, then to be sure suggestion is at work. The stronger
+the resistance, the greater the degree of suggestive power which is
+needed to overcome the motor setting. If I say to the normal man, "It
+rains," while he sees the blue sky and the dry street, his impression
+will be stronger than my suggestion; but if he is suggestible and I tell
+him that it will rain, he may accept it and take an umbrella on his
+walk, even if no indication makes a change of weather probable. The
+present impression of the dry street was strong enough to resist the
+suggestion, the imaginative idea of that which is to be expected in the
+next hour was too weak, and was overwhelmed by the suggestion of the
+weather prophecy.
+
+It is clear that the whole suggestive effect, being one of a new motor
+setting, depends thus entirely on the equilibrium of the personality
+which receives the suggestion. Every element which reaches the mind
+through sense organs or through associations must have influence in
+helping the one or the other side, that is, in opening the channels of
+action in the suggested direction or in the antagonistic one. The
+results appear surprising only if we forget how endlessly complex this
+psychomotor apparatus really is. If we disregard this complexity we may
+easily have the feeling that one person has an unexplainable influence
+over another, as if the will of the one could control in a mysterious
+way the will of the other. But as soon as we see that every action is
+the result of the coöperation of hundreds of thousands of psychomotor
+impulses which are in definite relation to antagonistic energies, and
+that the result depends upon the struggling and balancing of this most
+complex apparatus, then we understand more easily how outer influences
+may help the one or the other side to preponderance: as soon as the
+balance turns to the one side, a completely new adjustment must set in.
+And we understand especially that there is nowhere a sharp demarcation
+line between receiving communications and receiving suggestions. By
+small steps suggestion shades over into the ordinary exchange of ideas,
+propositions, and impressions, just as attention shades over into a
+neutral perception.
+
+To be suggestible means thus to be provided with a psychophysical
+apparatus in which new propositions for actions close easily the
+channels for antagonistic activity. Such an apparatus carries with it
+the disadvantage that the personality may too easily be guided contrary
+to his own knowledge and experience. He will be carried away by every
+new proposition and will accept beliefs which his own thoughts ought to
+reject. On the other hand, it has the advantage that he will be open to
+new ideas, be ready to follow good examples, never stubbornly close his
+mind to the unaccustomed and the uncomfortable. It is easy to determine
+the degree of suggestibility. Take this case. I draw on the blackboard
+of a classroom two circles of an equal size, and write in the one the
+number fourteen and in the other the number eighty-nine, and ask the
+children which is the larger circle. The suggestible ones will believe
+that the circle with the higher number in it is really larger than the
+other, the unsuggestible children will follow the advice of their senses
+and call both equal, and there may be a few children with negative
+suggestibility who would call the circle with the higher number the
+smaller circle. What happened to the suggestible ones was that the
+higher number brought about a motor attitude which faced that whole
+complex as being more imposing and this new motor setting was with them
+strong enough to overcome the motor adjustment which the circles alone
+produced. Such experiments of the psychological laboratory can be varied
+a thousandfold, and it might not be unwise to introduce them into many
+practical fields. Everybody knows for instance how much may depend upon
+the suggestibility of the witness in court. The suggestible witness
+believes himself to have seen and heard what the lawyer suggests. The
+memory picture which such a witness has in mind offers, of course, much
+less resistance to the opposite action and attitude and belief than the
+immediate impression. If I show the witness a colored picture of a room
+and close the book and ask him whether there were three or four chairs
+in the picture and whether the curtain was green or red, the suggestible
+man will decide for one or the other proposition, even if there were
+only two chairs and a blue curtain. The perception would have resisted
+the suggestion, the fading memory image cannot resist it. Thus
+suggestibility is really a practical factor in every walk of life. And
+it is in the highest interests of psychotherapy that this intimate
+connection between suggestion and ordinary talk and intercourse, between
+suggestion and ordinary choice of motives, between suggestion and
+attention be steadily kept in view and that suggestion is not
+transformed into a kind of mysterious agency.
+
+To be sure, the importance of suggestion for psychotherapy is not
+confined to these suggestive processes of daily life. They play a rôle
+there, as we shall see, and we shall claim that even the mere presence
+of the physician may have its suggestive power and so may every remedy
+which he applies. But no doubt many of his suggestive effects depend on
+a power which far transcends the suggestions of our daily life. Yet the
+psychologist must insist again that no new principle is involved, that
+even in the strongest forms of suggestion, in hypnotism, nothing depends
+upon any special influence emanating from the mind of the hypnotizer or
+upon any special power flowing over from brain to brain; but that
+everything results from the change of equilibrium in the psychomotor
+processes of the hypnotized, and thus upon the interplay of his own
+mental functions. All that is needed is a higher degree of
+suggestibility than is found in the normal life. In a more suggestible
+mind even the direct sense impressions may be overwhelmed by the
+proposition for an untrue belief and the strongest desires may yield to
+the new propositions of action. This library may then become a garden
+where the hypnotized person picks flowers from the floor, and the wise
+man stands on one leg and repeats the alphabet, if the hypnotizer asks
+him to do so. Let us consider at first this extreme case. By a few
+manipulations I have brought a man into a deep hypnotic state. He is now
+unable to resist any suggestion, either suggestion of impulse or
+suggestion of belief, and as every one of the hypnotic phenomena can be
+explained in this way, we may claim that the hypnotic state is in its
+very nature a state of reënforced suggestibility. Whether I say, "You
+will not move your arm," or whether I say, "You cannot move your arm,"
+awakening in the one case the impulse to the suppression of the
+movement, in the other case the belief in the impossibility of the
+movement, in either case the result is the same; the arm remains stiff
+and any effort of his to move it is inhibited. I may go to the extreme
+and tell him that our friend by my side has left the room; he will not
+see him, he will not even hear a word which the friend speaks. If I take
+a hat in my hand and put it on the friend's head, the hat appears to
+hang in the air. Every impression of sound or sight or touch which comes
+from the friend is entirely inhibited. The direct sense impression of
+eye and ear is thus completely overwhelmed by the suggestion.
+
+What has happened? Are the manipulations which I applied sufficient to
+produce the changes by their physical influence? Certainly not; they are
+of the most different kinds and yet all may have the same effect.
+Perhaps I may have used the easy method of making the subject stare at a
+shining button held in front of his forehead. Or I may have used slight
+tactual impressions, while he was lying with closed eyes, or I may have
+produced the abnormal state by monotonous noises of falling waterdrops,
+or I may have simply spoken to him and asked him to think of sleep and
+to relax and to feel tired, while I held my hand on his forehead or
+while I held his hand in mine. Or I may have relied upon mild talking
+without touching him at all; and yet every time the result was reached
+in the same degree. There is thus certainly no special physical energy
+which like a magnetic force flows over. It cannot even be said that my
+will is engaged. I have often hypnotized without even thinking of the
+subject before me, going through adjusted manipulations while my
+thoughts were engaged in something else. I have even hypnotized over the
+telephone; and a written note may be substituted with the same result. I
+write to the patient that two minutes after receiving this letter by
+mail, he will fall into hypnotic sleep. The effect sets in; and yet at
+that time, I may not remember sending the note at all.
+
+It is thus entirely evident that the hypnotic effect results only from
+the mental conditions of the subject. Whatever may stimulate his mind
+to the right kind of reaction will produce the desired result. The
+increased suggestibility thus sets in by his own imagination which may
+be stirred up by slight visual or tactual or acoustic stimuli or by
+monotonous words or by feelings of relaxation and especially by words
+which encourage sleep. But just because it is the play of his own
+imagination, the most essential factor certainly is the will and
+expectation of the subject. No one can really be hypnotized against his
+own will. And to expect strong hypnotic effect from a certain hypnotist
+is often in itself sufficient to produce hypnotic sleep. Thus there is
+no special personal power necessary to produce hypnotism. Everybody can
+hypnotize. And almost with the same sweeping statement it may be said
+everybody can be hypnotized, provided that he is willing to enter into
+this play of imagination. The young child or the insane person is
+therefore unfit.
+
+Of course, not everybody can be hypnotized to the same degree. Just as
+the normal suggestibility showed itself very different with different
+persons, the degree of artificial reënforcement varies still more.
+Practically everybody can be brought to that breakdown of the
+resistance in which he can no longer open the eyes against the order of
+the hypnotist, but rather few can be brought to the point of seeing
+extended hallucinations, or accepting the disappearance of persons who
+are speaking, or of yielding to the impulse to a dangerous action. The
+highest reported degree, in which even criminal actions are performed
+by honest men, exists in my opinion only in the imagination of
+amateurs; it is certainly not difficult to produce sham crimes for
+performance sake, with paper daggers and toy pistols, but that is no
+proof at all that the hypnotized person would commit a crime under
+conditions under which he has the conviction that he faces a real
+criminal situation. But if we abstract from real crime, we certainly
+have to acknowledge that actions can be performed which appear in
+striking contrast with the habits and character of the normal
+personality, upset his knowledge, and are based on beliefs which would
+be immediately rejected under ordinary conditions. These higher degrees
+of hypnotic state are easily followed by complete loss of memory for all
+that happened during the abnormal state.
+
+How have we to interpret such a surprising alteration of mind? It lies
+near to compare it with sleep. The brain seems powerless to produce its
+normal ideas, the associations do not arise, the normal impulses have
+disappeared and a general ineffectiveness has set in; in short, the
+brain cells seem unable to function. Of course, the explanation of sleep
+itself may offer difficulties. Is it a chemical substance which poisons
+the brain during the sleep, or are the brain cells contracted so that
+the excitement cannot run over from the branches of one nerve cell into
+those of another? Or are the blood-vessels contracted so that an anæmic
+state makes their normal function impossible? But whatever the physical
+condition of sleep may be, have we really a right to emphasize the
+similarity between sleep and hypnosis? After all that we have discussed,
+we ought rather to recognize that the hypnotic state too comes much
+nearer to the process of attention than to the process of sleep. We saw
+that in every act of attention the process of inhibition is essential.
+All that is not in harmony with the attended idea is suppressed. Yet we
+should hesitate to say that in attention parts of our brain are asleep.
+
+We should feel reluctance to group such inhibition together with sleep
+because it would be a sleep which at any moment can pass from one part
+of the brain to others and which certainly leaves at every moment most
+of the cell groups unaffected. We saw that attention does not at all
+focus on one narrow point, but that an abundance of impressions, of
+ideas and associations, of thoughts and emotions can enter the field of
+attention, if they all lead to one and the same motor attitude, and that
+only the one part is inhibited which involves the opposite action. Such
+a jumping sleep which at every moment selects a special part would be,
+of course, just the contrary of that which characterizes the sleep state
+of the fatigued brain. But exactly these characteristics of attention
+belong to hypnotism too. It is not true that the mind of the hypnotized
+is asleep and that perhaps only one or the other idea can be pushed into
+his mind. On the contrary, his mind is open to an abundance of ideas,
+just as in the normal state. If I tell him that this is a landscape in
+Switzerland, he sees at once the mountains and the lakes, and his mind
+provides all the details of his reminiscences, and his imagination
+furnishes plenty of additions. His whole mind is awake; the feelings and
+emotions and volitions, the memories and judgments and thoughts are
+rushing on, and only that is excluded which demands a contrary attitude.
+This selective process stands decidedly in the center of the hypnotic
+experience and makes it very doubtful whether we are psychophysically on
+the right track, if we make much of the slight similarity between
+hypnosis and sleep.
+
+This has nothing to do with the fact that hypnosis is best brought about
+by suggesting the idea of sleep, that is, the belief that sleep will
+set in. This belief is indeed effective in removing all the ideas
+which are awake in the mind which would interfere with the willingness
+to submit to the suggestions of the hypnotizer. But the fact that
+belief in sleep and expectation of sleep bring with them the hypnotic
+state is not a proof that the hypnotic state itself is sleep. Even
+the mental experiences which can remain in sleep, the dreams, are
+characteristically different from the hypnotic experience. Thus the
+dreams show that unselective awakening of ideas which is to be expected
+from a general decrease of functioning. The hypnotic variation is
+characterized just by its selective narrowing of consciousness. For the
+same reason, hypnotism is strikingly different from such diseases of the
+mind as dementia. Certainly in dementia too, many associations are cut
+off, but it is not a selective inhibition, it is a haphazard destruction
+resulting from the degeneration in the brain.
+
+The fundamental principle of the hypnotic state lies in its selective
+character. Inhibited and cut off are those states which are antagonistic
+to the beliefs in the suggested ideas, and as their antagonism consists
+in their connection with opposite actions, the whole is again a question
+of motor setting. No doubt, such new motor setting can precede the
+normal sleep too; thus the sleeper may be insensitive to any surrounding
+noises, but perhaps awake at the slightest call from a patient who is
+intrusted to his care. In that case, one special feature of hypnotism is
+superadded to sleep but the sleep itself is not hypnotic. Again sleep
+may go over into a state which shares many characteristic features with
+hypnotism, that is, somnambulism, and it may be said with a certain
+truth that hypnotism is artificial somnambulism. But somnambulism, while
+arising in sleep, is not at all a feature of sleep.
+
+While sleep is characterized by a decrease of sensitiveness and of
+selective powers, the selective process of hypnotism rather reënforces
+sensitiveness and memory in every field which is covered by the
+suggestive influence. Stimuli may become noticeable which the normal man
+is unable to perceive, and long-forgotten experiences which seem
+inaccessible to the search of the waking mind may reproduce themselves
+and may vividly enter consciousness. Again we have there symptoms which
+rather characterize the state of over-attention than the state of sleep.
+We might add further that we know states with all the characteristics of
+hypnotism in which even the subjective idea of sleep is entirely
+absent, for instance, all those which are usually called states of
+fascination. A certain shining light or a glimpse of an uncanny eye may
+startle and upset the imagination of the subject and throw him into a
+state of abnormally increased suggestibility. It is well known that
+whole epidemics of such captivation have occurred and have resulted in
+hysterias of the masses in which the subjects become the slaves of their
+impulse, perhaps to imitate what they see or hear, or to realize ideas
+in which they believe without logical warrant. They surely are not
+asleep, are not even partially asleep. Every center of their brains
+would be ready to work, if the captivated attention were not forcing the
+mind in one direction and selectively suppressing every impulse to
+opposite actions. The developed hypnotism finally shades off into
+innumerable states of hypnoid character in which the sleeplike symptoms
+are entirely in the background.
+
+Thus the increased suggestibility of the hypnotic state will result not
+from a partial sleeplike decrease of functioning but the decrease of
+function is a motor inhibition which results from over-attention. In the
+ordinary attention, our motor setting secures only an increase in
+clearness and vividness of the attended ideas, but in an abnormal
+over-attention the new motor setting produces a complete acceptance with
+all its consequences. Abnormal or heightened attention thus goes
+directly over into the belief and into the impulse without resistance.
+There is no hypnotism which does not contain from the first stage this
+definite relation to certain objects of attention, usually to a
+particular person. All the manipulations, passes, fixation, monotonous
+speaking, and so on narrow the contents of consciousness but hold the
+idea of the hypnotizing person steadily in the center of attention. The
+awakened expectation of sleep, the associated feeling of tiredness all
+help to cut off attention from the remainder of the world, but as no
+real sleep sets in, this cutting off from the remainder reënforces the
+focusing of attention on the one central idea of the hypnotizing
+personality. Every word and every movement of this personality become
+therefore absorbed with that over-attention which leads at once from a
+mere perceiving and grasping to a complete sinking into the suggested
+idea with the suppression of all opposites, and thus to a blind
+acceptance and belief. We saw before that such belief is indeed nothing
+else but a motor setting in which certain ways of action are prepared.
+We are to think in accordance with the belief in the suggested idea and
+the channels for discharge in the opposite direction are closed. Even
+the ordinary life shows us everywhere that the step from attention to
+belief is a short one. The effort to grasp the object clearly works as a
+suggestion to accept that which we are seeking as really existing, and
+that from which we are to abstract and which we are to rule out through
+our attention, we believe to be non-existent. The prestidigitator does
+his tricks in order to sidetrack our attention, but he succeeds in
+making us believe that we see or do not see whatever he wishes.
+
+That the motor setting alone determines those changes and that a real
+sleeplike inability of the centers does not set in, can also be
+demonstrated by the results of later hypnotizations. I ask my hypnotized
+subject not to perceive the friend in the room; he is indeed unable to
+see him or to hear him. Yet his visual and acoustic centers are not
+impaired, the defect is only selective, inasmuch as he sees me, the
+hypnotizer, and not the friend. But even this selection inhibits only
+the attitude and not the sensorial excitement. If I hypnotize him again
+to-morrow and suggest to him now to remember all that the friend did and
+said during yesterday's meeting, he is able to report correctly the
+sense impressions which he got, which were inhibited only as long as
+they contradicted the suggestion, but now rush to consciousness as soon
+as the suggestion is reversed. As a matter of course, he must therefore
+have received impressions through eye and ear in his hypnotic sleep of
+yesterday from all that happened, only he was not aware of it because
+the channels of the accepting attitude were blocked.
+
+As soon as the over-attention has produced the acceptance of the belief,
+all further effects are automatic and necessary. If I tell the
+hypnotized person that he cannot speak and he absorbs this proposition,
+with that completeness in which he accepts it as a fact, not speaking
+itself unavoidably results. The motor ideas with which the speech
+movement has to start are cut off and the subject yields passively to
+the fate that he cannot intonate his voice. Thus a special influence on
+the will is in no way involved. If the idea is accepted, and that means,
+if the preparatory setting for the action has been completed, the ideas
+of opposite activity must remain ineffective; the suggested idea must
+discharge itself in action without resistance. As a matter of course the
+new line of action will then surround itself with its own associations
+and will thus give to the subject the impression that he is acting from
+his own motives. As soon as the psychophysical principles are
+understood, there is indeed no difficulty in going from the simplest
+experience to those spectacular ones where we may suggest to the
+profoundly hypnotized person that he is a little child or that he is
+George Washington. In the one case, he will speak and cry and play and
+write as in his present imagination a child would behave; in the other
+case, he will pose in an attitude which he may have seen in a picture of
+Washington. There is nothing mysterious and his utterances are
+completely dependent upon his own ideas, which may be very different
+from the real wisdom of a Washington and the real unwisdom of a child. I
+may suggest to him to be the Czar, by that he will not become able to
+speak Russian. In the same way I may suggest changes of the
+surroundings; he may take my room for the river upon which he paddles
+his canoe, or for the orchard in which he picks apples from my
+bookshelves.
+
+Finally there is no new principle involved, if the action which is
+prepared by any belief has to set in after the awaking from hypnotic
+sleep, the so-called post-hypnotic suggestion. As a matter of course,
+just these have an eminent value for psychotherapy. I may suggest to-day
+that the subject will overcome to-morrow his desire for the morphine
+injection, or that he will feel to-night the restfulness which will
+overcome his insomnia. But if the suggestion of an idea means belief,
+and if belief means a preparation for action, we have indeed no new
+factor before us if the action for which we prepare the subject is from
+the start related to a definite time. If we do not link it with the
+consciousness of a special time or of a special occasion which will
+occur later, the suggestion soon fades away. That my library is an
+orchard is forgotten perhaps within ten minutes, if I have not come back
+to it in the conversation. But if I say that after awaking as soon as I
+shall knock on my desk three times, you will be in the orchard again,
+the psychophysical apparatus is prepared, a new setting has set in, the
+three knocks will bring about the complete transformation. In short the
+difficulties disappear as soon as we are consistent in interpreting all
+suggestive influences as changes in the motor setting and as the result
+of the antagonistic character of all of our motor paths.
+
+We say the difficulties disappear. Of course, that is meant in a
+relative sense only. It means essentially that we are able to bring the
+complex state of hypnotism down to the similar state of attention and
+motor adjustment, but of course we must not forget that we are far from
+a satisfactory explanation of the process in attention itself. We know
+that the opening of motor channels in one direction somewhat closes the
+channels for discharge in the opposite direction, but what mechanism
+does that work is still very obscure. Whichever principle of
+hypothetical explanation we might prefer, it certainly leads to
+difficulties in view of the extreme complexity of attention in states of
+suggestion and hypnotism. We might think of a mechanism which through
+the medium of the finest blood-vessels should produce a localized anæmia
+in those centers which lead to the antagonistic action. Or we might
+fancy that by extremely subtle machinery the resistance is increased in
+those tissues which lie between the various neurons, or we might even
+think of toxic and antitoxic processes in the cerebral regions; and any
+day may open entirely new ways of explanation. We may add that even if
+the mechanism of attention were completely explained, we are also still
+far from understanding the physiological changes which go on in the
+sphere of the blood-vessels or of the glands and the internal organs. We
+understand easily that the idea of the subject that he cannot move his
+arm keeps the arm stiff; but that his idea to blush really dilates the
+blood-vessels of his cheek is much less open to our causal
+understanding; still less that in very exceptional cases perhaps a part
+of the skin becomes inflamed, if we make believe that we touch it with a
+glowing iron. And yet here too we see that we move in the same direction
+and that we have to explain these exceptional and bewildering results by
+comparing them with the simpler and simpler forms, that the process of
+attention contains all the germs for the whole development.
+
+In claiming that hypnotism depends upon the over-attention to the
+hypnotizing person, we admit that the increased suggestibility belongs
+entirely to suggestions which come from without. Only that which at
+least takes its starting point from the words or the movements of the
+hypnotizer finds over-sensitive suggestibility. Ideas which arise merely
+from the associations of the subject himself have no especially
+favorable chance for acceptance. But surely we also know states in which
+the suggestibility for certain of one's own ideas is abnormally
+increased. Great individual differences exist in that respect in normal
+life. There are normal hypochondriacs who believe that they feel the
+symptoms of widely different diseases under the influence of their own
+ideas, and others who are torturing themselves with fears on account of
+unjustified beliefs. But the abnormal increase of suggestibility
+parallel to that of hypnotism for suggestions from without exists for
+suggestions from within, mainly in nervous diseases, especially in
+neurasthenic, hysteric, and psychasthenic states. Within certain limits,
+we might almost say that this increase of suggestibility for
+autosuggestion is the fundamental characteristic of these diseases, just
+as increase of suggestibility for heterosuggestions characterizes
+hypnotism.
+
+Especially in earlier times, the theory was often proposed that hypnosis
+is an artificial hysteria. Such a view is untenable to-day; but that
+hysteria too shows abundant effects of increased suggestibility is
+correctly indicated by such a theory. The hysteric patient may by any
+chance pick up the idea that her right arm is paralyzed or is
+anaesthetic and the idea at once transforms itself into a belief and the
+belief clings to her like an obsession and produces the effect that she
+is unable to move the arm or that she does not feel a pinprick on the
+skin. These autosuggestions may take a firmer hold of the mind than any
+suggestions from without, but surely such openness to selfimplanted
+beliefs must be acknowledged as symptomatic of disease, while hypnosis
+with its impositions can be broken off at any moment and thus should no
+more be classed among the diseases than are sleep and dreams. The
+hysteric or psychasthenic autosuggestion resists the mere will of
+breaking it off. Here, therefore, is the classical ground for strong
+mental counterinfluences, that is, for psychotherapeutic treatment.
+Experience shows that the strongest chance for the development of such
+autosuggestive beliefs exists wherever an emotional disposition is
+favorable to the arriving belief. But emotion too is after all
+fundamentally a motor reaction. The whole meaning of emotion in the
+biological sense is that it focuses the actions of man into one channel,
+cutting off completely all the other impulses and incipient actions.
+Emotion is therefore for the expressions of man what attention is for
+the impressions. An emotional disposition means thus in every case a
+certain motor setting by which transition to certain actions is
+facilitated. It is thus only natural that a belief can settle the more
+easily, the more it is favored by an emotional disposition, as the motor
+setting for the one must prepare the other. Hypnosis and hysteria thus
+represent the highest degrees of suggestibility, the one artificial, the
+other pathological; the one for suggestions from without, the other for
+suggestions from within. But between these two and the normal state
+there lie numberless steps of transition. The normal variations
+themselves may go to a limit where they overlap the abnormal artificial
+product, that is, the suggestibility of many normal persons may reach a
+degree in which they accept beliefs hardly acceptable to other persons
+in mild hypnotic condition. Thus there is no sharp demarcation between
+suggestions in a waking state and suggestions in a hypnoid state. And
+the expectation of coming under powerful influence may produce a
+sufficient change in the motor setting to realize any wonders. Moreover
+probably every physician who has a long experience in hypnotizing has
+found that his confidence in the effectiveness of the deep hypnotic
+states has been slowly diminished, while his belief in the surprising
+results of slight hypnotization and of hypnoid states has steadily grown
+and has encouraged him in his psychotherapeutic efforts.
+
+
+
+
+VI
+
+THE SUBCONSCIOUS
+
+
+The story of the subconscious mind can be told in three words: there is
+none. But it may need many more words to make clear what that means, and
+to show where the misunderstanding of those who give to the subconscious
+almost the chief rôle in the mental performance sets in. The psychology
+of suggestion, for instance, which we have now fully discussed without
+even mentioning the word subconscious, figures in most popular books in
+the treatises of both physicians and ministers as a wonderful dominance
+of the subconscious mind. The subconscious mind alone receives the
+suggestions and makes them effective, the subconscious mind controls the
+suggestive processes in consciousness, and the subconscious mind comes
+into the foreground and takes entire hold of the situation when the
+hypnotic state sets in.
+
+But we are always assured that there is no need of turning to the
+mystery of suggestion and hypnotism to find that uncanny subpersonality
+in us. We try to remember a name, or we think of the solution of a
+problem; what we are seeking does not come to consciousness and now we
+turn to other things; and suddenly the name flashes up in our mind or
+the solution of the problem becomes clear to us. Who can doubt that the
+subconscious mind has performed the act? While our attention was given
+over to other questions, the subconscious mind took up the search and
+troubled itself with the problem and neatly performed what our conscious
+mind was unable to produce. Moreover in every situation we are
+performing a thousand useful and well-adapted acts with our body without
+thinking of the end and aim. What else but the subconscious mind directs
+our steps, controls our movements, and adjusts our life to its
+surroundings? And is not every memory picture, every reminiscence of
+earlier experiences a sufficient proof that the subconscious mind holds
+its own? The poem which we learned years ago did not remain somewhere
+lingering in our consciousness, and if we can repeat it today, it must
+be because our subconscious mind has kept it carefully in its store and
+is ready to supply us when consciousness has need for it.
+
+Surely if we think how this, our subconscious mind, is able to hold all
+our memories and all our learning, and how it transacts all the work of
+controlling our useful actions and of bringing up the right ideas, we
+may well acknowledge that compared with it our conscious life is rather
+a small part. It is as with the iceberg in the ocean; we know that only
+a small part is visible above the surface of the water and a ten times
+larger mountain swims below the sea. It seems, therefore, only logical
+to attach this whole subconscious mental life to a special subconscious
+personality. Then we come to the popular theory of the two minds in us,
+the upper and the lower, of which we can hardly doubt that the lower one
+has on the whole the larger part of the business to perform. And we
+certainly have no right to give to the word lower mind the side-meaning
+that the activity is of a lower order. The most brilliant thoughts of
+the genius are not manufactured in his upper consciousness, they spring
+suddenly into his mind, their whole creation belongs thus to the
+assiduous work of the subconscious neighbor. There the inventor and
+discoverer gets his guidance, there the poet gets his inspiration, there
+the religious mind gets its beliefs. In short, the constitution of the
+mental state allows on the whole to the upper consciousness a rather
+decorative part while the real work is left for the lower house.
+
+Yet it must be acknowledged that the scholars somewhat disagree as to
+the dignity of the lower mind. Considering the usually accepted fact
+that in hypnotism the lower mind comes entirely over the surface, just
+these hypnotic events can indeed suggest two different views of the
+subconscious and this doubleness is reënforced if we still add the
+entertaining material which comes to light by the automatic writing of
+mediums in their trance. The hypnotized person is ready to perform any
+foolishness, is not influenced by any considerations of tact and taste
+and wisdom and respect, and thus some of the chief believers in the
+subconscious personality stick to the diagnosis that the lower mind in
+us which shows up in hypnotism is a rather brutal, stupid, lazy,
+cowardly, immoral creature which ordinarily rather deserves to be
+subdued by our noble and wise upper personality. And the automatic
+writings of the mediums indorse this disrespectful view, for it is
+difficult to gather more idiotic slang than the emanations of these
+letters of the planchette. On the other hand, the hypnotized person
+shows an increase of sensitiveness and hyperæsthesia in which perhaps
+optical impressions or smells may be noticed which the ordinary man
+cannot perceive. Moreover the memory of the hypnotized is, as we saw,
+abnormally sharpened. Entirely forgotten experiences may awake again.
+The same holds true for the hysteric in whom also, of course, the
+subconscious takes hold of the inner life. Thus it seems entirely safe
+to say that the powers of the subconscious personality far surpass those
+of the upper conscious fellow, and that agrees with all those facts as
+to the subconscious origin of the work of the genius. Further, has it
+not been found again and again that the hypnotized and the hysteric
+cannot only remember long-forgotten parts of the past but have
+telepathic knowledge for distant events and even mysterious premonitions
+of the field of occurrences of the future?
+
+Hypnotism is essentially the same as the old mesmerism, and mesmerism
+was widely acknowledged as clairvoyance, and all that harmonizes again
+with the experiences of the mediums whose subconscious mind in trance
+enters into contact with the spirits of the dead. The subconscious
+personality is thus really a metaphysical power which transcends the
+limitations of the earthly person altogether and has steady connection
+with the endless world of spirit and the inner soul of the universe.
+Most popular books, it is true, do not demand from their readers the
+choice between the one or the other type of the lower personality,
+between that brutal, vicious, ignorant creature and that far-seeing,
+inspired, powerful soul. They simply mix the two and adapt the special
+faculties of this underground man to the special requirements of the
+particular chapter, the subconscious being unusually wise or unusually
+stupid in accordance with the special facts which are just then to be
+explained. Even that does not always settle all difficulties. They may
+discover, for instance, that the subconscious mind with which we deal in
+the hypnotized person has again itself a subconsciousness. If we tell
+the hypnotized person not to see a certain picture on the wall, this
+subconscious personality perceives the whole room with the exception of
+the picture. Yet after all someone sees this picture, because if we
+hypnotize him the next time and ask him what the picture contained, he
+now knows its contents. Thus they must have been recognized in a
+sub-subconsciousness, and we therefore come to a personality which lives
+on a floor still below the basement. But experiment can demonstrate that
+even this most hidden personality has still its secrets which are handed
+downwards. In short, we finally have not merely two but a number of
+personalities in us.
+
+But now let us leave these fantasies of psychological fiction. Let us
+turn to the concrete facts, let us see them in the spirit of modern
+scientific psychology, let us try to explain them in harmony with the
+principles of psychological explanation, and let us discriminate the
+various groups of facts which have led to that easy-going hypothesis of
+the subconscious. Discrimination indeed is needed, as it would be
+impossible to bring the whole manifold of facts under one formula, but
+there is certainly no unification reached by simply putting the same
+label on all the varieties and behaving as if they are all at once
+explained when they are called the functions of the subconscious. Two
+large groups may be separated. Facts are referred to the subconscious
+mind which do not belong to the mind at all, neither to a conscious nor
+to a subconscious one, but which are simply processes in the physical
+organism; and secondly, facts are referred to the subconscious mind
+which go on in the conscious mind but which are abnormally connected.
+Thus the subconscious mental facts are either not mental but
+physiological, or mental but not subconscious.
+
+What does the scientific psychologist really mean by consciousness? We
+must now think back to our discussion of the principles which control
+the fundamental conceptions of modern psychology. We saw clearly that
+the psychology which is a descriptive and explanatory science of mental
+phenomena can by no means have the ambition to be a full interpretation
+of the inner reality. Our inner life, we saw, is not a series of
+phenomena, is not a chain of objects which we are aware of and which we
+therefore can describe, and which finally we can explain. But in its
+living reality, we saw that it is purposive, has a meaning and aim, is
+will and intention, and can thus be understood in its true character,
+not by describing and explaining it but by interpreting it and
+appreciating it. This is the life attitude towards personalities when we
+deal man to man. We do not at first consider ourselves or our fellows as
+mental objects to be explained but always as subjects to be understood
+in their meaning. If we pass from this primary attitude to the attitude
+of the scientific psychologist we gain, as we saw, an artificial
+perspective. We must consider then our inner experience of ourselves
+with all our states as a series of objects made up of elements connected
+by law. Instead of the real things which in our real life are objects of
+will and purpose, tools and means for us, the psychologist knows only
+objects of awareness, objects which have no meaning, but which simply
+exist and which are no longer related to a will but are connected with
+other objects as causes and effects. Now we deal no longer with the
+chairs and tables before us but from a psychological point of view they
+become perceptive ideas of chairs and tables, ideas which are not in the
+room but in our own minds. While these objects of our will and of our
+personality become mere ideas, our will and personality themselves
+become, too, a series of phenomena. Our self is now no longer the
+purposive will but is that group of sensations and ideas which clusters
+about the perception of our organism and its actions; in short, our
+self itself becomes an object of awareness.
+
+Our whole inner experience thus becomes a manifold of objects. Our self
+and the actions of our self are thus alike for the psychologist mere
+phenomena, mere objects which are perceived. Will and emotion, memory
+idea and thought--they all are now passing appearances like the sunshine
+and rain, the flowers and waves. By this transformation the immediate
+will character of real life is given up, but instead of it a system of
+objects is gained, that allows description and explanation. If we are to
+deal at all with inner life not from a purposive but from a causal point
+of view, we are obliged to admit this reconstruction. Without it we
+cannot have any science of the mind, without it we can understand the
+intentions of our neighbor and appreciate the truth and morality of his
+meanings but we cannot causally explain his experiences or determine
+which effects are to be expected. It is thus not an arbitrary
+substitution but a procedure just as necessary and logically obligatory
+as the work of the chemist who substitutes trillions of invisible atoms
+for the glass of water which he drinks. The possibility of causal
+explanation of the successive facts demands this remolding of the outer
+and of the inner world. We have discussed that before and now only have
+to draw the consequences.
+
+Thus for the psychologist the mental world is a system of mental
+objects. To be an object means of course to be object of some subject
+which is aware of it. What else could it mean to exist at all as object
+if not that it is given to some possible subject? But the world of
+objects is twofold; we have not only the mental objects of the
+psychologist but also the physical objects of the naturalist. Science
+must characterize the difference between those two and we pointed once
+before to the only fundamental difference. Physical objects are those
+which are possible objects of awareness for every subject; psychical
+objects are those which are possible objects of awareness for one
+subject only. The tree which I see is as physical tree object for every
+man, it is the same tree which you and I see; my psychical perception of
+the tree is object for one subject only. My perception can never be your
+perception. Our perceptions may agree but each has his own. As to the
+physical objects, we can entirely abstract from such reference to the
+subjects. We say simply: the tree exists or is part of nature; and only
+the philosopher is aware that we silently mean by it that it exists for
+every subject and that it is therefore not necessary to refer to any
+particular subject. But the perception of the tree which is either your
+idea or my idea evidently gets its existence only if it is referred and
+attached to a particular subject which is aware of it. Such subject of
+awareness is that which the psychologist calls consciousness and all the
+ideas and volitions and emotions and sensations and images which make up
+the mental life are then contents of the consciousness or objects of the
+consciousness. To have psychical existence at all means thus to be
+object of awareness for a consciousness. Something psychical which
+simply exists but is not object of consciousness is therefore an inner
+contradiction. Consciousness is the presupposition for the existence of
+the psychical objects. Psychical objects which enjoy their existence
+below consciousness are thus as impossible as a wooden piece of iron.
+
+If consciousness is nothing but the subject of awareness for the
+individual objects, we see at once certain consequences which are too
+often forgotten in the popular, haphazard psychology. In the scientific
+system of psychology, consciousness has for instance nothing whatever to
+perform, that is, consciousness itself is in no way active. The active
+personality of real life has been left behind and has itself been
+transformed into that self which is merely content of consciousness. The
+person who acts and performs the deeds of our life is then only a
+central content of our consciousness which is crystallized about the
+idea of our organism. It has thus become one of the contents of which
+consciousness itself is passively aware. Consciousness is an inactive
+spectator for the procession of the contents. Thus consciousness itself
+cannot change anything in the content nor can it connect the contents.
+No other function is left to consciousness but merely that of awareness.
+Every change and every fusion and every process must be explained
+through the relations of the various contents to one another.
+Consciousness has, therefore, not the power to prefer the one idea or to
+reject the other, to reënforce the one sensation and to inhibit the
+other. From a psychological point of view, we have seen before that
+even attention does not mean an activity of consciousness but a change
+in the content of consciousness. Certain sensations become more
+impressive, more clear, and more vivid, and others fade away, become
+indistinct and disappear, but all that goes on in the content of
+consciousness and the spectator, consciousness itself, simply becomes
+aware of those changes. Consciousness has also in itself no special
+span, ideas appear or disappear not because consciousness expands or
+narrows itself but because the causal conditions awaken or suppress the
+various contents.
+
+Consciousness has in itself no limit; all organization belongs to the
+content. Whatever psychical states are attributed to one organism belong
+thus to its consciousness but all the connections are entirely
+connections of the content. We, therefore, have not even the right to
+say that consciousness, as such, has unity. Unity too belongs to the
+organization of the content. One part of the content hangs together with
+the other parts but consciousness is only the constant condition for
+their existence. Where there is no unity, there it cannot have any
+meaning to speak of the double or triple existence. There may be a
+disconnection in the various parts of the content and a dissociation by
+which the normal ties between the various contents may be broken but
+consciousness itself cannot fall asunder. Thus consciousness cannot have
+any different degrees. The same consciousness experiences the distinct
+clear content and the vague fading confused content. Thus also
+consciousness can never be aware of itself and the word
+self-consciousness is easily misleading. In psychology, it can never
+mean that the consciousness which is a subject of all experience is at
+the same time object of any experience. Its whole meaning lies in its
+being the passive spectator. That of which consciousness becomes aware
+in self-consciousness is the idea of the personality, which is certainly
+a content. The personality, the actor of our actions, is thus never
+anything but an object in psychology, and consciousness never anything
+but a subject. Consciousness itself is thus in no way altered when the
+idea of the personality is changing. Only if all this is carelessly
+confused, if consciousness is sometimes treated as meaning subject of
+consciousness, and at another time as meaning the content of
+consciousness, and again at another time the unified organization of the
+content, and at still another time the connection of the content with
+the personality, and if finally all that is confused with the purposive
+reality of the immediate personal life--only then, do we find the way
+open to those tempting theories of the subconscious personality.
+
+       *       *       *       *       *
+
+If, instead, we stick to the scientific view, we find the following
+facts. First, we have everywhere with us the fact that the earlier
+experiences may again enter into consciousness as memory images or as
+imaginative ideas, that is, in the order in which they are experienced a
+long time before or in a new order, either with a feeling of
+acquaintance or without it. Certainly at no time is the millionth part
+of what we may be able to reproduce present in our consciousness. Where
+are those words of the language, those faces of our friends, those
+landscapes, and those thoughts; where have they lingered in the time of
+their seclusion? Scientific psychology has no right to propose any other
+theory as explanation but that no mental states at all remain and that
+all which remained was the disposition of physiological centers. When I
+coupled the impression of a man with the sound of his name, a certain
+excitement of my visual centers occurred together with the excitement of
+my acoustical centers; the connecting paths became paths of least
+resistance, and any subsequent excitement of the one cell group now
+flows over into the other. It is the duty of physiology to elaborate
+such a clumsy scheme and to make us understand in detail how those
+processes in the neurons can occur and it is not the duty of psychology
+to develop detailed physiological hypotheses. Psychology has to be
+satisfied with the fact that all the requirements of the case can be
+furnished by principle through physiological explanation. Least of all
+ought we to be discouraged by the mere complexity of the process. If a
+simple sound and a simple color sensation, or a simple taste and simple
+smell sensation, can associate themselves through mere nervous
+conditions of the brain, then there is nothing changed by going over to
+more and more complex contents of consciousness. We may substitute a
+whole landscape for a color patch or the memory of a book for a word,
+but we do not reach by that a point where the physiological principle of
+explanation, once admitted, begins to lose its value. Complexity is
+certainly in good harmony with the bewildering manifoldness of those
+thousands of millions of possible connections between the brain cells.
+
+Every experience leaves the brain altered. The nerve fibers and the
+cells have gone into new stages of disposition for certain excitements.
+This disposition may be slowly lost. In that case the earlier experience
+cannot be reproduced; we have forgotten it. But as long as the
+disposition lasts--it is quite indifferent whether we conceive it more
+in terms of chemical changes or physical variations, as processes in the
+nerve cells or between the nerve cells--the physiological change alone
+is responsible for the awakening of the memory idea under favoring
+associative conditions. Of course, someone might reply: can we not fancy
+that there remains on the psychical side also a disposition? Each idea
+which we have experienced may have left a psychical trace which alone
+may make it possible that the idea may come back to us again. But what
+is really meant and what is gained by such a hypothesis?
+
+First, do not let us forget that such a proposition could only have one
+possible end in view, namely, the explanation of the reappearance of
+memories. But when we discussed the basis of physiological psychology,
+we convinced ourselves that mental facts as such are not causally
+connected anyhow. Our real inner life has its internal connections,
+connections of will and purpose, but as soon as we have taken that great
+psychological step and look on inner life as merely psychological
+objects, then the material is connected only through the underlying
+physiological processes and we can never explain causally the appearance
+of an idea through the preceding existence of another idea. We may
+expect one after the other, but we have no insight into the mechanism
+which makes the second follow after the first. Such insight into
+necessary connection we find only on the physical side, and we saw that
+just here lies the starting point for the modern view of physiological
+psychology. If that holds true for the connections between idea and
+idea, of course it holds true in the same way for the connection between
+mental disposition and the corresponding memory. We can understand
+causally that a chemical disposition in the nerve fibers brings about a
+chemical excitement in those neurons, but how a mental disposition is to
+create mental experience we could not understand; and to explain it
+casually, we should need again a reference to the underlying
+physiological processes. The hypothesis of mental dispositions would
+thus be an entirely superfluous addition by which we transcend the real
+experience without gaining anything for the explanation.
+
+Secondly, if we really needed a mental disposition for each memory
+picture, in addition to the physiological disposition of the brain
+cells, can we overlook that exactly the same thing would then be
+necessary for every perception also? The outer impression produces,
+perhaps through eye or ear or skin, an excitement of the brain cell and
+this excitement is accompanied by a sensation; and no one fancies that
+the appearance of this sensation is dependent upon a special disposition
+for it on the mental side. No one fancies it, because it is evident that
+such a hypothesis again would be entirely useless. If every new
+perception needed such a special mental disposition, we should have to
+presuppose dispositions for everything which possibly can come into our
+surroundings. Every smell, every word, every face which comes anew to us
+would need its special ready-made disposition. In other words, our mind
+would contain the disposition for every possible idea and that would
+mean that these dispositions would be in no way helps for explanation.
+If the disposition exists for everything, no one particular thing can be
+explained by the existence of that disposition. Again we should have to
+rely entirely upon the physiological brain excitement for explaining
+that this word or that word is perceived by our mind. But if the brain
+excitement alone is sufficient to explain the new perception in the
+mind, then no reason can be found why the renewed brain excitement would
+not be sufficient to renew the mental experience. Thus there is nowhere
+room for mental dispositions below the level of consciousness.
+
+Thirdly, what could we really mean by such mental dispositions? A
+physiological disposition for a physiological action is certainly not
+the action itself. The finger movement in piano playing finds only a
+disposition in my brain centers, in case I am trained; the movement
+itself does not last. But the disposition is at least itself a change
+in the physical world. The molecules are somehow differently placed, the
+disposition has thus as much objective existence as the resulting
+movement. Nothing at all similar can be imagined in the sphere of
+psychical contents. Such mental dispositions would have to exist
+entirely outside the world of concrete mental experiences and, if we
+scrutinize carefully, we soon discover that such theories are only
+lingering reminiscences of the purposive view of life, and do not fit at
+all into the causal one. If we take the purposive attitude, then every
+idea and every will contains indeed all that its meaning involves and
+everything which we can logically develop out of it is by intention
+contained in it. All mathematical calculations are then contained in the
+thought of figures and forms, but they are contained there only by
+intention, they are logically inclosed; psychologically the
+consciousness of the figures and forms does not contain any disposition
+for the development of mathematical systems. We indeed have no right to
+throw into a psychological subconsciousness all that which is not
+present but involved by intention in the ideas and volitions of our
+purposive life.
+
+If thus the memory idea is linked with the past experience entirely by
+the lasting physiological change in the brain, we have no reason to
+alter the principle, when we meet the memory processes of the hypnotized
+person or the hysteric. It is true their memory may bring to light
+earlier experiences which are entirely forgotten by the conscious
+personality, but that ought to mean, of course, only that nerve paths
+have become accessible in which the propagation of the excitement was
+blocked up before. That does not bring us nearer to the demand for a
+subconscious mental memory. The threshold of excitability changes under
+most various conditions. Cells which respond easily in certain states
+may need the strongest stimulation in others. The brain cells which are
+too easily excited perhaps in maniacal exultation would respond too
+slowly in a melancholic depression. Hypnotism, too, by closing the
+opposite channels and opening wide the channels for the suggested
+discharge, may stir up excitements for which the disposition may have
+lingered since the days of childhood and yet which would not have been
+excited by the normal play of the neurons. Quite secondary remains the
+question of how these reproduced images finally appear in consciousness,
+that is, whether they appear with reference to earlier happenings and
+are thus felt as remembrances, or whether they enter as independent
+imaginations, or whether they finally, under special conditions, take
+the character of real, new perceptions. The latter case is well-known in
+crystal-gazing, where long-forgotten memory ideas project themselves
+into the visual field like hallucinations. But for the theory of the
+subconscious, even these uncanny crystal visions do not mean more than
+the simplest awakening of the experience of a landscape image of
+yesterday.
+
+We turn to a second group of facts and again we have no fault to find
+with the observation of the facts, even of the most surprising and
+exceptional ones. Our objection refers to the interpretation of them.
+This second group contains the active results of such physiological
+nervous dispositions. In the first group, the dispositions come in
+question only as conditions for a new excitement which was accompanied
+by mental experience. In this second group, the dispositions are causes
+for other physiological processes which either lead to actions or to
+influences on other mental processes. The dispositions are here working
+like the setting of switches which turn the nervous process into special
+tracks. In the simple cases, of course no one doubts that a purely
+physiological basis is involved. The decapitated frog rubs its skin
+where it is touched with a drop of muriatic acid in a way which is
+ordinarily referred to the trained apparatus of his spinal cord, as no
+brain is left, and the usefulness of the action and its adjustment is
+very well understood as the result of the connecting paths in the
+nervous system.
+
+From such simple adjustment of reactions of the spinal cord, we come
+step by step to the more complex activities of the subcortical brain
+centers, and finally to those which are evidently only short-cuts of the
+higher brain processes. That we react at every change of position with
+the right movements to keep our bodily balance, that we walk without
+thinking of our steps, that we speak without giving conscious impulse
+for the various speech movements, that we write without being aware of
+the motor activity which we had to learn slowly, that we play the piano
+without thinking of the special impulses of the hands, that we select
+the words of a hasty speech, if we have its aim in mind, without
+consciously selecting the appropriate words--all that is by continuous
+transitions connected with those simplest automatic reactions. And from
+here again, we are led over gradually perhaps to the automatic writings
+of the hysteric who writes complex messages without having any idea of
+their content in consciousness. It is in such cases certainly a symptom
+of disease that the activity of these lower brain centers can go over
+into the motor impulse of writing without producing secondary effects in
+the highest conscious brain centers; it is hysterical. But that the
+message of the pencil can be brought about by such operation of lower
+brain centers, or at least with imperfect coöperation of the higher
+brain centers, is certainly entirely within the limits of the same
+physiological explanation.
+
+On the other hand, nothing is changed in the theoretic principles of the
+case if the effect of these automatic processes in the nervous system is
+not an external muscle action at first, but an influence on other brain
+centers which may furnish the consciousness with new contents. We try to
+remember a name, that is, a large number of neuron processes are setting
+in which normally lead to the excitement of that particular process
+which furnishes us the memory image of the name. But those brain cells
+may not respond, the channels may be blocked somehow or the excitability
+of those cells may be lowered. Now new excitements engage our
+psychophysical system. We are thinking of other problems. In the
+meantime, by the new equilibrium in the brain the blockade in these
+first paths may slowly disappear or the threshold of excitability may be
+changed. The physiological excitement may now be carried effectively
+into those tracts. The cell response sets in and suddenly the name comes
+to our mind. This purely physiological operation in our brain paths must
+thus have exactly the same result which it would have had, if more parts
+of the process had been accompanied by conscious experience. And again
+from mere remembering a forgotten name, we come by slow steps to the
+solution of a problem, to the invention, and finally to the creation of
+the genius.
+
+Superficiality of thought is easily inclined to object to such a
+physiological interpretation and perhaps to denounce it pathetically as
+a crude materialism which lowers the dignity of mental work. Nothing
+shows more clearly the confusion between a purposive and causal view of
+the mind. In the purposive view of our real life, only our will and our
+personality have a meaning and can be related to the ideas and higher
+aims. Nature is there nothing but the dead material which is the tool of
+our will and which has to be mastered by the personality. In that world
+alone lie our duty and our morality. But as soon as we have gone over to
+the causal aspect of our life and have taken the point of view of the
+psychologist, making our inner life a series of contents of
+consciousness, of psychical phenomena, we have transformed our inner
+experience in such a way that it has become itself nothing but nature.
+
+It is mental nature, nature of psychical stuff, but each part of it is
+nothing but a mental element, a mental atom without any meaning and
+without any value; nothing but a link in the chain, nothing but a factor
+in the explanation of the whole, nothing to which any ethical or
+æsthetic or logical or religious significance can any longer be
+attached. The psychical sensations and the physical atoms are equally
+material for naturalistic explanation. To understand causally a certain
+effect, for instance the creation of a work of art, of a discovery or a
+thought or a deed as the product of psychical processes, is thus in no
+way more dignified or more valuable than to understand it as the product
+of physiological brain processes. The one is not more dignified than the
+other because both alike have nothing whatever to do with dignity. Both
+alike are the necessary results of the foregoing processes, and to
+attach a kind of sentimental preference to the explanation through
+conscious factors is nothing but a confused reminiscence again of the
+entirely different purposive view of life. And surely nothing is gained
+for the higher values of life if this confusion sets in, because if the
+popular mind becomes unable to discriminate between the secondary,
+causal, artificial aspect of science and the primary, purposive aspect
+of life, the opposite effect lies still nearer: the values of the real
+life suffer and are crowded out by the knowledge of the scientific
+facts. Man's moral freedom is then wrongly brought in question, as soon
+as it is learned that every action is the product of brain processes.
+Life and science alike will gain the more, the more clearly the
+purposive and the causal point of view are separated and the more it is
+understood that this causal aspect itself is demanded by certain
+purposes of life. The oratory of those who denounce the physiological
+theories as lacking idealism in reality undermines true moral
+philosophy. There is no idealism which can really flourish merely by
+ignoring the progress of science and confusing the issues. The true
+values of the higher life cannot be safely protected by that thoughtless
+idealism which draws its life from vagueness and which therefore has to
+be afraid of every new discovery in scientific psychology. Our real
+ideals do not lie at all in the sphere in which the problem of causally
+explaining the psychological phenomena arises.
+
+Our conscious experiences are thus indeed not only here and there, but
+usually the products of chains of processes which go on entirely on the
+physiological side. We have no reason at all to seek for those preceding
+actions any mental accompaniment outside of consciousness, that means,
+any subconscious mental states. Then, of course, this physiological
+explanation also covers entirely those after-effects of earlier
+experiences, especially emotional experiences, which the physician
+nowadays likes to call subconscious "complexes." We shall see what an
+important rôle belongs to these facts, especially in the treatment of
+hysteria and psychasthenia, but the interpretation again ought to avoid
+all playing with the conception of the subconscious. Emotional
+experiences may produce there some strong stable dispositions in the
+brain system which become mischievous in reënforcing or inhibiting
+certain thoughts and actions without awakening directly conscious
+experiences. The whole psychological switch system may have been brought
+into disorder by such abnormal setting of certain parts, but the
+connection of each resulting accident with the primary emotional
+disturbances does not contradict the fact that all the causes lie
+entirely in disturbances of the central paths. It is a change in the
+neurons and their connections. To discover it we may have to go back to
+early conscious experiences, but in the process itself there is no
+mental factor, and therefore no subconscious emotion is responsible for
+the mischief carried out.
+
+Both groups of facts which we have studied so far, have dealt with
+processes which were indeed not conscious but which we had no right to
+call subconscious inasmuch as they contained no mental process at all
+but only physiological dispositions and actions. We turn finally to the
+other smaller and more abnormal group of so-called subconscious facts in
+which the facts are mental indeed and not only physiological, but not at
+all outside of consciousness and thus again not subconscious. A
+conscious fact may easily suggest the appeal to subconscious theories to
+those who have accepted such theories for other reasons. There are, for
+instance, plenty of mental experiences which we do not notice or which
+we do not recognize. Yet if we find later that they must have influenced
+our mind, we are easily inclined to refer them to subconscious activity.
+But it is evident that to be content of consciousness means not at all
+necessarily to be object of attention or object of recognition.
+Awareness does not involve interest. If I hear a musical sound, I may
+not recognize at all the overtones which are contained in it. As soon as
+I take resonators and by them reënforce the loudness of those overtones,
+they become vivid for me and I can now notice them well even when the
+resonators are removed. I surely was aware of them, that is, had them in
+consciousness all the time but there were no contrast feelings and no
+associations in consciousness which gave them sufficient clearness to
+attract attention.
+
+In this way I may be again led by gradual stages to more and more
+complex experiences. I may overlook and yet include within my content of
+consciousness most various parts of my surroundings; and yet the
+neglected is not less in consciousness itself than the attended. Much
+that figures in literature as subconscious means indeed nothing else but
+the unattended. But it belongs to the elements of psychological analysis
+to recognize that the full content of consciousness is always larger
+than the narrow field of attention. This narrow field on the other hand
+has certainly no sharp demarcation line. There is a steady shading off
+from the most vivid to the least vivid. We cannot grasp those least
+vivid contents of consciousness, we cannot fixate them as such, because
+as soon as we try to hold them, they move from the periphery of the
+content into its center and become themselves vivid and clear. But as we
+are surely aware of different degrees of clearness and vividness in our
+central mass of contents, we have no difficulty in acknowledging the
+existence of still lower degrees of vividness in those elements which
+are blending and fusing into a general background of conscious
+experiences. Nothing stands out there, nothing can be discriminated in
+its detail. That background is not even made up of whole ideas and whole
+memories and whole emotions and feelings and judgments and volitions,
+but of loose fragments; half ideas and quarter ideas, atoms of feelings
+and incipient impulses and bits of memory images are always mixed in
+that half-dark background. And yet it is by principle not less in
+consciousness, and consciousness itself is not different for these
+contents. It is not half-clear consciousness, not a lower degree of
+awareness, only the objects of awareness are crumbled and fading.
+
+Whether these background objects really exist can only be made out by
+studying carefully the changes which result under different conditions,
+the influences which those loose parts have on the structure of the
+whole, and the effect of their complete disappearance. I may never
+really notice a little thing in my room and yet may be aware that it has
+been taken away. The visual image of it was an element of my mental
+background, when I was sitting at my desk, but it never before moved to
+the center of my conscious content. But this center itself is also
+constantly changing. Sometimes the one, sometimes the other idea may
+enter into it, but in this alternation that which is not in the focus
+either remains in consciousness unattended or when it disappears from it
+it loses its mental character altogether. If I attend a tiresome lecture
+while my mind is engaged with a practical problem of my own life, there
+may be a steady rivalry between the words which come with the force of
+outer stimulus to my brain and make me listen and my inner difficulties
+which claim my attention. I listen for a while, and then suddenly,
+without noticing it, my own thoughts may have taken the center of the
+stage and again without sudden interruption a word may catch my
+attention. While I was thinking of my own problem the sounds of the
+lecturer were really outside of my field of attention, yet some remark
+now pushes itself again into the center. That does not mean that a
+subconscious mind is listening while my lucid mind was thinking, but it
+does mean that those words were unattended and remained in the periphery
+of the field of consciousness. But when some of the sentences stirred up
+in that peripheral field some important associations, they were strong
+enough to produce a new motor reaction by which the mental equilibrium
+became changed again and by which the lecturer overwhelmed my private
+thoughts. Yet even this state of mind, without any break, can go over
+into an absolutely physiological process. I may for a while really
+inhibit the lecturer's voice completely and remain in the thoughts of my
+own imagination. After a minute or two, the resistance against the
+acoustical stimulus will certainly be broken and the sound will again
+enter into my consciousness, but in that interval there was no
+subconscious and not even any unattended mental function; there was no
+mental process at all. The sound reached my brain but as the motor
+setting was adverse, the sounds did not bring about that highest act of
+physiological transmission which is accompanied by mental contents. Thus
+it became entirely physiological. Yet of course every word reached my
+brain and left traces there. If I were hypnotized after the lecture and
+thus the threshold for the real awakening of brain excitements lowered,
+it might not be impossible that some of the thoughts of the lecturer
+which did not enter my consciousness at all, are now afterwards in the
+hypnotic state stirred up in me. Yet even that would not indicate that
+they had become mental and thus subconscious at the time of the lecture.
+
+The so-called subconscious, which in reality is fully in consciousness
+but only unnoticed, easily shades over into that unconscious which is
+also in consciousness but dissociated from the idea of the own
+personality and thus somewhat split off from the interconnected mass of
+conscious contents. Wherever we meet such phenomena, we are in the field
+of the abnormal. The normal mental life is characterized by the
+connectedness of the contents. Yet even that holds true, of course, only
+if we think of those mental states which exist at one and the same
+instant in consciousness. As soon as we consider the succession of
+mental events, we cannot doubt that even normal experience shows breaks,
+lapses, and complete annihilation of that which a moment before was a
+real content in our consciousness. We may have looked at our watch and
+certainly had in glancing at the dial a conscious impression, but in the
+next moment we no longer know how late it is. The impression did not
+connect itself with our continuous personal experience, that is, with
+that chief group of our conscious contents which we associate with the
+perception of our personality. Under abnormal conditions of the brain,
+larger and larger parts of the completely conscious experience may thus
+be cut off from the continuity of conscious life. But to be in
+consciousness, and therefore to be not-subconscious, does not mean to be
+through memory ties connected with the idea of our own personality.
+
+The somnanbulist, for instance, may get up at night time and write a
+letter, then go to bed again and not know anything of the event when he
+awakes in the morning. We have no reason to claim that he had no
+knowledge of the letter in his consciousness when he wrote it. It is
+exactly the same consciousness from a psychological standpoint as the
+one with which he wakes up. Only that special content has in an abnormal
+way entirely disappeared, has not left a possibility of awakening a
+memory image, and the action of the personality in writing has thus
+become separated and cut off from the connected experiences of the man.
+But while the nocturnal episode may be entirely forgotten, it was not
+less in consciousness for the time being, than if a normal man should
+leave his bed hastily to write a letter. Moreover under abnormal
+conditions, as for instance in severe hysteric cases, those dissociated
+contents may form large clusters of mental experiences in the midst of
+which a new idea of the own personality may develop. Considering that
+through such disconnection many channels of discharge are blocked, while
+others are abnormally opened, it seems only natural that the idea of the
+own acting personality becomes greatly changed. Thus we have in such an
+episode a new second personality which may be strikingly different in
+its behavior and in its power, in its memories and in its desires, from
+the continuous normal one, and this secondary personality may now
+develop its own continuity and may arise under special conditions in
+attacks which are connected among one another by their own memory bonds.
+
+The two personalities may even alternate from day to day and the normal
+one may itself become pathologically altered. In that case the two
+alternating personalities would both be different from the original one.
+But again we have even in such most complex and exceptional cases only
+an alternation in the contents, not an alternation in the consciousness
+itself. Different ideas of the own personality with different
+associations and impulses follow each other in consciousness and the
+abnormality of the situation lies in the lack of memory connections and
+of mutual influences, but consciousness remains the same throughout. It
+remains the same, just as we do not change consciousness if we feel
+ourselves in one hour as members of our family, in the next hour as
+professional workers in our office, again later as social personalities
+at a party or as citizens at a political meeting or as æsthetic
+subjects at the theater. Each time we are to a high degree a different
+personality, the idea of our self is each time determined by different
+groups of associations, memories, emotions, and impulses. The
+differentiation is to be considered as normal only because broad memory
+bridges lead over from one to the other. The connection of the various
+contents with the various ideas of the own personality constitutes thus
+in no way a break of consciousness itself and relegates no one content
+into a subconscious sphere.
+
+Finally the same holds true, if the idea of the personality as content
+of consciousness in the patient is split into two simultaneous groups,
+of which each one is furnished with its own associations. Yet the
+interpretation here becomes extremely difficult and arbitrary. Take the
+case that a patient in severe hysteria at our request writes down the
+history of her life. We should not hesitate to say that she is doing it
+consciously but now we begin to talk with her and slowly the
+conversation takes her attention while her pencil is continuing to write
+down the connected story of her youth. Again the conversation by itself
+gives the impression of completely conscious behavior. As both functions
+go on at the same time, the person who converses does not know what the
+person who writes is writing, and the writer is uninfluenced by the
+conversation. Various interpretations are possible. Indeed we might
+think that by such double setting in the pathological brain two
+independent groups in the content of consciousness are formed, each one
+fully in consciousness and yet both without any mutual influence and
+thus without mutual knowledge. In the light of such interpretation, it
+has been correctly proposed to speak of coconscious processes, rather
+than subconscious. Or we may interpret it more in harmony with the
+ordinary automatic writing or with other merely physiological reactions.
+Then we should suppose that as soon as the conversation sets in, the
+brain centers which control the writing movement work through channels
+in which no mental factors are involved. One of the two characteristic
+reaction systems would then be merely physiological. We saw before that
+the complexity of the process is no argument against the strictly
+physiological character of the event. That various activities can
+coexist in such a way that one of them may at any time slide down from
+the conscious centers to the merely physical ones, we all know by daily
+experience. We may go home through the streets of the busy town engaged
+with our thoughts. For a while the idea of our way and of the sidewalk
+is in our consciousness, when suddenly we reach our house and notice
+that for a long while we have no longer had any thought at all of the
+way. We were absorbed by our problems, and the motor activity of walking
+towards our goal was going on entirely in the physiological sphere. But
+whether we prefer the physiological account or insist on the coconscious
+phenomena, in either case is there any chance for the subconscious to
+slip in? That a content of consciousness is to a high degree dissociated
+or that the idea of the personality is split off is certainly a symptom
+of pathological disturbance, but it has nothing to do with the
+constituting of two different kinds of consciousness or with breaking
+the continuous sameness of consciousness itself. The most exceptional
+and most uncanny occurrences of the hospital teach after all the same
+which our daily experience ought to teach us: there is no
+subconsciousness.
+
+
+
+
+PART II
+
+THE PRACTICAL WORK OF PSYCHOTHERAPY
+
+
+
+
+VII
+
+THE FIELD OF PSYCHOTHERAPY
+
+
+We have discussed the psychological tools with which the psychotherapist
+has to work but we have not spoken as yet of psychotherapy itself. All
+that we have studied has been by way of preparation; and yet the right
+preparation is almost the most important factor for the right kind of
+work. To rush into psychotherapy with hastily gathered conceptions of
+mental life may be sometimes successful for the moment, but must always
+be ultimately dangerous. It is often most surprising what a haphazard
+kind of psychology is accepted as a basis for psychotherapy even by
+scientifically schooled physicians who would never believe that common
+sense would be sufficient to settle the problems of anatomy and
+physiology; as soon as the mind is in question, no serious study seems
+needed. Can we be surprised then that in the amateur medicine of the
+country within and without the church any fanciful idea of mental life
+may flourish? If we are to recognize the rights and wrongs of
+psychotherapy in a scientific spirit, a sober analysis of the mental
+facts involved was indeed at the very first most essential. Now we can
+easily draw the conclusions from our findings.
+
+We recognized from the start the fundamental difference between two
+different attitudes which we can take towards the inner life of any
+personality, the purposive view and the causal. We recognized the sphere
+to which each belongs and we saw that all medical treatment demands the
+causal view, thus dealing with inner life as part of the causal chain of
+events. Each inner experience became therefore a series of so-called
+contents of consciousness. These contents can be described and must be
+analyzed into their elements. The basis of psychotherapy is therefore an
+analytic psychology which conceives the inner experience as a
+combination of psychical elements.
+
+But the final aim was the causal connection. The appearance and
+disappearance of those millions of elements and their connection had to
+be explained. We recognized that such an explanation of the contents of
+consciousness was possible only through the connections between the
+accompanying brain processes. Every psychical change had to be conceived
+as parallel to a physiological change. The psychology which is to be the
+basis of psychotherapy had to be therefore a physiological psychology.
+
+We recognized that these psychophysiological processes were processes of
+transmission between impressions and expressions, that is, between
+incoming nervous currents and outgoing nervous currents, between stimuli
+and reactions. Thus we have no central process which is not influenced
+by the surroundings and which is not at the same time the starting point
+of an action. We have normal health of the personality as long as there
+is a complete equilibrium in the functions of the organism which adjusts
+the activities to the surroundings. Every abnormality is a disturbance
+of this equilibrium. A psychology which is the basis of psychotherapy
+thus conceives every mental process in relation to both the ideas and
+the actions; it avoids all one-sidedness by which the mind is cut off
+either from its resources or from its effects. The relations to the
+impressions are usually the less neglected: and we must the more
+emphasize the fact that the psychology needed for psychotherapy knows no
+mental fact which does not start an action and that every change in the
+system of actions involves a change in the central experience. Wherever
+this equilibrium of adjusted functions is disturbed, some therapy of the
+physician has to set in: whether psychotherapy is in order depends upon
+the special conditions.
+
+We have recognized that there are no mental facts outside of those which
+are in consciousness and that from a psychological point of view
+consciousness itself does not have different degrees and different
+levels, that all varieties of experience refer thus only to the special
+content and its organization. There is thus no subconscious. On the
+other hand, we saw that there is no conscious experience which is not
+based on a bodily brain process. By these two fundamental facts of
+scientific psychology, every possible psychotherapy gets from the start
+its clear middle way between two extreme views which are popular today.
+The one school nowadays lives from the contrast between consciousness
+and subconsciousness and makes all psychotherapy work with and through
+and in the subconscious. The other school creates a complete antithesis
+between mind and body and makes psychotherapy a kind of triumph of the
+mind over the body. Practically every popular treatise on
+psychotherapeutic subjects in recent years belongs to the one or the
+other group; and yet both are fundamentally wrong. And while, of course,
+this mistake is one of theoretical interpretation, it evidently has its
+practical consequences. The fantastic position allowed to a subconscious
+mind easily gives to the doctrine a religious or even a mystical turn
+and the artificial separation between the energies of the mind and those
+of the body leads easily to a moral sermon. Whether this amalgamation of
+medicine with religion or with morality may not be finally dangerous to
+true morality and true religion is a question which will interest us
+much later. Here we only have to ask whether it is not harmful to the
+interests of the patient and thus to the rights of medicine, and indeed
+that must be evident here at the very threshold. Both schools must have
+the tendency to extend psychotherapy at the expense of bodily therapy
+and to narrow down psychotherapy itself to a therapy by appeals which
+in the one case are suggestions to the subconscious and in the other
+case persuasions and encouragements to the conscious will. As soon as we
+have overcome the prejudices of those two rival schools and have
+recognized that both are wrong, that there is no subconscious and that
+there is no psychological fact which is not at the same time a
+physiological one, we see at once that this common procedure of both
+schools is unjustified and dangerous. Mental therapy and physical
+therapy ought to be most intimately connected parts of the same
+therapeutic effort and mental therapy includes by far more than mere
+suggestions and appeals. All that involves of course that its systematic
+application belongs in the hands of the well-trained physician and of
+nobody else, but on the other hand, it involves that every physician
+ought to be well schooled in psychology.
+
+As soon as a disturbance to be cured is considered as a lack of
+equilibrium in psychophysical functions, every mental influence, every
+suggestion and appeal becomes itself an excitement or an inhibition of
+nerve cells. The sharp demarcation line between a psychical agency and a
+physical one disappears altogether; the spoken word is then considered
+as physical airwaves which stimulate certain brain centers and in the
+given paths this stimulation is carried to hundreds of thousands of
+neurons. The protracted warm bath or the cold douche influences, too,
+large brain parts by changing the blood circulation which controls the
+activity of those neurons; or the bromides absorbed in the digestive
+apparatus, or the morphine injected, also reach the neurons and again
+have a different kind of influence on them, and the electric current may
+stimulate the nervous system in still a different way. It may be, and
+under many conditions certainly is, essential to influence the brain
+cells just in that particular way which results from the spoken word,
+but there too the causal influence remains a function of the physical
+effect and thus by principle there is no sharp separation from other
+physical means. Thus to believe in psychotherapy ought never to mean
+that we have a right to make light of the other means which, as
+experience shows, may help towards the treatment of disturbances in the
+central equilibrium. Suggestions and bromides together may secure an
+effect which neither of them alone will bring about. It is most
+unfortunate that not without some guilt on the part of the physicians
+themselves, the large public has begun to believe that orthodox
+psychotherapy has to mean a rejection of drugs and a contempt for the
+doctors who prescribe them.
+
+Of course a discussion of psychotherapy cannot enter into the study of
+these physical agencies of treatment, but at the threshold, we have to
+insist that there exists no opposition between psychophysiological and
+physiological means of influencing the brain. It may be true that drugs
+and baths and electricity have no influence on the subconscious, but the
+trouble is not that the drugs are inefficient but that they cannot
+influence what does not exist. In the same way disappears now that new
+boundary line for psychotherapy which wants to limit it to mere
+suggestion and appeal. If psychotherapy employs all the means by which
+we can influence mental states in the interest of the health of the
+personality, we have no reason to confine it either to a persuasion of
+the subconscious through suggestion and hypnotism or a persuasion of the
+conscious, in which it works as a moral appeal. Suggestion and hypnotism
+certainly must play a large part in psychotherapy and that part does not
+become smaller by the fact that we reject the subconscious
+interpretation of them and consider them entirely as psychophysical
+processes. And in the same way undoubtedly we have to acknowledge the
+psychophysiological effect of persuasion and of the appeals to the
+conscious intellect and will. But for us as psychotherapists all those
+factors have no moral value but only a therapeutic one, and thus stand
+in line with any other influence that may help, even though from a
+purposive point of view it stands on a much lower level. A mere mental
+distraction by enjoyment and play and sport, an æsthetic influence
+through art, a mere stimulus to automatic imitation, an enforced mental
+rest, an involuntary discharge of suppressed ideas, and many similar
+schemes and even tricks of the mental physician belong with the same
+right to psychotherapy.
+
+It is really doubtful whether the moral and religious appeals are always
+helpful and not sometimes or often even dangerous for the health of the
+individual; and it is not doubtful that morally and religiously
+indifferent mental influences are often of the highest curative value.
+The more we abstract from everything which suggests either the mysticism
+of the subconscious or the moral issues of a mind which is independent
+of the body, the more we shall be able to answer the question as to the
+means by which health can be restored. This question is neither a moral
+nor a philosophical one but strictly one of experience. In this
+connection, we must remember that we also have had to give up the
+artificial demarcation line between organic and functional diseases. We
+recognized that every so-called functional disease has its organic basis
+too, and that it is entirely secondary whether we are able to find
+visible traces of the organic disturbance. We had to acknowledge, to be
+sure, the difference between reparable and irreparable disturbances, but
+such grouping expresses only in another form the fact that experience
+alone can show whether the methods of treatment which we know so far
+will be successful or not. Not a few disturbances of the equilibrium
+which appeared irreparable to an earlier time yield to the treatment of
+to-day, and no one can determine whether much which appears irreparable
+today may not be accessible either to psychotherapeutic or to physical
+therapeutic means to-morrow. If we were carelessly to identify the
+reparable troubles with those which we cannot recognize visibly, we
+should be at a loss to understand why, for instance, many forms of
+insanity are entirely beyond our psychotherapeutic influences. On the
+other hand, every physician who uses psychotherapeutic means is
+surprised to see the effective bodily readjustment where serious
+disturbances perhaps of the circulatory system or the digestive system
+existed. What the methods can do and what they cannot do must simply be
+left to experience, but of course to an experience which is eager to
+expand itself by ever new experimental curative efforts.
+
+From this point of view we can see clearly the general division of the
+whole field of possible psychotherapy. Psychotherapy influences
+psychophysical states in the interest of health. There are only two
+possibilities open: either the disturbance is in the psychophysical
+system itself or it is outside of it, that is in the other parts of the
+body which are somehow under the influence of the mind. In the first
+case when the disturbance occurs in the mind-brain system itself, we
+ought to separate two large groups, first those cases in which the
+system itself is normal and the disturbance comes from without, and
+second those in which the constitution of the system itself was abnormal
+and led to disturbances under conditions in which a normal system would
+not have suffered. We have to consider both groups somewhat more in
+detail, as each again allows a large variety of cases.
+
+Thus we have before us, first the normal mind-brain system into which a
+disturbance breaks, injuring more or less severely and for a longer or
+shorter time the equilibrium of the psychophysical functions. Here
+belong any bodily processes which produce pain or any bodily defects
+which produce blanks in the content of consciousness; the pain of
+sciatica or of rheumatism, or the defect of the blind or of the deaf,
+certainly interferes in a disturbing way with the perfect harmony of
+psychophysical activities. But here also belongs the suffering which
+results from conditions in the surroundings, the loss of a friend, a
+disappointment in life, any source of worry and grief. Social and bodily
+conditions alike may thus work to break up the equilibrium. The pain
+sensation interferes with the normal flow of mental life and the grief
+may undermine the mental interests. The psychotherapeutic effort may be
+directed toward removing the source of the disturbance, bringing the
+patient under other conditions, curing the diseased organ, and where
+that is not possible, may work directly on the psychophysical state,
+inhibiting the pain, suppressing the emotion, substituting pleasant
+ideas, distracting the whole mind, filling it with agreeable feelings,
+until the normal equilibrium is restored.
+
+The psychophysical system itself was not really harmed by such
+influences. In the following groups, such is no longer the case. We here
+think at first of those severe injuries which have their sources in
+abnormal processes outside of the brain. The anæmia of the patient or
+the low state of his nutrition or the fever heat of his blood impairs
+the harmony of the mental functions. Another and for the psychotherapist
+much more important group is that in which the impairment results from
+toxic influences. Alcohol, morphine, cocaine, tobacco, and many other
+drugs may have been misused and may have produced a most marked
+alteration in the mind-brain system. Desires may have developed which
+completely destroy the balance of the normal functions and yet the
+satisfaction of which increases the poisoning effect. But here belongs
+further the effect of poisons which the body itself produces: the toxic
+disturbance of uræmia or the coma in diabetes, or especially the grave
+disturbances resulting from the abnormal action of the thyroid gland,
+the source of cretinism. Many indications suggest that a near future
+will consider this group much larger than we are really justified in
+doing today, probably soon connecting a number of other mental diseases
+like dementia præcox with toxic effects of bodily origin. Experience
+shows that in this group not a few chances exist for successful
+psychotherapeutic influence. Yet the means may be various in character
+and their effect may be a direct or an indirect one. A psychical shock
+may remove directly the mental disturbance of the alcoholic state, but
+it is more important that mental suggestion can remove the alcoholic
+disturbance indirectly by suppressing the desire for alcoholic excesses.
+Even where cure by psychotherapeutic means is out of the question, as is
+the case with feverish delirium or uræmic excitements, no skilled
+physician ignores the aid which a well-adjusted mental influence can
+offer to the patient.
+
+We come to a third group. Some outside cause has harmed the central
+nervous system directly, and has left it in a disabled state after the
+cause itself has disappeared. Such causes may have been at first purely
+functional: for instance, a neglect of training, or a wrong training, or
+an over-activity, but the ill-adjusted function which involved, of
+course, every time an ill-adjusted organic activity or lack of activity,
+has led to a lasting or at least relatively lasting disturbance in the
+system of paths. The neglect of training, for instance, in periods of
+development may have resulted in the retardation which yields the
+symptoms of a feeble-minded brain, or the wrong training may have
+created vicious habits, firmly established in the mind-brain system and
+gravely disturbing the equilibrium. Above all, the overstrain of
+function, especially of emotional functions, may lead to that exhaustion
+which produces the state of neurasthenia. It is true that not a few
+would doubt whether we have the right to class neurasthenia here where
+we speak of the harm done to the normal brain. Many neurologists are
+inclined to hold that neurasthenia demands a special predisposition and
+is therefore dependent upon a neurotic constitution of the brain itself.
+But if defenders of such a view, as for instance, Dubois, acknowledge
+that "we might say that everybody is more or less neurasthenic," we can
+no longer speak of any special predisposition. Certainly there exists a
+constitutional neurasthenia sometimes but we have hardly a right to deny
+that overstrain in the brain activity may produce a series of
+neurasthenic symptoms in any brain, and the special predisposition is
+responsible rather for the particular selection among the innumerable
+symptoms.
+
+Neurasthenia certainly is the classical ground for the psychotherapist.
+The patient's insomnia and his headache, his feeling of tiredness and
+his disgust with himself, his capricious manias and his absurd phobias,
+his obsessions and his fixed ideas all may yield to the "appeal to the
+subconscious," and as a neurasthenic easily believes in the existence of
+various organic diseases in his body, Christian Science can perform here
+even "miracles." In the case of retardation, the psychical influence
+will have to be in the first place one of training. Yet it would be
+narrow to overlook that in neurasthenia, too, suggestion has to be only
+a part of the psychical treatment. Training and rest, distraction and
+sympathy and many other factors have to enter into the plan.
+Incomparably small, on the other hand, is the aid which psychotherapy
+can offer in cases of real destructions in the brain, as in the case of
+tumors, hemorrhage, paresis or the degeneration by senility. More
+effective may be its work in concussion of the brain and especially with
+traumatic neuroses, as in the case when a railroad accident has put the
+mind-brain system out of gear.
+
+So far we presupposed that the central system itself was normal. No
+sharp separation line, however, lies between all these disturbances and
+the equally large group of psychophysical disabilities resulting from a
+defective constitution of the brain. The normal brain shades over by
+smallest differences into the abnormal one; yes, even the varieties of
+temperament and character and intellectual capacity and industry and
+energy represent, in the midst of our social surroundings, large
+deviations from the standard. That which might still pass as normal
+under certain conditions of life would be unadjusted and thus abnormal
+under other conditions. In the same way, we certainly cannot point out
+where the natural constitution of a brain ceases to be fit for its
+organic purposes and where the structural variations are ill-prepared
+for the struggle for existence. Just as we claimed that an entirely
+normal brain might be brought by an emotional overstrain to a state of
+exhaustion and disability, we may claim on the other side that a brain
+which nature has poorly provided may yet be protected against damage and
+injury. The inborn factor does not alone decide the fate. Psychophysical
+prophylaxis may secure steadiness of equilibrium to a system which
+inherited little resistance. Yet this large borderland region, where an
+ill-adjusted brain may be saved or lost in accordance with favorable or
+unfavorable circumstances, shades off again to the darker regions where
+the inner evolution leads by necessity to disaster even under favorable
+conditions.
+
+We might begin this large group of the constitutional disturbances with
+that neurasthenia which develops on the basis of inherited disability.
+Lack of energy resulting from a feeling of tiredness, a quick
+exhaustion, a mood of depression, an easy irritation, even despair and
+self-accusation, sullenness and fits of anger, cranky inclinations and
+useless brooding over problems, headache and insomnia characterize the
+picture which everyone finds more or less developed in some of his
+acquaintances. If we classify symptoms, we may separate from it that
+which we nowadays are inclined to call psychasthenia. An abnormal
+suggestibility for autosuggestions stands in the foreground. Fixed ideas
+and fixed emotions, especially fears, trouble the patient. He may pick
+up his obsession by any chance experience and no good-will liberates him
+from the intrusion perhaps for years. The patient is perfectly well
+aware that his ideas and his emotions are unjustified, he himself does
+not believe in them, and yet they come with the strength of an outer
+perception and with the vividness of a real attitude, and his whole
+mental equilibrium may be upset by the continuous fight against these
+involuntary interferences. In the light cases, sometimes the one and
+sometimes the other autosuggestion may hold the stage; in the severe
+cases, mental life turns more and more around certain definite fears and
+yet it may all still be in the limits where the daily work can go on and
+the world may not know of the hidden tortures. Here belongs the fear of
+open places or the fear of touching certain objects, the fear of doing
+harm to others or the fear of deciding actions wrongly, the fear of
+destroying valuable things or the fear of being the center of public
+attention, the fear of crowds or of closed doors, of altitudes or of
+bridges. And in all cases emotional reaction may set in with anxieties,
+and bodily symptoms such as palpitation of the heart may result,
+whenever an effort is made to disregard the nervous fear. There is
+perhaps no group of patients which so much deserves the most careful
+efforts of the psychotherapist. Still more than the hysterics they
+suffer from the fate of seeing their ills counted as not real. For them
+everybody has the good advice that they ought to overcome their fancies;
+and yet they feel their life ruined with their endless fight against the
+overpowering enemy. And if anywhere, it is here that the psychotherapist
+is successful. Psychasthenic fear can be removed, while the developed
+melancholic depression, for instance, is entirely beyond the reach of
+psychical influence.
+
+We have after all the same psychasthenic state before us when the
+obsession has impulsive character, from the mere abnormal impulse of
+lying, or making noise in a quiet place or crying in the dark, or
+touching certain places, to that of stealing, indecent speech, arson,
+and perhaps even murder. The symptoms might easily be mistaken for those
+of graver diseases. Yet the fact that the patient himself really does
+not will the effect at which he is aiming separates, mostly without
+difficulty, the diagnosis of psychasthenia from that of insanity. Quite
+nearly related to it are the manifold variations of abnormal and
+perverse sexual tendencies. The psychiatrists are perhaps too much
+inclined to bring all these pathological impulses and desires, fears and
+anxieties, into the nearest neighborhood to real insanity. The
+indisputable success of psychotherapy in these spheres ought to add a
+warning against these expansions of the strictly psychiatric domain. The
+psychologist will be more inclined to emphasize their relation to simple
+neurasthenia which itself imperceptibly shades over into our normal
+life.
+
+All neurasthenic and psychasthenic disabilities show a certain emotional
+continuity and uniformity. It is the emotional instability and the quick
+alternation of symptoms which characterize hysteria or rather the
+hysterias. It seems as if science were near to the point of explaining
+the hysterical disease by one common principle, but certainly the
+symptoms are an inexhaustible manifold. The rapid changes of the intense
+moods of the patient usually stand in the center. Torturing obsessions,
+abnormal impulses, over-suggestibility, hypochondriac depressions,
+paralysis of arms or legs, anæsthesia and paræsthesia, a mental stupor
+and confusion, illusions and perceptions of physiological symptoms may
+work together in spite of his, or rather her clear intelligence. It is
+probably on a hysteric basis also that somnambulic states arise during
+the night, and from them a straight way leads to those mental attacks
+after which the memory is entirely lost, or for which fundamental
+associative connections are cut off. And from here we come to the
+exceptional cases of alternating personality. The more we recognize the
+myriad symptoms in the hysteric patient as products of the emotional
+instability, of autosuggestibility and of inhibition, the more we
+understand the almost miraculous result of psychotherapeutic treatment.
+Autosuggestions can be fought by countersuggestions, anæsthesia and
+paræsthesia can be removed often in an instant, dissociated
+personalities may be built up again through hypnotism, the most severe
+bodily symptoms may disappear by influences in a waking state. Hysteria
+alone would justify the demand that every physician in his student days
+pass with open eyes through the field of psychology. Quite near stand
+chorea and the epidemic impulses to imitative movements. And we might
+bring into this neighborhood also the disturbance in the equilibrium of
+the speech movements through all degrees of stammering and severe
+impairment. Up to a certain degree, though not often completely, they
+too yield easily to psychotherapeutic influence.
+
+We enter now that region of constitutional disturbances in which
+psychotherapy is of small help. It leads from epilepsy to the periodic
+diseases, especially the maniacal depressive insanity, the paranoia
+which develops late, and finally to states of idiocy which cover the
+whole life. We are far from claiming that psychical influences are
+entirely powerless, the more as we insisted that psychotherapy goes much
+beyond mere suggestions and appeals. No psychiatrist will work without
+psychological tools when he deals with the exultations of the maniac and
+the depressions of the melancholic, with the hallucinations of
+persecution or the erotic insanities of the paranoiac. Still more the
+whole register of psychology has to be used, when we are to educate the
+idiot and the imbecile. But the disappearance of the disease or of the
+chief symptoms through the mental agencies is in all these cases out of
+the question. Only in incipient cases, especially of melancholia and
+mania, the psychotherapeutic work seems not entirely hopeless; and for
+epilepsy some distinct successes cannot be denied.
+
+We have reviewed the whole field of psychophysical disturbances, those
+produced through external conditions in the normal brain and those
+resulting from abnormal brain constitution. We have seen that the work
+of the psychotherapist is of very unequal value in different parts of
+the field; in some, as in neurasthenia, in psychasthenia, in hysteria
+and similar regions most effective, in others like paresis or paranoia
+reduced to an almost insignificant factor. Where it can help and where
+not we recognize as a mere question of experience. Certainly the
+severity of the symptoms alone does not decide it. As the treatment is
+entirely empirical, no one can foresee whether or not the situation may
+change to-morrow. We may find psychotherapeutic schemes by which
+epilepsy or maniacal depressive insanity or traumatic neuroses may
+become accessible. We simply do not know why we may remove stammering or
+synthesize a dissociated personality or overcome an inborn sexual
+perversity, while we are unable to remove the depression of the
+melancholic. Certainly the symptoms of the circulatory insanity
+disappear completely in the free intervals; there is no reason to give
+up hope that psychotherapy might find the way to hasten the appearance
+of such a normal period.
+
+But we have emphasized from the start that the psychotherapeutic work
+has not only to set in when the disturbance itself lies in the
+psychophysical system. We may utilize the influence which the
+mind-brain system has for the whole body and thus may apply the
+psychical tool to work on the disturbances in the bodily apparatus. We
+may discriminate a direct and an indirect influence in the psychical
+treatment of bodily diseases. Transition from the foregoing group of
+psychical disturbances offers itself perhaps most easily through the
+state of insomnia.
+
+The causes of sleeplessness may still lie in the psychophysical sphere;
+restless thoughts may inhibit the idea of sleep. The effect of sleep is
+again in the sphere of the mind, the annihilation of conscious contents.
+But the center which regulates and creates the sleep, probably by
+contracting the blood-vessels, lies outside of the psychophysical system
+in the lower centers of the brain. The real disturbance thus lies in the
+inactivity of this purely bodily apparatus and mental influence which is
+to create sleep has therefore to work downwards from the mind to a
+bodily organ. In the same way many other non-psychical centers of the
+brain may be brought to efficiency through psychophysical regulation.
+
+But the therapeutic effect is certainly not confined to the central
+nervous system. Whithersoever the centrifugal nerves lead there the
+mind-brain system may have its curative influence. In the most startling
+way that is true for the digestive apparatus. The secretions of the
+stomach, the activity of the intestines can be influenced to a decree
+which it is difficult to explain. Important also is the relation to the
+circulatory system, especially the disturbances of the heart:
+innervation may be corrected, abnormal dilations and contractions of
+blood-vessels may be regulated. The bladder, uterus, even the pancreas
+and the liver seem to be influenced by the peripheral effects of the
+central excitement. And while no warning can be serious enough against
+the absurd belief that diseases like cancer or tuberculosis can be cured
+by faith, it must be admitted that psychical influences under special
+conditions may have a retarding influence on any pathological process in
+the organism. Much of that certainly is indirect influence but the
+physician would be reckless if he should ignore the aid which may result
+from such indirect assistance. Even if psychotherapy could not do more
+in the treatment of bodily diseases than to secure a joyful obedience to
+the strict demands of the physician, it would yet have to be accredited
+with an extremely important service.
+
+In a parallel line comes the effective aid by the stimulation of hope
+and the suppression of fear, by suggestion of a feeling of encouragement
+and the inhibition of the emotions of worry. This is a field where even
+the average physician is most easily inclined to play the amateur
+psychotherapist. He knows how convalescence is disturbed by psychical
+depression and how much more quickly health returns, if it is
+confidently expected; he knows how many dangerous operations are
+disturbed by despondency and helped by bravery; he knows what a blessed
+change has come into the treatment of tuberculosis since a psychical
+factor of social interest has set in; he knows how many ills disappear
+when regular occupation and interesting work are established or the
+strain of distasteful work removed. Even the mere suppression of the
+pain works backwards on the bodily disease which produces it. The pain
+was a starting point for disturbing reactions; with its disappearance
+through psychotherapeutic influence, the reactions of the irritated
+brain come to rest, the diseased body can carry on its struggle without
+interference and may win the day. Often the psychical influence may not
+even change the symptoms at all but may remove other troublesome
+effects. The sufferer from locomotor ataxia may learn to walk again
+through mental education without any restitution of his spinal cord. In
+short, there are endless ways in which psychical influence may work
+towards the general health and towards the victory over bodily disease;
+and all that may be acknowledged without the slightest concession to the
+metaphysical creeds of mental healers and Christian Scientists. But to
+make use of those means and to harness such influences, it cannot be
+enough to rely on the common-sense of the physician any more than we
+should trust the common-sense of the surgeon to use his knife without
+condescending to the study of anatomy. The psychological study of the
+anatomy of the soul shows a not less complicated system of mental
+tissues and mental elements.
+
+To enter into the full richness of this whole, large field of course
+lies entirely beyond the scope of our short discussion, which seeks as
+its only aim a clear recognition of the principles. Yet it seems
+essential to illustrate at least this sketch of the field by a more
+detailed account of actual developments. Various ways of procedure might
+appear in order and the most natural one would be, of course, to pass
+down from disease to disease and sketch special cases from diagnosis to
+cure. We might go through the various stages of neurasthenia and then
+through psychasthenia and then through hysteria and so on. And if we had
+to write a handbook for physicians, it would certainly be the desirable
+way, in spite of the too frequent repetitions which would become
+necessary. But as our aim is only a discussion of principles of
+psychotherapy, we have no right to use this method. Moreover, such a
+method would suggest the misleading view that the psychotherapist is
+called and is able to treat diseases. All that he treats are symptoms
+and he ought not to pretend that he can do more, as long as he abstracts
+from all other therapeutic agencies. Psychotherapeutic influence may
+remove the phobia of a psychasthenic or the obsession of a neurasthenic
+or the emotion of a hysteric, and thus may bring not only momentary
+relief but a change which may be favorable for general improvement, but
+certainly the neurasthenia and psychasthenia and hysteria are not really
+removed by it. Of course, even the treatment of symptoms demands a
+constant reference to the whole background of the disease. The
+depression of the neurasthenic must not be treated like the depression
+of the melancholic, the obsession of the psychasthenic must not be
+mixed with the fixed ideas of a paranoiac, the hysteric inability to
+walk must not be confused with an injury of the motor nerves; in short,
+each symptom has to be treated as part of a complete situation. The
+efforts of the psychotherapist will move over as large a part of the
+disease as possible and cover, perhaps, the causes of the disturbance as
+far as they are of psychical origin. Yet it would remain dilettanteism
+if we were to accept the popular view that the mere psychotherapeutic
+aid is a sufficient treatment of the whole disease. The physician has to
+be much more than a psychotherapist. Our discussion only seeks to point
+out that whatever else he may be, he must be also a psychotherapist.
+
+The more conservative method which befits us may be, therefore, the
+method of dealing with symptoms only and abstracting from the more
+ambitious plan of discussing the diseases entire. We simply separate the
+mental symptoms and the bodily symptoms which the psychotherapist is to
+remove. And just in order to classify somehow the manifold mental
+symptoms, we might separate those in the sphere of ideas, those in the
+sphere of emotions, and those in the sphere of volitions. Of course,
+nothing is further from such a plan than the old-fashioned belief that
+intellect, feeling, and will represent three independent faculties of
+the soul. Modern psychology has not only substituted the millionfold
+phenomena for the schematic faculties, but emphasizes above all the
+interconnectedness of the mental facts. There is no experience into
+which ideas, and feelings, and impulses do not enter together. And
+correspondingly we emphasized that on the physiological side too, every
+sensory excitement is at the same time the middle point of central
+irradiation and the starting point of motor activity. Thus there can be
+no disturbance of ideas which does not influence feeling and will, and
+vice versa. Yet it would be artificial to deny that any one of those
+various sides of the psychical process may come to prominence, sometimes
+the impulse, sometimes the emotion, and sometimes the interplay of
+ideas. The separation means only an abstraction, but it is an
+abstraction which is justified and suggested by the actual experiences.
+Thus we shall deal with the psychical treatment of ideational,
+emotional, volitional, and bodily symptoms.
+
+Common to our discussions will be only the effort to avoid everything
+which is exceptional and by its unusual complications apparently
+unexplainable and mysterious. The greater complexity of the case
+certainly adds much fascination. Yet since we do not want to stimulate
+mere curiosity but clear understanding of the elements, we avoid every
+startling record. We confine ourselves carefully to those perhaps
+trivial experiences which daily enter into the view of those who come in
+contact with suffering mankind. There will be no startling stories of
+dissociated personalities, such as appear perhaps every few years on the
+horizon of the medical world, but we shall speak of those who every day
+in every town carry their trouble to the waiting room of the doctor and
+who might return more happily if he had more well-trained interest in
+the psychotherapeutic factors. Yet before we analyze some typical
+symptoms, it might be wise to review the whole series of means and tools
+which the psychotherapist finds at his disposal.
+
+
+
+
+VIII
+
+THE GENERAL METHODS OF PSYCHOTHERAPY
+
+
+The psychological work of the physician does not begin with his curative
+efforts. Therapy is always only the last step. Diagnosis and observation
+have to precede, and an inquiry into the causes of the disease is
+essential, and in every one of these steps psychology may play its rôle.
+The means of psychodiagnostic are not less manifold than those of
+psychotherapy. Moreover there the technique may be more complex and
+subtle. The whole equipment of the modern laboratory ought to be put at
+its disposal. Perceptions and associations, reactions and expressions
+ought to be examined with the same carefulness with which the
+conscientious physician examines the blood and the urine.
+
+A particular difficulty of the task more or less foreign to every other
+medical inquiry is the intentional or unintentional effort of the
+patient to hide the sources of the trouble and to mislead as to their
+true character. Too often he is entirely unconscious of the sources of
+trouble or else he has social reasons to deceive the world and himself,
+and ultimately the physician. And yet no psychical treatment can start
+successfully so long as the patient is brooding on secret thoughts at
+the bottom of his mind. The desire to hide them may often be itself a
+part of the disease. It is surprising how often unsuspected vistas of
+thoughts and impulses and emotions are opened by an inquiring analysis
+where the direct report of the patient does not awaken the least
+suspicion. In the field of insanity, naturally the physician at once
+goes to an examination on his own account, but in the borderland regions
+of the psychasthenics and hysterics and neurasthenics, the intellectual
+clearness of the patient too easily tempts one into trusting the
+sincerity of his story; and yet the most important ideas clustering
+perhaps about love or ambition, about vice or crime, about business
+failure or family secrets, about inherited or acquired diseases may be
+cunningly withheld and may frustrate every psychotherapeutic influence.
+Where suspicion is awake and mere confidential talk and persuasion seem
+insufficient, the physician may feel justified in the interest of his
+patient in drawing the thoughts out of their hiding-place by artificial
+means. Skill, tact, and experience are needed there.
+
+As a matter of course, in the overwhelming mass of cases the frankness
+and the good will of the patient himself will support the physician and
+accordingly his examination is not obliged to trap the patient but
+simply to guide him to important points. But then begins the most
+essential study of diagnostical differentiation. With all the means not
+only of psychology but of neurology and internal medicine, he has to
+separate the particular case from similar ones and to examine whether
+he deals with, for instance, a hysteric or with a paranoiac, with a
+neurasthenic or with a case of dementia præcox; and he will not forget
+that there exist almost no symptoms of serious diseases which the
+nervous system of the hysteric may not imitate for a time. Not ours is
+the task of analyzing special methods of neurological and mental
+differential diagnosis such as are used in the psychiatric clinic and in
+the office of the nerve specialist. There the family history with
+reference to nervous and other diseases, the history of the patient
+himself, the infectious diseases which he has passed through, his habits
+and anomalies, his use of alcohol and of drugs, his experiences in
+social life, the demands of his profession, his recent troubles and
+their first origin are to be recorded carefully. Then begins the
+physical examination, the study of his sense organs and his nerves, of
+the motor inabilities, the pains, the local anæsthesias and
+paræsthesias, the disturbances of the reflexes, of the spasms, tremors,
+convulsions, and incoördinations, of the vasomotor and trophic
+disorders, and so on. In a similar way the psychical examination tests
+the hallucinations and illusions, the variations and defects of memory
+and attention, of judgment and reasoning, of orientation and
+self-consciousness, of emotions and volitions, of intellectual
+capacities and organized actions. But we do not have to enter here into
+a discussion of such diagnostic means; our chief interest belongs to the
+therapy.
+
+The variety of the psychotherapeutic methods is great and only some
+types are to be characterized here. But one rule is common to all of
+them: never use psychotherapeutic methods in a schematic way like a
+rigid pattern. Schematic treatment is a poor treatment in every
+department of medicine, but in psychotherapeutics it is disastrous.
+There are no two cases alike and not only the easily recognizable
+differences of sex and age, and occupation and education, and financial
+means, and temperament and capacity are decisive, but all the subtle
+variations of prejudices and beliefs, preferences and dislikes, family
+life and social surroundings, ambitions and prospects, memories and
+fancies, diet and habits must carefully be considered. Every element of
+a man's life history, impressions of early childhood, his love and his
+successes, his diseases and his distresses, his acquaintances and his
+reading, his talent, his character, his sincerity, his energy, his
+intelligence--everything--ought to determine the choice of the
+psychotherapeutic steps. As it is entirely impossible to determine all
+those factors by any sufficient inquiry, most of the adjustment of
+method must be left to the instinct of the physician, in which wide
+experience, solid knowledge, tact, and sympathy ought to be blended.
+Even the way in which the patient reacts on the method will often guide
+the instinct of the well-trained psychotherapist.
+
+It is therefore certainly not enough that the knowledge of the physician
+simply decide beforehand on a definite course of psychical treatment and
+leave the carrying out to a well-meaning minister or any other medical
+amateur who schematically follows the indicated path. The finest
+adjustment has to come in during the treatment itself and the response
+of the patient often has to suggest entirely new lines of procedure.
+More than in any other field of medicine, the physician himself has to
+extend his influence far beyond the office hours and the strictly
+medical relations. And yet, on the other hand, there is no department of
+medicine in which the treatment might not profit by the
+psychotherapeutic influence. With a few vague words of encouragement
+mechanically uttered, or with a routine of tricks of suggestion by bread
+pills and colored water and tuning forks, not much will be gained even
+in the ordinary physician's practice. Subtle adjustment to the personal
+needs and to the individual conditions is necessary in every case where
+the psychical factor is to play an important rôle. It cannot be denied
+that the one great obstacle in the work of the routine physician is the
+lack of time and patience which is needed for successful treatment. To
+prescribe drugs is always quicker than to influence the mind; to cure a
+morphinist by hyoscine needs less effort than to cure him by suggestion.
+
+The first method to bring back the psychophysical equilibrium is of
+course the one which is also demanded by common-sense, namely, to remove
+the external sources of the disturbance. External indicates there not
+only the outer world but also the own body outside the conscious parts
+of the brain. If we take it in the widest meaning, this would evidently
+include every possible medical task from filling a painful tooth to
+operating on a painful appendix, as in every case where pain results,
+the mental equilibrium is disturbed by it and the normal mental life of
+the patient reduced in its efficiency. But in the narrower sense of the
+word, we shall rather think of those sources of trouble in the organism
+itself which interfere directly with the mental functions. The
+examination of any public school quickly leads to the discovery that
+much which is taken for impaired mental activity, for lack of attention,
+for stupidity, or laziness may be the result of defective hearing or
+sight or abnormal growth of the adenoids. Growths in the nose may be
+operated upon, the astigmatic or the short-sighted eye may be corrected
+by glasses, the child who is hard of hearing may at least be seated near
+the teacher; and the backward children quickly reach the average level.
+No doubt in the life of the adult as well, often almost insignificant
+and from a strictly physical point of view unimportant abnormities in
+the bodily system, especially in the digestive and sexual spheres, are
+sources of irritation which slowly influence the whole personality. To
+be sure, the brain disturbance may have reached a point where the mere
+removal of the original affliction is not sufficient to reinstate the
+normal balance of mental energies, but wherever such a bodily irritation
+goes on, it is never too late to abolish it in the interests of
+psychotherapy.
+
+The less evident and yet even more important source of the painful
+intrusions may lie outside of the organism in the social surroundings
+and conditions of life. Most of that has to be accepted. The physician
+cannot bring back the friend who died or the fortune which was lost in
+speculation or the man who married another girl. He will even avoid
+suggesting far-reaching social changes in the private life of the
+patient, changes like divorce in an unhappy marriage or the breaking of
+the home ties, however often he may get the impression that such a
+liberation would stop the source of the mental trouble. He will be the
+more careful not to overstep his medical rights as he seldom has the
+possibility to judge fairly on the basis of the one-sided complaint, and
+the probability is great that the character and temperament of the
+complainant may be a more essential factor of the ailment than the
+personalities which surround him. Yet even the conservative physician
+will find abundant opportunities for advice which will remove disturbing
+energies from the social surroundings of the sufferer. Even a short
+release from the burdening duties, a short vacation from the incessant
+needs of the nursery, a break in the monotony of the office, may often
+do wonders with a neurasthenic. Often within a surprisingly short time
+the brain gathers the energies to overcome the frictions with
+unavoidable surroundings.
+
+Yet here the physician has to adjust the prescribed dose of outing very
+carefully to the special case. We may be guided by the psychological
+experiments which have been made in the interest of testing the fatigue
+induced by mental work. If perhaps four hours of concentrated work are
+done without pauses, experiment shows that the quality of the work
+deteriorates, measured for instance by the number of mistakes in quick
+calculation. If certain relatively long pauses are introduced, the
+standard of work can be kept high all through. But if frequent pauses
+are made, and each short, the result is with many individuals the
+opposite. The experiment indicates that these frequent pauses are
+working as interruptions which hinder the perfect adjustment to the work
+in hand. That is suggestive. Our neurasthenic may complain about the
+life which he has to live and yet after all he is frequently so
+completely adjusted to it that it may not be in his interest to remove
+him far away from the conditions which cannot ultimately be changed but
+to which he has to return. The instinct of the physician has to find the
+middle way between a temporary removal of irritation which really allows
+a development of new energies and a mere interruption which simply
+damages the acquired relative adjustment. Every cause of friction which
+can be permanently annihilated for the patient certainly should be
+removed.
+
+This negative remedy demands its positive supplement. The patient must
+be brought under conditions and influences which give fair chances for
+the recuperation of his energies. Too often from the standpoint of the
+psychologist, the prescription is simply rest. As far as rest involves
+sleep, it is certainly the ideal prescription. There is no other
+influence which builds up the injured central nervous system as safely
+as sound natural sleep, and loss of sleep is certainly one of the most
+pernicious conditions for the brain. Again rest is a great factor in
+those systematic rest cures which for a long while were almost the
+fashion with the neurologist. Experience has shown that their
+stereotyped use is often unsuccessful, and moreover that the advantage
+gained by those months spent in bed completely isolated and overfed is
+perhaps due to the separation and changed nutrition more than to the
+overlong absolute rest. Yet used with discrimination, the physiological
+and the psychical effect of lying in bed for a few weeks has certainly
+often been a marked improvement, especially with young women. But more
+often the idea of rest in bed during daytime is not meant at all when
+the nerve specialist recommends rest to his over-strained patient. It is
+simply meant that he give up his fatiguing daily work, even if that work
+is made up of a round of entertainments and calls and social
+engagements. The neurasthenic and all similar varieties are sent away
+from the noise of the city, away from the rush of their busy life, away
+from telephones and street cars, away from the hustling business and
+politics.
+
+Indeed it is the dogma of most official and unofficial doctors that the
+restlessness and hurry and noise which all are characteristic of the
+technical conditions of our time are the chief sources of the prevailing
+nervousness. There was no time in the history of civilization in which
+the average man was overwhelmed by so many demands on his nerve energy,
+no time which asked such an abundance of interests even from the school
+child. The wild chase for luxury in the higher classes, reënforced by
+the commercialism of our time, the hard and monotonous labor in our
+modern mills and mines for the lower classes, the over-excitement
+brought to everybody by the sensationalism of our newspapers and of our
+public life all injure the brain cells and damage the equilibrium. That
+is a story which we hear a thousand times nowadays. Yet it is doubtful
+whether there is really much truth in such a claim and whether much wise
+psychotherapy can be deduced from it.
+
+We may begin even with the very justifiable doubt whether nervousness
+really has increased in our time. Earlier periods had not so many names
+for those symptoms and were not able to discriminate them with the same
+clearness. Above all, the milder forms of abnormities were not looked on
+as pathological disturbances. If a man has a pessimistic temperament, or
+has fits of temper, or cannot get rid of a sad memory idea, or imagines
+that he feels an illness which he does not have, or has no energy to
+work, even today most people are still without suspicion that a
+neurasthenic or a psychasthenic or a hysteric disturbance of the nervous
+system may be in its beginning. Earlier times surely may have treated
+even the stronger varieties of this kind as troublesome variations in
+the sphere of the normal. On the other hand, there can be no doubt that,
+for instance, the Middle Ages developed severe diseases of the nervous
+system in an almost epidemic way which is nearly unknown to our time.
+
+As to the conditions of life itself, there are certainly many factors at
+work which secure favorable influences for our cerebral activity. The
+progress of scientific hygiene has brought everyone much nearer to a
+harmonious functioning of the organism, and the progress of technique
+has removed innumerable difficulties from the play of life. Of course,
+we stand today before a much more complex surrounding than our ancestors
+but still more quickly than the complexity have grown the means to
+master it. We have to know more: yet the effort has not become greater
+since it has become easier to acquire knowledge. We have to endure much
+disturbing noise, and yet we forget how the sense organs of our
+forefathers must have been maltreated, for instance, by flickering
+light. We are in a rush of work and stand in thousandfold connections;
+and yet the neural energy which is demanded is not large because a
+thousand devices of our technical life have become our obedient
+servants. There is no nation on earth which is more proud of its rush
+and its hurry than the American people; and yet what an abundance of
+time is leisurely wasted that would have to be used for work if the
+country could not live from its richness. Moreover our life has probably
+become cooler, there is less emotionalism, less sentimentality, more
+business-like attitude, and that all means less inner friction and
+excitement; in public life too, less fear of war and less religious
+struggle. All has become a question of administration and efficiency.
+Our time is certainly not worse off on the score of neurasthenia than
+its predecessors.
+
+Above all the intensity of mental stimuli is always relative. The
+psychologist knows the experiments which determine that we perceive the
+difference of impressions as alike when the stimuli are proportional.
+If I have a ten-pound weight in one hand, I may find that I must have
+one pound more in the other hand to discriminate the difference. Now if
+I take twenty pounds in the one hand, then it is not sufficient to have
+one pound more in the other, but I must have twenty-two pounds in the
+other to feel a difference, and if I take thirty pounds, the other
+weight must be thirty-three. We feel equal differences when the weights
+stand in the same relation. The man who owns a hundred dollars will
+enjoy the gain of five and regret the loss of five just as much as the
+owner of a hundred thousand dollars would feel the gain or loss of five
+thousand. This fundamental law of the relativity of psychical
+impressions controls our whole life. The rush of stimuli which might
+mean a source of nervous disturbance for the villager whose quiet
+country life has brought about an adjustment to faint impressions may
+cause very slight stimulation for the metropolitan accustomed for a
+lifetime to the rhythm of the surroundings. Yet that quiet countryman
+may react in his narrow system not less when the modest changes in his
+surroundings provoke him. The gossip of his neighbor may undermine his
+nervous system just as much as a political fight or the struggles of the
+exchange that of the city man.
+
+The same holds true for the purely intellectual engagements. The work
+which the scholar undertakes should not be measured by the effect which
+the same appeal to concentrated attention would make on the average man
+of practical life. There, too, an adjustment to the demand has resulted
+during the whole period of training and professional work. Every effort
+should be estimated with reference to the standard of the particular
+case. This relativity of the mental reaction on the demands of life must
+always be in the foreground of the psychotherapeutic régime. Even the
+best physicians too often sin against this principle and accuse the life
+which a man or woman leads as too exhausting and overstraining simply
+because it would be overstraining and exhausting to others who are not
+adjusted to that special standard. Simply to withdraw a patient from the
+one kind of life and to force on him a new kind with new standards may
+not be a gain at all. A new adjustment begins and smaller differences
+from the standard may bring about the same strong intensities of
+reaction as the large differences brought before. Complete rest, for
+instance, for a hard brain-worker hardly ought to be recommended unless
+a high degree of exhaustion has come on. If routine prescriptions are to
+be admitted at all, they should not be complete rest or complete change
+of life for any length of time but a continuation of the life for which
+adjustment has been learned with a reasonable reduction of the demands
+and stimulations. The intellectual worker ought to decrease his work,
+the overbusy society woman ought to stay in bed one day in the week, the
+man in the midst of the rush of life ought to cut down his obligations,
+but probably each of them does better to go on than simply to swear off
+altogether.
+
+Their rest ought to have the character of vacation; that means
+interruptions without the usual activity ought to be short periods spent
+with the distinct feeling that they are interruptions of that which must
+last and that they are not themselves to become lasting states. Thus the
+inner adjustment to the work ought to be kept up and ought not to be
+substituted by a new adjustment to a less exacting life. In this way the
+episode of the vacation rest ought to be in a way included in the
+strenuous life almost as a part of its programme. Strenuosity must not
+mean an external rush with the gestures of overbusy excitement, but
+certainly the doctrine of the lazy life is wretched psychotherapy, as
+long as no serious illness is in question. By far the best alteration
+is, therefore, even in the periods of interruption, not simply rest but
+new engagements which awaken new interests and stimulate neglected
+mental factors, disburdening the over-strained elements of mental life.
+The most effective agency for this task is contact with beauty, beauty
+in nature and life, beauty in art and literature and music. To enjoy a
+landscape ought to be not merely a negative rest for the man of the
+office building, and good literature or music absorbs the mental
+energies and harmonizes them. In the second place come games and sport,
+which may enter into their right if fatigue can be avoided. Harmonious
+joyful company, as different as possible from the depressing company of
+the sanitariums, will add its pleasantness.
+
+While the advice of the physician ought thus to emphasize the positive
+elements which work, not towards rest, but toward a harmonious mental
+activity, we must not forget some essential negative prescriptions.
+Everything is to be avoided which interferes with the night's sleep.
+Furthermore, in the first place, alcohol must be avoided. There cannot
+be any doubt that alcoholic intemperance is one of the chief sources of
+brain disturbances and that the fight against intemperance, which in
+this country is essentially the fight against the disgusting saloon, is
+a duty of everyone who wants to prevent nervous disaster. There may and
+must be divergence of opinion as to the safest way to overcome
+intemperance. The conservative physician will feel grave doubt whether
+the hasty recommendation of complete prohibition is such a safe way,
+whether it does not contain many conditions of evil, and whether the
+fight against the misuse of alcohol will not be more successful if a
+true education for temperance is accepted as the next goal. But for the
+man of neurasthenic constitution and for any brain of weak resistance,
+the limit for permissible alcoholic beverages ought to be drawn very
+narrow and in such cases temporary abstinence is usually the safest
+advice. Individual cases must indicate where a glass of light beer with
+the meal or a glass of a mild wine may be permissible. Strong drinks
+like cocktails are absolutely to be excluded. In the same way a strong
+reduction is advisable in tobacco, tea, and especially coffee. A
+complete withdrawal of all stimulations to which a nervous system has
+been accustomed for years is not wise, or at least mild substitutes
+ought to be suggested, but if coffee can be ruled out at once, often
+much is gained. In the same way all passionate excitements are to be
+eliminated and sexual life to be wisely regulated. An especial warning
+signal is to be posted before all strong emotions, and if the patient
+cannot be asked to leave his worry at home, he can at least be asked to
+avoid situations which will necessarily lead to excitement and quarrel
+and possible disappointment.
+
+It is one of the surest tests of psychotherapeutic skill to discriminate
+wisely whether one or the other of these features of general treatment
+ought to be emphasized. They usually demand more insight than specific
+forms of psychotherapy like hypnotic suggestions. These general efforts
+are also much more directed against the disease itself where the
+specific methods are merely directed against the symptoms. The
+separation from disturbing surroundings, the reduction of engagements
+and work, the complete rest, the suppression of artificial stimulants,
+the enjoyment of art, of nature, of sport, the distractions of social
+life, each might be in one case a decisive help and indifferent, perhaps
+even harmful in another. All is a matter of choice and adjustment to the
+particular needs in which all the personal factors of inherited
+constitution, acquired adjustments, social surroundings, temperament,
+and education, and the probable later development have to be most
+tactfully weighed. Yet this general treatment may take and very often
+ought to take the opposite direction, not towards rest but towards work,
+not towards light distraction but towards serious effort, not towards
+reduction of engagements but towards energetic regulation. We said that
+it was an exaggeration to blame the external conditions of our life, the
+technical manifoldness of our surroundings as the source of the
+widespread nervousness. The mere complexity of the life, the rapidity of
+the demands, the amount of intellectual effort is in itself not
+dangerous and our time is not more pernicious than the past has been;
+but it is perhaps no exaggeration to say that our time is by many of its
+features more than the past tending towards an unsound inner attitude of
+man.
+
+Much of the present civilization leads the average man and woman to a
+superficiality and inner hastiness which undermines sound mental life
+much more than the external factors. We look with a condescending smile
+at the old-fashioned periods in which the demands of authority and
+discipline controlled the education of the child and after all the
+education of the adult to his last days. We have substituted for it the
+demand of freedom with all its blessings, but instead of the blessings
+we too often get all its vices. A go-as-you-please method characterizes
+our whole society from the kindergarten to the height of life. We
+eulogize the principle of following the paths of own true interest and
+mean by that too often paths of least resistance. Study becomes play,
+the child learns a hundred things but does not learn the most important
+one, to do his duty and to do it accurately and with submission to a
+general purpose. The power of attention thus never becomes trained, the
+energy to concentrate on that which is not interesting by its own
+appeal is slowly lost, a flabby superficiality must set in which is
+moved by nothing but the personal advantage and the zigzag impulses of
+the chance surroundings. He who has never learned obedience can never
+become his own master, and whoever is not his own master through all his
+life lacks the mental soundness and mental balance which a harmonious
+life demands. Flippancy and carelessness, haphazard interests and
+recklessness must result, mediocrity wins the day, cheap aims pervade
+the social life, hasty judgments, superficial emotions, trivial
+problems, sensational excitements, and vulgar pleasures appeal to the
+masses. Yellow papers and vaudeville shows--vaudeville shows on the
+stage, in the courtroom, on the political platform, in the pulpit of the
+church--are welcome, and of all the results, one is the most immediate,
+the disorganization of the brain energies.
+
+A sound mind is a well-organized mind in which a controlling idea is
+able to inhibit the opposites and is in no danger of being overrun by
+any chance intrusion into the mind. This power is the act of attention.
+An attention which is trained and disciplined can hold its ideas against
+chance impulses. An untrained attention is attracted by everything which
+is loud and shining, big and amusing. The trouble is not with the rush
+and hurry of the impressions which demand our attention; the trouble is
+with our attention which seeks a quick change of new and ever new
+impressions because it is not disciplined to hold firmly to one
+important interest. We want the hundred short-cut superficial magazines
+because we lack the energy to study one large volume; we want the
+thousand engagements because we are not concentrated enough to devote
+ourselves fully to one ideal task. The strong mind may find its sound
+adjustment even without such training for concentrated attention through
+obedience and discipline but the weak mind has to pay the penalty. For
+not a few it will mean social disaster. Yet our society is sufficiently
+adapted to this state so that it gives some good social chances to the
+superficial too, and this not only to the rich, but to those on every
+level. Only the nervous system cannot so easily be adjusted to the new
+régime. The loose interplay of the brain cells without the serious
+training of discipline must involve disorganization of the mind-brain
+system which may count often most powerfully in those spheres in which
+the mere needs of life are felt the least. There is only one great
+remedy: discipline, training for concentrated attention, for a work in
+submission of will to a steady purpose. And psychotherapeutic effort
+will often demand such a training for work rather than a reduction of
+work and rest.
+
+The most alarming product of the neglect in training is found in many of
+those retarded children who at fifteen show the intelligence of a boy of
+eight. They are not imbeciles and do not belong in the psychiatric
+domain; their development has simply been suspended by a mistaken
+education. Of course no neglect would have led to it without a
+constitutional, inherited weakness of the central nervous system, but
+the weakness would never have led to the retardation if perhaps a
+mistaken parental indulgence had not allowed a life without forced
+effort and, therefore, without progress. Even such extreme cases may not
+show on the surface. The boy may pass as all right if we meet him at a
+ball; only his tutor knows the whole misery. Still less does the surface
+view of many a grown-up neurasthenic alarm us who seems to live a
+well-ordered, perhaps an enviable life, and yet who suffers the penalty
+of a life without concentrated effort, really without anything to do in
+spite of a thousand engagements. Moreover this lack of important
+activity may often be forced on our patients. Married women without
+children, without household responsibilities, and without interests of
+their own and without strong nervous constitution will soon lose the
+power of effort and their brain will succumb. A dreary monotony is
+dangerous even for the worker; for the non-worker it may be ruinous.
+
+Yet mere flippant excitement and superficial entertainment is nothing
+but a cheap counterfeit of what is needed. Voluntary effort is needed,
+and this is the field where the psychotherapist must put in his most
+intelligent effort. There is no one for whom there is not a chance for
+work in our social fabric. The prescription of work has not only to be
+adjusted to the abilities, the knowledge, and social condition, but has
+to be chosen in such a way that it is full of associations and
+ultimately of joyful emotions. Useless work can never confer the
+greatest benefits; mere physical exercises are therefore
+psychophysically not as valuable as real sport while physically, of
+course, the regulated exercises may be far superior to the haphazard
+work in sport. To solve picture puzzles, even if they absorb the
+attention for a week, can never have the same effect as a real interest
+in a human puzzle. There is a chance for social work for every woman and
+every man, work which can well be chosen in full adjustment to the
+personal preference and likings. Not everybody is fit for charity work,
+and those who are may be entirely unfitted for work in the interest of
+the beautification of the town. Only it has to be work; mere
+automobiling to charity places or talking in meetings on problems which
+have not been studied will, of course, be merely another form of the
+disorganizing superficiality. The hysterical lady on Fifth Avenue and
+the psychasthenic old maid in the New England country town both simply
+have to learn to do useful work with a concentrated effort and a high
+purpose. From a long experience I have to confess that I have seen that
+this unsentimental remedy is the safest and most important prescription
+in the prescription book of the psychotherapist.
+
+There is one more feature of general treatment which seems almost a
+matter of course, and yet which is perhaps the most difficult to apply
+because it cannot simply be prescribed: the sympathy of the
+psychotherapist. The feelings with which an operation is performed or
+drugs given do not determine success, but when we build up a mental
+life, the feelings are a decisive factor. To be sure, we must not forget
+that we have to deal here with a causal and not with a purposive point
+of view. Our sympathy is therefore not in question in its moral value
+but only as a cause of a desired effect. It is therefore not really our
+sympathy which counts but the appearance of sympathy, the impression
+which secures the belief of the patient that sympathy for him exists.
+The physician who, although full of real sympathy, does not understand
+how to express it and make it felt will thus be less successful than his
+colleague who may at heart remain entirely indifferent but has a
+skillful routine of going through the symptoms of sympathy. The
+sympathetic vibration of the voice and skillful words and suggestive
+movements may be all that is needed, but without some power of awakening
+this feeling of personal relation, almost of intimacy, the wisest
+psychotherapeutic treatment may remain ineffective. That reaches its
+extreme in those frequent cases in which social conditions have brought
+about an emotional isolation of the patient and have filled him with an
+instinctive longing to break his mental loneliness, or in the still more
+frequent cases where the patient's psychical sufferings are
+misunderstood or ridiculed as mere fancies or misjudged as merely
+imaginary evils. Again everything depends upon the experience and tact
+of the physician. His sympathy may easily overdo the intention and
+further reënforce the patient's feeling of misery or make him an
+hypochondriac. It ought to be sympathy with authority and sympathy which
+always at the same time shows the way to discipline. Under special
+conditions it is even advisable to group patients with similar diseases
+together and to give them strength through the natural mutual sympathy;
+yet this too can be in question only where this community becomes a
+starting point for common action and common effort, not for mere common
+depression. In this way a certain psychical value must be acknowledged
+for the social classes of tuberculosis as they have recently been
+instituted.
+
+From sympathy it is only one step to encouragement, which indeed is
+effective only where sympathy or at least belief in sympathy exists. He
+who builds up a new confidence in a happy future most easily brings to
+the patient also that self-control and energy which is the greatest of
+helping agencies. The physical and mental efforts of the physician are
+alike deprived of their best efficiency if they are checked by worry and
+fear that the developments of the disease will be disastrous. As soon as
+new faith in life is given, and given even where a sincere prognosis
+must be a sad one, a great and not seldom unexpected improvement is
+secured. There is no doubt that the routine physician is doing by far
+too little in these respects. His instinctive feeling that disease is a
+causal process, and that he should therefore keep away from the
+purposive attitude, leads him too easily to a dangerous narrowness. He
+treats disease as if it were an isolated process and overlooks the
+thousandfold connections in which the nervous system stands with the
+patient's whole life experience in past and future. The physician is
+thus too easily inclined to underestimate the good which may come in the
+fight against disease from the ideas and emotions which form the
+background of the mind of the patient. Even if the disease cannot be
+vanquished, the mental disturbances which result from it, the pains and
+discomforts, may be inhibited, as soon as hopes and joyful purposes gain
+a dominating control of the mind. The nervous patient often needs a
+larger hold upon life, while the routine prescriptions may too easily
+reduce that hold by fixing the attention on the symptoms.
+
+Here then is the right place for the moral appeal and the religious
+stimulation. How psychotherapy is related to the church will interest us
+later. At this moment morality and religion are for us not inspirations
+but medicines. But from such a causal point of view, we should not
+underestimate the manifold good which can come from the causal effect of
+religious and ethical ideas. Those faith curists who bring mutual help
+by impressing each other with the beauty and goodness of the world
+really bring new strength to the wavering mind; and the most natural
+channel for religious help remains, of course, the word of the minister
+and the own prayer. Religion may work there causally in a double way.
+The own personality is submerging into a larger all-embracing hold and
+thus inhibits the small cares and troubles of merely personal origin.
+The consciousness sinks into God, a mental process which reaches its
+maximum in mysticism. The haphazard pains of the personality disappear
+and are suppressed by the joy and glory of the whole. This submission of
+will under a higher will and its inhibitory effect for suppression of
+disturbing symptoms must be wonderfully reënforced by the attitude of
+prayer. Even the physiological conditions of it, the clasping of the
+hands, the kneeling, and monotonous sounds reënforce this inhibition of
+the insignificant dissatisfactions. On the other hand, contact with the
+greater will must open the whole reservoir of suppressed energies, and
+this outbreak of hidden forces may work towards the regeneration of the
+whole psychophysical system. Neglected functions of the brain become
+released and give to the mind an energy and discipline and self-control
+and mastery of difficulties which restitutes the whole equilibrium, and
+with the equilibrium comes a new calmness and serenity which may react
+almost miraculously on the entire nervous system and through it on the
+whole organism and its metabolism.
+
+Seen from a causal point of view, however, there is no miracle in it at
+all. On the contrary, it is a natural psychophysical process which
+demands careful supervision not to become dangerous. It is not the value
+of the religion which determines the improvement, and it is not God who
+makes the cure; or to speak less irreligiously, the physician ought to
+say that if it is God who cures through the prayer, it is not less God
+who cures in other cases through bromide and morphine, and on the other
+side just as God often refuses to cure through the prescribed drugs of
+the drug store, God not less often refuses to cure through prayer and
+church influence. But the real standpoint of the physician will be to
+consider both the drugs and the religious ideas merely as causal
+agencies and to try to understand the conditions of their efficiency
+and the limits which are set for them. From such a point of view, he
+will certainly acknowledge that submission to a greater power is a
+splendid effect of inhibition and at the same time a powerful effect for
+the stimulation of unused energies; but he will recognize also that the
+use of those silent energies is not without dangers.
+
+Certainly nature has supplied us with a reservoir of normally unused
+psychophysical strength, to which we may resort just as the tissues of
+our body may nourish us for a few days when we are deprived of food, but
+such supply, which in exceptional cases may become the last refuge,
+cannot be used without a serious intrusion and interference with the
+normal household of mind and body. To extract these lowest layers of
+energies may mean for the psychophysical system a most exhausting effort
+which may soon bring a reaction of physical and nervous weakness. The
+chances are great that such a religious excitement, if it is really to
+have a deep effect, may go over into a mystic fascination which leads to
+hysteria or into an exhausting eruption of energies which ends in
+neurasthenic after-effects. The immediate successes of the strong
+religious influence on the weakened nervous system, especially on the
+nervous system of a weak inherited constitution, are too often stage
+effects which do not last. From a mere purposive point of view, they may
+be complete successes. They may have turned the immoral man into a moral
+man, the skeptic into a believer, but the physician cannot overlook
+that the result may be a moral man with a crippled nervous system, a
+believer with psychasthenic symptoms. From the point of view of the
+church, there cannot be too much religion; from a therapeutic point of
+view, religion works there like any other nervous remedy of which five
+grains may help and fifty grains may be ruinous.
+
+Moreover this power of inhibiting the little troubles of the body and of
+bringing to work and effectiveness the deepest powers of the mind
+belongs not less to any other important idea and overpowering purpose.
+The soldier in battle does not feel the pain of his wound, and in an
+emergency everybody develops powers of which he was not aware. The same
+effect which religion produces may thus be secured by any other deep
+interest: service for a great human cause, enthusiasm for a gigantic
+plan, even the prospect of a great personal success. Thus in a
+psychotherapeutic system, religion has only to take its place in line
+with many other efforts to inhibit the feeling of misery and to
+reënforce will and self-control by submission under a greater will. That
+in the case of religion this submission, from an entirely different
+purposive point of view, also has a moral and religious value, has in
+itself no relation to the question of its therapeutic character. It
+ought not to lead to any one-sided preference, inasmuch as religiously
+indifferent agencies may be in the particular case a more reliable means
+of improvement. Moreover the psychological symptoms are, after all, only
+a fraction of the disease and very different bodily factors, digestion
+and nutrition, heart and lungs and sexual organs may be most intimately
+connected with the disturbance of the equilibrium. Medicine today no
+longer believes that hysteria originates in the diseases of the uterus
+or that neurasthenia necessarily results from insufficiencies of the
+stomach, but it would be a graver mistake to believe that mental factors
+alone decide the progress of the disease, however prominent the mental
+symptoms may be in it.
+
+From the physician's encouragement and the minister's influence towards
+new faith in life, a short way leads to the influence of suggestion. It
+is on the whole the way which leads from the general psychotherapeutic
+treatment to the specific one directed against particular symptoms.
+
+
+
+
+IX
+
+THE SPECIAL METHODS OF PSYCHOTHERAPY
+
+
+Of course there is no abrupt division between special and general
+methods. Yet the different tendency is easily recognized, if we turn
+only, for instance, from the mere sympathy and encouragement to the
+method of reasoning with the patient about the origin of his special
+complaint. Just now the medical profession moves along this line a great
+deal. Of course no well-trained psychotherapist will make the blunder of
+arguing with the insane. To dispute by argument with the paranoiac and
+to try to convince him would not be only without success, but easily
+irritating. This does not mean that the not less amateurish way ought to
+be taken of accepting his delusions and appearing to be in full
+agreement with him. A tactful middle way, preferably a disciplinary
+ignoring attitude, ought to be taken. But it is entirely different with
+the mental states of the psychasthenic. The mere statement and objective
+proof that his obsession is based on an illusion would be ineffective.
+He knows that himself, but he may take the disturbance as the beginning
+of a brain disease, as a form of insanity, as a lasting damage which
+lies entirely beyond his control. Now the physician explains to him how
+it all came about. He shows to him that the symptoms resulted merely
+from autosuggestion or are the after-effects of a suggestion from
+without or of a forgotten emotional experience of the past. That is a
+new idea to the patient and one which changes the aspect and may have an
+inhibitory influence.
+
+Of course, the patient does not accept the explanation at once. He feels
+sure that he is not accessible to suggestion and that he has least of
+all a tendency to autosuggestions, but the skillful psychotherapist will
+find somewhere an opening for the entering wedge. He may develop to the
+patient the modern theories of the origin of neurotic disturbances, all
+with entire sincerity and yet all shaped in a way which gives to the
+special case an especially harmless appearance. He may even enter into
+experimental proof that the patient is really accessible to
+autosuggestions. A very simple scheme for instance is to put some
+interesting looking apparatus with a few metal rings on the fingers of
+the subject and connect it with a battery and electric keys. The key is
+then pushed down in view of the patient and he is to indicate the time
+when and the place where he begins to feel the galvanic current. The
+feeling will come up probably very soon in the one or the other finger,
+and as soon as he feels sure that the sensation is present, the
+physician can show him that there was no connection in the wires, that
+the whole galvanic sensation was the result of suggestion.
+
+Such a method demands patience and good will. The prejudices and
+deeply-rooted hypochondriac ideas, foolish theories of the patient and
+pessimistic emotions which have become habitual, must be removed piece
+by piece until the central symptoms themselves can be undermined and
+explored. It often takes hours of careful and fatiguing reasoning, in
+which at any time the patient may suddenly slip back to his old ideas.
+Yet if the explanatory arguments have once succeeded in making the
+patient himself believe firmly that his whole trouble resulted from
+suggestion only, the inhibitory effect of this idea may be an excellent
+one. The only serious defect of the method is that it often does not
+work. The credit which neurologists of today give to its effectiveness
+seems to me much too high. Even slight neurasthenic and psychasthenic
+disturbances remain too often in complete power when the patient is
+fully convinced that they originated with an emotional excitement which
+has long since lost its feeling value or that it resulted from a chance
+suggestion picked out from indifferent surroundings. The patient knows
+it and yet goes on suffering from the fruitless fight of his will
+against the intruder. Where mere reasoning is entirely successful, I am
+inclined to suspect that an element of suggestion has always been
+superadded. The authority of the physician has created a state of
+reënforced suggestibility in which the argument convinces, not by its
+logic but by its impressiveness.
+
+This element of suggestion is quite obvious when the argument takes the
+form of persuasion, a psychotherapeutic method which has found its
+independent development. Whoever seeks to persuade relies on the mental
+fringe of his propositions. The idea is not to work by its own meaning
+but by the manner of its presentation, by its impressiveness, by the
+authority, by the warmth of the voice, by the sympathy which stands
+behind it, by the attractiveness with which it is offered, by the
+advantages which are in sight. Thus persuasion relies on personal powers
+to secure conviction where the logic of the argument is insufficient to
+overcome contradictions. But just for that reason persuasion is after
+all only a special kind of suggestion.
+
+Other methods work on the same basis. Prominent among them is the
+psychotherapeutic effect of a formal assurance. The psychotherapist
+assures the patient that he will sleep the next night or that the pain
+will disappear or that he will be able to walk with such firmness that
+the counter-idea is undermined. It depends on the type of patient
+whether such suggestions of belief work better when it is assured with
+an air of condescension, spoken with an authority which simply ignores
+every possible contradiction, or with an air of sympathy and hope.
+Experience shows that it is favorable to connect such assurance with the
+entrance of a definite signal. "You will sleep to-night when the clock
+strikes ten," "The pain will disappear when you enter the door of your
+house," or perhaps, "Read this letter three times quietly in a low
+voice, and at the end of the third reading your fear will suddenly
+stop." Psychological insight will further decide whether it is wiser in
+the particular case to assure the patient of the resulting effect or
+rather of the power to bring about the effect. With some people, it
+works better to insist that the result will happen, with others to
+promise that they themselves can secure it; in the one case they feel
+themselves as passive instruments, in the other as real actors. To some
+hysterics, it is better to say: "You will walk," to others, "You can
+walk."
+
+This belief in the future entrance of a change frequently demands an
+artificial reënforcement. There belongs first the application of
+external factors which awaken in the background of the mind the
+supporting idea that something has been changed in the whole situation
+or that some helpful influence has made the improvement possible.
+Medicines of colored and flavored water, applications of electric
+instruments without currents, in extreme cases even the claptrap of a
+sham operation with a slight cut in the skin, may touch those brain
+cells which words alone cannot reach with sufficient energy and may thus
+secure the desired psychophysical effect. The patient who by merely
+mental inhibition has lost his voice for weeks may get it back as soon
+as the physician has looked into his larynx with a mirror and has held
+an electrode without battery connection on the throat. Another way of
+helping by make-believe methods is to give the impression that a decided
+improvement is noticeable. The uneducated patient believes it easily
+when the physician at his very entrance into the office expresses his
+surprise about the external symptoms of a change for the better, perhaps
+seen in the color of the skin or the shading of the iris in the eye and
+reaffirmed by some pseudotests of the muscle reflexes. All that is not
+very edifying and the decent physician, who justly feels somewhat
+dragged down to the level of the quack in applying such means
+frequently, will abstain from them wherever possible. He knows that in
+the long run, even the psychasthenics are best treated with frankness
+and sincerity and he will therefore only in exceptional cases resort to
+such short-cut treatment by making believe. Yet that it is sometimes
+almost the only way to help the patient cannot be denied.
+
+A neater way to secure the sufferer's belief in the possibility of a
+cure is by securing the desired effect at least once through little
+devices. As soon as it is once reached, the patient knows that it can be
+reached and this knowledge works as a suggestion. The hysteric who
+cannot speak when he thinks of his words, or who cannot walk when he
+thinks of his legs, may by the skillful physician be brought to a few
+words or steps before he himself is aware of it by completely turning
+his attention to something else and producing the stimulus toward the
+movement in a reflex-like way. Still more successful is the effort to
+resolve the inhibited action into its component parts and to show to the
+patient who cannot perform the action as a whole that he can go through
+the parts of it after all. As soon as he has passed through a few times,
+a new tactual-visual image of the whole complex is secured for his
+consciousness and this image works then as a new cue for the entire
+voluntary action, overcoming the associated counter-idea.
+
+Another excellent way to overpower a troublesome idea or impulse or
+emotion is to reënforce the opposite idea by breaking open the paths for
+its motor expression. The effort to hold the counter-idea before
+consciousness may be unsuccessful so long as it is only an idea which
+tries in vain to produce any motor effect; but if the action itself has
+been repeatedly gone through, the idea will find it easier to settle and
+it becomes vivid in proportion to the openness of the channels of motor
+discharge. This holds true even for emotional states. A certain word
+perhaps picked up by the psychasthenic in a particular experience may
+produce whenever it is seen a shock and a depressing emotion. If we ask
+the patient to go artificially through the movements which express joy
+and hilarity, make him intentionally grin and open wide the eyes and
+expand the arms and inhale deeply, and after training this movement
+complex of joyful expression, speak the dreaded word at the height of
+the movement a new feeling combination clusters about the sound and may
+overcome the antagonism. Sometimes you will give to the desirable idea
+sufficient strength by mere repetition, sometimes you force the
+attention better by unusual accentuation, connecting the suggestion with
+a kind of shock. From here it is only one step to the suggestion in the
+form of a sharp order which breaks down the resistance just by its
+suddenness and loudness, supported perhaps by a quick arm movement which
+gives a cue for imitative reflexes. In the case of a youngster even a
+slap may add to the nervous shock; also a sudden clapping of the hands
+may favor effectiveness of the suggestive order.
+
+Often it is wise to give the suggestion, not from without but to
+prescribe it in the form of autosuggestions. For instance, advise the
+patient not only to have the good will and intention of suppressing a
+certain fixed idea or by producing a certain inhibited impulse but to
+speak to himself in an audible voice, every morning and every evening,
+saying that he will overcome it now. Here, too, the autosuggestion may
+become effective by the frequency of the repetition or by the urgency of
+the expression or by the accompanying motor reactions. As a matter of
+course any associations which reënforce the idea may be used for
+assistance. Especially near-lying is the appeal to the man's conscience,
+but just such associations which touch the idea of the own personality
+and its deepest layers of feelings are always risky. They may touch and
+stir up old memories which interfere with success or they may awaken a
+feeling of contrast between duty and fulfillment which may disturb the
+whole equilibrium. If the physician knows that the good-will of the
+patient is insufficient to overcome the pathological disturbance, he
+ought not to make him feel ashamed or guilty, and that not only for
+moral reasons but also for strictly psychotherapeutic reasons.
+
+In certain easily recognizable cases, it is essential to give the
+suggestion with avoidance of any emphasis, only as a hint, passing as if
+the suggestion almost slipped from the tongue of the doctor without his
+real intention. The hysteric who is resisting the suggestion which is
+intentionally given to her is sometimes surprisingly trapped by a
+half-hidden suggestion, perhaps not spoken to the patient herself at all
+but spoken in a low voice to a colleague in the room. Sometimes we have
+to trick those who suffer by "negativism," that is by an obstinacy which
+exaggerates that of the ordinary stubborn man. In such cases the
+suggestion not to perform an action works best if we want the action
+performed. There is hardly an end to the list of such methods for
+bringing beliefs and attitudes with suggestive power to the mind of the
+sufferer. Definitely to describe the conditions under which the one or
+the other form ought to be applied would be no wiser than to tell a
+statesman what steps are to be taken in every possible diplomatic
+situation. The instinctive selection of the right means among the many
+possible ones characterizes both the true statesman and the true doctor.
+
+So far we have spoken only about the character of the suggestion,
+presupposing that the receiver remains in his natural state. This
+presupposition is certainly often entirely correct, but as far as it is
+correct, the results of the suggestion vary greatly with the different
+individuals. On the whole, we might say that such suggestions given to
+the subject in his normal state are effective only when the subject is
+by nature a suggestible being. In considering the psychology of
+suggestion, we recognized at once that the degree of natural
+suggestibility varies excessively. The non-suggestible mind is only to a
+slight degree influenced by any of these proposed forms of suggestion as
+long as the suggestibility itself is not heightened. To be sure, the
+question whether the person is suggestible by nature or not cannot be
+settled simply by his own impression. Many of the most suggestible
+persons believe firmly that they are superior to any suggestive
+influence.
+
+To bring suggestions to greater effectiveness and to exert their
+influence practically upon every possible subject, we have thus not only
+to give suggestions or to advise autosuggestion but in both cases we
+have to secure, especially for the naturally less suggestible patients,
+a somewhat heightened suggestibility. Yet no one can overlook that some
+of the methods which we described have in themselves the tendency to
+reënforce the mental suggestibility. Those methods of emphasis and
+order, of assurance and make-believe, of practical training and of
+awakening counter-ideas, of persuasion and even of reasoning, wherever
+they are in a high degree successful probably always gain a certain part
+of their success by the increased suggestibility which the whole
+situation brings with it.
+
+This reënforcement of the psychophysical readiness for suggestions
+results indeed quite directly both from expectation of the unknown and
+of the half-way mysterious, and from the confidence in the doctor. Of
+course it can work very differently. The expectation can upset the
+nervous system and produce unrest instead of suggestibility and, instead
+of confidence, the patient may feel that discouraging diffidence which
+settles easily upon those who have tried one fashionable physician after
+another. But where there is real confidence, based perhaps on the fame
+of the doctor and on the reports of his powerful achievements, there the
+conditions for effective suggestions are greatly strengthened. Still
+better is it if this confidence in the man is combined with a sincere
+hope for recovery. To lie down on a lounge on which hundreds have been
+cured fascinates the imagination sufficiently to give to every
+suggestion a much better chance to overcome the counter-idea. The
+expectation that something wonderful will happen can even produce an
+almost hypnoid state. The effect will be the greater, the less the
+barriers of systematic knowledge hinder the entrance of suggested ideas.
+The uneducated will on the whole offer less resistance to suggestions,
+just as superstitions find the freest play in the minds of the
+untrained. It is not by chance that the earlier epidemics of
+pathological suggestibility have on the whole disappeared with the
+better popular education. In a similar way work fatigue and exhaustion.
+The resistance has grown weaker, the suggested idea goes automatically
+into activity.
+
+Skillful artificial means can still surpass the effect of these natural
+conditions. Here belongs everything which accentuates the authority and
+dignity of the originator of the suggestion. The psychologically trained
+physician has no difficulty in heightening the effect by simple
+surprises, if he cares for such tricks. If the patient for whom a mental
+treatment is recognized as necessary shows himself too skeptical to
+submit to the powers of the psychotherapist, such captivation of his
+belief can easily be secured. Let the man perhaps fixate a penny on the
+table with his right eye, while the left is closed and you show him that
+you can make another penny suddenly disappear when you move it a certain
+distance to the right and appear again when you move it still further.
+As the man has never heard of the blind spot in the retina, he accredits
+you with a special power. Many similar psychological illusions can well
+be used to prepare the mind for unsuspected healing powers.
+
+Still stronger is the effect of personal contact. The psychophysiology
+of love indicates the most complex influence which contact sensations
+have on the whole nervous system and especially on the vasomotor
+apparatus of the body. Probably such vasomotor effect enters in,
+changing the blood circulation in the brain, when a personal contact
+between the transmitter and receiver of the suggestion is brought about.
+If the physician's hand rests quietly on the forehead of the patient who
+lies with closed eyes, or if he holds for a long while the hand of the
+patient, he may secure a nervous repose and submission which gives to
+the suggestions the most fertile soil. Needless to say that here again
+everything depends upon the accessories. An unsympathetic doctor may be
+entirely powerless where his neighbor has complete success. Neither a
+lifeless hand nor an agitating one will bring the desired repose,
+neither a cold nor a rough one. There must be strength and energy and
+even discipline, and yet sympathy in the pressure of the fingers. Again
+a psychologically different effect and yet one often to be preferred
+results from mild stroking movements, the stroke always to be repeated
+in the same direction, never up and down. The slow change in the
+position of the tactual sensations evidently produces a rather strong
+influence on the equilibrium of nervous impulses, and here again
+vasomotor reflexes seem to arise easily. Another variety of such bodily
+influences is given by artificial changes of the positions, for instance
+by bending the head of the subject backward while the eyes are closed.
+It may be that a certain lack of balance sets in in which the
+self-equilibrium is disturbed and an external influence can thus more
+easily get control of the psychophysical system. Again a certain
+monotony of speaking may easily add to the increase of the
+suggestibility.
+
+Everyone knows that another most fruitful cause of this change is any
+mystic inspiration, any emotion in which the individual feels himself in
+contact with something higher or larger or stronger. Of course, the
+church can secure this effect easily, and here again the maximum will be
+reached if a bodily contact with the symbol of religious exaltation can
+be established. The patient who can touch the relics of the saints or
+bathe in the waters of Lourdes or at least feel on his forehead the hand
+of the minister, is wrought up to a state of suggestibility which makes
+suggestions easily effective. The objective value of religion again has
+nothing to do with it, as exactly the same effect can result from the
+most barbarous superstition. The amulets of a gypsy might secure the
+same resetting of the psychophysical system which the most sacred
+symbols awaken, and even many an educated person is unable to cross the
+threshold of a palmist or an astrologist, or to attend the performance
+of a spiritist, or to sit down with a purchasable trance medium without
+feeling an uncanny mental state which is objectively characterized by an
+increased suggestibility. But finally, the same effect sets in when the
+symbols of other emotional spheres are applied, perhaps for the
+patriotic soldier the flag of his country.
+
+All the states of increased suggestibility which we have characterized
+so far still remain within the limit of normal wakefulness. We may turn
+now to the methods of the psychotherapist which produce in the interest
+of the suggestions an artificial state. However we have no right
+superficially to claim that the effectiveness of the suggestions is
+always greater in such unnatural states. On the contrary, we know that
+sometimes well applied suggestions work on wide-awake persons with
+increased suggestibility more strongly than on hypnotized subjects. Here
+even the instinct of the experienced physician may easily go astray, and
+it may need practical tests to find out which way will be the most
+accessible to the particular case. Often a certain rôle belongs even to
+natural sleep. It cannot be denied that some people can be influenced to
+some degree by words spoken to them during sleep. Most adults either
+wake up or show no signs of influence beyond effects on their dreams.
+But some absorb especially whispered words in such a way that their
+power becomes evident after the waking of the sleeper. Much more is this
+true of children. A suggestion to give up vicious habits, perhaps in the
+sexual sphere, or to speak fluently and no longer stammer may thus be
+beneficial. Yet the danger of this method is not small and extensive use
+of it is certainly not advisable. The more easily it can be carried into
+every bedchamber and can thus give to every mother and nurse the tools
+of a rather powerful therapy, the more a danger signal ought to be
+displayed. Interference with the natural sleep by outer influences
+creates abnormal conditions which cannot be removed at will. The chances
+are great that many unintended bad effects slip in and that not a few
+hysterias may be created by a method at the first glance so startling.
+Much less objectionable is it to make use of the effect of that period
+of half-sleep which precedes the natural sleep, and which is for many a
+period of increased suggestibility for autosuggestions. A resolution or
+the formulation of a belief which would be ineffective in a wide-awake
+state seems to get an accentuated effect on the mind, if it is
+repeatedly expressed in this transitional state. The psychasthenic who
+in such a half-dozing stage assures himself that he will no longer be
+afraid of going over a bridge or hearing a thunderstorm or will feel a
+disgust for whiskey or will have the energy for work, has a certain
+chance that such autosuggestions become reality the next morning. With
+many others there seems no effect to be obtained and not a few seem
+unable to catch the right moment. As soon as they begin to speak they
+become wide awake or fall asleep before they talk.
+
+Incomparably more value belongs to the artificial sleep, the mesmeric
+state of earlier days, the hypnotism of our time. We have discussed its
+theory and recognized that an abnormally increased suggestibility is
+indeed its chief feature. We know hypnotism in most various degrees; the
+lowest can be reached practically by everyone, the highest by rather
+few. It is almost arbitrary to decide where those waking states with
+high tension of suggestibility end and the hypnotic states begin, and
+not less arbitrary to call the higher degrees only hypnotism and to
+designate the lower degrees as hypnoid states. If we do it, we certainly
+should acknowledge from the start that the hypnoid states are for
+therapeutic purposes not a bit less important than the full hypnotic
+states. Certainly the hypnoid states do not allow complex hallucinations
+and absurd post-hypnotic actions, but they offer excellent starting
+points for the removal of light obsessions and phobias and for the
+reënforcement of desirable impulses, volitions, and emotions. Many
+persons cannot under any circumstances be brought beyond such a hypnoid
+degree. The physician who has not theoretical experiments but practical
+success in view ought therefore never to trouble himself with the
+inquiry exactly which degree has been reached. This advice is given
+because nothing interferes with the progress of hypnotic influence so
+badly as the constant testing. It must naturally often lead to a point
+where the subject finds that he can very well still do what the
+hypnotizer told him not to do. If the doctor assures him that he can no
+longer move his arm and the patient is yet able to move it, the doctor
+secures the very superfluous knowledge that this special degree of
+suggestibility has not been reached, but the patient is sliding backward
+and the lower degree which actually had been reached will be less
+accessible later. The physician might rather resort to the opposite
+course and assure the patient, even after the first treatment which
+might have been a slight success, that he saw from definite symptoms
+that hypnosis had set in. That will greatly smooth the way for real
+hypnotic effects the next time.
+
+The best method of hypnotizing is the one which relies essentially on
+the spoken word, awakening through speech the idea of the approach of
+sleep. If the hypnotizer assures the subject in monotonous words that a
+feeling of fatigue is setting in, that he is feeling a tiredness
+creeping over his shoulders and arms and legs, that his memories are
+fading away and that he is now hypnotized, for not a few all is done
+that is needed. The hypnotic state will come and will hold until the
+verbal suggestion takes it off again. Perhaps the hypnotizer says that
+he will count three and at three the subject is to open his eyes and
+feel perfectly comfortable. It is wise to tell the patient beforehand
+that he will not lose consciousness and that he will remember afterward
+whatever happens as many people believe that loss of memory belongs to
+the hypnotic state, and that they were not hypnotized if they can
+remember what happened. Such a skeptical after-attitude can seriously
+interfere with the success of the treatment.
+
+Yet in most cases, it will be safer not to rely on words only but to
+supplement them by manipulations which all converge towards the effect
+of increasing the suggestibility and thus of overcoming the resistance
+to the suggestions introduced. It is well known that for this purpose it
+is advisable to begin the influence with some slight fatiguing
+stimulations. The effect is most easily reached when the patient fixates
+perhaps a shining button held over his eyes or listens to monotonous
+sounds. A particularly strong effect belongs again to very slight touch
+stimuli. If the subject with his eyes closed is touched perhaps by two
+pencils at various and unexpected points of the face and hands, a
+skillful playing on his tactual senses soon produces a half-dozing state
+of hypnoid character. In the same group belong those so-called passes
+which evidently have a reflex influence in the blood-vessel system. It
+is advisable to combine the various elements in such a way that at first
+physical stimuli upon eye or skin produce an over-suggestible state and
+that only as soon as this state is reached the verbal suggestion sets
+in, perhaps with the words, "I shall hypnotize you now." Under such
+conditions every subject may soon be brought to that degree of
+hypnotization which is accessible to him. Yet more than one treatment is
+usually necessary for the higher degrees. Much less importance for
+therapeutic purposes belongs to that hypnoid state which is reached
+without the idea of sleep where the subject comes with open eyes into a
+kind of fascination, produced perhaps by a sudden flash of light or by
+the firm eye of the hypnotizer. It is a state which can lead to a strong
+submission of will and which has its legal importance. Therapeutically
+it can hardly secure an effect which cannot better be secured through
+the real sleeplike hypnotism. Under certain conditions, chemical
+substances may well prepare for the hypnotic treatment, for instance
+bromides or alcohol. Others rely on the suggestive effect of flavored
+water. But all that is unwise. The confidence of the patient is the best
+preparation for the securing of the helpful degree of hypnotism.
+
+Of course only a small part of the therapeutic usefulness is secured
+during the hypnotic state itself. A pain may be removed, sleep be
+secured, an idea be inhibited, a movement be reënforced in cases where
+non-hypnotic suggestions would have found insurmountable obstacles.
+During the hypnosis we may also open the storehouse of memory and bring
+to light the ideas which disturbed the equilibrium of the suffering
+mind. Further in those most complex hysteric cases of dissociated
+personality, new memory connections may be formed during the hypnosis
+by which a synthesis of the double or triple personalities into the old
+one may be secured. Yet the general effect which the physician has to
+hope for from hypnotic treatment is the post-hypnotic one. Not what
+happens during the hypnosis but what the suggestion will produce after
+hypnosis is essential to him. The fixed idea is to disappear forever,
+the paralyzed limb is under control, the desire for morphine and cocaine
+is gone for all future time, the perverse longing is annihilated, the
+old energy is to remain again for all time. It is the post-hypnotic
+after-effectiveness which gives to the hypnoid and to the hypnotic
+states their importance for the treatment of the most exasperating
+symptoms. To be sure, the treatment often must be a prolonged one. A man
+who for years has used thirty grains of morphine a day cannot be rid of
+the desire after two or three hypnotic sittings. In such a case the
+treatment may cover three or four months, if it is to be of lasting
+value and without any damage during the treatment.
+
+Still we are not at the end of the psychotherapeutic methods and we may
+turn to a fascinating group of curative efforts which has especially
+come to the foreground in recent years. We mentioned before that
+mischief cannot seldom be traced back to earlier experiences with a
+strong unpleasurable feeling. In certain cases, the subject remembers
+such particular experiences as the beginning of his discomfort; in
+others, especially those of hysteric character, the starting point may
+have long been forgotten, and yet that early impression evidently left
+traces in the brain which produce disturbances in conscious life. The
+psychotherapist nowadays calls these groups of traces "complexes." We
+recognized clearly that there is no reason to refer such forgotten
+remainders of the past to any subconscious mind; they are physical
+after-effects which keep their influence over the equilibrium of the
+psychophysical system. Now modern psychotherapy finds that the entire
+disturbances which arise from such emotional disagreeable experiences,
+forgotten or not forgotten, can often be removed by psychical means. Two
+ways in particular seem open. As soon as the idea is fully brought back
+to consciousness again, the patient must be made to express the primary
+emotion with full intensity. Subtle analysis has repeatedly shown that
+many of the gravest hysteric symptoms result from such a suppression of
+emotions at the beginning and disappear as soon as the primary
+experience comes to its right motor discharge and gains its normal
+outlet in action. The whole irritation becomes eliminated, the emotion
+is relieved from suppression and the source of the cortical uproar is
+removed forever.
+
+Practically still more important seems the other case which refers alike
+to hysterics and psychasthenics and which is applicable for the
+forgotten experience not less than for the well-remembered ones. This
+second way demands that the psychotherapist bring this primary
+experience strongly to consciousness and then by a new training link it
+with new and more desirable associations and reactions. The disturbing
+idea is thus not to be discharged but to be sidetracked so that in
+future it leads to harmless results. The new setting works towards an
+entirely new equilibrium. What was a starting point for abnormal fears
+now becomes an indifferent object of interest and all its evil
+consequences are cut off. It may be acknowledged that the full
+elaboration of these methods still belongs to the future. Both methods,
+the discharging, or the so-called cathartic one, and the side-tracking
+method evidently demand the discovery of the starting point in the
+service of the therapy and here again several methods are at the
+disposal of the psychologist.
+
+A promising way to this end is the inexhaustible association test which
+we mentioned when we discussed the contributions of the psychological
+laboratory to the medical diagnosis. A series of short words are spoken
+to the patient and, as soon as he hears one, he is to pronounce as
+quickly as possible the first word which comes to his mind. If we use
+fifty words, we should be able to learn something as to the inner states
+of the man and as to the working of his mind, if we analyze carefully
+his particular choices. But two further conditions ought to be
+fulfilled. The time of the association ought to be measured. Of course
+there will be wide differences. A word which is often in a certain
+connection will quickly bring the habitual association. Abstract words
+will call forth their associations more slowly than concrete words,
+familiar words more rapidly than unfamiliar words. To measure such
+association time with fullest accuracy, as it is necessary for the
+purpose of scientific investigations, delicate electrical instruments
+are needed that indicate thousandths parts of a second. For the purpose
+of the practical physician such accuracy would be superfluous. His
+examination will be perfectly successful if it is carefully done with a
+stop-watch which shows the fifth part of a second, like those which are
+used at races. He speaks a word, presses at the same time the button of
+the watch, and presses the stopper when he sees the lips of the patient
+moving. He is thus able to examine not only the involuntary choice of
+association but also the time of every associative process. But a second
+condition ought also to be fulfilled. After some indifferent words,
+others ought to be mixed into the series which touch in a tentative way
+on various spheres corresponding to the possible suspicions. The groups
+to which the hidden thoughts of psychasthenics, for instance, belong are
+not many. As soon as our series of words strikes such a group, the
+reaction of the mind may be discriminated. The effect may be a general
+perturbation resulting either in an unusual delay of the fitting
+association or in an effort to cover the sore spot by an unfitting
+association. Sometimes the dangerous association may rush forward even
+with unusual rapidity but, as soon as it is uttered, it gives a shock to
+the mental system, brings the whole associative process into disorder,
+and the result is that the next following associations are abnormally
+delayed. The skilled psychologist will quickly take such a change as a
+cue for the selection of the later words in his series. Of course, he
+will at first return to neutral words, but as soon as he has found a
+danger spot, he will approach it from various sides, perhaps in every
+fourth or fifth word, and may then find out which particular experiences
+are disquieting the patient. Words like women or money or career or
+family or disease are often sufficient to get the first inkling of a
+mental story.
+
+With less diagnostic elegance we sometimes reach the same end by taking
+careful records of pulse and breathing and involuntary movements during
+an apparently harmless conversation. The instruments at the disposal of
+the psychologist are those familiar to every psychological laboratory:
+the pneumograph, which registers the movements of respiration; the
+sphygmograph, which writes the pulsation of the artery in the wrist; the
+automatograph, or other instruments, which register the slight
+unintentional movements of the arm. If the examiner is skillful, he will
+not fail to discover the changes in breathing and pulse and reaction as
+soon as the painful groups of ideas are approached. More of theoretic
+interest and too cumbersome for practical diagnosis is the unfailing
+galvanic reaction from the skin in which the glands change their
+activity and their resistance to the galvanic current under the
+influence of hidden emotions. Yet all these methods, with exception of
+the last, are essentially useful only if the starting experience is
+still accessible to the memory of the patient. He may be unaware that it
+had anything to do with his nervous symptoms but he recognizes the
+experience still as soon as his attention is directed towards it. The
+psychologically more interesting but probably more exceptional situation
+is the one in which it is not only forgotten but cannot be recognized
+when it is brought to consciousness. The shortest way to get hold of
+such past impressions is the hypnotic one. The hypnotic state sharpens
+the memory and experiences of early childhood or apparently
+insignificant experiences of later life may be brought back when they
+would have been inaccessible to any intentional effort of the attention.
+Even still more surprising is the success if the association is left to
+a dreamy play of ideas suggested perhaps by gazing into a crystal ball
+or by a meaningless talking. Perhaps the patient lies with closed eyes
+on the couch while the physician holds his hand. A few words are given
+to him as a starting point and then he is thoughtlessly to pronounce
+whatever comes to his mind, not only unfinished sentences but loose
+phrases, single words, apparently without meaning and slowly ideas arise
+which betray the original intrusion. At last memories and lost emotions
+come again to the surface, and the watchful psychotherapist may discover
+the complex, which is then to be removed by discharge or by
+side-tracking. This is the so-called psychoanalytic method.
+
+Finally the psychotherapist may go still one step further. After all it
+often seems inexplainable that just this or that emotional experience
+made such a deep and lasting impression while a thousand other
+experiences passed by without leaving any mischievous after-effect. It
+seems that indeed the conditions are still more complicated. That
+emotional disturbance operated dangerously perhaps only because it
+itself appealed to a suppressed desire and this seems to hold true
+especially for suppressed emotions of the sexual sphere. The desire for
+gratification in normal or abnormal channels was perhaps attached by the
+mind to some group of objects. It was completely suppressed but it left
+an abnormal tension in the central system. If now a chance experience
+touches on this group of ideas, there results an explosive reaction; and
+movements, convulsions, spasms, obsessions, and fears set in which get
+their particular character not through the secondary intrusion but from
+the primary desire. To discharge that intrusion leads therefore only to
+the elimination of those symptoms which resulted from it, but the
+primary disturbance goes on and any new chance intrusion will produce
+new explosions. The psychotherapist should therefore go deeper and
+relieve the mind from those primary desires which may belong to early
+youth and which are entirely forgotten. Even the method of automatic
+writing may here sometimes lead to an unveiling of those deepest layers
+of suppressed desires. In the same way a careful, subtle analysis of
+dreams may support the search for the hidden source of interference.
+
+We have spoken of the technical methods of the psychotherapist. It would
+be short-sighted to ignore the great manifoldness of secondary methods
+which he shares with the ordinary intercourse between man and man, the
+methods which the teacher uses in the schoolroom, which the parents use
+in the nursery, which the neighbor uses with his neighbor, methods which
+build up the mind, methods which train the mind, methods which reënforce
+good habits and suppress unwholesome ones, methods which stimulate sound
+emotions and inhibit a quarrelsome temper, methods which indeed are not
+less important in the psychiatric clinic and in the hospital than in our
+daily life, and which certainly have central importance in that
+borderland region which is the particular working field of the
+psychotherapist.
+
+
+
+
+X
+
+THE MENTAL SYMPTOMS
+
+
+We have discussed both the psychological theory and the practical work
+of psychotherapy in a systematic order without any reference to personal
+chance experience. After studying the fundamental principles, we have
+sketched the whole field of disturbances in which psychotherapeutic
+influence might be possible and all the methods available. It seems
+natural that our next step should be an illustrating of such work by a
+number of typical cases. Here it seems advisable to leave the track of
+an objective system and to turn to the record of personal observation.
+As this is not a handbook for the physician, dealing with the special
+forms of disease, we emphasized before that we avoid even any attempt in
+such a direction because it would have to introduce not only the
+questions of diagnosis, but above all the highly important questions of
+treatment by physical agencies. We saw that for us nothing else can be
+desirable, but to show the way in which the various symptoms which
+suggest mental treatment occur, and how they yield to the psychical
+methods. We had also agreed beforehand that for a first survey we might
+separate the mental from the bodily symptoms and group the mental ones
+with reference to the predominance of ideational, emotional, and
+volitional factors. And finally it may be said that we abstain from
+everything which is exceptional or even unusual, and confine ourselves
+to the routine observations with which the psychotherapist comes in
+contact every day and the simplest country physician surely every week.
+
+Thus I turn from systematic objectivity to my unsystematic reminiscences
+of many years. Of course, they abound with eccentric abnormities and
+startling phenomena. As I have devoted myself to psychotherapeutics,
+always and only from scientific interest, as a part of my laboratory
+studies and therefore have refused to spend any time on cases which
+offered no special psychological interest to me, the striking and
+sensational cases have prevailed in my practice even to an unusual
+degree. Yet they are unessential for our purposes here, the more as
+their interest lies mostly in the complex structure of the mental state
+while the curative features are in the background. Our purpose of
+demonstrating practical cases as they occur in every village, and as
+they ought to be understood and treated by every doctor, thus rules out
+just those experiences which would be prominent in a theoretical study
+of abnormal psychology. We want to select only simple commonplace cases.
+Only those who have not learned to see are unaware that such cases are
+everywhere about them.
+
+As a matter of course, I also leave out everything which refers to
+insanity, that is, every mental disturbance which lies essentially
+outside of the domain of psychotherapy. The helpful influence which
+psychical factors can exert in the asylums for the insane is, as we
+emphasized, entirely secondary. The psychotherapeutic methods in the
+narrower sense of the word are in the present state of our knowledge
+ineffective in the insane asylum. I should also be unable to speak of
+laboratory experience with insanity, as I insist on sanitarium treatment
+in every such case. The question of how to differentiate the diagnosis
+of insanity from that of the other mental abnormities is not our
+question at this moment. I select the few illustrations which seem to me
+desirable for the purpose of making more concrete our abstract
+discussion of methods, essentially from the class of neurasthenics,
+psychasthenics, hysterics, and so on.
+
+In all these reports, I shall confine the account to the few points
+which are to illustrate the psychical factors, thus abstaining entirely
+from the further details which any medical history of the cases would
+demand and from all results of further examination and other
+particulars. As a matter of course, I exclude the possibility of
+identifying the patient. I may start with a typical case of obsessing
+ideas of simplest character and with simple routine treatment
+illustrating the emphasis on antagonistic ideas.
+
+     A man of mature age, well educated, well built and in every respect
+     in good health, without nervous history and without other nervous
+     symptoms, suffered vehemently by the persistent recurrence of a
+     visual image which entirely absorbed his attention. He knew
+     exactly the development of his trouble. A woman acquaintance of his
+     had committed suicide by poisoning herself. He knew her slightly
+     and the emotion of personal loss played hardly any rôle in the
+     case. But he had met her at a gay dinner a short time before her
+     death. The news of the suicide came to him when he was overtired
+     from work. The idea of the contrast between seeing his friend
+     partaking of the dinner and imagining her drinking the poison gave
+     him a strong shock. There was hardly any grief mixed in. He
+     remembers that he shivered at the thought of the contrast, and in
+     that moment the visual image of the woman raising a glass of poison
+     to her mouth flashed into his mind and thus became almost a part of
+     the shock. From that time on, the memory image of this scene
+     returned more and more frequently. At first it associated itself
+     with any chance mentioning of death or suicide and to a very slight
+     degree with the idea of a meal. More and more any element of a meal
+     and of social life, the word soup or meat, the word gown or dance,
+     brought up at once the picture of the woman, which had in the
+     meantime lost every element of personal relation. Any sad thought
+     of her ending had faded away. It remained merely a troublesome
+     impression. The man fought against it by trying to suppress the
+     idea but the more he fought against it, the more insistently it
+     rushed forward through new and ever new association paths. Any
+     advertisement in the newspaper referring to food, anything in a
+     shop window referring to ladies' dresses, any household utensils
+     related to a meal, and especially the meals themselves, forced the
+     visual image into the centre and captured the attention to such a
+     degree that a confusing distraction from the real surroundings
+     resulted. The struggle against the idea became more and more
+     exasperating, made life a torture, almost suggested despair, even
+     faint thoughts of suicide, and especially a growing fear that it
+     was a symptom of the beginning of insanity.
+
+     When he came to me, a number of physical cures, especially bromides
+     and electricity, had been tried in vain by the physician. Some
+     weeks in the country had not changed the distress. He came to me
+     with the direct request as a last resort to try hypnotic treatment.
+     I found in spite of the fact that he and his physician had
+     constantly spoken of visual hallucinations that the visual image
+     had no hallucinatory character at all, that is, he never believed
+     that he saw the image of that woman as if it were actually present,
+     he never took the product of his imagination for reality, nor had
+     it the vividness and character of reality. It was hardly more vivid
+     than any landscape which he tried to remember, only that it
+     controlled the interplay of ideas in such a persistent way. I found
+     that he was a strong visualizer and easily suggestible. I told him
+     beforehand that I should hypnotize him only to a slight degree,
+     that he would not lose consciousness, that he would remember
+     everything which I told him. Then I asked him to lie down and had
+     him gaze on a crystal only for half a minute, then close the eyes.
+     I asked him to relax and to think of sleep. With the two blunt
+     points of a compass, I touched his two cheeks at corresponding
+     places, then his forehead. And now I told him that I would begin
+     with the hypnotic influence. I put my hand on his forehead and
+     spoke to him in a monotonous way, saying that he felt a fatigue in
+     his shoulders, and in his arms, creeping over his whole body and
+     assured him that he was now fully hypnotized. To what degree he
+     really was hypnotized cannot be said as no effort was made to test
+     it by any experiments, thus avoiding any possible reaction against
+     the feeling of submission. Expression and breathing indicated a
+     slight hypnoid state. Then I removed my hand and spoke to him in a
+     warm and assuring way.
+
+     I told him that in future he would give his full attention to his
+     meal, and not give the slightest attention to any image of his
+     friend. If he should think of the friend the memory would appear
+     indifferent, he would not even notice the image and would give his
+     whole mind to the objects with which he was engaged. In the same
+     way, when he should be reading newspapers or looking in
+     shopwindows, his whole attention would belong to that which he
+     really perceived. Any passing inner image would be ignored. Then I
+     awoke him from his sleep. He was unwilling to believe that he had
+     been in hypnosis at all. I told him that the effect would prove it
+     and in his fully wakeful state I explained to him why there was not
+     the slightest fear of insanity justified, that it was a
+     psychasthenic state resulting from fatigue and shock and from a
+     wrong attitude of his attention during the past months, and then I
+     asked him to return the next day. Intentionally I had not given the
+     suggestion that the image would disappear. I could not expect it
+     would disappear entirely after a first treatment and even a faint
+     appearance of it would have at once fascinated the attention and
+     brought about the whole disturbance of the equilibrium which might
+     become habitual. Instead of it I gave the impulse to the
+     counter-idea, that is, I reënforced the attention towards that
+     which he really saw around him and thus withdrew the attention from
+     the rival image in the mind. The success was complete. He came the
+     next day in a much happier frame of mind, reporting that he still
+     had seen the image of the woman every few minutes, especially
+     strongly at the breakfast table, but it had no longer troubled him.
+     It was more in the background of consciousness, sometimes it
+     appeared transparent, it no longer held his attention, and he felt
+     free to give his full attention to the actual surroundings.
+
+     On that basis I hypnotized him the second day and he had hardly
+     heard me saying that he ought to try to sleep when he was evidently
+     in a much deeper hypnotic state than the first time. Again I
+     suggested only the opposite attitude, the positive turning to the
+     surroundings and the complete neglect and indifference for the
+     possible memory image. This time the effect was still stronger. On
+     the third day he reported that he still saw the image but he no
+     longer minded it, as it was like a veil through which he looked at
+     real objects and that left him entirely indifferent. His mind was
+     hardly engaged with it any more. The real spell of the attention
+     was broken. On the basis of this situation, I took the last step
+     and suggested that the image of the woman would disappear
+     altogether and would not trouble him any more. In the next
+     twenty-four hours, it still returned two or three times, but
+     colorless and faint. The following day I was able to eliminate it
+     altogether. Even when the last trace of the inner struggle between
+     the memory and the perceived surroundings had disappeared, I went
+     on with two hypnotic sittings to give stability to the new
+     equilibrium, to insist that the image would not come back and to
+     settle completely that inner repose with which every fear of
+     possible disease evaporated. I feel sure that the cure would not
+     have been reached so quickly, possibly not at all, if the second
+     suggestion, the disappearance of the image, had been given at the
+     first step. The improvement was secured because the antagonistic
+     process itself was used for the suggestion. On the other hand,
+     there was no doubt that in this case the strong will of the patient
+     or suggestion in a normal state would not alone have been
+     sufficient. The hypnotic treatment was indicated by the symptoms
+     and justified by the results.
+
+I may take another typical case in which also the obsession was brought
+about by an idea without emotional value or at least by an idea which
+had lost its emotional character; the idea came somewhat nearer to
+hallucination, but had its chief elements on tactual ground where the
+transition from image to hallucinatory perception is easier. I add this
+case to demonstrate that hypnosis is not the only open way of treatment
+in such cases and that the variations must always be adjusted to the
+special conditions. The case gains importance by the fact that the
+patient was himself a physician well trained in mental observation.
+
+     The patient is a highly educated physician of middle age. He
+     reports that he had been neurasthenic all his life with slight
+     ever-changing symptoms. He has always been troubled by the
+     "perseveration" of tactual images which had a strong feeling tone
+     and which were associated with seen or heard reports of the
+     experiences of others. For instance, when he read in a newspaper
+     that someone had hurt his hand with a pin, or that someone had cut
+     his foot on a nail, he immediately felt a not directly painful but
+     uncomfortable sensation at the particular place in the hand or in
+     the foot, together with a shrinking of the whole body and such
+     tactual sensation usually returned during the following days in
+     fainter and fainter form until it faded away. Most troublesome had
+     always been the reading of any torture processes in historical
+     books or in fiction. Yet there had never been a case in which the
+     sensations really had the vividness of hallucinations and never a
+     case in which the after effects had not disappeared at least in a
+     few weeks.
+
+     This time the effect had already lasted four months and it became
+     more and more troublesome. The patient had not the slightest fear
+     of mental disease and no anxiety, but he felt a very serious
+     disturbance by the instinctive effort to get rid of the intrusion.
+     The place of the disturbance was the wrists. The starting point was
+     a definite experience. On an unusually hot summer day the physician
+     had listened for a long time to the complaints of a female patient
+     who suffered vehemently from a nervous fear of scissors and knives
+     and who was afraid that she would cut her artery at the wrist. He
+     believes that it was the exhausting heat of the day which weakened
+     him to a point where the story of his patient affected him very
+     strongly and made him think of it all the time. Yet there was no
+     sensation element involved. A few hours later, he sat in a hotel at
+     his dinner. Just in front of him a butler started to carve a duck
+     with a long, sharp knife. In that moment he felt as if the knife
+     passed through the wrists of both arms. He felt for a moment almost
+     faint; arms and legs were contracted and an almost painful
+     sensation lingered in the skin, and did not disappear for hours.
+
+     From that day at the sight of knives or razors, not only in his
+     hands or his direct neighborhood, but also in a store and finally
+     in a picture, stirred up at once the optical image of that carving
+     knife cutting into the skin of the wrist, only with the difference
+     that it seldom was found in both arms, usually in the one or the
+     other. The sensation became a strictly tactual one with optical
+     overtone, but there was no emotion in it. The pain element had
+     disappeared. Also the shock, which still recurred in the first days
+     slowly disappeared. The longer the symptom lasted, the more the
+     optical factor faded away, and the tactual factor came into the
+     foreground after three or four weeks. Perhaps seeing a razor in a
+     store window or a pocket knife open no longer stirred up the image
+     of cutting the wrist, but simply a strong tactual sensation, as if
+     the skin of the wrist was scratched and pinched. Finally, after
+     about two months, the association character disappeared to a high
+     degree and the scratching and cutting sensation in the skin became
+     independent and automatic. The patient awoke in the morning with a
+     vivid tactual hallucination of being cut without associating with
+     it any picture of a knife. Throughout the day, in the midst of work
+     and in the midst of conversation, sometimes one and sometimes the
+     other wrist became the center of the exasperating sensation, easily
+     bringing with it involuntary reactions as if to withdraw the arm.
+     This became more and more frequent and more and more vivid.
+
+     The doctor, fully aware of the borderland character of this
+     experience, felt sure that his inner fight against the disturbance
+     would get control of it. The usual tonics did not show any
+     influence. On the other hand, there were no other nervous symptoms
+     and, with his most acute analysis, he did not find the slightest
+     trace of emotion any longer. When the symptoms reached a point at
+     which they seriously interfered with his comfort, he asked me for
+     psychotherapeutic treatment, under the condition that I was not to
+     apply hypnotism. He was absolutely averse to the use of hypnotism
+     in his own case because he was afraid that to be hypnotized would
+     mean for him a certain disposition to fall into hypnotic sleep by
+     auto-suggestion, as he knew the vividness of his imaginative
+     sensations. He wanted to avoid that the more as his own
+     professional work might sometimes demand hypnotizing in his own
+     practice. In any case he had an aversion to it and asked for other
+     means.
+
+     Under these circumstances, it seemed to me the most logical
+     conclusion that the counter idea with its antagonistic reactions
+     might be reënforced by direct perception. The abnormal tactual
+     sensation forced on consciousness the idea of the cutting of the
+     wrist. The necessary counter action would be to force to
+     consciousness the idea of the uninjured wrist and the corresponding
+     reactions. As the wrist can be easily made accessible to sight and
+     as I anticipated that the visual sensations would be more forceful
+     than the tactual ones, I told him to look straight at his own
+     wrists for ten minutes three times a day after waking, after
+     luncheon, and before going to bed. He had to hold his two forearms
+     close in front of his eyes and stare at them, giving his full
+     attention to the visual impression of the smooth, uninjured skin of
+     the wrist. If during this process, the tactual counter-sensations
+     were vivid, he had to go on with the staring at both arms, both
+     held near together until the perception had crowded out the rival
+     touch sensation. When this performance had been carried out six
+     times, he did not notice the coming up of the tactual sensation
+     with vividness any longer. From the third day it had disappeared
+     entirely. I told him to go on with the process still every morning
+     for some weeks. The physician himself considered the cure as
+     complete.
+
+Our first case dealt with hypnosis, our second case removed the
+intruding idea by a perception in a waking state. To point at once to
+the variety of methods which we sketched, we may turn again to a case of
+emotionless idea removed by the method of switching off and
+side-tracking the originating and physiological "complex."
+
+     The patient is a school-teacher in the Middle West, a nervous,
+     thin-looking woman of about twenty-five. Her only complaint is a
+     persistent idea that she may at any time get a child. She has had
+     this idea "as long as she can remember," according to her first
+     expression. She never had any intimate acquaintance with any man,
+     she was never engaged, she hated bitterly every thought of
+     immorality, she knows and has assured herself by much reading that
+     it is entirely impossible that she might get a child without sexual
+     contact. Yet this thought recurs to her all the time, even when she
+     is talking with other people. It embarrasses her in school, in
+     spite of her teaching only girls in a private institution. This
+     thought keeps her away from company and the effect of its
+     embarrassing occurrence depresses her, but she is sure that the
+     thought itself does not include any emotion. It is a mere thinking
+     of it with a full consciousness that it is absurd, and yet she
+     cannot suppress it.
+
+     I began at once to try to find the origin of her queer obsession.
+     After some efforts to pierce into her memories, we came to an
+     experience of her youth. When she was about thirteen years of age,
+     a young girl whom she had admired much for her beauty, living in
+     the neighborhood of her parents, suddenly got a child which died
+     after a few days. At that time no thought of immorality seems to
+     have entered into that news. It was evidently mere sadness about
+     the quick death of the child which gave to the experience its
+     emotional tone. She was at that time completely naïve. She received
+     an intense shock in the thought that an unmarried girl may suddenly
+     get a child which would then quickly die. She cannot tell whether
+     the thought that she herself would get a child had ever entered her
+     mind before this occurrence in her neighborhood, nor can she say
+     that it occurred immediately or very soon after it. She now knows
+     only that she has always had that thought, but whether that means
+     more than ten years, she does not know.
+
+     I considered it a justifiable hypothesis that this strong emotional
+     experience early in life had become the starting point for that
+     secondary absurd thought. I considered that primary experience as
+     cause for a deep physiological brain excitement which had
+     irradiated towards the ideas of her personality. It had stirred up
+     there associations which kept their psychological character while
+     the primary disturbance had long lost its psychical accompaniment.
+     It worked its mischief in a physiological sphere but was probably
+     still the starting point for the persistent obsession. My aim was
+     to remove this cause. It would have brought little improvement
+     simply to suppress the freak idea as long as that physiological
+     source was active. On the other hand I should not have the means to
+     stop the physiological after-effects of that real experience: I had
+     to sidetrack it and to secure thus a reduction. I decided therefore
+     to work on the basis of that hypothesis, to accept that
+     physiological complex as existing, but to switch it off by linking
+     it with appropriate associations, thus setting it right in the
+     whole system of her thoughts.
+
+     For that purpose I brought her into a hypnoid state, bending her
+     head backwards and speaking to her with slow voice until I saw that
+     a slight drowsy state was reached. In this state I asked her to
+     think back as vividly as she could of that experience of her youth,
+     to fancy herself meeting that pretty girl, her neighbor, once more.
+     She is to imagine that she speaks with her. Now I make her talk
+     with me and she assures me that she sees the scene distinctly. She
+     believes she sees the girl on the street. I ask her to tell the
+     girl how indignant she feels over her behavior; she is to tell her
+     that she understands now all which she did not understand in her
+     childhood, that she knows now that she must have lived an immoral
+     life; that she must have had a friend and that a pure girl like
+     herself could never under any circumstances come into such a
+     situation, that no pure girl could suddenly have a child. She is to
+     express to the other girl her deepest disapproval of such conduct
+     and her own feeling of happiness that anything like that could
+     never happen to her. In accordance with my demands, she worked
+     herself entirely into the scene: without using audible voice, she
+     internally spoke with great vividness to her neighbor. When I awoke
+     her from her drowsy state, she was quite exhausted from the
+     excitement. I repeated that scene with her four times. She assured
+     me that she felt it every time more dramatically. The power of the
+     obsession weakened from the first day. After the fourth time, it
+     had disappeared. The subcortical complex had evidently found its
+     normal channels of discharge.
+
+In discussing this method of side-tracking the complex, we mentioned
+that in other cases the result is reached by bringing the memory of that
+first experience to a vivid motor discharge, without substituting any
+other ideas. For that purpose no direct personal influence is necessary.
+Treatment might just as well be performed "by correspondence," provided
+that the right starting point is discovered and that right suggestions
+are given. As an illustration, I may choose a case which shows at least
+the maximum distance treatment by mail, from Boston to Seattle. This
+particular case presented no difficulty in getting hold of the starting
+point as my correspondent, whom I have never seen, himself at once
+pointed to the original source of his obsessing idea.
+
+     The patient who lived with his family in Seattle wrote to me the
+     following: "----I shall undertake to describe in a few words a
+     condition which the writer has fought against for about eight years
+     and which has subjected him to untold mental anguish.----I was
+     backward in a social way but altogether happy. After working in a
+     bank about a year, was discovered one evening by the cashier
+     smoking a cigar in the basement, was unable to look him in the face
+     at the time. Went home that night and thought very little about it,
+     but on the following morning during the regular course of business,
+     I stepped up to him to ask some question, and as usual,
+     unconsciously looked him in the face. His glance was questioning
+     and suspicious, and that was the beginning of a life of anguish for
+     me. At first I could not look him in the eyes, then when looking at
+     some other person, I happened to think of it and so on, until in
+     two or three days it was impossible to look at anyone who came to
+     my window. The cashier did everything he could for me. No use: I
+     quit my position, lost most of my friends, had to leave a happy
+     home and came to Seattle to work for an old school friend. In the
+     first year, owing to new environments, I managed to conceal my
+     mental condition to a certain degree. All of a sudden, I was again
+     plunged into the depths of black despair. It took me about two
+     years to (partially) forget it, when the same thing occurred again,
+     and I lost my grip. The last time about eighteen months ago was
+     almost more than I could stand. These three or four instances I
+     speak of were cases of extreme despondency, but my usual mental
+     condition is extremely unhappy. If occasions arise where I have to
+     sit and talk to anyone for ten minutes, controlling myself is such
+     an effort that it leaves me with a case of the blues.... I shall
+     come and see you as the relief would give me a new lease on life."
+
+     This letter was written on the twenty-third of January, 1908. I
+     replied to him at once that he certainly ought not to come from the
+     Pacific to the Atlantic, but that I wanted him to write to me much
+     more about that first occurrence. As he was evidently right in
+     considering that episode as the starting point of his troublesome
+     associations, I supposed that these associated ideas had not yet
+     become independent but were still the effect of that first
+     "complex." Therefore I wanted to bring that to complete discharge.
+     Accordingly I wrote him to think himself once more into that
+     happening of years ago, to pass through it with all the power of
+     his imagination, to describe it to me then in as full a statement
+     as possible and to express in the letter also his conviction that
+     there was no reason to avoid the eyes of his superior, that he
+     might have looked straight into his face. As soon as he got my
+     reply, he wrote to me on the sixth of February a description of
+     that first episode, filling nineteen pages, telling me all about
+     his relations to those various men and every minute detail was
+     brought clearly to consciousness again. I did not add anything
+     further, but the expected occurred. On the eighteenth of February,
+     he writes to me: "In the last week or ten days, the writer has
+     noted a decided improvement regarding mental condition. The result
+     is a new interest in life. If you can spare the time, would like to
+     have you write me a few lines. Gratefully yours." At the end of the
+     month he writes: "Received your letter about half an hour ago.
+     Hasten to assure you with a great deal of pleasure that I am
+     feeling much better. Since sending you the letter regarding the
+     first case, I have noticed day by day an improvement." On the
+     eighth of March: "Since writing you last I have noticed a gradual
+     improvement. It has given me wonderful encouragement." On the tenth
+     of March: "Just a line to say that I am still improving." On the
+     twelfth of April: "I desire to say that since the taking up of
+     treatment with you, life has had a far different appearance to me
+     than it has had for the last ten years." On the twenty-first of
+     April: "Since my first letter to you, there has been such an
+     improvement that I have accepted a position which carries with it
+     much responsibility."
+
+This case leads over to the large group in which the obsessing idea
+involves the relation to a particular person. I find in such cases
+autosuggestion more liberating than heterosuggestion if the development
+has not gone too far. Of course autosuggestion can never take hypnotic
+character, but makes use with profit of the transition state before
+normal sleep. The type of these cases which are everywhere about us may
+be indicated by the following letter.
+
+     The writer is a young woman of twenty-four, whom I did not know
+     personally. She wrote to me as follows: "I am a writer by
+     profession and during the last year and a half have been connected
+     with a leading magazine. In my work, I was constantly associated
+     with one man, the managing editor. This man exerted a very peculiar
+     influence over me. With everyone else connected with the magazine,
+     I was my natural self and at ease, but the minute this man came
+     into the room, I became an entirely different person, timid,
+     nervous, and awkward, always placing myself and my work in a bad
+     light. But under this man's influence, I did a great deal of
+     literary work, my own and his too. I felt that he willed me to do
+     it. The effect of this influence was that I suffered constantly
+     from deep fits of depression almost amounting to melancholia. This
+     lasted until last fall, when I felt that I should lose my mind if I
+     stayed under his influence any longer. So I resigned my position
+     and broke away. Then I felt like a person who, having a drug to
+     stimulate him to do a certain amount of work, has that drug
+     suddenly taken away, and without it I am unable to write at
+     all...." I wrote to the young lady that she could cure herself
+     without hypnotism and without my personal participation. I urged
+     her simply to speak to herself early in the morning and especially
+     in the evening before going to sleep, and to say to herself that
+     the man had never helped her at her work, but that she did it
+     entirely of her own power, and that he had never had any influence
+     on it, and that she can write splendidly since she has left the
+     place, and much better than before. A few months later, she came to
+     Cambridge and thanked me for the complete success which the
+     auto-suggestive treatment had secured. She was completely herself
+     again and was fully successful in filling a literary position in
+     which she had to write the editorials, the book reviews, the
+     dramatic criticisms, and the social news. As a matter of course,
+     such treatment had removed only the symptom. The over-suggestible
+     constitution had not been and could not be changed. Thus it was not
+     surprising that in the meantime, while her full literary strength
+     had come back, she had developed some entirely different symptoms
+     of bodily character which I had to remove by hypnotism.
+
+As soon as the obsessing idea of the influence of another person takes
+still a stronger hold and develops systems, the suspicion of insanity
+always lies near; especially when hallucinations are superadded, the
+probability is great that we then have to do with the delusions of a
+paranoiac, and thus no case for psychotherapeutic treatment. Yet it is
+always wise to keep a psychasthenic interpretation in view as long as
+the insanity is not evident. I may mention such an extreme case.
+
+     The patient, a man of middle age, highly educated, for years had
+     heard voices calling his name. A man with whom he had some personal
+     quarrel, had, as he believed, hypnotized him from a distance and
+     made him act queerly or do things which he really did not want to
+     do, by telepathic influence. It is a development which is found
+     quite frequently. Abnormal organic sensations or abnormal impulses
+     and inhibitions which the patient cannot account for by his own
+     motives become connected with some vague ideas which are in the
+     air, like wireless telegraphy or telepathy or hypnotism from a
+     distance or electrical influence, or magnetism or telephoning,
+     these then attached to an acquaintance who stands in a certain
+     emotional relation. Here, too, some organic sensations evidently
+     had been the starting point and the idea of the man with whom he
+     quarreled had been secondarily attached. From this starting point
+     more and more detail was reached. Every action was brought into
+     connection with the powerful enemy who controlled more and more
+     even the normal and reasonable doings of the patient. My first
+     impression was decidedly that of a paranoiac. Yet in some ways the
+     case suggested another view. There had remained an insight into the
+     unreality of the obsession. The patient did not really believe the
+     theory of the telepathic hypnotic influence. He felt it more as an
+     idea which he could not get rid of and he did not know clearly
+     himself whether he requested hypnotic treatment on my part for the
+     purpose of counteracting the hypnotic power of his enemy or for the
+     purpose of liberating him from his exasperating fixed idea.
+     Moreover, I found that his voices had no hallucinatory character,
+     but were merely sound images. I decided to make the experiment
+     without great hope of success.
+
+     I hypnotized the man deeply and suggested that no one can have
+     power over his actions, that he is the responsible originator of
+     everything that he does and that no one can influence him and that
+     from that hour he would feel free from any telepathic intrigue. The
+     effect of the very insistent and urgently repeated hypnotic
+     suggestion during the first rather long treatment was such a
+     surprisingly good one that I decided to continue the
+     psychotherapeutic cure. I hypnotized him daily for two weeks. The
+     belief in the real wrong doings of an enemy disappeared entirely
+     from the first. It was at once apprehended as a mere obsessing idea
+     in the own mind and this idea itself began to be resolved. It lost
+     its unity; the absurd impulses were still felt but they became less
+     and less connected with the idea of another man, and as soon as
+     they were rightly understood as doings of the own mind, the
+     opposite motives gained in strength. A stronger and stronger appeal
+     to his own power made these motives more and more influential.
+     Slowly the association of the influence of the other man faded away
+     entirely. I intentionally had not given any attention to the
+     pseudo-voices, inasmuch as they had not taken any relation to the
+     ideational delusion. I therefore did not include them in my
+     suggestions, as I consider it wise to confine hypnotic suggestions
+     always to as few points as possible. Yet these voices decreased
+     too. At a certain point in the cure I substituted--to save my own
+     time--an autosuggestive influence, or rather a mixed one, inasmuch
+     as I had him read ten times a day a letter of mine which contained
+     appropriate suggestions. After about six weeks, all the
+     disturbances for which he had sought my advice had disappeared.
+
+Obsessing ideas of such personal influence involve of course always a
+certain amount of emotional excitement and they may lead us to the
+unlimited field of disturbances in which the persecuting idea is
+surrounded by emotional attitudes. Analysis shows easily that the
+emotion is an essential factor and that it persists in the disease while
+the ideas to which it clings may change. Central is the emotion of fear;
+nearest to it that of worry, but any emotion may give color to the
+particular case. Again any number of methods may be applied and a few
+illustrations with quite different ways of treatment may indicate more
+fully the character of the trouble. There is no doctor in the city and
+none in the remotest village who may not find such cases in his near
+neighborhood. Of course slight degrees are easily hidden by the
+patient's own inhibition of external expression. If such suppression by
+the own will secures a real overcoming of the unjustified emotion, this
+is surely better than to begin any medical treatment. But as the
+suppression usually means simply lack of discharge and thus offers all
+the conditions for an unhealthy inner growth of the trouble, the neglect
+of such disturbances is most regrettable, and frankness of the patient
+must be encouraged. Such situation demands a careful observation of the
+whole case and a subtle adjustment of the treatment to the individual
+needs. It may perhaps be helpful at first simply to indicate the
+varieties of the more frequent disturbances of this kind by quoting from
+various letters. Each case belongs to a type which can easily be removed
+by psychotherapeutic influence, generally even by a skillfully directed
+autosuggestion.
+
+The writer is a young man.
+
+     "I have always, as long as I can remember, been very nervous and
+     sensitive. When about seven years of age, I was attacked by St.
+     Vitus' Dance. Before that I cannot say whether I was particularly
+     nervous or not. Afterward it was impressed upon me by the remarks
+     of relatives that I was nervous, so that I soon took note of this
+     condition myself. The manner in which this weakness has been
+     especially troublesome is that it has caused me to be very shy. I
+     shrank from new acquaintances and disliked being observed. Often in
+     walking along on the street, I imagined myself closely noticed by
+     the passerby and I always felt uncomfortable.
+
+     "About three years ago I suffered from typhoid fever and after
+     recovering, a new form of the old trouble showed itself. This time
+     I imagined that when eating I chewed my food in a manner that was
+     ridiculous and which made people hardly keep from laughter in
+     observing me. Often I had to leave the table when half through
+     because I felt I could not bear having critical eyes upon me any
+     longer. About three months ago I determined to be troubled no
+     further by my own foolish fancies and by constantly schooling
+     myself I have improved very much. Still, however, when I walk alone
+     along the street, I must fortify myself mentally before passing
+     each group of people. If once I allow myself to think that they are
+     looking at me, I feel almost paralyzed, my feet seem too heavy to
+     lift, my arms do not seem to swing naturally, and in attempting to
+     look placid and unconcerned, I feel that I am failing utterly. Also
+     when at table, I must still tell myself before each mouthful that I
+     have no need for fear, that my manner at table is equal and perhaps
+     superior to the others beside me. I have gone a certain length in
+     my self-training, and have relieved myself of a great deal of the
+     mental distress, but now I believe I can advance no further. What
+     seems needful now is to do away with the self-consciousness which
+     brought on my worries, though whether this is possible is hard to
+     say."
+
+Here the letter of a young woman, the type which fills the army of the
+mind healers and faith curists.
+
+     "For years I have been seeking, or perhaps to be more accurate I
+     should say waiting, for a mind to drift toward me; a mind that
+     would understand my particular case of fear brought on by the
+     constant bullying and nagging from my earliest childhood by those
+     in my home. This fear of brutality has greatly depleted my nervous
+     system and has unfitted me for the strong, useful, forceful life I
+     should have expressed. If I could only rid my mind of the thought
+     that I am always displeasing, or rather, going to displease people,
+     for I hardly do displease them; if I could get rid of the fear of
+     caring what the attitude of other minds toward me is, I feel that I
+     should then strike out into a strong life of helpfulness to others.
+     In other words I have always felt behind me a great force pressing
+     me out into public work. When I was a child, it was so strong that
+     I was sat down upon brutally, to so great an extent that I feared
+     to voice my convictions and that fear still clings to me like a
+     nemesis. It seems that every individual personality in a public or
+     private audience rises up to overwhelm me, causing my tongue to
+     grow heavy and my mind to become a blank. This enervating fear
+     blends into every thought I have, whether sleeping or waking. I
+     have fought with all my might to rid myself of it but so far in
+     vain."
+
+Here an expression of a very frequent variety. The writer is a
+middle-aged man.
+
+     "I am possessed of a fear that is constantly with me that something
+     dreadful is going to happen and I do not seem to be able to
+     overcome it. I am told by physicians that I am bodily sound,
+     although very nervous, and that the fear is generated entirely by
+     autosuggestion. When at its worst, it weakens and terrorizes me and
+     in my better moments I am tormented with a fear of a recurrence of
+     a bad spell. It is fear of a fear. A year ago at this time I had a
+     very bad spell but got along fairly well through the summer, but I
+     am afraid that I will soon again be in a bad condition and lose all
+     that I may have gained."
+
+The "fear of a fear" is indeed a symptom which the psychotherapist has
+to fight extremely often, but as soon as he has really recognized it and
+analyzed the whole mental condition, he will hardly have any difficulty
+in uprooting it. I add a letter of a school-teacher in New York. He
+writes:
+
+     "I am teaching in a high school. I am of a nervous temperament and
+     constitutionally limited in endurance. Often my work is done in a
+     condition of greater or less exhaustion. I find that I blush very
+     easily in purely freakish ways, when there is no occasion for it. I
+     find this blushing connecting itself with certain of the girl
+     pupils of my classes in a conspicuous way. It occurs hardly ever
+     except when my class is facing me and I seem to be powerless to
+     overcome it. I have always tried to live a careful moral life, but
+     my early life was very much secluded. I lacked entirely the free
+     intercourse young people usually have together and I felt awkward
+     with others for a long time. In the matter of the blushing, it
+     sometimes occurs in the case of girls who are especially pleasing
+     to me but also not infrequently in the case of some who are not at
+     all so. The whole thing might be passed over were it not that it
+     has considerable effect in causing constraint toward my students
+     and in some cases affecting them very strongly in an emotional way
+     at the very time of life when such things can do most harm. I
+     regard the matter as being so serious that it brings directly in
+     question my right to teach, but I do not feel at all sure I could
+     find other work that I could do if I give up my present position.
+     The very thought that on a particular occasion it would be
+     extremely awkward to blush makes it almost impossible for me to
+     avoid it."
+
+But we have rather now to consider the therapeutic side, and we may
+begin again with a routine method of a simple hypnotic treatment.
+
+     The patient is a young university professor. His intellectual work
+     is perfect in all directions. There are no nervous symptoms, though
+     there are some slight disturbances of digestion. He suffers as soon
+     as he comes into a crowd of people and as soon as he is on any high
+     place, where he has to look down; the worst when both conditions
+     are combined, as for instance, at a concert or a theatre in a
+     balcony seat. But every meeting of many persons, even at church,
+     produces all the symptoms of nervous excitement. He was easily
+     brought into hypnotic state by verbal suggestions. When he was in
+     hypnosis, I reënforced the conditions for an opposite attitude. I
+     told him that as soon as he was in a crowd of persons he would feel
+     especially comfortable, would enjoy himself, would fully enter into
+     the spirit of the occasion and feel especially secure in their
+     presence. Whenever he should be on a high place, he would enjoy the
+     safety of the ground on which he was standing or the seat on which
+     he was sitting. I assured him that he would neglect entirely
+     whatever he saw and would rely completely on his safe feeling
+     resulting from his tactual impressions. After having hypnotized him
+     three times the disturbance disappeared completely, and even an
+     evening at the theatre in an exposed box on the balcony was enjoyed
+     without any discomfort. After about a year, at a period of
+     fatiguing work, some traces of the anxiety appeared again. This
+     time two hypnotic sittings were sufficient to remove the
+     disturbance of the equilibrium, which as far as I know has not come
+     back. The same hypnotic treatments were used in a secondary way to
+     remove the digestive trouble.
+
+I again quote the case of a teacher, a profession in which the
+psychasthenics are unusually frequent. It is a case of a young woman
+from the Middle West.
+
+     The young lady wrote me: "I come of a race of strong women and am
+     not hysterical or easily frightened by many things that disturb
+     women. Since my fifteenth year I have been seized by hallucinations
+     of absurd or serious nature which no reasoning could explain away
+     and which have gradually undermined my power of resistance to them.
+     At the age of twenty-two, after a year of unusually hard work, my
+     nervous endurance gave way, and with this breakdown came a sense of
+     fear and a horror of crime that I have been unable to overcome. I
+     have never felt the slightest inclination toward wrongdoing. It is
+     a feeling rather that my shrinking from any mention of evil makes
+     it impossible for me to listen or think rationally when such things
+     are discussed. This feeling has seemed to change my whole attitude
+     toward life and has left me without power to control my facial
+     expression or carriage when it takes possession of me. I have been
+     able to teach more successfully than I could hope, but it is only
+     by cutting myself off from the friendships and pleasures incident
+     to my life that I am able to accomplish my work. I have fought this
+     trouble alone and will still do so if there is no help, but the
+     thought that it is the source of great distress to those dear to me
+     makes it very hard."
+
+     A few weeks later the lady insisted on coming to Cambridge. I found
+     that there had never been any hallucinations and that she used the
+     word in her letter only to indicate some insistent memory images
+     which had never taken the vividness of real impressions. In the
+     presence of her friend, I hypnotized her deeply and strengthened
+     through urgent suggestions her consciousness of her having done the
+     morally right thing at every situation in her life and her
+     conviction that she never did and never would commit a crime. Here
+     as always, if possible, I left alone the emotional idea but
+     reënforced the opposite. The effect was an immediate one. She felt
+     freer the next day than she had felt for years. I repeated the
+     treatment a few times and she assured me that the feeling had
+     disappeared entirely.
+
+I take the rather severe case of a woman of fifty.
+
+     The highly educated and refined lady had lost her husband by an
+     accident in Switzerland, which had been misrepresented by some of
+     the newspapers as suicide. Two years later she wrote to me: "I feel
+     as if I had received indelible photographs on my brain which have
+     since greatly affected my health and from which I may never
+     recover. This winter the symptoms I have been able to control
+     returned and I have been ill. I unfortunately saw the newspaper
+     headlines with my husband's supposed suicide. Though I exclaimed
+     then, 'how outrageous,' I felt as if I had been struck and since
+     then I can seldom read a paper without dread and apprehension, and
+     the hearing of anyone's suicide fills me with terror. When I
+     hurried to Europe, on the ocean a week from the day of my husband's
+     death, I had a curious and overwhelming shock. On opening a drawer
+     and seeing a pair of scissors, they looked to me like a dagger and
+     suddenly the whole cabin seemed filled with implements of death.
+     The doctors said that I would find it hard to get over such
+     impressions but I told them I would, as I had courage and will. But
+     I have been realizing in these two years that I may be suffering
+     from something that may be beyond the control of will. I often
+     become so nervously sensitive that scissors are unbearable for me
+     to see, or a steel knife or anything that might express death. Our
+     family physicians are still against hypnotism, and if I should go
+     to a neurologist of my own selection, it might be to one who
+     believed still only in nerve foods, baths, or a sanitarium."
+
+     The lady came from the South, with her nurse, to Boston and
+     insisted on being hypnotized by me. I cannot say whether a really
+     deep hypnotic state was produced at once as I refrained from
+     testing it. There was certainly no amnesia. Probably it began only
+     with a slight drowsiness but at the fifth treatment I found a
+     relatively deep hypnosis. It was a capricious case in which the
+     improvement was fluctuating but clearly setting in from the first
+     day. I trained her in hearing and seeing words like death and
+     suicide with a reënforced feeling of strength and calmness; I
+     forced her to see and touch scissors with an artificial attitude of
+     strength and indifference. At the same time I reënforced her good
+     mood and her enjoyment in life. When she left for England a few
+     weeks later, she felt herself mentally cured, and throughout the
+     summer her letters testified the wonderful change which the
+     treatment had brought about. Half a year later, as the result of
+     an exhausting physical local treatment, the psychophysiological
+     symptoms came back to a certain degree. She requested me by a
+     letter from England to give her some help by suggestion to suppress
+     again the recurring intrusions. As I had observed her strong
+     suggestibility, I sent her over the ocean a little pencil of
+     mother-of-pearl which she had seen in my hand, and advised her to
+     look at it until she counted twenty slowly and then to close her
+     eyes and simply to sleep. The autosuggestive effect was unusually
+     strong. She writes from London: "When I saw the enclosure of your
+     letter I felt as if it would burn through my hand and the feeling
+     became so overpowering that I locked it away with my jewels, but as
+     the days ran into a week I felt I could not live with it in my
+     apartment any more, and I felt almost ill, until it occurred to me
+     I could seal it and take it to my bankers. I felt as dreamy and
+     absent-minded and paralyzed as if you had just treated me."
+     Nevertheless the effect was on the whole the desired one and she
+     returned to America with a wholesome freedom of mind. I hypnotized
+     her twice again and she writes in her last letter: "I can never
+     repay you for what you have done for me. You have given me back my
+     courage and my love of life in its vividness and interest and
+     color, all that through the last years I had so entirely lost."
+
+Even in cases where the disease itself is inaccessible to
+psychotherapeutic treatment, the superadded grief and worry brought on
+by the disease might yield to the mental influence and the whole
+situation would to a high degree be transformed for the better by it. I
+have often been asked to hypnotize in such cases, where the depression
+was wrongly taken as a part of the nervous disease; sometimes I agreed
+to do it in spite of feeling sure that the disease itself could not be
+removed. I quote an instance.
+
+     A young woman afflicted with epilepsy was brought up in the belief
+     that she had only from time to time fainting attacks from overwork,
+     and with them secondarily neurasthenic symptoms, especially spells
+     of depression colored by a constant fear of the next fainting. She
+     had heard voices all her life and they frightened her in an
+     intolerable way. I produced a very slight hypnotic state. I
+     concentrated my effort entirely on suggestions which were to give
+     her new interest in life, and diminished the emotional character of
+     the voices without even trying to make them disappear. I proceeded
+     for several months. The young woman herself believed that the
+     fainting attacks came less frequently afterwards; yet I am inclined
+     to think that that is an illusion. But there was no doubt that her
+     whole personality became almost a different one with the new share
+     in the world. The epilepsy remained probably unchanged but all the
+     superadded emotions were annihilated and she felt an entirely new
+     courage which allowed her to control herself between her regular
+     attacks. She had been unable to undertake any regular work before
+     for a long while, but all that improved. More than a year
+     afterward, she wrote me: "I have really worked most of the time
+     this past winter and spring and I think I can see a steady though
+     slow gain. I am reading quite a little and doing it for the most
+     part easily. To be sure I have, after I have read, hard times with
+     the voices but their character is usually less determined and
+     fearful than formerly. Several times I have thought I must come
+     again to you but each time I have started again to fight it out for
+     myself, but now, as I am gaining, I can better estimate the great
+     help your influence was to me at a juncture when everything seemed
+     so hopeless and helpless."
+
+Even in slight psychasthenic disturbances, the psychotherapeutic
+influence is not always successful, especially if there is no time for
+full treatment. But it is very interesting to see how even in such cases
+the symptom is somehow changing, almost breaking to pieces. It becomes
+clear that a protracted effort in the same direction would destroy the
+trouble completely. Typical is a case like the following.
+
+     An elderly woman has been troubled her life long by a
+     disproportionate fear of thunderstorms with almost hysterical
+     symptoms. As she had no other complaint, I hardly found it worth
+     while to enter into a systematic treatment and could not expect
+     much of a change from a short treatment, considering that her
+     hysteric response had lasted through half a century. As she begged
+     for some treatment, I brought her into a drowsy state and told her
+     that she would in future enjoy the thunderstorms as noble
+     expressions of nature. The whole procedure took a few minutes. Yet
+     after some summer months she wrote me a letter which clearly
+     indicated this characteristic compromise between the habitual dread
+     and the reënforced counter idea. "I have the same sick dread at the
+     sight of thunder clouds that I have always had, but I seem to have
+     gotten somehow a most desperate determination to control my fear. I
+     have done this to the extent of keeping my eyes open and looking at
+     the storm. Is that hypnotism or pride?"
+
+Another thunderstorm case may lead us to other methods of treatment.
+Here again in the field of emotional response, we may consider the
+methods of going back to primary experience, known or forgotten.
+
+     A young married woman of the West had suffered always from
+     hysterical attacks in response to any sharp sudden impressions,
+     especially sudden loud noises. The banging of a door, but worst of
+     all a thunderstorm, could produce hours of weeping and crying and
+     desperate mental condition with all expressions of excitement. Her
+     husband wanted me to hypnotize her but I preferred another way. I
+     tried to get her memory back to the earliest case of which she
+     could think of this hysterical response. As long as we were in
+     ordinary conversation, she could not trace it beyond about her
+     twelfth year. But when I brought her into a drowsy state, her
+     memory revived older experiences and finally settled at a school
+     experience in her seventh year of age. She then had an excitable
+     country school-teacher who relied on whipping the children. Once
+     her neighbor in the class did something forbidden. Her teacher
+     mistook her for the culprit and began to whip her most forcibly
+     before she could explain anything; and while the punishment was
+     going on and she began to bleed from a wound, she all the time felt
+     that she wanted to express her innocence and could not speak. After
+     that, evidently the first attack of hysteric character followed.
+     From that time on any sudden impression released the same group of
+     reactions. The suppressed emotion had evidently become a
+     psychophysical "complex." As soon as I had reached this starting
+     point of her pathological history, I asked her to bring back to
+     consciousness as many details as possible of that first incident.
+     She told me all the names and described the classroom and brought
+     herself vividly into the whole situation. Then I asked her to tell
+     me the whole story once more and to express strongly her innocence
+     and the wrongness of the punishment, and when she had completed her
+     account, brought out with fullest indignation, I had her tell the
+     whole thing once more and then a third and a fourth time, until she
+     was quite tired out from it. That was all I did. Very soon after,
+     the husband reported that there was a great improvement in every
+     respect, no hysteric attacks, only slight discomfort. Most of the
+     stimuli which had previously produced strong reactions now passed
+     without any disturbance and even thunderstorms were experienced
+     with relative ease. A year later they came once more to Cambridge,
+     and she simply passed once more through the same process of
+     discharge which seems now to have removed the symptoms still
+     further.
+
+By far more reliable, however, is the method of side-tracking the
+starting experience into a new associational track.
+
+     A gentleman with a decidedly psychasthenic constitution developed a
+     tendency to hesitate in walking on the street. It was not a
+     complete stumbling but a disturbing inhibition, which set in when
+     he was walking alone and his attention was not absorbed by
+     something on the street. He believed that it came on most strongly
+     when he looked down at the pavement. He suffered from it vehemently
+     and avoided going on the street alone. He was unable to connect it
+     with any starting point. He interpreted it as merely a symptom of
+     overwork. But going with him through all kinds of experiences which
+     he had had on the street in previous years, we finally found that
+     once he was running to catch a street car, when he suddenly saw
+     almost immediately before him a big hole dug out for laying gas
+     pipes. He was able to stop himself quickly enough not to fall into
+     the hole but he got a strong emotional shock from the experience.
+     He, himself, did not think that his walking troubles set in
+     immediately after this shock. Yet the hypothesis seemed to me
+     sufficiently justified that there existed a connection, even though
+     some weeks lay between that first experience and the first
+     observation of the abnormal inhibition in walking. On that basis I
+     tried to train a new associative connection. I made him drowsy and
+     asked him to think himself once more into the situation of his run
+     for the car but as soon as he reached the hole to jump over it. He
+     went through this motor feature on ten successive days with new and
+     ever new energy and from that time up to the present the trouble on
+     the street has disappeared entirely.
+
+To mention at least one case of the large group in which suppressed
+sexual emotion was the evident source of an anxiety-neurosis, I mention
+the case of a woman who showed very strong symptoms of anxiety and
+oppression and who was cured by a simple advice.
+
+     The woman, aged thirty-two, was a saleswoman in a large store
+     selling gentlemen's gloves and ties. She suffered from time to time
+     by attacks of vague anxiety in which her heart showed vehement
+     palpitation. There were paleness and perspiration and at the height
+     a nervous trembling together with a feeling of despair. These
+     attacks were not frequent, separated sometimes by weeks, sometimes
+     by months, but troubling her exceedingly. She had been assured by a
+     physician that her heart was normal and that she was probably
+     overworked. She could find absolutely no source of the disturbance.
+     After a long conversation, I was also unable to discover any direct
+     or indirect causes until I worked on the basis of those theories
+     which we have discussed, the theories which connect hysteric
+     symptoms with chance intrusions which stand in relations to past
+     suppressed emotions of sexual character. The patient absolutely
+     denied any present sexual emotions. She had been engaged about
+     eight years before and acknowledged that at that time there were
+     strong sexual feelings connected with her fiancé, who broke the
+     engagement. Psychoanalytic methods now brought it to full clearness
+     that she had her first attack after selling a pair of gloves and
+     fitting them to the hand of a male customer who had a certain
+     similarity to her fiancé. It was not possible to trace this in the
+     same way for later cases too, but it seems that bodily contact with
+     a man by fitting gloves preceded every attack. All this was brought
+     out partly by questions, partly by free ascending associations
+     while she, herself, believed that she simply pronounced nonsense
+     words as they came to her mind, and partly it was secured in a
+     half-hypnotic state. I came to the conclusion that the suppressed
+     sexual emotions at the breaking of the engagement were the primary
+     cause of the disease. The similarity of the first customer together
+     with the tactual sensations had evidently touched that complex and
+     brought the suppressed emotion to an explosion which frequently
+     takes the form of palpitation and similar symptoms. Later the mere
+     tactual sensation alone produced by the contact with the hand of a
+     man, possibly with a similar optical impression, perhaps also with
+     the sound of the voice, brought back the reaction. Instead of
+     giving treatment, I insisted that she change stores, and become
+     saleswoman in a house where she would have to do only with women,
+     and to sell articles which did not bring her into personal contact
+     with customers. After more than six months of work in her new
+     place, she reported that the attacks had not come back again.
+
+Of course it may readily be acknowledged that this method does not allow
+a sharp demarcation line between its various factors. It cannot be
+denied that an element of straight suggestion may be included. The man
+whom I train in the forming of a new antagonistic motor response feels
+it of course all the time also as a silent suggestion to overcome the
+old disturbance. It is thus to a certain degree impossible to say where
+the effect of the discharge ends and where that of the hidden suggestion
+begins. Yet there certainly cannot be any doubt that this revival of the
+first experience and its improved discharge works directly towards the
+removal of the troublesome symptom.
+
+Abnormal fear is also the essential factor in most cases of stammering.
+The patients usually know it themselves. For instance, a lawyer writes
+to me:
+
+     "I have been a stammerer the greater part of my life and have
+     visited every stammering school in the country, but the relief
+     obtained has been temporary and in most cases I was not benefited
+     at all. I am convinced that stammering is due wholly to an abnormal
+     mental condition, which consists of an unreasoning fear that takes
+     possession of the individual when he attempts to utter certain
+     sounds. It is simply a lack of confidence inspired by numberless
+     failures to articulate properly and is not caused by any organic
+     trouble, because, taking my own case for example, I can at times
+     talk as fluently and easily as anyone. I am firmly convinced that
+     stammering can be cured by hypnotic suggestion. If you could get me
+     in the hypnotic state and suggest to me repeatedly that from
+     thenceforth I would have easy fluent speech, I feel absolutely
+     certain that such would be the case."
+
+Or an engineer writes to me:
+
+     "At times I stammer very badly. In an ordinary conversation it is
+     scarcely perceptible, but it is almost impossible for me to make an
+     explanation or relate an incident or tell an anecdote. I began to
+     stammer when I was about seven years of age--I am twenty-nine
+     now--and continued until I was seventeen, when I broke myself of it
+     by reading aloud. It came back on me about a year ago, at which
+     time I was laboring under a very severe nervous strain on account
+     of business matters. I have since tried to break myself of it in
+     the way that I did at first, reading aloud, but have been unable to
+     do so. Can it be cured by hypnotic treatment or suggestion? Can any
+     hypnotist of ordinary ability do it?"
+
+I should affirm this question, which is one of the most frequent put to
+the psychotherapist. And yet, if I myself have entirely given up the
+cure of stammerers in recent years, it was not only because there was
+little chance to learn anything new scientifically from it but also
+because it was ultimately disappointing, as the severe cases cannot be
+cured entirely. Every hypnotist can quickly secure a strong improvement.
+In even new cases I found an almost surprising improvement in the first
+two weeks, an improvement which stirs up the most vivid hopes of the
+sufferers. Then the improvement becomes slower and finally it stops
+before a complete cure is reached. The patient notices it and it easily
+works back on his emotion and thus begins again to disturb the speech,
+unless a very careful continuous counter-suggestion is given. Slight
+disturbances, to be sure, can be removed entirely. The essential point
+will always be to suggest to the stammerer the full belief that he is
+able to speak every word and that he is able to speak it in every
+situation. But where there is a limit for improvement, we must take for
+granted that the disturbing fear is only superadded to an organic
+trouble. In such cases, probably the inability of certain nervous paths
+was primarily irreparable. These inabilities then became the source of
+discomfort and of fear and this fear added greatly to the disturbance.
+Hypnotism then quickly removes that part of the disturbance which had
+been superadded by the mental emotion but it cannot remove that primary
+factor, the objective inability, and every cure thus finds its limit
+there.
+
+Near the field of emotions stand also the many varieties of sexual
+abnormities and perversities. I abstain from discussing any special
+cases but it may be said that suggestive treatment is in this region
+powerful to an almost surprising degree. Even homosexual tendencies
+which go back to the beginnings of the memory of the individual yield,
+as my experience shows, in a few weeks, if again the suggestion is not
+so much directed towards the suppression as to the creation of the
+antagonistic reaction, that means in this case, of the normal sexual
+desire.
+
+Both ideas and emotions, of course, lead to actions. Moreover we always
+insisted that the resulting action is an essential part of the
+psychophysical situation and that every mental experience has to be
+characterized as a starting point for action. Yet this factor of
+activity and of attitude sometimes stands in the foreground. The
+controlling idea is then the idea of an end of action, the predominant
+emotion, the emotion anticipated from a certain activity. Typical for
+that are those disturbances in which an abnormal impulse or an abnormal
+desire awakes perhaps a desire for ruinous drugs like morphine or
+cocaine or an impulse to criminal deeds, like stealing. But the
+disturbances of the psychomotor factor are not less present when the
+central complaint is a lack of energy, the most frequent symptom of the
+neurasthenic; and our whole discussion has made it clear that a mere
+lack of attention belongs to the same category.
+
+Of course, the abnormal impulse is psychophysically not different,
+whether it leads to a legally important result like the impulse to kill
+or leads to an indifferent result. The subjective suffering may be the
+same in both cases. The starting point of the impulse may be any chance
+experience. The psychasthenic may pick up such impulses from any model
+for imitation or from any haphazard report. It may be entirely freakish
+and yet beyond conscious control.
+
+     A physician had read in a well-known book on hysteria about a case
+     in which a girl was troubled by a constant effort to move the big
+     toe in her shoes. This idea worked on him as a suggestion for
+     several months. At my advice he fought it by auto-suggestion. He
+     brought himself into a slightly drowsy state by staring into a
+     crystal ball and assuring himself by spoken sentences with
+     monotonous repetition for a long while that he has perfectly the
+     power to hold the toe at rest. From the second day only a slight
+     kinæsthetic sensation remained; the movement itself disappeared.
+
+Or a more unusual case.
+
+     A young lady once noticed in a man a different color in the two
+     eyes. It gave her an uncanny feeling, together with the natural
+     impulse to compare the two eyes. Accordingly she shifted her own
+     eyes from one eyeball to the other in the man's face. The accent
+     which this shifting impulse had received by the disagreeable
+     feeling evidently forced her to repeat this movement with everyone.
+     At first it became half a play, but soon a disturbing habit and
+     finally an intolerable impulse. Whenever she talked with anyone,
+     she lost control of her eyes and was obliged to enter into a kind
+     of pendulum movement from eye to eye. The situation became so
+     unendurable that the thought of suicide began to occur to her. I
+     hypnotized her four times, suggesting to her complete indifference
+     as to the face of those with whom she spoke and at the same time
+     certain new habits of fixation. The impulse lost its hold and when
+     I saw her last, it had completely disappeared.
+
+By far more frequent than such neutral impulses are the desires, for
+instance, of the alcoholist. On the whole it may be said that
+psychotherapy can gain its easiest triumphs in the field of alcoholism
+and a wide propagation of psychotherapeutic methods and of a thorough
+understanding of psychotherapy would be fully justified, even if no
+other field were accessible but that of the desire for alcoholic
+intemperance. The moral disaster and economic ruin resulting from
+alcoholic intemperance, the physical harm to the drinker and to his
+offspring is so enormous, and the temporary cure of the victim is so
+probable that the movement certainly deserves most serious interest. Yet
+I speak of temporary cure and I refer here especially to the restriction
+with which I introduced the psychotherapeutic methods in general. They
+do not deal with diseases but with symptoms; and they certainly do not
+deal with constitutions, but with results of the coöperation of
+constitution and circumstances. That the given constitution may be
+brought anew under conditions which again stir up similar symptoms is
+always possible, and just with alcoholism the danger lies near unless
+beneficial influences remain in power. Certainly no one has a right to
+neglect such psychotherapeutic aid simply because relapses are possible.
+Even a temporary relief can be a great blessing. Moreover, the temporary
+relief is the safest basis to work towards the prevention of a
+recurrence of the evil. Only in two directions is further restriction
+needed. Psychotherapeutic methods are in my opinion of very small avail
+in cases of periodic drinkers. Such periodic attacks of patients who
+have not even a desire for alcohol in intervals between the attacks,
+intervals which may last a quarter of a year, are related to epilepsy.
+It seems that constant hypnotic influence during the interval has a
+certain power to reduce the periodic impulse. I personally have not
+seen any special improvement from it. The second restriction would be
+that the drinker has to be under constant supervision during the first
+days of hypnotic treatment. No patient, not even the morphinist, is so
+skillful in deceiving his friends and even the physician. Even the most
+emphatic gestures of sincerity ought to be distrusted.
+
+     Only a short time ago I dealt with a young man whom his parents and
+     a chauffeur had accompanied to Boston, exclusively for the purpose
+     of watching him constantly while I was to attempt to cure him from
+     excessive whiskey drinking. The chauffeur accompanied him from his
+     room in the Boston hotel to the threshold of my laboratory. All
+     through the day he was with his parents, and at the hotel the
+     management had given the strictest orders not to sell any drink to
+     the young spendthrift. He was an earlier student of mine and had
+     attached himself to me with such an apparent sincerity as removed
+     every possible doubt of his pledge. Intentionally I had not even
+     asked him for a pledge not to drink but only for a pledge to
+     confess to me the next day if he ever should take any alcohol. In a
+     tentative way I suggested to him in a half hypnotic state on the
+     first day that he would feel disgust for whiskey. I did not expect
+     much of an improvement before at least three or four treatments. I
+     was therefore most surprised when he most solemnly assured me the
+     next day that he awoke in the morning with an assured feeling that
+     he should never touch whiskey again and that he had not the
+     slightest desire for it. Instead of a systematic development of
+     suggestions, I confined myself therefore to a mere repetition of
+     the treatment of the first day and as every morning the same
+     assurance came forth, there seemed to be no need for any
+     variation. It was not before the fifth day that I discovered that
+     he had taken from the start a pint of whiskey every day. When he
+     first arrived he had bribed a laundress of the hotel to bring to
+     his room every day the whiskey hidden in the laundry and he drank
+     it during the night. Then I declined any further participation.
+
+The danger of deceit is of course less imminent when not the family but
+the patient himself takes the initiative. Yet even here distrust is
+wise. The patient has sometimes the most sincere intention to be cured,
+but under pressure of his craving he admits compromises which he hides
+from the physician. Having reduced the large quantity of alcohol to
+which he was accustomed, he hides the fact that he yet takes a few
+drinks, which he thinks cannot prevent the cure. Yet inasmuch as a
+complete cure has to rely on psychical factors, this consciousness of
+deceiving even with small transgressions interferes badly with progress
+and, inasmuch as the cunningness of the patient is itself a symptom of
+the disturbance, the strongest possible precaution is advisable at the
+beginning. For that reason it is also not best to begin at once with
+complete prohibition, but to lead to a total abstinence in about one
+week. But certainly in the case of every drunkard, total abstinence is
+the only desirable goal. A pronounced drinker ought never to be
+transformed simply into a moderate one. The return to intemperance would
+result rapidly. On the other hand it would be unfair to deny that
+psychotherapy has cured the symptom if the desire really once
+disappeared completely, even if, after years, new temptations develop a
+new desire. I myself had diphtheria three times in my life; my
+constitution is thus probably especially favorable to that disease but I
+do not estimate less the fact that I was perfectly cured the second
+time, in spite of the fact that I caught it a few years later a third
+time. To be sure, such experiences of relapse cannot be spared any
+psychotherapist. I may give a typical instance.
+
+     A well-known professional man of fifty years, through a long
+     bachelorhood, was accustomed to close his work at four o'clock and
+     then to sit comfortably in his study with a book and an unlimited
+     supply of brandy. He took one cognac after another and every
+     evening he was completely intoxicated. He married a young wife and
+     felt the need of changing his habits, the more as he himself saw
+     symptoms of his excess which alarmed him. When he came to me, I saw
+     that he was seriously wishing to give up, and he understood himself
+     that there was only the one way, namely, complete abstinence. He
+     felt that he could not reach it by his own will power alone and
+     sought my aid. I hypnotized him six times, suggesting at first a
+     reduction to four drinks, then to two, then to one and then to pure
+     mineral water. I concentrated my effort on stirring up the
+     antagonistic attitude, the dislike of the smell of brandy and the
+     aversion to its taste. The effect was excellent. After the fifth
+     time the mental torture which he had felt in the first afternoons
+     had completely disappeared. I considered further hypnotizing
+     superfluous and felt sure after the sixth time that the man was
+     cured. For about a year he remained abstinent, but in the meantime
+     his professional life brought severe disappointments, and with cool
+     consideration he decided that he might have at least some pleasure
+     from life and forget its miseries. Accordingly after a year he
+     determined again to take some brandy in his study, and of course,
+     that led rapidly to an increase of the dose and today he is
+     probably at the old point. And yet it may be said with correctness
+     that psychotherapy had done its duty. If at the right moment before
+     he took the first step again, even the slightest counter-suggestion
+     had been applied, the disastrous second development could have been
+     easily avoided.
+
+My experience indicates the best results where the suggestions are from
+the start directed as much against the unfavorable social conditions,
+with their temptations and impulses to imitation, as against the
+alcoholic beverages themselves. On the whole it is easier to break the
+vicious drinking habits of the social drinker than those of the lonely
+drinker, a point which ought to be well considered in settling the
+complex problem of prohibition versus the temperance movement.
+
+The situation of alcoholism repeats itself in still more ruinous forms
+with morphinism and cocainism, vices which grow in this country to an
+alarming degree. The psychotherapeutic treatment of such drug habits
+demands much patience and much skillful adjustment to the psychological
+conditions. Its general difference from the treatment of alcoholism is
+given by the circumstance that any too rapid withdrawing of the drug is
+certainly dangerous, if the organism is adjusted to a relatively strong
+dose. On the other hand, I may say that I have not seen a single case
+in which a really patient and insistent treatment of morphinism has not
+been successful, even if the destructive dose of forty grains a day had
+become habitual. The condition is only that the patient himself have the
+best will, a will which yet is not strong enough to win the fight
+without psychotherapeutic help. But no one ought to expect that the
+psychotherapist can secure miracles like some of the pill cures which
+treat the drug fiend in three days. Moreover neither physician nor
+patient ought to believe that the worst is to come at the beginning. On
+the contrary, it is the end which is hardest, the reduction of the small
+dose to nothing. As illustration, I give an extreme case.
+
+     A man who was formerly station master on a railroad had been
+     operated on in a hospital after an accident, and as some pain in
+     the hip remained which disturbed his sleep, the physician of the
+     hospital gave him some morphine and provided him with the material
+     for morphine injection after leaving the hospital. Then began the
+     usual story. He became more and more dependent upon his injection,
+     the dose was steadily increased, he found unscrupulous physicians
+     who yielded to his demand for morphine prescriptions; he lost his
+     position with the railway by the growing effects of the morphine
+     poisoning, he became divorced, sank lower and lower, his daily dose
+     fluctuating between thirty-five and forty grains a day, and when he
+     came to me, he presented a picture of the lowest type of hopeless
+     manhood. He spent practically the whole day in bed and was only
+     able to totter slowly along with a cane. He assured me that life
+     was hell for him. He could not sleep, he could not eat, he could
+     not think, he had made up his mind to commit suicide if I could not
+     help him. I foresaw that it would in the best case demand months of
+     insistent energy to make a man out of that unfortunate wreck. He
+     had gone through three different morphine cures in three
+     sanitariums and none had helped him, and every physician whom he
+     had consulted had declared his case as beyond any physical cure. I
+     decided to make the somewhat disproportionate sacrifice of time in
+     order to study whether even such an extreme case of morphinism is
+     accessible to psychotherapeutic treatment. Four months later, he
+     left my laboratory looking like an athlete, strong and vigorous,
+     joyful and energetic. For three weeks he had not received any
+     morphine, had good appetite, slept well, and had happily married.
+     As his wife was a trained nurse, she will take good care that no
+     new slip shall ever occur.
+
+     There was nothing remarkable in those four months of treatment. He
+     was easily hypnotized, and I hypnotized him at first every day,
+     then every second day, then every week. It was without difficulty
+     that I reduced the forty grains to about six grains a day. Then the
+     struggle began. To test the case as a strictly psychological
+     problem I left the effort entirely to his own will, that is, I did
+     not deprive him of the morphine supply but left the regulation in
+     his own hands. During that whole winter he had a bottle with a
+     thousand morphine tablets standing on his desk. Thus he would have
+     been entirely able to satisfy any craving, but by his own will he
+     followed my suggestions and never took more than I permitted. It
+     meant a terrible struggle. The tortures which he had to pass
+     through were perhaps worse than those which he had experienced at
+     the time of his lowest downfall. They came to a focus when he tried
+     to go from five grains to three grains a day and then again when
+     he approached half a grain. From there he had to move to a fourth
+     of a grain, then to an eighth, and even that had still to be
+     divided into four different doses which were then reduced to three,
+     to two, and finally to one dose and ultimately to injections of
+     warm water. A rapid increase in general strength and a return of
+     appetite for food began when he had reached the five grain limit. I
+     did not allow on any occasion the introduction of a substitute. On
+     the other hand, I added every day suggestions covering the various
+     secondary symptoms, especially the pains in the stomach and the
+     feelings of faintness and the emotional depression.
+
+There, is no doubt that under favorable conditions, especially if the
+dose of morphine is not too strong, autosuggestion can bring about a
+similar effect. A reduction of ten per cent every week can be carried
+through, if a pledge is given to one's self in a drowsy state. The great
+value of autosuggestion showed itself not seldom in the fact that
+morphinists who had applied to me by mail for a cure in the mistaken
+belief that I do work in a professional way for payment and who got from
+me a written reply that I could not receive them, but that they can help
+themselves, wrote to me that my letter gave them strength to reduce
+their dose considerably.
+
+Quite similar is the situation with cocainism or with the combination of
+morphine and cocaine which is so frequent nowadays with young
+physicians. I have repeatedly seen cures where the case already gave the
+impression of insanity. Again I give a rather extreme case.
+
+     A physician had acquired the habit of using and misusing cocaine
+     for the treatment of a disease of his nose. The habit grew to a
+     craving for cocaine while the cocaine itself poisoned the brain.
+     Acoustical hallucinations began; he heard voices from every corner
+     of the room, and on the street the voices took persecutory
+     character. He connected them with his brother living in Europe,
+     heard his voice in the denunciations, and developed a pathological
+     system of ideas around the central thought that his brother had a
+     telepathic influence on him. His reason succumbed, he lost all
+     consciousness of delusion, and believed himself really to be under
+     the control of the absent brother. When he came to me he had been
+     without sleep and without food for several days, and he was not
+     seeking my help to get rid of the mental disturbance but to
+     overcome the power of his older brother. He did not connect the
+     fear at all with his misuse of cocaine. When I discovered the rôle
+     which the cocaine played, I determined to try the suggestive
+     influence, the more as I found that he was in a half-hypnotic state
+     as soon as he had entered my room. I suggested to him to sleep and
+     to take food and to reduce the cocaine dose by a fourth. The next
+     day he was an entirely different man by the effect of ten hours'
+     sleep and a large breakfast. Now I concentrated my efforts on the
+     reduction of the cocaine. After ten days of hypnotic treatment he
+     gave up cocaine entirely, after three weeks the voices disappeared
+     and slowly the other symptoms faded away. The pathological idea of
+     the telepathic influence lasted a while after the voices had gone
+     until this idea, too, yielded to suggestion. It still took six
+     weeks before he himself felt that he was entirely normal.
+
+The way in which the average physician nowadays neglects the simple tool
+of suggestive treatment, when it can be used for the protection of
+society, is perhaps nowhere so reckless as in the case of the morphinist
+and cocainist. To give a typical case of this neglect I may mention that
+of a highly intelligent young man who had been in the habit of using
+both cocaine and morphine for ten years when at his own request he was
+sent to a New York hospital. He had been taking alternately morphine for
+a year or two, then cocaine for a year or two, and had sometimes
+alternated and sometimes combined both in an irregular way. When he
+entered the hospital in May, 1908, he was in a cocaine period and was
+taking the enormous dose of one hundred and eighty grains of cocaine
+every day. In the hospital they withdrew the drug altogether. During the
+first weeks, he was entirely sleepless. They energetically refused him
+any substitutes and after six weeks he began to feel comfortable. He
+gained steadily in weight and after three months, when he left, he had
+gained fifty pounds, felt entirely comfortable, and seemed in all
+respects normal again. Before twelve hours had passed after leaving the
+hospital, he had again taken thirty grains of cocaine and ten grains of
+morphine, and this dose rapidly grew until after a few weeks it again
+reached a hundred grains of cocaine and up to sixty grains of morphine a
+day. Then came the complete breakdown. If that man in the last two or
+three weeks of the hospital treatment, when he felt entirely comfortable
+and normal and had gained his normal weight, had received even a slight
+suggestive treatment suppressing any desire for cocaine or morphine, he
+would easily have been saved. To let such a man after a drug career of
+ten years go out again to the places of his old associations, where the
+desire had to be stirred up, is inexcusable at a time when
+psychotherapeutics has won its triumphs in this field. It might have
+been sufficient to give him preventive treatment at least for the first
+three days of his freedom. And such a case is typical of hundreds.
+
+The overstrong impulse and overstrong desire finds its counterpart in
+the abnormal lack of energy and lack of attention. The patient--and it
+is especially the neurasthenic patient--has lost his usual strength, he
+shrinks from every undertaking, he cannot decide upon any action, he
+needs a disproportionate effort for the smallest task, and cannot
+concentrate his attention in spite of his best will. The varieties of
+this lack of power and inertia are familiar to every physician. They
+certainly often need much more than merely psychotherapeutic treatment,
+although on the physical side no schematic method is admissible. The
+laziness of the anæmic needs a different treatment from the laziness of
+the exhausted but in every case psychological factors can be of decisive
+influence, whatever the physical and chemical treatment besides them may
+be. A few letters may again illustrate the varieties. Here again there
+is no sharp demarcation line between the normal and the abnormal.
+Letters like the two following, for instance, are hardly letters of
+patients. They show a variation which is still entirely within normal
+limits and yet a source of suffering; it is a disturbance which usually
+can be removed by psychotherapeutic means.
+
+     "I do almost everything with effort, nothing spontaneously. I have
+     been writing for five years but am a mood writer of the worst type.
+     The mood comes at such uncertain times that I seem to be absolutely
+     at the mercy of caprice. This might not in itself be a misfortune
+     but writing is my only calling and I suffer the proverbial torments
+     of lost spirits when I am idle. The necessity of driving myself to
+     every piece of work, aggravated by the fact that my parents allowed
+     my constitutional inertness to have full play, has hitherto
+     prevented me from forming any regular habit of labor. I am now
+     thirty-eight. Would you suppose that if I kept my nose to the
+     grindstone for one, two or three years, I might yet hope to work
+     with some ease and regularity? That is, if I compelled myself to
+     write a certain number of hours every day as a discipline,
+     regardless of the quality of matter I produce, is there any
+     probability that I might ultimately overcome the fearful paralysis
+     that so often grips my faculties? Can constitutional indolence be
+     overcome by determination? I put in a little time on a couch every
+     day. When worried I get neurasthenia and all kinds of phobias. Just
+     now I am afraid to look at the newspapers on account of the cholera
+     in St. Petersburg, and I have seen the time when I found it
+     difficult to drink water after I had boiled it myself."
+
+Also the next man is familiar to all of us.
+
+     "Plainly we are told every man is born into the world to fill some
+     purpose, or at least be of some benefit to himself or his
+     fellowmen. For some reason I do not make friends among men. I have
+     not the zeal or ambition to carry or even begin a conversation
+     that will interest the individual man. I worry a great deal. I have
+     never been able to concentrate my mind to study and figure out
+     problems. I can read them zealously but apparently do not get to
+     the bottom and cannot retain what I do read. If I could just get
+     hold of the power of thinking and dig out that tangible something
+     that holds me back, I could go forward and make myself what I know
+     I should be. But I feel that so far I am a total failure. If I only
+     had that one great gift, the power of concentration and will power,
+     I would make what I so much desire, a success of myself."
+
+A similar effect and yet psychologically a different condition exists
+where the lack of energy results from the suggestive power of the
+opposite, producing a constant indecision.
+
+     "I am thirty years old and nearly all my life since childhood I
+     have been fearfully troubled with the habit of indecision and
+     regretting whatever I do. It has grown into a habit so fixed that
+     at times I am fearful of losing my mind. I feel anxious to do
+     something and decide to do it, then as soon as it is done, I nearly
+     go wild with regrets until I have to undo it, if possible, and then
+     only to regret that. I am this way about the most trifling things
+     and about the most serious. I can't perform any duty well. In
+     business and in social affairs, it is always with me. It has me in
+     its clutches, a horrible monster dragging me down. My friends
+     misinterpret me and wonder what I mean by doing so when all the
+     time I want to do what is for the best and cannot for this tyrant
+     who is ever present with me. I will plod for hours and hours at a
+     time, and at every turn I am handicapped. I am intelligent
+     naturally and appear a perfect fool."
+
+From the report of such chronic cases we may turn to the acute ones.
+Here a characteristic letter of, a typical neurasthenic young modern
+poet.
+
+     "These are my plans but I hardly think that I can carry them
+     through, although perhaps you can help me by suggestion. I have the
+     feeling that through the whole of last year my development did not
+     go forward but backward. It is as if by a mental or physical
+     overstrain, my whole personality has entered into a transition. I
+     have no joy in life, no sensation in love, no satisfaction in
+     labor. My will has become weak where it was strong. I am lazy, up
+     to an absolute dislike of everything, while I have been energy
+     itself. Often I have only the one desire, to end my life from mere
+     fatigue. If there had been any external reason for ending my life,
+     I should perhaps have done it long ago. I am so apathetic that I no
+     longer take myself seriously. My successes do not please me; the
+     idea of writing anything gives me anxiety. I have become less
+     resisting, more sweet, more soft, I should almost like to say, more
+     feminine. I became infatuated with a girl, simply because I knew
+     that she hates all men. The inaccessible is still the only thing
+     which can stimulate me somewhat. I have even written a poem on her,
+     but nothing can satisfy me in love. I consider my state a disease
+     of the will as a result of nervous exhaustion. I must find some one
+     who, with kindly power, reënforces my will system. I need a strong
+     mind--it may be a man or a woman. It would even be possible in the
+     latter case that I might marry her.
+
+     "Even the writing of this letter has fatigued me so much that I
+     should like best to sleep. In moments like the present I should
+     like best to throw myself down on the street or ... quickly ...
+     sink ... into the ocean. (I regret having made the little points.
+     They look as if my expressions are a pose.) Yet there are moods in
+     which I am entirely normal and no one fancies what I am passing
+     through. I have even become superstitious lately. Are there perhaps
+     beings which can absorb our energy? Perhaps another being has drunk
+     up my energy."
+
+Authors run easily into such states. Here is another.
+
+     "I am a neurasthenic, and I am beginning to believe, a professional
+     one. My object in writing is to ask concerning the advisability of
+     my visiting you for treatment. I am ready to take the next train if
+     you say the word, if you believe you can help me. It seems that the
+     regular practitioner, who is very irregular, cannot. If there is
+     one good doctor I have not consulted, I would like to know his
+     name. I was doing editorial work in X and broke down. Still the
+     doctor said that if I liked my work, I should go back to it and
+     pitch in. I did. It lasted a few days and then I had to give up
+     altogether, couldn't grind out another word. Then to another
+     doctor----also the best in the city. He told me to give up all
+     work, which I did, and then I went on a farm for six months. That
+     did not help me either. Later I went west and spent some time in
+     the mountains. I felt no better there. Then I went to Arizona and
+     lived in a tent out on the desert; that did not help me. There was
+     always a sensation of exhaustion and any physical exertion put me
+     on my back, even when it was light and pleasant exercise. Then I
+     went to California; it did me little good. It is a perfect paradise
+     for anyone who has not got neurasthenia. I still have not got
+     myself in hand. I cannot do or say or write just what I wish, and
+     cannot concentrate my thoughts. To try to read a book is punishment
+     because I forget as fast as I read." And so on.
+
+     I answered him certainly not to come but tried to induce some
+     autosuggestions. A few weeks later, he wrote me: "Ever since you
+     wrote me, I am now feeling somewhat improved." Yet I cannot judge
+     how far the improvement belonged to the psychical factor only,
+     inasmuch as I had advised him also to take some bromides. The
+     really effective treatment would have been heterosuggestion and I
+     had no time to enter into the case.
+
+Where direct suggestion is used, the effect is often surprising.
+
+     A young lawyer after a period of overwork had come to a state of
+     complete lack of energy. He could not find strength to write a
+     letter and he came to me at a day when he did not see any way but
+     suicide open for himself. He complained that, as soon as he began
+     to grasp a thought, it was evaporating. He stared absently about
+     the room and felt sure that he would never again achieve anything.
+     He had not even the energy to read the newspaper. I hypnotized him
+     three times, each time waking in him the pleasure in a definite
+     piece of work, at first simply in a novel which he was to read,
+     then in some letters which he was to write, and then in his
+     professional work. There was always an interval of three days. The
+     fourth time he declared himself that the hypnotic influence was
+     unnecessary, as he felt that he was again in the midst of his work.
+
+As a rule the effect is a much slower one, but if all personal factors
+are well considered and especially physical disturbances are excluded,
+the result is usually satisfactory.
+
+Very different from such neurasthenics, of course, is the lack of
+attention in the feeble-minded, and suggestion of the ordinary type is
+hardly advisable, but it is surprising how much can be reached by a
+systematic psychical régime. I give one typical instance, representative
+of many.
+
+     A boy of twelve years when he was brought to me showed the mental
+     powers of a stupid child of four. In a silly way he repeated every
+     question which he heard without answering it; he talked steadily to
+     himself in a nonsensical manner, mostly repeating nursery rhymes
+     without end, never holding his attention to anything in the room,
+     giving the impression that there was no attention whatever. The boy
+     was a child of rich parents; he had his own teachers, but was for a
+     large part of the year under the influence of the parents only, who
+     very naturally yielded to every desire of the unfortunate child. I
+     insisted on a complete change of the education. It was my effort to
+     build up the mind by a rigorous training and by development of the
+     power of inhibition. I absolutely forbade any meaningless material
+     like the nursery rhymes, insisted that the child should never be
+     allowed to talk to himself, and whenever he began to speak to
+     himself he was to be addressed sharply, and if he yet went on, to
+     be slapped on his hands. In the same way he was not allowed to
+     repeat a question, but the question was repeated until he answered
+     it, the question always formulated in simple words. He was forced
+     to go through simple reading and writing without being allowed to
+     make his silly diversions. His whole life was brought under strict
+     discipline and no parental indulgence was permitted. Six months
+     later the child was completely changed. It seemed as if he had gone
+     through an improvement of three years. I regulated the whole of
+     his elementary studies in accordance with the successful principle.
+     The training of inhibition stood in the foreground and every
+     haphazard reaction was severely rebuked. The summer vacations spent
+     with the parents in the fashionable surroundings, to be sure, had
+     always a retarding influence, but the main part of the year in
+     which it was possible to carry through the strict discipline showed
+     such steady and inspiring progress that the boy, while of course
+     feeble-minded for life, can yet live externally a harmonious life.
+
+A systematic training of the power of inhibition is indeed the
+fundamental factor in all psychotherapeutic treatment when the
+disturbance is in the volitional sphere, but the inhibition is secured
+most safely by reënforcement of the antagonistic attitude. From these
+volitional variations on the one side, from the ideational disturbances
+on the other, only a few steps lead to those dissociations of the
+personality which are characteristic of many graver cases of hysteria.
+But to give to them any adequate analysis, it would be insufficient to
+refer in this brief way to particular cases. Psychopathological
+literature possesses some excellent analyses of such complex
+disturbances. As I said before, I abstain entirely here from such
+complex phenomena, as they enter too seldom into the sphere of the
+practitioner and as the bewildering manifoldness of their symptoms does
+not allow us so easily to recognize the fundamental principles which
+alone were to be illustrated by our short survey of practical cases.
+
+
+
+
+XI
+
+THE BODILY SYMPTOMS
+
+
+The discussion of the bodily symptoms which may yield to
+psychotherapeutic treatment, naturally forms only a short appendix to
+our discussion of the mental symptoms. Our interest was from the
+beginning essentially a psychological one. I shall have to be the more
+brief as my personal experience in the treatment of bodily diseases
+through mental therapy is entirely secondary and accidental. The
+psychological laboratory would, of course, be an entirely unfit place to
+struggle with diseases of which the chief symptoms are not
+psychophysical. Yet in spite of frequent testimonies of well-known
+physicians to the contrary, I am still inclined to think that this is
+also the situation at large. I think that in medicine in general the
+psychophysical effect of mental treatment is by far more important and
+by far more extended than the healing effect on diseased peripheral
+organs. Of course these peripheral parts of the body may be favorably
+influenced in an indirect way by the mental treatment; we shall have to
+take notice of this important result but that is strictly not a
+therapeutic effect on the bodily symptoms. Moreover, purely psychical
+effects may give an impression as if the bodily symptom itself has been
+removed.
+
+To begin with the latter case, it is especially the inhibition of pain
+which easily makes one believe that a bodily disturbance is successfully
+treated. I have repeatedly seen cases in which I tried by suggestion to
+soften the pain resulting from a peripheral disturbance like
+inflammations, rheumatism, decayed teeth and so on. The effect was often
+such a total disappearance of the pain that the patient himself was
+inclined to believe that the objective disease had been ended, while in
+reality the state of the diseased organ was not changed at all. It has
+often happened that I tried to cure a person of certain mental symptoms
+by suggestion, ignoring entirely the existence of some pain resulting
+from a bodily disease with which I had nothing to do. Yet the suggestion
+of improvement seemed almost to irradiate and the pain disappeared in
+spite of having been ignored by the hypnotizer. For instance, I treated
+a woman who suffered from psychasthenic obsessions, fearing all the time
+that something would happen to her child. I did not give any direct
+attention to the fact that she had had for years a painful disease of
+the bladder for which she was constantly treated by a specialist. But
+while I did not mention the bladder in my hypnotic suggestion, yet the
+abdominal pain disappeared together with the obsession and the situation
+might easily have suggested that the bladder trouble was a nervous one
+which had been cured by the hypnotic sleep. The fact was that the
+bladder disease was not influenced by the mental treatment at all, and
+needed a continuation of the same local treatment. It was only the
+psychophysical pain in the brain which had been inhibited.
+
+Quite parallel to the disappearance of the organic pain sensation is the
+arising of a general feeling of improvement. This organic sensation of
+general betterment may again be a strictly mental occurrence without any
+objective reference to a real improvement in the bodily conditions. Yet
+again that easily gives the impression of an important change in the
+bodily conditions themselves. The miraculous cures of various diseases
+through mystic agencies generally belong to this category. There is no
+doubt that often the migrating charlatans who advertise themselves by a
+free treatment of the sick and invalids on the theater stage of small
+towns, produce momentary effects which are sufficient to deceive. The
+quack handles the diseased organ, perhaps a goiter or a leg crippled by
+rheumatism, with a cruel rudeness and overwhelms the suggestible mind so
+completely that the first autosuggestion is that of a complete change,
+and that means cure. The disastrous results follow later. But from such
+barbarisms we come by gradual steps to the suggestion of improvement
+where the feeling of betterment can be in itself an important factor for
+the cure. Yet even there we must not mistake the possible secondary
+effect of a mental change from a psychotherapeutic cure of the bodily
+disease.
+
+Not seldom the removal of physical disability seems secured as soon as
+certain mental disturbances are removed. There is no reason to believe
+for instance that suggestion can have an important influence on a
+diseased sense organ, and yet hypnotic influence and even autosuggestive
+influence can under certain circumstances greatly improve seeing and
+hearing. Especially in the field of hearing the central factor is of
+enormous importance. Hyperæmic and anæmic conditions in the brain
+centers of hearing control the vividness of the received sound. The
+patient who cannot hear a certain watch more than one foot distant may
+be able to hear it after some glasses of wine at a distance of three or
+four feet. Thus it is only natural that a hypnotic influence can produce
+similar changes on the psychophysical centers in such cases in which the
+source of the trouble is a psychophysical laziness in the acoustical
+center. Sometimes even this laziness itself is the result of psychical
+autosuggestion which can be fought by counter-suggestion. I saw, for
+instance, a distinct improvement in hearing in the case of a young woman
+who had increasing deafness while the aurists declared that the ears
+were in proper condition. I found that she lived with a father who
+suffered from a severe middle-ear catarrh and that she was simply
+controlled by a hidden fear that she might have inherited the ear
+disease of her father. I removed this fear, partly by reasoning, partly
+by suggestion, and partly by tricks which surprised her, for instance,
+making her hear her watch with unaccustomed strength when she took it
+between her teeth and closed both ears. The autosuggestive fear was
+uprooted by these and the central ear organs slowly came to normal
+functioning.
+
+The purely psychical character is still more evident in the frequent
+hysterical anæsthesias. No one doubts that here the sensations are
+inhibited only and that the mental influence removes this inhibition
+without any influence on the sense organs proper. Frequently also
+organic troubles like stomach diseases appear cured when in reality
+hysterical disturbances are at the bottom. The stomach may be sensitive
+to any pressure and may produce severe pains and vomiting on taking any
+food and everything may indicate a serious local disturbance. Yet
+hypnotic treatment may quickly remove the symptoms because the whole
+reaction may have resulted from the shock which perhaps a too hot piece
+of potato caused. The removal of this mental starting point results in a
+cure of the apparent stomach disease. Again in other cases, the
+appearance of a physical cure is given by the creation of psychophysical
+substitutes. I do not believe that hypnotism or suggestive treatment can
+influence the brain parts which have suffered from a hemorrhage. Yet the
+paralysis of the arm, for instance, which resulted from such a breaking
+of a blood-vessel in the brain may be to a high degree repaired by
+building up new motor images in the psychophysical system, which become
+starting points for a new learning of movements. The patient did not
+understand how to make the most out of those motor paths which had been
+left. The destruction of the chief channels of discharge had inhibited
+in his mind the idea of possible movement. He no longer believes that he
+can move and it needs new suggestions to overcome this inhibition. The
+curative effect on bodily disabilities is thus often an illusory one.
+
+That does not mean that the field in which psychotherapeutics may work
+directly on the body is not after all a large and interesting one.
+Theoretically it is still little open to real understanding. The
+explanation has essentially to rest on the acceptance of a given
+physiological apparatus. A certain psychophysical excitement produces by
+existing nerve connections a certain effect, for instance, on the
+blood-vessels or on the glands of a certain region, or on a certain
+lower nervous center. That such apparatus exists, the physiological
+experiment with persons who are hypnotized to a high degree can easily
+demonstrate. Their nose bleeds at a command; a blister may arise on a
+part of the skin which is simply covered with a penny, when the
+suggestion is given that the penny is glowing hot. With some subjects,
+the pulse can become slower and quicker in accordance with the
+suggestion; with some even the bodily temperature can change on order.
+Our understanding of these indubitable facts indeed does not go further
+than the acknowledgment that the paths for such central connections
+exist. That means we simply describe the facts once more in the terms of
+anatomy. But after all in the same way we rely on the nervous
+connections, if a thought makes us blush and ultimately if our will
+moves our arm or if our ideas move our speech apparatus. We do not
+choose the muscles of our arm, we hardly know them; we know still less
+in speaking, of the movements of our vocal cords, and in blushing of the
+dilated blood-vessels. That ideas work on the lower centers of our
+central nervous system, centers which regulate the actions of our
+muscles and blood-vessels and glands, must simply be accepted as the
+machinery of our physiological theory. The connection of such theories
+with purely physical facts is given by the experience that an electrical
+stimulation of the nerve may have the same influence as ideas. The
+electric current, too, can regulate the beat of the heart, or contract
+and dilate the vessels, or reënforce and relax the contraction of the
+muscles, or strengthen and weaken the functions of the glands.
+
+Nearest to the psychophysical processes stands the bodily symptom of
+insomnia. There is no doubt possible that the work of the
+psychotherapist can be very beneficial in producing sleep by suggestion.
+That autosuggestions for sleep play an important rôle is popularly
+accepted. Next to the most immediate means such as lying down, or
+cutting off sense stimuli, or trying not to think, or avoiding
+movements, certainly the most well known factor is the expectation of
+sleep with the belief that sleep will come. This belief may be
+reënforced to strong autosuggestion which may then overcome other
+factors that hinder sleep. For instance, I have repeatedly received
+letters from strangers containing expressions of gratitude with news
+which under other circumstances would at least not flatter an author.
+They wrote to me that immediately after reading one or another essay of
+mine on hypnotism, they fell into deep sleep. Yet as they were always
+patients who had suffered from insomnia, I was pleased with this
+unintended effect of my writings. But in most cases a real cure demands
+heterosuggestion.
+
+There is room for any variety of effects; often they enter immediately.
+The other day I gave sleep suggestion to a young woman who had
+overworked herself in literary production. For months she had not slept
+more than three or four hours a night and even that only after taking
+narcotics. I intentionally did not allow her to come into a hypnotic
+sleep but kept her fully awake, increasing her suggestibility while her
+eyes were wide open. I suggested to her to take a walk, then to eat her
+dinner, and after that to go to bed at once. She went to bed at seven
+o'clock and slept without waking until ten o'clock the next morning, and
+after fifteen hours' sleep she was like a different being. A regular
+eight hour sleep is sometimes secured, even where no immediate direction
+has been given for it. On the other hand, I cannot deny that I have
+sometimes been entirely unsuccessful in securing better sleep by the
+first three hypnotic treatments. When the first three treatments were
+unsuccessful, I always gave it up on account of lack of time. Yet the
+experience of others shows that in such cases, often after a long
+continued hypnotic treatment insomnia yields to suggestion. One of the
+great factors which work against the mental treatment is the habit of so
+many sufferers of relying on their sleeping powders which, to be sure,
+remain effective only by increasing the dose and thus finally by making
+them dangerous. Every chemical narcotic has in itself suggestive power
+and strengthens the belief of the sleep-seeker that he cannot find rest
+without his dose. To overcome the monopoly of the opiates is one of the
+most important functions of psychotherapy.
+
+It is not surprising that the relations of psychotherapy to sleep show
+such a great variety. The factors which coöperate in normal sleep are
+many and the disturbance can have very different character. We had to
+speak of the psychophysics of sleep when we discussed the theoretical
+relation of sleep to hypnotism and insisted that it is misleading to
+consider hypnosis simply as partial sleep. We claimed a fundamental
+difference between the selective inhibition in hypnotism and the general
+reduction of functions in sleep. To understand sleep, we have to
+recognize it as one of the fundamental instincts, comparable with the
+instinct for food or for sexual satisfaction. Every one of such
+instincts has a circular character. Mental processes, subcortical
+processes, and physical effects are involved in such a way that each
+reënforces the others. The physical effect of the sleep instinct,
+comparable with the pepsin secretion in the food instinct, or with the
+hyperæmia of the sexual organs in the sexual instinct, is a change in
+the cortex by which the sensory and motor brain centers are put out of
+action. What kind of a change that is, is quite indifferent. It may be a
+chemical one but more probably it is a circulatory one. Let us say it is
+a contraction of blood-vessels which by the resulting anæmia makes the
+sensory centers unfit for perception and the motor centers unfit for
+action. In this way the brain becomes protected by sleep against the
+demands of the surroundings. The mental reactions are eliminated and the
+central nervous substance has an opportunity to build itself up. This
+protective physical activity is now evidently itself controlled by a
+subcortical center, just as secretion and sexual hyperæmia are
+controlled. This center probably lies in the medulla oblongata.
+
+Some theorists, to be sure, are inclined to think that the fatigued
+brain cells enter directly through their exhaustion into the protective
+sleep state. But that simplifies the situation too much. It is quite
+true, as these theorists claim, that monotonous stimulation of the
+senses produces sleep. But it is evident that the sleep occurs even then
+not only in the particular overtired brain cells. A monotonous
+stimulation of the acoustical center raises the threshold of perception
+for all the senses and brings sleep to the whole brain. This control of
+the whole apparatus is thus surely regulated by one definite center. But
+this lower center, which controls the anæmia of the cortex, is itself
+directly dependent again upon a mental condition, the mental experience
+of fatigue. The fatigue sensation, which is possibly the result of toxic
+processes, works on that lower sleep center, just as the appetizing
+impression or the sensual images work on the centers of the other two
+instincts. On the other hand this protective blood-vessel contraction
+creates again as in the other cases a characteristic organic sensation,
+the sensation of rest which arises when the threshold of perception and
+activity is raised. The world begins to appear dim and far away, no
+impulse for action excites us. This organic feeling of rest associates
+itself with the fatigue feeling. The fatigue sensation, the subcortical
+sleep center, the contraction of the vessels in the cortex, and finally
+the rest sensation form together the complete circle. The difficulty
+which arises in this case lies only in the fact that the cortex gone to
+sleep annihilates also, of course, the fatigue sensation and the rest
+sensation. For that reason the real circle can appear only in the
+preparatory stages of sleep. As soon as sleep itself sets in, the circle
+is broken. The circle character of every instinct must lead the physical
+effect upward to a higher and higher degree. Not to become excessive,
+the physical effect must be checked somehow. In all other spheres, it
+finds its end in satisfaction, for instance, by eating or by the sexual
+act. In sleep the circular process ends automatically by its own effect
+as soon as complete sleep is reached. Its causes, the fatigue and the
+rest feeling, are stopped, as soon as the effect, the anæmia, is
+secured.
+
+We see now how widely different starting points can lead to sleep and
+can understand from it how widely different disturbances can prevent
+sleep. Sleep must result when fatigue is coming, but sleep must also
+result when the elements of the rest feeling are produced, and as we saw
+that the components of the rest feeling were the sensations of decreased
+sensitiveness and decreased activity, sleep must result when either the
+sensations and associations are absent and actions are suppressed, or
+when monotonous sensations and automatic actions raise the threshold.
+Sleep must arise further if our will associates the mere idea of such
+rest, and finally physical or chemical means may produce a sleep
+bringing effect either on the lower center or on the blood-vessels and
+cells of the cortex. Correspondingly sleep may be prevented by
+disturbances in any one of these spheres. There may be no normal
+fatigue, there may be no fatigue sensation, there may be no rest feeling
+on account of perceptions, or on account of associations, or on account
+of impulses to action; there may be no normal response in the
+subcortical center, there may be no physical effect in the cortex on
+account of an existing hyperæmia or on account of an abnormal condition
+of the cells. The psychotherapeutic treatment must carefully analyze
+which element would be fit to supply the last link in the circular
+chain. Sometimes we need the suggestion of fatigue, sometimes the
+inhibition of ideas, sometimes the suppression of impulses, sometimes
+the suggestion of rest, and so on. A mere general suggestion of sleep is
+on the whole effective only in the cases of those persons in whom this
+idea in itself awakens those various components. Very often it is
+entirely ineffective in this general form. Sometimes it is possible to
+carry the hypnotic state itself directly over into sleep, but it seems
+more in the interest of the patient to separate those two states
+distinctly.
+
+We are still confined to processes in the brain itself if we turn to
+headache. If it were only a question of inhibiting the pain by mental
+suggestion, the case would not be different from inhibiting the pain of
+a peripheral organ without attempting to cure the diseased organ itself.
+But in the case of headaches, it seems justified to claim that in
+certain varieties of this multifold symptom, not only the pain is
+suppressed but the disturbance itself is removed. Especially where the
+headache seems to result from hyperæmia, the trouble seems to be
+accessible to psychotherapeutics. On the other hand I have never seen
+any lasting effect on the so-called sick headache or migraine. While
+continuous headaches or headaches which occur daily yielded to my
+influence, sometimes completely, I was unable to prevent even by
+preparatory hypnotization any migraine which appears periodically, for
+instance, simultaneously with menstruation.
+
+A few words only as to the general diseases and disturbances for which a
+very strong therapeutic effect has been claimed by masters of the craft
+like Wetterstrand, Moll, Dubois, and others. From my own experience I
+can affirm the often lasting effect in the disturbances of the functions
+of the digestive apparatus. The stomach and the intestines seem to a
+high degree under nervous influences which can be changed through
+hypnotic suggestion. If we consider what intimate connection exists
+between the functions of these organs and the normal emotions, it seems
+hardly surprising that mental factors can regulate their disturbances.
+Vomiting, diarrhea, and especially constipation, often yield to slight
+suggestions, even in a superficial hypnotic state. Here, too, I have
+seen repeatedly a complete regulation of a long-standing disturbance as
+an unintended by-product of hypnotic suggestion directed towards the
+cure of psychical troubles. Much value is claimed for hypnotic method in
+the treatment of anæmic conditions. It is said that anæmia improves
+after a few hypnotic treatments, the appetite becomes better, the cold
+hands and feet grow warmer, the headaches disappear, the capacity for
+work increases rapidly, and most surprising of all the leucorrhea
+ceases. As to heart disease, we ought to think in the first place of the
+disturbances of nervous innervation. I have seen repeatedly a remarkable
+decrease of nervous palpitation of the heart through direct mental
+influence, abstracting here from the secondary effect of suppressing
+mental excitement and fear. Where organic heart diseases are surely
+present, it seems that hypnotism can sometimes act beneficially if the
+heart trouble is accompanied by anæmia and general debility; of course a
+developed valvular disease cannot be removed. In the same way it seems
+that in Bright's disease, certain painful symptoms may be suppressed,
+but the kidneys certainly cannot be influenced. At least open to
+serious suspicion are the insistent claims that diabetes can be cured by
+suggestion. Dr. Quackenbos of New York, for instance, gives to some of
+his diabetes patients a hypnotic suggestion by the following words: "If
+your pancreas be crippled in its production of the natural ferment which
+is given off to blood and lymph and which conditions the normal
+condition of sugar in the body or restrains the output of sugar from the
+liver tissues, you will see that it forthwith pours into your blood or
+lymph the sufficient quantity of sugar oxidizing ferments." It certainly
+transcends our present understanding if we are to believe that a
+suggestion of this type will change the action of the pancreas. It is
+hardly worth while to enter into the still more extravagant claims from
+other sides like those for curing cancer and phthisis. On the other
+hand, in the light of all that we have discussed, there is no difficulty
+in understanding the easily observable influence in the regulation of
+menstruation, in the cure of contractions, local congestions, and
+incontinency of urine. I may mention finally the use of hypnotism for
+helping in a safe and quick confinement.
+
+But in addition to all this, we have the great help which psychotherapy
+may bring indirectly in the treatment of physical diseases. I said, for
+instance, that I do not believe in a real help by mere suggestion in
+cases of diabetes. But no one ought to underestimate the value which may
+result for the treatment from a suggestion of a well-adapted diet. The
+patient who feels a craving for bread and potatoes and perhaps sweets,
+and is too weak to resist it, is indeed brought into safety if
+suggestion liberates him from such desires. The same holds true for
+every other diet and for any medical régime of life which does not
+harmonize with the natural instincts of the patient. For not a few
+sufferers, reënforcement of the interdict against coffee and tea or
+alcohol and tobacco is more important than any medicine. Hypnotic
+suggestion can easily create dislike of the prohibited material and can
+build up new desires and inclinations. In the same way it is indirectly
+most important to stir up, for instance, the sensations and feelings of
+appetite and thus to make normal nutrition possible. Also in cases of
+anæmia or tuberculosis, such indirect assistance can produce some
+beneficial consequences.
+
+The same holds true of the power of the psychotherapist to secure sleep.
+The fight against insomnia which we discussed referred only to that
+sleeplessness which is itself an expression of the disease. But as a
+matter of course, the loss of sleep can accompany most different
+diseases, as an almost accidental result. To secure sleep means then not
+to treat the symptoms of the disease but a by-product; and yet every
+physician knows how much is gained if the lost energies are restituted
+by a sound sleep. And finally we have the indirect help towards the cure
+by the suggestive removal of pain. We have no right to say that it is a
+pure advantage for the treatment of the disease if the pain is centrally
+inhibited. Pain surely has its great biological significance and is in
+itself to a certain degree helpful towards the cure, inasmuch as it
+indicates clearly the seat and character of the trouble and warns
+against the misuse of the damaged organ which needs rest and protection.
+To annihilate pain may mean to remove the warning signal and thus to
+increase the chance for an injury. If we had no pain, our body would be
+much more rapidly destroyed in the struggle for existence. But that does
+not contradict the other fact that pain is exhausting and that the fight
+against the pain decreases the resistance of the organism. As soon as
+the disease is well recognized through the medium of pain and the
+correct treatment is inaugurated, not only the subjective comfort of the
+patient but the objective interest of his cure makes a removal of pain
+most desirable. While it would be absurd to say that hypnotism can cure
+tuberculosis or cancer, it is fully justifiable to say that hypnotic
+treatment in tuberculosis or cancer is to a high degree beneficial,
+inasmuch as it can secure sleep, appetite, and freedom from pain, three
+factors which indirectly help to fight the disease. The elimination of
+pain may sometimes also play its rôle in slight operations where other
+methods of narcosis seem for any reason undesirable, and very frequently
+hypnotic suggestion has been used for this purpose at childbirth.
+
+The same importance which belongs to the removal of bodily pain in the
+treatment of a peripheral disease may be given to its mental
+counterpart, to the worry, excitement, and emotional shock. They all
+stand in the way of a real success in any cure. Even the chances of a
+dangerous operation are entirely different for the patient who goes to
+it with free mind and a happy mood, with full confidence in its success,
+from those of a patient who has worked himself into a state of fear and
+anxiety. Here again the depression and the excitement are not in
+question as symptoms of a disease, as they were when we discussed the
+phobias and despondencies of the neurasthenic and of the hysteric. They
+are merely normal side-effects of the bodily disease, accentuated
+perhaps by a suggestible temperament. To eliminate all these emotions
+means to change most helpfully the whole atmosphere of the sick-room and
+to deprive invalidism of its saddest feature. This negative factor
+corresponds of course most directly to the positive feature of building
+up new hope and joyful expectation. He who creates confidence makes
+convalescence rapid and strengthens the power to overcome disease.
+
+It would be medical narrowness if the physician were strictly to deny
+that the effect of such emotional change may sometimes lead far beyond
+the ordinary suggestive influences and that in this sense the miraculous
+really happens. When out of a despondent mood in a suggestible brain an
+absorbing emotion of confidence breaks through, a completely new
+equilibrium of the psychophysical system may indeed result. In such
+cases, improvements may set in which no sober physician can determine
+beforehand. Central inhibitions which may have interfered a life long
+with the normal functioning of the organism may suddenly be broken down
+and in an entirely unexpected way the mental influence gives to the
+forces of the body a new chance to help themselves. The reasoning of the
+scientific physician may easily stand in the way there. He may be afraid
+of such overstrong emotion because he knows too well that such
+unregulated powers may just as well destroy the good as in another case
+the bad; in short, that ruin may result just as well as health. But that
+does not exclude the fact that indeed almost mysterious cures can be
+made without really contradicting the scientific theories. Such are the
+means by which the mystical cults earn their laurels. A chance letter of
+the type which often swells the mail of the psychologist may illustrate
+this effect. I choose it because it is evidently written by a skeptic. A
+short quotation from the lengthy epistle is sufficient.
+
+"My condition was horrible in the extreme. I had consumption of the
+lungs and other supposedly fatal troubles, complicated by wrecked
+nerves. At the present writing, I am robust and splendidly healthy,
+looking twenty years younger than I did at the period previously
+described. The Christian Scientist saw my condition but appeared
+unconcerned and unafraid, I being absolutely hopeless, skeptical, and
+deeply contemptuous meanwhile. On the third day of her treatment I was
+desperate for sleep, she having forbidden drugs, and I deliberately took
+an overdose of chloral, thinking to die at once and end it. My
+condition justified the act. She brought me out of the coma of the
+chloral after three hours of mental work, and the next day I felt
+decidedly calmer and less afraid of the coming of night, should I live
+to meet it, which seemed doubtful. At noon she left me to go to her home
+to lunch. I was pondering seriously on her reiterated 'God is love and
+fills the universe and there is nothing beside Him,' when I suddenly had
+a sensation of being lifted up or rising slowly and becoming lighter in
+body. A rush of power that I have no way of describing to you filled me.
+I seemed to be a tremendous dynamo in the air several inches above the
+ground and still ascending. When I noticed everything around me becoming
+prismatic and more or less translucent, I could have walked on water
+without sinking, and I had distinct understanding that matters seemed to
+be disintegrating and dissolving around me. I was frightened but
+self-conscious and quiet. I remained in this state for about three
+hours, my consciousness seeming to have reached almost cosmic greatness.
+I could have cured, I felt, any human ill, was filled with an absorbing
+altruistic desire to help suffering. It was tremendous and totally
+foreign to my everyday attitude. At the end of the day, towards
+twilight, I became wearied of the tremendous throbbing and exalted state
+in which I still remained and gave utterance to the thought aloud.
+Almost before I had formulated it the condition left me, and like the
+sudden dropping of a weight, I struck the ground, the same dull,
+ordinary person of everyday experience, but with the vast difference of
+perfect health, radiant and lasting to the present writing. My father
+like myself is baffled and wondering. We are both pretty hard skeptics.
+I want the truth, whether it be terrible or otherwise. I am profoundly
+grateful to the Christian Scientist, if I regained my health through her
+ministrations, but I have not so far been able to label myself and rise
+in their church services to tell what has been done on me. The
+performance repels me as crude and rather bad taste. I swear to you on
+my honor as an American woman and a mother that what I have written you
+is true, absolutely. If you can give me any light or if my experience
+may perchance give you a helping ray, my renewed lease on life may have
+had some purpose after all, which I have often questioned in my cynical
+moods."
+
+The unprejudiced psychotherapist will be perfectly able to find room for
+such cures and, if it is the duty of the scientific physician to make
+use of every natural energy in the interest of the patient's health, he
+has no right to neglect the overwhelming powers of the apparently
+mysterious states. Some of this power ought to irradiate from his eye
+and his voice whenever he crosses the threshold of a sick-room. Some of
+that power ought to emanate from him with every pill and drug which he
+prescribes. The psychotherapeutic energies which work for real health
+outside of the medical profession form a stream of vast power, but
+without solid bed and without dam. That stream when it overfloods will
+devastate its borders and destroy its bridges. The physicians are the
+engineers whose duty it is to direct that stream into safe channels, to
+distribute it so that it may work under control wherever it is needed,
+and to take care that its powerful energy is not lost for suffering
+mankind.
+
+
+
+
+PART III
+
+THE PLACE OF PSYCHOTHERAPY
+
+
+
+
+XII
+
+PSYCHOTHERAPY AND THE CHURCH
+
+
+The belief in supernatural energies has cured diseases at all times and
+among all peoples. Everywhere the patient sought help through the agents
+of higher forces and everywhere these agents themselves utilized their
+therapeutic success for strengthening the belief in their over-natural
+power. The psychologist would say that it was always the same story, the
+influence of suggestion on the imagination of those who suffer. Yet the
+variety of forms is abundant. Not only the special symbols but the whole
+attitude may take most varied character, and every special appearance is
+intimately related to the whole mystical background and to the
+religious, scientific, and social ideas of the time. If nevertheless,
+even at the same time in the same country, very different forms of
+religious suggestion are at work, it must not be forgotten that those
+who live together in any nation and are united in many common purposes
+represent, after all, different stages in the development of
+civilization. It has always been true that those whose minds are
+saturated with the real culture of their time are working together with
+those whose culture belongs to earlier centuries and with others whose
+minds are essentially of the type of the primitive peoples.
+
+Let us glance at the life of the savages. In darkest Africa, we find a
+special caste with its professional secrets which accepts new members
+only after long tests. They are evidently persons with over-sensitive
+nervous systems and liable to hallucinations. As soon as they have their
+attacks of abnormal excitement, they are conceived to be agents of
+superhuman powers, and on account of this they are able to prescribe the
+cure of any diseases. In Australia, therapeutic power belongs to the
+koonkie, a man who as a child had a vision of a demonic god. From him he
+received the power to heal the sick. He goes to the patient, touches the
+painful parts and rubs them and after a few minutes, he shows a little
+piece of wood which he had hidden in his hand and which he claims to
+have extracted from the body of the sufferer. The native feels actually
+cured after such manipulation of the koonkie, who evidently believes
+himself in his power. In Siberia, we find shamanism. The shaman stands
+between man and the gods. These shamans are excitable persons with
+epileptic tendencies, or at least over-suggestible men or women who by
+autosuggestion and imitation can bring themselves into ecstatic
+convulsions. They alone know from the gods the means to treat diseases
+and their personal influence overcomes the ailment. In early America,
+before the European discovery, the cure of disease belonged in the same
+way to the middleman between the gods and human beings. In the Antilles,
+for instance, the bohuti heals the diseases which are regarded as
+punishments of the gods for human neglect. The priest by inhaling a
+certain powder brings himself into an ecstatic condition, then presses
+the painful organs of the patient, sucks at various parts of his body
+until he finally produces some little bone or piece of meat which until
+then he kept hidden in his mouth. The disease disappears, and the
+extracted bone is used as an amulet which secures good harvests. Other
+Indians had their piachas. They were selected from among the boys of
+about ten years old and were then sent to lonely forests where they had
+to live for years upon plants and water without any friends, seeing only
+at night the older priests from whom they learned the ceremonies for
+curing the sick. Here too their art consisted mostly in touching the
+painful parts of the body with the lips and sucking them to bring the
+evil saps out of the body by their supernatural power. In short, at the
+most primitive stages in Africa and Asia, in America and Australia,
+therapy was acknowledged to be a special power of men who had superhuman
+forces derived from good or evil gods.
+
+All this repeats itself in the so-called half-civilizations. Among the
+masses of China, mental and bodily diseases were ascribed to the fox,
+which plays such a large part in the superstitions of eastern Asia. The
+priest has the power to banish the fox by mystical writings which he
+pastes on the wall of the sick-room, and the patient recovers, as the
+fox has to leave his body. In old Japan the mountain monks, who
+inherited their superhuman powers from a martyr of the fifth century,
+can remove the diseases which have magical origin or which are induced
+by the devil. They also supply the magical papers covered with writings
+and pictures of birds, to prevent the appearance of smallpox and
+pestilence and to cure a number of diseases. India, the classical land
+of suggestion and hypnosis, shows the most extensive connection between
+religious and magical powers among which the cure of diseases is only
+one feature. Such cure may be with medicaments or without, but the
+essential part always belongs to the prayers which make the good and
+evil spirits obedient to the healer. These prayers were often spoken in
+Sanscrit, which the people did not understand and which thus added to
+the mystic solemnity of the procedure. This suggestive influence of the
+use of older languages for religious solemnities, known only to the
+priests, repeats itself also at all times and among all nations. In
+Assyria and Babylonia, too, medicine was exclusively a branch of
+mysticism and essentially in the hands of the priests, who by words and
+magical beverages annihilated the influence of the malevolent demons. It
+is well known how the Old Testament reports the same traits of belief
+among the Jewish nation. We hear there that Miriam became leprous,
+white as snow, and Moses cried unto the Lord, saying: "Heal her now, oh
+God, I beseech thee." And after seven days Miriam was cured in
+consequence of Moses' prayer. And again, "The Lord sent fiery serpents
+among the people and they bit the people and much people of Israel
+died.--And Moses prayed for the people.--And Moses made a serpent of
+brass and put it upon a pole and it came to pass that if a serpent had
+bitten any man, when he beheld the serpent of brass, he lived."
+
+Among the old Egyptians, it was especially Isis who discovered many
+remedies and had been much experienced in medicine, and after having
+become immortal, it was her greatest pleasure to cure the sick and to
+announce the right remedies in dreams to those who came to sleep in her
+temples. Many who could not be cured by any physician, and who had lost
+their sight and hearing or could not move their limbs, became well again
+when they took refuge in her temples. The same holds true for the
+Serapis temple; even the best known men go there to sleep to get from
+the goddess cures for themselves or for their friends. It is well known
+again that in other ways the old Greeks attached medical influence to
+temples and sacred springs and rivers and tombs. There were sacred
+springs which cured everybody who drank from them, there were statues
+which removed every disease when offerings were brought to them. Here
+again the most frequent is the cure of paralytic symptoms and of
+obsessions. The Orphic priests of old Greece most nearly resembled the
+shamans of the savages.
+
+Those who are inclined to give to the life of Christ a rationalistic
+interpretation have often pointed out that the therapeutic effects
+described in the Gospels might also be understood as effects of
+suggestion by word and tactual impressions, produced especially on
+hysterics, epileptics, paralytics, and psychasthenics. Such
+rationalistic interpretations could also explain in the same way through
+the suggestive influence in the minds of the sick, those cures which
+Christ effected through others without being present himself. Here
+belongs perhaps the cure of the servant of the centurion in Capernaum or
+the cure of the daughter of the woman of Canaan. "And when he had called
+unto him his twelve disciples, he gave them power against unclean
+spirits to cast them out and to heal all manner of sickness and all
+manner of disease." The Acts give us the full details of how Peter and
+Paul cured the lame and how special miracles were performed by their
+hands. No doubt this belief in the curative effect of the disciples and
+their successors fills the first centuries after Christ. Eusebius tells
+us how they healed the sick by laying on of hands. The forms were
+frequently changing through the history of Christianity but the essence
+remains the same. Sometimes more emphasis is laid on the personal factor
+of the priest, sometimes more on the sacred origin of the symbol as in
+the case of the relics, sometimes more on prayer and godly works, but it
+is always the religious belief which cures. Typical are the therapeutic
+wonders of Francis de Assisi. He banishes devils, cures gout, lameness,
+and blindness. The traditional means of suggestion, prayer and the
+laying on of hands, had in the meantime been supplemented by the sign of
+the cross which the church had added. Moreover whatever he had only
+touched became a remedy for the sick. Protestantism brought no change in
+this respect. Martin Luther writes: "The physicians consider in the
+diseases only the natural causes from which a disease results and want
+to remove them by their medicines, and they are quite right in it. But
+they do not see that the devil often sends to one a disease which has no
+natural causes. Therefore there must exist a higher medicine, namely,
+the religious belief and the prayer through which the spiritual medicine
+can be found in the word of God."
+
+The broad undercurrent of religious cures, especially in the Catholic
+Church and in the Greek Church, but with fewer symbols also outside of
+them, has up to the present time never ceased to flow. But independent
+of it the therapeutic belief has again and again been focused on certain
+individuals or certain sects or certain schools, in the midst of the
+steady progress of scientific medicine and sometimes synthesizing the
+religious claims with new-fashioned scholarly ideas. In the seventeenth
+century, for instance, the Irish nobleman Greatrakes became a famous
+center of attraction. He felt himself to be the bearer of a divine
+mission and healed the sick, appealing to their belief by laying on of
+hands and by movements which we nowadays call passes. Much more
+influential in the eighteenth century was Pastor Gassner in Germany.
+Gassner succeeded in producing with his religious psychotherapy such a
+tremendous stir that many thousands who needed cure from functional
+diseases, and thousands of curious people, too, streamed to his church
+in Ellwangen, and his methods of cure spread almost contagiously among
+the ministers of the country: an Emmanuel Church Movement of the
+eighteenth century. Gassner, too, discriminated between the diseases
+which have natural causes, that is the organic diseases, which he did
+not treat, and the functional ones, which were obsessions of the devil.
+To determine to which group the disease belonged, he ordered the devil
+to produce the symptoms of the sickness. When in this way the
+obsessional character of the disease was recognized, the minister began
+with his suggestive influences to banish the devil. He demanded firm
+confidence in the name of Christ, reënforced his effectiveness by
+narration of the cures he had perfected, used further certain
+manipulations such as the rubbing of the skin and passes on the head,
+and finally gave his suggestions with authoritative firmness. Many
+ministers who became his pupils treated like him with skillful
+combination of religion and hypnoid influences the spasms, catalepsies,
+neurasthenias, paralysis, and deafness, of neurotic patients.
+
+There is no need to follow in detail the frequent similar occurrences
+between Gassner's time and our own. We all know where we are to-day.
+The medical profession and the medical science with its bacteriology
+and serum therapy, its Roentgen rays and its organic chemistry is far
+away from the church and without concession to religious aspects. On the
+other hand there are the yearly processions of thousands and thousands
+who make their pilgrimage to the sacred waters of Lourdes, guided by the
+Catholic priests, half-hypnotized by the hope that the Virgin will cure
+them. In every niche of the Catholic churches in all Europe, there are
+kneeling before the burning candles those who pray for nothing but their
+health; and their belief will sometimes yield almost miraculous cures.
+In England the Society of Emmanuel was founded by men and women to whom
+it seemed necessary to bring back to the minds of Christians the
+undoubted fact that Christ taught and worked for physical heath and to
+revive this sense of power over disease. Thousands were treated and the
+results have been "most encouraging." Among the cases successfully
+treated may be mentioned "one of cancer in which case the specialist
+called in had given the sufferer only three months to live while by
+means of the laying on of hands in prayer, a complete cure was
+effected."
+
+Not dissimilar in its proceedings, though much more elaborate in its
+metaphysics than this movement in the midst of the Church of England, we
+find in America the Christian Science movement started by Mrs. Eddy. It
+was new as a therapeutic system, however old its philosophic elements.
+Mrs. Mary Baker Eddy writes: "In the year 1866 I discovered the Christ
+science or divine laws of life and named them Christian Science. God had
+been graciously fitting me during many years for the reception of a
+final revelation of the absolute divine principle of scientific being
+and healing." The disease is cured for the Christian Scientist by the
+belief in God because a true belief in God includes the insight that God
+is all reality and that reality therefore cannot include the ungodlike,
+that is, error and sin and disease. Disease is thus recognized as unreal
+and if it has become unreal, of course it has disappeared as part of our
+real life. Thousands and thousands have been cured under this symbol.
+And as the latest chapter of this history of five thousand years, we
+find the movement which Dr. Worcester has started in Boston and which,
+too, spreads rapidly over the continent and awakens the ambition of many
+a minister in every denomination in the land. The aim is to cure the
+patient by reënforcing in him through religious persuasion, through the
+contact with the symbols of the church and with godly men and through
+religious suggestion, a confident belief which gives new unity and
+through it new strength to the mind of the sufferer until it overcomes
+the functional disease of the body. The physician at first examines
+whether or not an irreparable organic disease has attacked the body, but
+if he does not find such organic destruction, then the patient is to be
+handed over to the minister, who will take care that through his
+religious belief and inspiration the mind will triumph over the weakness
+of the body.
+
+Whoever looks in this way over the history of mankind can no longer
+doubt that belief in supernatural powers is really an agency for the
+overcoming of disease. We may be interested in it from the standpoint of
+religion or from the standpoint of psychology or from the standpoint of
+ethnology. In every case we have to acknowledge that he who believes may
+be cured. If we abstract first from the religious point of view and
+consider the problem as a scientific one, we have to interpret all those
+curative effects of belief as results of suggestion. The attitude of the
+one who gives the suggestion has gone in the history of mankind through
+all possible variations. He may have been filled with fervent belief,
+rejecting any interpretation except the religious one, or he may have
+produced the suggestion of belief almost with the intentions of a
+physician who simply relies on the physiological effects of any
+suggestion; and between these two extremes any number of steps is
+possible. Moreover the suggestion may have been detached from any
+personality and may have belonged to any symbol of religious energies,
+like the relics of the Catholic Church. Even the most skeptical of
+ethnologists ought to acknowledge that very little in this history of
+religious psychotherapy points to a conscious fraud. Those shamans of
+the savages from Siberia to South Africa, from Australia to Mexico, are
+in ecstasies which make them really believe in the mysterious power of
+their manipulations. The ethnologist finds indeed as most common
+characteristics of all those primitive movements that those who cure
+are chosen from among neurotics who by epileptic attacks or
+hallucinations and obsessions are predisposed to feel themselves as
+bearers of a higher mission.
+
+Yet whether the attitude of the transmitter is religious or
+half-scientific, is inspired or insincere, the receiver of the
+suggestion is always in the same condition: he is believing in his cure
+through religious influence and through his belief he is helped, if he
+is helped at all. This uniformity does not exclude the fact that the
+patients too may show a manifoldness of mental states. They may remain
+in a completely waking state with reënforced suggestibility, or they may
+go over into a drowsy or hypnoid state or deeply into a hypnotic state,
+or may receive the suggestions as we saw even in sleep. Further their
+minds may be entirely filled with fine religious emotions and the
+therapeutic effect be only an appendix or, on the other hand, this
+confident expectation of the relief from pain may be their central
+content of consciousness and may control the whole mental interplay. The
+practical problem of the scientist is to consider how far these
+religious energies ought to be used today in the interests of the cure
+of diseases.
+
+From a scientific standpoint such a discussion can hardly be fruitful
+with those who consistently take the religious point of view only. A
+view of the world which demands the faith that religious belief moves an
+almighty power to cure a diseased organ, or that the disease has no
+reality for one who lives in God, is invulnerable to merely scientific
+arguments. The sick woman who kneels between the candles before the
+picture of the Virgin, praying that her heart, which the physicians
+declare incurable on account of a valvular disease, be cured, moves in a
+sphere of thought which lies entirely outside of the medical study of
+causes and effects. The same holds true, for instance, of Christian
+Science. This statement is in itself no criticism and no argument; it
+only acknowledges that any possible exchange of opinions has to be
+carried over from the scientific psychological ground to that of
+metaphysics and philosophy. It is quite different with modern movements
+of the type of the Emmanuel Church Movement, where the religious thought
+is intertwined with the psychological theory and where an actual
+coöperation of physician and minister is sought. Here church and science
+really meet on common ground, and it is important to examine objectively
+whether it is wise and beneficial to encourage the spreading of this
+tempting enterprise. The movement has reached the large cities between
+the Atlantic and the Pacific and is beginning to captivate the ministers
+of the small towns and villages. It seems as if an epoch has come for
+the church--the church which too long has ministered only to the
+spiritual needs of the community will at last remember again that Christ
+healed the sick, that mind and body are one, that the personality must
+be understood in its unity, and that endless fields of blessed influence
+may again be opened to the church when the minister becomes the
+physician of his congregation. Whoever knows the suggestive power of
+such a social movement, and considers the ease with which triumphant
+successes may be reached in this field and the disappointing and
+discouraging reduction of power which the church shows everywhere in its
+purely spiritual hold on the community, can foresee that all the
+conditions are favorable for a rapid spread and that the church clinics
+will become the American fashion of the near future.
+
+It cannot be denied that the Christian church takes in hand there once
+more a work which belonged to it through centuries. But they were
+centuries in which the priest was in a certain degree the physician,
+just as he was the educator and teacher, simply because in the church
+there was centered all cultural influences which the community knew. The
+complexity of modern times has for centuries demanded the opposite
+system. Centralization is allowed only to the purely administrative
+influence of the state, while all the active functions are divided among
+specialists. We rely on the expert in education, we demand the expert in
+medicine: is more gained or lost if the religious leader now again
+suddenly undertakes a part of the functions which belong to the
+physician? It is true that the ministers of this school do not propose
+to undertake the physician's work to its full extent. They leave to him
+the first and in some respects most important step, the diagnosis, and
+abstain from the treatment of such cases as the physician declares
+inaccessible to psychical influences. They do not heal cancer and
+phthisis like the Emmanuel Movement in England or like the mental
+healers in America.
+
+But is not perhaps just this compromise dangerous in another direction,
+inasmuch as it awakens a feeling of safety in those who feel in sympathy
+with scientific medicine? They have passed the hand of the physician and
+believe accordingly that because their illness is recognized as
+functional, the minister can really perform all that ought to be done.
+Is this belief justified? At the threshold, it occurs to every one that
+such a diagnosis by physicians may be erroneous and that the chances for
+such error are under the conditions of the church clinic much greater
+than under the conditions of a regular medical treatment. The
+diagnostician who treats the patient himself has ever new chances to
+remodel his diagnosis and to correct it under the influence of
+therapeutic effects. The danger is great that under the proposed
+conditions, the activity of the physician will be superficial, because
+he is deprived of his chief means, the constant observation. But we may
+abstract from this possibility of error. Does the fact that the disease
+is one the symptoms of which may yield to psychical treatment really
+make it advisable that the further treatment be handed over to the
+clergyman? To begin at the beginning, the usefulness of psychical
+treatment does not at all exclude the strong desirability of physical
+treatment at the same time. The emphasis which is laid on religious
+persuasion and inspiration, on prayer and spiritual uplift practically
+excludes the use of baths and douches, of massage and electricity, of
+tonics and sedatives. And yet it is not caprice or sham when every
+well-schooled medical specialist applies such means in the treatment of
+these so-called functional diseases of the nervous system. The minister
+applies and can apply only one of many possible methods for cure and
+yet, if we really want to make use of the resources of modern knowledge,
+we have to adapt most carefully all possible means to the individual
+case. If we take the strictly religious standpoint the situation is of
+course different, but if we speak of psychophysiological effects, we may
+acknowledge the healing influence of prayer and yet rely in the special
+case still more on bromide or strychnine. Yet the religious
+psychotherapists not only neglect the physical help but usually
+emphasize the antagonism. Some of the strongest supporters proclaim it
+as a non-drug healing, thus deciding adversely about a medical method
+regarding which they have no means at all to judge.
+
+Parallel to this neglect of physical theory goes, of course, the neglect
+of the physical factors in the disease. The physician may have justly
+diagnosed that the case is "merely" neurasthenia or hysteria and not a
+brain tumor or paralysis of the brain. Yet that does not mean in the
+least that a real treatment which remains in harmony with the progress
+of modern medicine ought to ignore the hundred physical elements which
+enter daily into the disease. There are the most complex digestive
+problems involved which demand a thorough understanding of chemical
+metabolism, there are still more complex problems of the sexual organs
+which the minister certainly ought not to discuss with his female
+parishioners, there are bacteriological questions, there are questions
+of the peripheral nervous system and sense organs; in short, questions
+which belong to a world into which the minister as minister has never
+looked. Even if he believes he might gather in an amateurish way some
+information as to those questions which lie so far from his experience
+as student of divinity, how can his half-baked knowledge compare with
+the experienced study of the regular physician? Such physical questions
+cannot be settled by the preparatory examination of the physician; they
+come up every day during the treatment and what the spiritual diet which
+the minister offers may help, may at the same time be ruined by the
+physical diet about which the minister without chemistry cannot judge.
+
+But let us abstract from the bodily aspect. Is the situation really very
+different for the mental one? The appeal to the religious emotion, the
+reënforcement of religious faith is from the religious point of view
+certainly the one central effort from which everything has to irradiate.
+The unity of this controlling thought is the glory of such inspiration.
+But as soon as we handle this thought as a psychotherapeutic remedy,
+destined to restitute the disturbed psychological equilibrium, it
+becomes evident that the very uniformity of it makes it a clumsy,
+inadjustable pattern. If there is anything which impresses the careful
+student of psychology, it is the over-rich manifoldness, the complexity
+of mental life. Even the simplest content of consciousness is a tissue
+woven from millions of threads and any stereotyped influence means
+crudeness and destruction. The minister's attitude towards inner life is
+there directly opposite to that of the psychologist. He cannot enter
+into those endless interplays of associations and memories, or
+inhibitions and sensations and impulses, he cannot examine from which
+remote psychological sources those ideas have arisen, how the feelings
+become disturbed and the judgments sidetracked. He should not analyze
+even if he could, because his whole aim is to synthesize. He asks for
+the meaning and not for the structure, for the aims and not for the
+elements. His therapeutic effort is therefore not even directed towards
+a careful rebuilding of the injured parts of the mind, but it is nothing
+more than a general stimulation to the mind to help itself. By touching
+on one of the deepest emotional layers of the mind, the layer of
+religious ideas, the minister gives to the soul an intense shock and
+expects that in the resulting perturbation, everything will be shaken
+and may then settle itself by its own energies in a healthful way. It is
+a fact that that can sometimes happen and under certain conditions the
+chances for it are even favorable. Under many other conditions the
+chances are unfavorable and the result does not happen at all.
+
+But whether or not a cure results, in any case it is certainly not an
+effort which can be said to be in harmony with modern science. The idea
+of science is always to understand the complex from its elements and to
+restore the disturbed complex object by recognizing the disturbances in
+the elements and by bringing those disturbed elements into right shape
+again. Certainly the psychologist, too, in examining carefully the
+injured mental mechanism may discover emotional injuries which might be
+cured by the introduction of religious ideas, but he will not give to
+them a value different from the introduction of any other ideas and
+emotions, for instance, those of art and music and poetry, those of
+social company or civic interest, of travel or sport or politics. Each
+may have its particular value and to cure every mind with religious
+emotion would be from a psychological point of view as one-sided as it
+would be to cure every disturbed stomach by milk alone. Moreover in very
+frequent cases, for instance, of neurasthenia or hysteria or
+psychasthenia, such wholesale remedies can form only the background of
+the treatment, but all the details have to be furnished with reference
+to a most subtle analysis of the special symptoms, and a particular
+organic symptom or a particular memory idea or a special inhibition by a
+well-selected counter-idea will do much more than any great emotional
+revival.
+
+Stereotyped religious appeal is not only insufficient in an abundance of
+cases--it must never be forgotten that those who nowadays go to the
+minister for their health are already selected cases more open to
+religious suggestion than the average--but can easily be decidedly
+harmful. Of course that holds true for every physical remedy too, and
+the judgment of the exact limit is one of the chief duties of the
+physician. It holds also for the other mental factors like sympathy. A
+certain amount of sympathy may save a neurasthenic from despair, and
+only a little more may make his disease much worse and may develop in
+him a consciousness of misery which makes him a complete invalid. Still
+more is it true for the religious emotion, from the standpoint of
+nervous physiology the strongest next to the sexual emotion, that it can
+be the healing drug or the destructive poison. Everything depends upon
+the degree of the intrusion and upon the resistance of the
+psychophysical system. From a purposive point of view there cannot be
+faith enough, from a causal point of view there can easily be too much
+of the faith emotion. Religious fervor has at all times helped to create
+hysteria and to develop psychasthenias. It cannot be otherwise. A group
+of ideas which has such tremendous power over man must easily be able to
+produce inhibitions and exertions which become dangerous to a nervous
+system the constitution of which is pathological. To leave such a
+dangerous and powerful remedy entirely in the hands of men who by their
+profession must aim towards a maximum dose of religious influence can
+certainly not be in the interests of the patients or of the community.
+
+Even the whole technique of this movement awakens the fear of possible
+harmful consequences. On the one hand we have the movement itself as a
+popular suggestion for the suggestible masses. The patient who seeks the
+help of a scientific neurologist hardly becomes a center of psychical
+contagion, but the church services for the sick offer favorable
+conditions for an epidemic development of hysterical symptoms. But more
+important are the influences on the individual patient. The whole
+purpose of the treatment demands the highest possible degree of
+suggestibility brought about by the ministerial persuasion. But it is
+evident that this degree of suggestibility means at the same time the
+most fertile soil for every chance suggestion and for influences which
+are perhaps entirely unintended. The physician and the psychologist,
+considering the mental state with reference to its elements, will make
+most careful use of those accessory influences. The minister, who
+necessarily has his spiritual aim in mind, cannot even become aware of
+all the involuntary influences which reach the mind in its most
+suggestible state. There can be no doubt that it would often need
+psychological art to avoid the creation of new pathological symptoms in
+such half-hypnotized patients. Yet the minister even goes so far as to
+make use of the sleeping mind without any consideration of the possible
+damage which may be done to his subject. He goes to the bedside of a
+sleeping girl and whispers his suggestions and is satisfied when they
+show their effects the next day. It does not lie in his horizon to
+consider the grave consequences which such suggestions during sleep may
+produce during future years in the brain the sleep of which has been
+transformed into such half-somnambulic relations. Hysterias may be
+created by such methods. No one can blame the minister for his
+remoteness from such doubts and problems, but the physician is to be
+blamed if he encourages the belief that all this still belongs to the
+proper sphere of the ministerial worker in abnormal psychology.
+
+Those engaged in such work were not long in finding out that the mere
+emotional inspiration is often no sufficient remedy, and the development
+went along the same lines in which it has gone everywhere for some
+thousands of years. Not to disappoint the sufferers, the religion had to
+become in very many cases simply an inactive side issue and the real
+cure was performed by the same methods with which any worldly
+neuropathologist would go to work. If the woman who cannot sleep is
+cured from her insomnia by being made to listen to the beats of a
+metronome, it may sometimes be effective, however crude, but it is
+certainly no longer religion, even though the metronome stands in a
+minister's room. The more the movement spreads to those who have no
+psychological training and knowledge, the more it must be necessary for
+them to import the whole claptrap of the quack hypnotist and soon the
+minister may discover that in certain cases physical means and drugs
+help still better. Thus he simply enters into competition with the
+regular physician, only with the difference that he has never studied
+medicine. The chances are great that in his hands even such remedies and
+drugs may do harm and finally, even if they were effective, is not the
+question justified: will not religion suffer?
+
+Indeed we have so far considered the question from one side only. We
+have confined ourselves to the question of how far such a movement is
+sound for the interests of the patient; but can we be blind to the other
+side and overlook the not less important problem of whether it lies in
+the interests of religion and of the church to amalgamate its spiritual
+work with a medical one? We are not thinking of those widespread, unfair
+arguments to the effect that this whole movement is undignified because
+it is instituted by the desire to fill the empty pews or to make
+competition with the success of Christian Science. That is utterly
+unjust. But there are intrinsic factors in the movement which interfere
+with the true aims of religion. First of all it cheapens religion by
+putting the accent in the meaning of life on personal comfort and
+absence of pain. The originators of the Emmanuel Movement stand well
+above such error, but their national congregations do not. Certainly the
+longing for pleasure and a well feeling and the abhorrence of pain and
+illness pervades our practical life and keeps in motion all our
+utilitarian efforts. But if there is one power in our life which ought
+to develop in us a conviction that pleasure is not the highest goal and
+that pain is not the worst evil, then it ought to be philosophy and
+religion. It is only the surface appearance if it seems as if the
+religious therapeutics minimizes the importance of pain; in truth it
+does the opposite. It tries to abolish pain, but not because it thinks
+little of pain; on the contrary, because it thinks so much of pain that
+it is willing even to put the whole of religion into the service of
+this strife for bodily comfort. The longing for freedom from pain
+becomes the one aim for which we are to be religious. In a time which
+denies all absolute ideals, which seeks the meaning of truth only in a
+pragmatic usefulness, it may be quite consistent to seek the meaning of
+religion in its service for removal of pain, and personal enjoyment. But
+in that case the ideal of both religion and truth is lost. It is finally
+not less undignified for religion to seek support for the religious
+belief in effects which it shares and knows that it shares with any
+superstitious belief on earth. Granted that the church can cure: the
+shaman of Siberia can cure too, and the amulets of Thibet not less. The
+psychologizing church knows, therefore, that it is not the value of the
+religion which restores the unbalanced nervous system; and yet it wants
+to provide for the spreading of true belief by the miraculous cures
+which it exhibits.
+
+This situation naturally produces the desire of the church to substitute
+a religious explanation for a psychological one. It is claimed that
+after all it is not the mental effect of the prayer, but the prayer
+itself, not the psychophysical emotion of religion, but the value of
+religion which determines the cure. Yet in that moment the whole
+movement in its modern shape comes into a still more precarious
+position. If the cure results from the inner value of the religion how
+can we confine it to the so-called functional diseases and abstain from
+any hope in organic diseases? Luther, from his religious point of view,
+still had the right to separate the two groups because only those
+functional diseases were effects of the devil, obsessions which could be
+banished by the minister and by prayer, while the other diseases did not
+result from the devil, but merely from natural causes. Such a definition
+does not fit into the modern system. To-day from a really religious
+point of view, both groups of diseases must be acknowledged to be
+natural or with Mrs. Eddy, as the work of the unholy spirit. Christian
+Science is indeed by far more consistent. If the cure results through
+the meaning and value of religion, there is no reason whatever why
+cancer and diphtheria and paralysis should not be cured as well as
+psychasthenia. And if, on the other hand, organic diseases cannot be
+cured because the psychophysical process of the religious emotion has no
+influence over diphtheria bacilli, then the whole process is removed to
+the causal sphere and it is acknowledged that the purposive meaning of
+religion is not in question at all. The whole system of such religious
+psychotherapeutics is therefore in its inner structure contradictory. It
+contains causal and purposive elements without any possibility of
+unifying them. They are loosely mixed, and the power of prayer means on
+one page something entirely different from what it means on another. In
+these respects Christian Science is by far more unified and in harmony
+with itself; its therapeutics is really anchored in a system.
+
+From a scientific point of view, its dangerousness is of course much
+greater inasmuch as it extends its methods over every organic disease
+and thus applies merely psychical treatment where from a standpoint of
+scientific medicine, physical treatment would be absolutely necessary.
+Moreover its philosophy is after all only a pseudophilosophy; its
+tempting equations of disease and error and sin and unreality are
+ultimately a mere playing with conceptions. If we were to point to the
+root of the misunderstanding in Christian Science, we should say that
+everything depends on the philosophical commonplace that the objects
+with which we deal in our life are ideas and that our whole experience
+is mind. "Christian Science reveals incontrovertibly that Mind is
+All-in-All, that the only realities are the divine mind and idea." But
+now silently this mental character of the real world is identified with
+the mental experience which stands in contrast to the physical
+experience. There results the impression that physical experience
+therefore, does not belong to the world of reality. It is evident,
+however, that mental in contrast to physical means something entirely
+different from mental in the philosophical sense. In the latter meaning
+of the word, we all agree that the world is mental; the word mental
+indicates there that the world has reality not in itself but only as
+experience of subjects. In the second sense, mental or psychical means
+that it is experience for one particular subject only and not for every
+possible subject. The physical thing, for instance this table, is indeed
+different from my mental memory idea of a table, inasmuch as every
+possible subject can experience this table while my mental memory image
+belongs to me alone. The physical table and the mental memory image of
+it are both equally mental in the philosophical sense, inasmuch as the
+physical which is object for every possible subject and in this sense
+not mental is therefore not less given to subjects. Every physical body
+with its disease is thus in one sense taken as something not mental
+while in another sense as mental; if we use the same word in two
+entirely different meanings, it indeed cannot be difficult to
+demonstrate any metaphysical consequences.
+
+But we do not have to deal here with the metaphysics of "Science and
+Health." If it is brought down to the concrete application, we stand
+before the same confusion which characterizes all compromises. Causal
+effects are sought in a sphere which belongs to purposive values. The
+psychological effects of the emotion of faith are sought and are
+misinterpreted as the emanations of religious powers. Religious
+psychotherapeutics in all its forms seeks to demonstrate to us the
+triumph of the soul over the body, while in reality it deals only with
+the mental mechanism which as such belongs to the chain of causal events
+in the same natural way as the organism. The soul, as spiritual agency
+in its sphere of purposes and ideals, does not enter the machinery of
+psychotherapy, and the psychological material on which psychotherapy is
+applied is not freer and not better and does not stand higher than the
+material of the bodily cells and tissues. The Emmanuel Movement
+deserves the highest credit for bringing about a systematic contact
+between religious faith cure and scientific medicine, but the time in
+which the minister himself undertook the medical treatment had to be a
+time of transition. It had to lead to a new relation in which the
+ministerial function is confined to the spiritual task of upbuilding a
+mind while the therapeutic function remains entirely in the hands of the
+physician. Where the physician believes that the psychomedical treatment
+demands a new equilibrium of the patient to be secured by religion,
+there the minister should be called for assistance. Psychotherapeutic
+hospitals would offer the most favorable conditions for such
+coöperation. But the minister ought to enter even such a hospital with a
+strictly spiritual aim, and he should never forget that the task of the
+church stands much higher than the utilitarian task of removing pain
+from the sick room. But if those psychotherapeutic hospitals will
+flourish and the physicians will at last make use of psychical factors
+in their regular practice, they ought not to forget on their part that
+the important step forward was taken under the pressure of popular
+religious movements. The ministers first saw what the physicians ought
+to have seen before, but the physicians will see it more fully and more
+correctly.
+
+
+
+
+XIII
+
+PSYCHOTHERAPY AND THE PHYSICIAN
+
+
+Every thought of the physician moves in a world the structure of which
+is determined by the thought forms of cause and effect. He knows the
+effect which he wants to produce; it is the restitution of the organic
+equilibrium. He studies the causes which can secure that end. And again
+the disturbance of the equilibrium itself, the disease, is for him an
+effect which he seeks to understand by an analysis of the preceding
+causes. The means which he applies can therefore be valued only in
+reference to their efficiency; no other point of view belongs to his
+world. The religiously valuable may be indifferent or even undesirable
+in the interplay of causes, and the morally indifferent may be most
+important for the physician's interests. The religious emotion
+accordingly has to stand in line with any other mental excitement or
+with a hundred physical means which the laboratory and the drug store
+supply. The physician will welcome the methods of treatment without
+reference to metaphysical systems or to religious beliefs. To him it is
+an empirical fact that many disturbances of mind and body which
+interfere with the equilibrium of life can be repaired by influences on
+certain psychophysical organs. A part of these repairing influences he
+finds in the sense stimuli, for instance, of spoken or written words
+which reach the brain and awaken associative and reactive processes. He
+finds further that these influences can be reënforced in their
+effectiveness by certain general conditions of the nervous system and
+again finds that these can be secured partly by sense impressions, and
+once more especially by words.
+
+It is a matter of course to the physician that application of any sense
+influence on the brain demands a most subtle analysis of the
+psychophysical situation. Therefore he gives no less attention to the
+disentangling of the whole history of the individual brain, to its
+stored-up energies and to its mental possibilities. If he knows the
+psychophysical status, and finally if he knows the means of influencing
+those psychophysical organs which stimulate or inhibit the disturbed
+central parts, he can foresee the psychophysical effects with a certain
+definiteness. Thus everything depends upon the sharpest possible, almost
+microscopic, mental analysis, together with a most thorough examination
+of the whole nervous system and the most careful calculation of the
+mental influences applied. The vagueness of the religious appeal
+transforms itself into an exact calculation and the unity of the soul
+which seeks spiritual uplift transforms itself into a mental mechanism
+of bewildering complexity, and yet not more complex than the physical
+organism, to which for instance, the chemical means of the physician
+administer. To-day medical science is certainly only in the beginning of
+this great movement. Especially the analysis of the psychophysical
+conditions still lacks a sufficient refinement of method. But at least
+the causal principle is now fully recognized and the scientific man of
+today no longer doubts that this whole play of psychotherapeutic
+processes goes on as a causal process in the psychophysical system of
+the individual without any mysteriousness, without any magnetic
+influences, without any miraculous interference, without any agencies
+except those which are working in our ordinary mental life in attention
+and reaction, in memory and sleep.
+
+It is surprising how late this recognition appeared in the history of
+human knowledge. It occurred here as in so many places in the history of
+human civilization that the simple is the late outcome of the complex.
+Just as in technique the apparatus often began in a complex, cumbersome
+way and then became steadily simplified, so it is with explanations. The
+complex machinery of cosmic influences and obsessions by demons and
+magnetic mysteries was at first necessary until the simple explanation
+was found that all the results depend upon the working of the mind
+itself. Yet in technique and explanation alike, such progress to the
+simpler means always at the same time the making use of much richer
+knowledge. To explain an obsession or a sleep state by the agencies of
+evil spirits or magnetic fluids is certainly an unnecessary side
+conception. But to understand it from the working of the mind
+presupposes after all the whole modern physiological psychology, and
+thus had to be the latest step.
+
+The effects themselves were certainly observed in all times. Even the
+phenomena of hypnotism date probably back some thousands of years,
+however difficult it may sometimes be to discriminate between the
+artificial hypnotic states and hysteric or hystero-epileptic occurrences
+in the past. Certainly it may be acknowledged that the Yogi in India
+cultivated in the most remote times the methods of autosuggestion which
+evidently led to hypnotic states, and everywhere around the
+Mediterranean, antiquity knew the hypnotizing effect of staring on
+polished metals and crystals. So in Egypt, so in Greece and Rome; and it
+has often been claimed that the priestesses of Delphi and the sibyls of
+the Romans were in states of hystero-hypnotic character. As to the
+therapeutic use, especially the Greek physicians applied hypnotic means.
+Excited patients were brought to repose by methods of stroking. The
+efforts to explain scientifically the mysterious powers which men can
+gain over the mind and will of another begin at the end of the Middle
+Age and were developed quite naturally from the prevailing astrological
+doctrines. Astrology worked on the theory that the human fate depends
+upon the stars. These stars have an effect on the human organism. That
+proves that an influence can exist between distant bodies. It is,
+therefore, not more surprising that one organism can also have an
+influence on another organism. Well known since antiquity were such
+influences from one object to another, as in the case of the magnet.
+Thus there may be a kind of magnetic power which creates relations
+between all objects in the universe.
+
+Pomponnazi explained thus at the end of the fifteenth century the
+therapeutic effects of the human soul by the mutual influence which
+stars and men have on each other. This theory comes to much more
+important development in the writings of the physician Paracelsus. One
+individual by the power of his effort can influence the will of another
+individual, can fight with it, and suppress it; and all through energies
+which are analogous to the magnetic power which binds stars and men. In
+the middle of the seventeenth century, Helmont connects this power of
+magnetic attraction and repulsion with an ethereal element which
+penetrates all bodies and keeps them in motion. Through it man, too, can
+by his mere imagination work on other men. This will can also be
+effective on drugs which get through it a special therapeutic power.
+Somewhat different was the theory of a Scotch physician, Maxwell, in the
+second half of the seventeenth century. The ethereal spirit, which is
+identical with light, can be artificially cumulated in any organism and
+that secures its health. As one man can influence this vivifying ether
+in any other man, he can produce cures even from a great distance. All
+diseases are merely reductions of this ethereal spirit in the organism.
+
+But the general stream of the explanation continued in the direction of
+the magnetic doctrine. It was especially Mesmer in the eighteenth
+century who, in a long life of fantastic mysticism and yet of universal
+serious study, surely contributed much to the development of the theory.
+He had started to use, like others, the magnet in his medical practice.
+But he discovered that the same therapeutic successes could be gained
+without applying the magnet itself, but by simply using his own hands.
+The patients became cured when he moved his hands slowly from their
+heads to their feet. The magnetic power was therefore evidently in man
+himself. It was an animal magnetism in opposition to the mineral one
+which belonged to the magnet and to the stars. He believed further that
+he was able to infuse this magnetic power into any lifeless thing, which
+would then have curative influence on the nerves. There can be no doubt
+that, whatever may have been the value of his theories, he cured a large
+number of patients, evidently producing a state which we would call
+today a hypnoid state and often simply appealing to the natural
+suggestibility of the impressionable minds. Among his pupils, usually
+called mesmerists, was Puysèyur, who discovered, in 1784, the state
+which was called artificial somnambulism, a kind of sleep in which the
+ideas and feelings of the magnetized can be guided by the magnetizer.
+Here evidently was the first recognition of the psychotherapeutic
+variation which we call today hypnotism. There followed a period in
+which the scientific interest of the physicians was somewhat sidetracked
+by an unsound connection of these studies with mystic speculations and
+with clairvoyance. But especially in Germany animal magnetism in
+Mesmer's form and in the form of artificial somnambulism grew in
+influence through the first decades of the nineteenth century and
+succeeded in entering the medical schools. The reaction came through
+popular misuse. At about the third decade of the century, interest
+ceased everywhere.
+
+The Portuguese Faria insisted in 1819, practically as the first, that
+all those so-called magnetic influences, including the delusions, the
+amnesias after awaking, and the actions at a command, did not result
+from a magnetic power but from the imagination of the subject himself.
+He believed that the effect depended upon a disposition of the
+individual which resulted from a special thinness of blood. He abstained
+therefore from the magnetic manipulations and produced the somnambulic
+state by making the patients simply fixate his hands and by ordering
+them to sleep. Thus he is the first who understood these changes as
+results of mental suggestion. The next great step was due to the English
+surgeon, Braid, who in the forties studied the magnetic phenomena and
+like Faria insisted on the merely mental origin of the abnormal state.
+He proved that a person can bring himself into such an artificial state
+and that it is therefore entirely independent of energies from without.
+He examined especially the influence of staring at a shining object, a
+method which not seldom was called Braidism. He also introduced the
+word hypnotism. In America mesmerism was generally known under the
+name of electrobiology; and Grimes in particular came to results
+similar to those of Braid. Yet the influence of these movements on
+the medical world remained insignificant until a new great wave of
+psychotherapeutics by means of suggestion began in France in the
+sixties.
+
+Of course this development from astrology to magnetism and from
+magnetism to hypnotism represented only one side of psychotherapy.
+Parallel to it goes the progress in the treatment of the insane. In the
+first half of the eighteenth century, they are still on the whole thrown
+together with the criminals but the more the disease character of the
+disturbance is acknowledged, and the more special hospitals for the
+insane are created, and finally the more the humane treatment in them
+supersedes the brutal, the more psychotherapy enters into the work.
+England showed the way. Especially Arnold, Crichton, and Perfect became
+influential; and soon Pinel and Esquirol followed in France; and Reil
+and Langermann in Germany. Reil recognized clearly at the threshold of
+the nineteenth century that "Both psychical and physical diseases may be
+cured by psychical means, but at the same time psychical diseases may
+also be cured by physical means." And in his "Rhapsodies," rhapsodies on
+the application of psychical methods in the treatment of mental
+disturbances, he declared, "that the medical Faculties will soon be
+obliged to add to the two existing medical degrees still a third,
+namely, the doctorate in psychotherapy." This stream became broader and
+broader and every new development of psychiatry in the last hundred
+years did new justice to the influence of psychological means in the
+treatment of mental diseases; to be sure, without allowing up to the
+present day the hope that mental factors as such can cure the grave
+forms of insanity. The borderland cases and the incipient mild forms
+alone allow the hope of a cure. Outside of them the work of
+psychotherapy in the insane asylum meant essentially improvement and
+relief only. Again, in another direction, the general dietetic influence
+of sound mental life may be called a part of psychotherapy and this
+engaged not a few of the leading medical thinkers in all countries
+during the last century, especially the nerve physicians who gave
+serious attention to the wholesome engagements of the mind. Finally,
+might not much be attributed to psychotherapy, which offically belongs
+to the doctrines of homeopathy?
+
+But we may return to the new heralds of suggestion. Liébeault's book on
+the artificial sleep in 1866 became the starting point of the new great
+movement. Yet at first it remained unnoticed. It is claimed that for a
+long time only one copy was sold. But he continued to make his hypnotic
+experiments on the poor population of Nancy and they finally attracted
+the attention of some of the leading medical men there. Bernheim became
+convinced and Dumont, the physiologist Beaunis joined the movement, and
+in the eighties we find Nancy the center of hypnotic interest to which
+medical men from everywhere made their pilgrimage. This latter phase was
+paralleled by Charcot's studies in Paris, who brought hypnotism into
+nearest neighborhood with hysteria. And also the later development of
+the Paris school by Richer, and especially the brilliant work of Janet,
+kept hysteria in the foreground of the therapeutic interest. Liébeault's
+experiment had brought the psychology of suggestion entirely into the
+center of this whole circle of phenomena and this view controlled the
+development of the last few decades, which was essentially an
+elaboration of the special treatment of diseases. Forel in Switzerland,
+Moll and Vogt in Germany, Wetterstrand in Sweden became the chief
+exponents of therapy by hypnotism. Others, like Dubois, in Switzerland,
+emphasized more the suggestive treatment through persuasion. In England
+at first Carpenter, later Hack-Tuke gave serious attention to hypnotism,
+in Russia Bechterew, and in the last few years the literature on therapy
+by suggestion became developed in practically all countries. In America
+Beard, Hammond, and others belong to the older school; Osgood, Prince,
+Peterson, Putnam, Sidis, and others to the most recent years. At the
+same time, under the leadership of Kraepelin, Ziehen, Sommer, and
+others, the methods of the psychological laboratory, especially the
+reaction and association methods, were made useful for the purposes of
+psychopathology.
+
+But interest in suggestion does not represent to-day the last step of
+psychotherapy. The latest movement, which is entirely in its beginning,
+the development of which no one can foresee, but which promises wide
+perspectives, is connected with the name of Freud in Vienna. The
+entirely new turn of psychotherapy is given by the fact that his aim is
+not to overcome a symptom by suggestion but to make it disappear by
+removing the ultimate mental cause. He found that large groups of mental
+disturbances result from a psychical trauma, a disagreeable idea which,
+inhibited in the mind, becomes the source of mischief and produces
+phobias and obsessions and hysterical motions. The cure of the symptoms
+demands the recognition of this first mental accident, which may lie
+back for years and which may no longer be in the memory of the patient.
+As soon as this earlier experience is brought to consciousness again, it
+needs only a natural discharge and a normal expression and the symptoms
+which it brought about will disappear. Thus the cure itself needs no
+hypnotism and no persuasion or suggestion but the reawakening of
+forgotten situations, and only in the service of this effort hypnotism
+may be used to reënforce the memory. Yet this represents only the first
+period of Freud's activity, in which he collaborated with Breuer, a
+phase which is represented by their book on hysteria, in 1895. But there
+followed a further development which is still more essential. The
+hysterical disturbance may indeed have started with such an accidental
+traumatic impression but that does not explain why just this impression
+had such a strong effect. Other impressions of equal strength and
+emotional vividness may have passed without leaving any damaging result.
+And therefore there must be some prior cause in the subject which makes
+just this particular impression so injurious; and here is the point of
+Freud's fundamental discovery, which for the layman appears on the
+surface to have little probability but which has proved of greatest
+consequence for clinical work. It was found that only those situations
+become injurious and become starting points for hysterical symptoms
+which touch on repressed and artificially inhibited ideas of the sexual
+sphere.
+
+Entirely new perspectives have been opened by these studies. Above all,
+now for the first time there is in sight a psychotherapy which not only
+aims to remove symptoms but which really uproots the disease itself.
+That earlier method of bringing the trauma to consciousness and making
+it discharge, the so-called cathartic method, removes only the
+particular group of disturbances but the patient remains a hysteric, and
+if ever new accidents should happen which would touch again those inmost
+repressed ideas, new hysterical symptoms would develop. But if we can go
+back to that starting point, if we can discover those first suppressions
+of desired gratifications which often most indirectly are related to the
+sexual sphere, and if we can liberate the mind from those primary
+strangulated affections, then the patient is really cured. Freud himself
+practically abstained from the help which hypnotism can give for the
+reawakening of forgotten experiences, while some of his pupils still
+prefer this short way to the forgotten memories. His way is, on the
+whole, to let the imagination bring up any chance material of associated
+ideas and then to study their connections and follow the hints they
+give. He calls it the psychoanalytic method. Others prefer the methods
+of association tests, again others tap the lower layers by automatic
+writing, but the chief problem remains always to discover those
+repressed desires and to understand through them the injurious effects
+of accidental experiences. The whole field of hysteria, and perhaps
+still more that of the anxiety neurosis, has come into new perspective
+through this pioneer work which men like Bleuler, Jung, and Stekel have
+developed in various directions.
+
+Thus in recent decades the thorough work of scientific physicians has
+developed a psychotherapy of considerable extent and of indubitable
+usefulness, far removed from the simultaneous efforts of the churches
+and of the popular mental healing cures. A number of eminent men in all
+countries have tested the methods and have published the results. But
+the curious side of it is that all this is essentially a movement of
+leaders while the masses of the profession hesitate to follow. It is a
+set of officers without an army. Every large city has one or another
+specialist who applies suggestive therapy, one or another nerve
+specialist who hypnotizes, but the average physician moves on without
+any serious effort to utilize psychotherapy. It is as if the
+prescription of the modern chemical drugs were confined to some leading
+scholars in the country, while the thousands abstained from it in their
+office work and in their family practice. In reality psychotherapy ought
+to be used by every physician, as it fits perfectly the needs of the
+whole suffering community. Its almost exceptional use in the hands of a
+few scholarly leaders deprives it of its true importance. It is the
+village doctor who needs psychotherapy much more than he needs the knife
+and the electric current.
+
+Why does the medical profession on the whole show this shyness in the
+face of such surprising results? In other fields they do not show any
+reluctance in taking up the newer developments of method. Even the
+Roentgen ray apparatus has quickly won its way, and psychotherapy is
+less expensive. To be sure, the most important reason is probably one
+which is most honorable. The physicians do not like to touch a tool
+which has been misused so badly. Psychotherapy has come too much into
+the neighborhood of superstition and humbug. Where miracles are
+performed, the man of science prefers to leave the field. The less one
+knows about those groups of problems, the less one is able to see the
+sharp demarcation line between true scientific studies, for instance, in
+hypnotism, and the pseudo-scientific fancies of psychical research.
+Experiments in suggestibility are then easily mixed with experiments in
+telepathy, and those go over by gradual degrees to clairvoyance and
+premonitory apparitions, and from there the way is not far to the
+reappearance of the dead and the routine performances of the spiritists.
+It seems to many as if there is no point where they have a reason to
+stop. If they begin with such abnormal phenomena at all, it seems as if
+they are necessarily carried over to all the mysteries of supernatural
+energies. Even the competition with Christian Science, and other mental
+healers whose judgment is not hampered by any previous study of
+medicine, might seem rather unattractive to the serious physician.
+
+Further not a few have the impression that such suggestive treatment
+directly demands from them that they also begin to humbug their patients
+or to throw out suggestions which they themselves do not believe, in
+short, that they be brought down to the level of the miracle performer.
+Yet, however much all that speaks in favor of the conscientious instinct
+in the physician, it is ultimately based upon a misinterpretation. The
+line between real science and its counterfeit is here as everywhere a
+distinct one, and the true man of science ought not to hesitate in doing
+his duty from fear that he might not be discriminated from the
+charlatan. A well-conducted psychotherapeutic treatment as a scientific
+physician ought to carry it out, is entirely different in meaning and
+appearance, from the first step of diagnosis to the last treatment of
+after-effects, from every unscientific faith cure. It is also in no way
+necessary that the psychotherapist ever leave the path of complete
+sincerity. There is no reason at all for promising that the patient will
+be entirely cured if the physician believes that a real cure through
+suggestion is impossible. The more the true physicians undertake
+psychotherapeutic work, the more it will carry with it that dignity
+which is now too often lost by the predominance of those who treat
+without diagnosis and cure by mere appeal to superstition.
+
+All that does not mean that other motives do not hold the physician
+back. Not seldom he is afraid of unfavorable consequences. He does not
+feel sure that, for instance, a deep hypnosis is without dangerous
+results or that he will be able to produce it in the technically correct
+way. But all these objections mean nothing but insufficient acquaintance
+with the facts. Of course every technique needs its period of
+preparation for the task, but it is now sufficiently demonstrated that
+hypnotism carried through in a scientific spirit will never have any
+injurious consequences. The morphine injection and the Roentgen rays are
+by far more dangerous. Those who think that for hypnotizing especially
+inborn power is needed stand, of course, outside of a serious
+discussion. They do not even know the elements of the modern theories.
+Every physician has in himself the necessary means for a
+psychotherapeutic treatment in every form.
+
+More scientific insight belongs to the argument that most of these
+psychotherapeutic schemes are essentially for treatment of symptoms. We
+have acknowledged that throughout. The possibility of a relapse or of a
+new obsession is thus to a high degree open, and that is certainly a
+discouraging feature. Yet we have seen sufficiently that as soon as the
+symptoms are removed, there is no lack of means, also by psychotherapy,
+to prevent the recurrence. Moreover, to remove the present symptoms is
+in any case a great gain and in many cases a decisive gain. And whatever
+can be secured by such methods is of such a character that hardly any
+other method could have been substituted. It can be said with certainty
+that hundreds of thousands leave the offices of their doctors every year
+without relief where relief could be secured by psychotherapeutic means.
+
+To be sure, one reply of the physicians is not infrequent and carries
+some weight. Psychotherapeutic methods demand much time and patience and
+skill. To relieve a cocainist of his desire by mere suggestion may
+demand an assiduity which the average physician simply cannot afford;
+and nothing requires more time than a real use of Freud's psychoanalytic
+method. Hours and hours of conversation about the most trivial
+occurrences have to be spent to relieve the repressed ideas and to give
+them a chance for a free ascension. It cannot be denied that most of the
+really illuminating work in all these fields has been done by scholars
+who combine a strong theoretical interest with their effort to cure the
+patients, and who therefore examine and treat the individual case
+primarily from the wish to get new insight into the laws of nature. The
+average physician whose time is his income may be the less willing to
+enter into such time-devouring schemes, as the patients too easily may
+think that the physician did not do much for them when he simply was
+sitting down and gossiping with them.
+
+Yet after all, behind all of it stands one motive which has held back
+the development of psychotherapy in the medical profession more than
+anything else. The physician feels instinctively that a real success can
+be reached in every one of these fields, only if he possesses a
+reasonable amount of knowledge of psychology. He feels that wherever he
+touches the patient's body, examines his lungs or his heart or his
+reflexes, that a large background of anatomical knowledge and of general
+pathology gives meaning to every single observation. But in the field of
+mental abnormities, in the whole world of ideas and emotions and
+volitions, he simply lacks that background. Everything seems to him
+without reference to real knowledge. He feels as amateurish as if he
+were to operate on the abdomen without knowing its anatomy. He is
+instinctively aware that even the simplest mental life represents a
+bewildering complexity and that to stimulate ideas or feelings or to
+suppress emotions, to inhibit volitions, must demand always a most
+subtle disentanglement of the most widely different components. He
+abstains from approaching that ground at all rather than to blunder by
+his ignorance of psychology. And after all, he is right. But is he right
+in allowing that ignorance? Can the medical profession afford to send
+into the world every year thousands of young doctors who are unable to
+use some of the most effective tools of modern medicine, and tools which
+do not belong to the specialist but just to the average practitioner,
+simply because they have not learned any psychology?
+
+Indeed the times seem ripe for a systematic introduction of
+psychological studies into every regular medical course. It is not a
+question of mental research in the psychological laboratory where
+advanced work is carried on, but a solid foundation in empirical
+psychology can be demanded of everyone. He ought to have as much
+psychology as he has physiology. Moreover the psychological study ought
+not to be confined to the normal mental life. Again we do not speak of
+psychiatry. What is needed is abnormal psychology, entirely independent
+of the therapeutic interests of the alienist. The mental variations
+within the limits of normal life and the borderland cases ought to be
+studied there as well as the complete derangements. The ideal demand
+would be that the future physician should spend at least a year of his
+undergraduate time on empirical psychology, especially on experimental
+and physiological psychology. He would take perhaps half a year's
+lecture course on the whole field of psychology as covered in the
+English language by the well-known text-books of James, Wundt,
+Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus,
+Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the
+course ought to be either advanced psychology entering into the more
+complex phenomena or a practical training course in elementary
+laboratory psychology as indicated for instance by Titchener's
+"Experimental Psychology. A Manual of Laboratory Practice." If the
+undergraduate can possibly afford the time in his college course, he
+ought to add courses which either lead him towards the philosophical
+problems of psychology or towards the comparative aspect of psychology.
+If he can find time for a year of post-graduate work between college and
+medical school, he could hardly spend it more profitably than by a year
+of research in a well-conducted psychological laboratory to become
+really acquainted with an independent analysis of mental states. On the
+other hand in the medical school, room must be found for a course in
+abnormal psychology, which of course presupposes a thorough knowledge of
+normal psychology and, if possible, follows the courses on nervous
+diseases and precedes the course on psychiatry.
+
+For the average future physician, it would be wiser to omit even the
+psychiatry studies than those in abnormal psychology. The latter ought
+to lead him far enough to discriminate early between a mere
+neurasthenia, for instance, and a beginning of insanity. As soon as the
+discrimination is perfected and insanity is found, he has to give the
+case out of his care anyhow and hand it over to the specialist and to
+the asylum. The knowledge of psychiatric treatment is, therefore, not
+essential for the average practitioner. But no one can relieve him from
+the responsibility for those borderland cases, for the hysterias and
+psychasthenias and neurasthenias, and he can never master them without
+normal and abnormal psychology. Moreover it must not be forgotten that
+mental factors may enter into every disease. The psychology of pain, for
+instance, and of comfort feeling, the psychology of hunger and thirst,
+of nausea and dizziness, the psychology of the sexual feelings, the
+psychology of hope and fear, of confidence and discouragement, of
+laziness and energy, of sincerity and cunningness play their rôle in
+almost every sick room. And if the physician haughtily declares that he
+does not care for the methods of suggestion, it might justly be asked
+whether he can be a physician at all if he does not apply some
+suggestions; yes, if his very entrance into the sick room does not
+suggest relief and improvement from the start. The introduction of a
+serious study of psychology is the most immediate need of the medical
+curriculum. Instructorships in abnormal psychology must be created in
+every medical school; institutes for psychotherapy should soon follow.
+But in all this, there is nowhere to appear any artificial antithesis
+between mind and body, any more than between organic and functional
+diseases; we have discussed all that with full detail. Only the
+physician who has a thorough psychological preparation can fulfill the
+manifold demands which modern life must raise; he alone is prepared to
+coöperate with the other factors of the community in the development of
+a sound and healthful nation, to work towards the hygiene of the nervous
+system and of the mental life; and to correct the injuries which the
+perversities of our civilization inflict.
+
+In all that he will not avoid the comradeship of the clergyman. He will,
+of course, not forget the fundamental difference of attitude between
+them, he will not forget that the minister seeks for the meaning and
+values of inner life while he, the physician, has to consider that same
+inner life from a causal point of view and thus has to work with it as
+with natural material for the normal functioning of the organism. But
+the interrelation between them can be intimate in spite of the
+difference of their standpoints. The minister, to be sure, ought not to
+consider health as such as the greatest good, but he will not forget
+that a wholesome devotion to ideals cannot be carried through when the
+attention is absorbed by the sufferings of the body and the mental
+powers are debilitated. Only in a sound mind the full ideal meanings of
+life can be realized. The minister must therefore seek the health of his
+congregation not because health is the ideal of life but because the
+true ideals cannot be appreciated by the mental cripple. On the other
+hand, the physician from his standpoint should in no way feel it his
+duty to play the amateur minister and to put emphasis on the spiritual
+uplifting of his patients. But he knows well that not a few of the
+suggestive influences which are needed for the relief from disease are
+most effective when an emotional emphasis can be given to the
+suggestions and that this emphasis is for large numbers most powerfully
+supplied by the religious emotion. Thus the minister will be a very
+important assistant to him and the church will most successfully do for
+many patients what for other patients perhaps travel or music or the
+theatre, sport or social life, may do.
+
+Just in the relation to the church, the physician will need subtlest
+discrimination, and he will not forget that while even a strong
+religious emotion may be without damage for a normal man, it may well be
+injurious to the unstable brain. But if the physician uses tact and
+wisdom, he will be surprised to find how often the religious stimulation
+can indeed be helpful for his purposes and the division of labor
+demands that this be supplied not by himself but by the minister. He
+will advise the consulting sufferer to seek the influence of a godly man
+who awakens in him upbuilding wholesome emotions and volitions. The
+minister may in this way very well become the assistant of the
+physician. But whether this coöperation is looked on from the one or
+from the other point of view, in every case it needs absolute clearness.
+Nothing is gained and too much is lost if the two functions are
+carelessly mixed together. It is never the task of the minister to heal
+a mind and never the task of a physician to uplift a mind. One moves in
+the purposive sphere, the other in the causal sphere. Their friendship
+can seriously endure only as long as they remain conscious of the fact
+that they have two entirely different functions in the service of
+mankind.
+
+
+
+
+XIV
+
+PSYCHOTHERAPY AND THE COMMUNITY
+
+
+Both the physician and the patient find their place in the community the
+life interests of which are superior to the interests of the individual.
+It is an unavoidable question how far from the higher point of view of
+the social mind the psychotherapeutic efforts should be encouraged or
+suppressed. Are there any conditions which suggest suspicion of or
+direct opposition to such curative work?
+
+Of course society has to be sure that no possible misuse and damage are
+to result from such practice. Fears in that direction have been uttered
+repeatedly, but from very different standpoints. One which is perhaps
+most often heard in popular circles results from an entire
+misunderstanding and deserves hardly any discussion after our detailed
+study of the processes involved. It is claimed that suggestive power,
+especially in the form of hypnotization, may be secretly misused to make
+anyone without his knowledge and against his will a passive instrument
+of the hypnotist's intent. Often this is coupled with telepathic
+fancies. The hypnotist is believed to have mystic power to bring any
+person in a distant region under his mental control and thus to be able
+to carry out any sinister plans by the help of his innocent victim. All
+hypnotizing therefore ought to be interdicted by the state. The
+presuppositions of such a view are, as we know now, entirely absurd. We
+know that hypnotism is not based on any special power of the hypnotizer;
+there is no magnetic fluid in the sense of the old mesmerism. The
+imagination of the hypnotized person is the only hypnotizing agency.
+Thus no one can be hypnotized without his knowledge or against his will.
+The story of telepathic mysteries which is often brought before the
+public is probably always the outcome of a diseased brain. It is indeed
+a frequent symptom in paranoia and other insanities that the patient who
+feels abnormal organic sensations and abnormal unaccountable impulses
+interprets them as influences of a distant enemy. Whole pamphlets have
+been written with elaboration of such insane misinterpretations and
+requests to legislatures have been made in that spirit, but the
+physician recognizes easily throughout the whole argumentation the
+well-known phenomena of the mental disease.
+
+To be sure, while no one can be hypnotized against his will, many a
+person is liable to accept suggestions from others and thus to carry out
+the wishes of others almost without knowing and certainly without
+willing that the other mind interfere with the interplay of the own
+motives. But if we were to strike out all suggestive influences from
+social life, we should give up social life itself. Suggestion is given
+wherever men come in contact; in itself it is neither good nor bad. The
+good resolution and the bad one can be suggested, the good example and
+the bad can be effective; both encouragement of the noble and imitation
+of the evil may work with the same mental technique. Certainly there are
+some persons who have a stronger influence than others on the
+imagination of those with whom they come in contact; their expression
+awakens confidence, their voice and their words reach deeper layers of
+the mind, their calmness and firmness overwhelm more easily the
+antagonistic ideas. But the chief difference lies after all in the
+different degrees of suggestibility among those who receive such
+impressions. The easily suggestible person cannot be protected by any
+interdict; he may catch suggestions everywhere, any advertisement in the
+newspaper and any display in the shop-window may overrun his own
+intentions. What he needs is training in firmness. The application of
+reënforced suggestion or even of hypnotism in the doctor's office is
+even for him no possible source of danger.
+
+On a higher level are objections which come from serious quarters and
+which are not without sympathy with true science. In recent times this
+opposition has repeatedly found eloquent expression. It is an objection
+from the standpoint of morality, belonging therefore entirely to the
+purposive view of the mind, but we have now reached a point where it is
+our duty to do justice to this purposive view too. As long as we
+discussed the problem entirely from the standpoint of the physician, no
+other view of mental life except the causal one could be in question. As
+soon as we look at it from the standpoint of the community, it becomes
+our duty to bring the causal and the purposive view into harmony, and it
+would be narrow and short-sighted simply to draw the practical
+consequences of a naturalistic view of the mind without inquiring
+whether or not serious interests in the purposive sphere are injured. If
+there is moral criticism against suggestive therapy, it is the duty of
+the community to consider it. This opposition argues as follows:
+Hypnotic influence brings the patient under the will control of the
+hypnotizer and thus destroys his own freedom. Whatever the patient may
+reach in the altered states is reached without his own effort, while he
+is the passive receiver of the other man's will. His achievement has
+therefore no moral value, and if he is really cured of his drunkenness
+or of his perverse habits, of his misuse of cocaine or of his criminal
+tendencies, he has lost the right to be counted a moral agent. It would
+be better if there were more suffering in the world than that the
+existence of the moral will should be undermined.
+
+No one ought to take such arguments lightly. The spirit which directs
+them is needed more than anything else in our time of reaching out for
+superficial goods. No one can insist too earnestly that life is worth
+living only if it serves moral duties and moral freedom and is not
+determined by pleasures and absence of pain only. Those who set forth
+this argument are entirely willing to acknowledge the profound effect
+which suggestive therapeutics may create. More than this, they have to
+acknowledge it to gain a basis for their attack. Just because the
+hypnotizer can entirely change the desires and passions, the habits and
+perversities of the suffering victim, he seems to them a moral wrongdoer
+who negates the principle of human freedom. A forcible book of recent
+days calls the suggestive power of the psychotherapist "The Great
+Psychological Crime." It says to the hypnotist: "By your own testimony,
+you stand convicted of applying a process which deprives your subjects
+of the inalienable right and power of individual self-control. In
+proportion as you deprive him of the power of self-control, you deprive
+him of that upon which his individual responsibility and moral status
+depend. In proportion as you deprive him of the free control and
+exercise of those powers of the soul upon which his individual
+responsibility and moral status depend, you thereby rob him of those
+powers upon which he must depend for the achievement of individual
+immortality."
+
+But this censure too is entirely mistaken, not because it urges the
+purposive views against the causal but because it is in error as to the
+facts. Such critics are fully under the influence of the startling
+results which are reached; they do not take the trouble to examine the
+long and difficult way which has had to be traversed with patience and
+energy. It is quite true that if I hypnotize a man and suggest to him to
+take up after awaking the book which lies on my table, he follows my
+suggestion without conflict and in a certain sense without freedom. He
+feels a simple impulse to go to the table and lift the book and, as no
+stronger natural desire and no moral objection stand in the way, he
+carries out that meaningless impulse and perhaps even invents a foolish
+motive to explain to himself why he wanted to look at that book. But
+after a long experience, I have my doubts as to whether a man was ever
+cured in such a way by hypnotism of serious disturbances and of those
+anomalous actions which the critics want to see overcome by the
+patient's own moral efforts. On the contrary, every suggestion has to
+rely on the efforts and struggles of the patient himself and all that
+the psychotherapists can give him is help in his own moral fight. His
+own will is presupposition for being hypnotized and for realizing the
+suggestion. If again and again I hesitate to undertake new cases, it is
+just because I have to see during the treatment too much of this daily
+and hourly striving against overpowering impulses. The joy of removing
+some obstacles from the way of the patients is too much overshadowed by
+the deep pity and sympathy with their suffering and craving during the
+whole period of successive treatments. To make a man fight where despair
+is inevitable, and where the enemy is necessarily stronger than his own
+powers, can certainly not be the moral demand. Morality postulates that
+everyone find conditions in which he can be victorious if he puts his
+strongest efforts to the task.
+
+In our discussion of the mental symptoms I reported as an illustration
+of the suggestive treatment of the drug passion the case of a
+morphinist. To make clear this purposive side of the case as against the
+causal one which alone interested the physician, I may add a few
+features to the short report as a typical example. When that man left my
+laboratory for the last time to go out to work and happiness, you might
+well have believed from his joyful face that it had been an easy and
+pleasant time in which hypnotic influence smoothly removed from him the
+dangerous desire for morphine. In truth it was the result of four months
+of the most noble and courageous suffering and struggling. He had been
+for years a slave to his passion. To quote from his little
+autobiography: "When I realized that I was addicted to morphine, I was
+at first not at all worried as I did not then understand the real horror
+of the thing, and did not then realize all the future suffering and
+misery that is coming to anyone who is the user of opium or any of its
+alkaloids. For the first few months, I found great relief after every
+injection of morphine, but soon I could not get the same easy feeling
+and could eat but very little and what sleep I got was in the daytime. I
+finally went to the sanitarium of a doctor but it was simply a
+money-making business for him; if he ever cured anyone, I never heard of
+it. I then tried another one; it was the same kind of a place as the
+former. When I first went to see the professor in the Harvard
+Psychological Laboratory, I was using between thirty-two and
+thirty-eight grains of morphine daily. He put me under his treatment
+October 6th and that day cut me down by hypnotic treatment to nine
+grains a day or three doses of three grains a day. I took my hypodermic
+as directed, but on the following day I lay on the bed too exhausted to
+get up even to get around the room, and I could not eat and only drank a
+very little water. The desire for the drug was something terrible. But
+in about four days I got used to the loss of so much morphine and stayed
+on this amount for a week, seeing the professor every other day for
+hypnotic treatment and then returning to my room where I spent
+twenty-two hours of the twenty-four on the bed, but did not sleep more
+than two or three hours a day. At the end of the week I was cut off by
+hypnotic suggestion half a grain and this put me to fighting the desire
+again. This lasted two or three days and then I began to feel better and
+began to sleep a little more. But at the end of the week I was cut off
+another half grain, and the whole fight would have to be begun over.
+These reductions of the dose were made a week apart and sometimes only
+two days. The worst time of all was a cut from four injections of a
+fourth of a grain each to four of one eighth of a grain each, which was
+about January 10th. At this time I had the worst two days of my life. I
+tried whiskey, but it gave relief only for about half an hour and then
+the desire was worse than ever."
+
+In this way every few days I gave the poor fellow under hypnotic
+influence the suggestion to reduce the dose of morphine in a prescribed
+way, and with enormous effort he withstood his craving for more, in
+spite of the fact that he had during all this winter a bottle with a
+thousand tablets of morphine, prescribed by an unscrupulous physician,
+in his writing desk. He was thus at every moment during the day and
+night in full possession of the deadly poison with which he could have
+fully satisfied his craving. It was a moral victory when he finally
+reached the point at which he went for several weeks without any desire
+for morphine and finally presented the remaining tablets to a hospital.
+And yet there would not have been the least chance for his winning this
+ethical victory without the outer help of the hypnotist. We do not
+eliminate the moral will but we remove some unfair obstacles from its
+path. We have no mystic power by which our will simply takes hold of the
+other man's will, but we inhibit and suppress by influence on the
+imagination those abnormal impulses which resist the sound desires. If
+that were immoral, we should have to make up our minds that all
+education and training were perverted with such immoral elements. Every
+sound respect for authority which makes a child willing to accept the
+advice and maxims of his elders is just such an influence. If it were
+really a moral demand that the will be left to its own resources and
+that no outside influence come to strengthen its power or remove its
+hindrances or smooth its path, then we ought to let the children grow up
+as nature created them and ought not to try to suppress from without by
+discipline and training, by love and encouragement, the willful
+impulses and the ugly habits. Even every good model for imitation is
+such a suggestive influence from without and every solemn appeal to
+loyalty and friendship, to patriotism and religion, increases the degree
+of suggestibility. That is the glory of life that the suggestive power
+may belong to moral values instead of mere pleasures, but it is not the
+aim of life to remain untouched by suggestion. And he who by suggestion
+helps the weak mind to overcome obstacles which the strong mind can
+overthrow from its inborn resources works for the good of the individual
+and of the community in the spirit of truest morality.
+
+Much more justified than such ethical objections are the fears which
+move entirely in the causal sphere. It must be acknowledged that a
+method which has such powerful influence over the mind that it can
+secure ideas and emotions and impulses which the own will of the patient
+cannot produce, ought to be allowed only to those who are prepared for
+its skillful use. To hypnotize or to perform any persistent
+psychotherapeutic treatment may thus be dangerous, if it is done by the
+unfit. We have discussed before the injuries which might result from the
+administration of such powerful psychotherapeutic effects through the
+best meaning minister, but we can extend this fear to anyone who has not
+systematically studied medicine and to a certain degree normal and
+abnormal psychology. The possibilities of overlooking symptoms which
+ought to suggest an entirely different treatment, or of adjusting the
+treatment badly to the special physical conditions, or of ignoring the
+desirable physical supplement by drugs, or of creating unintentionally
+by suggestion injurious effects, are always open when medical amateurs
+undertake such work. Certainly there is no physician who is not liable
+to make mistakes, and a physician who has never given any attention to
+psychology and psychiatry would also be a rather poor agent of
+psychotherapeutic methods, but the probability is that such a physician
+would simply abstain by principle from all psychotherapeutic methods;
+his mistake only begins if from his lack of acquaintance with the
+subject he draws the conclusion that the method itself is undesirable.
+That his real preparation ought to include psychological studies we have
+pointed out before, and the time seems ripe for the community to urge
+such a reform of the studies.
+
+All that involves the conviction that even the experimental psychologist
+as such is not prepared to enter into medical treatment; and a
+"Psychological Clinic," managed by a psychologist who is not a doctor of
+medicine, is certainly not better than a church clinic. I cannot even
+acknowledge the right of psychologists to make hypnotic experiments
+merely for the psychological experiment's sake. Nobody ought to be
+brought into a hypnotic or otherwise abnormal state of mind if it is not
+suggested by the interests of the subject himself. Science has the right
+to make hypnotic experiments, or experiments with abnormal mental
+states, only under the one condition that a physician has hypnotized the
+subject in the interests of his health and that the patient has agreed
+beforehand to allow in the presence of witnesses certain psychological
+studies. Needless to say that any hypnotization for mere amusement and
+as a parlor trick ought to be considered as criminal.
+
+On some other objections which interest the community as such we had to
+touch before, and there is no need of returning to them with any
+fullness of argument. We spoke of the danger which the mental cures
+carry with them when they are based on any particular creed, and
+especially when they are tied up with a semi-religious arbitrary
+metaphysics. What is gained if some nervous disorders are helped by
+belief, if the belief itself devastates our intellectual culture and
+brings the masses down again to a view of the world which has all the
+earmarks of barbarism? That is indeed one of the central dangers of all
+non-medical suggestive cures, that while any belief may cure through the
+mere emotional power of the act of believing, the content of the belief
+gains an undeserved appearance of truth. Any absurd superstition can
+become accredited because its curative value may be equal to a truly
+valuable suggestion. The intellectual life of the community would have
+to suffer greatly if the way to be freed from bodily suffering had to be
+the belief in the metaphysical doctrines of Mrs. Eddy's "Science and
+Health." From a cultural viewpoint, too, suggestive therapeutics must
+stand the higher, the more sharply it is separated from special
+philosophical or religious doctrines. No theory of the world and of God
+ought to gain authority over the mind from such an external motive as a
+belief in its curative effects. Freest from such implications is
+certainly the hypnotic method of the physician who does not need the
+strong religious reënforcement of the suggestion because he reënforces
+instead the suggestibility of the patient by slight influences on his
+senses.
+
+Even where sound religion without superstition and without
+pseudophilosophy stands behind the therapeutic work, the community will
+not give up the question whether the church does not necessarily neglect
+by it the interests which are superior. The community becomes more and
+more strongly aware that too many factors of our modern society urge the
+church to undertake non-religious work. Social aid and charity work
+ought to be filled with religious spirit, but to perform it is not
+itself religion. Still more that is true of the healing of the sick.
+Whether or not such expansion of church activity in different directions
+saps the vital strength of religion itself is indeed a problem for the
+whole community. The fear suggests itself that the spiritual achievement
+may become hampered, that in the competition of the church with the
+other agencies of social life the particular church task may be pushed
+to the background, and that thus the church in imitating that which
+others can do just as well or better loses the power to do that which
+the church alone can do. The final outcome is therefore practically in
+every way the same. From whatever starting point we may come, we are led
+to the conviction that the physician alone is called to administer
+psychotherapeutic work, but that he needs a thorough psychological
+training besides his medical one.
+
+But the interest of the community is not only a negative one. Society
+does not only ask where psychical treatment can be dangerous, but asks
+with not less right whether the scheme and the method might not be
+fructified for other social ends besides the mere healing of the sick.
+If psychotherapy demonstrates that for instance hypnotism makes possible
+the reshaping of a pathological mind, it is a natural thought to use the
+same power for remodeling perhaps the lazy or the intemperate, the
+careless or the inattentive, the dishonest or the criminal mind. Both
+educators and criminologists have indeed often raised such questions,
+and social reformers have not seldom seen there wide perspectives for
+social movements in future times.
+
+There can be no doubt that the possibility of such remodeling activity
+is given, but as far as education is concerned certainly grave
+misgivings ought to be felt. When we spoke of the treatment of the sick,
+we had always to emphasize that the suggestion cures symptoms but not
+diseases. In the same way hypnotic suggestion might reënforce a single
+trait but would not reform the personality of the child. Yes, the
+artificial reënforcement of such special features would deprive
+education of that which is the most essential, namely, the development
+of the power to overcome difficulties by own energy. Wherever a
+reasonable amount of own will force and attention can be expected to
+overcome the antagonistic influence, there artificial hypnotic
+influence ought to be avoided. Everything ought to be left in that case
+to suggestions within normal limits, in the form of good example and
+persuasions, authority and discipline, love and sympathy. That holds
+true even for very slight abnormalities which seem still within the
+limits where the own energies can bring about the cure. For instance, I
+have steadily refused requests of students and others to use hypnotism
+for the purpose of overcoming merely bad habits, such as the habit of
+biting the nails. A child who finds some difficulty in sticking
+seriously to his tasks might learn now this and now that under the
+influence of hypnotic suggestions but he would remain entirely untrained
+for mastering the next lesson. In the same way some naughty traits might
+be artificially removed but the child would not gain anything towards
+the much more important power of suppressing an ugly tendency by his own
+effort. All that finds its limits where the inhibitions or obstacles in
+the brain of the child are too strong possibly to be overcome by the own
+good will, but in that case we already stand in the field of abnormal
+mental life and then of course psychotherapy has its right. The
+feeble-minded and the retarded child, the perverse child and the
+emotionally unstable child, belong under the care of the physician, and
+in such a case he ought not to hesitate to use the whole supply of
+psychotherapeutic methods which are at his disposal.
+
+Still more complex is the criminological problem. It sounds like an easy
+remedy for the greatest social calamity, if it is proposed simply to
+hypnotize the criminal and to supplant his antisocial will by a moral
+one. And if the absurdity of such a proposal is recognized it seems to
+many justified to demand such an intrusion at least in the case of the
+born criminal, even if the occasional criminal cannot be reached. But
+the conception of the born criminal is also only a label which is
+superficially used for a great variety of minds. That men are born with
+a brain which necessarily produces criminal actions is not indicated by
+any facts. The varieties which nature really produces are brains which
+are more liable than others to produce antisocial actions. We recognized
+from the start that the abnormal mind never introduces any new elements
+but is characterized only by a change of proportions. There is too much
+or too little of a certain mental process and just for that reason there
+must be a steady and continuous transition from the normal to the
+entirely abnormal. Here again we have not a special class of brains
+which are criminal; but we have an endless variety of brains with a
+greater or smaller predisposition for antisocial outbreaks. The
+variations which produce this criminal effect may lie in most different
+directions.
+
+The brain may be for instance inclined to overstrong impulses, so that
+any desire rushes to action before the inhibiting counter-idea gets to
+work. Or, on the other hand, the brain may have unusually weak
+counter-ideas so that even a normal impulse does not find its normal
+checking. The fact that selfish and thus antisocial desires awake in the
+mind is not abnormal at all; only if they are not normally inhibited,
+the disturbance sets in. Furthermore the associative apparatus of the
+brain may work especially slowly; it may thus bring it about that the
+counteracting ideas do not arise in time. Or the emotions of a person
+may be unusually strong. Or there may be strong suggestibility, by which
+a bad example or a strong temptation has especially easy access. Or
+there may be negative suggestibility, by which a moral admonition stirs
+up a vivid idea of the opposite. In short, there may be a large number
+of factors, sometimes even in combination, each one of which increases
+the chances that the individual may come in danger in the midst of
+developed society. Yet no one of those factors involves just the
+necessity of crime. The same kinds of brains might simply show stupidity
+or credulity or inconsiderateness or brutality or stubbornness or
+egotism, and might by each of those factors decrease their chances in
+the community without directly running into conflict with the law. The
+criminal is therefore never born as such. He is only born with a brain
+which is in some directions inefficient and which thus, under certain
+unfavorable conditions, will more easily come to criminal deeds than the
+normal brain.
+
+With the idea of a stereotyped born criminal there disappears also the
+idea of a uniform treatment against criminal tendencies. That men are
+different in their power of resistance or in their power of efficiency
+or in their intellect or in their emotions, we have to accept as the
+fundamental condition with which every society starts. It would be
+absurd to remodel them artificially after a pattern. The result would be
+without value anyhow, inasmuch as our appreciation is relative. No
+character is perfect. The more the differences were reduced, the more we
+should become sensitive even for the smaller variations. All that
+society can do is, therefore, not to remodel the manifoldness of brains,
+but to shape the conditions of life in such a way that the weak and
+unstable brains also have a greater chance to live their lives without
+conflicts with the community.
+
+The situation is different as soon as the particular surroundings have
+brought it about that such a brain with reduced powers has entered a
+criminal career. The thought of crime now becomes a sort of obsession or
+rather an autosuggestion. The way to this idea has become a path of
+least resistance, and as soon as such an unfortunate situation has
+settled itself, the chances are overwhelming that a criminal career has
+been started. If such cases should come early to suggestive treatment
+which really would close the channels of the antisocial autosuggestion,
+much harm might be averted. Yet again the liability of the brain to
+become antisocial would not have been removed, and thus not much would
+be secured unless such a person after the treatment could be kept under
+favorable conditions. With young boys who through unfortunate influence
+have caught a tendency, for instance, to steal, and where the fault does
+not yield to sympathetic reasoning and to punishment, an early hypnotic
+treatment might certainly be tried. I myself have seen promising
+results. But if the impulse has irresistible character in such a way
+that the good will is powerless, we are again in the field of disease
+and the point of view of the physician has to be substituted for that of
+the criminologist.
+
+Whether pedagogy and criminology are to make use of the services of
+psychotherapy is thus certainly an open question. It would be
+short-sighted to overlook the serious obstacles which stand in the way.
+But while the social life outside of the circle of real disease may
+better go on without direct interference by psychotherapeutic
+influences, it is certainly the duty of the community to make the
+underlying principles of psychotherapy useful for the sound development
+of society. The artificial over-suggestions which are needed to overcome
+the pathological disturbances of mental equilibrium may be left for the
+cases of illness. But we saw that every mental symptom of disease was
+only an exaggeration of abnormal variations which occurred within the
+limit of health. To reduce these abnormalities means to secure a more
+stable equilibrium and thus to avoid social damages, and at the same
+time to prevent the growth of the abnormality to pathological
+dimensions. To counteract these slighter variations, these abnormalities
+which have not yet reached the degree of disease, will demand the same
+principles of treatment, only in a weaker form. It is in a way not
+psychical therapy but psychical hygiene. And this is no longer confined
+to the physician but must be intrusted to all organs of the community.
+And here more than in the case of disease, the causal point of view of
+the physician ought to be brought into harmony with the purposive view
+of the social reformer, of the educator and of the moralist.
+
+The ideal of such mental hygiene is the complete equilibrium of all
+mental energies together with their fullest possible development. To
+work towards this end does not mean to aim towards the impossible and
+undesirable end of making all men alike, but to give to all, in spite of
+the differences which nature and society condition, the greatest
+possible inner completeness and outer usefulness. The efforts in that
+direction have to begin with the earliest infancy and are at no age to
+be considered as finished; the whole school work and to a high degree
+the professional work has to be subordinated to such endeavor. Society
+has further to take care that those spheres of life which stand less
+under systematic principles, such as the home life of the child and the
+social life of the man, his family life and his public life, are
+steadily under the pressure of influences which urge in the same
+direction.
+
+Harmonious development without one-sidedness, and yet with full justice
+to the individual talents and equipments, should be secured. That means
+from the start an effort to secure balance between general education and
+particular development. The latter has to strengthen those powers by
+which the boy or girl by special natural fitness promises to be
+especially efficient and happy. It has to be supplemented later by a
+wise and deliberate choice of such a vocation as brings these
+particular abilities most strongly to a focus. Yet this alone would mean
+a one-sidedness in which the equilibrium would be lost. More important,
+it would leave undeveloped that power which the youth especially needs
+to acquire by serious education, the power to master what does not
+appeal to the personal likings and interests. An equilibrium is secured
+only if at the same time full emphasis is given to the learning and
+training in all which is the common ground of our social existence. From
+the multiplication table to the highest cultural studies in college, the
+youth is to be adjusted to the material of our civilization without any
+concession to the emasculating desire to adjust civilization simply to
+the particular youth. He has to learn learning and not only to play with
+knowledge, he has to learn to force his attention in adjustment to those
+factors of civilization which are foreign to his personal tendencies and
+perhaps unsympathetic. Free election of life's work and unyielding
+mental discipline in the service of the common demands should thus
+steadily coöperate. The one without the other creates a lack of mental
+balance which is the most favorable condition for a pathological
+disturbance.
+
+The mere learning is of course on both sides only a fraction of what the
+community has to develop in the youth. Mental hygiene begins with
+physiological hygiene. The nourishment of the child, the care for the
+child's sense organs, the recesses and the rest from fatigue, and
+especially the undisturbed sleep are essential conditions. The
+interferences with sufficient sleep are to a high degree responsible
+for the later disturbances of the mental life. It must not be forgotten
+that the decomposition of the brain molecules can never be restituted by
+anything but rest, and ultimately by sleep. Physical exercise is
+certainly not such restitution. In the best case it brings a certain
+rest to some brain centers by engaging other brain parts. The child
+needs sleep and fresh air and healthful food more than anything else, if
+his mind is active. The careful examination of the sense organs and of
+the unhindered breathing through the nose is most important. Even a
+slight defect in hearing may become the cause of an under-development of
+attention.
+
+More important than mere physical hygiene is the demand that a sound
+character and a sound temperament are also to be built up, at the side
+of a sound interest. Here again everything depends upon a wise balance
+between the development of that which is given by nature to the
+particular individual and the reënforcement of that which society
+demands and which belongs therefore to the common equipment. The
+emotional stability and emotional enlargement of the mind is perhaps
+most neglected in our educational schemes. On the one side it demands a
+systematic discipline of the emotions, on the other a healthy
+stimulation of emotions. Here is the place where imagination in play and
+later in art come in. The biological value of play always lies in the
+training for the functions of later life, and especially for the
+emotional functions. The play of our children is too little adjusted to
+this task. For this reason it leaves too many unprepared for the world
+of art and for the emotional experiences of real life. Both lack of
+emotional discipline and narrow one-sidedness of emotions interfere with
+the harmonious development. Destructive emotions like terror ought to be
+kept away and not needlessly brought near by uncanny stories and mystic
+superstitions. It is the healthy love and sympathy of the home which
+contributes most strongly to the normal development of emotions. Again
+in the field of will, we want the strong, spontaneous, independent will
+which is not frightened by discomfort and not discouraged by obstacles,
+and yet we want the will which is not stubborn and selfish but which
+subordinates itself to the larger will of the social group and to the
+eternal will of the norm. There is no balance where independence and
+subordination do not supplement each other. A wide education not only
+trains for both but also secures habits which work as autosuggestions in
+both directions.
+
+But all this harmonious development of intellect and temperament and
+character has to go on when the school days are over and just here
+begins the duty of the community as a whole. The special functions of
+the teachers have to be taken up by the public institutions. The whole
+social life must shape itself in such a way that everyone finds the best
+possible chances to perfect this harmonious growth. In the field of the
+intellect, the community must take care that thoroughness of training
+and accuracy of information is rigidly demanded and not thrust out by
+an easy-going superficiality. The expert ought to replace the amateur in
+every field. Every society which allows successes to superficiality
+diminishes its chances for mental health. Yet while thoroughness demands
+concentration in one direction, society must with the same earnestness
+insist on well-rounded general education and continuity of general
+interests through life. Literature and the libraries, the newspapers and
+the magazines play there a foremost rôle, and again the mental health of
+the community has to pay the penalty if its newspapers work against
+general culture. In the emotional field art and music, fiction and the
+theater on the one side, the church on the other side, remain the great
+schools for a development of sound emotions. Where literature becomes
+trivial, where the stage becomes degraded, and where the church becomes
+utilitarian and uninspiring, great powers for possible good in emotional
+education are lost. But with this enrichment of feelings the
+disciplinary influence too has to go through the whole social life.
+Where art is sensational and the church hysterical,--in short, where the
+community stirs up overstrong feelings,--the wholesome balance is lost
+again. In a similar way the public demands should throughout stimulate
+the energy and ambitions and initiative of the man, and yet should keep
+his desires and impulses in control.
+
+Few factors are more influential in all these directions than the
+administration of law. Sound sober lawmaking and fair judgment in court
+secure to the community a feeling of safety which gives stability to
+emotions and feelings. The disorganization which results from arbitrary
+laws, from habitual violation of laws, from corruption and injustice
+works like a poison on the psychophysical system. A similar unbalancing
+influence emanates from overstrong contrasts of poverty and comfort. A
+poverty which discourages and leaves no chances and a wealth which
+annihilates the energies and effaces the consciousness of moral
+equality, create alike pernicious conditions for mental balance.
+
+Unlimited furthermore are the influences which depend upon the sexual
+ideas of the society. It is the sphere in which it may be most difficult
+to indicate the way towards a development without dangers. There is no
+doubt the arbitrary suppression of the sexual instinct must be
+acknowledged as the source of nervous injury while indulgence may lead
+to disease and misery. But in any case frivolous habits and easy divorce
+contribute much to the unbalanced life which ruins the unstable
+individual. Not less difficult and not less connected with the mental
+hygiene is the alcohol problem. For normal adult men mild doses have
+through their power to relieve the inhibitions undeniable value for the
+sound development of the community. Its intemperate use or its use by
+young people and by pathological persons is one of the gravest dangers.
+Whether intemperance ought to be fought by prohibition or rather by an
+education to temperance is a difficult question in which the
+enthusiastic women and ministers, backed by the well justified fears of
+psychiatrists, will hardly be on the same side as the sober judgment of
+scientists, unprejudiced physicians, and historians. In any case the
+saloon and its humiliating indecency must disappear and every temptation
+to intemperance should be removed. Above all, from early childhood the
+self-control has to be strengthened, the child has to learn from the
+beginning to know the limits to the gratification of his desires and to
+abstain from reckless over-indulgence. With such a training later on
+even the temptations of alcoholic beverages would lose their danger. Not
+less injurious than the strong drinks are the cards. All gambling from
+the child's play to the stock exchange is ruinous for the psychophysical
+equilibrium. The same is true of any overuse of coffee and tea and
+tobacco, and as a matter of course still more the habitual use of the
+drugs like the popular headache powders and sleeping medicines. The life
+at home and in public ought to be manifold and expansive but ought to
+avoid over-excitement and over-anxiety. A good conscience, a congenial
+home, and a serious purpose are after all the safest conditions for a
+healthy mind, and the community works in preventive psychotherapy
+wherever it facilitates the securing of these three factors.
+
+For that end society may take over directly from the workshop of the
+psychotherapist quite a number of almost technical methods. Suggestion
+is one of them. The means of suggestion through education and art,
+through the church and through public opinion, through example and
+tradition, and even through fashion and prejudices, are millionfold,
+but not less numerous are the channels for antisocial and antihygienic
+suggestions. No one can measure the injury done to the psychophysical
+balance of the weaker brains, for instance, by the sensational court
+gossip and reports of murder trials in the newspapers for the masses.
+But while the influence of suggestion is on the whole familiar to public
+opinion, the community is much less aware of another factor which we
+found important in the hands of the psychotherapist. We recognized that
+mental disturbances were often the result of suppressed emotion and
+repressed wishes. For the cure the psychotherapist has to aim toward the
+cathartic result. The suppressed ideas had to be brought to
+consciousness again and then to be discharged through vivid expression.
+Society ought to learn from it that few factors are more disturbing for
+the mental balance than feelings and emotions which do not come to a
+normal expression. It is no chance that in countries of mixed Protestant
+and Catholic civilization, the number of suicides is larger in
+Protestant regions than in the Catholic ones where the confessional
+relieves the suppressed emotions of the masses. This is also the most
+destructive effect of social and legal injustice; emotions are
+strangulated and then begin to work mischief. The community should take
+care early that secret feelings are avoided, that the child is cured
+from all sullenness which stores up the emotion instead of discharging
+it. Certainly all education and social life demands inhibition and also
+the child has to learn not to give expression to every passing feeling.
+To find there the sound middle way is again the real hygienic ideal. Too
+much in our social life and especially in the sphere of sexuality forces
+on the individual a hypocrisy and secrecy which is among the most
+powerful conditions of later mental instability.
+
+Of course the background of a hygienic life of the community remains the
+philosophy of life which gives unity to the scattered energies and
+consequently steadiness to the individual through all his hazards of
+fate. It might seem doubtful whether society could get the prescription
+for such a steady view of the world also from the workshop of the
+psychotherapist. To the superficial observer the opposite might seem
+evident, as every word of our psychotherapeutic study indicated that
+that is a view of life which makes man's inner experience simply an
+effect of foregoing causes. All life becomes a psychophysical mechanism
+and from that point of view man's thinking and acting become the
+necessary outcome of the foregoing conditions. Nothing seems more unfit
+to give a deeper meaning to life and a higher value. And yet if there
+was one thought which controlled our discussion from the beginning, it
+was certainly the conviction that this causal view itself is only an
+instrument in the service of idealistic endeavors; the reality of man's
+life is the reality of will and freedom directed towards ideals. One of
+these ideals is the reconstruction of the world in the thought forms of
+causality. In the service of our ideals we may thus transform the world
+into a mechanism: out of our freedom we desire to conceive ourselves as
+necessary products. Whenever we aim to produce changes in the world, we
+must calculate the effects through the means of this causal
+construction, but we never have a right to forget that this calculation
+itself is therefore only a tool and that our reality, in which our
+duties and our real aims lie, is itself outside of this construction.
+The psychotherapist wants to produce effects inasmuch as he wants to
+cure disease. He is therefore obliged to adjust his work as such
+entirely to the causal aspect of man, as soon as he wants to seek the
+means by which he can reach the end. But even the fact that he decides
+in favor of those ends, that he aims towards their realization, binds
+him to a world of purposes, and therefore, he, too, with his whole
+psychophysical work, stands with both feet in a reality of will which is
+controlled not by causes but by purposes, not by natural laws but by
+ideals.
+
+
+
+
+INDEX
+
+
+Abnormal, 75
+
+Abstinence, 281
+
+Action, 34, 101, 276
+
+Adenoids, 189
+
+Adjustment, 102
+
+Æsthetic, 63
+
+Alcohol, 198
+
+Alcoholism, 278
+
+Alternation, 154, 174
+
+Anæmia, 310
+
+Anæsthesia, 174, 301
+
+Analysis, 21
+
+Antagonistic, 24
+
+Anxiety, 272
+
+Appeal, 93
+
+Applied Psychology, 60
+
+Appreciation, 10
+
+Art, 87
+
+Association, 29, 32, 42
+
+Association Experiment, 72, 233, 359
+
+Associationism, 44
+
+Astrology, 350
+
+Assurance, 215
+
+Assyria, 322
+
+Ataxia, 179
+
+Atoms, 27
+
+Attention, 46, 95, 99, 113, 200, 244
+
+Attitudes, 13
+
+Authority, 222
+
+Automatic, 144, 237
+
+Autosuggestion, 122, 172, 219, 255, 266
+
+Awareness, 133, 149
+
+
+Beauty, 197
+
+Belief, 100, 329
+
+Blood-vessels, 302
+
+Blushing, 262
+
+Braidism, 353
+
+Brain, 29, 34, 67, 139
+
+
+Cancer, 178
+
+Cathartic, 233, 358
+
+Causality, 14, 32, 57
+
+Cell, 44, 81, 89
+
+China, 321
+
+Church, 319
+
+Christianity, 324
+
+Christian Science, 7, 55, 317, 327, 343, 344
+
+Chronoscope, 71
+
+Circulation, 79
+
+Clairvoyant, 128
+
+Clearness, 103
+
+Cocainism, 283
+
+Coconscious, 156
+
+Communication, 22
+
+Community, 370
+
+Company, 197
+
+Comparative Anatomy, 38
+
+Complex, 232, 249, 270
+
+Confidence, 221, 230
+
+Conscience, 219
+
+Consciousness, 11, 125, 130, 134
+
+Contact, 223
+
+Cortex, 47
+
+Cretinism, 168
+
+Crime, 112
+
+Criminology, 383
+
+
+Dementia, 168
+
+Depression, 178, 267, 314
+
+Description, 19
+
+Diabetes, 311
+
+Diagnosis, 66, 184, 241
+
+Digestive, 177, 309
+
+Dilettanteism, 2
+
+Discharge, 49, 90, 218, 232, 252, 396
+
+Discipline, 202
+
+Disposition, 138, 143
+
+Dissociation, 135, 152
+
+Dream, 114
+
+Drugs, 163, 334
+
+
+Education, 389
+
+Effort, 289
+
+Efficiency, 194
+
+Egyptians, 323
+
+Electrobiology, 353
+
+Emmanuel Church, 326, 328, 331, 341
+
+Emotion, 88, 123, 235, 259, 314, 392
+
+Encouragement, 206
+
+Energy, 276, 288
+
+Epidemic, 193
+
+Epilepsy, 80, 207
+
+Equilibrium, 160
+
+Ergograph, 71
+
+Ethics, 16
+
+Ethnology, 329
+
+Examination, 186
+
+Exhaustion, 196
+
+Experimental Psychology, 5, 61
+
+Explanation, 19, 28, 41
+
+
+Faith, 6, 335
+
+Fascination, 116, 230
+
+Fear, 172, 259, 263
+
+Feeble-minded, 72, 295
+
+Feelings, 23
+
+Freedom, 51, 146
+
+Functional Diseases, 81, 343
+
+
+Galvanoscope, 71
+
+Genetic Psychology, 39
+
+Gospels, 324
+
+Greeks, 323, 350
+
+
+Half-sleep, 226
+
+Hallucination, 246
+
+Hastiness, 200
+
+Headache, 309
+
+Hearing, 300
+
+Heart Disease, 310
+
+Heterosuggestion, 122
+
+History, 16
+
+Hygiene, 389
+
+Hypnoid, 116, 227
+
+Hypnotism, 74, 85, 109, 122, 227, 243, 350
+
+Hysteria, 122, 174, 269, 356
+
+
+Idealism, 2, 33, 397
+
+Illness, 67
+
+Imagination, 111
+
+Impulse, 89
+
+Improvement, 299
+
+Indecision, 290
+
+Indians, 321
+
+Inherited, 171
+
+Inhibition, 86, 95, 113, 295, 305, 315
+
+Insanity, 165, 256
+
+Insomnia, 303, 312
+
+Instinct, 305
+
+Intemperance, 281
+
+Intensity, 194
+
+Interruption, 191
+
+
+Japan, 322
+
+Jews, 322
+
+
+Kymograph, 71
+
+Knowledge, 11
+
+
+Lawyer, 87
+
+Learning, 390
+
+
+Magnetism, 351
+
+Make-believe, 216
+
+Memory, 138
+
+Mesmerism, 128, 253
+
+Minister, 57, 207, 332, 340, 367
+
+Monotony, 203
+
+Moral, 65, 84
+
+Morality, 372
+
+Morphinism, 283, 376
+
+Motor Process, 46, 97, 218
+
+Movement Sensation, 24
+
+Mystic, 224, 315
+
+
+Naturalism, 4
+
+Negativism, 220
+
+Nervousness, 193
+
+Neurasthenia, 169, 246, 290, 292
+
+Neuron, 164
+
+Nutrition, 79, 312
+
+
+Obedience, 201
+
+Object, 13, 18
+
+Obsession, 246
+
+Opposite Idea, 97
+
+Oppression, 272
+
+Organic Diseases, 81, 343
+
+Organism, 23
+
+
+Pain, 69, 167, 298, 309, 313, 342
+
+Parallelism, 33, 37, 40
+
+Passes, 117
+
+Pathology, 36
+
+Pauses, 190
+
+Pedagogy, 63
+
+Perception, 20, 34, 133
+
+Personality, 11, 25, 154
+
+Persuasion, 214
+
+Perversity, 176
+
+Phobia, 94
+
+Physical, 18
+
+Physician, 57, 347
+
+Physicotherapy, 1
+
+Pneumograph, 71, 235
+
+Poet, 59
+
+Posthypnotic, 120, 231
+
+Postulate, 41
+
+Prayer, 207
+
+Prohibition, 198
+
+Protestantism, 325
+
+Psychasthenia, 172, 264, 277
+
+Psychiatry, 70
+
+Psychical, 18
+
+Psychoanalytic, 236, 272
+
+Psychological Laboratory, 5, 36, 60, 72, 356
+
+Psychology, 5, 8, 25, 39, 364
+
+Pulse, 235, 294
+
+Purposes, 11, 17
+
+Purposive, 13, 33, 65, 145, 338
+
+
+Reactions, 50, 143
+
+Realism, 2
+
+Reality, 15
+
+Reasoning, 212
+
+Recklessness, 201
+
+Recuperation, 191
+
+Relapse, 281
+
+Relativity, 195
+
+Religion, 84, 207, 329, 341
+
+Reparable, 165
+
+Reservoir, 209
+
+Resistance, 105
+
+Rest, 191
+
+Retardation, 169, 202
+
+Revival, 337
+
+
+Savages, 320
+
+Secrets, 185
+
+Self, 24, 131
+
+Self-consciousness, 136
+
+Sensation, 22, 28
+
+Sense Organ, 300
+
+Shamanism, 320
+
+Sidetracking, 236, 249, 271
+
+Sleep, 112, 177, 226, 303, 307
+
+Somnambulism, 114, 153, 352
+
+Sphygmograph, 71, 235
+
+Stammering, 175, 274
+
+Stomach, 309
+
+Subconscious, 125, 161
+
+Subcortical, 143, 306
+
+Subject, 13
+
+Suggestibility, 88, 107, 221
+
+Suggestion, 85, 100, 213, 273, 395
+
+Superficiality, 200
+
+Supervision, 279
+
+Surroundings, 189
+
+Sympathy, 205
+
+Symptoms, 80, 186
+
+
+Temperance, 198
+
+Tones, 44
+
+Toxic, 167
+
+
+Unity, 52, 135
+
+
+Vacation, 197
+
+Vividness, 50
+
+
+Will, 11, 31
+
+Witness, 107
+
+Worry, 259
+
+
+Yogi, 350
+
+
+
++----------------------------------------------------+
+|Transcriber's note:                                 |
+|                                                    |
+|Inconsistencies in hyphenation reflect the original |
+| text.                                              |
++----------------------------------------------------+
+
+
+
+
+
+
+End of the Project Gutenberg EBook of Psychotherapy, by Hugo Münsterberg
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+
+The Project Gutenberg EBook of Psychotherapy, by Hugo Münsterberg
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Psychotherapy
+
+Author: Hugo Münsterberg
+
+Release Date: September 27, 2007 [EBook #22775]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK PSYCHOTHERAPY ***
+
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+
+Produced by Audrey Longhurst and the Online Distributed
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+</pre>
+
+
+<table summary="dedication">
+<tr>
+<td colspan="3"><hr class="hrd1" /></td>
+</tr>
+<tr>
+<td class="t1">&#8747;</td>
+<td class="t2" rowspan="3">This book has been transcribed for Project Gutenberg by Distributed Proofreaders,<br />
+in memory of our friend and colleague Laura Wisewell<br />
+&#8212;Champion of Accessibility&#8212;</td>
+<td class="t3">&#8747;</td>
+
+</tr>
+</table>
+
+<hr class="hrd2" />
+
+
+<div class="figcenter" style="width: 530px;">
+<img src="images/imgcover3.jpg" width="510" height="595" alt="" title="Book Cover" />
+</div>
+
+
+
+
+<h1>PSYCHOTHERAPY</h1>
+
+<p class="title"><small>BY</small><br />
+<br />
+<strong>HUGO M&Uuml;NSTERBERG</strong><br />
+<br />
+<small>M.D., PH.D., LITT.D., LL.D.<br />
+PROFESSOR OF PSYCHOLOGY IN HARVARD UNIVERSITY</small></p>
+
+
+<p class="center">NEW YORK<br />
+MOFFAT, YARD AND COMPANY<br />
+1909<br /><br />
+
+<span class="smcap">Copyright, 1909, by</span><br />
+MOFFAT, YARD AND COMPANY<br />
+<br />
+<i>All Rights Reserved</i><br />
+<br />
+Published, April, 1909<br />
+Second Printing, May, 1909<br />
+</p>
+
+
+
+<hr class="section" />
+
+<div class="bklst">
+<h3>RECENT BOOKS BY THE SAME AUTHOR</h3>
+
+<ul>
+<li>Psychology and Life, Boston, 1899</li>
+
+<li>Grundz&uuml;ge der Psychologie, Leipzig, 1900</li>
+
+<li>American Traits, Boston, 1902</li>
+
+<li>Die Amerikaner, Berlin, 1904</li>
+
+<li>Principles of Art Education, New York, 1905</li>
+
+<li>The Eternal Life, Boston, 1905</li>
+
+<li>Science and Idealism, Boston, 1906</li>
+
+<li>Philosophie der Werte, Leipzig, 1907</li>
+
+<li>On the Witness Stand, New York, 1908</li>
+
+<li>Aus Deutsch-Amerika, Berlin, 1908</li>
+
+<li>The Eternal Values, Boston, 1909</li>
+</ul>
+</div>
+
+
+<hr class="section" />
+
+
+<h2><small>TO</small><br />
+MY FRIEND AND COLLEAGUE<br />
+<br />
+DR. FRANZ PFAFF<br />
+<br />
+<small>PROFESSOR OF THERAPEUTICS IN<br />
+HARVARD UNIVERSITY</small></h2>
+
+<p><span class='pagenum'><a name="Page_vii" id="Page_vii">[Pg vii]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="PREFACE" id="PREFACE"></a>PREFACE</h2>
+
+
+<p>This volume on psychotherapy belongs to a series of books which I am
+writing to discuss for a wider public the practical applications of
+modern psychology. The first book, called "On the Witness Stand,"
+studied the relations of scientific psychology to crime and the law
+courts. This new book deals with the relations of psychology to
+medicine. Others discussing its relations to education, to social
+problems, to commerce and industry will follow soon.</p>
+
+<p>For popular treatment I divide applied psychology into such various,
+separated books because they naturally address very different audiences.
+That which interests the lawyer does not concern the physician, and
+again the school-teacher has his own sphere of interests. Moreover the
+different subjects demand a different treatment. The problems of
+psychology and law were almost entirely neglected. I was anxious to draw
+wide attention to this promising field and therefore I chose the form of
+loose popular essays without any aim towards systematic presentation of
+the subject. As to psychology and medicine almost the opposite situation
+prevails. There is perhaps too much talk afloat about psychotherapy, the
+widest circles cultivate the discussion, the magazines<span class='pagenum'><a name="Page_viii" id="Page_viii">[Pg viii]</a></span> overflow with
+it. The duty of the scientific psychologist is accordingly not to stir
+up interest in this topic but to help in bringing this interest from
+mere gossip, vague mysticism, and medical amateurishness to a clear
+understanding of principles. What is needed in this time of faith cures
+of a hundred types is to deal with the whole circle of problems in a
+serious, systematic way and to emphasize the aspect of scientific
+psychological theory.</p>
+
+<p>Hence the whole first part of this book is an abstract discussion and
+its first chapters have not even any direct relation to disease. I am
+convinced that both physicians and ministers and all who are in
+practical contact with these important questions ought to be brought to
+such painstaking and perhaps fatiguing inquiry into principles before
+the facts are reached. To those who seek a discussion of life facts
+alone, the whole first part will of course appear to be a tedious way
+around; they may turn directly to the second and third parts.</p>
+
+<p>One word for my personal right to deal with these questions, as too much
+illegitimate psychotherapeutics is heard to-day. For me, the relation
+between psychology and medicine is not a chance chapter of my science to
+which I have turned simply in following up the various sides of applied
+psychology. And still less have I turned to it because it has become the
+fashion in recent years. On the contrary, it has been an important
+factor in all my work since my student days. I have been through five
+years of regular medical studies, three years in Leipzig and two years<span class='pagenum'><a name="Page_ix" id="Page_ix">[Pg ix]</a></span>
+in Heidelberg; I have an M.D. degree from the University of Heidelberg.
+In my first year as docent in a German university twenty years ago, I
+gave throughout the winter semester before several hundred students a
+course in hypnotism and its medical application. It was probably the
+first university course on hypnotism given anywhere. Since that time I
+have never ceased to work psychotherapeutically in the psychological
+laboratory. Yet that must not be misunderstood. I have no clinic, and
+while by principle I have never hypnotized anyone for mere experiment's
+sake but always only for medical purposes, yet I adjust my practical
+work entirely to the interests of my scientific study. The limitations
+of my time force me to refuse the psychotherapeutic treatment of any
+case which has not a certain scientific interest for me, and of the many
+hundreds whom I have helped in the laboratory, no one ever had to pay
+anything. Thus my practical work has strictly the character of
+laboratory research.</p>
+
+<p>The chief aim of this book is twofold. It is a negative one: I want to
+counteract the misunderstandings which overflood the whole field,
+especially by the careless mixing of mental and moral influence. And a
+positive one: I want to strengthen the public feeling that the time has
+come when every physician should systematically study psychology, the
+normal in the college years and the abnormal in the medical school. This
+demand of medical education cannot be postponed any longer. The aim of
+the book is not to fight the Emmanuel Church Movement, or<span class='pagenum'><a name="Page_x" id="Page_x">[Pg x]</a></span> even
+Christian Science or any other psychotherapeutic tendency outside of the
+field of scientific medicine. I see the element of truth in all of them,
+but they ought to be symptoms of transition. Scientific medicine should
+take hold of psychotherapeutics now or a most deplorable disorganization
+will set in, the symptoms of which no one ought to overlook to-day.</p>
+
+<p class="author"><span class="smcap">Hugo M&uuml;nsterberg.</span></p>
+<p><span class="smcap i">Harvard University</span>, March 20, 1909.</p>
+
+<p><span class='pagenum'><a name="Page_xi" id="Page_xi">[Pg xi]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="toc" id="toc"></a>CONTENTS</h2>
+
+<table class="toc" summary="CONTENTS">
+<tr><td>&nbsp;</td><th class='thl'>CHAPTER</th><th class='thr'>PAGE</th></tr>
+<tr><td class='tdr'>I.</td><td class='tdl'><span class="smcap">Introduction</span></td><td class='tdr'><a href='#Page_1'><b>1</b></a></td></tr>
+<tr><td colspan="3">&nbsp;</td></tr><tr><th class='thc' colspan="3">PART I</th></tr>
+<tr><th class='thc' colspan="3">THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY</th></tr>
+<tr><td colspan="3">&nbsp;</td></tr>
+<tr><td class='tdr'>II.</td><td class='tdl'><span class="smcap">The Aim of Psychology</span></td><td class='tdr'><a href='#Page_9'><b>9</b></a></td></tr>
+<tr><td class='tdr'>III.</td><td class='tdl'><span class="smcap">Mind and Brain</span></td><td class='tdr'><a href='#Page_27'><b>27</b></a></td></tr>
+<tr><td class='tdr'>IV.</td><td class='tdl'><span class="smcap">Psychology and Medicine</span></td><td class='tdr'><a href='#Page_55'><b>55</b></a></td></tr>
+<tr><td class='tdr'>V.</td><td class='tdl'><span class="smcap">Suggestion and Hypnotism</span></td><td class='tdr'><a href='#Page_85'><b>85</b></a></td></tr>
+<tr><td class='tdr'>VI.</td><td class='tdl'><span class="smcap">The Psychology of the Subconscious</span></td><td class='tdr'><a href='#Page_125'><b>125</b></a></td></tr>
+<tr><td colspan="3">&nbsp;</td></tr>
+<tr><th class='thc' colspan="3">PART II</th></tr>
+<tr><th class='thc' colspan="3">THE PRACTICAL WORK OF PSYCHOTHERAPY</th></tr>
+<tr><td colspan="3">&nbsp;</td></tr>
+<tr><td class='tdr'>VII.</td><td class='tdl'><span class="smcap">The Field of Psychotherapy</span></td><td class='tdr'><a href='#Page_158'><b>158</b></a></td></tr>
+<tr><td class='tdr'>VIII.</td><td class='tdl'><span class="smcap">The General Methods of Psychotherapy</span></td><td class='tdr'><a href='#Page_184'><b>184</b></a></td></tr>
+<tr><td class='tdr'>IX.</td><td class='tdl'><span class="smcap">The Special Methods of Psychotherapy</span></td><td class='tdr'><a href='#Page_212'><b>212</b></a></td></tr>
+<tr><td class='tdr'>X.</td><td class='tdl'><span class="smcap">The Mental Symptoms</span></td><td class='tdr'><a href='#Page_239'><b>239</b></a></td></tr>
+<tr><td class='tdr'>XI.</td><td class='tdl'><span class="smcap">The Bodily Symptoms</span></td><td class='tdr'><a href='#Page_297'><b>297</b></a></td></tr>
+<tr><td colspan="3">&nbsp;</td></tr>
+<tr><th class='thc' colspan="3">PART III</th></tr>
+<tr><th class='thc' colspan="3">THE PLACE OF PSYCHOTHERAPY</th></tr>
+<tr><td colspan="3">&nbsp;</td></tr>
+<tr><td class='tdr'>XII.</td><td class='tdl'><span class="smcap">Psychotherapy and the Church</span></td><td class='tdr'><a href='#Page_319'><b>319</b></a></td></tr>
+<tr><td class='tdr'>XIII.</td><td class='tdl'><span class="smcap">Psychotherapy and the Physician</span></td><td class='tdr'><a href='#Page_347'><b>347</b></a></td></tr>
+<tr><td class='tdr'>XIV.</td><td class='tdl'><span class="smcap">Psychotherapy and the Community</span></td><td class='tdr'><a href='#Page_370'><b>370</b></a></td></tr>
+</table>
+
+<p><span class='pagenum'><a name="Page_1" id="Page_1">[Pg 1]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="I" id="I"></a>I<br /><br />
+<span class="sub">INTRODUCTION</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>Psychotherapy is the practice of treating the sick by influencing the
+mental life. It stands at the side of physicotherapy, which attempts to
+cure the sick by influencing the body, perhaps with drugs and medicines,
+or with electricity or baths or diet.</p>
+
+<p>Psychotherapy is sharply to be separated from psychiatry, the treatment
+of mental diseases. Of course to a certain degree, mental illness too,
+is open to mental treatment; but certainly many diseases of the mind lie
+entirely beyond the reach of psychotherapy, and on the other hand
+psychotherapy may be applied also to diseases which are not mental at
+all. That which binds all psychotherapeutic efforts together into unity
+is the method of treatment. The psychotherapist must always somehow set
+levers of the mind in motion and work through them towards the removal
+of the sufferer's ailment; but the disturbances to be treated may show
+the greatest possible variety and may belong to mind or body.</p>
+
+<p>Treatment of diseases by influence on the mind is as old as human
+history, but it has attained at various times very different degrees of
+importance. There is no lack of evidence that we have entered into a<span class='pagenum'><a name="Page_2" id="Page_2">[Pg 2]</a></span>
+period in which an especial emphasis will be laid on the too long
+neglected psychical factor. This new movement is probably only in its
+beginning and the loudness with which it presents itself to-day is one
+of the many indications of its immaturity. Whether it will be a blessing
+or a danger, whether it will really lead forward in a lasting way, or
+whether it will soon demand a reaction, will probably depend in the
+first place on the soberness and thoroughness of the discussion. If the
+movement is carried on under the control of science, it may yield
+lasting results. If it keeps the features of dilettanteism and prefers
+association with the antiscientific tendencies, it is pre-destined to
+have a spasmodic character and ultimately to be harmful.</p>
+
+<p>The chaotic character of psychotherapy in this first decade of the
+twentieth century can be easily understood. It results from the fact
+that in our period one great wave of civilization is sinking and a new
+wave rising, while the one has not entirely disappeared and the other is
+still far from its height. The history of civilization has shown at all
+times a wavelike alternation between realism and idealism, that is,
+between an interest in that which is, and an interest in that which
+ought to be. In the realistic periods, the study of facts, especially of
+the facts of nature, is prevalent; in idealistic periods, history and
+literature appeal to the world. In realistic periods, technique enjoys
+its triumphs; in idealistic periods, art and religion prevail. Such a
+realistic movement lies behind us. It began with the incomparable
+de<span class='pagenum'><a name="Page_3" id="Page_3">[Pg 3]</a></span>velopment of physics, chemistry, and biology, in the middle of the
+last century, and it brought with it the achievements of modern
+engineering and medicine. We are still fully under the influence of this
+gigantic movement and its real achievements will never leave us; and yet
+this realistic wave is ebbing to-day and a new period of idealism is
+rising. If the signs are not deceitful, this new movement may reach its
+historical climax a few decades hence, when new leaders may give to the
+idealistic view of the world the same classical expression which Darwin
+and others gave to the receding naturalistic age. The signs are clear
+indeed that the days of idealistic philosophy and of art, and of
+religion, are approaching; that the world is tired of merely connecting
+facts without asking what their ultimate meaning is. The world dimly
+feels again that technical civilization alone cannot make life more
+worth living. The aim of the last generation was to explain the world;
+the aim of the next generation will be to interpret the world; the one
+was seeking laws, the other will seek ideals.</p>
+
+<p>Psychotherapy stands in the service of both; it is the last word of the
+passing naturalistic movement, and yet in another way it tries to be the
+first word of the coming idealistic movement; and because it is under
+the influence of both, it speaks sometimes the language of the one, and
+sometimes the language of the other. That brings about a confusion and a
+disorder which must be detrimental. To transform this vagueness into
+clear, distinct relations is the immediate duty of science.</p>
+
+<p><span class='pagenum'><a name="Page_4" id="Page_4">[Pg 4]</a></span>Indeed it may be said that psychotherapy is the last word of a
+naturalistic age, because psychotherapy finds its real stronghold in a
+systematic study of the mental laws, and such study of mental laws,
+psychology, must indeed be the ultimate outcome of a naturalistic view
+of the world. Realism begins with the analysis of lifeless nature,
+begins with the study of the stars and the stones, of masses and of
+atoms. At a higher level, it turns then to the living organism, studies
+plants and animals and even brings the human organism entirely under the
+point of view of natural law. When science has thus mastered the whole
+physical universe, it finally brings even the mental life of man under
+the naturalistic point of view, treats his inner experiences like any
+outer objects, tears them in pieces, analyzes them, and studies them as
+functions of the nervous system. A scientific psychology is thus reached
+which is the climax of realism, because it means that even the ideas and
+emotions and volitions of man are treated as natural phenomena, that
+their causes are sought and that their effects are determined, that
+their laws are found out. To apply this realistic knowledge of the mind
+in the interest of therapy is merely to use it in the same way in which
+the engineer uses his knowledge of physics, when he wants to harness
+outer nature. As that is possible only when theoretical science has
+reached a certain height of development, it can indeed be said that
+practical psychotherapy on a scientific basis can be considered almost
+as the ultimate point of a realistic movement; it cannot set in until
+psychology has<span class='pagenum'><a name="Page_5" id="Page_5">[Pg 5]</a></span> reached high development, and psychology cannot set in
+unless biology has preceded it.</p>
+
+<p>There is no doubt that we are still far from this last phase of the
+realistic period. The practical application of scientific psychology is
+still a new problem. Experimental psychology began about twenty-five
+years ago; at that time there existed one psychological laboratory.
+To-day there is no university in the world which does not have a
+psychological workshop. But laboratories for applied psychology are only
+arising in these present days, and the systematic application of
+scientific psychology to education and law and industry and social life
+and medicine is almost at its beginning. While the height of the last
+realistic wave was in the period of the sixties, seventies, and
+eighties, of the last century, its last phase, the practical application
+of physiological psychology, including psychotherapy, is only at its
+commencement.</p>
+
+<p>But while this last great movement has not yet reached its end, the new
+idealistic movement to come has not yet reached a clear self-expression.
+A general philosophical interest can be felt, but a great philosophical
+synthesis seems still lacking. A new sense of duty can vaguely be felt,
+but great new tasks have not yet found common acknowledgment. Above all,
+the unshaped emotionalism of the masses has not yet been brought into
+any real contact with the new idealism which grows up on the higher
+level of scholarly thought. But it is evident, if a new great mood of
+idealism is to come, one of its popular forerunners<span class='pagenum'><a name="Page_6" id="Page_6">[Pg 6]</a></span> must be the demand
+that the spirit is real in a higher sense than matter, that the mind
+controls the body, that faith can cure. In such unphilosophic crudeness,
+no definite thought is expressed, as everything would depend on the
+definition of spirit, of faith, of mind, of reality. Moreover, every
+inquiry would prove that the idealistic value of such statements as are
+afloat among the masses to-day is reached only by a juggling with words.
+That faith can cure appears to point towards the higher world, as the
+word faith has there the connotation of the faith in a religious sense;
+and yet the faith which really cures a digestive trouble, for instance,
+is the faith in the final overcoming of the intestinal disturbance, an
+idea which belongs evidently in the region of physiological psychology,
+but not in the region of the church. Yet, however clumsy such statements
+may be, they are surely controlled by the instinctive desire for a new
+idealistic order of our life, and the time will come when their
+unreasoning and unreasonable wisdom will be transformed into sound
+philosophy without losing its deepest impulse. The realistic conviction
+that even the mind is completely controlled by natural laws and the
+idealistic inspiration that the mind of man has in its freedom mastery
+over the body, are thus most curiously mixed in the popular
+psychotherapy of the day, and too few recognize that the real meaning of
+mind is an entirely different one in these two propositions.</p>
+
+<p>Of course the one or the other of these two elements prevails in the
+systematic treatises on the sub<span class='pagenum'><a name="Page_7" id="Page_7">[Pg 7]</a></span>ject; the realistic one in those written
+by the psychiatrists, the idealistic one in those written by clergymen
+or Christian Scientists. The literature indeed is almost entirely
+supplied from these two quarters: and yet it is evident that neither the
+one nor the other party can give to the problem its most natural
+setting. The student of mental diseases naturally emphasizes the
+abnormal features of the situation, and thus brings the
+psychotherapeutic process too much into the neighborhood of pathology.
+Psychotherapy became in such hands essentially a study of hypnotism,
+with especial interest in its relation to hysteria and similar diseases.
+The much more essential relation of psychotherapy to the normal mental
+life, the relation of suggestion and hypnotism to the normal functions
+seemed too often neglected. Whoever wants to influence the mind in the
+interest of the patient, must in the first place be in intimate contact
+with psychology. On the other hand, the minister's spiritual interest
+brings the facts nearer to religion than they really are. That a
+suggestion to get rid of toothache, or to sleep the next night, is given
+by a minister, does not constitute it as a religious suggestion. If the
+belief in religion simply lies alongside of the belief in most trivial
+effects, and both are applied in the same way for curing the sick, it is
+evident that not the spiritual meaning of religion is responsible for
+the cure, but the psychological process of believing. But if that is the
+case, it is clear that here again the psychologist, and not the
+moralist, will give the correct account of the real process involved.<span class='pagenum'><a name="Page_8" id="Page_8">[Pg 8]</a></span>In short, it is psychology, psychology in its scientific modern form,
+which has to furnish the basis for a full understanding of
+psychotherapy. From psychology it cannot be difficult to bridge over to
+the medical interests, on the one side, to the idealistic ones on the
+other side.</p>
+
+<p>Our task here is, therefore, to lay a broad psychological foundation. We
+must carefully inquire how the modern psychologist looks on mental life
+and how the inner experiences appear from such a psychological
+standpoint. The first chapters of this volume may appear like a long,
+tiresome way around before we come to our goal, the study of the
+psychotherapeutic agencies. And yet it is the only possible way to
+overcome the superficiality with which the discussion is too often
+carried on; we must understand exactly how the psychological analysis
+and explanation of the scientist differ from the popular point of view.
+After studying in this spirit the foundation of psychotherapy, we shall
+carefully examine the practical work, its methods and its results, its
+possibilities and its limitations. We shall inquire finally into the
+place which it has to take, looking back upon its history, criticising
+the present status and outlining the development which has to set in for
+the future, if a haphazard zigzag movement is not to destroy this great
+agency for human welfare by transforming it into a source of
+superstition and bodily danger.<span class='pagenum'><a name="Page_9" id="Page_9">[Pg 9]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="PART_I" id="PART_I"></a>PART I<br /><br />
+<span class="sub">THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY</span></h2>
+
+
+
+<hr class="section" />
+
+<h2><a name="II" id="II"></a>II<br /><br />
+<span class="sub">THE AIM OF PSYCHOLOGY</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>The only safe basis of psychotherapy is a thorough psychological
+knowledge of the human personality. Yet such a claim has no value until
+it is entirely clear what is meant by psychological knowledge. We can
+know man in many ways. Not every study of man's inner life is psychology
+and the careless mixing of different ways of dealing with man's inner
+life is largely responsible for the vagueness which characterizes the
+popular literature of psychotherapy. It is not enough to say that a
+statement is true or not true. It may be true under one aspect and
+entirely meaningless under another. For instance, a minister's
+discussion of man's energies may be full of deep truth and may be
+inspiring; and yet it may not contain the slightest contribution to a
+really psychological knowledge of those energies, and would mislead
+entirely the physician were he to base his treatment of human energies
+on such a religious interpretation.</p>
+
+<p>Can we not look from different standpoints even<span class='pagenum'><a name="Page_10" id="Page_10">[Pg 10]</a></span> on any part of the
+outer world? I see before me the ocean with its excited waves splashing
+against the rocks and shore, I see the boats tossed on the stormy sea
+and I am fascinated by the new and ever new impulses of the tumultuous
+waves. The whole appears to me like one gigantic energy, like one great
+emotional expression, and I feel deeply how I understand this beautiful
+scenery in appreciating its unity and its meaning. Yet would I ever
+think that it is the only way to understand this turmoil of the waters
+before me? I know there is no unity and no emotion in the excited sea;
+each wave is composed of hundreds of thousands of single drops of water,
+and each drop composed of billions of atoms, and every movement results
+from mechanical laws under the influence of the pressing water and air.
+There is hydrogen and there is oxygen, and there is chloride of sodium,
+and the dark blue color is nothing but the reflection of billions of
+ether vibrations. But have I really to choose between two statements
+concerning the waves, one of which is valuable and the other not? On the
+contrary, both have fundamental value. If I take the attitude of
+appreciation, it would be absurd to say that this wave is composed of
+chemical elements which I do not see; and if I take the attitude of
+physical explanation, it would be equally absurd to deny that such
+elements are all of which the wave is made. From the one standpoint, the
+ocean is really excited; from the other standpoint, the molecules are
+moving according to the laws of hydrodynamics. If I want to understand
+the meaning of this scene every<span class='pagenum'><a name="Page_11" id="Page_11">[Pg 11]</a></span> reminiscence of physics will lead me
+astray; if I want to calculate the movement of my boat, physics alone
+can help me.</p>
+
+<p>As long as we deal with outer nature, there is hardly a fear of
+confusing the various attitudes; but it becomes by far more complex when
+we deal with man and his inner life. We might abstract entirely from
+&aelig;sthetic appreciation or from moral valuation, we might take man just as
+an object of knowledge; and yet what we know about him may be entirely
+different in accordance with our special attitude. Each kind of
+knowledge may be entirely true, and yet true only from the particular
+standpoint. Let us consider two extremes. If I meet a friend and we
+enter into a talk, I try to understand his thoughts and to share his
+views. I agree or disagree with him; I sympathize with his feelings, I
+estimate his purposes. In short, he is for me a center of aims and
+intentions which I interpret: he comes in question for me as a self
+which has its meaning and has its unity. The more I am interested in his
+opinions, the more I feel in every utterance, in every gesture, the
+expression of his will and his purposes; their whole reality for me lies
+in the fact that they point to something which the speaker intends; his
+personality lies in his attitude towards the surroundings, towards the
+world. Yet I may take an entirely different relation to the same man. I
+may ask myself what processes are going on in his mind, what are the
+real contents of his consciousness, that is, what perceptions and memory
+pictures and imaginative ideas and feelings and<span class='pagenum'><a name="Page_12" id="Page_12">[Pg 12]</a></span> emotions and judgments
+and volitions are really present in his consciousness. I watch him to
+find out, I observe his mental states, I do not ask whether I agree or
+disagree; his will is for me now not something which has a meaning, but
+simply something which occurs in his inner experience; his ideas now
+have for me no reference to something in the world, but they are simply
+contents of his consciousness; his memories now are for me not symbols
+of a past to which he refers, but they are present pictures in his mind;
+in short, what I now find is not a self which shows itself in its aims
+and purposes and attitudes, but a complex content of consciousness which
+is composed of numberless elements. I might say in the first place that
+my friend was to me a subject whom I tried to understand by interpreting
+his meaning, and in the second case, an object which I understand by
+describing its structure, its elements, and their connections.</p>
+
+<p>Both ways of looking on man are constantly needed. We might alternate
+between them in any experience. In the heat of argument, my friend will
+certainly be for me the subject with whose meanings I try to agree or
+disagree, whose emotions carry me away, whose ideas open the world to
+me. Yet in the next moment, I may notice that his ideas were shaped and
+determined by certain earlier experiences; that they linked themselves
+in memory according to certain laws of mental flow; that the vividness
+of his ideas made him overlook certain impressions of the surroundings;
+and that may turn my attention to an<span class='pagenum'><a name="Page_13" id="Page_13">[Pg 13]</a></span> entirely different aspect of his
+inner life. His feelings and emotions, his volitions and judgments now
+have for me simply the character of processes which go on and which are
+observed, which coincide and which succeed each other, which fuse and
+overlap, and which are composed of smaller parts. My interest is now no
+longer in the meaning and intentions of this self, but it belongs to the
+structure and the connections in this system of mental facts. At first,
+I wanted to understand him by living with him, by participating in his
+attitudes, and by feeling with his will; now I want to understand him by
+examining all the processes which go on in his consciousness, by
+studying their make-up and their behavior, their elements and their
+laws. In one case I wanted to interpret the man, and finally to
+appreciate him; in the other case I wanted to describe his inner life,
+and finally to explain it. The man whose inner life I want to share I
+treat as a subject, the man whose inner life I want to describe and
+explain I treat as an object.</p>
+
+<p>I might express these two standpoints still otherwise. If my neighbor is
+to me a subject, for instance, in the midst of an ordinary conversation,
+he comes in question only with reference to his aims and meanings:
+whatever he utters has a purpose and end. I understand his inner life by
+taking a purposive point of view. On the other hand, the man whose inner
+life is to me an object can satisfy my interest only if I understand
+every particular happening in his mind from its preceding causes. I
+transform his whole life<span class='pagenum'><a name="Page_14" id="Page_14">[Pg 14]</a></span> into a chain of causes and effects. My
+standpoint is thus a causal one. No doubt in our daily life, our
+purposive interest and our causal interest may intertwine at any moment.
+I may sympathize with the hopes and fears of my neighbor in a purposive
+way, and may yet in the next moment consider from a causal standpoint
+how these emotions of his are perhaps affected by his fatigue or by some
+glasses of wine, or by a hereditary disposition, or by a suggestion; in
+short, at one time I look out for the meaning of the emotion as a part
+of the expression of a self, and at another time for the structure and
+appearance of the emotion as a part of a causal chain of events. In both
+directions I can go on with entire consistency, and there cannot be any
+part of inner experience which cannot be fully brought under either
+point of view. How far we have a right to mix the two standpoints in
+practical life, we shall carefully examine; but it is clear that if we
+want to understand the true meaning of the study of inner life, we have
+no longer any right carelessly to mix the two standpoints without being
+conscious of their fundamental difference. We must understand exactly
+what the aim of the one and of the other is, and where each has its
+particular value; science certainly has no right to throw together such
+different views of life. And now this may be said at once: the causal
+view only is the view of psychology; the purposive view lies outside of
+psychology.</p>
+
+<p>Such a separation does not at all aim to indicate that the one view is
+more important than the other,<span class='pagenum'><a name="Page_15" id="Page_15">[Pg 15]</a></span> or that the one has more scientific
+dignity than the other; both yield us truth, and both may be carried
+from the simplest and most trivial observations of daily life to the
+highest elaborations of scholarship. To those who are inclined to give
+all value and all credit only to the strictly psychological view, it may
+be replied at once that surely our most immediate life experience is
+carried on by the non-psychological attitude. If we love our family and
+like our friends, and deal with the man of the street, we are certainly
+moving in a world of purposive reality. We try to understand each other,
+to agree and to disagree, to be in sympathy and antipathy, without
+asking how those volitions and feelings and ideas of other people are
+built as mental structures, and from what causes they arose; we are
+satisfied to understand what they mean. In the same way with ourselves.
+We live our lives by hinging them on our aims and purposes and ideas,
+and do not ask ourselves what are the causes of our attitudes and of our
+thoughts.</p>
+
+<p>This purposive view has in no respect to disappear if we move on from
+our personal intercourse to a scholarly study of reality. The historian,
+for instance, who tries to understand the will relations of humanity, is
+the more the true historian the more he sticks to this purposive view of
+man. The truth which he seeks is to interpret the personalities, to
+understand them through their attitudes, to make their will living once
+more, and to link it by agreement and disagreement, by love and hate,
+with the will of friends and enemies, groups and parties,<span class='pagenum'><a name="Page_16" id="Page_16">[Pg 16]</a></span> nations and
+mankind. It is only a loose popular way of speaking, if this purposive
+analysis of a character is often called psychological. In a stricter
+sense of the word, it is not psychological. If the historian really were
+to take the psychological attitude, he would make of history simply a
+social psychology, seeking the laws of the social mind, and treating the
+individual, the hero, and the leader, merely as the crossing-point of
+psychological law. For such a psychological view the mental life of the
+hero would not be more important or more interesting than the mental
+life of a scoundrel, and the psychology of the king would not draw his
+interest more than the psychology of the beggar. The historian has to
+shape all that from an entirely different standpoint: his scientific
+interest depends upon the importance of men's attitudes and actions, and
+such importance refers to the world of purposes.</p>
+
+<p>In the same way, we have to stick to the non-psychological point of view
+whenever man's life, his thoughts and feelings and volitions, are to be
+measured with reference to ideals; that is in ethics and &aelig;sthetics and
+logic, sciences which ask whether the volitions are good or bad, whether
+the feelings are valuable or worthless, whether the thoughts are true or
+false. The psychologist does not care; just as the botanist is
+interested in the weed as much as in the flower, the psychologist is
+interested in the causal connections of the most heinous crime not less
+than in those of the noblest deed, in the structure of the most absurd
+error not less than in that of the maturest<span class='pagenum'><a name="Page_17" id="Page_17">[Pg 17]</a></span> wisdom. Truth, beauty, and
+morality are thus expressions of the self in its purposive aspect.</p>
+
+<p>We can go one step further. Those who narrowly seek every truth only in
+the scientific understanding, ought to be reminded that this seeking for
+causal connections is itself, after all, only a life experience which as
+such is not of causal but of purposive character. "Life is bigger than
+thought." In the immediate reality of our purposive life we aim towards
+mastering the world by a causal understanding, and for this end we
+create science; but this aim itself is then a purpose and not an object.
+The first act is thus for us, the thinkers, not a part of the causal
+events, but a purposive intention towards an ideal. Therefore, our
+purposes have the first right; they represent the fundamental reality;
+the value of causal connections and thus of all scientific and
+psychological explanation, depends on the value of the purpose. Causal
+truth can be only the second word; the first word remains to purposive
+truth. From this point of view we may understand why there is no
+conflict between the most consistent causal explanation of mental life
+on the one side, and an idealistic view of life on the other side; yes,
+we can see that the fullest emphasis on a scientific psychology&mdash;which
+is necessarily realistic and, to a certain degree, materialistic&mdash;is
+fully embedded in an idealistic philosophy of life, and that without
+conflict. And we shall see how this consistency in sharply separating
+the psychological view from the non-psychological, secures much greater
+safety for true idealism than the inconsistent<span class='pagenum'><a name="Page_18" id="Page_18">[Pg 18]</a></span> popular mixing of the
+two principles, where scientific psychology is constantly encroached
+upon by demands of faith and religion, and where faith and religion seem
+constantly in danger of being overturned by new discoveries in
+physiological psychology. We may, indeed, remove from the start the
+mistaken fear that a consistent causal aspect of life leads to injustice
+to the higher aims and ideal purposes of mankind. If we want to have
+psychology,&mdash;and that means if we want to consider the mental life in a
+system of causes and effects,&mdash;we must proceed without prejudices, and
+without side-thoughts.</p>
+
+<p>From a psychological standpoint our own mental life and that of our
+neighbor, that of the man and that of the child, that of the normal and
+that of the insane, that of the human being and that of the animal, are
+to be considered as a series of mental objects. They are to be analyzed,
+and to be described, and to be classified and to be explained, just as
+we deal with the physical objects in the outer world. How are these
+objects of the psychologist different from the objects of the physicist,
+from the pebbles on the way and the stars in the sky? There is only one
+fundamental difference and all other differences result from it. Those
+outer objects which we call physical, are objects for everybody. The
+star which I see is conceived as the same star which you see, the table
+which I touch is the table which you may grasp, too. But every psychical
+object is an object for one particular person only. My visual impression
+of the star, that is, my optical perception, is a content of my own<span class='pagenum'><a name="Page_19" id="Page_19">[Pg 19]</a></span>
+consciousness only, and your impression of the star can be a content of
+your consciousness only. We both may mean the same by our ideas, but I
+can never have your perception and you can never have my perception. My
+ideas are enclosed in my mind. I may awaken in your mind ideas which
+have the same purpose and meaning, but they are new copies in your mind.
+We both may be angry, but your anger can never be my anger, and your
+volitions can never enter my mind. Every possible psychical fact thus
+exists in one consciousness only, while every physical fact exists for
+every possible consciousness.</p>
+
+<p>The psychologist's final task is to explain the appearance and
+disappearance, the connections and sequences of these mental objects,
+the contents of consciousness. But before he can start on explanation of
+the facts, he has to describe them, and describing means analyzing them
+into their elements and fixating those elements and their combinations
+for an exact report. Such descriptive work is in a way preparatory for
+the further task of real explanation; yet it is in itself important,
+complicated, and difficult. Of course, it may be easy to separate the
+complex content into some big groups of facts, to point out that this is
+a memory idea and this an imaginative idea and the other an abstract
+idea, and this a perception and that a feeling, this an emotion and that
+a volition. But such clumsy first discrimination does not go further,
+perhaps, than does the naturalist's, who tells us that this is a
+mountain and that a tree, this a pond and that a bird. The real
+description would demand, of course,<span class='pagenum'><a name="Page_20" id="Page_20">[Pg 20]</a></span> an exact measurement of the height
+of the mountain and the geological analysis of its structure, or an
+exact classification of the tree and the bird, with a complete
+description of their organs, and in each organ the various tissues have
+to be described, and in each tissue the various cells, and the
+microscopist goes further and describes the structure of the cell.
+Certainly in the same way the psychologist has to go on to resolve every
+one of those complex structures; he has to examine the mental tissues
+and the mental cells of which a volition or a memory idea or a
+perception are composed. And while he cannot use a microscope for these
+mental elements, yet his studies may cause elements to appear which the
+na&iuml;ve observation remains entirely unaware of.</p>
+
+<p>Perhaps he finds in his consciousness the perception of the table before
+him which lingers for a little while in his mind. He finds no difficulty
+in analyzing it into color sensations and tactual sensations; and yet he
+is aware of so much more in it. The table, for instance, has form for
+him and he may find that these form perceptions involve the sensations
+of the eye movements which he makes from one corner of the table to the
+other; he may find that if the idea lasts in him, he becomes aware of
+the time by sensations of tension; he finds that in his perception of
+the table lies an idea of its use, and he discovers that that is made up
+of elements which are partly memory reproductions of earlier
+impressions, partly sensations of movement impulses; he also finds that
+the table feels smooth, and he discovers by his analysis that this
+im<span class='pagenum'><a name="Page_21" id="Page_21">[Pg 21]</a></span>pression of smoothness results from a special combination of tactual
+sensations and movement sensations; and again those movement sensations
+he analyzes further into sensations of muscle contraction and sensations
+of pressure in the joints and sensations of tension in the tendons.
+Before a zo&ouml;logist has completed his description of a bird in the
+landscape, he has given account of hundreds of thousands of things; but
+before the psychologist would complete the enumeration of the mental
+elements which enter into the seeing of the table, he would have to give
+account of by far more psychical elements. Every point in the surface of
+the table has its own light value, perhaps different in its quality and
+intensity and saturation, in its hue and tint and shade from the next
+one, and at whatever point of the table's edge our attention is
+directed, each one involves numberless shades in the vividness of all
+the other points and numberless mental relations of space perception
+among the various parts of the table. In the thorough analysis of the
+describing psychologist, every single idea, and in the same way, every
+single emotion or feeling or judgment becomes complex like a living
+organism, an aggregate of thousands of mental tissues, and yet made up
+from "the stuff that dreams are made of."</p>
+
+<p>But there is one particular difficulty which makes the psychological
+description so much harder than that of the physicist, and which gives
+rise to many disagreements and discussions in psychological literature.
+The psychologist has not only to tear the complex into pieces and thus
+to seek the elements, but he has to<span class='pagenum'><a name="Page_22" id="Page_22">[Pg 22]</a></span> fixate those elements for the
+purpose of communication, as, of course, a scientific description
+demands that he be able to give account to others of what he
+experiences. The physicist has no difficulty whatever in that line
+because, as we saw, the world of physical things is the world which all
+men are sharing together. Every element which I find in it, I can show
+to every other person, and if I cannot show that particular thing,
+because I cannot yet carry the mountain to another place, then I can at
+least measure it, as we share those standards of space. Thus natural
+science has in its objective measurements the possibility of describing
+every part of the physical world. The psychical world, on the other
+hand, is as we saw, the world which is private property. Every effort at
+description is thus entirely in vain as long as our mental facts cannot
+somehow be linked with physical happenings. If I say that I have in my
+mind sweetness or sourness, or bitterness or saltness, I cannot carry
+any understanding to anyone else and therefore cannot give any
+description until I have agreed that I mean by sweetness the sensation
+which sugar gives me, and by saltness the sensation of salt. The sugar
+and salt I can point out to my neighbor and only in that way I
+understand what he means if he says that he tastes salt and sweet;
+otherwise I should have no means whatever to discriminate whether that
+which he calls a sweet taste sensation is not just what I call headache.
+Where no such direct relation for a physical thing is known, description
+of the mental element would remain impossible. Of course, every<span class='pagenum'><a name="Page_23" id="Page_23">[Pg 23]</a></span>perception of the outer world, all our seeing and hearing, and touching
+and tasting, offers us at once such definite connection between the
+inner experience and a piece of the physical universe. Our own organism
+is also such a piece of physical nature: just as I describe my tasting
+or touching, I may describe the perception of my arms and legs or my
+inner organs. Thus everything which is material of perception gives us a
+handle for a real psychological description. Psychology usually calls
+the elements of these perceptions sensations. Whatever is composed of
+sensations is thus describable.</p>
+
+<p>On the other hand, no other way of description is open. If there were
+mental states which are composed of other elements than sensations, they
+would necessarily remain indescribable; we could not grasp them because
+they would not have any definite relation to the common physical world.
+We might say, for instance, that our mental content is made up of
+sensations and feelings, but if such feelings were really entirely
+different from sensations, they would have to remain for all time
+mysterious and unknown. We could not compare notes. The feeling which I
+call joy may feel just like the one which you call despair. The
+consistent development of modern psychology and its emancipation from
+vagueness and superficial analysis became possible only through the fact
+that such recourse to indescribable elements has become unnecessary.
+Modern psychology has been able to demonstrate more and more that the
+same elements which constitute our perceptions are also the<span class='pagenum'><a name="Page_24" id="Page_24">[Pg 24]</a></span> elements of
+the other contents of consciousness. In other words modern psychology
+has recognized that the volitions and emotions and feelings and
+judgments, and the whole stream of inner life, are made up of
+sensations. Millions of sensations in all degrees of vividness and
+clearness, of intensity and fusion, in endless manifoldness of rhythms
+and relations constitute their whole content. It is a discovery quite
+similar to the one which chemistry made when it found that the same
+elements which are part of the inorganic substances are also the only
+possible elements of the organic world.</p>
+
+<p>From a strictly psychological standpoint, the ideas and the not-ideas
+contain thus nothing but sensations. Their grouping, their shading,
+their combination, their succession decide whether we have before us a
+perception or an imagination, a volition or an emotion. What are we
+ourselves then for the psychologist? Evidently we ourselves belong also
+to the inner experiences which we know; and psychology has succeeded in
+analyzing this idea of our own self just in the same way as it analyzes
+our idea of the moon. In this analysis, psychology finds its idea of the
+self as a content of consciousness crystallized about the sensations
+from the body. Every one of our bodily activities is represented in our
+consciousness by movement sensations, and these sensations form the core
+of the complex aggregate which develops into the idea of ourselves.
+Organic sensations from our inner organs, pain sensations and pleasure
+sensations fuse with the movement sensations, and the whole<span class='pagenum'><a name="Page_25" id="Page_25">[Pg 25]</a></span> complex
+shapes itself slowly into the idea of the personality of the self in
+contrast to the idea of other personalities. We ourselves are for
+ourselves a complex combination of sensations; and yet all our feelings
+and emotions and volitions are only a part of it. Psychology thus
+necessarily considers those experiences of feeling and will and
+character simply as changes in the midst of that central experience of
+personality which is itself made up of bodily sensations. Each bit of
+will and emotion must be decomposed into its finest elements. There is
+no passing mood, and no floating half-thought in our mind, no dream and
+no intuition, no slightest change of attention, no instinct and desire
+which cannot be analyzed thus into its sensation elements or rather
+which must not be analyzed, if we are to describe it at all, and that
+means if we are to give a psychological account. Psychology is endlessly
+far from this ideal to-day. It has been claimed, not without justice,
+that psychology has reached to-day only the level which physics attained
+in the seventeenth century; but psychology must insist that its ideal
+lies in this direction. No one takes a real psychological view of the
+human mind who does not understand this endless complexity of the
+material, and who does not see that even the simplest mental state
+practically presents a most complex problem to scientific analysis. The
+physician who really aims towards scientifically exact influence on the
+human mind has reached the first step of his preparation as soon as he
+understands that the content of conscious<span class='pagenum'><a name="Page_26" id="Page_26">[Pg 26]</a></span>ness is composed of hundreds
+of thousands of elements. To treat the mind as if there were only a few
+large pieces, one thing called memory and one thing called will and one
+called emotion and so on, is as if a surgeon were to perform an
+operation, knowing that there are arms and legs, but not knowing the
+ramifications of the nerves and blood-vessels which his knife may
+injure. Yet the description of these complex facts is only the beginning
+of psychology. We saw that the real aim is their explanation.<span class='pagenum'><a name="Page_27" id="Page_27">[Pg 27]</a></span></p>
+
+
+
+
+
+<hr class="section" />
+
+<h2><a name="III" id="III"></a>III<br /><br />
+<span class="sub">MIND AND BRAIN</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>The central aim of the psychologist must be to explain the mental facts.
+It is not sufficient to describe the procession of mental experiences in
+us, we must understand the causes which determine that now this and now
+that appears and disappears, and appears just in this combination of
+elements. The astronomer is not satisfied with describing the stars, he
+wants to explain their movements and to determine which movements are to
+be expected. The psychologist, like the naturalist, aims towards
+explanation, and it is this demand which forces him to look from the
+psychical facts to the physical ones, from the mind to the brain. He is
+under an illusion if he fancies that he can explain mental facts by
+themselves. The purposive mind has its connection in itself, the causal
+psychological mind demands for its connection the body. To understand
+this necessity is the first step towards understanding the relation of
+mind and brain.</p>
+
+<p>The psychologist's problem of explanation is in one way entirely
+different from that of the physicist. The physicist finds a world of an
+unlimited number of atoms which are ultimately conceived as all alike,<span class='pagenum'><a name="Page_28" id="Page_28">[Pg 28]</a></span>
+but each one in a different place, and all the changes in the universe,
+the movements of the stars, the waves of the ocean, are to be explained
+by the causal connections of the movements of these atoms. The
+psychologist, on the other hand, finds an endless manifoldness of
+elements which are not in space, and which have no space form whatever.
+My will is neither triangular nor oval; my emotion is neither shorter
+than five feet nor longer; my memory image of a melody has no thickness
+and no tallness; my contents of consciousness are as such not in space;
+their elements cannot pass through any space movements like the atoms of
+the physicist. Instead of it, the psychical atoms, the sensations, have
+different qualities, are blue and green, and cold and warm, and sweet
+and sour, and toothache and headache. The changes which go on in such a
+system are thus not changes of position and movements, but changes in
+kind and strength and vividness and fusion; and exactly such changes are
+the processes which the psychologist wants to explain. He wants to make
+us understand why this idea grows up and the other fades away, why this
+impression stands out with clearness as an attended object while the
+other lacks vividness and disappears, why this volition grows out of
+that emotion, why this feeling leads to this imaginative thought.</p>
+
+<p>The first step towards such explanation is, of course, in psychology, as
+in all other sciences, the careful observation of regularities. It
+quickly leads us to formulate some general laws. Psychology has<span class='pagenum'><a name="Page_29" id="Page_29">[Pg 29]</a></span> known,
+for instance, for two thousand years, that if we have perceived two
+things together, and later we see the one again, the new perception
+brings us a memory image of the other thing. If we saw a man's face and
+heard at the same time his name, seeing his face may later awaken in us
+the memory of his name, or the hearing of his name may later awaken in
+us a reproduced memory image of his face. On such a basis, for instance,
+we formulate some general laws of association of ideas, and as soon as
+we have such laws laid down, we consider the appearance of such a memory
+image by association as sufficiently explained. We feel that it gives us
+sufficient basis to predict that in the future this idea will stir up in
+us the other idea. Psychology has formulated plenty of such general
+statements, and they serve well for a first orientation.</p>
+
+<p>Yet can this ever be considered as a last word of scientific explanation
+of psychical facts? Can psychology really in this way reach an ideal
+similar to that of scientific astronomy or chemistry? Would the
+scientist of nature ever be satisfied with this kind of explanation,
+which is nothing but generalization of certain sequences? Does not the
+explanation of the naturalist contain an entirely different element? He
+does not merely want to say that this effect has sometimes been observed
+and that there is thus probability that it will come again, when similar
+causes are given. No, the physicist wants to understand those
+connections of cause and effect as necessary ones. He tries to find
+sequences which cannot be<span class='pagenum'><a name="Page_30" id="Page_30">[Pg 30]</a></span> otherwise because they cannot be thought in
+any other way. Therefore he is not satisfied with complex regularities,
+but analyzes them until he can bring them down to simple physical
+connections, and these physical connections finally to mechanical
+processes, which realize for us logical necessities. That matter lasts
+and cannot disappear is such a presupposition, which comes to us with
+the necessity of logical thinking. We simply cannot think it otherwise.
+And the whole idea of natural science is to conceive the physical
+universe in such a way that all changes in the outer world can be
+understood as the movements of its parts in accordance with such
+necessary physical axioms. If we knew all the atoms of the present
+status of the universe, and we knew every present movement of every
+atom, we should be able to foresee the position of every atom in the
+next moment and in the following moment and in all following moments,
+and all that by the necessary continuation of the substance and its
+energies. That alone is the background of all special physical inquiry,
+and we rely on the special laws of physics and chemistry, because we
+trust that this universe, as a whole, could be ultimately understood as
+such a system of necessary changes in the positions of the lasting
+atoms.</p>
+
+<p>For the psychologist there is no hope of finding such necessity in the
+mental processes. The point is not that psychology is to-day too far
+removed from the fulfillment of such an ideal, the point is rather that
+such an ideal would be meaningless for the psychologist. His materials,
+the psychical contents of<span class='pagenum'><a name="Page_31" id="Page_31">[Pg 31]</a></span> consciousness, are by their nature unfit to
+enter into such necessary connections; they cannot do it because they
+cannot last. The physical object, we saw, is the object which is common
+property, which we all feel in common, which must thus exist for all
+time. The things in nature may burn down or decay, but no atom of them
+can ever disappear from the universe, each must enter into new and ever
+new combinations and last through all changes. The psychical thing, on
+the other hand, can exist only for the one immediate experience. Every
+sensation which enters into my ideas or volitions or emotions is a new
+creation of the instant which cannot last; each one flashes up and is
+lost with the moment's experience. My will to-day may have the same aim
+as my will of yesterday, but as psychical object, my will to-day is a
+new will, is a new creation in every pulse beat of my life. I must will
+it again, I cannot store it up. And my joy of to-day can never be as
+psychical fact the same joy which I may have to-morrow. Mental objects
+as such, as psychological material, are not destined to last. It has no
+meaning whatever to think of their being kept over until another time.
+It is a coarse materialism to conceive the mental contents like pebbles
+which may remain on the road from one day to another. Our ideas and
+feelings are mental appearances which have their existence in the act of
+the one experience; each new experience must be an entirely new
+creation.</p>
+
+<p>If I remember my last year's perception, I do not dig it out from an
+under-mind, in which it was stored<span class='pagenum'><a name="Page_32" id="Page_32">[Pg 32]</a></span> up and buried, but I create an
+entirely new memory picture, just as I may make to-day a speech which
+says the same thing which I said last year, and yet my action of
+speaking is not last year's speech movement. It is a new action, and the
+movement did not lie over somewhere during the interval. Mental life is
+produced anew in every moment. When the first experience is gone and the
+second comes, nothing of the stuff from which the first was made still
+has existence in the content of consciousness. By this fact it becomes
+entirely impossible ever to conceive necessary connections in the sense
+of physical necessity in the world of consciousness. The one idea may
+bring to me another idea by association, but as long as I consider both
+strictly as mental facts, I can never understand why this association
+happens, I can never grasp the real mechanism of the connection, I can
+never see necessity between the disappearance of the one and the
+appearance of the other. It remains a mystery which does not justify any
+expectation that the same sequence will result again. Whatever belongs
+to the psychical world can never be linked by a real insight into
+necessity. Causality there remains an empty name without promise of a
+real explanation.</p>
+
+<p>Only when we have recognized this fundamental difficulty in the efforts
+for psychological explanation, can we understand the way which modern
+psychology has taken most successfully. The end of this way is simply
+this: every psychical fact is to be thought of as an accompaniment of a
+physical process and the<span class='pagenum'><a name="Page_33" id="Page_33">[Pg 33]</a></span> necessary connections of these physical
+processes determine, then, the connections of the mental facts. Indeed
+this has become the method of modern psychology. It has brought about
+the intimate relation between psychology and the physiology of the
+brain, and has given us, as foundation, the theory of psychophysical
+parallelism; the theory that there is no psychical process without a
+parallel brain process. But the real center of the theory lies indeed in
+the fact which we discussed; it lies in the fact that we cannot have any
+explanation of mental states as such at all, if we do not link them with
+physical processes.</p>
+
+<p>Is it necessary to express again the assurance that such statements of a
+parallelism between mind and brain in no way interfere with an
+idealistic view of inner life? Have we not seen clearly enough that
+these mental facts which are conceived parallel to physiological brain
+processes do not represent the immediate reality of our inner life, that
+our life reality is purposive and as such outside of all causal
+explanation, and that we have to take a special, almost artificial,
+point of view to consider inner life at all as objects, as contents of
+consciousness, and thus as psychological material? But since we have
+seen that for certain purposes such a point of view is necessary, as
+soon as we have taken it we must be consistent. Our inner life in its
+purposive reality has therefore nothing to do with brain processes, but
+if we are on the psychological track and consider man as a system of
+psychological phenomena, then to be sure, we must see that our only
+possible interest<span class='pagenum'><a name="Page_34" id="Page_34">[Pg 34]</a></span> lies in the finding of necessary causal connections.
+But these cannot be found otherwise than by linking the mental facts
+with the physical ones, the psychological material with the processes of
+the brain.</p>
+
+<p>Of course, that mental experience stands in intimate relations to the
+body is a knowledge which does not wait for such philosophical
+arguments. That mind and body come in contact is a conviction which goes
+with every single sense perception. I see and hear because light and
+sound stimulate my sense organs, and the sense organs stimulate my
+brain. The explanation of perception through causes in the physical
+system seems the more natural as it is evident that in such cases there
+are no psychical causes which might have brought forward the perception.
+If I suddenly hear bells ringing, there was on the mental side nothing
+preceding which could be responsible for my sound perception. And the
+same holds true if the physical source lies in my own body, if perhaps
+my tooth begins to ache, although no expectation preceded it.</p>
+
+<p>In the same way it seems a matter of course that mind and body are
+connected wherever an action is performed. I have the will to grasp for
+the book before me, and obediently my arm performs the movement; the
+muscles contract themselves, the whole physical apparatus comes into
+motion through the preceding mental fact. The same holds true where no
+special will act arouses the muscles. If a thought is in my mind and it
+discharges itself in appropriate words, those words are after all as
+physical<span class='pagenum'><a name="Page_35" id="Page_35">[Pg 35]</a></span> facts the movements of lips and tongue and vocal cords and
+chest; in short, a whole system of physical responses has set in through
+a mental experience. But the same thought may be the starting-point for
+many other bodily changes; it may make me blush, and that means that
+large groups of blood-vessels become dilated; or I may get pale, the
+blood-vessels are contracted. Or I may cry, the lachrymal gland is
+working; or it may spoil my appetite, the membranes of my stomach cease
+to produce; or my muscles may tremble, or my skin may perspire; in
+short, my whole organism may resound with mental excitement which some
+words may set up.</p>
+
+<p>But it is not only the impression of outer stimuli and the expression of
+inner thoughts in which mind and body come together. Daily life teaches
+us, for instance, how our mental states are dependent upon most various
+bodily influences. If the temperature of the blood is raised in fever,
+the mental processes may go over into far-reaching confusion; if hashish
+is smoked, the mind wanders to paradise, and a few glasses of wine may
+give a new mental optimism and exuberance; a cup of tea may make us
+sociable, a dose of bromide may annihilate the irritation of our mind,
+and when we inhale ether, the whole content of consciousness fades away.
+In every one of these cases, the body received the chemical substance,
+the blood absorbed and carried it to the brain, and the change in the
+brain was accompanied by a change in the mental behavior. Even ordinary
+sleep at night presents itself surely as a bodily state&mdash;the fatigued<span class='pagenum'><a name="Page_36" id="Page_36">[Pg 36]</a></span>
+brain cells demand their rest, and yet at the same time the whole mental
+life becomes entirely changed. It is not difficult to carry over such
+observations of daily life to the more exact studies of the
+psychological laboratory and to examine with the subtle means of the
+psychological experiment the mental variations which occur with changes
+of physical conditions. We might feel, without instruments, that our
+ideas pass on more easily after a few cups of strong coffee, but the
+laboratory may measure that with its exact methods and study in
+thousandth parts of a second, the quickening or retarding in the flow of
+ideas. Every subjective illusion is then excluded, our electrical
+clocks, which measure the rapidity of mental action and of thought
+association, will show then beyond doubt how every change in the
+organism influences the processes of the mind. Bodily fatigue and
+indigestion, physical health and blood circulation, everything,
+influence our mental make-up. In the same way it is the laboratory
+experiment which shows by the subtlest means that every mental state
+produces bodily effects where we ordinarily ignore them. As soon as we
+apply the equipment of the psychological workshop, it is easy to show
+that even the slightest feeling may have its influence on the pulse and
+the respiration, on the blood circulation and on the glands; or, that
+our thoughts give impulse to our muscles and move our organs when we
+ourselves are entirely unaware of it.</p>
+
+<p>Again we may turn in another direction. Pathology shows us how every
+physical disablement of<span class='pagenum'><a name="Page_37" id="Page_37">[Pg 37]</a></span> the brain is accompanied by mental processes.
+If the blood supply to the brain is cut off, we faint; a blow on the
+head may wipe out the memory of the preceding hours, and a hemorrhage in
+the brain, the bursting of a blood vessel which destroys groups of brain
+cells, produces serious defects in the mental content. A tumor in the
+brain may completely change the personality; the bodily disease of
+certain convolutions in the brain brings with it the loss of the power
+of speech; paralysis of the brain dissolves the whole mental
+personality. Physical inhibition in the growth of the brain involves, on
+the mental side, feeble-mindedness and idiocy. Of course, all this is
+not sufficient to bring out a definite parallelism between special
+mental functions and special physical processes, as the phenomena are
+extremely complex. If a patient who has suffered from a mental
+disturbance dies, and his brain is examined, there is no simple
+correlation before us. It may be difficult to diagnose exactly the
+mental symptoms. If we have heard that the man was unable to read, we do
+not know from that what really happened in his brain. He may not have
+read because he did not see the words, or because the letters were
+confusing, or because he had lost memory for the meaning, or because he
+had lost the impulse to speak the words, or because he felt unable to
+turn his attention, or because the impulse to read aloud was not carried
+out by his organism, or because an inner voice told him that it is a sin
+to read, or for many similar reasons; and yet each one represents
+psychologically an en<span class='pagenum'><a name="Page_38" id="Page_38">[Pg 38]</a></span>tirely different situation. On the other hand, on
+the physical side, the destruction is probably not confined to one
+particular spot. Complications have crept over to other places or the
+disturbance in one part works as inhibitory influence on other brain
+parts, or a tumor may press on a far-removed part, or the disturbance
+may be one which cannot be examined with our present microscopic means.
+In short, we have always a complex mental situation and a complex
+physical one, and to find definite correlations may be possible only by
+the comparison of very many cases.</p>
+
+<p>Other methods, however, may supplement the pathological one. The
+comparative anatomist shows us that the development of the central
+nervous system in the kingdom of animals goes parallel to the
+development of the mental functions, and that it is not only a question
+of progress along all lines. Any special function of the mind may have
+in certain animal groups an especially high development, and we see
+certain parts correspondingly developed. The dog has certainly a keener
+sense of smell than the man&mdash;the part of the brain which is in direct
+connection with the olfactory nerve is correspondingly much bulkier in
+the dog's brain than in the human organism. Here too, of course,
+research may be carried to the subtlest details and the microscope has
+to tell the full story. Not the differences in the big structure, but
+the microscopical differences in the brain cells of special parts are to
+be held responsible. But comparison may not be confined to the various<span class='pagenum'><a name="Page_39" id="Page_39">[Pg 39]</a></span>
+species of animals; it may refer not less to the various stages of man.
+The genetic psychologist knows how the child's mind develops in a
+regular rhythm, one mental function after another, how the first days
+and first weeks and first months in the infant's life have their
+characteristic mental possibilities, and no mental function can be
+anticipated there. The new-born child can taste milk, but cannot hear
+music. The anatomist shows us that correspondingly only certain nervous
+tracts have the anatomical equipment by which they become ready for
+functioning. Most of the tracts at first lack the so-called medullar
+sheath, and from month to month new paths are provided with this
+physical equipment.</p>
+
+<p>Finally we have the experiment of the physiologist. His vivisectional
+experiments, for instance, demonstrate that the electrical stimulation
+of a definite spot on the surface of a dog's brain produces movements
+which we should ordinarily take as expressions of mental states,
+movements of the front legs or of the tail, movements of barking or
+whining. On the other hand, the dog becomes unable to fulfill the mental
+impulses if certain definite parts of his brain are destroyed. The
+physiologist may show from the monkey down to the pigeon, to the frog,
+to the ant, to the worm, how the behavior of animals is changed as soon
+as certain groups of nervous elements are extirpated. It is the mental
+emotional character of the pigeon which is changed when the physiologist
+cuts off parts of his brain. In short, stimulation and destruction
+demonstrate, by experiments which sup<span class='pagenum'><a name="Page_40" id="Page_40">[Pg 40]</a></span>plement each other, that mental
+functions correspond to brain functions.</p>
+
+<p>There is thus no lack of demonstration from all quarters that mental
+facts and brain processes belong together; and yet, however much we may
+cumulate such popular and scientific observations, they would never by
+themselves admit of the sweeping generalization that there cannot be any
+mental state which is not accompanied by a process in the central
+nervous system. Someone might say, to be sure, the perceptions and
+memory images, the volitions and instincts and impulses, have their
+physiological basis, but there remain after all acts of attention, or
+decisions, or subtle feelings, or flights of imagination, which are
+independent of any brain action. Here, indeed, observation cannot settle
+such a general principle. Its real hold lies in the fact with which we
+started: there is no causal connection in the mental states as such. If
+we want to understand mental facts as such in a chain, of causal events,
+we have first to conceive them as parallel to physical events. The
+principle of psychophysical parallelism, that is, the principle that
+every psychical process accompanies a physiological change is thus not a
+mere result of observation. It is simply a postulate. Every science
+begins with postulates and only that which fulfills such postulates has
+the dignity of truth in the midst of that scientific realm. The
+astronomer cannot find by observation that there is no star the
+movements of which are not the effects of foregoing causes. He knows it
+beforehand, he demands it, he does not<span class='pagenum'><a name="Page_41" id="Page_41">[Pg 41]</a></span> recognize any movement as
+understood until he has found the causes, he presupposes that such
+causes exist, that no star moves simply by a magic power, and that
+nowhere in the astronomical universe is the chain of causality broken.
+He postulates it, and where he does not discover the causes, he is sure
+that he has not solved the real problem.</p>
+
+<p>In the same way the psychologist who aims towards explanation of mental
+facts must postulate that there cannot be any mental state which is not
+an accompaniment of a physical brain process, and is as such connected
+through physical means with the preceding and the following events in
+the psychophysical system. Only when such a general framework of theory
+is built up by a logical postulate, is the way open to make use of all
+those observations of the laboratory and of the clinic, of the zo&ouml;logist
+and of the anatomist. It is the theory which has to give the right
+setting to those scattered observations. However far we may be from
+being able to point to the special brain process which lies at the
+bottom of the higher mental state, we know beforehand that there is no
+shadow of an idea, no fringe of a feeling, no suggestion of a desire
+which does not correspond to definite processes in the brain. The
+details may and must be material for diverging theories, but the
+conflict of such hypothetical opinions has nothing to do with the
+certainty of the underlying conviction that if we knew the whole truth,
+we should recognize every single mental happening as parallel to
+physical processes in the nervous system. To explain mental<span class='pagenum'><a name="Page_42" id="Page_42">[Pg 42]</a></span> facts means
+to think them as parallel to the brain processes which have their own
+causal connections in the physical world.</p>
+
+<p>We started, for instance, from the old observation that two impressions
+which come to our mind at the same time have a tendency to reawaken one
+another; and we saw that psychology was well able to formulate these
+facts in general statements of the association of ideas. But we realized
+that that in itself is not really explanation. If the odor which we
+smell awakes in us the name of a chemical substance, and if we now bring
+this under the general heading of association of ideas, an explanation
+is not really given by it. That smell sensation itself is not really
+understood as a cause of those sound sensations of the word. We have no
+insight into the connection of those two happenings. But the situation
+is entirely changed, if we consider the smell effect from the point of
+view of the parallelistic theory. Now the association of facts would
+indicate that we got the first two impressions together, because two
+brain processes were going on at the same time. My nose brought me the
+smell stimulus, my ear gave me the sound stimulus, each going on in a
+particular center, or, to express it in a simplified schematic way, each
+reaching particular brain cells, and the excitement of these brain cells
+being accompanied by the particular sensations. The physiologist has
+many possibilities of conceiving the further stages of the process, in
+order to satisfy the demand of explanation. He may say the excitement of
+each<span class='pagenum'><a name="Page_43" id="Page_43">[Pg 43]</a></span> of these two brain cells, the one in the olfactory center, the
+other in the auditory center, irradiates in all directions through the
+fine branches of the brain fibers. Each cell has relations to every
+other cell in the brain; thus there is also one connecting path between
+those two cells which were stimulated at once. Now if the two ends of an
+anatomical path are excited at the same time, the path itself becomes
+changed. The connecting way becomes a path of least resistance, and that
+means that if, in future, one of the two brain cells becomes excited
+again, the overflow of the nervous excitement will not now go on easily
+in all directions, but only just along that one channel which leads to
+that other brain cell. A theory like this explains in real explanatory
+terms, in ways which physics and chemistry can demonstrate as necessary,
+that any excitement of the odor cell runs over into the sound cell and
+vice versa. In short, the psychological association of ideas, which we
+should simply have to accept as inexplainable fact, is thus transformed
+into a connection which we understand as necessary; and the fact is
+really explained.</p>
+
+<p>This simple scheme of the physiology of association for a hundred years
+has given a most decided impulse to the progress of psychology. As the
+association process can so easily be expressed in physiological terms,
+the aim was prevalent to understand the interplay of mental life more
+and more as the result of association. The underlying thought of this
+whole association psychology was thus a conviction that whenever two
+mental experiences occur<span class='pagenum'><a name="Page_44" id="Page_44">[Pg 44]</a></span> together, either of them keeps the tendency to
+reawaken the other at a later time. Through the endless combination
+which life's impressions awaken in the mind from the first hour after
+birth, the whole stream of memory images and thoughts and aims and
+imaginations is thus to be explained.</p>
+
+<p>The whole theory of physiological associationism works evidently with
+two factors. First, there are millions of brain cells of which each one
+may have its particular quality of sensation, and second, each brain
+cell may work with any degree of energy, to which the intensity of the
+sensation would correspond. If I distinguish ten thousand different
+pitches of tone, they would be located in ten thousand different cell
+groups, each one connected through a special fiber with a special string
+in the ear. And each of these tones may be loud or faint, corresponding
+to the amount of excitement in the particular cell group. Every other
+variation must then result from the millionfold connections between
+these brain cells. Indeed, the brain furnishes all possibilities for
+such a theory. We know how every brain cell resolves itself into
+tree-like branch systems which can take up excitements from all sides,
+and how it can carry its own excitement through long connecting fibers
+to distant places, and how the endings of these fibers clasp into the
+branches of the next cell, allowing the propagation of excitement from
+cell to cell. We know further how large spheres of the brain are
+confined to cells of particular function, that for instance cells which
+serve visual sensations are in the rear part of<span class='pagenum'><a name="Page_45" id="Page_45">[Pg 45]</a></span> the brain hemispheres,
+and so on. Finally we know how millions of connecting fibers represent
+paths in all directions, allowing very well a co&ouml;peration by association
+between the most distant parts of the brain. The theories found their
+richest development, when it was recognized that large spheres of our
+brain centers evidently do not serve at all merely sensory states, but
+that their cells have as their function only the intermediating between
+different sensory centers. Such so-called association centers are thus
+like complex switchboards between the various mental centers. Their own
+activity is not accompanied by any mental content, but has only the
+function of regulating transmission of the excitement from the one to
+the other. Above all their operation would make it possible that through
+associative processes, the wonderful complexity of our trains of thought
+may be reached.</p>
+
+<p>Yet even the highest development of the association theories did not
+seem to do justice to the whole richness of the inner life. We may well
+understand through those association processes that a rich supply of
+memory pictures is at our disposal, that ideas stream plentifully to our
+minds and enter into new and ever new combinations. But that alone is
+not an account of our inner experience. If there is anything essential
+for inner life, it is the attention which gives emphasis to certain
+states and neglects others. And that means that certain mental contents
+are growing not only in strength but in vividness and clearness, and
+that others are losing their vividness,<span class='pagenum'><a name="Page_46" id="Page_46">[Pg 46]</a></span> are inhibited and suppressed.
+Here were always the real difficulties of the association theories; they
+seemed so entirely unable to explain from their own means why certain
+states become foremost in our minds and others fade away, why some have
+the power to grow and others are neglected. These facts of attention and
+vividness, inhibition and fading, worked almost as a temptation to give
+up the physiological explanation altogether and to rely on some mystical
+power, some mental influence which could pull and push the ideas without
+any interference and help from the side of the brain. Yet since we have
+seen that the truth of psychophysical parallelism has the meaning of a
+postulate which we cannot escape unless we want to give up explanation
+altogether, it is evident that such falling back into un-physiological
+agencies would be just as inconsistent as if the naturalist should posit
+miracles in the midst of chemistry or astronomy. If the facts which
+cluster about attention cannot be understood by the simple scheme of
+associationism, the demand must be for a better physiological theory.</p>
+
+<p>The development of physiological psychology in recent years has indeed
+shown the way to such a wider theory, which furnishes the physiological
+accompaniment also for those experiences of attention and vividness
+which form the weakness of associationism. This new development has come
+up with the growing insight that the brain's mental functions are
+related not only to the sensory impressions, but at the same time to the
+motor expressions. The older<span class='pagenum'><a name="Page_47" id="Page_47">[Pg 47]</a></span> view, still prevalent to-day in popular
+writings, made the brain the reservoir of physical stimuli, which come
+from the sense organs to the cortex of the brain hemispheres. There the
+perceptions arose and through associative interplay the memory pictures
+and the ideas of action and the feelings arose, and the whole inner life
+was thus bound up with the processes in these sensorial spheres. When
+the mind had done its work, finally an impulse was sent to some motor
+apparatus in the brain which then sent off the impulse to some acting
+muscles. That whole motor part was thus a kind of appendix to the brain
+process. The psychical life had nothing to do with it but to give the
+command for its action. The process in the motor part thus began when
+the mental proceeding was completed. But it became clear that this view
+was only the outgrowth of the strong interest which physiology took in
+the sense processes. If a neutral fair account of the brain actions is
+attempted, there can hardly be doubt that this whole sensorial view of
+the brain is only half of the story and that the motor half has exactly
+the same right to consideration. The cortex of the brain, the functions
+of which are accompanied by mental processes, is always and everywhere
+not only the recipient of sensory stimuli but at the same time the
+starting point of motor impulses. That which is centripetal, leading to
+the cortex, is therefore not more important for the central process than
+that which is centrifugal, leading from the cortex. The cortex is the
+apparatus of transmission between the incoming and the outgoing<span class='pagenum'><a name="Page_48" id="Page_48">[Pg 48]</a></span>
+currents, between the excitements which run to the brain and the
+discharges which go from the brain, and the mental accompaniments are
+thus accompaniments of these transmission processes. If the channels of
+discharge are closed and the transmission is thus impossible, a blockade
+must result at the central station and the accompanying mental processes
+must be entirely different from those which happen there when the
+channels of discharge are wide open. Here too all the special theories
+are still in the midst of tumultuous discord. Yet this new emphasis on
+the motor side of the psychical process seems to influence modern
+psychology more and more.</p>
+
+<p>Nobody can deny that first of all this is the necessary outcome of a
+biological view of the brain. What else can be the brain's function in
+the midst of nature than the transforming of impressions into
+expressions, stimuli into actions? It is the great apparatus by which
+the organism steadily adjusts itself to the surroundings. There would be
+no use whatever biologically in a brain which had connections with the
+sense organs, but which had no connections with the muscular system, and
+on the other hand, a brain which had motor nerves and muscular
+adjustment would be entirely useless if it had not sensory nerves and
+sense organs connected with it. In the one case the world would be
+experienced, but no response would be possible; in the other case, the
+means for response would be given, but no adjustment could set in
+because no experience of the surroundings would be possible. Adjustment
+every<span class='pagenum'><a name="Page_49" id="Page_49">[Pg 49]</a></span> moment demands the relation of the brain in both directions.
+Through the sensory nerves the brain receives; through the motor nerves
+the brain directs, and this whole arc from the sense organs through the
+sensory nerves, through the brain, through the motor nerves and finally
+to the muscles, is one unified apparatus of which no part can be thought
+away. The brain in itself would be just as useless for the organism as
+the heart would be without the arteries and veins.</p>
+
+<p>We must keep this intimate and necessary relation between the sensory
+and motor parts constantly in view, and must understand that there
+cannot be any sensory process which does not go over into motor
+response. Then only the ways are open to develop physiological views
+which give a physical basis to the processes of attention and vividness
+and inhibition, just as well as to the processes of memory and
+association. Such motor theories take many forms. Perhaps we shall most
+quickly bring the most essential factors together, if we say that full
+vividness belongs only to those sensations for which the channels of
+motor discharge are open, while those are inhibited for which the
+channels of discharge are closed; and any channel of discharge is
+closed, if action is proceeding in the opposite channel. If I open my
+hand, the motor paths which lead to closing my fist are blocked; and if
+I close my fist, the channels which lead to the opening of the hand are
+closed. Now if only those ideas are vivid which find the channels open,
+it is clear that all the ideas which<span class='pagenum'><a name="Page_50" id="Page_50">[Pg 50]</a></span> would lead to the opposite action
+have no chance for development; they remain inhibited, and just this
+relation between the vividness of certain ideas and inhibition for those
+ideas which lead to the opposite action is the characteristic of the
+process of attention.</p>
+
+<p>From such a point of view, the total mental life can be brought into the
+psychophysical scheme. We now have not two variable factors, but three,
+namely, the qualities of the elements, the intensities of the elements,
+and, as a third, the vividness of the elements. The quality corresponds,
+as we saw in the association theory, to the local position and
+connection of the brain cells; the intensity corresponds to the energy
+of the excitement; and the vividness, we may add now, corresponds to the
+relation to motor channels. The whole mental life thus becomes the
+accompaniment of a steady process of transmitting impressions and
+memories into reactions. That every experience involves millions of such
+elements we saw when we spoke of the description of mental life. The
+effort to explain mental life shows us now that this millionfold
+manifoldness belongs to a system of reactions of which all parts are in
+steady correlation: a moving equilibrium of unlimited complexity. Surely
+no one can reduce this wonderful manifoldness to those clumsy concepts
+with which popular psychology is reporting the story of the mind and its
+relations to the brain.</p>
+
+<p>It may seem that such a psychological view of inner life annihilates
+that which we feel as the most essential characteristic of our inner
+experience, its<span class='pagenum'><a name="Page_51" id="Page_51">[Pg 51]</a></span> unity and its freedom. In one sense that is certainly
+true. In the real life which we live and fight through, where our duties
+and our happiness lie, we know a unity and freedom of our personality
+which psychology must destroy. Of course that does not mean that
+psychology denies the truth of that freedom and unity. Moreover it would
+condemn itself if it were to deny that which gives meaning to the
+endeavors of our life and thus also to every search for truth.
+Psychology claims only that we must abstract from it, when we take the
+psychological standpoint towards life. Freedom of our real life means
+that we must know ourselves in the midst of our life work as guided by
+aims and obligations, and that in this purposive existence of ourselves
+we do not feel ourselves as determined by causes. I will the fulfillment
+of my ideals only because I will them. That this will itself may be the
+effect of foregoing causes is an aspect which does not belong to my
+na&iuml;ve experience. Our freedom means that in our real life our will is
+not related to causes, that the point of view of causality is thus
+meaningless for the value of our achievements. And the other man's will
+too comes in question for us as something to be interpreted and to be
+appreciated, but not to be explained by connection with causes. As long
+as we move in this sphere of purposive interest, we are free and deal
+with free selves; but if in the midst of these free aims, the will
+arises to consider the actions of others and of ourselves from the
+standpoint of causality, then we have ourselves decided to enter a new
+sphere in which<span class='pagenum'><a name="Page_52" id="Page_52">[Pg 52]</a></span> it would be meaningless to seek for any will which is
+not determined by causes. As soon as we have chosen the psychological
+standpoint and are in the midst of the work of causal reconstruction,
+any will which is not understood as determined by causes is simply an
+unsolved problem. In the midst of a causal construction, absence of
+causes would never mean real freedom.</p>
+
+<p>In that purposive world of immediate life experience, we also are
+unities inasmuch as we ourselves know us as the same in every new will
+of ours. We remain identical with ourselves because every purpose is
+posited in the midst of, and bound up with, the general purpose of
+ourselves. And in this internal unity of meaning, nothing breaks
+ourselves into pieces, and the whole manifold of experience is thus
+expressed by a personality which knows itself in its purposive unity.
+But this unity again is denied by our own intention as soon as we decide
+to take the causal view of inner life. The purposive unity must now
+transform itself into an endless complexity, and our own self becomes a
+composite of hundreds of thousands of elements.</p>
+
+<p>On the other hand, all this does not mean that psychology cannot have
+its own consistent conception of the mind's unity and freedom. Our
+psychological mind is a unity because its manifold is a system in which
+all parts hang together. A change in any one part involves changes in
+the whole system. The interrelation, to be sure, is not a strictly
+psychical one, for we have seen that the causal connection as such<span class='pagenum'><a name="Page_53" id="Page_53">[Pg 53]</a></span>
+appears at the physical side. But, inasmuch as there is no psychical
+process which does not belong to a physiological one, the
+interconnection of the mental facts is complete and involves the
+totality of neural processes of which after all a small part only has
+its psychological record. We might compare those hundreds of millions of
+neurons in each brain with the hundreds of millions of individuals who
+make up the population of the nations, and the psychical accompaniment
+we might compare with the written historical record of mankind. The
+written records themselves have no direct interconnection, they are only
+accompaniments of what happens in these millions of men. And again only
+the higher layer of the neurons in the population sees its doings
+recorded in the annals of history; and yet whatever those leaders of
+action and thought and emotion may achieve is dependent upon and working
+on the actions of those millions of subcortical population neurons. The
+historical record has its unity through the interrelation of all parts
+of historical mankind.</p>
+
+<p>But after all the psychologist has no less a right to speak of freedom.
+Of course his freedom cannot mean exemption from causality. Whatever
+happens in the psychological system must be perfectly determined by the
+foregoing causes. But the psychologist has good reason to discriminate
+between those actions which result from the normal psychophysical
+factors and such actions as result from broken machinery. If the brain
+is poisoned by alcohol or in fever, if an infectious disease has
+de<span class='pagenum'><a name="Page_54" id="Page_54">[Pg 54]</a></span>stroyed the brain cells, action is no longer the outcome of the
+normal co&ouml;peration of the organs, and even those clusters of neural
+activities which are accompanied by the consciousness of the own
+personality lose their control of the motor outcome. The man in delirium
+or paralysis acts without causal connection with his past; the action
+is, therefore, not the product of his whole personality, and the
+psychologist is justified in calling the man unfree. But, whenever the
+motor response results from the undisturbed co&ouml;peration of the normal
+brain parts, then the inherited equipment and the whole experience and
+the whole training, the acquired habits and the acquired inhibitions
+will count in bringing about the reaction. This is the psychological
+freedom of man. The unity of an interconnected composite and the freedom
+of causal determination through normal co&ouml;peration of all its parts
+characterize the only personality which the psychologist has to
+recognize.<span class='pagenum'><a name="Page_55" id="Page_55">[Pg 55]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="IV" id="IV"></a>IV<br /><br />
+<span class="sub">PSYCHOLOGY AND MEDICINE</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>We are now ready to take the first step towards an examination of the
+problem of curing suffering mankind. So far we have spoken only of the
+meaning of psychology, of its principles and of its fundamental theories
+as to mind and brain. We have moved in an entirely theoretical sphere.
+Now we approach a field in which everything is controlled by a practical
+aim, the treatment of the sick. Yet our discussion of psychology should
+have brought us much nearer to the point where we can enter this realm
+of medicine. Everything depends on the right point of entrance. That an
+influence on the inner life of man may be beneficial for his health is a
+commonplace truth to-day for everybody. Every serious discussion of the
+question has to consider which influences are appropriate, and in which
+cases of illness the influence on inner life is advisable. The popular
+treatises usually start this chapter by speaking of the "mental and
+moral" factors; and this coupling of mental influences and moral
+influences characterizes large parts of the discussions of the Christian
+Scientists and the Christian half-scientists. Yet we must<span class='pagenum'><a name="Page_56" id="Page_56">[Pg 56]</a></span> insist that
+the right entrance to psychotherapy is missed if the difference between
+morality and mentality is not clearly recognized from the beginning. The
+confusion of the two harms every statement. To avoid such a fundamental
+mistake, we had to take the long way around and to examine carefully
+what psychology really means and what it does not mean.</p>
+
+<p>We know now that inner life can be looked on from two entirely different
+standpoints: a purposive one and a causal one, and we have seen that
+these two ways of looking on inner life bring about entirely different
+aspects of man's inner experience, serve different aims, and stand in
+different relations to the immediate needs of our real life. We know
+that the one, the causal aspect, belongs to psychology, while the
+non-psychological, the purposive aspect, belongs to our immediate mutual
+understanding in the walks of life. If the physician is to make use of
+inner experience in the interests of overcoming sickness, he must first
+decide whether to take the causal or the purposive point of view in
+dealing with the patient's mind. This problem is too carelessly ignored
+and through that neglect arises much of the popular confusion. Of course
+just this carelessness becomes in some ways the ground for apparent
+strength for many a superstition and prejudice. If the doors of the
+causal mind and of the purposive mind are both open, and the spectator
+does not notice that there are two, any trick on thought and reason can
+easily be played. Whatever cannot pass through<span class='pagenum'><a name="Page_57" id="Page_57">[Pg 57]</a></span> the causal door slips in
+through the other, and whatever does not go in through the door of
+purpose marches through the entrance of causality. With such methods
+anything can be proved, and the most unscrupulous doctrines can be
+nicely demonstrated. If we are to avoid such logical smuggling, we must
+see clearly which attitude towards mental life belongs properly to the
+domain of psychotherapy.</p>
+
+<p>But what we have discussed now leaves little doubt as to the necessary
+decision. The physician is interested in the mental life with the aim of
+producing a certain effect, namely, that of health. Thus the mental life
+of the whole personality comes in question for him as belonging to a
+chain of causes and effects; whichever levers he may move, everything is
+to be a cause which, in accordance with causal laws, is to produce a
+certain change. Inner life is thus, in the interests of medical
+treatment, necessarily a part of a causal system. This means the
+standpoint of scientific psychology is the only adequate one. The
+purposive view of inner life ought not to be in question when the
+patient enters the doctor's office.</p>
+
+<p>To characterize the difference, it may be said at once that it is a
+purposive view which belongs to the minister. If the minister says to
+his despairing parishioner, "Be courageous, my friend, and be faithful,"
+nothing but a strictly purposive view gives meaning to the situation.
+The word friend indicates it, that one subject of will approaches
+another subject of will, with the intention of sympathy and
+understanding of the attitude of the other; and the advice<span class='pagenum'><a name="Page_58" id="Page_58">[Pg 58]</a></span> to be
+courageous and faithful means an appeal which has its whole meaning in
+the relation to aims and ends. The speaker and the hearer are both
+moving in a sphere of will relations, purposes and ideals, sin and
+virtue, hope and belief. To take the other extreme: if the neurasthenic
+in his state of depression and in his feeling of inability seeks relief
+from the nerve specialist, he too may say: "My friend, be courageous and
+faithful," yet his words have an entirely different purpose. They are
+not appeals to a common interest of belief; they are subtle tools with
+which to touch and to change certain psychophysical processes, certain
+states in mind and brain; there each word is a sound which awakens
+certain mental associations, and these associations are expected to be
+causes of certain effects and these effects are to inhibit those
+disturbing states of emotional depression. If a few grains of sodium
+bromide were to produce the same effect, they would be just as welcome.
+The whole consideration moves in a sphere in which only physiological
+and psychological processes are happening. Thus the physician may work
+with the ideas of religious belief, but those ideas are then no longer
+religious values but natural psychophysical material, which is to be
+applied whenever it appears as the right means to secure a certain
+effect.</p>
+
+<p>On the other hand the minister also knows, of course, that every word
+which he speaks has its psychological effect, but he abstracts from that
+entirely, as his belief should appeal directly to the struggling will of
+the man. As minister, he is thus not a psy<span class='pagenum'><a name="Page_59" id="Page_59">[Pg 59]</a></span>chologist. He works with
+moral means; the physician, with causal means. The view which the doctor
+has to take of the man before him is therefore thoroughly psychological;
+whereas that of the religious friend is thoroughly unpsychological, or
+better, apsychological. Indeed it is misleading, or at least demands a
+special kind of definition, if people say that the minister has to be a
+good psychologist. It is just as misleading as the claim, which we hear
+so often, that for instance Shakespeare was a great psychologist. No,
+the poet deals with human beings from the purposive standpoint of life
+and the mere resolving of complex purposes into parts of purposes is not
+psychology in the technical sense of the term. The poet makes us
+understand the inner life, but he does not describe or explain it; he
+makes us feel with other people, but he does not make those feelings
+causally understood. The realistic novelists sometimes undertake this
+psychological task, but they are then on the borderland of literature,
+the analysis of their heroes becomes then a psychological one.
+Shakespeare understood human beings better than anyone and therefore the
+men and women whom his imagination created are so fully lifelike that
+the psychologist may feel justified in using them as material for his
+psychological analysis, but Shakespeare himself did not enter into that
+psychological dissection; he kept the purposive point of view. In the
+same way certainly the minister&mdash;the same holds true for the lawyer or
+the tradesman or anyone who enters into practical dealings with his
+neighbor&mdash;may<span class='pagenum'><a name="Page_60" id="Page_60">[Pg 60]</a></span> resolve complex attitudes of will into their components,
+but each part still remains a will attitude which has to be understood
+and to be interpreted and to be appreciated, while the psychologist
+would take every one of those parts as a conscious content to be
+described and to be explained. But here we abstract from the purposive
+relations. Our attention belongs now to the doctor's dealing with man;
+for him cause and effect are the only vehicles of connection. Thus he
+has to exclude the purposive interpretation of inner life and has to
+understand every factor involved from a psychological point of view: his
+psychotherapy must be thoroughly applied psychology.</p>
+
+<p>The day of applied psychology is only dawning. The situation is indeed
+surprising. The last three or four decades have given to the world at
+last a really scientific study of psychology, a study not unworthy of
+being compared with that of physics or chemistry or biology. In the
+center of the whole movement stood the psychological laboratory with its
+equipment for the most subtle analysis and explanatory investigation of
+mental phenomena. The first psychological laboratory was created in
+Leipzig, Germany, in 1878. It became the parent institution for
+laboratories in all countries. At present, America alone has more than
+fifty psychological laboratories, many of them large institutions
+equipped with precious instruments for the study of ideas and emotions,
+memories and feelings, sensations and actions. Still more rapid than
+this external growth of the laboratory psychology was the inner growth<span class='pagenum'><a name="Page_61" id="Page_61">[Pg 61]</a></span>
+of the experimental method. It began with simple experiments on
+sensations and impulses, and it seemed as if it would remain impossible
+to attack with the experimental scheme the higher and more complex
+psychical structures. But just as in physics and chemistry the triumphal
+march of the experimental method could not be stopped, one part of the
+psychological field after another was conquered. Attention and memory,
+association and inhibition, emotion and volition, judgment and feeling
+all became subjected to the scientific scheme of experiment. And that
+was all supplemented by the progress of physiological psychology,
+pathological psychology, child psychology, animal psychology. In this
+way the last decades created a science which of course was by principle
+a continuation of the old psychology, but yet which had good reason to
+designate itself as a "new" psychology.</p>
+
+<p>But in this whole development, until yesterday, the curious fact
+remained that it was going on without any narrow contact with practical
+life; it was a science for the scientist and measured by its practical
+achievements in daily life, it seemed barren and unproductive.
+Psychology was studied as pal&aelig;ontology and Sanscrit were studied,
+without any direct relation to the life which surrounds us. And yet
+after all it deals with the mental facts which have to enter into every
+one of our practical deeds, if we are to consider mental life from a
+psychological point of view. The psychologists were certainly not to be
+blamed for sticking to their theoretical interests.<span class='pagenum'><a name="Page_62" id="Page_62">[Pg 62]</a></span> More than that,
+they were certainly justified in their reluctance, as everything was in
+the making, and incomplete theories can easily do more harm than good.
+But slowly a certain consolidation has set in; large sets of facts have
+been secured, and psychology seems better prepared to become serviceable
+to the practical tasks. On the other hand, it has been noticeable for
+some time that not a few of the psychological results have gone over
+into unprofessional hands and have been thrown on the market places and
+have been brought into many a home where no one knew how to deal with
+them rightly. Thus the need seems urgent that the psychologists give up
+their over-reserved attitude and recognize it as their duty to serve the
+needs of the community.</p>
+
+<p>It is not sufficient for that end, simply to take odds and ends of
+psychology and to hand them over to anyone who can see some use for
+them. We must have a systematic scientific work done for the special
+purpose of adjusting psychological knowledge to the definite practical
+tasks and of examining the psychological facts with that practical end
+in view. A science must be developed which is related to psychology as
+engineering is related to physics and chemistry. Just as the
+technological laboratories of the engineer bring out many new problems
+which the physicist would never have approached, in the same way we may
+expect that special institutions for applied psychology will shape the
+psychological inquiry in a new way.</p>
+
+<p>Such a new science of applied psychology of course<span class='pagenum'><a name="Page_63" id="Page_63">[Pg 63]</a></span> has before it a
+field just as large and manifold as the field of technology, where
+physical engineering, chemical engineering, mechanical engineering, and
+electrical engineering and so on are separated. Such a future
+psychological technology would deal, for instance, with
+psychopedagogical problems. There belongs everything which refers to the
+psychology of memory or attention, of discipline, of fatigue, of habit,
+of imitation or effort; in short, all those mental factors which have to
+be considered whenever the schoolchild is looked on from a causal point
+of view. Further there is the psycholegal field where the memory and the
+perceptions, the suggestibility and the emotions of the witness are to
+be studied, where the psychological conditions which lead to crime, the
+means to tap the hidden thoughts of the criminal, the inhibitions for
+the prevention of crime, the mental effects of punishment and similar
+causal processes must be determined. There are the psychoscientific
+problems referring to psychological influences on the observations and
+judgments and discriminations of the scholar who watches the stars or
+who translates an inscription. There are the psycho&aelig;sthetic problems
+where the task is to examine causally the factors which lead to the
+agreeable effects of beautiful surroundings, and from the height of the
+psychology of &aelig;sthetics in painting and sculpture, the inquiry may go to
+the psychology of the pleasant effects in dress-making or cooking. There
+are the large groups of psychotechnical problems where the effort refers
+to the application of psychology in securing the best<span class='pagenum'><a name="Page_64" id="Page_64">[Pg 64]</a></span> conditions for
+labor and industry and commerce. It leads from the mental effects of
+signals or the mental fatigue in mills to the secrets of advertisements
+and salesmanship. There are especially important psychodiagnostical
+studies where the aim is to determine the individual differences of man
+by experimental methods and to make use of them for the selection of the
+right man for the right place. There are psychosocial problems where we
+examine the psychological factors which have to enter into public
+movements, into social reforms, into legislation and into politics. In
+this way new and ever new groups may be added; every time the central
+thought is: how far can causal psychological knowledge help us to reach
+a certain end? Together with these forms of applied psychology, we find
+the psychomedical problems; here belongs everything which allows the
+application of causal psychology in the interests of health.</p>
+
+<p>It might be answered that this demand for a strictly causal point of
+view can hardly be fulfilled, because, if I am acting,&mdash;it may be in the
+interest of education or law or technique or medicine,&mdash;I must always
+have an end in view and to select such an end belongs after all to my
+system of purposes. If I am a teacher and have to deal with children,
+then it may be said that after all, my knowledge of causal psychology
+cannot help me if I am uncertain for which ideals I want to educate
+these children. Psychology can tell me that I need these means, if I
+want to reach certain effects, but I cannot find out by psychology which
+effects are desirable. Psychology may tell me<span class='pagenum'><a name="Page_65" id="Page_65">[Pg 65]</a></span> how to make a good
+business man or a good scholar or a good soldier out of my boy, but
+whether I want him to become a soldier or a merchant I must decide for
+myself with reference to general aims, and that leads me back to the
+purposive view of life. Such argument is entirely correct. Yes, it is
+evident that it is in full harmony with our whole understanding of the
+purpose of psychology. We saw that psychology with its causal treatment
+of man's mind does not express the immediate reality, but is a certain
+reconstruction which allows a calculation of certain effects. Thus it is
+itself a system existing for a subject who has certain ends in view. The
+whole causal view of man is thus a tool in the service of the purposive
+man. This is the reason why it is indeed utterly absurd to think that
+psychology can ever help us to determine which end we ought to reach.</p>
+
+<p>In education, for instance, very many different ends might be reached;
+psychology cannot decide anything. The decision as to the aims of
+education must be made by ethics, which indeed takes not a causal but a
+purposive attitude. Only after ethics has selected the aim, psychology
+can teach us how to reach it. Of course this principle must hold for the
+physician too. All his causal dealing with the mind presupposes that he
+has selected a certain end in harmony with his purpose. The only
+difference is that, in the case of the physician, there can be no
+possible doubt as to the desirable end; what he aims at is a matter of
+course, namely, the health of the patient. To desire the health of the
+sufferer is thus<span class='pagenum'><a name="Page_66" id="Page_66">[Pg 66]</a></span> itself a function which belongs entirely to the
+purposive view of the world, and only in the interest of this purpose
+does the physician apply his knowledge of psychology or of the causal
+sciences of physics, physiology, and chemistry. Indeed only with this
+limitation have we the right to say that the psychotherapist takes the
+causal,&mdash;and that means the psychological,&mdash;view of his patient. As far
+as he decides to take care of the health of his patient, this decision
+itself belongs to the purposive world and to his moral system. The
+physician is thus ultimately just like the minister and just like anyone
+who deals with his neighbor, a purposive worker; but while the minister,
+for instance, remains on this purposive track, the physician puts a
+causal system into the service of his purpose. He knows the end, and his
+whole aim is to apply his causal knowledge of the physical and psychical
+world to the one accepted end of restoring the health of the patient. He
+has to ask thus in general: what has psychology to-day to offer which
+can be applied in the interests of medicine?</p>
+
+<p>It would be an inexcusable narrowness to confine that chapter of applied
+psychology which is to deal with the psychomedical problems to the work
+of psychotherapy. Medicine involves diagnosis of illness as well as
+therapeutics. Between the recognition and the treatment of the illness
+lies the observation of its development and all this is preceded by
+steps towards the prevention of illness. In every one of these regions,
+psychology may be serviceable. Psycho<span class='pagenum'><a name="Page_67" id="Page_67">[Pg 67]</a></span>therapy is thus only one special
+part of psychomedicine. But the situation becomes still more complex by
+the fact that the illness to be treated or the disturbance to be removed
+may stand in different relations to the psychophysical processes. The
+illness may be a disturbance in the psychophysical brain parts, or it
+may belong to other brain parts which are only in an indirect way under
+the influence of mental states or which are themselves indirectly
+producing changes in the mental life. And finally the disturbance may
+exist outside of the brain in any part of the body, and yet again
+through the medium of brain and nervous system it may produce effects in
+the mind or be open to the influence of the mind. Thus we have entirely
+different groups of medical interests and it would be superficial to
+ignore the differences.</p>
+
+<p>Both psychodiagnostic and psychotherapeutic studies must be devoted to
+cases in which the mind itself is abnormal, further to cases in which
+the normal minds registers the abnormalities in other parts of the body,
+and finally to cases in which the normal mind influences abnormal
+processes in the body. These latter two cases have to be subdivided into
+those where the bodily disturbance still lies in the brain parts and
+those where it lies outside of the brain. But the situation becomes
+still more complex by the mutual relations of those various processes.
+The impulse to take morphine injections may have reached the character
+of a mental obsession and thus represent an abnormality of the mind, but
+yielding to it produces at the same time disturbances<span class='pagenum'><a name="Page_68" id="Page_68">[Pg 68]</a></span> in the whole body
+which thus become again external sources for abnormal experiences in
+otherwise normal layers of the mind.</p>
+
+<p>Of course the interest of the psychologist as such remains always
+related to the psychological factor, but the relation of the
+psychological factor itself to the total disturbance may be of most
+different character. If I diagnose or treat the fixed idea of a
+psychasthenic, the psychological factor itself represents the
+disturbance. On the other hand, if I study the pain sensations of a
+patient who suffers from a disease of the spinal cord, then the
+sensations themselves, the only psychological factor in the case, are
+only indications of a disease which belongs to an entirely different
+physical region; the mind itself is normal. Or, on the other hand, if I
+try to educate a sufferer from locomotor ataxia to develop his walking
+by building up in his mind new motor ideas to regulate his co&ouml;rdinated
+movements, the mind again is entirely normal but the physician needs his
+psychology on account of the influence which the mind has on the bodily
+system. Again, we must insist that psychomedicine covers this whole
+ground. Wherever a psychical factor enters into the calculations of the
+physician either by reason of its own abnormality or by its relation as
+effect or as cause to a diseased part of the body in the brain or
+without, there we have a psychomedical task, and as far as it is
+therapeutic, we have psychotherapy.</p>
+
+<p>The psychodiagnostic research lies outside of the compass of our book,
+but we cannot emphasize suffi<span class='pagenum'><a name="Page_69" id="Page_69">[Pg 69]</a></span>ciently the great importance which belongs
+to that work. Moreover, just in the field of psychodiagnostics, the
+methods of the modern experimental psychological laboratory are most
+promising and successful. Let us not forget that we deal with such
+psychological factors even when we test the functions of eye and ear and
+skin and nose by examining the sensations and perceptions. The oculist
+who analyzes the color sensations of a patient and the aurist who finds
+defects in the hearing of the musical scale and discovers that certain
+pitches cannot be discriminated, is certainly dealing, for diagnostic
+purposes, with the material that the psychological laboratory has sifted
+and studied. Even that sensation symptom which enters into so many
+diseases, the sensation of pain, belongs certainly within the compass of
+the psychologist and it is only to be regretted that the systematic
+study of the pain sensations, mostly for evident practical reasons, has
+been much neglected in the psychological laboratory.</p>
+
+<p>The psychologists have been at work all the more eagerly in the fields
+of association and memory, attention and emotion, habit and volition,
+distraction and fatigue. Here subtle methods have been elaborated,
+methods which surely common sense cannot supply, and which showed
+differences of mental behavior with the exactitude with which the
+microscope reveals the hidden differences of form. If physicians are
+slow in accepting the help which the psychological laboratory can
+furnish, it may be in good harmony with the desirable conservative
+policy in medicine, but<span class='pagenum'><a name="Page_70" id="Page_70">[Pg 70]</a></span> finally the time must come when this
+instinctive resistance against new methods will be overcome. The recent
+attachment of psychological laboratories to certain leading psychiatric
+clinics is a most promising symptom. Yet the diagnostic studies with the
+means of the psychological laboratory cannot be confined to the cases of
+mental disease. The mild abnormalities of the mind, and especially the
+nervous disturbances which exist outside the field of insanity, demand
+this support of psychology much more. And even the normal personality
+will be more safely protected from disease and from social dangers for
+its mental constitution if the resources of experimental psychology are
+employed. The more we know of the psychological constitution of the
+individual, the more we can foresee the development which is to be hoped
+for or feared and which may be encouraged or retarded.</p>
+
+<p>The psychologist may determine, for instance, the degree of attention
+with its resistance against distracting stimuli, the power of memory
+under various conditions and on various material, the mental
+excitability and power of discrimination, the quickness and correctness
+of perception, the chains of associations, the rapidity of the
+associative process for various groups, the types of reaction, the
+forming of habits and their persistence, the conditions of fatigue and
+of exhaustion, the emotional expressions and the emotional stability,
+the time needed for recreation and the resistance against drugs, the
+degree of suggestibility and the power of inhibition: and every re<span class='pagenum'><a name="Page_71" id="Page_71">[Pg 71]</a></span>sult
+in any of these lines may contribute to the diagnosis and prognosis of
+cases. The chronoscope here measures the reaction times and association
+times in thousandths of a second; the kymograph, by the help of the
+sphygmograph, writes the record of the pulse and its changes in
+emotional states, while the pneumograph records the variations of
+breathing, and the plethysmograph shows the changes in the filling of
+blood vessels in the limbs which is immediately related to the blood
+supply of the brain. Here belongs also the ergograph, which gives the
+exact record of muscular work with all the influences of will and
+attention and fatigue, the automatograph which writes the involuntary
+movements, especially also the galvanoscope which may register the
+influence of ideas and emotions on the glands of the skin, and thus lead
+to an analysis of repressed mental states, and hundreds of other
+instruments which are used in the psychological laboratory.</p>
+
+<p>Yet it would be misleading to think only of complex apparatus when
+experimental psychology is in question. An experiment is given whenever
+the observation is made under conditions which are artificially
+introduced for the purpose of the observation. Thus there is no need of
+the physical instrument. If I bring a spoonful of soup to my mouth at
+dinner and I become interested in the combination of warmth sensation
+and touch sensation and taste sensation and smell sensation, then I have
+performed an experiment if I take one more spoonful of soup just for the
+purpose of the observation. The physician<span class='pagenum'><a name="Page_72" id="Page_72">[Pg 72]</a></span> too may carry out important
+psychological experiments, without needing the outfit of a real
+laboratory. Association experiments, for instance, promise to become of
+steadily growing importance. To make them serviceable to the problems of
+his office, nothing but a subtle psychological understanding is needed,
+inasmuch as any routine work schematically applied to every case alike
+would be utterly useless. Give your man perhaps a hundred words and let
+him speak the very first word which comes to his mind when he hears the
+given ones. You call rose, and he may say red or flower or lily or
+thorn; you call frog and he may answer pond or turtle or green or jump,
+and if you choose your hundred words with psychological insight, his
+hundred answers will allow a full view of his mental make-up. This is an
+experiment which does not require any instruments at all but a man's
+subtle analysis of the replies. That is not seldom sufficient to secure
+the diagnosis of complex mental variations. The method yields still more
+if the time for such a reply is measured, but there again not the costly
+chronoscope of the laboratory is indispensable; a simple stop watch
+which gives the fifths of a second would be fully sufficient for all
+practical purposes. From such simple facts of the mental inventory the
+association experiments may lead to complex questions which slowly may
+disentangle the confused ideas, for instance, of a dementia pr&aelig;cox, and
+thus lead to subtle differential diagnosis.</p>
+
+<p>The psychological laboratory alone can also elaborate the methods of
+studying, for instance, the feeble-<span class='pagenum'><a name="Page_73" id="Page_73">[Pg 73]</a></span>minded with all the individual
+variations. New and ever new methods have been tried; the memory was
+tested by reading and repeating figures or letters, or colored papers
+were shown or cardboards of different forms or nonsense syllables, and
+the powers of remembering were studied. Or the accuracy of arm movements
+was examined, or the quickness of understanding associated words, or the
+success in planning a complex movement like throwing a ball at a target,
+or the tapping of a key in the rhythm of a metronome, or the
+discrimination and recognition of the pieces in the game of dominoes and
+many another scheme. The laboratory has to analyze the conditions for
+such methods and the psychologist has to prepare the means for the use
+of the physician, just as the chemist has to prepare the sleeping
+powders. In a similar way the laboratory may furnish means to analyze
+the mental disturbances by a comparison with the experimental results of
+artificial influences, for instance, of over-fatigue or half-sleep, of
+drugs or alcohol, of poisons and emotional excitements. The
+psychological resolving of the mental symptoms may of course, in the
+same way, furnish the diagnosis where the mental variation is only a
+distant effect of a bodily ailment. The changes in the emotions, for
+instance, may lead to the recognition of a heart disease; lack of
+attention may be a hint of the overgrowth of the adenoids; irritability
+or apathy or delirious character of the mental behavior may indicate
+whether ur&aelig;mic acid is in the system or an infectious disease: an&aelig;mia
+and undernutrition may be diagnosed and the<span class='pagenum'><a name="Page_74" id="Page_74">[Pg 74]</a></span> psychology of fever demands
+too a much closer analysis with the means of the psychological
+laboratory than it has received so far.</p>
+
+<p>We have not spoken as yet about those psychological methods which
+themselves introduce abnormal mental states like hypnotism, and which
+also not seldom are only means for diagnostic purposes. The hypnotic
+state may bring to memory forgotten experiences of which the
+physiological effects may have lasted in the brain and which may have
+brought injury to the psychophysical system. Hypnotic inquiry can thus
+lead to the recognition of the first causes in many hysterical states
+and where hypnotism is not the best adjusted tool, a certain dreamlike
+staring may be more effective. We have to return to much of that later
+in full detail because just for instance in hysteria, the clear
+recognition of the sources and of the character of the disease may at
+the same time prove to be in itself the right starting point for
+curative treatment.</p>
+
+<p>We have spoken so far only about the relations of psychology and
+medicine from the point of view of diagnosis; the relations from the
+point of view of therapy will make up the second part of this book. We
+shall describe the methods and the results, the possibilities and the
+limitations with manifold detail. That is the chief topic of this
+volume. All that is needed to prepare for this principal problem is on
+the one side a preparatory clearing up of some fundamental conceptions,
+especially of those two which have played the chief r&ocirc;le in the whole
+discussion,<span class='pagenum'><a name="Page_75" id="Page_75">[Pg 75]</a></span> namely the subconscious and suggestion. And on the other
+side, we may consider at first some fundamental discriminations which
+steadily influence the inquiries and controversies in the field. I think
+of the difference between normal and abnormal mental states, between
+psychical and physical facts in psychotherapy, between functional and
+organic diseases, and to return to our starting point, between mental
+and moral influences.</p>
+
+<p>Every curative effort presupposes that the normal state of health has
+been lost and that a diseased state has set in. Yet the mental analysis
+suggests still less than the bodily inquiry, just where the normal
+functioning is really lost. It would be easy to draw a demarcation line
+if the pathology of the mind introduced any mental features which are
+unknown in our normal existence, but the opposite is true. No mental
+disease introduces elements which do not occur in the sphere of health.
+A degenerated brain cell looks differently under the microscope from a
+normal one, but the ideas of a paranoiac, the emotion of a maniac, the
+volition of a hysteric, the memory idea of a paralytic is each in its
+own structure not different from such elements in any one of us. The
+total change lies thus only in the proportion; there is too much or too
+little of it. The pathological mental life is like a caricature of a
+face&mdash;each feature is contained, as in the ordinary portrait, but the
+proportion is distorted, there is too much or too little of chin or of
+nose. But who can indicate exactly the point where the distortion of the
+features constitutes a caricature?<span class='pagenum'><a name="Page_76" id="Page_76">[Pg 76]</a></span> Every grotesque change in the
+relations ruins the healthy state: what makes us sure that the harmony
+of health is spoiled?</p>
+
+<p>Certainly we cannot settle it by mere statistics. The norm never means
+merely a majority. Even if the overwhelmingly larger part of mankind
+suffered from phthisis, the few who were free from it would be
+recognized as well and all the others would be considered ill. In mental
+life still more, no one ought to propose that the exceptional function
+is the symptom of disease. The few persons who never had a dream in
+their lives differ much in their mental experience from the large
+majority and yet their peculiarity is certainly not a symptom which
+needs curative treatment. The only real test of health is the
+serviceableness to the needs of life. We have an unhealthy state of the
+personality before us wherever the equilibrium of the human functions is
+disturbed in a way which diminishes the chances of existence, and the
+seriousness of the ailment depends upon the degree of this diminishing
+power. Seen from a strictly psychological point of view, we must expect
+thus a broad borderland region between the entirely normal well-balanced
+mental life and that unbalanced disorder of functions which really
+interferes with the chance for self-protection and effectiveness. That
+the melancholic who declines to take any nourishment, or the paranoiac
+who misjudges his surroundings, is unable to secure by his own energies
+the safety of his life cannot be doubted. The balance is completely
+destroyed and the will and the intellect of the<span class='pagenum'><a name="Page_77" id="Page_77">[Pg 77]</a></span> physician and of the
+nurse must be substituted for his own mental powers, if his life is to
+be prolonged at all. But the misjudgment and the depression of the
+insane are only an exaggeration of that which may occur in any man.</p>
+
+<p>There are therefore thousands of steps which lead from the normal error
+or regret to the destructive disturbance. Everyone knows persons whose
+pessimistic temperament makes them inclined to an over-frequent
+depression, or others whose silly disposition brings out constantly
+those emotional tendencies which the maniac shows in an exaggerated
+degree. The stupid mind shows those lacks of association and connection
+which reach their maximum degree in the mind of the idiot. We know from
+daily life the timid, undecided man who cannot come to a will impulse;
+the hasty man who rushes towards decisions; the inattentive man who can
+never focus his consciousness; and the overattentive man who can never
+dismiss any subject; the indifferent man on whom nothing produces
+evident impression and feeling; the over-sensitive man who reacts on
+slight impressions with exaggerated emotion; and yet every one of such
+and a thousand similar variations, needs only the projection on a larger
+scale to demonstrate a mental life which is self-destructive. The silly
+girl and the stupid boy, the man who has the blues and the reckless
+creature, are certainly worse equipped for the struggles of existence
+than those who are intellectually and emotionally and volitionally
+well-balanced. They will take wrong steps in life, they may be
+unsuccessful,<span class='pagenum'><a name="Page_78" id="Page_78">[Pg 78]</a></span> their stupidity may lead them to the poorhouse, their
+recklessness may lead them to the penitentiary. And yet we do not speak
+of them as patients because their disproportionate mental features may
+be sufficiently corrected by other mental states which are perhaps more
+strongly developed.</p>
+
+<p>Further, inasmuch as human life just in its mental functions is related
+to its social surroundings, much must depend on the external conditions,
+whether the disproportion and abnormality has to be treated as
+pathological. The mind which may find perhaps its way under the most
+simple rural conditions would be unable to protect life under the
+complex conditions of a great city. The man who in certain surroundings
+may appear a crank has to be treated as a patient in a different set of
+life conditions. Wherever psychotherapeutic work is in question, perhaps
+nothing is more important than to keep steadily in mind this continuity
+between normal and abnormal mental features. The mental disturbance must
+constantly be looked upon as a change of proportions between functions
+which, as such, belong to every normal life. We have to train and to
+develop, and thus to re&euml;nforce, that which is too weak, and we have to
+drain off and to suppress and to inhibit that which is too strong.</p>
+
+<p>Yet just this functional view of disease must remind us strongly from
+the beginning that it would be utterly in vain to draw any demarcation
+line between psychical disturbances and physical ones. We have seen from
+the start that from the point of view of<span class='pagenum'><a name="Page_79" id="Page_79">[Pg 79]</a></span> physiological psychology,
+there can be no psychical process without an accompanying physiological
+process in the brain. Every disturbance in mental actions is thus at the
+same time a disturbance in the equilibrium of nervous functions. Yet
+that alone would not exclude the possibility of considering some
+diseases, for instance, exclusively from the mental side, and we should
+be justified in doing so if those parts of the brain which are the seat
+of the mental processes could remain in the diseased state without
+influence on other parts of the nervous system and of the whole body. In
+such a case it would indeed be sufficient to consider the psychophysical
+disturbance from the psychological point of view only, that is, to speak
+of the disease as a disorder of intellect, of emotion or will, without
+thinking of changes in the brain cells. But such isolation does not
+exist in nature. Not only the bodily factors like nutrition and
+circulation and sexual functions have a thousandfold influence on the
+psychophysical processes, and these in turn change the vegetative
+functions of the body, but especially the other parts of the brain and
+nervous system can be affected in most different ways. If we want to
+consider whether a certain variation of the personality demands curative
+treatment, we certainly cannot confine ourselves to the mental
+variations. They are after all only parts of the whole group of changes
+in the organism and are thus symptoms of a disease which has to be
+studied in its totality. The mental symptoms alone may be relatively
+slight variations, which in themselves<span class='pagenum'><a name="Page_80" id="Page_80">[Pg 80]</a></span> might be sufficiently balanced
+not to disturb the equilibrium of life, and yet they may be symptoms of
+a brain disturbance which as a whole must interfere with the safety of
+life. On the other hand, mental life may appear like a chaos and yet the
+disturbance may be the symptom of merely a slight brain affection and
+the treatment of the mental symptoms in their apparent severity would be
+a useless effort. The mental disturbance, for instance, of the
+intoxicated or the hashish smoker, even the delirium of the feverish,
+does not suggest a fight against the mental symptoms during the attack.</p>
+
+<p>On the whole, there is a far-reaching independence between the apparent
+mental variations and the seriousness of the brain affection. Light
+hysteric states may produce a strong absenting of the mind while severe
+epileptic conditions of the brain may be accompanied by very slight
+mental changes. Every neurasthenic state may play havoc with mental
+life, while grave brain destructions may only shade slightly the
+character or the intellect. To deal with the mental changes as if they
+belonged to a sphere by itself, to the soul which is well or ill through
+its own independent alterations without steadily relating the changes to
+the total organism, leads therefore necessarily to failure. The mind
+reflects only symptoms of the disease; the disease itself belongs always
+to the organism. Psychotherapy has suffered too much from the belief
+that the removal of mental symptoms is a cure of disease.</p>
+
+<p>Certainly the psychophysical symptoms may often<span class='pagenum'><a name="Page_81" id="Page_81">[Pg 81]</a></span> stand in the foreground
+of the disease, and in that case it may be left to the special needs
+whether we deal with them as psychical or as physical changes. Even the
+patient may be made to see them in one or the other way in accordance
+with his special needs. To tell him that his brain cells are in disorder
+and that they can be cured will be the right thing for him who takes
+only the introspective view of his suffering and is in despair because
+his own will seems powerless to overcome those mental changes. For the
+next patient, the opposite may be wiser. The belief that his brain is
+ill may have induced him to give up effort of the will instead of
+helping along by steady self-suggestion. He will be helped more if he
+understands that his mind is working wrongly. But the full truth is that
+both mind and body are in disorder; the function of the disturbed brain
+cells accompanies the ineffective will, and to re&euml;nforce the will means
+to bring into equilibrium again the disturbed brain cells. For the
+psychotherapist the temptation of giving the attention to the mental
+symptoms only is strong. The more firmly the physician sticks to the
+standpoint of psychophysiology, the better he will see ailment and cure
+in their right proportion.</p>
+
+<p>This demand for the consideration of the whole personality, mind and
+body, ought not to be influenced by the popular separation between
+organic and functional diseases. If we call organic diseases of the mind
+those in which the mental disturbance is the accompaniment of a brain
+disturbance, and functional those in which no brain disturbance exists,
+we<span class='pagenum'><a name="Page_82" id="Page_82">[Pg 82]</a></span> leave entirely the ground of modern psychology. As soon as we
+believe that the mind can be disturbed without a change in the functions
+of the brain, we give away all that which has brought scientific order
+into the study of psychological existence. Every mental disturbance
+corresponds to a disorder in the brain's functions. But there cannot be
+a change in the functions of the brain without a change in its
+structure. Thus we must claim that all those so-called functional
+disturbances like neurasthenia and hysteria, fixed ideas and obsessions,
+phobias and dissociations of the personality, as well as the typical
+insane states of the maniac or paranoiac have their basis in a
+pathological change of the anatomical structure of the brain. This
+postulate cannot be influenced by the fact that the microscope has been
+unable to detect the character of most of these changes.</p>
+
+<p>Of course all this does not exclude its being perfectly justifiable to
+separate those diseases for which a definite destruction of the brain
+parts can be detected, as in paralysis of the brain, from those where
+that is impossible. We may also expect that those disturbances in the
+brain which we cannot as yet make visible, may allow more easily an
+organic repair and thus a restoration to the normal functions. Just as a
+disjointed arm may be brought to function quickly again, a broken arm
+slowly, an amputated arm never, each brain cell too may suffer lesions
+which are reparable in different degrees. But it is evident that it
+remains then an entirely empirical question whether the invisible damage
+allows repair<span class='pagenum'><a name="Page_83" id="Page_83">[Pg 83]</a></span> or not. We have no right to say that where the
+destruction cannot be seen under the microscope there is no organic
+change and the disturbance is therefore only a psychical one and can be
+removed by mental means. All changes are physical and experience has to
+decide whether they are accessible to psychological influences or not.
+States like epilepsy may not allow any recognition of definite brain
+destruction and are yet on the whole inaccessible to mental influence,
+while many a brain disturbance with visible alterations, resulting
+perhaps from an&aelig;mia or hyper&aelig;mia, may be caused to disappear. If on the
+other hand we say that we can cure with psychotherapeutic means only the
+functional brain diseases and define as functional simply those diseases
+which can be cured by such means, we move, of course, in the most
+obvious circle and yet just that is the too frequent fate of the
+discussions in certain quarters.</p>
+
+<p>Every psychical disturbance is organic inasmuch as it is based on a
+molecular change which deranges the function. Some of these changes are
+beyond restitution; some can be brought back to a well-working structure
+by strictly physical agencies like drugs or electricity; others can be
+repaired by physiological stimuli which reach directly the higher brain
+cells through the sense organs and which we call psychical under one
+aspect, but which certainly remain physiological influences from another
+aspect. And these psychophysiological influences of the spoken words or
+similar agencies are thus indeed for therapeutic effect entirely
+co&ouml;rdinated with the douche and the<span class='pagenum'><a name="Page_84" id="Page_84">[Pg 84]</a></span> bath and the electric current and
+the opiate. It is a stimulation of certain brain cells, an inhibition of
+certain others: a subtle apparatus which must be handled with careful
+calculation of its microscopical causes and effects. That these words
+from an entirely different point of view may mean a moral appeal and
+have ethical value, point to moral and religious ideas and re&euml;nforce the
+spiritual personality, lies entirely outside of the psychotherapeutic
+calculation. As long as the curing of the patient is the aim, the faith
+in God is not more valuable than the faith in the physician and the
+moral appeal of no higher order than the influence through the galvanic
+current. They come in question only as means to an end and they are
+valuable only in so far as they reach the end. That they can be related
+to an entirely different series of purposes, to the system of our moral
+ideas, ought not to withdraw the attention of the psychotherapist from
+his only aim, to cure the patient. The highest moral appeal may be even
+a most unfit method of treatment and the religious emotion may just as
+well do harm as good from the point of view of the physician.
+Psychotherapy has suffered too much from the usual confusion of
+standpoints.<span class='pagenum'><a name="Page_85" id="Page_85">[Pg 85]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="V" id="V"></a>V<br /><br />
+<span class="sub">SUGGESTION AND HYPNOTISM</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>Psychotherapy has now become for us the effort to repair the disturbed
+equilibrium of human functions by influencing the mental life. It is
+acknowledged on all sides that the most powerful of these influences is
+that of suggestion. This is an influence which is most easily
+misunderstood and which has most often become the starting point for
+misleading theories. Before we enter into the study of the practical
+effects of suggestion and the psychotherapeutic results, we must examine
+this tool in the hand of the psychotherapist from a purely psychological
+viewpoint. The patient may perhaps sometimes profit from suggestion the
+more, the less he understands about its nature, but the physician will
+always secure the better results, the more clearly he apprehends the
+working of this subtle tool. Of course, that does not mean that any
+psychology is able to explain the process of suggestion to a point where
+all difficulties are removed, but at least the mysteries can be removed
+and the effects can be linked with other well-known processes.</p>
+
+<p>Let us be clear from the start that suggestion is<span class='pagenum'><a name="Page_86" id="Page_86">[Pg 86]</a></span> certainly nothing
+abnormal and exceptional, nothing which leads us away from our ordinary
+life, nothing which brings us nearer to the great riddles of the
+universe. There is no human life into which suggestion does not enter in
+a hundred forms. Family life and education, law and business, public
+life and politics, art and religion are carried by suggestion. A
+suggestion is, we might say at first, an idea which has a power in our
+mind to suppress the opposite idea. A suggestion is an idea which in
+itself is not different from other ideas, but the way in which it takes
+possession of the mind reduces the chances of any opposite ideas; it
+inhibits them. It is indeed the best result of any successful education,
+that the teachings have taken hold of the mind of the young in such a
+way that all the opposite tendencies and impulses and wishes do not come
+to development. The well-educated person does not need to participate in
+a struggle between good and bad motives, for that which has been
+impressed upon his mind does not allow the other side to come up at all.
+Our life would be crowded with inner conflicts if education had not
+secured for us from the start preponderance for the suggestions of our
+educators.</p>
+
+<p>The love of family and friends, of our country and our party are in the
+same way such suggestions. We may hear arguments for the other side,
+arguments which easily convince the man of the other party, but they do
+not appeal to us: they are emasculated before they enter our minds; they
+have no chance to overcome the resistance because suggestions stand in
+their<span class='pagenum'><a name="Page_87" id="Page_87">[Pg 87]</a></span> way. No argument will overwhelm the suggestion which religion has
+settled in our inner life, and from this strongest suggestion which can
+stand against any temptation of life small psychological steps lead down
+to the little bits of suggestion with which our daily chance life is
+over-flooded. Every advertisement in the newspaper, every display in the
+shop-window, every warm intonation in the voice of our neighbor has its
+suggestive power, that is, it brings its content in such a way to our
+minds that the desire to do the opposite is weakened. We do buy the
+object that we do not need, and we do follow the advice which we ought
+to have reconsidered. And what would remain of art if it had not this
+power of suggestion by which it comes to us and wins the victory over
+every opposing idea? We believe the painter and we believe the novelist,
+if their technique is good. We do not remember that the inventions of
+their genius are contrary to our life experience; we feel sympathy with
+the hero and do not care in the least that he has no real life. The
+suggestion of art has inhibited in us every contrary idea.</p>
+
+<p>Such daily experience shows us that suggestive power may belong to
+different men in different degree. There are lawyers whose arguments and
+whose presentation open our mind, it seems, to any suggestion: while
+others leave us indifferent; we understand their idea, we follow their
+thoughts, and yet we remain accessible to opposite influences. There are
+teachers whose authority gives to every word such an impressiveness and
+dignity that every<span class='pagenum'><a name="Page_88" id="Page_88">[Pg 88]</a></span> opposite thought disappears, while others throw out
+words which are forgotten. On the other hand, the readiness to accept
+suggestions is evidently also quite different with different
+individuals. From the most credulous to the stubborn, we have every
+degree of suggestibility, the one impressed by the suggestive power of
+any idea which is brought to his mind, the other always inclined to
+distrust and to look over to the opposite argument. Such a stubborn mind
+is indeed not only without inclination for suggestions, but it may
+develop even a negative suggestibility; whatever it receives awakens an
+instinctive impulse towards the opposite. Moreover we are all in
+different degrees suggestible at different times and under various
+conditions. Emotions re&euml;nforce our readiness to accept suggestions. Hope
+and fear, love and jealousy give to the impression and the idea a power
+to overwhelm the opposite idea, which otherwise might have influenced
+our deliberation. Fatigue and intoxicants increase suggestibility very
+strongly. To look out on a wider perspective, we may add at once that an
+artificial increase of suggestibility is all which constitutes the state
+of hypnotism.</p>
+
+<p>At first, however, we want to understand the ordinary process of
+suggestion in that normal form in which it enters into every hour of our
+life and into every relation of our social intercourse. But if we begin
+to examine the structure of the process, we can no longer be satisfied
+with the vague reference to ideas and their opposites. What does it mean
+after all if we speak of opposite ideas? Can we not en<span class='pagenum'><a name="Page_89" id="Page_89">[Pg 89]</a></span>tertain any ideas
+peacefully together in our consciousness? From a logical standpoint,
+ideas may contradict each other, but that refers to their meaning. As
+mere bits of psychological experience, I may have any ideas together in
+my consciousness. I can think summer and winter or day and night or
+right and left or black and white or love and hate in one embracing
+thought. As mere mental stuff, the one idea does not interfere with the
+other. On the other hand, this is evident: I cannot will to turn to the
+right and to turn to the left at the same time. There may be a wrangling
+between those two impulses, but as soon as my will stands for the one,
+the other is really excluded. Any action which I am starting to do thus
+crowds out the impulse to the opposed action.</p>
+
+<p>In the sphere of psychological facts, we have here indeed the only
+relation between two happenings which necessarily involves an
+opposition. We could never understand why one brain cell might not work
+together with any other brain cell, but we do understand that nature
+must provide for an apparatus by which the impulse to one action makes
+the impulse to the opposite action ineffective. There is no action which
+has not its definite opposite. The carrying out of any impulse involves
+the suppression of the contrary impulse, and the impulse not to do an
+action involves the suppression of the impulse to do it. When we spoke
+of the relations of mind and brain, we mentioned that such a corelation
+of mental centers indeed exists. Physiological experiments have
+demonstrated that the activity of those centers<span class='pagenum'><a name="Page_90" id="Page_90">[Pg 90]</a></span> which stimulate a
+certain action reduce the excitability of those brain parts which awaken
+the antagonistic action. As far as the world of actions is concerned,
+the mechanism of the process of suggestion thus seems not inaccessible
+to a physiological understanding.</p>
+
+<p>Various ideas of movements to be carried out are struggling for control
+in the cortex of the brain. That is the normal status which precedes any
+decision. The channels of motor discharge are open for both
+possibilities; we may turn to the right or to the left. Then the play of
+associations begins. A larger and larger circle of ideas surrounds the
+idea of the one and of the other goal. Those ideas awaken emotions. On
+the one side may call our duty and on the other side our pleasure.
+Larger and larger parts of the central content of our consciousness, of
+our own personality, become involved; our principles and maxims, our
+memories, our hopes and fears, enter into the battle until deeper strata
+of the idea of ourselves enter into a firm association with the one
+side, re&euml;nforcing, perhaps, the idea of the goal at the right. This
+opens wide the channels of discharge for the movement to the right and
+inhibits thereby the excitability of the center which leads to the
+opposite action. The channel of discharge to the movement towards the
+left becomes closed, the idea of that movement fades away and becomes
+inhibited: we are moving towards the right. The outcome was the product
+of our total personality.</p>
+
+<p>But this result would have been different, if from<span class='pagenum'><a name="Page_91" id="Page_91">[Pg 91]</a></span> the start the
+channels of discharge had not been equally open for both possible
+movements, and if thus the relative resistance to the impulse had not
+been equal on both sides. If, for instance, we had gone from the given
+point frequently to the left, as a result of the habit and training, the
+impulse to the left would have found less nervous resistance. The
+channels would have become widened by the repetition and the opposite
+channels would have been somewhat closed by the lack of use. Or if
+instead of such previous habit, we should see at the decisive moment
+others turning to the left, the impression would have become the
+starting point for a reaction of mere instinctive imitation. While we
+might not have followed that imitative impulse at once, yet the channels
+would have been widened, the discharge in the direction would have been
+prepared by it, the resistance would have been lowered and the chances
+for the opposite movement would have been decreased. Those people who
+moved to the left gave us by their action the same kind of an impulse
+which they would have furnished if they had begged us with words, or if
+they had ordered us to follow them with authoritative firmness. In each
+of these cases, the influence would have amounted to a suggestion.
+Whether we watched the movements of other people or whether their words
+made an impression on us, in either case the way became prepared for a
+certain line of action and therefore the way for the opposite action
+became blocked. The final outcome was thus no longer an entirely free
+play of motor ideas, but there was a little<span class='pagenum'><a name="Page_92" id="Page_92">[Pg 92]</a></span> inequality in play. The one
+had from the start a better chance, the other was from the start
+laboring under difficulties. The suggestion of actions is thus nothing
+but making use of the antagonistic character in the nervous paths which
+start from the motor centers. That all such phrases as the opening and
+the closing, the widening and blocking, of channels of discharge are
+only metaphors hardly needs special emphasis. Instead of such
+comparisons, we ought rather to think of chemical processes which offer
+various degrees of resistance to the propagation of the nervous
+excitement.</p>
+
+<p>We see from here the direction in which many psychotherapeutic efforts
+must lie, efforts which are entirely within the limits of the daily
+normal experience, and belong to the medical practice of every
+physician, yes, to the helpful influence of every man in practical life.
+The intemperate man may suffer from his inability to resist his desire
+for whiskey. The idea of his visit to the saloon finds the channels of
+discharge open. We argue with him, we tempt him by attractions which
+lead to other ways, we suggest to him that he spend those evening hours
+perhaps with friends or with books for which we awaken his interest; we
+do it as impressively as we can, we appeal to his friendly feeling for
+us; and if again the hour comes in which the desire for the artificial
+stimulation sets in with a motor impulse towards the bottle, the
+channels for discharge have now been blocked. The idea of the opposite
+action arises, it associates itself with the emotions which we stirred
+up in his mind,<span class='pagenum'><a name="Page_93" id="Page_93">[Pg 93]</a></span> it associates itself with the respect for the adviser,
+and thus new clusters of thought re&euml;nforce that idea of action which we
+suggested, and this opposite line of action now finds a minimum
+resistance because our appeal has opened beforehand the gate. The desire
+for the book works itself out into action while the desire for the cup
+finds increased resistance.</p>
+
+<p>Just this is the kind of suggestion with which we correct faulty action
+everywhere in our social circle; and yet small steps lead on from here
+to the case where perhaps the desire for alcohol has reached that
+pathological intensity in which the equilibrium is entirely disturbed
+and cannot be repaired without suggestions of a much more powerful
+character, given in a state of artificially increased suggestibility&mdash;in
+hypnotism. The principle of opening certain channels of discharge for
+the purpose of closing the opposite channels remains in the extreme case
+the same as in the more ordinary cases. The impulse to drink is a
+positive one, but the principle is not different where the impulse is
+negative. A friend who comes from the quiet country may feel unable to
+pass the busy square of the city. The fear of an accident holds back his
+steps, he cannot give the impulse to walk through the crowded rush of
+vehicles. Now either by words of advice, by persuasion or by showing the
+way, we may apply our suggestion, we open the channels of discharge for
+the necessary movements and thus decrease the excitability of those
+centers in which nervous fear was playing. And again small steps lead
+from here to the case of the<span class='pagenum'><a name="Page_94" id="Page_94">[Pg 94]</a></span> psychasthenic sufferer whose phobia does
+not allow him to cross any square and where re&euml;nforced suggestion has to
+break open the ways for the walking movement when the square is reached.</p>
+
+<p>Thus we are not far from a causal understanding of suggestive influences
+wherever actions are concerned, where movements are to be re&euml;nforced or
+to be suppressed and where antagonism of the motor paths is involved.
+But that does not seem to lead us nearer to the much larger group of
+states in which the whole suggestive process concerns apparently the
+interplay of ideas alone, where not actions but impressions are
+controlled by suggestion, where not impulses but thoughts are
+strengthened or inhibited. Here lies the real psychophysical problem
+which has been by far too much neglected in scientific psychology and
+has almost been hidden and made to disappear in the wonderful accounts
+of the hypnotists. But all those mysterious stories as to the
+achievements of suggestion cannot help so long as we do not understand
+the working of the process, and we shall have the better chance to
+understand it the more we keep away from the uncanny and mysterious
+results which refer to the most complex conditions, and rather seek to
+analyze the state in its simplest forms and compare it with other simple
+mental processes. The psychology of suggestion has suffered too much by
+the fascination which its most complex forms exert on a trivial
+curiosity.</p>
+
+<p>Yet the problem of suggestion in the field of ideas stands after all not
+isolated. Instead of connecting<span class='pagenum'><a name="Page_95" id="Page_95">[Pg 95]</a></span> it with the weird reports of mystic
+influence from man to man, let us rather link it with the simple
+experience of attention. There is no pulse-beat of our life in which
+attention does not play its little r&ocirc;le. But does not attention share
+with suggestion the characteristic feature that some contents of
+consciousness are re&euml;nforced and others are suppressed? This negative,
+this suppressing character of attention is not a chance by-product, it
+is most essential. There is no attention without it. If I am studying, I
+do not hear the conversation around me, and if I listen to the
+conversation, my studies in hand become inhibited. If I enjoy the play
+on the stage and give to it my full attention, my memories of the day's
+work are suppressed; if I think of the happenings of the day, I am not
+attentive to the play and hardly notice what is going on. The inhibited
+impression may often disappear entirely. While I am reading I am not at
+all aware of the tactual and muscular sensations in my legs, and if I am
+completely absorbed by my book, I may not even notice that the bell
+rings. In short, we have here as the most characteristic relation, just
+as in suggestion, the fact that one mental state becomes vivid, and that
+others are losing ground, become less vivid, are inhibited and perhaps
+disappear entirely.</p>
+
+<p>Of course, to point to the similarity between suggestion and attention
+is not a real explanation. It may be answered that attention simply
+offers the same difficulties once more. How can we explain in the
+attention process the fact that one idea, the one<span class='pagenum'><a name="Page_96" id="Page_96">[Pg 96]</a></span> attended to, becomes
+vivid and that others evaporate? The difficulty evidently cannot be
+removed by simply saying that only one sensorial process can be
+developed in the brain at one time. The popular descriptions of
+attention easily make it appear as if such were the solution of the
+problem. If one sensorial brain part is intensely engaged, the remainder
+of the brain is condemned to a kind of inactivity. Yet such a dogma is
+hardly better than the old-fashioned one that the soul can have only one
+idea at a time. We know too well now that the psychophysical system is
+an extremely complex equilibrium of millions of elements. Thus every
+change must be explained with reference to this complex manifold. Above
+all, the facts simply contradict such an over-simple explanation,
+inasmuch as it is not at all true that only one content of consciousness
+can become vivid. Our attention does not focus upon one point at all but
+may illuminate a large field and thus give vividness to various complex
+groups. If I am thinking about a scientific problem, an abundance of
+reminiscences of previous reading and imaginative ideas of possible
+solutions, associative thoughts and conclusions are with equal vividness
+before my mind and the forthcoming thought may be influenced by this
+total combination. I have no right whatever to say that the idea of a
+certain solution excludes there in my mind the consideration of the
+books which I have read and of the discussions which I have heard.
+Emotions may be superadded. In short, a world of mental states may be
+held together by one act of at<span class='pagenum'><a name="Page_97" id="Page_97">[Pg 97]</a></span>tention. And new and ever new thoughts
+are shooting in, and all still find place there in the field attended
+to, while on the other hand my slight headache is inhibited and an
+appointment is forgotten. At a gay banquet, my attention may be given to
+the whole hall with all its color effects and its flowers, and to all
+that the table offers and to the music from the orchestra and to the
+jokes of my neighbors. It is not true that any one of those parts
+suppresses the vividness of the others, they seem rather to maintain and
+to help one another; and yet in the next moment, my neighbor may bring
+me news which absorbs my mind entirely and leaves no room for the
+flowers and the music and the meal. How far can psychology do justice to
+these characteristics of attention?</p>
+
+<p>There seems to be but one way. The attended-to idea does not exclude
+every other idea, but it does exclude the opposite idea, and opposite to
+each other is here again that pair of ideas which lead to opposite
+actions, to opposite psychophysical attitudes. We must remember here the
+psychomotor character of our brain processes which we so fully
+discussed. We recognized the fundamental truth that there is no
+sensorial state which is not at the same time the starting-point for
+motor reaction. We recognized that the brain is by its whole
+psychological development a great switchboard which transfers incoming
+currents into outgoing ones and that its biological meaning lies in the
+fact that it is the center piece of an arc which leads from the sense
+organs to the muscles. We cannot conceive of those relations as complex<span class='pagenum'><a name="Page_98" id="Page_98">[Pg 98]</a></span>
+enough; we know, of course, that millions of nerve fibers lead from the
+periphery to the highest psychophysical apparatus in the cortex of the
+brain and that millions of fibers bring about the interrelation between
+these central stations, but we must never forget that millions of fibers
+also represent the outgoing paths and that they too lead down to lower
+central motor instruments which are again in numberless corelations. Any
+impression is thus a starting point for attitudes and reactions and it
+is an empty abstraction to consider it otherwise. An idea is never,
+psychophysically considered, the end of the process, it is always also a
+beginning. No external action may follow, but the mental impulse to such
+is nevertheless starting in the highest center.</p>
+
+<p>If we look at the landscape, every single spot of color, reaching a
+nerve fiber in our eye and finally a sensory cell in our brain, is there
+the starting point for an impulse to make an eye movement in the
+direction of the seen point. The eye may remain entirely quiet as the
+impulse to move to the right and to the left, to move up and to move
+down, may be equally strong, but those thousands of impulses work in the
+motor paths and only their equilibrium results in the suppression of the
+outer movement. With such motor scheme, we begin to understand the
+selective process in attention. An impression may be accompanied by
+other stimuli and associations, by thoughts and ideas, and thousands of
+sensory excitements may thus arise in the cortex, but only those have a
+chance for full vividness of development which co<span class='pagenum'><a name="Page_99" id="Page_99">[Pg 99]</a></span>&ouml;perate in the motor
+action already started. Those impressions which would lead to the
+opposite actions have no chance because their motor paths are blocked
+and their own full development is dependent upon their possibility of
+expression. To close the path means to inhibit the idea which demands
+such action. We can attend to a hundred thoughts together, if they all
+lead to the same attitude and deed. We can look at the opera, can see
+every singer and every singer's gown, can listen to every word, can have
+the whole plot in mind, can hear the thousands of tones which come from
+the orchestra; and yet combine all that in one act of attention, because
+it all belongs to the same setting of our reactive apparatus. Whatever
+the one wants is wanted by the others. But if at the same time our
+neighbor speaks to us, we do not notice it; his words work as a stimulus
+which demands an entirely different motor setting as answer. Therefore
+the words remain unvivid and unnoticed.</p>
+
+<p>To attend means therefore to bring about a motor setting by which the
+object of attention finds open channels for discharge in action. Which
+particular action is needed in the state of attention cannot be
+doubtful. Attention demands those motor responses and those inner steps
+by which the object of attention shows itself more fully and more
+clearly. When we give attention to the picture we want to see more
+details, when we give attention to the problem we want to recognize more
+of the factors involved, when we give attention to the banquet we want
+to grasp more of the pleasurable features. This aim of attention<span class='pagenum'><a name="Page_100" id="Page_100">[Pg 100]</a></span>
+involves that, as part of such reactions, the sense organs become
+adjusted; we fixate the eyeball, we listen, and in consequence the
+object itself becomes clearer, and through the easy passage into the
+motor channels the whole impression becomes vivid. At the same time, all
+those associations must be re&euml;nforced and become vivid too which lead to
+the same action. On the other hand, the opening of the one passageway
+closes the path to the opposite action and inhibits the impressions
+which would interfere with our interest. Every act of attention becomes,
+therefore, a complex distribution in the re&euml;nforcement and inhibition of
+mental states.</p>
+
+<p>Now let us come back to suggestion. It shares, we said, with attention,
+the power to re&euml;nforce and to inhibit. But if we examine what is
+involved in the suggestion of an idea, we find surely more than a mere
+turning of the attention towards one idea and turning the attention away
+from another idea. That which characterizes and constitutes suggestion
+is a belief in the idea, an acceptance of the idea as real and the
+dismissal of the opposite idea as unreal. Yes, we may say directly that
+it is meaningless to speak of suggesting an idea; we suggest either an
+action or, if no action is concerned, we suggest belief in an idea. If I
+suggest to the fearful man at twilight that the willow-tree trunk by the
+wayside is a man with a gun, I do not turn his attention to an abstract
+idea of a robber nor do I simply awaken the visual impression of one,
+but I make him believe that such an idea is there realized, that he
+really sees<span class='pagenum'><a name="Page_101" id="Page_101">[Pg 101]</a></span> the person. If I suggest to him that he hears distant bells
+ringing or that he feels a slight headache, he may not be suggestible
+enough to accept it, but if he accepts it he is not simply attending to
+the idea which I propose but he is convinced of its real existence. The
+same holds true with the negative; if I suggest to him that the slight
+headache of which he complained has disappeared or that the smell which
+he noticed has stopped, I do not simply invite him to think of the
+absence of such sensations. It becomes for him a suggestion only if he
+becomes convinced that these disturbances have now become unreal. The
+same holds true for all those suggestions of ideas which belong to our
+practical life, the suggestions which art imprints on our minds, or
+which politics and religion impart. As long as we are under the
+suggestion of the novelist, we really believe in the existence of the
+heroine; we really believe in the validity of the political party
+principle; it is not an argument to which we simply give our attention,
+it becomes a suggestion only when the belief in its objective existence
+controls our minds. We may say in general that suggestions which are not
+suggestions of actions are without exception suggestions of belief.
+Actions and beliefs are the only possible material of any suggestion.</p>
+
+<p>Yet what else is a belief than a preparation for action? I may think of
+an object without preparing myself for any particular line of behavior.
+Here in the room I may think of rain or sunshine on the street as a mere
+idea, but to know that it now really<span class='pagenum'><a name="Page_102" id="Page_102">[Pg 102]</a></span> rains or shines means something
+entirely different. It means a completely new setting in my present
+attitude, a setting by which I am prepared to act along the one or the
+other line, to take an umbrella or to take a straw hat, when I am to
+leave the house. I may think of the door of this room as locked or
+unlocked without transcending the mere sphere of imagination, but to
+believe that it is the one or the other means a new setting in my motor
+adjustments. If it is locked I know that I cannot leave the room without
+a key. Every belief means the preparation for a definite line of action
+and a new motor adjustment in the whole system of motor paths, an
+adjustment by which my actions in future will be switched off at once
+into particular paths. And there is theoretically no difference whether
+my belief refers to the proposition that the door is locked or that a
+God exists in Heaven.</p>
+
+<p>But if every belief is such a new motor setting, then we are evidently
+brought back to the mechanism which was essential for every suggestion
+of action on the one side and for every process of attention on the
+other side, namely, the mechanism of antagonistic movements. To prepare
+ourselves for one line of action means to close beforehand the channels
+of discharge for the opposite. The suggestible mind sees the man with a
+gun on the wayside because he is preparing himself in his expectation
+for the appropriate action; he is ready for the fight or ready to run
+away, and every line of the tree trunk is apperceived with reference to
+this motor setting. The smell, on the other hand, has disappeared under
+the<span class='pagenum'><a name="Page_103" id="Page_103">[Pg 103]</a></span> influence of the suggestion because a new motor adjustment has set
+in, in which he is prepared to act as if there were no smell.</p>
+
+<p>The difference between suggestion and attention lies thus only in this:
+the motor response in attention aims towards a fuller clearness of the
+idea, for instance, by fixating, listening, observing, searching; while
+the motor response in suggestion aims towards the practical action in
+which the object of the idea is accepted as real. In attention, we
+change the object in making it clearer; in suggestion, we change
+ourselves in adapting ourselves to the new situation in which we
+believe. If you consider attention as a psychophysical process open to
+physiological explanation, you have surely no reason to seek anything
+mysterious in the process of suggestion; and no new principle is
+involved, if we come from the effect of the smallest suggestive hint to
+the complex and powerful suggestions which overwhelm the whole
+personality.</p>
+
+<p>The two great types of suggestion, the suggestion of actions and the
+suggestion of ideas, have now come nearer together since we have seen
+that the suggestion of ideas is really a suggestion of the practical
+acceptance of ideas, and that means, of a preparation towards a certain
+line of action. In the one case I suggest the idea of a certain action
+and this motor idea leads to the action itself, and in the other case I
+suggest a certain preparatory setting for action and that will lead to
+the appropriate action whenever the time for action comes. Every
+suggestion is thus ulti<span class='pagenum'><a name="Page_104" id="Page_104">[Pg 104]</a></span>mately a suggestion of activity. The most
+effective suggestion for an action results, of course, if both methods
+are combined, that is, if we suggest not only the will to perform the
+action, but at the same time the belief that the end of the action will
+be real. Suggestion reaches us usually from without. Yet there is again
+no new principle involved, when the new motor setting results from one's
+own associations and emotions. Then we speak of auto-suggestion. It is
+the same difference which exists between the attention called forth
+through an outer impression and the attention directed by our own will.
+Loud noise demands our attention, and even a whispered word may awaken
+associations which stir up the attention. In both cases the channels for
+adjustment become opened without our intention. But if we are expecting
+something of importance, if we start to watch a certain development and
+to find something which we seek, we open the channels by our own effort
+beforehand and produce our own settings thus through a voluntary
+attention. In this way suggestion too may start from without,&mdash;by a
+spoken word, by a movement, by a hint; or may start within us and may
+give us our caprices and our prejudices.</p>
+
+<p>We must not neglect one other feature of the suggestion. Not every
+proposition to action or to belief can be called a suggestion. Essential
+too remains the other side of it, the overcoming of the resistance. A
+mere request, "Please hand me the book on the table," or a mere
+communication, "It rains," may produce and will produce the fit motor<span class='pagenum'><a name="Page_105" id="Page_105">[Pg 105]</a></span>
+response, the movement towards handing over the book or opening of the
+umbrella, and yet there may be no suggestive element involved. We have a
+right to speak of suggestion only if a resistance is to be broken down,
+that is, if the antagonistic impulse, or the motor setting for the
+antagonistic action is relatively strong. If I say to the boy, "Hand me
+the book," when he was anxious to hide the book from my eyes and thus
+had the wish not to hand it to me and the tone of my request overwhelmed
+his own intention, then to be sure suggestion is at work. The stronger
+the resistance, the greater the degree of suggestive power which is
+needed to overcome the motor setting. If I say to the normal man, "It
+rains," while he sees the blue sky and the dry street, his impression
+will be stronger than my suggestion; but if he is suggestible and I tell
+him that it will rain, he may accept it and take an umbrella on his
+walk, even if no indication makes a change of weather probable. The
+present impression of the dry street was strong enough to resist the
+suggestion, the imaginative idea of that which is to be expected in the
+next hour was too weak, and was overwhelmed by the suggestion of the
+weather prophecy.</p>
+
+<p>It is clear that the whole suggestive effect, being one of a new motor
+setting, depends thus entirely on the equilibrium of the personality
+which receives the suggestion. Every element which reaches the mind
+through sense organs or through associations must have influence in
+helping the one or the other side, that is, in opening the channels of
+action in the sug<span class='pagenum'><a name="Page_106" id="Page_106">[Pg 106]</a></span>gested direction or in the antagonistic one. The
+results appear surprising only if we forget how endlessly complex this
+psychomotor apparatus really is. If we disregard this complexity we may
+easily have the feeling that one person has an unexplainable influence
+over another, as if the will of the one could control in a mysterious
+way the will of the other. But as soon as we see that every action is
+the result of the co&ouml;peration of hundreds of thousands of psychomotor
+impulses which are in definite relation to antagonistic energies, and
+that the result depends upon the struggling and balancing of this most
+complex apparatus, then we understand more easily how outer influences
+may help the one or the other side to preponderance: as soon as the
+balance turns to the one side, a completely new adjustment must set in.
+And we understand especially that there is nowhere a sharp demarcation
+line between receiving communications and receiving suggestions. By
+small steps suggestion shades over into the ordinary exchange of ideas,
+propositions, and impressions, just as attention shades over into a
+neutral perception.</p>
+
+<p>To be suggestible means thus to be provided with a psychophysical
+apparatus in which new propositions for actions close easily the
+channels for antagonistic activity. Such an apparatus carries with it
+the disadvantage that the personality may too easily be guided contrary
+to his own knowledge and experience. He will be carried away by every
+new proposition and will accept beliefs which his own thoughts ought to
+reject. On the other hand, it has the advantage that<span class='pagenum'><a name="Page_107" id="Page_107">[Pg 107]</a></span> he will be open to
+new ideas, be ready to follow good examples, never stubbornly close his
+mind to the unaccustomed and the uncomfortable. It is easy to determine
+the degree of suggestibility. Take this case. I draw on the blackboard
+of a classroom two circles of an equal size, and write in the one the
+number fourteen and in the other the number eighty-nine, and ask the
+children which is the larger circle. The suggestible ones will believe
+that the circle with the higher number in it is really larger than the
+other, the unsuggestible children will follow the advice of their senses
+and call both equal, and there may be a few children with negative
+suggestibility who would call the circle with the higher number the
+smaller circle. What happened to the suggestible ones was that the
+higher number brought about a motor attitude which faced that whole
+complex as being more imposing and this new motor setting was with them
+strong enough to overcome the motor adjustment which the circles alone
+produced. Such experiments of the psychological laboratory can be varied
+a thousandfold, and it might not be unwise to introduce them into many
+practical fields. Everybody knows for instance how much may depend upon
+the suggestibility of the witness in court. The suggestible witness
+believes himself to have seen and heard what the lawyer suggests. The
+memory picture which such a witness has in mind offers, of course, much
+less resistance to the opposite action and attitude and belief than the
+immediate impression. If I show the witness a colored picture of a room
+and close the<span class='pagenum'><a name="Page_108" id="Page_108">[Pg 108]</a></span> book and ask him whether there were three or four chairs
+in the picture and whether the curtain was green or red, the suggestible
+man will decide for one or the other proposition, even if there were
+only two chairs and a blue curtain. The perception would have resisted
+the suggestion, the fading memory image cannot resist it. Thus
+suggestibility is really a practical factor in every walk of life. And
+it is in the highest interests of psychotherapy that this intimate
+connection between suggestion and ordinary talk and intercourse, between
+suggestion and ordinary choice of motives, between suggestion and
+attention be steadily kept in view and that suggestion is not
+transformed into a kind of mysterious agency.</p>
+
+<p>To be sure, the importance of suggestion for psychotherapy is not
+confined to these suggestive processes of daily life. They play a r&ocirc;le
+there, as we shall see, and we shall claim that even the mere presence
+of the physician may have its suggestive power and so may every remedy
+which he applies. But no doubt many of his suggestive effects depend on
+a power which far transcends the suggestions of our daily life. Yet the
+psychologist must insist again that no new principle is involved, that
+even in the strongest forms of suggestion, in hypnotism, nothing depends
+upon any special influence emanating from the mind of the hypnotizer or
+upon any special power flowing over from brain to brain; but that
+everything results from the change of equilibrium in the psychomotor
+processes of the hypnotized, and thus upon the<span class='pagenum'><a name="Page_109" id="Page_109">[Pg 109]</a></span> interplay of his own
+mental functions. All that is needed is a higher degree of
+suggestibility than is found in the normal life. In a more suggestible
+mind even the direct sense impressions may be overwhelmed by the
+proposition for an untrue belief and the strongest desires may yield to
+the new propositions of action. This library may then become a garden
+where the hypnotized person picks flowers from the floor, and the wise
+man stands on one leg and repeats the alphabet, if the hypnotizer asks
+him to do so. Let us consider at first this extreme case. By a few
+manipulations I have brought a man into a deep hypnotic state. He is now
+unable to resist any suggestion, either suggestion of impulse or
+suggestion of belief, and as every one of the hypnotic phenomena can be
+explained in this way, we may claim that the hypnotic state is in its
+very nature a state of re&euml;nforced suggestibility. Whether I say, "You
+will not move your arm," or whether I say, "You cannot move your arm,"
+awakening in the one case the impulse to the suppression of the
+movement, in the other case the belief in the impossibility of the
+movement, in either case the result is the same; the arm remains stiff
+and any effort of his to move it is inhibited. I may go to the extreme
+and tell him that our friend by my side has left the room; he will not
+see him, he will not even hear a word which the friend speaks. If I take
+a hat in my hand and put it on the friend's head, the hat appears to
+hang in the air. Every impression of sound or sight or touch which comes
+from the friend is entirely inhibited. The direct sense im<span class='pagenum'><a name="Page_110" id="Page_110">[Pg 110]</a></span>pression of
+eye and ear is thus completely overwhelmed by the suggestion.</p>
+
+<p>What has happened? Are the manipulations which I applied sufficient to
+produce the changes by their physical influence? Certainly not; they are
+of the most different kinds and yet all may have the same effect.
+Perhaps I may have used the easy method of making the subject stare at a
+shining button held in front of his forehead. Or I may have used slight
+tactual impressions, while he was lying with closed eyes, or I may have
+produced the abnormal state by monotonous noises of falling waterdrops,
+or I may have simply spoken to him and asked him to think of sleep and
+to relax and to feel tired, while I held my hand on his forehead or
+while I held his hand in mine. Or I may have relied upon mild talking
+without touching him at all; and yet every time the result was reached
+in the same degree. There is thus certainly no special physical energy
+which like a magnetic force flows over. It cannot even be said that my
+will is engaged. I have often hypnotized without even thinking of the
+subject before me, going through adjusted manipulations while my
+thoughts were engaged in something else. I have even hypnotized over the
+telephone; and a written note may be substituted with the same result. I
+write to the patient that two minutes after receiving this letter by
+mail, he will fall into hypnotic sleep. The effect sets in; and yet at
+that time, I may not remember sending the note at all.</p>
+
+<p>It is thus entirely evident that the hypnotic effect results only from
+the mental conditions of the subject.<span class='pagenum'><a name="Page_111" id="Page_111">[Pg 111]</a></span> Whatever may stimulate his mind
+to the right kind of reaction will produce the desired result. The
+increased suggestibility thus sets in by his own imagination which may
+be stirred up by slight visual or tactual or acoustic stimuli or by
+monotonous words or by feelings of relaxation and especially by words
+which encourage sleep. But just because it is the play of his own
+imagination, the most essential factor certainly is the will and
+expectation of the subject. No one can really be hypnotized against his
+own will. And to expect strong hypnotic effect from a certain hypnotist
+is often in itself sufficient to produce hypnotic sleep. Thus there is
+no special personal power necessary to produce hypnotism. Everybody can
+hypnotize. And almost with the same sweeping statement it may be said
+everybody can be hypnotized, provided that he is willing to enter into
+this play of imagination. The young child or the insane person is
+therefore unfit.</p>
+
+<p>Of course, not everybody can be hypnotized to the same degree. Just as
+the normal suggestibility showed itself very different with different
+persons, the degree of artificial re&euml;nforcement varies still more.
+Practically everybody can be brought to that breakdown of the
+resistance in which he can no longer open the eyes against the order of
+the hypnotist, but rather few can be brought to the point of seeing
+extended hallucinations, or accepting the disappearance of persons who
+are speaking, or of yielding to the impulse to a dangerous action. The
+highest reported degree, in which even criminal actions are performed
+by<span class='pagenum'><a name="Page_112" id="Page_112">[Pg 112]</a></span> honest men, exists in my opinion only in the imagination of
+amateurs; it is certainly not difficult to produce sham crimes for
+performance sake, with paper daggers and toy pistols, but that is no
+proof at all that the hypnotized person would commit a crime under
+conditions under which he has the conviction that he faces a real
+criminal situation. But if we abstract from real crime, we certainly
+have to acknowledge that actions can be performed which appear in
+striking contrast with the habits and character of the normal
+personality, upset his knowledge, and are based on beliefs which would
+be immediately rejected under ordinary conditions. These higher degrees
+of hypnotic state are easily followed by complete loss of memory for all
+that happened during the abnormal state.</p>
+
+<p>How have we to interpret such a surprising alteration of mind? It lies
+near to compare it with sleep. The brain seems powerless to produce its
+normal ideas, the associations do not arise, the normal impulses have
+disappeared and a general ineffectiveness has set in; in short, the
+brain cells seem unable to function. Of course, the explanation of sleep
+itself may offer difficulties. Is it a chemical substance which poisons
+the brain during the sleep, or are the brain cells contracted so that
+the excitement cannot run over from the branches of one nerve cell into
+those of another? Or are the blood-vessels contracted so that an an&aelig;mic
+state makes their normal function impossible? But whatever the physical
+condition of sleep may be, have we really a right to em<span class='pagenum'><a name="Page_113" id="Page_113">[Pg 113]</a></span>phasize the
+similarity between sleep and hypnosis? After all that we have discussed,
+we ought rather to recognize that the hypnotic state too comes much
+nearer to the process of attention than to the process of sleep. We saw
+that in every act of attention the process of inhibition is essential.
+All that is not in harmony with the attended idea is suppressed. Yet we
+should hesitate to say that in attention parts of our brain are asleep.</p>
+
+<p>We should feel reluctance to group such inhibition together with sleep
+because it would be a sleep which at any moment can pass from one part
+of the brain to others and which certainly leaves at every moment most
+of the cell groups unaffected. We saw that attention does not at all
+focus on one narrow point, but that an abundance of impressions, of
+ideas and associations, of thoughts and emotions can enter the field of
+attention, if they all lead to one and the same motor attitude, and that
+only the one part is inhibited which involves the opposite action. Such
+a jumping sleep which at every moment selects a special part would be,
+of course, just the contrary of that which characterizes the sleep state
+of the fatigued brain. But exactly these characteristics of attention
+belong to hypnotism too. It is not true that the mind of the hypnotized
+is asleep and that perhaps only one or the other idea can be pushed into
+his mind. On the contrary, his mind is open to an abundance of ideas,
+just as in the normal state. If I tell him that this is a landscape in
+Switzerland, he sees at once the mountains and the lakes, and his mind
+provides all the de<span class='pagenum'><a name="Page_114" id="Page_114">[Pg 114]</a></span>tails of his reminiscences, and his imagination
+furnishes plenty of additions. His whole mind is awake; the feelings and
+emotions and volitions, the memories and judgments and thoughts are
+rushing on, and only that is excluded which demands a contrary attitude.
+This selective process stands decidedly in the center of the hypnotic
+experience and makes it very doubtful whether we are psychophysically on
+the right track, if we make much of the slight similarity between
+hypnosis and sleep.</p>
+
+<p>This has nothing to do with the fact that hypnosis is best brought about
+by suggesting the idea of sleep, that is, the belief that sleep will set
+in. This belief is indeed effective in removing all the ideas which are
+awake in the mind which would interfere with the willingness to submit
+to the suggestions of the hypnotizer. But the fact that belief in sleep
+and expectation of sleep bring with them the hypnotic state is not a
+proof that the hypnotic state itself is sleep. Even the mental
+experiences which can remain in sleep, the dreams, are
+characteristically different from the hypnotic experience. Thus the
+dreams show that unselective awakening of ideas which is to be expected
+from a general decrease of functioning. The hypnotic variation is
+characterized just by its selective narrowing of consciousness. For the
+same reason, hypnotism is strikingly different from such diseases of the
+mind as dementia. Certainly in dementia too, many associations are cut
+off, but it is not a selective inhibition, it is a haphazard destruction
+resulting from the degeneration in the brain.<span class='pagenum'><a name="Page_115" id="Page_115">[Pg 115]</a></span></p>
+
+<p>The fundamental principle of the hypnotic state lies in its selective
+character. Inhibited and cut off are those states which are antagonistic
+to the beliefs in the suggested ideas, and as their antagonism consists
+in their connection with opposite actions, the whole is again a question
+of motor setting. No doubt, such new motor setting can precede the
+normal sleep too; thus the sleeper may be insensitive to any surrounding
+noises, but perhaps awake at the slightest call from a patient who is
+intrusted to his care. In that case, one special feature of hypnotism is
+superadded to sleep but the sleep itself is not hypnotic. Again sleep
+may go over into a state which shares many characteristic features with
+hypnotism, that is, somnambulism, and it may be said with a certain
+truth that hypnotism is artificial somnambulism. But somnambulism, while
+arising in sleep, is not at all a feature of sleep.</p>
+
+<p>While sleep is characterized by a decrease of sensitiveness and of
+selective powers, the selective process of hypnotism rather re&euml;nforces
+sensitiveness and memory in every field which is covered by the
+suggestive influence. Stimuli may become noticeable which the normal man
+is unable to perceive, and long-forgotten experiences which seem
+inaccessible to the search of the waking mind may reproduce themselves
+and may vividly enter consciousness. Again we have there symptoms which
+rather characterize the state of over-attention than the state of sleep.
+We might add further that we know states with all the characteristics of
+hypnotism in which even the subjective idea<span class='pagenum'><a name="Page_116" id="Page_116">[Pg 116]</a></span> of sleep is entirely
+absent, for instance, all those which are usually called states of
+fascination. A certain shining light or a glimpse of an uncanny eye may
+startle and upset the imagination of the subject and throw him into a
+state of abnormally increased suggestibility. It is well known that
+whole epidemics of such captivation have occurred and have resulted in
+hysterias of the masses in which the subjects become the slaves of their
+impulse, perhaps to imitate what they see or hear, or to realize ideas
+in which they believe without logical warrant. They surely are not
+asleep, are not even partially asleep. Every center of their brains
+would be ready to work, if the captivated attention were not forcing the
+mind in one direction and selectively suppressing every impulse to
+opposite actions. The developed hypnotism finally shades off into
+innumerable states of hypnoid character in which the sleeplike symptoms
+are entirely in the background.</p>
+
+<p>Thus the increased suggestibility of the hypnotic state will result not
+from a partial sleeplike decrease of functioning but the decrease of
+function is a motor inhibition which results from over-attention. In the
+ordinary attention, our motor setting secures only an increase in
+clearness and vividness of the attended ideas, but in an abnormal
+over-attention the new motor setting produces a complete acceptance with
+all its consequences. Abnormal or heightened attention thus goes
+directly over into the belief and into the impulse without resistance.
+There is no hypnotism which does not contain from the first stage this
+defi<span class='pagenum'><a name="Page_117" id="Page_117">[Pg 117]</a></span>nite relation to certain objects of attention, usually to a
+particular person. All the manipulations, passes, fixation, monotonous
+speaking, and so on narrow the contents of consciousness but hold the
+idea of the hypnotizing person steadily in the center of attention. The
+awakened expectation of sleep, the associated feeling of tiredness all
+help to cut off attention from the remainder of the world, but as no
+real sleep sets in, this cutting off from the remainder re&euml;nforces the
+focusing of attention on the one central idea of the hypnotizing
+personality. Every word and every movement of this personality become
+therefore absorbed with that over-attention which leads at once from a
+mere perceiving and grasping to a complete sinking into the suggested
+idea with the suppression of all opposites, and thus to a blind
+acceptance and belief. We saw before that such belief is indeed nothing
+else but a motor setting in which certain ways of action are prepared.
+We are to think in accordance with the belief in the suggested idea and
+the channels for discharge in the opposite direction are closed. Even
+the ordinary life shows us everywhere that the step from attention to
+belief is a short one. The effort to grasp the object clearly works as a
+suggestion to accept that which we are seeking as really existing, and
+that from which we are to abstract and which we are to rule out through
+our attention, we believe to be non-existent. The prestidigitator does
+his tricks in order to sidetrack our attention, but he succeeds in
+making us believe that we see or do not see whatever he wishes.</p>
+
+<p><span class='pagenum'><a name="Page_118" id="Page_118">[Pg 118]</a></span>That the motor setting alone determines those changes and that a real
+sleeplike inability of the centers does not set in, can also be
+demonstrated by the results of later hypnotizations. I ask my hypnotized
+subject not to perceive the friend in the room; he is indeed unable to
+see him or to hear him. Yet his visual and acoustic centers are not
+impaired, the defect is only selective, inasmuch as he sees me, the
+hypnotizer, and not the friend. But even this selection inhibits only
+the attitude and not the sensorial excitement. If I hypnotize him again
+to-morrow and suggest to him now to remember all that the friend did and
+said during yesterday's meeting, he is able to report correctly the
+sense impressions which he got, which were inhibited only as long as
+they contradicted the suggestion, but now rush to consciousness as soon
+as the suggestion is reversed. As a matter of course, he must therefore
+have received impressions through eye and ear in his hypnotic sleep of
+yesterday from all that happened, only he was not aware of it because
+the channels of the accepting attitude were blocked.</p>
+
+<p>As soon as the over-attention has produced the acceptance of the belief,
+all further effects are automatic and necessary. If I tell the
+hypnotized person that he cannot speak and he absorbs this proposition,
+with that completeness in which he accepts it as a fact, not speaking
+itself unavoidably results. The motor ideas with which the speech
+movement has to start are cut off and the subject yields passively to
+the fate that he cannot intonate his voice. Thus a special influence<span class='pagenum'><a name="Page_119" id="Page_119">[Pg 119]</a></span> on
+the will is in no way involved. If the idea is accepted, and that means,
+if the preparatory setting for the action has been completed, the ideas
+of opposite activity must remain ineffective; the suggested idea must
+discharge itself in action without resistance. As a matter of course the
+new line of action will then surround itself with its own associations
+and will thus give to the subject the impression that he is acting from
+his own motives. As soon as the psychophysical principles are
+understood, there is indeed no difficulty in going from the simplest
+experience to those spectacular ones where we may suggest to the
+profoundly hypnotized person that he is a little child or that he is
+George Washington. In the one case, he will speak and cry and play and
+write as in his present imagination a child would behave; in the other
+case, he will pose in an attitude which he may have seen in a picture of
+Washington. There is nothing mysterious and his utterances are
+completely dependent upon his own ideas, which may be very different
+from the real wisdom of a Washington and the real unwisdom of a child. I
+may suggest to him to be the Czar, by that he will not become able to
+speak Russian. In the same way I may suggest changes of the
+surroundings; he may take my room for the river upon which he paddles
+his canoe, or for the orchard in which he picks apples from my
+bookshelves.</p>
+
+<p>Finally there is no new principle involved, if the action which is
+prepared by any belief has to set in after the awaking from hypnotic
+sleep, the so-called<span class='pagenum'><a name="Page_120" id="Page_120">[Pg 120]</a></span> post-hypnotic suggestion. As a matter of course,
+just these have an eminent value for psychotherapy. I may suggest to-day
+that the subject will overcome to-morrow his desire for the morphine
+injection, or that he will feel to-night the restfulness which will
+overcome his insomnia. But if the suggestion of an idea means belief,
+and if belief means a preparation for action, we have indeed no new
+factor before us if the action for which we prepare the subject is from
+the start related to a definite time. If we do not link it with the
+consciousness of a special time or of a special occasion which will
+occur later, the suggestion soon fades away. That my library is an
+orchard is forgotten perhaps within ten minutes, if I have not come back
+to it in the conversation. But if I say that after awaking as soon as I
+shall knock on my desk three times, you will be in the orchard again,
+the psychophysical apparatus is prepared, a new setting has set in, the
+three knocks will bring about the complete transformation. In short the
+difficulties disappear as soon as we are consistent in interpreting all
+suggestive influences as changes in the motor setting and as the result
+of the antagonistic character of all of our motor paths.</p>
+
+<p>We say the difficulties disappear. Of course, that is meant in a
+relative sense only. It means essentially that we are able to bring the
+complex state of hypnotism down to the similar state of attention and
+motor adjustment, but of course we must not forget that we are far from
+a satisfactory explanation of the process in attention itself. We know
+that the opening of<span class='pagenum'><a name="Page_121" id="Page_121">[Pg 121]</a></span> motor channels in one direction somewhat closes the
+channels for discharge in the opposite direction, but what mechanism
+does that work is still very obscure. Whichever principle of
+hypothetical explanation we might prefer, it certainly leads to
+difficulties in view of the extreme complexity of attention in states of
+suggestion and hypnotism. We might think of a mechanism which through
+the medium of the finest blood-vessels should produce a localized an&aelig;mia
+in those centers which lead to the antagonistic action. Or we might
+fancy that by extremely subtle machinery the resistance is increased in
+those tissues which lie between the various neurons, or we might even
+think of toxic and antitoxic processes in the cerebral regions; and any
+day may open entirely new ways of explanation. We may add that even if
+the mechanism of attention were completely explained, we are also still
+far from understanding the physiological changes which go on in the
+sphere of the blood-vessels or of the glands and the internal organs. We
+understand easily that the idea of the subject that he cannot move his
+arm keeps the arm stiff; but that his idea to blush really dilates the
+blood-vessels of his cheek is much less open to our causal
+understanding; still less that in very exceptional cases perhaps a part
+of the skin becomes inflamed, if we make believe that we touch it with a
+glowing iron. And yet here too we see that we move in the same direction
+and that we have to explain these exceptional and bewildering results by
+comparing them with the simpler and simpler forms, that the process of
+atten<span class='pagenum'><a name="Page_122" id="Page_122">[Pg 122]</a></span>tion contains all the germs for the whole development.</p>
+
+<p>In claiming that hypnotism depends upon the over-attention to the
+hypnotizing person, we admit that the increased suggestibility belongs
+entirely to suggestions which come from without. Only that which at
+least takes its starting point from the words or the movements of the
+hypnotizer finds over-sensitive suggestibility. Ideas which arise merely
+from the associations of the subject himself have no especially
+favorable chance for acceptance. But surely we also know states in which
+the suggestibility for certain of one's own ideas is abnormally
+increased. Great individual differences exist in that respect in normal
+life. There are normal hypochondriacs who believe that they feel the
+symptoms of widely different diseases under the influence of their own
+ideas, and others who are torturing themselves with fears on account of
+unjustified beliefs. But the abnormal increase of suggestibility
+parallel to that of hypnotism for suggestions from without exists for
+suggestions from within, mainly in nervous diseases, especially in
+neurasthenic, hysteric, and psychasthenic states. Within certain limits,
+we might almost say that this increase of suggestibility for
+autosuggestion is the fundamental characteristic of these diseases, just
+as increase of suggestibility for heterosuggestions characterizes
+hypnotism.</p>
+
+<p>Especially in earlier times, the theory was often proposed that hypnosis
+is an artificial hysteria. Such a view is untenable to-day; but that
+hysteria too shows<span class='pagenum'><a name="Page_123" id="Page_123">[Pg 123]</a></span> abundant effects of increased suggestibility is
+correctly indicated by such a theory. The hysteric patient may by any
+chance pick up the idea that her right arm is paralyzed or is
+anaesthetic and the idea at once transforms itself into a belief and the
+belief clings to her like an obsession and produces the effect that she
+is unable to move the arm or that she does not feel a pinprick on the
+skin. These autosuggestions may take a firmer hold of the mind than any
+suggestions from without, but surely such openness to selfimplanted
+beliefs must be acknowledged as symptomatic of disease, while hypnosis
+with its impositions can be broken off at any moment and thus should no
+more be classed among the diseases than are sleep and dreams. The
+hysteric or psychasthenic autosuggestion resists the mere will of
+breaking it off. Here, therefore, is the classical ground for strong
+mental counterinfluences, that is, for psychotherapeutic treatment.
+Experience shows that the strongest chance for the development of such
+autosuggestive beliefs exists wherever an emotional disposition is
+favorable to the arriving belief. But emotion too is after all
+fundamentally a motor reaction. The whole meaning of emotion in the
+biological sense is that it focuses the actions of man into one channel,
+cutting off completely all the other impulses and incipient actions.
+Emotion is therefore for the expressions of man what attention is for
+the impressions. An emotional disposition means thus in every case a
+certain motor setting by which transition to certain actions is
+facilitated. It is thus only natural that a<span class='pagenum'><a name="Page_124" id="Page_124">[Pg 124]</a></span> belief can settle the more
+easily, the more it is favored by an emotional disposition, as the motor
+setting for the one must prepare the other. Hypnosis and hysteria thus
+represent the highest degrees of suggestibility, the one artificial, the
+other pathological; the one for suggestions from without, the other for
+suggestions from within. But between these two and the normal state
+there lie numberless steps of transition. The normal variations
+themselves may go to a limit where they overlap the abnormal artificial
+product, that is, the suggestibility of many normal persons may reach a
+degree in which they accept beliefs hardly acceptable to other persons
+in mild hypnotic condition. Thus there is no sharp demarcation between
+suggestions in a waking state and suggestions in a hypnoid state. And
+the expectation of coming under powerful influence may produce a
+sufficient change in the motor setting to realize any wonders. Moreover
+probably every physician who has a long experience in hypnotizing has
+found that his confidence in the effectiveness of the deep hypnotic
+states has been slowly diminished, while his belief in the surprising
+results of slight hypnotization and of hypnoid states has steadily grown
+and has encouraged him in his psychotherapeutic efforts.<span class='pagenum'><a name="Page_125" id="Page_125">[Pg 125]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="VI" id="VI"></a>VI<br /><br />
+<span class="sub">THE SUBCONSCIOUS</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>The story of the subconscious mind can be told in three words: there is
+none. But it may need many more words to make clear what that means, and
+to show where the misunderstanding of those who give to the subconscious
+almost the chief r&ocirc;le in the mental performance sets in. The psychology
+of suggestion, for instance, which we have now fully discussed without
+even mentioning the word subconscious, figures in most popular books in
+the treatises of both physicians and ministers as a wonderful dominance
+of the subconscious mind. The subconscious mind alone receives the
+suggestions and makes them effective, the subconscious mind controls the
+suggestive processes in consciousness, and the subconscious mind comes
+into the foreground and takes entire hold of the situation when the
+hypnotic state sets in.</p>
+
+<p>But we are always assured that there is no need of turning to the
+mystery of suggestion and hypnotism to find that uncanny subpersonality
+in us. We try to remember a name, or we think of the solution of a
+problem; what we are seeking does not come to consciousness and now we
+turn to other things; and sud<span class='pagenum'><a name="Page_126" id="Page_126">[Pg 126]</a></span>denly the name flashes up in our mind or
+the solution of the problem becomes clear to us. Who can doubt that the
+subconscious mind has performed the act? While our attention was given
+over to other questions, the subconscious mind took up the search and
+troubled itself with the problem and neatly performed what our conscious
+mind was unable to produce. Moreover in every situation we are
+performing a thousand useful and well-adapted acts with our body without
+thinking of the end and aim. What else but the subconscious mind directs
+our steps, controls our movements, and adjusts our life to its
+surroundings? And is not every memory picture, every reminiscence of
+earlier experiences a sufficient proof that the subconscious mind holds
+its own? The poem which we learned years ago did not remain somewhere
+lingering in our consciousness, and if we can repeat it today, it must
+be because our subconscious mind has kept it carefully in its store and
+is ready to supply us when consciousness has need for it.</p>
+
+<p>Surely if we think how this, our subconscious mind, is able to hold all
+our memories and all our learning, and how it transacts all the work of
+controlling our useful actions and of bringing up the right ideas, we
+may well acknowledge that compared with it our conscious life is rather
+a small part. It is as with the iceberg in the ocean; we know that only
+a small part is visible above the surface of the water and a ten times
+larger mountain swims below the sea. It seems, therefore, only logical
+to attach this whole subconscious mental life to a special subconscious
+personal<span class='pagenum'><a name="Page_127" id="Page_127">[Pg 127]</a></span>ity. Then we come to the popular theory of the two minds in us,
+the upper and the lower, of which we can hardly doubt that the lower one
+has on the whole the larger part of the business to perform. And we
+certainly have no right to give to the word lower mind the side-meaning
+that the activity is of a lower order. The most brilliant thoughts of
+the genius are not manufactured in his upper consciousness, they spring
+suddenly into his mind, their whole creation belongs thus to the
+assiduous work of the subconscious neighbor. There the inventor and
+discoverer gets his guidance, there the poet gets his inspiration, there
+the religious mind gets its beliefs. In short, the constitution of the
+mental state allows on the whole to the upper consciousness a rather
+decorative part while the real work is left for the lower house.</p>
+
+<p>Yet it must be acknowledged that the scholars somewhat disagree as to
+the dignity of the lower mind. Considering the usually accepted fact
+that in hypnotism the lower mind comes entirely over the surface, just
+these hypnotic events can indeed suggest two different views of the
+subconscious and this doubleness is re&euml;nforced if we still add the
+entertaining material which comes to light by the automatic writing of
+mediums in their trance. The hypnotized person is ready to perform any
+foolishness, is not influenced by any considerations of tact and taste
+and wisdom and respect, and thus some of the chief believers in the
+subconscious personality stick to the diagnosis that the lower mind in
+us which shows up<span class='pagenum'><a name="Page_128" id="Page_128">[Pg 128]</a></span> in hypnotism is a rather brutal, stupid, lazy,
+cowardly, immoral creature which ordinarily rather deserves to be
+subdued by our noble and wise upper personality. And the automatic
+writings of the mediums indorse this disrespectful view, for it is
+difficult to gather more idiotic slang than the emanations of these
+letters of the planchette. On the other hand, the hypnotized person
+shows an increase of sensitiveness and hyper&aelig;sthesia in which perhaps
+optical impressions or smells may be noticed which the ordinary man
+cannot perceive. Moreover the memory of the hypnotized is, as we saw,
+abnormally sharpened. Entirely forgotten experiences may awake again.
+The same holds true for the hysteric in whom also, of course, the
+subconscious takes hold of the inner life. Thus it seems entirely safe
+to say that the powers of the subconscious personality far surpass those
+of the upper conscious fellow, and that agrees with all those facts as
+to the subconscious origin of the work of the genius. Further, has it
+not been found again and again that the hypnotized and the hysteric
+cannot only remember long-forgotten parts of the past but have
+telepathic knowledge for distant events and even mysterious premonitions
+of the field of occurrences of the future?</p>
+
+<p>Hypnotism is essentially the same as the old mesmerism, and mesmerism
+was widely acknowledged as clairvoyance, and all that harmonizes again
+with the experiences of the mediums whose subconscious mind in trance
+enters into contact with the spirits of the dead. The subconscious
+personality is thus really<span class='pagenum'><a name="Page_129" id="Page_129">[Pg 129]</a></span> a metaphysical power which transcends the
+limitations of the earthly person altogether and has steady connection
+with the endless world of spirit and the inner soul of the universe.
+Most popular books, it is true, do not demand from their readers the
+choice between the one or the other type of the lower personality,
+between that brutal, vicious, ignorant creature and that far-seeing,
+inspired, powerful soul. They simply mix the two and adapt the special
+faculties of this underground man to the special requirements of the
+particular chapter, the subconscious being unusually wise or unusually
+stupid in accordance with the special facts which are just then to be
+explained. Even that does not always settle all difficulties. They may
+discover, for instance, that the subconscious mind with which we deal in
+the hypnotized person has again itself a subconsciousness. If we tell
+the hypnotized person not to see a certain picture on the wall, this
+subconscious personality perceives the whole room with the exception of
+the picture. Yet after all someone sees this picture, because if we
+hypnotize him the next time and ask him what the picture contained, he
+now knows its contents. Thus they must have been recognized in a
+sub-subconsciousness, and we therefore come to a personality which lives
+on a floor still below the basement. But experiment can demonstrate that
+even this most hidden personality has still its secrets which are handed
+downwards. In short, we finally have not merely two but a number of
+personalities in us.</p>
+
+<p>But now let us leave these fantasies of psycholog<span class='pagenum'><a name="Page_130" id="Page_130">[Pg 130]</a></span>ical fiction. Let us
+turn to the concrete facts, let us see them in the spirit of modern
+scientific psychology, let us try to explain them in harmony with the
+principles of psychological explanation, and let us discriminate the
+various groups of facts which have led to that easy-going hypothesis of
+the subconscious. Discrimination indeed is needed, as it would be
+impossible to bring the whole manifold of facts under one formula, but
+there is certainly no unification reached by simply putting the same
+label on all the varieties and behaving as if they are all at once
+explained when they are called the functions of the subconscious. Two
+large groups may be separated. Facts are referred to the subconscious
+mind which do not belong to the mind at all, neither to a conscious nor
+to a subconscious one, but which are simply processes in the physical
+organism; and secondly, facts are referred to the subconscious mind
+which go on in the conscious mind but which are abnormally connected.
+Thus the subconscious mental facts are either not mental but
+physiological, or mental but not subconscious.</p>
+
+<p>What does the scientific psychologist really mean by consciousness? We
+must now think back to our discussion of the principles which control
+the fundamental conceptions of modern psychology. We saw clearly that
+the psychology which is a descriptive and explanatory science of mental
+phenomena can by no means have the ambition to be a full interpretation
+of the inner reality. Our inner life, we saw, is not a series of
+phenomena, is not a chain of objects which<span class='pagenum'><a name="Page_131" id="Page_131">[Pg 131]</a></span> we are aware of and which we
+therefore can describe, and which finally we can explain. But in its
+living reality, we saw that it is purposive, has a meaning and aim, is
+will and intention, and can thus be understood in its true character,
+not by describing and explaining it but by interpreting it and
+appreciating it. This is the life attitude towards personalities when we
+deal man to man. We do not at first consider ourselves or our fellows as
+mental objects to be explained but always as subjects to be understood
+in their meaning. If we pass from this primary attitude to the attitude
+of the scientific psychologist we gain, as we saw, an artificial
+perspective. We must consider then our inner experience of ourselves
+with all our states as a series of objects made up of elements connected
+by law. Instead of the real things which in our real life are objects of
+will and purpose, tools and means for us, the psychologist knows only
+objects of awareness, objects which have no meaning, but which simply
+exist and which are no longer related to a will but are connected with
+other objects as causes and effects. Now we deal no longer with the
+chairs and tables before us but from a psychological point of view they
+become perceptive ideas of chairs and tables, ideas which are not in the
+room but in our own minds. While these objects of our will and of our
+personality become mere ideas, our will and personality themselves
+become, too, a series of phenomena. Our self is now no longer the
+purposive will but is that group of sensations and ideas which clusters
+about the perception of our organ<span class='pagenum'><a name="Page_132" id="Page_132">[Pg 132]</a></span>ism and its actions; in short, our
+self itself becomes an object of awareness.</p>
+
+<p>Our whole inner experience thus becomes a manifold of objects. Our self
+and the actions of our self are thus alike for the psychologist mere
+phenomena, mere objects which are perceived. Will and emotion, memory
+idea and thought&mdash;they all are now passing appearances like the sunshine
+and rain, the flowers and waves. By this transformation the immediate
+will character of real life is given up, but instead of it a system of
+objects is gained, that allows description and explanation. If we are to
+deal at all with inner life not from a purposive but from a causal point
+of view, we are obliged to admit this reconstruction. Without it we
+cannot have any science of the mind, without it we can understand the
+intentions of our neighbor and appreciate the truth and morality of his
+meanings but we cannot causally explain his experiences or determine
+which effects are to be expected. It is thus not an arbitrary
+substitution but a procedure just as necessary and logically obligatory
+as the work of the chemist who substitutes trillions of invisible atoms
+for the glass of water which he drinks. The possibility of causal
+explanation of the successive facts demands this remolding of the outer
+and of the inner world. We have discussed that before and now only have
+to draw the consequences.</p>
+
+<p>Thus for the psychologist the mental world is a system of mental
+objects. To be an object means of course to be object of some subject
+which is aware of<span class='pagenum'><a name="Page_133" id="Page_133">[Pg 133]</a></span> it. What else could it mean to exist at all as object
+if not that it is given to some possible subject? But the world of
+objects is twofold; we have not only the mental objects of the
+psychologist but also the physical objects of the naturalist. Science
+must characterize the difference between those two and we pointed once
+before to the only fundamental difference. Physical objects are those
+which are possible objects of awareness for every subject; psychical
+objects are those which are possible objects of awareness for one
+subject only. The tree which I see is as physical tree object for every
+man, it is the same tree which you and I see; my psychical perception of
+the tree is object for one subject only. My perception can never be your
+perception. Our perceptions may agree but each has his own. As to the
+physical objects, we can entirely abstract from such reference to the
+subjects. We say simply: the tree exists or is part of nature; and only
+the philosopher is aware that we silently mean by it that it exists for
+every subject and that it is therefore not necessary to refer to any
+particular subject. But the perception of the tree which is either your
+idea or my idea evidently gets its existence only if it is referred and
+attached to a particular subject which is aware of it. Such subject of
+awareness is that which the psychologist calls consciousness and all the
+ideas and volitions and emotions and sensations and images which make up
+the mental life are then contents of the consciousness or objects of the
+consciousness. To have psychical existence at all means thus to be
+object of awareness for a consciousness.<span class='pagenum'><a name="Page_134" id="Page_134">[Pg 134]</a></span> Something psychical which
+simply exists but is not object of consciousness is therefore an inner
+contradiction. Consciousness is the presupposition for the existence of
+the psychical objects. Psychical objects which enjoy their existence
+below consciousness are thus as impossible as a wooden piece of iron.</p>
+
+<p>If consciousness is nothing but the subject of awareness for the
+individual objects, we see at once certain consequences which are too
+often forgotten in the popular, haphazard psychology. In the scientific
+system of psychology, consciousness has for instance nothing whatever to
+perform, that is, consciousness itself is in no way active. The active
+personality of real life has been left behind and has itself been
+transformed into that self which is merely content of consciousness. The
+person who acts and performs the deeds of our life is then only a
+central content of our consciousness which is crystallized about the
+idea of our organism. It has thus become one of the contents of which
+consciousness itself is passively aware. Consciousness is an inactive
+spectator for the procession of the contents. Thus consciousness itself
+cannot change anything in the content nor can it connect the contents.
+No other function is left to consciousness but merely that of awareness.
+Every change and every fusion and every process must be explained
+through the relations of the various contents to one another.
+Consciousness has, therefore, not the power to prefer the one idea or to
+reject the other, to re&euml;nforce the one sensation and to inhibit the
+other. From a psychological point of view, we have seen<span class='pagenum'><a name="Page_135" id="Page_135">[Pg 135]</a></span> before that
+even attention does not mean an activity of consciousness but a change
+in the content of consciousness. Certain sensations become more
+impressive, more clear, and more vivid, and others fade away, become
+indistinct and disappear, but all that goes on in the content of
+consciousness and the spectator, consciousness itself, simply becomes
+aware of those changes. Consciousness has also in itself no special
+span, ideas appear or disappear not because consciousness expands or
+narrows itself but because the causal conditions awaken or suppress the
+various contents.</p>
+
+<p>Consciousness has in itself no limit; all organization belongs to the
+content. Whatever psychical states are attributed to one organism belong
+thus to its consciousness but all the connections are entirely
+connections of the content. We, therefore, have not even the right to
+say that consciousness, as such, has unity. Unity too belongs to the
+organization of the content. One part of the content hangs together with
+the other parts but consciousness is only the constant condition for
+their existence. Where there is no unity, there it cannot have any
+meaning to speak of the double or triple existence. There may be a
+disconnection in the various parts of the content and a dissociation by
+which the normal ties between the various contents may be broken but
+consciousness itself cannot fall asunder. Thus consciousness cannot have
+any different degrees. The same consciousness experiences the distinct
+clear content and the vague fading confused content. Thus also
+consciousness can never<span class='pagenum'><a name="Page_136" id="Page_136">[Pg 136]</a></span> be aware of itself and the word
+self-consciousness is easily misleading. In psychology, it can never
+mean that the consciousness which is a subject of all experience is at
+the same time object of any experience. Its whole meaning lies in its
+being the passive spectator. That of which consciousness becomes aware
+in self-consciousness is the idea of the personality, which is certainly
+a content. The personality, the actor of our actions, is thus never
+anything but an object in psychology, and consciousness never anything
+but a subject. Consciousness itself is thus in no way altered when the
+idea of the personality is changing. Only if all this is carelessly
+confused, if consciousness is sometimes treated as meaning subject of
+consciousness, and at another time as meaning the content of
+consciousness, and again at another time the unified organization of the
+content, and at still another time the connection of the content with
+the personality, and if finally all that is confused with the purposive
+reality of the immediate personal life&mdash;only then, do we find the way
+open to those tempting theories of the subconscious personality.</p>
+
+<hr class="subsection" />
+
+<p>If, instead, we stick to the scientific view, we find the following
+facts. First, we have everywhere with us the fact that the earlier
+experiences may again enter into consciousness as memory images or as
+imaginative ideas, that is, in the order in which they are experienced a
+long time before or in a new order, either with a feeling of
+acquaintance or without it. Certainly at no time is the millionth part
+of what we<span class='pagenum'><a name="Page_137" id="Page_137">[Pg 137]</a></span> may be able to reproduce present in our consciousness. Where
+are those words of the language, those faces of our friends, those
+landscapes, and those thoughts; where have they lingered in the time of
+their seclusion? Scientific psychology has no right to propose any other
+theory as explanation but that no mental states at all remain and that
+all which remained was the disposition of physiological centers. When I
+coupled the impression of a man with the sound of his name, a certain
+excitement of my visual centers occurred together with the excitement of
+my acoustical centers; the connecting paths became paths of least
+resistance, and any subsequent excitement of the one cell group now
+flows over into the other. It is the duty of physiology to elaborate
+such a clumsy scheme and to make us understand in detail how those
+processes in the neurons can occur and it is not the duty of psychology
+to develop detailed physiological hypotheses. Psychology has to be
+satisfied with the fact that all the requirements of the case can be
+furnished by principle through physiological explanation. Least of all
+ought we to be discouraged by the mere complexity of the process. If a
+simple sound and a simple color sensation, or a simple taste and simple
+smell sensation, can associate themselves through mere nervous
+conditions of the brain, then there is nothing changed by going over to
+more and more complex contents of consciousness. We may substitute a
+whole landscape for a color patch or the memory of a book for a word,
+but we do not reach by that a point where the physiological principle of
+explanation, once ad<span class='pagenum'><a name="Page_138" id="Page_138">[Pg 138]</a></span>mitted, begins to lose its value. Complexity is
+certainly in good harmony with the bewildering manifoldness of those
+thousands of millions of possible connections between the brain cells.</p>
+
+<p>Every experience leaves the brain altered. The nerve fibers and the
+cells have gone into new stages of disposition for certain excitements.
+This disposition may be slowly lost. In that case the earlier experience
+cannot be reproduced; we have forgotten it. But as long as the
+disposition lasts&mdash;it is quite indifferent whether we conceive it more
+in terms of chemical changes or physical variations, as processes in the
+nerve cells or between the nerve cells&mdash;the physiological change alone
+is responsible for the awakening of the memory idea under favoring
+associative conditions. Of course, someone might reply: can we not fancy
+that there remains on the psychical side also a disposition? Each idea
+which we have experienced may have left a psychical trace which alone
+may make it possible that the idea may come back to us again. But what
+is really meant and what is gained by such a hypothesis?</p>
+
+<p>First, do not let us forget that such a proposition could only have one
+possible end in view, namely, the explanation of the reappearance of
+memories. But when we discussed the basis of physiological psychology,
+we convinced ourselves that mental facts as such are not causally
+connected anyhow. Our real inner life has its internal connections,
+connections of will and purpose, but as soon as we have taken that great
+psychological step and look on inner life as<span class='pagenum'><a name="Page_139" id="Page_139">[Pg 139]</a></span> merely psychological
+objects, then the material is connected only through the underlying
+physiological processes and we can never explain causally the appearance
+of an idea through the preceding existence of another idea. We may
+expect one after the other, but we have no insight into the mechanism
+which makes the second follow after the first. Such insight into
+necessary connection we find only on the physical side, and we saw that
+just here lies the starting point for the modern view of physiological
+psychology. If that holds true for the connections between idea and
+idea, of course it holds true in the same way for the connection between
+mental disposition and the corresponding memory. We can understand
+causally that a chemical disposition in the nerve fibers brings about a
+chemical excitement in those neurons, but how a mental disposition is to
+create mental experience we could not understand; and to explain it
+casually, we should need again a reference to the underlying
+physiological processes. The hypothesis of mental dispositions would
+thus be an entirely superfluous addition by which we transcend the real
+experience without gaining anything for the explanation.</p>
+
+<p>Secondly, if we really needed a mental disposition for each memory
+picture, in addition to the physiological disposition of the brain
+cells, can we overlook that exactly the same thing would then be
+necessary for every perception also? The outer impression produces,
+perhaps through eye or ear or skin, an excitement of the brain cell and
+this excitement is ac<span class='pagenum'><a name="Page_140" id="Page_140">[Pg 140]</a></span>companied by a sensation; and no one fancies that
+the appearance of this sensation is dependent upon a special disposition
+for it on the mental side. No one fancies it, because it is evident that
+such a hypothesis again would be entirely useless. If every new
+perception needed such a special mental disposition, we should have to
+presuppose dispositions for everything which possibly can come into our
+surroundings. Every smell, every word, every face which comes anew to us
+would need its special ready-made disposition. In other words, our mind
+would contain the disposition for every possible idea and that would
+mean that these dispositions would be in no way helps for explanation.
+If the disposition exists for everything, no one particular thing can be
+explained by the existence of that disposition. Again we should have to
+rely entirely upon the physiological brain excitement for explaining
+that this word or that word is perceived by our mind. But if the brain
+excitement alone is sufficient to explain the new perception in the
+mind, then no reason can be found why the renewed brain excitement would
+not be sufficient to renew the mental experience. Thus there is nowhere
+room for mental dispositions below the level of consciousness.</p>
+
+<p>Thirdly, what could we really mean by such mental dispositions? A
+physiological disposition for a physiological action is certainly not
+the action itself. The finger movement in piano playing finds only a
+disposition in my brain centers, in case I am trained; the movement
+itself does not last. But the dis<span class='pagenum'><a name="Page_141" id="Page_141">[Pg 141]</a></span>position is at least itself a change
+in the physical world. The molecules are somehow differently placed, the
+disposition has thus as much objective existence as the resulting
+movement. Nothing at all similar can be imagined in the sphere of
+psychical contents. Such mental dispositions would have to exist
+entirely outside the world of concrete mental experiences and, if we
+scrutinize carefully, we soon discover that such theories are only
+lingering reminiscences of the purposive view of life, and do not fit at
+all into the causal one. If we take the purposive attitude, then every
+idea and every will contains indeed all that its meaning involves and
+everything which we can logically develop out of it is by intention
+contained in it. All mathematical calculations are then contained in the
+thought of figures and forms, but they are contained there only by
+intention, they are logically inclosed; psychologically the
+consciousness of the figures and forms does not contain any disposition
+for the development of mathematical systems. We indeed have no right to
+throw into a psychological subconsciousness all that which is not
+present but involved by intention in the ideas and volitions of our
+purposive life.</p>
+
+<p>If thus the memory idea is linked with the past experience entirely by
+the lasting physiological change in the brain, we have no reason to
+alter the principle, when we meet the memory processes of the hypnotized
+person or the hysteric. It is true their memory may bring to light
+earlier experiences which are entirely forgotten by the conscious
+personality, but<span class='pagenum'><a name="Page_142" id="Page_142">[Pg 142]</a></span> that ought to mean, of course, only that nerve paths
+have become accessible in which the propagation of the excitement was
+blocked up before. That does not bring us nearer to the demand for a
+subconscious mental memory. The threshold of excitability changes under
+most various conditions. Cells which respond easily in certain states
+may need the strongest stimulation in others. The brain cells which are
+too easily excited perhaps in maniacal exultation would respond too
+slowly in a melancholic depression. Hypnotism, too, by closing the
+opposite channels and opening wide the channels for the suggested
+discharge, may stir up excitements for which the disposition may have
+lingered since the days of childhood and yet which would not have been
+excited by the normal play of the neurons. Quite secondary remains the
+question of how these reproduced images finally appear in consciousness,
+that is, whether they appear with reference to earlier happenings and
+are thus felt as remembrances, or whether they enter as independent
+imaginations, or whether they finally, under special conditions, take
+the character of real, new perceptions. The latter case is well-known in
+crystal-gazing, where long-forgotten memory ideas project themselves
+into the visual field like hallucinations. But for the theory of the
+subconscious, even these uncanny crystal visions do not mean more than
+the simplest awakening of the experience of a landscape image of
+yesterday.</p>
+
+<p>We turn to a second group of facts and again we have no fault to find
+with the observation of the facts,<span class='pagenum'><a name="Page_143" id="Page_143">[Pg 143]</a></span> even of the most surprising and
+exceptional ones. Our objection refers to the interpretation of them.
+This second group contains the active results of such physiological
+nervous dispositions. In the first group, the dispositions come in
+question only as conditions for a new excitement which was accompanied
+by mental experience. In this second group, the dispositions are causes
+for other physiological processes which either lead to actions or to
+influences on other mental processes. The dispositions are here working
+like the setting of switches which turn the nervous process into special
+tracks. In the simple cases, of course no one doubts that a purely
+physiological basis is involved. The decapitated frog rubs its skin
+where it is touched with a drop of muriatic acid in a way which is
+ordinarily referred to the trained apparatus of his spinal cord, as no
+brain is left, and the usefulness of the action and its adjustment is
+very well understood as the result of the connecting paths in the
+nervous system.</p>
+
+<p>From such simple adjustment of reactions of the spinal cord, we come
+step by step to the more complex activities of the subcortical brain
+centers, and finally to those which are evidently only short-cuts of the
+higher brain processes. That we react at every change of position with
+the right movements to keep our bodily balance, that we walk without
+thinking of our steps, that we speak without giving conscious impulse
+for the various speech movements, that we write without being aware of
+the motor activity which we had to learn slowly, that we play the piano
+without thinking of the special impulses of the hands,<span class='pagenum'><a name="Page_144" id="Page_144">[Pg 144]</a></span> that we select
+the words of a hasty speech, if we have its aim in mind, without
+consciously selecting the appropriate words&mdash;all that is by continuous
+transitions connected with those simplest automatic reactions. And from
+here again, we are led over gradually perhaps to the automatic writings
+of the hysteric who writes complex messages without having any idea of
+their content in consciousness. It is in such cases certainly a symptom
+of disease that the activity of these lower brain centers can go over
+into the motor impulse of writing without producing secondary effects in
+the highest conscious brain centers; it is hysterical. But that the
+message of the pencil can be brought about by such operation of lower
+brain centers, or at least with imperfect co&ouml;peration of the higher
+brain centers, is certainly entirely within the limits of the same
+physiological explanation.</p>
+
+<p>On the other hand, nothing is changed in the theoretic principles of the
+case if the effect of these automatic processes in the nervous system is
+not an external muscle action at first, but an influence on other brain
+centers which may furnish the consciousness with new contents. We try to
+remember a name, that is, a large number of neuron processes are setting
+in which normally lead to the excitement of that particular process
+which furnishes us the memory image of the name. But those brain cells
+may not respond, the channels may be blocked somehow or the excitability
+of those cells may be lowered. Now new excitements engage our
+psychophysical system. We are thinking of other problems. In the
+meantime, by<span class='pagenum'><a name="Page_145" id="Page_145">[Pg 145]</a></span> the new equilibrium in the brain the blockade in these
+first paths may slowly disappear or the threshold of excitability may be
+changed. The physiological excitement may now be carried effectively
+into those tracts. The cell response sets in and suddenly the name comes
+to our mind. This purely physiological operation in our brain paths must
+thus have exactly the same result which it would have had, if more parts
+of the process had been accompanied by conscious experience. And again
+from mere remembering a forgotten name, we come by slow steps to the
+solution of a problem, to the invention, and finally to the creation of
+the genius.</p>
+
+<p>Superficiality of thought is easily inclined to object to such a
+physiological interpretation and perhaps to denounce it pathetically as
+a crude materialism which lowers the dignity of mental work. Nothing
+shows more clearly the confusion between a purposive and causal view of
+the mind. In the purposive view of our real life, only our will and our
+personality have a meaning and can be related to the ideas and higher
+aims. Nature is there nothing but the dead material which is the tool of
+our will and which has to be mastered by the personality. In that world
+alone lie our duty and our morality. But as soon as we have gone over to
+the causal aspect of our life and have taken the point of view of the
+psychologist, making our inner life a series of contents of
+consciousness, of psychical phenomena, we have transformed our inner
+experience in such a way that it has become itself nothing but nature.<span class='pagenum'><a name="Page_146" id="Page_146">[Pg 146]</a></span></p>
+
+<p>It is mental nature, nature of psychical stuff, but each part of it is
+nothing but a mental element, a mental atom without any meaning and
+without any value; nothing but a link in the chain, nothing but a factor
+in the explanation of the whole, nothing to which any ethical or
+&aelig;sthetic or logical or religious significance can any longer be
+attached. The psychical sensations and the physical atoms are equally
+material for naturalistic explanation. To understand causally a certain
+effect, for instance the creation of a work of art, of a discovery or a
+thought or a deed as the product of psychical processes, is thus in no
+way more dignified or more valuable than to understand it as the product
+of physiological brain processes. The one is not more dignified than the
+other because both alike have nothing whatever to do with dignity. Both
+alike are the necessary results of the foregoing processes, and to
+attach a kind of sentimental preference to the explanation through
+conscious factors is nothing but a confused reminiscence again of the
+entirely different purposive view of life. And surely nothing is gained
+for the higher values of life if this confusion sets in, because if the
+popular mind becomes unable to discriminate between the secondary,
+causal, artificial aspect of science and the primary, purposive aspect
+of life, the opposite effect lies still nearer: the values of the real
+life suffer and are crowded out by the knowledge of the scientific
+facts. Man's moral freedom is then wrongly brought in question, as soon
+as it is learned that every action is the product of brain processes.
+Life and science alike will gain the<span class='pagenum'><a name="Page_147" id="Page_147">[Pg 147]</a></span> more, the more clearly the
+purposive and the causal point of view are separated and the more it is
+understood that this causal aspect itself is demanded by certain
+purposes of life. The oratory of those who denounce the physiological
+theories as lacking idealism in reality undermines true moral
+philosophy. There is no idealism which can really flourish merely by
+ignoring the progress of science and confusing the issues. The true
+values of the higher life cannot be safely protected by that thoughtless
+idealism which draws its life from vagueness and which therefore has to
+be afraid of every new discovery in scientific psychology. Our real
+ideals do not lie at all in the sphere in which the problem of causally
+explaining the psychological phenomena arises.</p>
+
+<p>Our conscious experiences are thus indeed not only here and there, but
+usually the products of chains of processes which go on entirely on the
+physiological side. We have no reason at all to seek for those preceding
+actions any mental accompaniment outside of consciousness, that means,
+any subconscious mental states. Then, of course, this physiological
+explanation also covers entirely those after-effects of earlier
+experiences, especially emotional experiences, which the physician
+nowadays likes to call subconscious "complexes." We shall see what an
+important r&ocirc;le belongs to these facts, especially in the treatment of
+hysteria and psychasthenia, but the interpretation again ought to avoid
+all playing with the conception of the subconscious. Emotional
+experiences may produce there some strong stable dispositions in the
+brain<span class='pagenum'><a name="Page_148" id="Page_148">[Pg 148]</a></span> system which become mischievous in re&euml;nforcing or inhibiting
+certain thoughts and actions without awakening directly conscious
+experiences. The whole psychological switch system may have been brought
+into disorder by such abnormal setting of certain parts, but the
+connection of each resulting accident with the primary emotional
+disturbances does not contradict the fact that all the causes lie
+entirely in disturbances of the central paths. It is a change in the
+neurons and their connections. To discover it we may have to go back to
+early conscious experiences, but in the process itself there is no
+mental factor, and therefore no subconscious emotion is responsible for
+the mischief carried out.</p>
+
+<p>Both groups of facts which we have studied so far, have dealt with
+processes which were indeed not conscious but which we had no right to
+call subconscious inasmuch as they contained no mental process at all
+but only physiological dispositions and actions. We turn finally to the
+other smaller and more abnormal group of so-called subconscious facts in
+which the facts are mental indeed and not only physiological, but not at
+all outside of consciousness and thus again not subconscious. A
+conscious fact may easily suggest the appeal to subconscious theories to
+those who have accepted such theories for other reasons. There are, for
+instance, plenty of mental experiences which we do not notice or which
+we do not recognize. Yet if we find later that they must have influenced
+our mind, we are easily inclined to refer them to subconscious activity.
+But it is evident that to be con<span class='pagenum'><a name="Page_149" id="Page_149">[Pg 149]</a></span>tent of consciousness means not at all
+necessarily to be object of attention or object of recognition.
+Awareness does not involve interest. If I hear a musical sound, I may
+not recognize at all the overtones which are contained in it. As soon as
+I take resonators and by them re&euml;nforce the loudness of those overtones,
+they become vivid for me and I can now notice them well even when the
+resonators are removed. I surely was aware of them, that is, had them in
+consciousness all the time but there were no contrast feelings and no
+associations in consciousness which gave them sufficient clearness to
+attract attention.</p>
+
+<p>In this way I may be again led by gradual stages to more and more
+complex experiences. I may overlook and yet include within my content of
+consciousness most various parts of my surroundings; and yet the
+neglected is not less in consciousness itself than the attended. Much
+that figures in literature as subconscious means indeed nothing else but
+the unattended. But it belongs to the elements of psychological analysis
+to recognize that the full content of consciousness is always larger
+than the narrow field of attention. This narrow field on the other hand
+has certainly no sharp demarcation line. There is a steady shading off
+from the most vivid to the least vivid. We cannot grasp those least
+vivid contents of consciousness, we cannot fixate them as such, because
+as soon as we try to hold them, they move from the periphery of the
+content into its center and become themselves vivid and clear. But as we
+are<span class='pagenum'><a name="Page_150" id="Page_150">[Pg 150]</a></span> surely aware of different degrees of clearness and vividness in our
+central mass of contents, we have no difficulty in acknowledging the
+existence of still lower degrees of vividness in those elements which
+are blending and fusing into a general background of conscious
+experiences. Nothing stands out there, nothing can be discriminated in
+its detail. That background is not even made up of whole ideas and whole
+memories and whole emotions and feelings and judgments and volitions,
+but of loose fragments; half ideas and quarter ideas, atoms of feelings
+and incipient impulses and bits of memory images are always mixed in
+that half-dark background. And yet it is by principle not less in
+consciousness, and consciousness itself is not different for these
+contents. It is not half-clear consciousness, not a lower degree of
+awareness, only the objects of awareness are crumbled and fading.</p>
+
+<p>Whether these background objects really exist can only be made out by
+studying carefully the changes which result under different conditions,
+the influences which those loose parts have on the structure of the
+whole, and the effect of their complete disappearance. I may never
+really notice a little thing in my room and yet may be aware that it has
+been taken away. The visual image of it was an element of my mental
+background, when I was sitting at my desk, but it never before moved to
+the center of my conscious content. But this center itself is also
+constantly changing. Sometimes the one, sometimes the other idea may
+enter into it, but in this alternation that which is not<span class='pagenum'><a name="Page_151" id="Page_151">[Pg 151]</a></span> in the focus
+either remains in consciousness unattended or when it disappears from it
+it loses its mental character altogether. If I attend a tiresome lecture
+while my mind is engaged with a practical problem of my own life, there
+may be a steady rivalry between the words which come with the force of
+outer stimulus to my brain and make me listen and my inner difficulties
+which claim my attention. I listen for a while, and then suddenly,
+without noticing it, my own thoughts may have taken the center of the
+stage and again without sudden interruption a word may catch my
+attention. While I was thinking of my own problem the sounds of the
+lecturer were really outside of my field of attention, yet some remark
+now pushes itself again into the center. That does not mean that a
+subconscious mind is listening while my lucid mind was thinking, but it
+does mean that those words were unattended and remained in the periphery
+of the field of consciousness. But when some of the sentences stirred up
+in that peripheral field some important associations, they were strong
+enough to produce a new motor reaction by which the mental equilibrium
+became changed again and by which the lecturer overwhelmed my private
+thoughts. Yet even this state of mind, without any break, can go over
+into an absolutely physiological process. I may for a while really
+inhibit the lecturer's voice completely and remain in the thoughts of my
+own imagination. After a minute or two, the resistance against the
+acoustical stimulus will certainly be broken and the sound will again
+enter into my consciousness, but in<span class='pagenum'><a name="Page_152" id="Page_152">[Pg 152]</a></span> that interval there was no
+subconscious and not even any unattended mental function; there was no
+mental process at all. The sound reached my brain but as the motor
+setting was adverse, the sounds did not bring about that highest act of
+physiological transmission which is accompanied by mental contents. Thus
+it became entirely physiological. Yet of course every word reached my
+brain and left traces there. If I were hypnotized after the lecture and
+thus the threshold for the real awakening of brain excitements lowered,
+it might not be impossible that some of the thoughts of the lecturer
+which did not enter my consciousness at all, are now afterwards in the
+hypnotic state stirred up in me. Yet even that would not indicate that
+they had become mental and thus subconscious at the time of the lecture.</p>
+
+<p>The so-called subconscious, which in reality is fully in consciousness
+but only unnoticed, easily shades over into that unconscious which is
+also in consciousness but dissociated from the idea of the own
+personality and thus somewhat split off from the interconnected mass of
+conscious contents. Wherever we meet such phenomena, we are in the field
+of the abnormal. The normal mental life is characterized by the
+connectedness of the contents. Yet even that holds true, of course, only
+if we think of those mental states which exist at one and the same
+instant in consciousness. As soon as we consider the succession of
+mental events, we cannot doubt that even normal experience shows breaks,
+lapses, and complete annihilation of that which a moment before was a
+real content<span class='pagenum'><a name="Page_153" id="Page_153">[Pg 153]</a></span> in our consciousness. We may have looked at our watch and
+certainly had in glancing at the dial a conscious impression, but in the
+next moment we no longer know how late it is. The impression did not
+connect itself with our continuous personal experience, that is, with
+that chief group of our conscious contents which we associate with the
+perception of our personality. Under abnormal conditions of the brain,
+larger and larger parts of the completely conscious experience may thus
+be cut off from the continuity of conscious life. But to be in
+consciousness, and therefore to be not-subconscious, does not mean to be
+through memory ties connected with the idea of our own personality.</p>
+
+<p>The somnanbulist, for instance, may get up at night time and write a
+letter, then go to bed again and not know anything of the event when he
+awakes in the morning. We have no reason to claim that he had no
+knowledge of the letter in his consciousness when he wrote it. It is
+exactly the same consciousness from a psychological standpoint as the
+one with which he wakes up. Only that special content has in an abnormal
+way entirely disappeared, has not left a possibility of awakening a
+memory image, and the action of the personality in writing has thus
+become separated and cut off from the connected experiences of the man.
+But while the nocturnal episode may be entirely forgotten, it was not
+less in consciousness for the time being, than if a normal man should
+leave his bed hastily to write a letter. Moreover under abnormal
+conditions, as for instance in severe hysteric cases,<span class='pagenum'><a name="Page_154" id="Page_154">[Pg 154]</a></span> those dissociated
+contents may form large clusters of mental experiences in the midst of
+which a new idea of the own personality may develop. Considering that
+through such disconnection many channels of discharge are blocked, while
+others are abnormally opened, it seems only natural that the idea of the
+own acting personality becomes greatly changed. Thus we have in such an
+episode a new second personality which may be strikingly different in
+its behavior and in its power, in its memories and in its desires, from
+the continuous normal one, and this secondary personality may now
+develop its own continuity and may arise under special conditions in
+attacks which are connected among one another by their own memory bonds.</p>
+
+<p>The two personalities may even alternate from day to day and the normal
+one may itself become pathologically altered. In that case the two
+alternating personalities would both be different from the original one.
+But again we have even in such most complex and exceptional cases only
+an alternation in the contents, not an alternation in the consciousness
+itself. Different ideas of the own personality with different
+associations and impulses follow each other in consciousness and the
+abnormality of the situation lies in the lack of memory connections and
+of mutual influences, but consciousness remains the same throughout. It
+remains the same, just as we do not change consciousness if we feel
+ourselves in one hour as members of our family, in the next hour as
+professional workers in our office, again later as social personalities
+at<span class='pagenum'><a name="Page_155" id="Page_155">[Pg 155]</a></span> a party or as citizens at a political meeting or as &aelig;sthetic
+subjects at the theater. Each time we are to a high degree a different
+personality, the idea of our self is each time determined by different
+groups of associations, memories, emotions, and impulses. The
+differentiation is to be considered as normal only because broad memory
+bridges lead over from one to the other. The connection of the various
+contents with the various ideas of the own personality constitutes thus
+in no way a break of consciousness itself and relegates no one content
+into a subconscious sphere.</p>
+
+<p>Finally the same holds true, if the idea of the personality as content
+of consciousness in the patient is split into two simultaneous groups,
+of which each one is furnished with its own associations. Yet the
+interpretation here becomes extremely difficult and arbitrary. Take the
+case that a patient in severe hysteria at our request writes down the
+history of her life. We should not hesitate to say that she is doing it
+consciously but now we begin to talk with her and slowly the
+conversation takes her attention while her pencil is continuing to write
+down the connected story of her youth. Again the conversation by itself
+gives the impression of completely conscious behavior. As both functions
+go on at the same time, the person who converses does not know what the
+person who writes is writing, and the writer is uninfluenced by the
+conversation. Various interpretations are possible. Indeed we might
+think that by such double setting in the pathological brain two
+independent groups in the content of consciousness are formed, each one<span class='pagenum'><a name="Page_156" id="Page_156">[Pg 156]</a></span>
+fully in consciousness and yet both without any mutual influence and
+thus without mutual knowledge. In the light of such interpretation, it
+has been correctly proposed to speak of coconscious processes, rather
+than subconscious. Or we may interpret it more in harmony with the
+ordinary automatic writing or with other merely physiological reactions.
+Then we should suppose that as soon as the conversation sets in, the
+brain centers which control the writing movement work through channels
+in which no mental factors are involved. One of the two characteristic
+reaction systems would then be merely physiological. We saw before that
+the complexity of the process is no argument against the strictly
+physiological character of the event. That various activities can
+coexist in such a way that one of them may at any time slide down from
+the conscious centers to the merely physical ones, we all know by daily
+experience. We may go home through the streets of the busy town engaged
+with our thoughts. For a while the idea of our way and of the sidewalk
+is in our consciousness, when suddenly we reach our house and notice
+that for a long while we have no longer had any thought at all of the
+way. We were absorbed by our problems, and the motor activity of walking
+towards our goal was going on entirely in the physiological sphere. But
+whether we prefer the physiological account or insist on the coconscious
+phenomena, in either case is there any chance for the subconscious to
+slip in? That a content of consciousness is to a high degree dissociated
+or that the idea of the personality is split<span class='pagenum'><a name="Page_157" id="Page_157">[Pg 157]</a></span> off is certainly a symptom
+of pathological disturbance, but it has nothing to do with the
+constituting of two different kinds of consciousness or with breaking
+the continuous sameness of consciousness itself. The most exceptional
+and most uncanny occurrences of the hospital teach after all the same
+which our daily experience ought to teach us: there is no
+subconsciousness.<span class='pagenum'><a name="Page_158" id="Page_158">[Pg 158]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="PART_II" id="PART_II"></a>PART II<br /><br />
+<span class="sub">THE PRACTICAL WORK OF PSYCHOTHERAPY</span></h2>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="VII" id="VII"></a>VII<br /><br />
+<span class="sub">THE FIELD OF PSYCHOTHERAPY</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>We have discussed the psychological tools with which the psychotherapist
+has to work but we have not spoken as yet of psychotherapy itself. All
+that we have studied has been by way of preparation; and yet the right
+preparation is almost the most important factor for the right kind of
+work. To rush into psychotherapy with hastily gathered conceptions of
+mental life may be sometimes successful for the moment, but must always
+be ultimately dangerous. It is often most surprising what a haphazard
+kind of psychology is accepted as a basis for psychotherapy even by
+scientifically schooled physicians who would never believe that common
+sense would be sufficient to settle the problems of anatomy and
+physiology; as soon as the mind is in question, no serious study seems
+needed. Can we be surprised then that in the amateur medicine of the
+country within and without the church any fanciful<span class='pagenum'><a name="Page_159" id="Page_159">[Pg 159]</a></span> idea of mental life
+may flourish? If we are to recognize the rights and wrongs of
+psychotherapy in a scientific spirit, a sober analysis of the mental
+facts involved was indeed at the very first most essential. Now we can
+easily draw the conclusions from our findings.</p>
+
+<p>We recognized from the start the fundamental difference between two
+different attitudes which we can take towards the inner life of any
+personality, the purposive view and the causal. We recognized the sphere
+to which each belongs and we saw that all medical treatment demands the
+causal view, thus dealing with inner life as part of the causal chain of
+events. Each inner experience became therefore a series of so-called
+contents of consciousness. These contents can be described and must be
+analyzed into their elements. The basis of psychotherapy is therefore an
+analytic psychology which conceives the inner experience as a
+combination of psychical elements.</p>
+
+<p>But the final aim was the causal connection. The appearance and
+disappearance of those millions of elements and their connection had to
+be explained. We recognized that such an explanation of the contents of
+consciousness was possible only through the connections between the
+accompanying brain processes. Every psychical change had to be conceived
+as parallel to a physiological change. The psychology which is to be the
+basis of psychotherapy had to be therefore a physiological psychology.</p>
+
+<p>We recognized that these psychophysiological processes were processes of
+transmission between impres<span class='pagenum'><a name="Page_160" id="Page_160">[Pg 160]</a></span>sions and expressions, that is, between
+incoming nervous currents and outgoing nervous currents, between stimuli
+and reactions. Thus we have no central process which is not influenced
+by the surroundings and which is not at the same time the starting point
+of an action. We have normal health of the personality as long as there
+is a complete equilibrium in the functions of the organism which adjusts
+the activities to the surroundings. Every abnormality is a disturbance
+of this equilibrium. A psychology which is the basis of psychotherapy
+thus conceives every mental process in relation to both the ideas and
+the actions; it avoids all one-sidedness by which the mind is cut off
+either from its resources or from its effects. The relations to the
+impressions are usually the less neglected: and we must the more
+emphasize the fact that the psychology needed for psychotherapy knows no
+mental fact which does not start an action and that every change in the
+system of actions involves a change in the central experience. Wherever
+this equilibrium of adjusted functions is disturbed, some therapy of the
+physician has to set in: whether psychotherapy is in order depends upon
+the special conditions.</p>
+
+<p>We have recognized that there are no mental facts outside of those which
+are in consciousness and that from a psychological point of view
+consciousness itself does not have different degrees and different
+levels, that all varieties of experience refer thus only to the special
+content and its organization. There is thus no subconscious. On the
+other hand, we saw<span class='pagenum'><a name="Page_161" id="Page_161">[Pg 161]</a></span> that there is no conscious experience which is not
+based on a bodily brain process. By these two fundamental facts of
+scientific psychology, every possible psychotherapy gets from the start
+its clear middle way between two extreme views which are popular today.
+The one school nowadays lives from the contrast between consciousness
+and subconsciousness and makes all psychotherapy work with and through
+and in the subconscious. The other school creates a complete antithesis
+between mind and body and makes psychotherapy a kind of triumph of the
+mind over the body. Practically every popular treatise on
+psychotherapeutic subjects in recent years belongs to the one or the
+other group; and yet both are fundamentally wrong. And while, of course,
+this mistake is one of theoretical interpretation, it evidently has its
+practical consequences. The fantastic position allowed to a subconscious
+mind easily gives to the doctrine a religious or even a mystical turn
+and the artificial separation between the energies of the mind and those
+of the body leads easily to a moral sermon. Whether this amalgamation of
+medicine with religion or with morality may not be finally dangerous to
+true morality and true religion is a question which will interest us
+much later. Here we only have to ask whether it is not harmful to the
+interests of the patient and thus to the rights of medicine, and indeed
+that must be evident here at the very threshold. Both schools must have
+the tendency to extend psychotherapy at the expense of bodily therapy
+and to narrow down psychotherapy itself to a therapy by<span class='pagenum'><a name="Page_162" id="Page_162">[Pg 162]</a></span> appeals which
+in the one case are suggestions to the subconscious and in the other
+case persuasions and encouragements to the conscious will. As soon as we
+have overcome the prejudices of those two rival schools and have
+recognized that both are wrong, that there is no subconscious and that
+there is no psychological fact which is not at the same time a
+physiological one, we see at once that this common procedure of both
+schools is unjustified and dangerous. Mental therapy and physical
+therapy ought to be most intimately connected parts of the same
+therapeutic effort and mental therapy includes by far more than mere
+suggestions and appeals. All that involves of course that its systematic
+application belongs in the hands of the well-trained physician and of
+nobody else, but on the other hand, it involves that every physician
+ought to be well schooled in psychology.</p>
+
+<p>As soon as a disturbance to be cured is considered as a lack of
+equilibrium in psychophysical functions, every mental influence, every
+suggestion and appeal becomes itself an excitement or an inhibition of
+nerve cells. The sharp demarcation line between a psychical agency and a
+physical one disappears altogether; the spoken word is then considered
+as physical airwaves which stimulate certain brain centers and in the
+given paths this stimulation is carried to hundreds of thousands of
+neurons. The protracted warm bath or the cold douche influences, too,
+large brain parts by changing the blood circulation which controls the
+activity of those neurons; or the bromides absorbed in<span class='pagenum'><a name="Page_163" id="Page_163">[Pg 163]</a></span> the digestive
+apparatus, or the morphine injected, also reach the neurons and again
+have a different kind of influence on them, and the electric current may
+stimulate the nervous system in still a different way. It may be, and
+under many conditions certainly is, essential to influence the brain
+cells just in that particular way which results from the spoken word,
+but there too the causal influence remains a function of the physical
+effect and thus by principle there is no sharp separation from other
+physical means. Thus to believe in psychotherapy ought never to mean
+that we have a right to make light of the other means which, as
+experience shows, may help towards the treatment of disturbances in the
+central equilibrium. Suggestions and bromides together may secure an
+effect which neither of them alone will bring about. It is most
+unfortunate that not without some guilt on the part of the physicians
+themselves, the large public has begun to believe that orthodox
+psychotherapy has to mean a rejection of drugs and a contempt for the
+doctors who prescribe them.</p>
+
+<p>Of course a discussion of psychotherapy cannot enter into the study of
+these physical agencies of treatment, but at the threshold, we have to
+insist that there exists no opposition between psychophysiological and
+physiological means of influencing the brain. It may be true that drugs
+and baths and electricity have no influence on the subconscious, but the
+trouble is not that the drugs are inefficient but that they cannot
+influence what does not exist. In the same way<span class='pagenum'><a name="Page_164" id="Page_164">[Pg 164]</a></span> disappears now that new
+boundary line for psychotherapy which wants to limit it to mere
+suggestion and appeal. If psychotherapy employs all the means by which
+we can influence mental states in the interest of the health of the
+personality, we have no reason to confine it either to a persuasion of
+the subconscious through suggestion and hypnotism or a persuasion of the
+conscious, in which it works as a moral appeal. Suggestion and hypnotism
+certainly must play a large part in psychotherapy and that part does not
+become smaller by the fact that we reject the subconscious
+interpretation of them and consider them entirely as psychophysical
+processes. And in the same way undoubtedly we have to acknowledge the
+psychophysiological effect of persuasion and of the appeals to the
+conscious intellect and will. But for us as psychotherapists all those
+factors have no moral value but only a therapeutic one, and thus stand
+in line with any other influence that may help, even though from a
+purposive point of view it stands on a much lower level. A mere mental
+distraction by enjoyment and play and sport, an &aelig;sthetic influence
+through art, a mere stimulus to automatic imitation, an enforced mental
+rest, an involuntary discharge of suppressed ideas, and many similar
+schemes and even tricks of the mental physician belong with the same
+right to psychotherapy.</p>
+
+<p>It is really doubtful whether the moral and religious appeals are always
+helpful and not sometimes or often even dangerous for the health of the
+individual; and it is not doubtful that morally and reli<span class='pagenum'><a name="Page_165" id="Page_165">[Pg 165]</a></span>giously
+indifferent mental influences are often of the highest curative value.
+The more we abstract from everything which suggests either the mysticism
+of the subconscious or the moral issues of a mind which is independent
+of the body, the more we shall be able to answer the question as to the
+means by which health can be restored. This question is neither a moral
+nor a philosophical one but strictly one of experience. In this
+connection, we must remember that we also have had to give up the
+artificial demarcation line between organic and functional diseases. We
+recognized that every so-called functional disease has its organic basis
+too, and that it is entirely secondary whether we are able to find
+visible traces of the organic disturbance. We had to acknowledge, to be
+sure, the difference between reparable and irreparable disturbances, but
+such grouping expresses only in another form the fact that experience
+alone can show whether the methods of treatment which we know so far
+will be successful or not. Not a few disturbances of the equilibrium
+which appeared irreparable to an earlier time yield to the treatment of
+to-day, and no one can determine whether much which appears irreparable
+today may not be accessible either to psychotherapeutic or to physical
+therapeutic means to-morrow. If we were carelessly to identify the
+reparable troubles with those which we cannot recognize visibly, we
+should be at a loss to understand why, for instance, many forms of
+insanity are entirely beyond our psychotherapeutic influences. On the
+other hand, every<span class='pagenum'><a name="Page_166" id="Page_166">[Pg 166]</a></span> physician who uses psychotherapeutic means is
+surprised to see the effective bodily readjustment where serious
+disturbances perhaps of the circulatory system or the digestive system
+existed. What the methods can do and what they cannot do must simply be
+left to experience, but of course to an experience which is eager to
+expand itself by ever new experimental curative efforts.</p>
+
+<p>From this point of view we can see clearly the general division of the
+whole field of possible psychotherapy. Psychotherapy influences
+psychophysical states in the interest of health. There are only two
+possibilities open: either the disturbance is in the psychophysical
+system itself or it is outside of it, that is in the other parts of the
+body which are somehow under the influence of the mind. In the first
+case when the disturbance occurs in the mind-brain system itself, we
+ought to separate two large groups, first those cases in which the
+system itself is normal and the disturbance comes from without, and
+second those in which the constitution of the system itself was abnormal
+and led to disturbances under conditions in which a normal system would
+not have suffered. We have to consider both groups somewhat more in
+detail, as each again allows a large variety of cases.</p>
+
+<p>Thus we have before us, first the normal mind-brain system into which a
+disturbance breaks, injuring more or less severely and for a longer or
+shorter time the equilibrium of the psychophysical functions. Here
+belong any bodily processes which produce pain or any bodily defects
+which produce blanks in the<span class='pagenum'><a name="Page_167" id="Page_167">[Pg 167]</a></span> content of consciousness; the pain of
+sciatica or of rheumatism, or the defect of the blind or of the deaf,
+certainly interferes in a disturbing way with the perfect harmony of
+psychophysical activities. But here also belongs the suffering which
+results from conditions in the surroundings, the loss of a friend, a
+disappointment in life, any source of worry and grief. Social and bodily
+conditions alike may thus work to break up the equilibrium. The pain
+sensation interferes with the normal flow of mental life and the grief
+may undermine the mental interests. The psychotherapeutic effort may be
+directed toward removing the source of the disturbance, bringing the
+patient under other conditions, curing the diseased organ, and where
+that is not possible, may work directly on the psychophysical state,
+inhibiting the pain, suppressing the emotion, substituting pleasant
+ideas, distracting the whole mind, filling it with agreeable feelings,
+until the normal equilibrium is restored.</p>
+
+<p>The psychophysical system itself was not really harmed by such
+influences. In the following groups, such is no longer the case. We here
+think at first of those severe injuries which have their sources in
+abnormal processes outside of the brain. The an&aelig;mia of the patient or
+the low state of his nutrition or the fever heat of his blood impairs
+the harmony of the mental functions. Another and for the psychotherapist
+much more important group is that in which the impairment results from
+toxic influences. Alcohol, morphine, cocaine, tobacco, and many other
+drugs may have been misused and may have pro<span class='pagenum'><a name="Page_168" id="Page_168">[Pg 168]</a></span>duced a most marked
+alteration in the mind-brain system. Desires may have developed which
+completely destroy the balance of the normal functions and yet the
+satisfaction of which increases the poisoning effect. But here belongs
+further the effect of poisons which the body itself produces: the toxic
+disturbance of ur&aelig;mia or the coma in diabetes, or especially the grave
+disturbances resulting from the abnormal action of the thyroid gland,
+the source of cretinism. Many indications suggest that a near future
+will consider this group much larger than we are really justified in
+doing today, probably soon connecting a number of other mental diseases
+like dementia pr&aelig;cox with toxic effects of bodily origin. Experience
+shows that in this group not a few chances exist for successful
+psychotherapeutic influence. Yet the means may be various in character
+and their effect may be a direct or an indirect one. A psychical shock
+may remove directly the mental disturbance of the alcoholic state, but
+it is more important that mental suggestion can remove the alcoholic
+disturbance indirectly by suppressing the desire for alcoholic excesses.
+Even where cure by psychotherapeutic means is out of the question, as is
+the case with feverish delirium or ur&aelig;mic excitements, no skilled
+physician ignores the aid which a well-adjusted mental influence can
+offer to the patient.</p>
+
+<p>We come to a third group. Some outside cause has harmed the central
+nervous system directly, and has left it in a disabled state after the
+cause itself has disappeared. Such causes may have been at first<span class='pagenum'><a name="Page_169" id="Page_169">[Pg 169]</a></span> purely
+functional: for instance, a neglect of training, or a wrong training, or
+an over-activity, but the ill-adjusted function which involved, of
+course, every time an ill-adjusted organic activity or lack of activity,
+has led to a lasting or at least relatively lasting disturbance in the
+system of paths. The neglect of training, for instance, in periods of
+development may have resulted in the retardation which yields the
+symptoms of a feeble-minded brain, or the wrong training may have
+created vicious habits, firmly established in the mind-brain system and
+gravely disturbing the equilibrium. Above all, the overstrain of
+function, especially of emotional functions, may lead to that exhaustion
+which produces the state of neurasthenia. It is true that not a few
+would doubt whether we have the right to class neurasthenia here where
+we speak of the harm done to the normal brain. Many neurologists are
+inclined to hold that neurasthenia demands a special predisposition and
+is therefore dependent upon a neurotic constitution of the brain itself.
+But if defenders of such a view, as for instance, Dubois, acknowledge
+that "we might say that everybody is more or less neurasthenic," we can
+no longer speak of any special predisposition. Certainly there exists a
+constitutional neurasthenia sometimes but we have hardly a right to deny
+that overstrain in the brain activity may produce a series of
+neurasthenic symptoms in any brain, and the special predisposition is
+responsible rather for the particular selection among the innumerable
+symptoms.</p>
+
+<p>Neurasthenia certainly is the classical ground for<span class='pagenum'><a name="Page_170" id="Page_170">[Pg 170]</a></span> the psychotherapist.
+The patient's insomnia and his headache, his feeling of tiredness and
+his disgust with himself, his capricious manias and his absurd phobias,
+his obsessions and his fixed ideas all may yield to the "appeal to the
+subconscious," and as a neurasthenic easily believes in the existence of
+various organic diseases in his body, Christian Science can perform here
+even "miracles." In the case of retardation, the psychical influence
+will have to be in the first place one of training. Yet it would be
+narrow to overlook that in neurasthenia, too, suggestion has to be only
+a part of the psychical treatment. Training and rest, distraction and
+sympathy and many other factors have to enter into the plan.
+Incomparably small, on the other hand, is the aid which psychotherapy
+can offer in cases of real destructions in the brain, as in the case of
+tumors, hemorrhage, paresis or the degeneration by senility. More
+effective may be its work in concussion of the brain and especially with
+traumatic neuroses, as in the case when a railroad accident has put the
+mind-brain system out of gear.</p>
+
+<p>So far we presupposed that the central system itself was normal. No
+sharp separation line, however, lies between all these disturbances and
+the equally large group of psychophysical disabilities resulting from a
+defective constitution of the brain. The normal brain shades over by
+smallest differences into the abnormal one; yes, even the varieties of
+temperament and character and intellectual capacity and industry and
+energy represent, in the midst of our<span class='pagenum'><a name="Page_171" id="Page_171">[Pg 171]</a></span> social surroundings, large
+deviations from the standard. That which might still pass as normal
+under certain conditions of life would be unadjusted and thus abnormal
+under other conditions. In the same way, we certainly cannot point out
+where the natural constitution of a brain ceases to be fit for its
+organic purposes and where the structural variations are ill-prepared
+for the struggle for existence. Just as we claimed that an entirely
+normal brain might be brought by an emotional overstrain to a state of
+exhaustion and disability, we may claim on the other side that a brain
+which nature has poorly provided may yet be protected against damage and
+injury. The inborn factor does not alone decide the fate. Psychophysical
+prophylaxis may secure steadiness of equilibrium to a system which
+inherited little resistance. Yet this large borderland region, where an
+ill-adjusted brain may be saved or lost in accordance with favorable or
+unfavorable circumstances, shades off again to the darker regions where
+the inner evolution leads by necessity to disaster even under favorable
+conditions.</p>
+
+<p>We might begin this large group of the constitutional disturbances with
+that neurasthenia which develops on the basis of inherited disability.
+Lack of energy resulting from a feeling of tiredness, a quick
+exhaustion, a mood of depression, an easy irritation, even despair and
+self-accusation, sullenness and fits of anger, cranky inclinations and
+useless brooding over problems, headache and insomnia characterize the
+picture which everyone finds more or less developed<span class='pagenum'><a name="Page_172" id="Page_172">[Pg 172]</a></span> in some of his
+acquaintances. If we classify symptoms, we may separate from it that
+which we nowadays are inclined to call psychasthenia. An abnormal
+suggestibility for autosuggestions stands in the foreground. Fixed ideas
+and fixed emotions, especially fears, trouble the patient. He may pick
+up his obsession by any chance experience and no good-will liberates him
+from the intrusion perhaps for years. The patient is perfectly well
+aware that his ideas and his emotions are unjustified, he himself does
+not believe in them, and yet they come with the strength of an outer
+perception and with the vividness of a real attitude, and his whole
+mental equilibrium may be upset by the continuous fight against these
+involuntary interferences. In the light cases, sometimes the one and
+sometimes the other autosuggestion may hold the stage; in the severe
+cases, mental life turns more and more around certain definite fears and
+yet it may all still be in the limits where the daily work can go on and
+the world may not know of the hidden tortures. Here belongs the fear of
+open places or the fear of touching certain objects, the fear of doing
+harm to others or the fear of deciding actions wrongly, the fear of
+destroying valuable things or the fear of being the center of public
+attention, the fear of crowds or of closed doors, of altitudes or of
+bridges. And in all cases emotional reaction may set in with anxieties,
+and bodily symptoms such as palpitation of the heart may result,
+whenever an effort is made to disregard the nervous fear. There is
+perhaps no group of patients which so much deserves the<span class='pagenum'><a name="Page_173" id="Page_173">[Pg 173]</a></span> most careful
+efforts of the psychotherapist. Still more than the hysterics they
+suffer from the fate of seeing their ills counted as not real. For them
+everybody has the good advice that they ought to overcome their fancies;
+and yet they feel their life ruined with their endless fight against the
+overpowering enemy. And if anywhere, it is here that the psychotherapist
+is successful. Psychasthenic fear can be removed, while the developed
+melancholic depression, for instance, is entirely beyond the reach of
+psychical influence.</p>
+
+<p>We have after all the same psychasthenic state before us when the
+obsession has impulsive character, from the mere abnormal impulse of
+lying, or making noise in a quiet place or crying in the dark, or
+touching certain places, to that of stealing, indecent speech, arson,
+and perhaps even murder. The symptoms might easily be mistaken for those
+of graver diseases. Yet the fact that the patient himself really does
+not will the effect at which he is aiming separates, mostly without
+difficulty, the diagnosis of psychasthenia from that of insanity. Quite
+nearly related to it are the manifold variations of abnormal and
+perverse sexual tendencies. The psychiatrists are perhaps too much
+inclined to bring all these pathological impulses and desires, fears and
+anxieties, into the nearest neighborhood to real insanity. The
+indisputable success of psychotherapy in these spheres ought to add a
+warning against these expansions of the strictly psychiatric domain. The
+psychologist will be more inclined to emphasize their relation to simple
+neurasthenia which<span class='pagenum'><a name="Page_174" id="Page_174">[Pg 174]</a></span> itself imperceptibly shades over into our normal
+life.</p>
+
+<p>All neurasthenic and psychasthenic disabilities show a certain emotional
+continuity and uniformity. It is the emotional instability and the quick
+alternation of symptoms which characterize hysteria or rather the
+hysterias. It seems as if science were near to the point of explaining
+the hysterical disease by one common principle, but certainly the
+symptoms are an inexhaustible manifold. The rapid changes of the intense
+moods of the patient usually stand in the center. Torturing obsessions,
+abnormal impulses, over-suggestibility, hypochondriac depressions,
+paralysis of arms or legs, an&aelig;sthesia and par&aelig;sthesia, a mental stupor
+and confusion, illusions and perceptions of physiological symptoms may
+work together in spite of his, or rather her clear intelligence. It is
+probably on a hysteric basis also that somnambulic states arise during
+the night, and from them a straight way leads to those mental attacks
+after which the memory is entirely lost, or for which fundamental
+associative connections are cut off. And from here we come to the
+exceptional cases of alternating personality. The more we recognize the
+myriad symptoms in the hysteric patient as products of the emotional
+instability, of autosuggestibility and of inhibition, the more we
+understand the almost miraculous result of psychotherapeutic treatment.
+Autosuggestions can be fought by countersuggestions, an&aelig;sthesia and
+par&aelig;sthesia can be removed often in an instant, dissociated
+personalities may be built up again through<span class='pagenum'><a name="Page_175" id="Page_175">[Pg 175]</a></span> hypnotism, the most severe
+bodily symptoms may disappear by influences in a waking state. Hysteria
+alone would justify the demand that every physician in his student days
+pass with open eyes through the field of psychology. Quite near stand
+chorea and the epidemic impulses to imitative movements. And we might
+bring into this neighborhood also the disturbance in the equilibrium of
+the speech movements through all degrees of stammering and severe
+impairment. Up to a certain degree, though not often completely, they
+too yield easily to psychotherapeutic influence.</p>
+
+<p>We enter now that region of constitutional disturbances in which
+psychotherapy is of small help. It leads from epilepsy to the periodic
+diseases, especially the maniacal depressive insanity, the paranoia
+which develops late, and finally to states of idiocy which cover the
+whole life. We are far from claiming that psychical influences are
+entirely powerless, the more as we insisted that psychotherapy goes much
+beyond mere suggestions and appeals. No psychiatrist will work without
+psychological tools when he deals with the exultations of the maniac and
+the depressions of the melancholic, with the hallucinations of
+persecution or the erotic insanities of the paranoiac. Still more the
+whole register of psychology has to be used, when we are to educate the
+idiot and the imbecile. But the disappearance of the disease or of the
+chief symptoms through the mental agencies is in all these cases out of
+the question. Only in incipient cases, especially of melancholia and<span class='pagenum'><a name="Page_176" id="Page_176">[Pg 176]</a></span>
+mania, the psychotherapeutic work seems not entirely hopeless; and for
+epilepsy some distinct successes cannot be denied.</p>
+
+<p>We have reviewed the whole field of psychophysical disturbances, those
+produced through external conditions in the normal brain and those
+resulting from abnormal brain constitution. We have seen that the work
+of the psychotherapist is of very unequal value in different parts of
+the field; in some, as in neurasthenia, in psychasthenia, in hysteria
+and similar regions most effective, in others like paresis or paranoia
+reduced to an almost insignificant factor. Where it can help and where
+not we recognize as a mere question of experience. Certainly the
+severity of the symptoms alone does not decide it. As the treatment is
+entirely empirical, no one can foresee whether or not the situation may
+change to-morrow. We may find psychotherapeutic schemes by which
+epilepsy or maniacal depressive insanity or traumatic neuroses may
+become accessible. We simply do not know why we may remove stammering or
+synthesize a dissociated personality or overcome an inborn sexual
+perversity, while we are unable to remove the depression of the
+melancholic. Certainly the symptoms of the circulatory insanity
+disappear completely in the free intervals; there is no reason to give
+up hope that psychotherapy might find the way to hasten the appearance
+of such a normal period.</p>
+
+<p>But we have emphasized from the start that the psychotherapeutic work
+has not only to set in when the disturbance itself lies in the
+psychophysical sys<span class='pagenum'><a name="Page_177" id="Page_177">[Pg 177]</a></span>tem. We may utilize the influence which the
+mind-brain system has for the whole body and thus may apply the
+psychical tool to work on the disturbances in the bodily apparatus. We
+may discriminate a direct and an indirect influence in the psychical
+treatment of bodily diseases. Transition from the foregoing group of
+psychical disturbances offers itself perhaps most easily through the
+state of insomnia.</p>
+
+<p>The causes of sleeplessness may still lie in the psychophysical sphere;
+restless thoughts may inhibit the idea of sleep. The effect of sleep is
+again in the sphere of the mind, the annihilation of conscious contents.
+But the center which regulates and creates the sleep, probably by
+contracting the blood-vessels, lies outside of the psychophysical system
+in the lower centers of the brain. The real disturbance thus lies in the
+inactivity of this purely bodily apparatus and mental influence which is
+to create sleep has therefore to work downwards from the mind to a
+bodily organ. In the same way many other non-psychical centers of the
+brain may be brought to efficiency through psychophysical regulation.</p>
+
+<p>But the therapeutic effect is certainly not confined to the central
+nervous system. Whithersoever the centrifugal nerves lead there the
+mind-brain system may have its curative influence. In the most startling
+way that is true for the digestive apparatus. The secretions of the
+stomach, the activity of the intestines can be influenced to a decree
+which it is difficult to explain. Important also is the relation to the<span class='pagenum'><a name="Page_178" id="Page_178">[Pg 178]</a></span>
+circulatory system, especially the disturbances of the heart:
+innervation may be corrected, abnormal dilations and contractions of
+blood-vessels may be regulated. The bladder, uterus, even the pancreas
+and the liver seem to be influenced by the peripheral effects of the
+central excitement. And while no warning can be serious enough against
+the absurd belief that diseases like cancer or tuberculosis can be cured
+by faith, it must be admitted that psychical influences under special
+conditions may have a retarding influence on any pathological process in
+the organism. Much of that certainly is indirect influence but the
+physician would be reckless if he should ignore the aid which may result
+from such indirect assistance. Even if psychotherapy could not do more
+in the treatment of bodily diseases than to secure a joyful obedience to
+the strict demands of the physician, it would yet have to be accredited
+with an extremely important service.</p>
+
+<p>In a parallel line comes the effective aid by the stimulation of hope
+and the suppression of fear, by suggestion of a feeling of encouragement
+and the inhibition of the emotions of worry. This is a field where even
+the average physician is most easily inclined to play the amateur
+psychotherapist. He knows how convalescence is disturbed by psychical
+depression and how much more quickly health returns, if it is
+confidently expected; he knows how many dangerous operations are
+disturbed by despondency and helped by bravery; he knows what a blessed
+change has come into the treatment of tuber<span class='pagenum'><a name="Page_179" id="Page_179">[Pg 179]</a></span>culosis since a psychical
+factor of social interest has set in; he knows how many ills disappear
+when regular occupation and interesting work are established or the
+strain of distasteful work removed. Even the mere suppression of the
+pain works backwards on the bodily disease which produces it. The pain
+was a starting point for disturbing reactions; with its disappearance
+through psychotherapeutic influence, the reactions of the irritated
+brain come to rest, the diseased body can carry on its struggle without
+interference and may win the day. Often the psychical influence may not
+even change the symptoms at all but may remove other troublesome
+effects. The sufferer from locomotor ataxia may learn to walk again
+through mental education without any restitution of his spinal cord. In
+short, there are endless ways in which psychical influence may work
+towards the general health and towards the victory over bodily disease;
+and all that may be acknowledged without the slightest concession to the
+metaphysical creeds of mental healers and Christian Scientists. But to
+make use of those means and to harness such influences, it cannot be
+enough to rely on the common-sense of the physician any more than we
+should trust the common-sense of the surgeon to use his knife without
+condescending to the study of anatomy. The psychological study of the
+anatomy of the soul shows a not less complicated system of mental
+tissues and mental elements.</p>
+
+<p>To enter into the full richness of this whole, large field of course
+lies entirely beyond the scope of our<span class='pagenum'><a name="Page_180" id="Page_180">[Pg 180]</a></span> short discussion, which seeks as
+its only aim a clear recognition of the principles. Yet it seems
+essential to illustrate at least this sketch of the field by a more
+detailed account of actual developments. Various ways of procedure might
+appear in order and the most natural one would be, of course, to pass
+down from disease to disease and sketch special cases from diagnosis to
+cure. We might go through the various stages of neurasthenia and then
+through psychasthenia and then through hysteria and so on. And if we had
+to write a handbook for physicians, it would certainly be the desirable
+way, in spite of the too frequent repetitions which would become
+necessary. But as our aim is only a discussion of principles of
+psychotherapy, we have no right to use this method. Moreover, such a
+method would suggest the misleading view that the psychotherapist is
+called and is able to treat diseases. All that he treats are symptoms
+and he ought not to pretend that he can do more, as long as he abstracts
+from all other therapeutic agencies. Psychotherapeutic influence may
+remove the phobia of a psychasthenic or the obsession of a neurasthenic
+or the emotion of a hysteric, and thus may bring not only momentary
+relief but a change which may be favorable for general improvement, but
+certainly the neurasthenia and psychasthenia and hysteria are not really
+removed by it. Of course, even the treatment of symptoms demands a
+constant reference to the whole background of the disease. The
+depression of the neurasthenic must not be treated like the depression
+of the melancholic, the<span class='pagenum'><a name="Page_181" id="Page_181">[Pg 181]</a></span> obsession of the psychasthenic must not be
+mixed with the fixed ideas of a paranoiac, the hysteric inability to
+walk must not be confused with an injury of the motor nerves; in short,
+each symptom has to be treated as part of a complete situation. The
+efforts of the psychotherapist will move over as large a part of the
+disease as possible and cover, perhaps, the causes of the disturbance as
+far as they are of psychical origin. Yet it would remain dilettanteism
+if we were to accept the popular view that the mere psychotherapeutic
+aid is a sufficient treatment of the whole disease. The physician has to
+be much more than a psychotherapist. Our discussion only seeks to point
+out that whatever else he may be, he must be also a psychotherapist.</p>
+
+<p>The more conservative method which befits us may be, therefore, the
+method of dealing with symptoms only and abstracting from the more
+ambitious plan of discussing the diseases entire. We simply separate the
+mental symptoms and the bodily symptoms which the psychotherapist is to
+remove. And just in order to classify somehow the manifold mental
+symptoms, we might separate those in the sphere of ideas, those in the
+sphere of emotions, and those in the sphere of volitions. Of course,
+nothing is further from such a plan than the old-fashioned belief that
+intellect, feeling, and will represent three independent faculties of
+the soul. Modern psychology has not only substituted the millionfold
+phenomena for the schematic faculties, but emphasizes above all the
+interconnectedness of the mental facts. There is no experience into<span class='pagenum'><a name="Page_182" id="Page_182">[Pg 182]</a></span>
+which ideas, and feelings, and impulses do not enter together. And
+correspondingly we emphasized that on the physiological side too, every
+sensory excitement is at the same time the middle point of central
+irradiation and the starting point of motor activity. Thus there can be
+no disturbance of ideas which does not influence feeling and will, and
+vice versa. Yet it would be artificial to deny that any one of those
+various sides of the psychical process may come to prominence, sometimes
+the impulse, sometimes the emotion, and sometimes the interplay of
+ideas. The separation means only an abstraction, but it is an
+abstraction which is justified and suggested by the actual experiences.
+Thus we shall deal with the psychical treatment of ideational,
+emotional, volitional, and bodily symptoms.</p>
+
+<p>Common to our discussions will be only the effort to avoid everything
+which is exceptional and by its unusual complications apparently
+unexplainable and mysterious. The greater complexity of the case
+certainly adds much fascination. Yet since we do not want to stimulate
+mere curiosity but clear understanding of the elements, we avoid every
+startling record. We confine ourselves carefully to those perhaps
+trivial experiences which daily enter into the view of those who come in
+contact with suffering mankind. There will be no startling stories of
+dissociated personalities, such as appear perhaps every few years on the
+horizon of the medical world, but we shall speak of those who every day
+in every town carry their trouble to the waiting room of the doctor<span class='pagenum'><a name="Page_183" id="Page_183">[Pg 183]</a></span> and
+who might return more happily if he had more well-trained interest in
+the psychotherapeutic factors. Yet before we analyze some typical
+symptoms, it might be wise to review the whole series of means and tools
+which the psychotherapist finds at his disposal.<span class='pagenum'><a name="Page_184" id="Page_184">[Pg 184]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="VIII" id="VIII"></a>VIII<br /><br />
+<span class="sub">THE GENERAL METHODS OF PSYCHOTHERAPY</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>The psychological work of the physician does not begin with his curative
+efforts. Therapy is always only the last step. Diagnosis and observation
+have to precede, and an inquiry into the causes of the disease is
+essential, and in every one of these steps psychology may play its r&ocirc;le.
+The means of psychodiagnostic are not less manifold than those of
+psychotherapy. Moreover there the technique may be more complex and
+subtle. The whole equipment of the modern laboratory ought to be put at
+its disposal. Perceptions and associations, reactions and expressions
+ought to be examined with the same carefulness with which the
+conscientious physician examines the blood and the urine.</p>
+
+<p>A particular difficulty of the task more or less foreign to every other
+medical inquiry is the intentional or unintentional effort of the
+patient to hide the sources of the trouble and to mislead as to their
+true character. Too often he is entirely unconscious of the sources of
+trouble or else he has social reasons to deceive the world and himself,
+and ultimately the physician. And yet no psychical treatment can start
+successfully so long as<span class='pagenum'><a name="Page_185" id="Page_185">[Pg 185]</a></span> the patient is brooding on secret thoughts at
+the bottom of his mind. The desire to hide them may often be itself a
+part of the disease. It is surprising how often unsuspected vistas of
+thoughts and impulses and emotions are opened by an inquiring analysis
+where the direct report of the patient does not awaken the least
+suspicion. In the field of insanity, naturally the physician at once
+goes to an examination on his own account, but in the borderland regions
+of the psychasthenics and hysterics and neurasthenics, the intellectual
+clearness of the patient too easily tempts one into trusting the
+sincerity of his story; and yet the most important ideas clustering
+perhaps about love or ambition, about vice or crime, about business
+failure or family secrets, about inherited or acquired diseases may be
+cunningly withheld and may frustrate every psychotherapeutic influence.
+Where suspicion is awake and mere confidential talk and persuasion seem
+insufficient, the physician may feel justified in the interest of his
+patient in drawing the thoughts out of their hiding-place by artificial
+means. Skill, tact, and experience are needed there.</p>
+
+<p>As a matter of course, in the overwhelming mass of cases the frankness
+and the good will of the patient himself will support the physician and
+accordingly his examination is not obliged to trap the patient but
+simply to guide him to important points. But then begins the most
+essential study of diagnostical differentiation. With all the means not
+only of psychology but of neurology and internal medicine, he has to
+separate the particular case from similar ones and to<span class='pagenum'><a name="Page_186" id="Page_186">[Pg 186]</a></span> examine whether
+he deals with, for instance, a hysteric or with a paranoiac, with a
+neurasthenic or with a case of dementia pr&aelig;cox; and he will not forget
+that there exist almost no symptoms of serious diseases which the
+nervous system of the hysteric may not imitate for a time. Not ours is
+the task of analyzing special methods of neurological and mental
+differential diagnosis such as are used in the psychiatric clinic and in
+the office of the nerve specialist. There the family history with
+reference to nervous and other diseases, the history of the patient
+himself, the infectious diseases which he has passed through, his habits
+and anomalies, his use of alcohol and of drugs, his experiences in
+social life, the demands of his profession, his recent troubles and
+their first origin are to be recorded carefully. Then begins the
+physical examination, the study of his sense organs and his nerves, of
+the motor inabilities, the pains, the local an&aelig;sthesias and
+par&aelig;sthesias, the disturbances of the reflexes, of the spasms, tremors,
+convulsions, and inco&ouml;rdinations, of the vasomotor and trophic
+disorders, and so on. In a similar way the psychical examination tests
+the hallucinations and illusions, the variations and defects of memory
+and attention, of judgment and reasoning, of orientation and
+self-consciousness, of emotions and volitions, of intellectual
+capacities and organized actions. But we do not have to enter here into
+a discussion of such diagnostic means; our chief interest belongs to the
+therapy.</p>
+
+<p>The variety of the psychotherapeutic methods is great and only some
+types are to be characterized<span class='pagenum'><a name="Page_187" id="Page_187">[Pg 187]</a></span> here. But one rule is common to all of
+them: never use psychotherapeutic methods in a schematic way like a
+rigid pattern. Schematic treatment is a poor treatment in every
+department of medicine, but in psychotherapeutics it is disastrous.
+There are no two cases alike and not only the easily recognizable
+differences of sex and age, and occupation and education, and financial
+means, and temperament and capacity are decisive, but all the subtle
+variations of prejudices and beliefs, preferences and dislikes, family
+life and social surroundings, ambitions and prospects, memories and
+fancies, diet and habits must carefully be considered. Every element of
+a man's life history, impressions of early childhood, his love and his
+successes, his diseases and his distresses, his acquaintances and his
+reading, his talent, his character, his sincerity, his energy, his
+intelligence&mdash;everything&mdash;ought to determine the choice of the
+psychotherapeutic steps. As it is entirely impossible to determine all
+those factors by any sufficient inquiry, most of the adjustment of
+method must be left to the instinct of the physician, in which wide
+experience, solid knowledge, tact, and sympathy ought to be blended.
+Even the way in which the patient reacts on the method will often guide
+the instinct of the well-trained psychotherapist.</p>
+
+<p>It is therefore certainly not enough that the knowledge of the physician
+simply decide beforehand on a definite course of psychical treatment and
+leave the carrying out to a well-meaning minister or any other medical
+amateur who schematically follows the indicated path. The finest
+adjustment has to come in<span class='pagenum'><a name="Page_188" id="Page_188">[Pg 188]</a></span> during the treatment itself and the response
+of the patient often has to suggest entirely new lines of procedure.
+More than in any other field of medicine, the physician himself has to
+extend his influence far beyond the office hours and the strictly
+medical relations. And yet, on the other hand, there is no department of
+medicine in which the treatment might not profit by the
+psychotherapeutic influence. With a few vague words of encouragement
+mechanically uttered, or with a routine of tricks of suggestion by bread
+pills and colored water and tuning forks, not much will be gained even
+in the ordinary physician's practice. Subtle adjustment to the personal
+needs and to the individual conditions is necessary in every case where
+the psychical factor is to play an important r&ocirc;le. It cannot be denied
+that the one great obstacle in the work of the routine physician is the
+lack of time and patience which is needed for successful treatment. To
+prescribe drugs is always quicker than to influence the mind; to cure a
+morphinist by hyoscine needs less effort than to cure him by suggestion.</p>
+
+<p>The first method to bring back the psychophysical equilibrium is of
+course the one which is also demanded by common-sense, namely, to remove
+the external sources of the disturbance. External indicates there not
+only the outer world but also the own body outside the conscious parts
+of the brain. If we take it in the widest meaning, this would evidently
+include every possible medical task from filling a painful tooth to
+operating on a painful appendix, as in every case where pain results,
+the mental equilibrium is dis<span class='pagenum'><a name="Page_189" id="Page_189">[Pg 189]</a></span>turbed by it and the normal mental life of
+the patient reduced in its efficiency. But in the narrower sense of the
+word, we shall rather think of those sources of trouble in the organism
+itself which interfere directly with the mental functions. The
+examination of any public school quickly leads to the discovery that
+much which is taken for impaired mental activity, for lack of attention,
+for stupidity, or laziness may be the result of defective hearing or
+sight or abnormal growth of the adenoids. Growths in the nose may be
+operated upon, the astigmatic or the short-sighted eye may be corrected
+by glasses, the child who is hard of hearing may at least be seated near
+the teacher; and the backward children quickly reach the average level.
+No doubt in the life of the adult as well, often almost insignificant
+and from a strictly physical point of view unimportant abnormities in
+the bodily system, especially in the digestive and sexual spheres, are
+sources of irritation which slowly influence the whole personality. To
+be sure, the brain disturbance may have reached a point where the mere
+removal of the original affliction is not sufficient to reinstate the
+normal balance of mental energies, but wherever such a bodily irritation
+goes on, it is never too late to abolish it in the interests of
+psychotherapy.</p>
+
+<p>The less evident and yet even more important source of the painful
+intrusions may lie outside of the organism in the social surroundings
+and conditions of life. Most of that has to be accepted. The physician
+cannot bring back the friend who died or the fortune which was lost in
+speculation or the man who married<span class='pagenum'><a name="Page_190" id="Page_190">[Pg 190]</a></span> another girl. He will even avoid
+suggesting far-reaching social changes in the private life of the
+patient, changes like divorce in an unhappy marriage or the breaking of
+the home ties, however often he may get the impression that such a
+liberation would stop the source of the mental trouble. He will be the
+more careful not to overstep his medical rights as he seldom has the
+possibility to judge fairly on the basis of the one-sided complaint, and
+the probability is great that the character and temperament of the
+complainant may be a more essential factor of the ailment than the
+personalities which surround him. Yet even the conservative physician
+will find abundant opportunities for advice which will remove disturbing
+energies from the social surroundings of the sufferer. Even a short
+release from the burdening duties, a short vacation from the incessant
+needs of the nursery, a break in the monotony of the office, may often
+do wonders with a neurasthenic. Often within a surprisingly short time
+the brain gathers the energies to overcome the frictions with
+unavoidable surroundings.</p>
+
+<p>Yet here the physician has to adjust the prescribed dose of outing very
+carefully to the special case. We may be guided by the psychological
+experiments which have been made in the interest of testing the fatigue
+induced by mental work. If perhaps four hours of concentrated work are
+done without pauses, experiment shows that the quality of the work
+deteriorates, measured for instance by the number of mistakes in quick
+calculation. If certain relatively long pauses<span class='pagenum'><a name="Page_191" id="Page_191">[Pg 191]</a></span> are introduced, the
+standard of work can be kept high all through. But if frequent pauses
+are made, and each short, the result is with many individuals the
+opposite. The experiment indicates that these frequent pauses are
+working as interruptions which hinder the perfect adjustment to the work
+in hand. That is suggestive. Our neurasthenic may complain about the
+life which he has to live and yet after all he is frequently so
+completely adjusted to it that it may not be in his interest to remove
+him far away from the conditions which cannot ultimately be changed but
+to which he has to return. The instinct of the physician has to find the
+middle way between a temporary removal of irritation which really allows
+a development of new energies and a mere interruption which simply
+damages the acquired relative adjustment. Every cause of friction which
+can be permanently annihilated for the patient certainly should be
+removed.</p>
+
+<p>This negative remedy demands its positive supplement. The patient must
+be brought under conditions and influences which give fair chances for
+the recuperation of his energies. Too often from the standpoint of the
+psychologist, the prescription is simply rest. As far as rest involves
+sleep, it is certainly the ideal prescription. There is no other
+influence which builds up the injured central nervous system as safely
+as sound natural sleep, and loss of sleep is certainly one of the most
+pernicious conditions for the brain. Again rest is a great factor in
+those systematic rest cures which for a long while were almost the
+fashion<span class='pagenum'><a name="Page_192" id="Page_192">[Pg 192]</a></span> with the neurologist. Experience has shown that their
+stereotyped use is often unsuccessful, and moreover that the advantage
+gained by those months spent in bed completely isolated and overfed is
+perhaps due to the separation and changed nutrition more than to the
+overlong absolute rest. Yet used with discrimination, the physiological
+and the psychical effect of lying in bed for a few weeks has certainly
+often been a marked improvement, especially with young women. But more
+often the idea of rest in bed during daytime is not meant at all when
+the nerve specialist recommends rest to his over-strained patient. It is
+simply meant that he give up his fatiguing daily work, even if that work
+is made up of a round of entertainments and calls and social
+engagements. The neurasthenic and all similar varieties are sent away
+from the noise of the city, away from the rush of their busy life, away
+from telephones and street cars, away from the hustling business and
+politics.</p>
+
+<p>Indeed it is the dogma of most official and unofficial doctors that the
+restlessness and hurry and noise which all are characteristic of the
+technical conditions of our time are the chief sources of the prevailing
+nervousness. There was no time in the history of civilization in which
+the average man was overwhelmed by so many demands on his nerve energy,
+no time which asked such an abundance of interests even from the school
+child. The wild chase for luxury in the higher classes, re&euml;nforced by
+the commercialism of our time, the hard and monotonous labor in our
+modern mills and mines for the lower classes, the<span class='pagenum'><a name="Page_193" id="Page_193">[Pg 193]</a></span> over-excitement
+brought to everybody by the sensationalism of our newspapers and of our
+public life all injure the brain cells and damage the equilibrium. That
+is a story which we hear a thousand times nowadays. Yet it is doubtful
+whether there is really much truth in such a claim and whether much wise
+psychotherapy can be deduced from it.</p>
+
+<p>We may begin even with the very justifiable doubt whether nervousness
+really has increased in our time. Earlier periods had not so many names
+for those symptoms and were not able to discriminate them with the same
+clearness. Above all, the milder forms of abnormities were not looked on
+as pathological disturbances. If a man has a pessimistic temperament, or
+has fits of temper, or cannot get rid of a sad memory idea, or imagines
+that he feels an illness which he does not have, or has no energy to
+work, even today most people are still without suspicion that a
+neurasthenic or a psychasthenic or a hysteric disturbance of the nervous
+system may be in its beginning. Earlier times surely may have treated
+even the stronger varieties of this kind as troublesome variations in
+the sphere of the normal. On the other hand, there can be no doubt that,
+for instance, the Middle Ages developed severe diseases of the nervous
+system in an almost epidemic way which is nearly unknown to our time.</p>
+
+<p>As to the conditions of life itself, there are certainly many factors at
+work which secure favorable influences for our cerebral activity. The
+progress of scientific hygiene has brought everyone much nearer<span class='pagenum'><a name="Page_194" id="Page_194">[Pg 194]</a></span> to a
+harmonious functioning of the organism, and the progress of technique
+has removed innumerable difficulties from the play of life. Of course,
+we stand today before a much more complex surrounding than our ancestors
+but still more quickly than the complexity have grown the means to
+master it. We have to know more: yet the effort has not become greater
+since it has become easier to acquire knowledge. We have to endure much
+disturbing noise, and yet we forget how the sense organs of our
+forefathers must have been maltreated, for instance, by flickering
+light. We are in a rush of work and stand in thousandfold connections;
+and yet the neural energy which is demanded is not large because a
+thousand devices of our technical life have become our obedient
+servants. There is no nation on earth which is more proud of its rush
+and its hurry than the American people; and yet what an abundance of
+time is leisurely wasted that would have to be used for work if the
+country could not live from its richness. Moreover our life has probably
+become cooler, there is less emotionalism, less sentimentality, more
+business-like attitude, and that all means less inner friction and
+excitement; in public life too, less fear of war and less religious
+struggle. All has become a question of administration and efficiency.
+Our time is certainly not worse off on the score of neurasthenia than
+its predecessors.</p>
+
+<p>Above all the intensity of mental stimuli is always relative. The
+psychologist knows the experiments which determine that we perceive the
+difference of impressions as alike when the stimuli are propor<span class='pagenum'><a name="Page_195" id="Page_195">[Pg 195]</a></span>tional.
+If I have a ten-pound weight in one hand, I may find that I must have
+one pound more in the other hand to discriminate the difference. Now if
+I take twenty pounds in the one hand, then it is not sufficient to have
+one pound more in the other, but I must have twenty-two pounds in the
+other to feel a difference, and if I take thirty pounds, the other
+weight must be thirty-three. We feel equal differences when the weights
+stand in the same relation. The man who owns a hundred dollars will
+enjoy the gain of five and regret the loss of five just as much as the
+owner of a hundred thousand dollars would feel the gain or loss of five
+thousand. This fundamental law of the relativity of psychical
+impressions controls our whole life. The rush of stimuli which might
+mean a source of nervous disturbance for the villager whose quiet
+country life has brought about an adjustment to faint impressions may
+cause very slight stimulation for the metropolitan accustomed for a
+lifetime to the rhythm of the surroundings. Yet that quiet countryman
+may react in his narrow system not less when the modest changes in his
+surroundings provoke him. The gossip of his neighbor may undermine his
+nervous system just as much as a political fight or the struggles of the
+exchange that of the city man.</p>
+
+<p>The same holds true for the purely intellectual engagements. The work
+which the scholar undertakes should not be measured by the effect which
+the same appeal to concentrated attention would make on the average man
+of practical life. There, too, an adjust<span class='pagenum'><a name="Page_196" id="Page_196">[Pg 196]</a></span>ment to the demand has resulted
+during the whole period of training and professional work. Every effort
+should be estimated with reference to the standard of the particular
+case. This relativity of the mental reaction on the demands of life must
+always be in the foreground of the psychotherapeutic r&eacute;gime. Even the
+best physicians too often sin against this principle and accuse the life
+which a man or woman leads as too exhausting and overstraining simply
+because it would be overstraining and exhausting to others who are not
+adjusted to that special standard. Simply to withdraw a patient from the
+one kind of life and to force on him a new kind with new standards may
+not be a gain at all. A new adjustment begins and smaller differences
+from the standard may bring about the same strong intensities of
+reaction as the large differences brought before. Complete rest, for
+instance, for a hard brain-worker hardly ought to be recommended unless
+a high degree of exhaustion has come on. If routine prescriptions are to
+be admitted at all, they should not be complete rest or complete change
+of life for any length of time but a continuation of the life for which
+adjustment has been learned with a reasonable reduction of the demands
+and stimulations. The intellectual worker ought to decrease his work,
+the overbusy society woman ought to stay in bed one day in the week, the
+man in the midst of the rush of life ought to cut down his obligations,
+but probably each of them does better to go on than simply to swear off
+altogether.</p>
+
+<p>Their rest ought to have the character of vacation;<span class='pagenum'><a name="Page_197" id="Page_197">[Pg 197]</a></span> that means
+interruptions without the usual activity ought to be short periods spent
+with the distinct feeling that they are interruptions of that which must
+last and that they are not themselves to become lasting states. Thus the
+inner adjustment to the work ought to be kept up and ought not to be
+substituted by a new adjustment to a less exacting life. In this way the
+episode of the vacation rest ought to be in a way included in the
+strenuous life almost as a part of its programme. Strenuosity must not
+mean an external rush with the gestures of overbusy excitement, but
+certainly the doctrine of the lazy life is wretched psychotherapy, as
+long as no serious illness is in question. By far the best alteration
+is, therefore, even in the periods of interruption, not simply rest but
+new engagements which awaken new interests and stimulate neglected
+mental factors, disburdening the over-strained elements of mental life.
+The most effective agency for this task is contact with beauty, beauty
+in nature and life, beauty in art and literature and music. To enjoy a
+landscape ought to be not merely a negative rest for the man of the
+office building, and good literature or music absorbs the mental
+energies and harmonizes them. In the second place come games and sport,
+which may enter into their right if fatigue can be avoided. Harmonious
+joyful company, as different as possible from the depressing company of
+the sanitariums, will add its pleasantness.</p>
+
+<p>While the advice of the physician ought thus to emphasize the positive
+elements which work, not towards<span class='pagenum'><a name="Page_198" id="Page_198">[Pg 198]</a></span> rest, but toward a harmonious mental
+activity, we must not forget some essential negative prescriptions.
+Everything is to be avoided which interferes with the night's sleep.
+Furthermore, in the first place, alcohol must be avoided. There cannot
+be any doubt that alcoholic intemperance is one of the chief sources of
+brain disturbances and that the fight against intemperance, which in
+this country is essentially the fight against the disgusting saloon, is
+a duty of everyone who wants to prevent nervous disaster. There may and
+must be divergence of opinion as to the safest way to overcome
+intemperance. The conservative physician will feel grave doubt whether
+the hasty recommendation of complete prohibition is such a safe way,
+whether it does not contain many conditions of evil, and whether the
+fight against the misuse of alcohol will not be more successful if a
+true education for temperance is accepted as the next goal. But for the
+man of neurasthenic constitution and for any brain of weak resistance,
+the limit for permissible alcoholic beverages ought to be drawn very
+narrow and in such cases temporary abstinence is usually the safest
+advice. Individual cases must indicate where a glass of light beer with
+the meal or a glass of a mild wine may be permissible. Strong drinks
+like cocktails are absolutely to be excluded. In the same way a strong
+reduction is advisable in tobacco, tea, and especially coffee. A
+complete withdrawal of all stimulations to which a nervous system has
+been accustomed for years is not wise, or at least mild substitutes
+ought to be suggested, but if coffee can be<span class='pagenum'><a name="Page_199" id="Page_199">[Pg 199]</a></span> ruled out at once, often
+much is gained. In the same way all passionate excitements are to be
+eliminated and sexual life to be wisely regulated. An especial warning
+signal is to be posted before all strong emotions, and if the patient
+cannot be asked to leave his worry at home, he can at least be asked to
+avoid situations which will necessarily lead to excitement and quarrel
+and possible disappointment.</p>
+
+<p>It is one of the surest tests of psychotherapeutic skill to discriminate
+wisely whether one or the other of these features of general treatment
+ought to be emphasized. They usually demand more insight than specific
+forms of psychotherapy like hypnotic suggestions. These general efforts
+are also much more directed against the disease itself where the
+specific methods are merely directed against the symptoms. The
+separation from disturbing surroundings, the reduction of engagements
+and work, the complete rest, the suppression of artificial stimulants,
+the enjoyment of art, of nature, of sport, the distractions of social
+life, each might be in one case a decisive help and indifferent, perhaps
+even harmful in another. All is a matter of choice and adjustment to the
+particular needs in which all the personal factors of inherited
+constitution, acquired adjustments, social surroundings, temperament,
+and education, and the probable later development have to be most
+tactfully weighed. Yet this general treatment may take and very often
+ought to take the opposite direction, not towards rest but towards work,
+not towards light distraction but towards serious effort, not towards<span class='pagenum'><a name="Page_200" id="Page_200">[Pg 200]</a></span>
+reduction of engagements but towards energetic regulation. We said that
+it was an exaggeration to blame the external conditions of our life, the
+technical manifoldness of our surroundings as the source of the
+widespread nervousness. The mere complexity of the life, the rapidity of
+the demands, the amount of intellectual effort is in itself not
+dangerous and our time is not more pernicious than the past has been;
+but it is perhaps no exaggeration to say that our time is by many of its
+features more than the past tending towards an unsound inner attitude of
+man.</p>
+
+<p>Much of the present civilization leads the average man and woman to a
+superficiality and inner hastiness which undermines sound mental life
+much more than the external factors. We look with a condescending smile
+at the old-fashioned periods in which the demands of authority and
+discipline controlled the education of the child and after all the
+education of the adult to his last days. We have substituted for it the
+demand of freedom with all its blessings, but instead of the blessings
+we too often get all its vices. A go-as-you-please method characterizes
+our whole society from the kindergarten to the height of life. We
+eulogize the principle of following the paths of own true interest and
+mean by that too often paths of least resistance. Study becomes play,
+the child learns a hundred things but does not learn the most important
+one, to do his duty and to do it accurately and with submission to a
+general purpose. The power of attention thus never becomes trained, the
+energy to concentrate on that which is not inter<span class='pagenum'><a name="Page_201" id="Page_201">[Pg 201]</a></span>esting by its own
+appeal is slowly lost, a flabby superficiality must set in which is
+moved by nothing but the personal advantage and the zigzag impulses of
+the chance surroundings. He who has never learned obedience can never
+become his own master, and whoever is not his own master through all his
+life lacks the mental soundness and mental balance which a harmonious
+life demands. Flippancy and carelessness, haphazard interests and
+recklessness must result, mediocrity wins the day, cheap aims pervade
+the social life, hasty judgments, superficial emotions, trivial
+problems, sensational excitements, and vulgar pleasures appeal to the
+masses. Yellow papers and vaudeville shows&mdash;vaudeville shows on the
+stage, in the courtroom, on the political platform, in the pulpit of the
+church&mdash;are welcome, and of all the results, one is the most immediate,
+the disorganization of the brain energies.</p>
+
+<p>A sound mind is a well-organized mind in which a controlling idea is
+able to inhibit the opposites and is in no danger of being overrun by
+any chance intrusion into the mind. This power is the act of attention.
+An attention which is trained and disciplined can hold its ideas against
+chance impulses. An untrained attention is attracted by everything which
+is loud and shining, big and amusing. The trouble is not with the rush
+and hurry of the impressions which demand our attention; the trouble is
+with our attention which seeks a quick change of new and ever new
+impressions because it is not disciplined to hold firmly to one
+important interest. We want the hundred<span class='pagenum'><a name="Page_202" id="Page_202">[Pg 202]</a></span> short-cut superficial magazines
+because we lack the energy to study one large volume; we want the
+thousand engagements because we are not concentrated enough to devote
+ourselves fully to one ideal task. The strong mind may find its sound
+adjustment even without such training for concentrated attention through
+obedience and discipline but the weak mind has to pay the penalty. For
+not a few it will mean social disaster. Yet our society is sufficiently
+adapted to this state so that it gives some good social chances to the
+superficial too, and this not only to the rich, but to those on every
+level. Only the nervous system cannot so easily be adjusted to the new
+r&eacute;gime. The loose interplay of the brain cells without the serious
+training of discipline must involve disorganization of the mind-brain
+system which may count often most powerfully in those spheres in which
+the mere needs of life are felt the least. There is only one great
+remedy: discipline, training for concentrated attention, for a work in
+submission of will to a steady purpose. And psychotherapeutic effort
+will often demand such a training for work rather than a reduction of
+work and rest.</p>
+
+<p>The most alarming product of the neglect in training is found in many of
+those retarded children who at fifteen show the intelligence of a boy of
+eight. They are not imbeciles and do not belong in the psychiatric
+domain; their development has simply been suspended by a mistaken
+education. Of course no neglect would have led to it without a
+constitutional, inherited weakness of the central nervous sys<span class='pagenum'><a name="Page_203" id="Page_203">[Pg 203]</a></span>tem, but
+the weakness would never have led to the retardation if perhaps a
+mistaken parental indulgence had not allowed a life without forced
+effort and, therefore, without progress. Even such extreme cases may not
+show on the surface. The boy may pass as all right if we meet him at a
+ball; only his tutor knows the whole misery. Still less does the surface
+view of many a grown-up neurasthenic alarm us who seems to live a
+well-ordered, perhaps an enviable life, and yet who suffers the penalty
+of a life without concentrated effort, really without anything to do in
+spite of a thousand engagements. Moreover this lack of important
+activity may often be forced on our patients. Married women without
+children, without household responsibilities, and without interests of
+their own and without strong nervous constitution will soon lose the
+power of effort and their brain will succumb. A dreary monotony is
+dangerous even for the worker; for the non-worker it may be ruinous.</p>
+
+<p>Yet mere flippant excitement and superficial entertainment is nothing
+but a cheap counterfeit of what is needed. Voluntary effort is needed,
+and this is the field where the psychotherapist must put in his most
+intelligent effort. There is no one for whom there is not a chance for
+work in our social fabric. The prescription of work has not only to be
+adjusted to the abilities, the knowledge, and social condition, but has
+to be chosen in such a way that it is full of associations and
+ultimately of joyful emotions. Useless work can never confer the
+greatest benefits; mere physical exercises are therefore
+psychophysically not<span class='pagenum'><a name="Page_204" id="Page_204">[Pg 204]</a></span> as valuable as real sport while physically, of
+course, the regulated exercises may be far superior to the haphazard
+work in sport. To solve picture puzzles, even if they absorb the
+attention for a week, can never have the same effect as a real interest
+in a human puzzle. There is a chance for social work for every woman and
+every man, work which can well be chosen in full adjustment to the
+personal preference and likings. Not everybody is fit for charity work,
+and those who are may be entirely unfitted for work in the interest of
+the beautification of the town. Only it has to be work; mere
+automobiling to charity places or talking in meetings on problems which
+have not been studied will, of course, be merely another form of the
+disorganizing superficiality. The hysterical lady on Fifth Avenue and
+the psychasthenic old maid in the New England country town both simply
+have to learn to do useful work with a concentrated effort and a high
+purpose. From a long experience I have to confess that I have seen that
+this unsentimental remedy is the safest and most important prescription
+in the prescription book of the psychotherapist.</p>
+
+<p>There is one more feature of general treatment which seems almost a
+matter of course, and yet which is perhaps the most difficult to apply
+because it cannot simply be prescribed: the sympathy of the
+psychotherapist. The feelings with which an operation is performed or
+drugs given do not determine success, but when we build up a mental
+life, the feelings are a decisive factor. To be sure, we must not forget
+that we have to deal here with a causal and not with a pur<span class='pagenum'><a name="Page_205" id="Page_205">[Pg 205]</a></span>posive point
+of view. Our sympathy is therefore not in question in its moral value
+but only as a cause of a desired effect. It is therefore not really our
+sympathy which counts but the appearance of sympathy, the impression
+which secures the belief of the patient that sympathy for him exists.
+The physician who, although full of real sympathy, does not understand
+how to express it and make it felt will thus be less successful than his
+colleague who may at heart remain entirely indifferent but has a
+skillful routine of going through the symptoms of sympathy. The
+sympathetic vibration of the voice and skillful words and suggestive
+movements may be all that is needed, but without some power of awakening
+this feeling of personal relation, almost of intimacy, the wisest
+psychotherapeutic treatment may remain ineffective. That reaches its
+extreme in those frequent cases in which social conditions have brought
+about an emotional isolation of the patient and have filled him with an
+instinctive longing to break his mental loneliness, or in the still more
+frequent cases where the patient's psychical sufferings are
+misunderstood or ridiculed as mere fancies or misjudged as merely
+imaginary evils. Again everything depends upon the experience and tact
+of the physician. His sympathy may easily overdo the intention and
+further re&euml;nforce the patient's feeling of misery or make him an
+hypochondriac. It ought to be sympathy with authority and sympathy which
+always at the same time shows the way to discipline. Under special
+conditions it is even advisable to group patients with similar diseases
+to<span class='pagenum'><a name="Page_206" id="Page_206">[Pg 206]</a></span>gether and to give them strength through the natural mutual sympathy;
+yet this too can be in question only where this community becomes a
+starting point for common action and common effort, not for mere common
+depression. In this way a certain psychical value must be acknowledged
+for the social classes of tuberculosis as they have recently been
+instituted.</p>
+
+<p>From sympathy it is only one step to encouragement, which indeed is
+effective only where sympathy or at least belief in sympathy exists. He
+who builds up a new confidence in a happy future most easily brings to
+the patient also that self-control and energy which is the greatest of
+helping agencies. The physical and mental efforts of the physician are
+alike deprived of their best efficiency if they are checked by worry and
+fear that the developments of the disease will be disastrous. As soon as
+new faith in life is given, and given even where a sincere prognosis
+must be a sad one, a great and not seldom unexpected improvement is
+secured. There is no doubt that the routine physician is doing by far
+too little in these respects. His instinctive feeling that disease is a
+causal process, and that he should therefore keep away from the
+purposive attitude, leads him too easily to a dangerous narrowness. He
+treats disease as if it were an isolated process and overlooks the
+thousandfold connections in which the nervous system stands with the
+patient's whole life experience in past and future. The physician is
+thus too easily inclined to underestimate the good which may come in the
+fight against disease from the ideas and emotions<span class='pagenum'><a name="Page_207" id="Page_207">[Pg 207]</a></span> which form the
+background of the mind of the patient. Even if the disease cannot be
+vanquished, the mental disturbances which result from it, the pains and
+discomforts, may be inhibited, as soon as hopes and joyful purposes gain
+a dominating control of the mind. The nervous patient often needs a
+larger hold upon life, while the routine prescriptions may too easily
+reduce that hold by fixing the attention on the symptoms.</p>
+
+<p>Here then is the right place for the moral appeal and the religious
+stimulation. How psychotherapy is related to the church will interest us
+later. At this moment morality and religion are for us not inspirations
+but medicines. But from such a causal point of view, we should not
+underestimate the manifold good which can come from the causal effect of
+religious and ethical ideas. Those faith curists who bring mutual help
+by impressing each other with the beauty and goodness of the world
+really bring new strength to the wavering mind; and the most natural
+channel for religious help remains, of course, the word of the minister
+and the own prayer. Religion may work there causally in a double way.
+The own personality is submerging into a larger all-embracing hold and
+thus inhibits the small cares and troubles of merely personal origin.
+The consciousness sinks into God, a mental process which reaches its
+maximum in mysticism. The haphazard pains of the personality disappear
+and are suppressed by the joy and glory of the whole. This submission of
+will under a higher will and its inhibitory effect for suppression of
+dis<span class='pagenum'><a name="Page_208" id="Page_208">[Pg 208]</a></span>turbing symptoms must be wonderfully re&euml;nforced by the attitude of
+prayer. Even the physiological conditions of it, the clasping of the
+hands, the kneeling, and monotonous sounds re&euml;nforce this inhibition of
+the insignificant dissatisfactions. On the other hand, contact with the
+greater will must open the whole reservoir of suppressed energies, and
+this outbreak of hidden forces may work towards the regeneration of the
+whole psychophysical system. Neglected functions of the brain become
+released and give to the mind an energy and discipline and self-control
+and mastery of difficulties which restitutes the whole equilibrium, and
+with the equilibrium comes a new calmness and serenity which may react
+almost miraculously on the entire nervous system and through it on the
+whole organism and its metabolism.</p>
+
+<p>Seen from a causal point of view, however, there is no miracle in it at
+all. On the contrary, it is a natural psychophysical process which
+demands careful supervision not to become dangerous. It is not the value
+of the religion which determines the improvement, and it is not God who
+makes the cure; or to speak less irreligiously, the physician ought to
+say that if it is God who cures through the prayer, it is not less God
+who cures in other cases through bromide and morphine, and on the other
+side just as God often refuses to cure through the prescribed drugs of
+the drug store, God not less often refuses to cure through prayer and
+church influence. But the real standpoint of the physician will be to
+consider both the drugs and the religious ideas merely as causal
+agencies and<span class='pagenum'><a name="Page_209" id="Page_209">[Pg 209]</a></span> to try to understand the conditions of their efficiency
+and the limits which are set for them. From such a point of view, he
+will certainly acknowledge that submission to a greater power is a
+splendid effect of inhibition and at the same time a powerful effect for
+the stimulation of unused energies; but he will recognize also that the
+use of those silent energies is not without dangers.</p>
+
+<p>Certainly nature has supplied us with a reservoir of normally unused
+psychophysical strength, to which we may resort just as the tissues of
+our body may nourish us for a few days when we are deprived of food, but
+such supply, which in exceptional cases may become the last refuge,
+cannot be used without a serious intrusion and interference with the
+normal household of mind and body. To extract these lowest layers of
+energies may mean for the psychophysical system a most exhausting effort
+which may soon bring a reaction of physical and nervous weakness. The
+chances are great that such a religious excitement, if it is really to
+have a deep effect, may go over into a mystic fascination which leads to
+hysteria or into an exhausting eruption of energies which ends in
+neurasthenic after-effects. The immediate successes of the strong
+religious influence on the weakened nervous system, especially on the
+nervous system of a weak inherited constitution, are too often stage
+effects which do not last. From a mere purposive point of view, they may
+be complete successes. They may have turned the immoral man into a moral
+man, the skeptic into a believer, but the physician cannot overlook<span class='pagenum'><a name="Page_210" id="Page_210">[Pg 210]</a></span>
+that the result may be a moral man with a crippled nervous system, a
+believer with psychasthenic symptoms. From the point of view of the
+church, there cannot be too much religion; from a therapeutic point of
+view, religion works there like any other nervous remedy of which five
+grains may help and fifty grains may be ruinous.</p>
+
+<p>Moreover this power of inhibiting the little troubles of the body and of
+bringing to work and effectiveness the deepest powers of the mind
+belongs not less to any other important idea and overpowering purpose.
+The soldier in battle does not feel the pain of his wound, and in an
+emergency everybody develops powers of which he was not aware. The same
+effect which religion produces may thus be secured by any other deep
+interest: service for a great human cause, enthusiasm for a gigantic
+plan, even the prospect of a great personal success. Thus in a
+psychotherapeutic system, religion has only to take its place in line
+with many other efforts to inhibit the feeling of misery and to
+re&euml;nforce will and self-control by submission under a greater will. That
+in the case of religion this submission, from an entirely different
+purposive point of view, also has a moral and religious value, has in
+itself no relation to the question of its therapeutic character. It
+ought not to lead to any one-sided preference, inasmuch as religiously
+indifferent agencies may be in the particular case a more reliable means
+of improvement. Moreover the psychological symptoms are, after all, only
+a fraction of the disease and very different bodily factors, digestion
+and nutrition,<span class='pagenum'><a name="Page_211" id="Page_211">[Pg 211]</a></span> heart and lungs and sexual organs may be most intimately
+connected with the disturbance of the equilibrium. Medicine today no
+longer believes that hysteria originates in the diseases of the uterus
+or that neurasthenia necessarily results from insufficiencies of the
+stomach, but it would be a graver mistake to believe that mental factors
+alone decide the progress of the disease, however prominent the mental
+symptoms may be in it.</p>
+
+<p>From the physician's encouragement and the minister's influence towards
+new faith in life, a short way leads to the influence of suggestion. It
+is on the whole the way which leads from the general psychotherapeutic
+treatment to the specific one directed against particular symptoms.<span class='pagenum'><a name="Page_212" id="Page_212">[Pg 212]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="IX" id="IX"></a>IX<br /><br />
+<span class="sub">THE SPECIAL METHODS OF PSYCHOTHERAPY</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>Of course there is no abrupt division between special and general
+methods. Yet the different tendency is easily recognized, if we turn
+only, for instance, from the mere sympathy and encouragement to the
+method of reasoning with the patient about the origin of his special
+complaint. Just now the medical profession moves along this line a great
+deal. Of course no well-trained psychotherapist will make the blunder of
+arguing with the insane. To dispute by argument with the paranoiac and
+to try to convince him would not be only without success, but easily
+irritating. This does not mean that the not less amateurish way ought to
+be taken of accepting his delusions and appearing to be in full
+agreement with him. A tactful middle way, preferably a disciplinary
+ignoring attitude, ought to be taken. But it is entirely different with
+the mental states of the psychasthenic. The mere statement and objective
+proof that his obsession is based on an illusion would be ineffective.
+He knows that himself, but he may take the disturbance as the beginning
+of a brain disease, as a form of insanity, as a lasting damage which
+lies entirely beyond his control. Now the physician<span class='pagenum'><a name="Page_213" id="Page_213">[Pg 213]</a></span> explains to him how
+it all came about. He shows to him that the symptoms resulted merely
+from autosuggestion or are the after-effects of a suggestion from
+without or of a forgotten emotional experience of the past. That is a
+new idea to the patient and one which changes the aspect and may have an
+inhibitory influence.</p>
+
+<p>Of course, the patient does not accept the explanation at once. He feels
+sure that he is not accessible to suggestion and that he has least of
+all a tendency to autosuggestions, but the skillful psychotherapist will
+find somewhere an opening for the entering wedge. He may develop to the
+patient the modern theories of the origin of neurotic disturbances, all
+with entire sincerity and yet all shaped in a way which gives to the
+special case an especially harmless appearance. He may even enter into
+experimental proof that the patient is really accessible to
+autosuggestions. A very simple scheme for instance is to put some
+interesting looking apparatus with a few metal rings on the fingers of
+the subject and connect it with a battery and electric keys. The key is
+then pushed down in view of the patient and he is to indicate the time
+when and the place where he begins to feel the galvanic current. The
+feeling will come up probably very soon in the one or the other finger,
+and as soon as he feels sure that the sensation is present, the
+physician can show him that there was no connection in the wires, that
+the whole galvanic sensation was the result of suggestion.</p>
+
+<p>Such a method demands patience and good will.<span class='pagenum'><a name="Page_214" id="Page_214">[Pg 214]</a></span> The prejudices and
+deeply-rooted hypochondriac ideas, foolish theories of the patient and
+pessimistic emotions which have become habitual, must be removed piece
+by piece until the central symptoms themselves can be undermined and
+explored. It often takes hours of careful and fatiguing reasoning, in
+which at any time the patient may suddenly slip back to his old ideas.
+Yet if the explanatory arguments have once succeeded in making the
+patient himself believe firmly that his whole trouble resulted from
+suggestion only, the inhibitory effect of this idea may be an excellent
+one. The only serious defect of the method is that it often does not
+work. The credit which neurologists of today give to its effectiveness
+seems to me much too high. Even slight neurasthenic and psychasthenic
+disturbances remain too often in complete power when the patient is
+fully convinced that they originated with an emotional excitement which
+has long since lost its feeling value or that it resulted from a chance
+suggestion picked out from indifferent surroundings. The patient knows
+it and yet goes on suffering from the fruitless fight of his will
+against the intruder. Where mere reasoning is entirely successful, I am
+inclined to suspect that an element of suggestion has always been
+superadded. The authority of the physician has created a state of
+re&euml;nforced suggestibility in which the argument convinces, not by its
+logic but by its impressiveness.</p>
+
+<p>This element of suggestion is quite obvious when the argument takes the
+form of persuasion, a psycho<span class='pagenum'><a name="Page_215" id="Page_215">[Pg 215]</a></span>therapeutic method which has found its
+independent development. Whoever seeks to persuade relies on the mental
+fringe of his propositions. The idea is not to work by its own meaning
+but by the manner of its presentation, by its impressiveness, by the
+authority, by the warmth of the voice, by the sympathy which stands
+behind it, by the attractiveness with which it is offered, by the
+advantages which are in sight. Thus persuasion relies on personal powers
+to secure conviction where the logic of the argument is insufficient to
+overcome contradictions. But just for that reason persuasion is after
+all only a special kind of suggestion.</p>
+
+<p>Other methods work on the same basis. Prominent among them is the
+psychotherapeutic effect of a formal assurance. The psychotherapist
+assures the patient that he will sleep the next night or that the pain
+will disappear or that he will be able to walk with such firmness that
+the counter-idea is undermined. It depends on the type of patient
+whether such suggestions of belief work better when it is assured with
+an air of condescension, spoken with an authority which simply ignores
+every possible contradiction, or with an air of sympathy and hope.
+Experience shows that it is favorable to connect such assurance with the
+entrance of a definite signal. "You will sleep to-night when the clock
+strikes ten," "The pain will disappear when you enter the door of your
+house," or perhaps, "Read this letter three times quietly in a low
+voice, and at the end of the third reading your fear will suddenly
+stop." Psy<span class='pagenum'><a name="Page_216" id="Page_216">[Pg 216]</a></span>chological insight will further decide whether it is wiser in
+the particular case to assure the patient of the resulting effect or
+rather of the power to bring about the effect. With some people, it
+works better to insist that the result will happen, with others to
+promise that they themselves can secure it; in the one case they feel
+themselves as passive instruments, in the other as real actors. To some
+hysterics, it is better to say: "You will walk," to others, "You can
+walk."</p>
+
+<p>This belief in the future entrance of a change frequently demands an
+artificial re&euml;nforcement. There belongs first the application of
+external factors which awaken in the background of the mind the
+supporting idea that something has been changed in the whole situation
+or that some helpful influence has made the improvement possible.
+Medicines of colored and flavored water, applications of electric
+instruments without currents, in extreme cases even the claptrap of a
+sham operation with a slight cut in the skin, may touch those brain
+cells which words alone cannot reach with sufficient energy and may thus
+secure the desired psychophysical effect. The patient who by merely
+mental inhibition has lost his voice for weeks may get it back as soon
+as the physician has looked into his larynx with a mirror and has held
+an electrode without battery connection on the throat. Another way of
+helping by make-believe methods is to give the impression that a decided
+improvement is noticeable. The uneducated patient believes it easily
+when the physician at his very entrance into the office<span class='pagenum'><a name="Page_217" id="Page_217">[Pg 217]</a></span> expresses his
+surprise about the external symptoms of a change for the better, perhaps
+seen in the color of the skin or the shading of the iris in the eye and
+reaffirmed by some pseudotests of the muscle reflexes. All that is not
+very edifying and the decent physician, who justly feels somewhat
+dragged down to the level of the quack in applying such means
+frequently, will abstain from them wherever possible. He knows that in
+the long run, even the psychasthenics are best treated with frankness
+and sincerity and he will therefore only in exceptional cases resort to
+such short-cut treatment by making believe. Yet that it is sometimes
+almost the only way to help the patient cannot be denied.</p>
+
+<p>A neater way to secure the sufferer's belief in the possibility of a
+cure is by securing the desired effect at least once through little
+devices. As soon as it is once reached, the patient knows that it can be
+reached and this knowledge works as a suggestion. The hysteric who
+cannot speak when he thinks of his words, or who cannot walk when he
+thinks of his legs, may by the skillful physician be brought to a few
+words or steps before he himself is aware of it by completely turning
+his attention to something else and producing the stimulus toward the
+movement in a reflex-like way. Still more successful is the effort to
+resolve the inhibited action into its component parts and to show to the
+patient who cannot perform the action as a whole that he can go through
+the parts of it after all. As soon as he has passed through a few times,
+a new tactual-visual image of the whole<span class='pagenum'><a name="Page_218" id="Page_218">[Pg 218]</a></span> complex is secured for his
+consciousness and this image works then as a new cue for the entire
+voluntary action, overcoming the associated counter-idea.</p>
+
+<p>Another excellent way to overpower a troublesome idea or impulse or
+emotion is to re&euml;nforce the opposite idea by breaking open the paths for
+its motor expression. The effort to hold the counter-idea before
+consciousness may be unsuccessful so long as it is only an idea which
+tries in vain to produce any motor effect; but if the action itself has
+been repeatedly gone through, the idea will find it easier to settle and
+it becomes vivid in proportion to the openness of the channels of motor
+discharge. This holds true even for emotional states. A certain word
+perhaps picked up by the psychasthenic in a particular experience may
+produce whenever it is seen a shock and a depressing emotion. If we ask
+the patient to go artificially through the movements which express joy
+and hilarity, make him intentionally grin and open wide the eyes and
+expand the arms and inhale deeply, and after training this movement
+complex of joyful expression, speak the dreaded word at the height of
+the movement a new feeling combination clusters about the sound and may
+overcome the antagonism. Sometimes you will give to the desirable idea
+sufficient strength by mere repetition, sometimes you force the
+attention better by unusual accentuation, connecting the suggestion with
+a kind of shock. From here it is only one step to the suggestion in the
+form of a sharp order which breaks<span class='pagenum'><a name="Page_219" id="Page_219">[Pg 219]</a></span> down the resistance just by its
+suddenness and loudness, supported perhaps by a quick arm movement which
+gives a cue for imitative reflexes. In the case of a youngster even a
+slap may add to the nervous shock; also a sudden clapping of the hands
+may favor effectiveness of the suggestive order.</p>
+
+<p>Often it is wise to give the suggestion, not from without but to
+prescribe it in the form of autosuggestions. For instance, advise the
+patient not only to have the good will and intention of suppressing a
+certain fixed idea or by producing a certain inhibited impulse but to
+speak to himself in an audible voice, every morning and every evening,
+saying that he will overcome it now. Here, too, the autosuggestion may
+become effective by the frequency of the repetition or by the urgency of
+the expression or by the accompanying motor reactions. As a matter of
+course any associations which re&euml;nforce the idea may be used for
+assistance. Especially near-lying is the appeal to the man's conscience,
+but just such associations which touch the idea of the own personality
+and its deepest layers of feelings are always risky. They may touch and
+stir up old memories which interfere with success or they may awaken a
+feeling of contrast between duty and fulfillment which may disturb the
+whole equilibrium. If the physician knows that the good-will of the
+patient is insufficient to overcome the pathological disturbance, he
+ought not to make him feel ashamed or guilty, and that not only for
+moral reasons but also for strictly psychotherapeutic reasons.</p>
+
+<p><span class='pagenum'><a name="Page_220" id="Page_220">[Pg 220]</a></span>In certain easily recognizable cases, it is essential to give the
+suggestion with avoidance of any emphasis, only as a hint, passing as if
+the suggestion almost slipped from the tongue of the doctor without his
+real intention. The hysteric who is resisting the suggestion which is
+intentionally given to her is sometimes surprisingly trapped by a
+half-hidden suggestion, perhaps not spoken to the patient herself at all
+but spoken in a low voice to a colleague in the room. Sometimes we have
+to trick those who suffer by "negativism," that is by an obstinacy which
+exaggerates that of the ordinary stubborn man. In such cases the
+suggestion not to perform an action works best if we want the action
+performed. There is hardly an end to the list of such methods for
+bringing beliefs and attitudes with suggestive power to the mind of the
+sufferer. Definitely to describe the conditions under which the one or
+the other form ought to be applied would be no wiser than to tell a
+statesman what steps are to be taken in every possible diplomatic
+situation. The instinctive selection of the right means among the many
+possible ones characterizes both the true statesman and the true doctor.</p>
+
+<p>So far we have spoken only about the character of the suggestion,
+presupposing that the receiver remains in his natural state. This
+presupposition is certainly often entirely correct, but as far as it is
+correct, the results of the suggestion vary greatly with the different
+individuals. On the whole, we might say that such suggestions given to
+the subject in his normal state are effective only when the subject<span class='pagenum'><a name="Page_221" id="Page_221">[Pg 221]</a></span> is
+by nature a suggestible being. In considering the psychology of
+suggestion, we recognized at once that the degree of natural
+suggestibility varies excessively. The non-suggestible mind is only to a
+slight degree influenced by any of these proposed forms of suggestion as
+long as the suggestibility itself is not heightened. To be sure, the
+question whether the person is suggestible by nature or not cannot be
+settled simply by his own impression. Many of the most suggestible
+persons believe firmly that they are superior to any suggestive
+influence.</p>
+
+<p>To bring suggestions to greater effectiveness and to exert their
+influence practically upon every possible subject, we have thus not only
+to give suggestions or to advise autosuggestion but in both cases we
+have to secure, especially for the naturally less suggestible patients,
+a somewhat heightened suggestibility. Yet no one can overlook that some
+of the methods which we described have in themselves the tendency to
+re&euml;nforce the mental suggestibility. Those methods of emphasis and
+order, of assurance and make-believe, of practical training and of
+awakening counter-ideas, of persuasion and even of reasoning, wherever
+they are in a high degree successful probably always gain a certain part
+of their success by the increased suggestibility which the whole
+situation brings with it.</p>
+
+<p>This re&euml;nforcement of the psychophysical readiness for suggestions
+results indeed quite directly both from expectation of the unknown and
+of the half-way mysterious, and from the confidence in the doctor. Of
+course it can work very differently. The expec<span class='pagenum'><a name="Page_222" id="Page_222">[Pg 222]</a></span>tation can upset the
+nervous system and produce unrest instead of suggestibility and, instead
+of confidence, the patient may feel that discouraging diffidence which
+settles easily upon those who have tried one fashionable physician after
+another. But where there is real confidence, based perhaps on the fame
+of the doctor and on the reports of his powerful achievements, there the
+conditions for effective suggestions are greatly strengthened. Still
+better is it if this confidence in the man is combined with a sincere
+hope for recovery. To lie down on a lounge on which hundreds have been
+cured fascinates the imagination sufficiently to give to every
+suggestion a much better chance to overcome the counter-idea. The
+expectation that something wonderful will happen can even produce an
+almost hypnoid state. The effect will be the greater, the less the
+barriers of systematic knowledge hinder the entrance of suggested ideas.
+The uneducated will on the whole offer less resistance to suggestions,
+just as superstitions find the freest play in the minds of the
+untrained. It is not by chance that the earlier epidemics of
+pathological suggestibility have on the whole disappeared with the
+better popular education. In a similar way work fatigue and exhaustion.
+The resistance has grown weaker, the suggested idea goes automatically
+into activity.</p>
+
+<p>Skillful artificial means can still surpass the effect of these natural
+conditions. Here belongs everything which accentuates the authority and
+dignity of the originator of the suggestion. The psychologically trained
+physician has no difficulty in height<span class='pagenum'><a name="Page_223" id="Page_223">[Pg 223]</a></span>ening the effect by simple
+surprises, if he cares for such tricks. If the patient for whom a mental
+treatment is recognized as necessary shows himself too skeptical to
+submit to the powers of the psychotherapist, such captivation of his
+belief can easily be secured. Let the man perhaps fixate a penny on the
+table with his right eye, while the left is closed and you show him that
+you can make another penny suddenly disappear when you move it a certain
+distance to the right and appear again when you move it still further.
+As the man has never heard of the blind spot in the retina, he accredits
+you with a special power. Many similar psychological illusions can well
+be used to prepare the mind for unsuspected healing powers.</p>
+
+<p>Still stronger is the effect of personal contact. The psychophysiology
+of love indicates the most complex influence which contact sensations
+have on the whole nervous system and especially on the vasomotor
+apparatus of the body. Probably such vasomotor effect enters in,
+changing the blood circulation in the brain, when a personal contact
+between the transmitter and receiver of the suggestion is brought about.
+If the physician's hand rests quietly on the forehead of the patient who
+lies with closed eyes, or if he holds for a long while the hand of the
+patient, he may secure a nervous repose and submission which gives to
+the suggestions the most fertile soil. Needless to say that here again
+everything depends upon the accessories. An unsympathetic doctor may be
+entirely powerless where his neighbor has complete<span class='pagenum'><a name="Page_224" id="Page_224">[Pg 224]</a></span> success. Neither a
+lifeless hand nor an agitating one will bring the desired repose,
+neither a cold nor a rough one. There must be strength and energy and
+even discipline, and yet sympathy in the pressure of the fingers. Again
+a psychologically different effect and yet one often to be preferred
+results from mild stroking movements, the stroke always to be repeated
+in the same direction, never up and down. The slow change in the
+position of the tactual sensations evidently produces a rather strong
+influence on the equilibrium of nervous impulses, and here again
+vasomotor reflexes seem to arise easily. Another variety of such bodily
+influences is given by artificial changes of the positions, for instance
+by bending the head of the subject backward while the eyes are closed.
+It may be that a certain lack of balance sets in in which the
+self-equilibrium is disturbed and an external influence can thus more
+easily get control of the psychophysical system. Again a certain
+monotony of speaking may easily add to the increase of the
+suggestibility.</p>
+
+<p>Everyone knows that another most fruitful cause of this change is any
+mystic inspiration, any emotion in which the individual feels himself in
+contact with something higher or larger or stronger. Of course, the
+church can secure this effect easily, and here again the maximum will be
+reached if a bodily contact with the symbol of religious exaltation can
+be established. The patient who can touch the relics of the saints or
+bathe in the waters of Lourdes or at least feel on his forehead the hand
+of the minister, is wrought up to<span class='pagenum'><a name="Page_225" id="Page_225">[Pg 225]</a></span> a state of suggestibility which makes
+suggestions easily effective. The objective value of religion again has
+nothing to do with it, as exactly the same effect can result from the
+most barbarous superstition. The amulets of a gypsy might secure the
+same resetting of the psychophysical system which the most sacred
+symbols awaken, and even many an educated person is unable to cross the
+threshold of a palmist or an astrologist, or to attend the performance
+of a spiritist, or to sit down with a purchasable trance medium without
+feeling an uncanny mental state which is objectively characterized by an
+increased suggestibility. But finally, the same effect sets in when the
+symbols of other emotional spheres are applied, perhaps for the
+patriotic soldier the flag of his country.</p>
+
+<p>All the states of increased suggestibility which we have characterized
+so far still remain within the limit of normal wakefulness. We may turn
+now to the methods of the psychotherapist which produce in the interest
+of the suggestions an artificial state. However we have no right
+superficially to claim that the effectiveness of the suggestions is
+always greater in such unnatural states. On the contrary, we know that
+sometimes well applied suggestions work on wide-awake persons with
+increased suggestibility more strongly than on hypnotized subjects. Here
+even the instinct of the experienced physician may easily go astray, and
+it may need practical tests to find out which way will be the most
+accessible to the particular case. Often a certain r&ocirc;le belongs even to<span class='pagenum'><a name="Page_226" id="Page_226">[Pg 226]</a></span>
+natural sleep. It cannot be denied that some people can be influenced to
+some degree by words spoken to them during sleep. Most adults either
+wake up or show no signs of influence beyond effects on their dreams.
+But some absorb especially whispered words in such a way that their
+power becomes evident after the waking of the sleeper. Much more is this
+true of children. A suggestion to give up vicious habits, perhaps in the
+sexual sphere, or to speak fluently and no longer stammer may thus be
+beneficial. Yet the danger of this method is not small and extensive use
+of it is certainly not advisable. The more easily it can be carried into
+every bedchamber and can thus give to every mother and nurse the tools
+of a rather powerful therapy, the more a danger signal ought to be
+displayed. Interference with the natural sleep by outer influences
+creates abnormal conditions which cannot be removed at will. The chances
+are great that many unintended bad effects slip in and that not a few
+hysterias may be created by a method at the first glance so startling.
+Much less objectionable is it to make use of the effect of that period
+of half-sleep which precedes the natural sleep, and which is for many a
+period of increased suggestibility for autosuggestions. A resolution or
+the formulation of a belief which would be ineffective in a wide-awake
+state seems to get an accentuated effect on the mind, if it is
+repeatedly expressed in this transitional state. The psychasthenic who
+in such a half-dozing stage assures himself that he will no longer be
+afraid of going over a bridge or<span class='pagenum'><a name="Page_227" id="Page_227">[Pg 227]</a></span> hearing a thunderstorm or will feel a
+disgust for whiskey or will have the energy for work, has a certain
+chance that such autosuggestions become reality the next morning. With
+many others there seems no effect to be obtained and not a few seem
+unable to catch the right moment. As soon as they begin to speak they
+become wide awake or fall asleep before they talk.</p>
+
+<p>Incomparably more value belongs to the artificial sleep, the mesmeric
+state of earlier days, the hypnotism of our time. We have discussed its
+theory and recognized that an abnormally increased suggestibility is
+indeed its chief feature. We know hypnotism in most various degrees; the
+lowest can be reached practically by everyone, the highest by rather
+few. It is almost arbitrary to decide where those waking states with
+high tension of suggestibility end and the hypnotic states begin, and
+not less arbitrary to call the higher degrees only hypnotism and to
+designate the lower degrees as hypnoid states. If we do it, we certainly
+should acknowledge from the start that the hypnoid states are for
+therapeutic purposes not a bit less important than the full hypnotic
+states. Certainly the hypnoid states do not allow complex hallucinations
+and absurd post-hypnotic actions, but they offer excellent starting
+points for the removal of light obsessions and phobias and for the
+re&euml;nforcement of desirable impulses, volitions, and emotions. Many
+persons cannot under any circumstances be brought beyond such a hypnoid
+degree. The physician who has not theoretical experiments<span class='pagenum'><a name="Page_228" id="Page_228">[Pg 228]</a></span> but practical
+success in view ought therefore never to trouble himself with the
+inquiry exactly which degree has been reached. This advice is given
+because nothing interferes with the progress of hypnotic influence so
+badly as the constant testing. It must naturally often lead to a point
+where the subject finds that he can very well still do what the
+hypnotizer told him not to do. If the doctor assures him that he can no
+longer move his arm and the patient is yet able to move it, the doctor
+secures the very superfluous knowledge that this special degree of
+suggestibility has not been reached, but the patient is sliding backward
+and the lower degree which actually had been reached will be less
+accessible later. The physician might rather resort to the opposite
+course and assure the patient, even after the first treatment which
+might have been a slight success, that he saw from definite symptoms
+that hypnosis had set in. That will greatly smooth the way for real
+hypnotic effects the next time.</p>
+
+<p>The best method of hypnotizing is the one which relies essentially on
+the spoken word, awakening through speech the idea of the approach of
+sleep. If the hypnotizer assures the subject in monotonous words that a
+feeling of fatigue is setting in, that he is feeling a tiredness
+creeping over his shoulders and arms and legs, that his memories are
+fading away and that he is now hypnotized, for not a few all is done
+that is needed. The hypnotic state will come and will hold until the
+verbal suggestion takes it off again. Perhaps the hypnotizer says that
+he will<span class='pagenum'><a name="Page_229" id="Page_229">[Pg 229]</a></span> count three and at three the subject is to open his eyes and
+feel perfectly comfortable. It is wise to tell the patient beforehand
+that he will not lose consciousness and that he will remember afterward
+whatever happens as many people believe that loss of memory belongs to
+the hypnotic state, and that they were not hypnotized if they can
+remember what happened. Such a skeptical after-attitude can seriously
+interfere with the success of the treatment.</p>
+
+<p>Yet in most cases, it will be safer not to rely on words only but to
+supplement them by manipulations which all converge towards the effect
+of increasing the suggestibility and thus of overcoming the resistance
+to the suggestions introduced. It is well known that for this purpose it
+is advisable to begin the influence with some slight fatiguing
+stimulations. The effect is most easily reached when the patient fixates
+perhaps a shining button held over his eyes or listens to monotonous
+sounds. A particularly strong effect belongs again to very slight touch
+stimuli. If the subject with his eyes closed is touched perhaps by two
+pencils at various and unexpected points of the face and hands, a
+skillful playing on his tactual senses soon produces a half-dozing state
+of hypnoid character. In the same group belong those so-called passes
+which evidently have a reflex influence in the blood-vessel system. It
+is advisable to combine the various elements in such a way that at first
+physical stimuli upon eye or skin produce an over-suggestible state and
+that only as soon as this state is reached the verbal suggestion sets
+in, perhaps with the words,<span class='pagenum'><a name="Page_230" id="Page_230">[Pg 230]</a></span> "I shall hypnotize you now." Under such
+conditions every subject may soon be brought to that degree of
+hypnotization which is accessible to him. Yet more than one treatment is
+usually necessary for the higher degrees. Much less importance for
+therapeutic purposes belongs to that hypnoid state which is reached
+without the idea of sleep where the subject comes with open eyes into a
+kind of fascination, produced perhaps by a sudden flash of light or by
+the firm eye of the hypnotizer. It is a state which can lead to a strong
+submission of will and which has its legal importance. Therapeutically
+it can hardly secure an effect which cannot better be secured through
+the real sleeplike hypnotism. Under certain conditions, chemical
+substances may well prepare for the hypnotic treatment, for instance
+bromides or alcohol. Others rely on the suggestive effect of flavored
+water. But all that is unwise. The confidence of the patient is the best
+preparation for the securing of the helpful degree of hypnotism.</p>
+
+<p>Of course only a small part of the therapeutic usefulness is secured
+during the hypnotic state itself. A pain may be removed, sleep be
+secured, an idea be inhibited, a movement be re&euml;nforced in cases where
+non-hypnotic suggestions would have found insurmountable obstacles.
+During the hypnosis we may also open the storehouse of memory and bring
+to light the ideas which disturbed the equilibrium of the suffering
+mind. Further in those most complex hysteric cases of dissociated
+personality, new memory connections may be formed during the hypnosis
+by<span class='pagenum'><a name="Page_231" id="Page_231">[Pg 231]</a></span> which a synthesis of the double or triple personalities into the old
+one may be secured. Yet the general effect which the physician has to
+hope for from hypnotic treatment is the post-hypnotic one. Not what
+happens during the hypnosis but what the suggestion will produce after
+hypnosis is essential to him. The fixed idea is to disappear forever,
+the paralyzed limb is under control, the desire for morphine and cocaine
+is gone for all future time, the perverse longing is annihilated, the
+old energy is to remain again for all time. It is the post-hypnotic
+after-effectiveness which gives to the hypnoid and to the hypnotic
+states their importance for the treatment of the most exasperating
+symptoms. To be sure, the treatment often must be a prolonged one. A man
+who for years has used thirty grains of morphine a day cannot be rid of
+the desire after two or three hypnotic sittings. In such a case the
+treatment may cover three or four months, if it is to be of lasting
+value and without any damage during the treatment.</p>
+
+<p>Still we are not at the end of the psychotherapeutic methods and we may
+turn to a fascinating group of curative efforts which has especially
+come to the foreground in recent years. We mentioned before that
+mischief cannot seldom be traced back to earlier experiences with a
+strong unpleasurable feeling. In certain cases, the subject remembers
+such particular experiences as the beginning of his discomfort; in
+others, especially those of hysteric character, the starting point may
+have long been forgotten, and yet that early impression evidently left
+traces in the brain<span class='pagenum'><a name="Page_232" id="Page_232">[Pg 232]</a></span> which produce disturbances in conscious life. The
+psychotherapist nowadays calls these groups of traces "complexes." We
+recognized clearly that there is no reason to refer such forgotten
+remainders of the past to any subconscious mind; they are physical
+after-effects which keep their influence over the equilibrium of the
+psychophysical system. Now modern psychotherapy finds that the entire
+disturbances which arise from such emotional disagreeable experiences,
+forgotten or not forgotten, can often be removed by psychical means. Two
+ways in particular seem open. As soon as the idea is fully brought back
+to consciousness again, the patient must be made to express the primary
+emotion with full intensity. Subtle analysis has repeatedly shown that
+many of the gravest hysteric symptoms result from such a suppression of
+emotions at the beginning and disappear as soon as the primary
+experience comes to its right motor discharge and gains its normal
+outlet in action. The whole irritation becomes eliminated, the emotion
+is relieved from suppression and the source of the cortical uproar is
+removed forever.</p>
+
+<p>Practically still more important seems the other case which refers alike
+to hysterics and psychasthenics and which is applicable for the
+forgotten experience not less than for the well-remembered ones. This
+second way demands that the psychotherapist bring this primary
+experience strongly to consciousness and then by a new training link it
+with new and more desirable associations and reactions. The disturbing
+idea is thus not to be discharged but to be side<span class='pagenum'><a name="Page_233" id="Page_233">[Pg 233]</a></span>tracked so that in
+future it leads to harmless results. The new setting works towards an
+entirely new equilibrium. What was a starting point for abnormal fears
+now becomes an indifferent object of interest and all its evil
+consequences are cut off. It may be acknowledged that the full
+elaboration of these methods still belongs to the future. Both methods,
+the discharging, or the so-called cathartic one, and the side-tracking
+method evidently demand the discovery of the starting point in the
+service of the therapy and here again several methods are at the
+disposal of the psychologist.</p>
+
+<p>A promising way to this end is the inexhaustible association test which
+we mentioned when we discussed the contributions of the psychological
+laboratory to the medical diagnosis. A series of short words are spoken
+to the patient and, as soon as he hears one, he is to pronounce as
+quickly as possible the first word which comes to his mind. If we use
+fifty words, we should be able to learn something as to the inner states
+of the man and as to the working of his mind, if we analyze carefully
+his particular choices. But two further conditions ought to be
+fulfilled. The time of the association ought to be measured. Of course
+there will be wide differences. A word which is often in a certain
+connection will quickly bring the habitual association. Abstract words
+will call forth their associations more slowly than concrete words,
+familiar words more rapidly than unfamiliar words. To measure such
+association time with fullest accuracy, as it is necessary<span class='pagenum'><a name="Page_234" id="Page_234">[Pg 234]</a></span> for the
+purpose of scientific investigations, delicate electrical instruments
+are needed that indicate thousandths parts of a second. For the purpose
+of the practical physician such accuracy would be superfluous. His
+examination will be perfectly successful if it is carefully done with a
+stop-watch which shows the fifth part of a second, like those which are
+used at races. He speaks a word, presses at the same time the button of
+the watch, and presses the stopper when he sees the lips of the patient
+moving. He is thus able to examine not only the involuntary choice of
+association but also the time of every associative process. But a second
+condition ought also to be fulfilled. After some indifferent words,
+others ought to be mixed into the series which touch in a tentative way
+on various spheres corresponding to the possible suspicions. The groups
+to which the hidden thoughts of psychasthenics, for instance, belong are
+not many. As soon as our series of words strikes such a group, the
+reaction of the mind may be discriminated. The effect may be a general
+perturbation resulting either in an unusual delay of the fitting
+association or in an effort to cover the sore spot by an unfitting
+association. Sometimes the dangerous association may rush forward even
+with unusual rapidity but, as soon as it is uttered, it gives a shock to
+the mental system, brings the whole associative process into disorder,
+and the result is that the next following associations are abnormally
+delayed. The skilled psychologist will quickly take such a change as a
+cue for the selection of the later words in his series. Of course, he
+will<span class='pagenum'><a name="Page_235" id="Page_235">[Pg 235]</a></span> at first return to neutral words, but as soon as he has found a
+danger spot, he will approach it from various sides, perhaps in every
+fourth or fifth word, and may then find out which particular experiences
+are disquieting the patient. Words like women or money or career or
+family or disease are often sufficient to get the first inkling of a
+mental story.</p>
+
+<p>With less diagnostic elegance we sometimes reach the same end by taking
+careful records of pulse and breathing and involuntary movements during
+an apparently harmless conversation. The instruments at the disposal of
+the psychologist are those familiar to every psychological laboratory:
+the pneumograph, which registers the movements of respiration; the
+sphygmograph, which writes the pulsation of the artery in the wrist; the
+automatograph, or other instruments, which register the slight
+unintentional movements of the arm. If the examiner is skillful, he will
+not fail to discover the changes in breathing and pulse and reaction as
+soon as the painful groups of ideas are approached. More of theoretic
+interest and too cumbersome for practical diagnosis is the unfailing
+galvanic reaction from the skin in which the glands change their
+activity and their resistance to the galvanic current under the
+influence of hidden emotions. Yet all these methods, with exception of
+the last, are essentially useful only if the starting experience is
+still accessible to the memory of the patient. He may be unaware that it
+had anything to do with his nervous symptoms but he recognizes the
+experience<span class='pagenum'><a name="Page_236" id="Page_236">[Pg 236]</a></span> still as soon as his attention is directed towards it. The
+psychologically more interesting but probably more exceptional situation
+is the one in which it is not only forgotten but cannot be recognized
+when it is brought to consciousness. The shortest way to get hold of
+such past impressions is the hypnotic one. The hypnotic state sharpens
+the memory and experiences of early childhood or apparently
+insignificant experiences of later life may be brought back when they
+would have been inaccessible to any intentional effort of the attention.
+Even still more surprising is the success if the association is left to
+a dreamy play of ideas suggested perhaps by gazing into a crystal ball
+or by a meaningless talking. Perhaps the patient lies with closed eyes
+on the couch while the physician holds his hand. A few words are given
+to him as a starting point and then he is thoughtlessly to pronounce
+whatever comes to his mind, not only unfinished sentences but loose
+phrases, single words, apparently without meaning and slowly ideas arise
+which betray the original intrusion. At last memories and lost emotions
+come again to the surface, and the watchful psychotherapist may discover
+the complex, which is then to be removed by discharge or by
+side-tracking. This is the so-called psychoanalytic method.</p>
+
+<p>Finally the psychotherapist may go still one step further. After all it
+often seems inexplainable that just this or that emotional experience
+made such a deep and lasting impression while a thousand other
+experiences passed by without leaving any mischie<span class='pagenum'><a name="Page_237" id="Page_237">[Pg 237]</a></span>vous after-effect. It
+seems that indeed the conditions are still more complicated. That
+emotional disturbance operated dangerously perhaps only because it
+itself appealed to a suppressed desire and this seems to hold true
+especially for suppressed emotions of the sexual sphere. The desire for
+gratification in normal or abnormal channels was perhaps attached by the
+mind to some group of objects. It was completely suppressed but it left
+an abnormal tension in the central system. If now a chance experience
+touches on this group of ideas, there results an explosive reaction; and
+movements, convulsions, spasms, obsessions, and fears set in which get
+their particular character not through the secondary intrusion but from
+the primary desire. To discharge that intrusion leads therefore only to
+the elimination of those symptoms which resulted from it, but the
+primary disturbance goes on and any new chance intrusion will produce
+new explosions. The psychotherapist should therefore go deeper and
+relieve the mind from those primary desires which may belong to early
+youth and which are entirely forgotten. Even the method of automatic
+writing may here sometimes lead to an unveiling of those deepest layers
+of suppressed desires. In the same way a careful, subtle analysis of
+dreams may support the search for the hidden source of interference.</p>
+
+<p>We have spoken of the technical methods of the psychotherapist. It would
+be short-sighted to ignore the great manifoldness of secondary methods
+which he shares with the ordinary intercourse between man<span class='pagenum'><a name="Page_238" id="Page_238">[Pg 238]</a></span> and man, the
+methods which the teacher uses in the schoolroom, which the parents use
+in the nursery, which the neighbor uses with his neighbor, methods which
+build up the mind, methods which train the mind, methods which re&euml;nforce
+good habits and suppress unwholesome ones, methods which stimulate sound
+emotions and inhibit a quarrelsome temper, methods which indeed are not
+less important in the psychiatric clinic and in the hospital than in our
+daily life, and which certainly have central importance in that
+borderland region which is the particular working field of the
+psychotherapist.<span class='pagenum'><a name="Page_239" id="Page_239">[Pg 239]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="X" id="X"></a>X<br /><br />
+<span class="sub">THE MENTAL SYMPTOMS</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+
+<p>We have discussed both the psychological theory and the practical work
+of psychotherapy in a systematic order without any reference to personal
+chance experience. After studying the fundamental principles, we have
+sketched the whole field of disturbances in which psychotherapeutic
+influence might be possible and all the methods available. It seems
+natural that our next step should be an illustrating of such work by a
+number of typical cases. Here it seems advisable to leave the track of
+an objective system and to turn to the record of personal observation.
+As this is not a handbook for the physician, dealing with the special
+forms of disease, we emphasized before that we avoid even any attempt in
+such a direction because it would have to introduce not only the
+questions of diagnosis, but above all the highly important questions of
+treatment by physical agencies. We saw that for us nothing else can be
+desirable, but to show the way in which the various symptoms which
+suggest mental treatment occur, and how they yield to the psychical
+methods. We had also agreed beforehand that for a first survey we might
+separate the mental from the<span class='pagenum'><a name="Page_240" id="Page_240">[Pg 240]</a></span> bodily symptoms and group the mental ones
+with reference to the predominance of ideational, emotional, and
+volitional factors. And finally it may be said that we abstain from
+everything which is exceptional or even unusual, and confine ourselves
+to the routine observations with which the psychotherapist comes in
+contact every day and the simplest country physician surely every week.</p>
+
+<p>Thus I turn from systematic objectivity to my unsystematic reminiscences
+of many years. Of course, they abound with eccentric abnormities and
+startling phenomena. As I have devoted myself to psychotherapeutics,
+always and only from scientific interest, as a part of my laboratory
+studies and therefore have refused to spend any time on cases which
+offered no special psychological interest to me, the striking and
+sensational cases have prevailed in my practice even to an unusual
+degree. Yet they are unessential for our purposes here, the more as
+their interest lies mostly in the complex structure of the mental state
+while the curative features are in the background. Our purpose of
+demonstrating practical cases as they occur in every village, and as
+they ought to be understood and treated by every doctor, thus rules out
+just those experiences which would be prominent in a theoretical study
+of abnormal psychology. We want to select only simple commonplace cases.
+Only those who have not learned to see are unaware that such cases are
+everywhere about them.</p>
+
+<p>As a matter of course, I also leave out everything which refers to
+insanity, that is, every mental dis<span class='pagenum'><a name="Page_241" id="Page_241">[Pg 241]</a></span>turbance which lies essentially
+outside of the domain of psychotherapy. The helpful influence which
+psychical factors can exert in the asylums for the insane is, as we
+emphasized, entirely secondary. The psychotherapeutic methods in the
+narrower sense of the word are in the present state of our knowledge
+ineffective in the insane asylum. I should also be unable to speak of
+laboratory experience with insanity, as I insist on sanitarium treatment
+in every such case. The question of how to differentiate the diagnosis
+of insanity from that of the other mental abnormities is not our
+question at this moment. I select the few illustrations which seem to me
+desirable for the purpose of making more concrete our abstract
+discussion of methods, essentially from the class of neurasthenics,
+psychasthenics, hysterics, and so on.</p>
+
+<p>In all these reports, I shall confine the account to the few points
+which are to illustrate the psychical factors, thus abstaining entirely
+from the further details which any medical history of the cases would
+demand and from all results of further examination and other
+particulars. As a matter of course, I exclude the possibility of
+identifying the patient. I may start with a typical case of obsessing
+ideas of simplest character and with simple routine treatment
+illustrating the emphasis on antagonistic ideas.</p>
+
+<div class="blockquot"><p>A man of mature age, well educated, well built and in every respect
+in good health, without nervous history and without other nervous
+symptoms, suffered vehemently by the persistent recurrence of a
+visual image which entirely<span class='pagenum'><a name="Page_242" id="Page_242">[Pg 242]</a></span> absorbed his attention. He knew
+exactly the development of his trouble. A woman acquaintance of his
+had committed suicide by poisoning herself. He knew her slightly
+and the emotion of personal loss played hardly any r&ocirc;le in the
+case. But he had met her at a gay dinner a short time before her
+death. The news of the suicide came to him when he was overtired
+from work. The idea of the contrast between seeing his friend
+partaking of the dinner and imagining her drinking the poison gave
+him a strong shock. There was hardly any grief mixed in. He
+remembers that he shivered at the thought of the contrast, and in
+that moment the visual image of the woman raising a glass of poison
+to her mouth flashed into his mind and thus became almost a part of
+the shock. From that time on, the memory image of this scene
+returned more and more frequently. At first it associated itself
+with any chance mentioning of death or suicide and to a very slight
+degree with the idea of a meal. More and more any element of a meal
+and of social life, the word soup or meat, the word gown or dance,
+brought up at once the picture of the woman, which had in the
+meantime lost every element of personal relation. Any sad thought
+of her ending had faded away. It remained merely a troublesome
+impression. The man fought against it by trying to suppress the
+idea but the more he fought against it, the more insistently it
+rushed forward through new and ever new association paths. Any
+advertisement in the newspaper referring to food, anything in a
+shop window referring to ladies' dresses, any household utensils
+related to a meal, and especially the meals themselves, forced the
+visual image into the centre and captured the attention to such a
+degree that a confusing distraction from the real surroundings
+resulted. The struggle against the idea became more and more
+exasperating, made<span class='pagenum'><a name="Page_243" id="Page_243">[Pg 243]</a></span> life a torture, almost suggested despair, even
+faint thoughts of suicide, and especially a growing fear that it
+was a symptom of the beginning of insanity.</p>
+
+<p>When he came to me, a number of physical cures, especially bromides
+and electricity, had been tried in vain by the physician. Some
+weeks in the country had not changed the distress. He came to me
+with the direct request as a last resort to try hypnotic treatment.
+I found in spite of the fact that he and his physician had
+constantly spoken of visual hallucinations that the visual image
+had no hallucinatory character at all, that is, he never believed
+that he saw the image of that woman as if it were actually present,
+he never took the product of his imagination for reality, nor had
+it the vividness and character of reality. It was hardly more vivid
+than any landscape which he tried to remember, only that it
+controlled the interplay of ideas in such a persistent way. I found
+that he was a strong visualizer and easily suggestible. I told him
+beforehand that I should hypnotize him only to a slight degree,
+that he would not lose consciousness, that he would remember
+everything which I told him. Then I asked him to lie down and had
+him gaze on a crystal only for half a minute, then close the eyes.
+I asked him to relax and to think of sleep. With the two blunt
+points of a compass, I touched his two cheeks at corresponding
+places, then his forehead. And now I told him that I would begin
+with the hypnotic influence. I put my hand on his forehead and
+spoke to him in a monotonous way, saying that he felt a fatigue in
+his shoulders, and in his arms, creeping over his whole body and
+assured him that he was now fully hypnotized. To what degree he
+really was hypnotized cannot be said as no effort was made to test
+it by any experiments, thus avoiding any possible reaction against
+the feeling of submission. Expression<span class='pagenum'><a name="Page_244" id="Page_244">[Pg 244]</a></span> and breathing indicated a
+slight hypnoid state. Then I removed my hand and spoke to him in a
+warm and assuring way.</p>
+
+<p>I told him that in future he would give his full attention to his
+meal, and not give the slightest attention to any image of his
+friend. If he should think of the friend the memory would appear
+indifferent, he would not even notice the image and would give his
+whole mind to the objects with which he was engaged. In the same
+way, when he should be reading newspapers or looking in
+shopwindows, his whole attention would belong to that which he
+really perceived. Any passing inner image would be ignored. Then I
+awoke him from his sleep. He was unwilling to believe that he had
+been in hypnosis at all. I told him that the effect would prove it
+and in his fully wakeful state I explained to him why there was not
+the slightest fear of insanity justified, that it was a
+psychasthenic state resulting from fatigue and shock and from a
+wrong attitude of his attention during the past months, and then I
+asked him to return the next day. Intentionally I had not given the
+suggestion that the image would disappear. I could not expect it
+would disappear entirely after a first treatment and even a faint
+appearance of it would have at once fascinated the attention and
+brought about the whole disturbance of the equilibrium which might
+become habitual. Instead of it I gave the impulse to the
+counter-idea, that is, I re&euml;nforced the attention towards that
+which he really saw around him and thus withdrew the attention from
+the rival image in the mind. The success was complete. He came the
+next day in a much happier frame of mind, reporting that he still
+had seen the image of the woman every few minutes, especially
+strongly at the breakfast table, but it had no longer troubled him.
+It was more in the back<span class='pagenum'><a name="Page_245" id="Page_245">[Pg 245]</a></span>ground of consciousness, sometimes it
+appeared transparent, it no longer held his attention, and he felt
+free to give his full attention to the actual surroundings.</p>
+
+<p>On that basis I hypnotized him the second day and he had hardly
+heard me saying that he ought to try to sleep when he was evidently
+in a much deeper hypnotic state than the first time. Again I
+suggested only the opposite attitude, the positive turning to the
+surroundings and the complete neglect and indifference for the
+possible memory image. This time the effect was still stronger. On
+the third day he reported that he still saw the image but he no
+longer minded it, as it was like a veil through which he looked at
+real objects and that left him entirely indifferent. His mind was
+hardly engaged with it any more. The real spell of the attention
+was broken. On the basis of this situation, I took the last step
+and suggested that the image of the woman would disappear
+altogether and would not trouble him any more. In the next
+twenty-four hours, it still returned two or three times, but
+colorless and faint. The following day I was able to eliminate it
+altogether. Even when the last trace of the inner struggle between
+the memory and the perceived surroundings had disappeared, I went
+on with two hypnotic sittings to give stability to the new
+equilibrium, to insist that the image would not come back and to
+settle completely that inner repose with which every fear of
+possible disease evaporated. I feel sure that the cure would not
+have been reached so quickly, possibly not at all, if the second
+suggestion, the disappearance of the image, had been given at the
+first step. The improvement was secured because the antagonistic
+process itself was used for the suggestion. On the other hand,
+there was no doubt that in this case the strong will of the patient
+or suggestion in a normal state would not alone have been
+sufficient. The<span class='pagenum'><a name="Page_246" id="Page_246">[Pg 246]</a></span> hypnotic treatment was indicated by the symptoms
+and justified by the results.</p></div>
+
+<p>I may take another typical case in which also the obsession was brought
+about by an idea without emotional value or at least by an idea which
+had lost its emotional character; the idea came somewhat nearer to
+hallucination, but had its chief elements on tactual ground where the
+transition from image to hallucinatory perception is easier. I add this
+case to demonstrate that hypnosis is not the only open way of treatment
+in such cases and that the variations must always be adjusted to the
+special conditions. The case gains importance by the fact that the
+patient was himself a physician well trained in mental observation.</p>
+
+<div class="blockquot"><p>The patient is a highly educated physician of middle age. He
+reports that he had been neurasthenic all his life with slight
+ever-changing symptoms. He has always been troubled by the
+"perseveration" of tactual images which had a strong feeling tone
+and which were associated with seen or heard reports of the
+experiences of others. For instance, when he read in a newspaper
+that someone had hurt his hand with a pin, or that someone had cut
+his foot on a nail, he immediately felt a not directly painful but
+uncomfortable sensation at the particular place in the hand or in
+the foot, together with a shrinking of the whole body and such
+tactual sensation usually returned during the following days in
+fainter and fainter form until it faded away. Most troublesome had
+always been the reading of any torture processes in historical
+books or in fiction. Yet there had never been a case in which the
+sensations really had the vividness<span class='pagenum'><a name="Page_247" id="Page_247">[Pg 247]</a></span> of hallucinations and never a
+case in which the after effects had not disappeared at least in a
+few weeks.</p>
+
+<p>This time the effect had already lasted four months and it became
+more and more troublesome. The patient had not the slightest fear
+of mental disease and no anxiety, but he felt a very serious
+disturbance by the instinctive effort to get rid of the intrusion.
+The place of the disturbance was the wrists. The starting point was
+a definite experience. On an unusually hot summer day the physician
+had listened for a long time to the complaints of a female patient
+who suffered vehemently from a nervous fear of scissors and knives
+and who was afraid that she would cut her artery at the wrist. He
+believes that it was the exhausting heat of the day which weakened
+him to a point where the story of his patient affected him very
+strongly and made him think of it all the time. Yet there was no
+sensation element involved. A few hours later, he sat in a hotel at
+his dinner. Just in front of him a butler started to carve a duck
+with a long, sharp knife. In that moment he felt as if the knife
+passed through the wrists of both arms. He felt for a moment almost
+faint; arms and legs were contracted and an almost painful
+sensation lingered in the skin, and did not disappear for hours.</p>
+
+<p>From that day at the sight of knives or razors, not only in his
+hands or his direct neighborhood, but also in a store and finally
+in a picture, stirred up at once the optical image of that carving
+knife cutting into the skin of the wrist, only with the difference
+that it seldom was found in both arms, usually in the one or the
+other. The sensation became a strictly tactual one with optical
+overtone, but there was no emotion in it. The pain element had
+disappeared. Also the shock, which still recurred in the first days
+slowly disappeared. The longer the symptom lasted, the more the<span class='pagenum'><a name="Page_248" id="Page_248">[Pg 248]</a></span>
+optical factor faded away, and the tactual factor came into the
+foreground after three or four weeks. Perhaps seeing a razor in a
+store window or a pocket knife open no longer stirred up the image
+of cutting the wrist, but simply a strong tactual sensation, as if
+the skin of the wrist was scratched and pinched. Finally, after
+about two months, the association character disappeared to a high
+degree and the scratching and cutting sensation in the skin became
+independent and automatic. The patient awoke in the morning with a
+vivid tactual hallucination of being cut without associating with
+it any picture of a knife. Throughout the day, in the midst of work
+and in the midst of conversation, sometimes one and sometimes the
+other wrist became the center of the exasperating sensation, easily
+bringing with it involuntary reactions as if to withdraw the arm.
+This became more and more frequent and more and more vivid.</p>
+
+<p>The doctor, fully aware of the borderland character of this
+experience, felt sure that his inner fight against the disturbance
+would get control of it. The usual tonics did not show any
+influence. On the other hand, there were no other nervous symptoms
+and, with his most acute analysis, he did not find the slightest
+trace of emotion any longer. When the symptoms reached a point at
+which they seriously interfered with his comfort, he asked me for
+psychotherapeutic treatment, under the condition that I was not to
+apply hypnotism. He was absolutely averse to the use of hypnotism
+in his own case because he was afraid that to be hypnotized would
+mean for him a certain disposition to fall into hypnotic sleep by
+auto-suggestion, as he knew the vividness of his imaginative
+sensations. He wanted to avoid that the more as his own
+professional work might sometimes demand hypnotizing in his own
+practice. In any case he had an aversion to it and asked for other
+means.</p>
+
+<p><span class='pagenum'><a name="Page_249" id="Page_249">[Pg 249]</a></span>Under these circumstances, it seemed to me the most logical
+conclusion that the counter idea with its antagonistic reactions
+might be re&euml;nforced by direct perception. The abnormal tactual
+sensation forced on consciousness the idea of the cutting of the
+wrist. The necessary counter action would be to force to
+consciousness the idea of the uninjured wrist and the corresponding
+reactions. As the wrist can be easily made accessible to sight and
+as I anticipated that the visual sensations would be more forceful
+than the tactual ones, I told him to look straight at his own
+wrists for ten minutes three times a day after waking, after
+luncheon, and before going to bed. He had to hold his two forearms
+close in front of his eyes and stare at them, giving his full
+attention to the visual impression of the smooth, uninjured skin of
+the wrist. If during this process, the tactual counter-sensations
+were vivid, he had to go on with the staring at both arms, both
+held near together until the perception had crowded out the rival
+touch sensation. When this performance had been carried out six
+times, he did not notice the coming up of the tactual sensation
+with vividness any longer. From the third day it had disappeared
+entirely. I told him to go on with the process still every morning
+for some weeks. The physician himself considered the cure as
+complete.</p></div>
+
+<p>Our first case dealt with hypnosis, our second case removed the
+intruding idea by a perception in a waking state. To point at once to
+the variety of methods which we sketched, we may turn again to a case of
+emotionless idea removed by the method of switching off and
+side-tracking the originating and physiological "complex."<span class='pagenum'><a name="Page_250" id="Page_250">[Pg 250]</a></span></p>
+
+<div class="blockquot"><p>The patient is a school-teacher in the Middle West, a nervous,
+thin-looking woman of about twenty-five. Her only complaint is a
+persistent idea that she may at any time get a child. She has had
+this idea "as long as she can remember," according to her first
+expression. She never had any intimate acquaintance with any man,
+she was never engaged, she hated bitterly every thought of
+immorality, she knows and has assured herself by much reading that
+it is entirely impossible that she might get a child without sexual
+contact. Yet this thought recurs to her all the time, even when she
+is talking with other people. It embarrasses her in school, in
+spite of her teaching only girls in a private institution. This
+thought keeps her away from company and the effect of its
+embarrassing occurrence depresses her, but she is sure that the
+thought itself does not include any emotion. It is a mere thinking
+of it with a full consciousness that it is absurd, and yet she
+cannot suppress it.</p>
+
+<p>I began at once to try to find the origin of her queer obsession.
+After some efforts to pierce into her memories, we came to an
+experience of her youth. When she was about thirteen years of age,
+a young girl whom she had admired much for her beauty, living in
+the neighborhood of her parents, suddenly got a child which died
+after a few days. At that time no thought of immorality seems to
+have entered into that news. It was evidently mere sadness about
+the quick death of the child which gave to the experience its
+emotional tone. She was at that time completely na&iuml;ve. She received
+an intense shock in the thought that an unmarried girl may suddenly
+get a child which would then quickly die. She cannot tell whether
+the thought that she herself would get a child had ever entered her
+mind before this occurrence in her neighborhood, nor can she say
+that it occurred immediately or very soon after it. She now knows<span class='pagenum'><a name="Page_251" id="Page_251">[Pg 251]</a></span>
+only that she has always had that thought, but whether that means
+more than ten years, she does not know.</p>
+
+<p>I considered it a justifiable hypothesis that this strong emotional
+experience early in life had become the starting point for that
+secondary absurd thought. I considered that primary experience as
+cause for a deep physiological brain excitement which had
+irradiated towards the ideas of her personality. It had stirred up
+there associations which kept their psychological character while
+the primary disturbance had long lost its psychical accompaniment.
+It worked its mischief in a physiological sphere but was probably
+still the starting point for the persistent obsession. My aim was
+to remove this cause. It would have brought little improvement
+simply to suppress the freak idea as long as that physiological
+source was active. On the other hand I should not have the means to
+stop the physiological after-effects of that real experience: I had
+to sidetrack it and to secure thus a reduction. I decided therefore
+to work on the basis of that hypothesis, to accept that
+physiological complex as existing, but to switch it off by linking
+it with appropriate associations, thus setting it right in the
+whole system of her thoughts.</p>
+
+<p>For that purpose I brought her into a hypnoid state, bending her
+head backwards and speaking to her with slow voice until I saw that
+a slight drowsy state was reached. In this state I asked her to
+think back as vividly as she could of that experience of her youth,
+to fancy herself meeting that pretty girl, her neighbor, once more.
+She is to imagine that she speaks with her. Now I make her talk
+with me and she assures me that she sees the scene distinctly. She
+believes she sees the girl on the street. I ask her to tell the
+girl how indignant she feels over her behavior; she is to tell her
+that she understands now all which she did not understand in her
+childhood, that she knows now that she must<span class='pagenum'><a name="Page_252" id="Page_252">[Pg 252]</a></span> have lived an immoral
+life; that she must have had a friend and that a pure girl like
+herself could never under any circumstances come into such a
+situation, that no pure girl could suddenly have a child. She is to
+express to the other girl her deepest disapproval of such conduct
+and her own feeling of happiness that anything like that could
+never happen to her. In accordance with my demands, she worked
+herself entirely into the scene: without using audible voice, she
+internally spoke with great vividness to her neighbor. When I awoke
+her from her drowsy state, she was quite exhausted from the
+excitement. I repeated that scene with her four times. She assured
+me that she felt it every time more dramatically. The power of the
+obsession weakened from the first day. After the fourth time, it
+had disappeared. The subcortical complex had evidently found its
+normal channels of discharge.</p></div>
+
+<p>In discussing this method of side-tracking the complex, we mentioned
+that in other cases the result is reached by bringing the memory of that
+first experience to a vivid motor discharge, without substituting any
+other ideas. For that purpose no direct personal influence is necessary.
+Treatment might just as well be performed "by correspondence," provided
+that the right starting point is discovered and that right suggestions
+are given. As an illustration, I may choose a case which shows at least
+the maximum distance treatment by mail, from Boston to Seattle. This
+particular case presented no difficulty in getting hold of the starting
+point as my correspondent, whom I have never seen, himself at once
+pointed to the original source of his obsessing idea.<span class='pagenum'><a name="Page_253" id="Page_253">[Pg 253]</a></span></p>
+
+<div class="blockquot"><p>The patient who lived with his family in Seattle wrote to me the
+following: "&mdash;&mdash;I shall undertake to describe in a few words a
+condition which the writer has fought against for about eight years
+and which has subjected him to untold mental anguish.&mdash;&mdash;I was
+backward in a social way but altogether happy. After working in a
+bank about a year, was discovered one evening by the cashier
+smoking a cigar in the basement, was unable to look him in the face
+at the time. Went home that night and thought very little about it,
+but on the following morning during the regular course of business,
+I stepped up to him to ask some question, and as usual,
+unconsciously looked him in the face. His glance was questioning
+and suspicious, and that was the beginning of a life of anguish for
+me. At first I could not look him in the eyes, then when looking at
+some other person, I happened to think of it and so on, until in
+two or three days it was impossible to look at anyone who came to
+my window. The cashier did everything he could for me. No use: I
+quit my position, lost most of my friends, had to leave a happy
+home and came to Seattle to work for an old school friend. In the
+first year, owing to new environments, I managed to conceal my
+mental condition to a certain degree. All of a sudden, I was again
+plunged into the depths of black despair. It took me about two
+years to (partially) forget it, when the same thing occurred again,
+and I lost my grip. The last time about eighteen months ago was
+almost more than I could stand. These three or four instances I
+speak of were cases of extreme despondency, but my usual mental
+condition is extremely unhappy. If occasions arise where I have to
+sit and talk to anyone for ten minutes, controlling myself is such
+an effort that it leaves me with a case of the blues.... I shall
+come and see you as the relief would give me a new lease on life."</p>
+
+<p><span class='pagenum'><a name="Page_254" id="Page_254">[Pg 254]</a></span>This letter was written on the twenty-third of January, 1908. I
+replied to him at once that he certainly ought not to come from the
+Pacific to the Atlantic, but that I wanted him to write to me much
+more about that first occurrence. As he was evidently right in
+considering that episode as the starting point of his troublesome
+associations, I supposed that these associated ideas had not yet
+become independent but were still the effect of that first
+"complex." Therefore I wanted to bring that to complete discharge.
+Accordingly I wrote him to think himself once more into that
+happening of years ago, to pass through it with all the power of
+his imagination, to describe it to me then in as full a statement
+as possible and to express in the letter also his conviction that
+there was no reason to avoid the eyes of his superior, that he
+might have looked straight into his face. As soon as he got my
+reply, he wrote to me on the sixth of February a description of
+that first episode, filling nineteen pages, telling me all about
+his relations to those various men and every minute detail was
+brought clearly to consciousness again. I did not add anything
+further, but the expected occurred. On the eighteenth of February,
+he writes to me: "In the last week or ten days, the writer has
+noted a decided improvement regarding mental condition. The result
+is a new interest in life. If you can spare the time, would like to
+have you write me a few lines. Gratefully yours." At the end of the
+month he writes: "Received your letter about half an hour ago.
+Hasten to assure you with a great deal of pleasure that I am
+feeling much better. Since sending you the letter regarding the
+first case, I have noticed day by day an improvement." On the
+eighth of March: "Since writing you last I have noticed a gradual
+improvement. It has given me wonderful encouragement." On the tenth
+of March: "Just a line to say that I am still<span class='pagenum'><a name="Page_255" id="Page_255">[Pg 255]</a></span> improving." On the
+twelfth of April: "I desire to say that since the taking up of
+treatment with you, life has had a far different appearance to me
+than it has had for the last ten years." On the twenty-first of
+April: "Since my first letter to you, there has been such an
+improvement that I have accepted a position which carries with it
+much responsibility."</p></div>
+
+<p>This case leads over to the large group in which the obsessing idea
+involves the relation to a particular person. I find in such cases
+autosuggestion more liberating than heterosuggestion if the development
+has not gone too far. Of course autosuggestion can never take hypnotic
+character, but makes use with profit of the transition state before
+normal sleep. The type of these cases which are everywhere about us may
+be indicated by the following letter.</p>
+
+<div class="blockquot"><p>The writer is a young woman of twenty-four, whom I did not know
+personally. She wrote to me as follows: "I am a writer by
+profession and during the last year and a half have been connected
+with a leading magazine. In my work, I was constantly associated
+with one man, the managing editor. This man exerted a very peculiar
+influence over me. With everyone else connected with the magazine,
+I was my natural self and at ease, but the minute this man came
+into the room, I became an entirely different person, timid,
+nervous, and awkward, always placing myself and my work in a bad
+light. But under this man's influence, I did a great deal of
+literary work, my own and his too. I felt that he willed me to do
+it. The effect of this influence was that I suffered constantly
+from deep fits of depression almost amounting to melancholia. This
+lasted until last fall, when I felt that I should lose my mind if I
+stayed under his influence any longer. So I resigned my position
+and broke<span class='pagenum'><a name="Page_256" id="Page_256">[Pg 256]</a></span> away. Then I felt like a person who, having a drug to
+stimulate him to do a certain amount of work, has that drug
+suddenly taken away, and without it I am unable to write at
+all...." I wrote to the young lady that she could cure herself
+without hypnotism and without my personal participation. I urged
+her simply to speak to herself early in the morning and especially
+in the evening before going to sleep, and to say to herself that
+the man had never helped her at her work, but that she did it
+entirely of her own power, and that he had never had any influence
+on it, and that she can write splendidly since she has left the
+place, and much better than before. A few months later, she came to
+Cambridge and thanked me for the complete success which the
+auto-suggestive treatment had secured. She was completely herself
+again and was fully successful in filling a literary position in
+which she had to write the editorials, the book reviews, the
+dramatic criticisms, and the social news. As a matter of course,
+such treatment had removed only the symptom. The over-suggestible
+constitution had not been and could not be changed. Thus it was not
+surprising that in the meantime, while her full literary strength
+had come back, she had developed some entirely different symptoms
+of bodily character which I had to remove by hypnotism.</p></div>
+
+<p>As soon as the obsessing idea of the influence of another person takes
+still a stronger hold and develops systems, the suspicion of insanity
+always lies near; especially when hallucinations are superadded, the
+probability is great that we then have to do with the delusions of a
+paranoiac, and thus no case for psychotherapeutic treatment. Yet it is
+always wise to keep a psychasthenic interpretation in view as long as
+the<span class='pagenum'><a name="Page_257" id="Page_257">[Pg 257]</a></span> insanity is not evident. I may mention such an extreme case.</p>
+
+<div class="blockquot"><p>The patient, a man of middle age, highly educated, for years had
+heard voices calling his name. A man with whom he had some personal
+quarrel, had, as he believed, hypnotized him from a distance and
+made him act queerly or do things which he really did not want to
+do, by telepathic influence. It is a development which is found
+quite frequently. Abnormal organic sensations or abnormal impulses
+and inhibitions which the patient cannot account for by his own
+motives become connected with some vague ideas which are in the
+air, like wireless telegraphy or telepathy or hypnotism from a
+distance or electrical influence, or magnetism or telephoning,
+these then attached to an acquaintance who stands in a certain
+emotional relation. Here, too, some organic sensations evidently
+had been the starting point and the idea of the man with whom he
+quarreled had been secondarily attached. From this starting point
+more and more detail was reached. Every action was brought into
+connection with the powerful enemy who controlled more and more
+even the normal and reasonable doings of the patient. My first
+impression was decidedly that of a paranoiac. Yet in some ways the
+case suggested another view. There had remained an insight into the
+unreality of the obsession. The patient did not really believe the
+theory of the telepathic hypnotic influence. He felt it more as an
+idea which he could not get rid of and he did not know clearly
+himself whether he requested hypnotic treatment on my part for the
+purpose of counteracting the hypnotic power of his enemy or for the
+purpose of liberating him from his exasperating fixed idea.
+Moreover, I found that his voices had no hallucinatory character,
+but were merely sound images. I decided to make the experiment
+without great hope of success.</p>
+
+<p><span class='pagenum'><a name="Page_258" id="Page_258">[Pg 258]</a></span>I hypnotized the man deeply and suggested that no one can have
+power over his actions, that he is the responsible originator of
+everything that he does and that no one can influence him and that
+from that hour he would feel free from any telepathic intrigue. The
+effect of the very insistent and urgently repeated hypnotic
+suggestion during the first rather long treatment was such a
+surprisingly good one that I decided to continue the
+psychotherapeutic cure. I hypnotized him daily for two weeks. The
+belief in the real wrong doings of an enemy disappeared entirely
+from the first. It was at once apprehended as a mere obsessing idea
+in the own mind and this idea itself began to be resolved. It lost
+its unity; the absurd impulses were still felt but they became less
+and less connected with the idea of another man, and as soon as
+they were rightly understood as doings of the own mind, the
+opposite motives gained in strength. A stronger and stronger appeal
+to his own power made these motives more and more influential.
+Slowly the association of the influence of the other man faded away
+entirely. I intentionally had not given any attention to the
+pseudo-voices, inasmuch as they had not taken any relation to the
+ideational delusion. I therefore did not include them in my
+suggestions, as I consider it wise to confine hypnotic suggestions
+always to as few points as possible. Yet these voices decreased
+too. At a certain point in the cure I substituted&mdash;to save my own
+time&mdash;an autosuggestive influence, or rather a mixed one, inasmuch
+as I had him read ten times a day a letter of mine which contained
+appropriate suggestions. After about six weeks, all the
+disturbances for which he had sought my advice had disappeared.</p></div>
+
+<p>Obsessing ideas of such personal influence involve of course always a
+certain amount of emotional ex<span class='pagenum'><a name="Page_259" id="Page_259">[Pg 259]</a></span>citement and they may lead us to the
+unlimited field of disturbances in which the persecuting idea is
+surrounded by emotional attitudes. Analysis shows easily that the
+emotion is an essential factor and that it persists in the disease while
+the ideas to which it clings may change. Central is the emotion of fear;
+nearest to it that of worry, but any emotion may give color to the
+particular case. Again any number of methods may be applied and a few
+illustrations with quite different ways of treatment may indicate more
+fully the character of the trouble. There is no doctor in the city and
+none in the remotest village who may not find such cases in his near
+neighborhood. Of course slight degrees are easily hidden by the
+patient's own inhibition of external expression. If such suppression by
+the own will secures a real overcoming of the unjustified emotion, this
+is surely better than to begin any medical treatment. But as the
+suppression usually means simply lack of discharge and thus offers all
+the conditions for an unhealthy inner growth of the trouble, the neglect
+of such disturbances is most regrettable, and frankness of the patient
+must be encouraged. Such situation demands a careful observation of the
+whole case and a subtle adjustment of the treatment to the individual
+needs. It may perhaps be helpful at first simply to indicate the
+varieties of the more frequent disturbances of this kind by quoting from
+various letters. Each case belongs to a type which can easily be removed
+by psychotherapeutic influence, generally even by a skillfully directed
+autosuggestion.</p>
+
+<p><span class='pagenum'><a name="Page_260" id="Page_260">[Pg 260]</a></span>The writer is a young man.</p>
+
+<div class="blockquot"><p>"I have always, as long as I can remember, been very nervous and
+sensitive. When about seven years of age, I was attacked by St.
+Vitus' Dance. Before that I cannot say whether I was particularly
+nervous or not. Afterward it was impressed upon me by the remarks
+of relatives that I was nervous, so that I soon took note of this
+condition myself. The manner in which this weakness has been
+especially troublesome is that it has caused me to be very shy. I
+shrank from new acquaintances and disliked being observed. Often in
+walking along on the street, I imagined myself closely noticed by
+the passerby and I always felt uncomfortable.</p>
+
+<p>"About three years ago I suffered from typhoid fever and after
+recovering, a new form of the old trouble showed itself. This time
+I imagined that when eating I chewed my food in a manner that was
+ridiculous and which made people hardly keep from laughter in
+observing me. Often I had to leave the table when half through
+because I felt I could not bear having critical eyes upon me any
+longer. About three months ago I determined to be troubled no
+further by my own foolish fancies and by constantly schooling
+myself I have improved very much. Still, however, when I walk alone
+along the street, I must fortify myself mentally before passing
+each group of people. If once I allow myself to think that they are
+looking at me, I feel almost paralyzed, my feet seem too heavy to
+lift, my arms do not seem to swing naturally, and in attempting to
+look placid and unconcerned, I feel that I am failing utterly. Also
+when at table, I must still tell myself before each mouthful that I
+have no need for fear, that my manner at table is equal and perhaps
+superior to the others beside me. I have gone a certain length in
+my self-training, and have relieved myself of a great deal of the
+mental distress, but now I believe<span class='pagenum'><a name="Page_261" id="Page_261">[Pg 261]</a></span> I can advance no further. What
+seems needful now is to do away with the self-consciousness which
+brought on my worries, though whether this is possible is hard to
+say."</p></div>
+
+<p>Here the letter of a young woman, the type which fills the army of the
+mind healers and faith curists.</p>
+
+<div class="blockquot"><p>"For years I have been seeking, or perhaps to be more accurate I
+should say waiting, for a mind to drift toward me; a mind that
+would understand my particular case of fear brought on by the
+constant bullying and nagging from my earliest childhood by those
+in my home. This fear of brutality has greatly depleted my nervous
+system and has unfitted me for the strong, useful, forceful life I
+should have expressed. If I could only rid my mind of the thought
+that I am always displeasing, or rather, going to displease people,
+for I hardly do displease them; if I could get rid of the fear of
+caring what the attitude of other minds toward me is, I feel that I
+should then strike out into a strong life of helpfulness to others.
+In other words I have always felt behind me a great force pressing
+me out into public work. When I was a child, it was so strong that
+I was sat down upon brutally, to so great an extent that I feared
+to voice my convictions and that fear still clings to me like a
+nemesis. It seems that every individual personality in a public or
+private audience rises up to overwhelm me, causing my tongue to
+grow heavy and my mind to become a blank. This enervating fear
+blends into every thought I have, whether sleeping or waking. I
+have fought with all my might to rid myself of it but so far in
+vain."</p></div>
+
+<p>Here an expression of a very frequent variety. The writer is a
+middle-aged man.<span class='pagenum'><a name="Page_262" id="Page_262">[Pg 262]</a></span></p>
+
+<div class="blockquot"><p>"I am possessed of a fear that is constantly with me that something
+dreadful is going to happen and I do not seem to be able to
+overcome it. I am told by physicians that I am bodily sound,
+although very nervous, and that the fear is generated entirely by
+autosuggestion. When at its worst, it weakens and terrorizes me and
+in my better moments I am tormented with a fear of a recurrence of
+a bad spell. It is fear of a fear. A year ago at this time I had a
+very bad spell but got along fairly well through the summer, but I
+am afraid that I will soon again be in a bad condition and lose all
+that I may have gained."</p></div>
+
+<p>The "fear of a fear" is indeed a symptom which the psychotherapist has
+to fight extremely often, but as soon as he has really recognized it and
+analyzed the whole mental condition, he will hardly have any difficulty
+in uprooting it. I add a letter of a school-teacher in New York. He
+writes:</p>
+
+<div class="blockquot"><p>"I am teaching in a high school. I am of a nervous temperament and
+constitutionally limited in endurance. Often my work is done in a
+condition of greater or less exhaustion. I find that I blush very
+easily in purely freakish ways, when there is no occasion for it. I
+find this blushing connecting itself with certain of the girl
+pupils of my classes in a conspicuous way. It occurs hardly ever
+except when my class is facing me and I seem to be powerless to
+overcome it. I have always tried to live a careful moral life, but
+my early life was very much secluded. I lacked entirely the free
+intercourse young people usually have together and I felt awkward
+with others for a long time. In the matter of the blushing, it
+sometimes occurs in the case of girls who are especially pleasing
+to me but also not in<span class='pagenum'><a name="Page_263" id="Page_263">[Pg 263]</a></span>frequently in the case of some who are not at
+all so. The whole thing might be passed over were it not that it
+has considerable effect in causing constraint toward my students
+and in some cases affecting them very strongly in an emotional way
+at the very time of life when such things can do most harm. I
+regard the matter as being so serious that it brings directly in
+question my right to teach, but I do not feel at all sure I could
+find other work that I could do if I give up my present position.
+The very thought that on a particular occasion it would be
+extremely awkward to blush makes it almost impossible for me to
+avoid it."</p></div>
+
+<p>But we have rather now to consider the therapeutic side, and we may
+begin again with a routine method of a simple hypnotic treatment.</p>
+
+<div class="blockquot"><p>The patient is a young university professor. His intellectual work
+is perfect in all directions. There are no nervous symptoms, though
+there are some slight disturbances of digestion. He suffers as soon
+as he comes into a crowd of people and as soon as he is on any high
+place, where he has to look down; the worst when both conditions
+are combined, as for instance, at a concert or a theatre in a
+balcony seat. But every meeting of many persons, even at church,
+produces all the symptoms of nervous excitement. He was easily
+brought into hypnotic state by verbal suggestions. When he was in
+hypnosis, I re&euml;nforced the conditions for an opposite attitude. I
+told him that as soon as he was in a crowd of persons he would feel
+especially comfortable, would enjoy himself, would fully enter into
+the spirit of the occasion and feel especially secure in their
+presence. Whenever he should be on a high place, he would enjoy the
+safety of the ground on which he was standing or<span class='pagenum'><a name="Page_264" id="Page_264">[Pg 264]</a></span> the seat on which
+he was sitting. I assured him that he would neglect entirely
+whatever he saw and would rely completely on his safe feeling
+resulting from his tactual impressions. After having hypnotized him
+three times the disturbance disappeared completely, and even an
+evening at the theatre in an exposed box on the balcony was enjoyed
+without any discomfort. After about a year, at a period of
+fatiguing work, some traces of the anxiety appeared again. This
+time two hypnotic sittings were sufficient to remove the
+disturbance of the equilibrium, which as far as I know has not come
+back. The same hypnotic treatments were used in a secondary way to
+remove the digestive trouble.</p></div>
+
+<p>I again quote the case of a teacher, a profession in which the
+psychasthenics are unusually frequent. It is a case of a young woman
+from the Middle West.</p>
+
+<div class="blockquot"><p>The young lady wrote me: "I come of a race of strong women and am
+not hysterical or easily frightened by many things that disturb
+women. Since my fifteenth year I have been seized by hallucinations
+of absurd or serious nature which no reasoning could explain away
+and which have gradually undermined my power of resistance to them.
+At the age of twenty-two, after a year of unusually hard work, my
+nervous endurance gave way, and with this breakdown came a sense of
+fear and a horror of crime that I have been unable to overcome. I
+have never felt the slightest inclination toward wrongdoing. It is
+a feeling rather that my shrinking from any mention of evil makes
+it impossible for me to listen or think rationally when such things
+are discussed. This feeling has seemed to change my whole attitude
+toward life and has left me without power to control my facial
+expression or carriage when it takes possession of me. I have been
+able to teach more successfully than I<span class='pagenum'><a name="Page_265" id="Page_265">[Pg 265]</a></span> could hope, but it is only
+by cutting myself off from the friendships and pleasures incident
+to my life that I am able to accomplish my work. I have fought this
+trouble alone and will still do so if there is no help, but the
+thought that it is the source of great distress to those dear to me
+makes it very hard."</p>
+
+<p>A few weeks later the lady insisted on coming to Cambridge. I found
+that there had never been any hallucinations and that she used the
+word in her letter only to indicate some insistent memory images
+which had never taken the vividness of real impressions. In the
+presence of her friend, I hypnotized her deeply and strengthened
+through urgent suggestions her consciousness of her having done the
+morally right thing at every situation in her life and her
+conviction that she never did and never would commit a crime. Here
+as always, if possible, I left alone the emotional idea but
+re&euml;nforced the opposite. The effect was an immediate one. She felt
+freer the next day than she had felt for years. I repeated the
+treatment a few times and she assured me that the feeling had
+disappeared entirely.</p></div>
+
+<p>I take the rather severe case of a woman of fifty.</p>
+
+<div class="blockquot"><p>The highly educated and refined lady had lost her husband by an
+accident in Switzerland, which had been misrepresented by some of
+the newspapers as suicide. Two years later she wrote to me: "I feel
+as if I had received indelible photographs on my brain which have
+since greatly affected my health and from which I may never
+recover. This winter the symptoms I have been able to control
+returned and I have been ill. I unfortunately saw the newspaper
+headlines with my husband's supposed suicide. Though I exclaimed
+then, 'how outrageous,' I felt as if I had been struck and since
+then I can seldom read a paper without<span class='pagenum'><a name="Page_266" id="Page_266">[Pg 266]</a></span> dread and apprehension, and
+the hearing of anyone's suicide fills me with terror. When I
+hurried to Europe, on the ocean a week from the day of my husband's
+death, I had a curious and overwhelming shock. On opening a drawer
+and seeing a pair of scissors, they looked to me like a dagger and
+suddenly the whole cabin seemed filled with implements of death.
+The doctors said that I would find it hard to get over such
+impressions but I told them I would, as I had courage and will. But
+I have been realizing in these two years that I may be suffering
+from something that may be beyond the control of will. I often
+become so nervously sensitive that scissors are unbearable for me
+to see, or a steel knife or anything that might express death. Our
+family physicians are still against hypnotism, and if I should go
+to a neurologist of my own selection, it might be to one who
+believed still only in nerve foods, baths, or a sanitarium."</p>
+
+<p>The lady came from the South, with her nurse, to Boston and
+insisted on being hypnotized by me. I cannot say whether a really
+deep hypnotic state was produced at once as I refrained from
+testing it. There was certainly no amnesia. Probably it began only
+with a slight drowsiness but at the fifth treatment I found a
+relatively deep hypnosis. It was a capricious case in which the
+improvement was fluctuating but clearly setting in from the first
+day. I trained her in hearing and seeing words like death and
+suicide with a re&euml;nforced feeling of strength and calmness; I
+forced her to see and touch scissors with an artificial attitude of
+strength and indifference. At the same time I re&euml;nforced her good
+mood and her enjoyment in life. When she left for England a few
+weeks later, she felt herself mentally cured, and throughout the
+summer her letters testified the wonderful change which the
+treatment had brought about. Half a<span class='pagenum'><a name="Page_267" id="Page_267">[Pg 267]</a></span> year later, as the result of
+an exhausting physical local treatment, the psychophysiological
+symptoms came back to a certain degree. She requested me by a
+letter from England to give her some help by suggestion to suppress
+again the recurring intrusions. As I had observed her strong
+suggestibility, I sent her over the ocean a little pencil of
+mother-of-pearl which she had seen in my hand, and advised her to
+look at it until she counted twenty slowly and then to close her
+eyes and simply to sleep. The autosuggestive effect was unusually
+strong. She writes from London: "When I saw the enclosure of your
+letter I felt as if it would burn through my hand and the feeling
+became so overpowering that I locked it away with my jewels, but as
+the days ran into a week I felt I could not live with it in my
+apartment any more, and I felt almost ill, until it occurred to me
+I could seal it and take it to my bankers. I felt as dreamy and
+absent-minded and paralyzed as if you had just treated me."
+Nevertheless the effect was on the whole the desired one and she
+returned to America with a wholesome freedom of mind. I hypnotized
+her twice again and she writes in her last letter: "I can never
+repay you for what you have done for me. You have given me back my
+courage and my love of life in its vividness and interest and
+color, all that through the last years I had so entirely lost."</p></div>
+
+<p>Even in cases where the disease itself is inaccessible to
+psychotherapeutic treatment, the superadded grief and worry brought on
+by the disease might yield to the mental influence and the whole
+situation would to a high degree be transformed for the better by it. I
+have often been asked to hypnotize in such cases, where the depression
+was wrongly taken as a part of<span class='pagenum'><a name="Page_268" id="Page_268">[Pg 268]</a></span> the nervous disease; sometimes I agreed
+to do it in spite of feeling sure that the disease itself could not be
+removed. I quote an instance.</p>
+
+<div class="blockquot"><p>A young woman afflicted with epilepsy was brought up in the belief
+that she had only from time to time fainting attacks from overwork,
+and with them secondarily neurasthenic symptoms, especially spells
+of depression colored by a constant fear of the next fainting. She
+had heard voices all her life and they frightened her in an
+intolerable way. I produced a very slight hypnotic state. I
+concentrated my effort entirely on suggestions which were to give
+her new interest in life, and diminished the emotional character of
+the voices without even trying to make them disappear. I proceeded
+for several months. The young woman herself believed that the
+fainting attacks came less frequently afterwards; yet I am inclined
+to think that that is an illusion. But there was no doubt that her
+whole personality became almost a different one with the new share
+in the world. The epilepsy remained probably unchanged but all the
+superadded emotions were annihilated and she felt an entirely new
+courage which allowed her to control herself between her regular
+attacks. She had been unable to undertake any regular work before
+for a long while, but all that improved. More than a year
+afterward, she wrote me: "I have really worked most of the time
+this past winter and spring and I think I can see a steady though
+slow gain. I am reading quite a little and doing it for the most
+part easily. To be sure I have, after I have read, hard times with
+the voices but their character is usually less determined and
+fearful than formerly. Several times I have thought I must come
+again to you but each time I have started again to fight it out for
+myself, but now, as I am gaining, I can better esti<span class='pagenum'><a name="Page_269" id="Page_269">[Pg 269]</a></span>mate the great
+help your influence was to me at a juncture when everything seemed
+so hopeless and helpless."</p></div>
+
+<p>Even in slight psychasthenic disturbances, the psychotherapeutic
+influence is not always successful, especially if there is no time for
+full treatment. But it is very interesting to see how even in such cases
+the symptom is somehow changing, almost breaking to pieces. It becomes
+clear that a protracted effort in the same direction would destroy the
+trouble completely. Typical is a case like the following.</p>
+
+<div class="blockquot"><p>An elderly woman has been troubled her life long by a
+disproportionate fear of thunderstorms with almost hysterical
+symptoms. As she had no other complaint, I hardly found it worth
+while to enter into a systematic treatment and could not expect
+much of a change from a short treatment, considering that her
+hysteric response had lasted through half a century. As she begged
+for some treatment, I brought her into a drowsy state and told her
+that she would in future enjoy the thunderstorms as noble
+expressions of nature. The whole procedure took a few minutes. Yet
+after some summer months she wrote me a letter which clearly
+indicated this characteristic compromise between the habitual dread
+and the re&euml;nforced counter idea. "I have the same sick dread at the
+sight of thunder clouds that I have always had, but I seem to have
+gotten somehow a most desperate determination to control my fear. I
+have done this to the extent of keeping my eyes open and looking at
+the storm. Is that hypnotism or pride?"</p></div>
+
+<p>Another thunderstorm case may lead us to other methods of treatment.
+Here again in the field of<span class='pagenum'><a name="Page_270" id="Page_270">[Pg 270]</a></span> emotional response, we may consider the
+methods of going back to primary experience, known or forgotten.</p>
+
+<div class="blockquot"><p>A young married woman of the West had suffered always from
+hysterical attacks in response to any sharp sudden impressions,
+especially sudden loud noises. The banging of a door, but worst of
+all a thunderstorm, could produce hours of weeping and crying and
+desperate mental condition with all expressions of excitement. Her
+husband wanted me to hypnotize her but I preferred another way. I
+tried to get her memory back to the earliest case of which she
+could think of this hysterical response. As long as we were in
+ordinary conversation, she could not trace it beyond about her
+twelfth year. But when I brought her into a drowsy state, her
+memory revived older experiences and finally settled at a school
+experience in her seventh year of age. She then had an excitable
+country school-teacher who relied on whipping the children. Once
+her neighbor in the class did something forbidden. Her teacher
+mistook her for the culprit and began to whip her most forcibly
+before she could explain anything; and while the punishment was
+going on and she began to bleed from a wound, she all the time felt
+that she wanted to express her innocence and could not speak. After
+that, evidently the first attack of hysteric character followed.
+From that time on any sudden impression released the same group of
+reactions. The suppressed emotion had evidently become a
+psychophysical "complex." As soon as I had reached this starting
+point of her pathological history, I asked her to bring back to
+consciousness as many details as possible of that first incident.
+She told me all the names and described the classroom and brought
+herself vividly into the whole situation.<span class='pagenum'><a name="Page_271" id="Page_271">[Pg 271]</a></span> Then I asked her to tell
+me the whole story once more and to express strongly her innocence
+and the wrongness of the punishment, and when she had completed her
+account, brought out with fullest indignation, I had her tell the
+whole thing once more and then a third and a fourth time, until she
+was quite tired out from it. That was all I did. Very soon after,
+the husband reported that there was a great improvement in every
+respect, no hysteric attacks, only slight discomfort. Most of the
+stimuli which had previously produced strong reactions now passed
+without any disturbance and even thunderstorms were experienced
+with relative ease. A year later they came once more to Cambridge,
+and she simply passed once more through the same process of
+discharge which seems now to have removed the symptoms still
+further.</p></div>
+
+<p>By far more reliable, however, is the method of side-tracking the
+starting experience into a new associational track.</p>
+
+<div class="blockquot"><p>A gentleman with a decidedly psychasthenic constitution developed a
+tendency to hesitate in walking on the street. It was not a
+complete stumbling but a disturbing inhibition, which set in when
+he was walking alone and his attention was not absorbed by
+something on the street. He believed that it came on most strongly
+when he looked down at the pavement. He suffered from it vehemently
+and avoided going on the street alone. He was unable to connect it
+with any starting point. He interpreted it as merely a symptom of
+overwork. But going with him through all kinds of experiences which
+he had had on the street in previous years, we finally found that
+once he was running to catch a street car, when he suddenly saw
+almost immedi<span class='pagenum'><a name="Page_272" id="Page_272">[Pg 272]</a></span>ately before him a big hole dug out for laying gas
+pipes. He was able to stop himself quickly enough not to fall into
+the hole but he got a strong emotional shock from the experience.
+He, himself, did not think that his walking troubles set in
+immediately after this shock. Yet the hypothesis seemed to me
+sufficiently justified that there existed a connection, even though
+some weeks lay between that first experience and the first
+observation of the abnormal inhibition in walking. On that basis I
+tried to train a new associative connection. I made him drowsy and
+asked him to think himself once more into the situation of his run
+for the car but as soon as he reached the hole to jump over it. He
+went through this motor feature on ten successive days with new and
+ever new energy and from that time up to the present the trouble on
+the street has disappeared entirely.</p></div>
+
+<p>To mention at least one case of the large group in which suppressed
+sexual emotion was the evident source of an anxiety-neurosis, I mention
+the case of a woman who showed very strong symptoms of anxiety and
+oppression and who was cured by a simple advice.</p>
+
+<div class="blockquot"><p>The woman, aged thirty-two, was a saleswoman in a large store
+selling gentlemen's gloves and ties. She suffered from time to time
+by attacks of vague anxiety in which her heart showed vehement
+palpitation. There were paleness and perspiration and at the height
+a nervous trembling together with a feeling of despair. These
+attacks were not frequent, separated sometimes by weeks, sometimes
+by months, but troubling her exceedingly. She had been assured by a
+physician that her heart was normal and that<span class='pagenum'><a name="Page_273" id="Page_273">[Pg 273]</a></span> she was probably
+overworked. She could find absolutely no source of the disturbance.
+After a long conversation, I was also unable to discover any direct
+or indirect causes until I worked on the basis of those theories
+which we have discussed, the theories which connect hysteric
+symptoms with chance intrusions which stand in relations to past
+suppressed emotions of sexual character. The patient absolutely
+denied any present sexual emotions. She had been engaged about
+eight years before and acknowledged that at that time there were
+strong sexual feelings connected with her fianc&eacute;, who broke the
+engagement. Psychoanalytic methods now brought it to full clearness
+that she had her first attack after selling a pair of gloves and
+fitting them to the hand of a male customer who had a certain
+similarity to her fianc&eacute;. It was not possible to trace this in the
+same way for later cases too, but it seems that bodily contact with
+a man by fitting gloves preceded every attack. All this was brought
+out partly by questions, partly by free ascending associations
+while she, herself, believed that she simply pronounced nonsense
+words as they came to her mind, and partly it was secured in a
+half-hypnotic state. I came to the conclusion that the suppressed
+sexual emotions at the breaking of the engagement were the primary
+cause of the disease. The similarity of the first customer together
+with the tactual sensations had evidently touched that complex and
+brought the suppressed emotion to an explosion which frequently
+takes the form of palpitation and similar symptoms. Later the mere
+tactual sensation alone produced by the contact with the hand of a
+man, possibly with a similar optical impression, perhaps also with
+the sound of the voice, brought back the reaction. Instead of
+giving treatment, I insisted that she change stores, and become
+saleswoman in a house where she would have to do only with women,
+and to sell<span class='pagenum'><a name="Page_274" id="Page_274">[Pg 274]</a></span> articles which did not bring her into personal contact
+with customers. After more than six months of work in her new
+place, she reported that the attacks had not come back again.</p></div>
+
+<p>Of course it may readily be acknowledged that this method does not allow
+a sharp demarcation line between its various factors. It cannot be
+denied that an element of straight suggestion may be included. The man
+whom I train in the forming of a new antagonistic motor response feels
+it of course all the time also as a silent suggestion to overcome the
+old disturbance. It is thus to a certain degree impossible to say where
+the effect of the discharge ends and where that of the hidden suggestion
+begins. Yet there certainly cannot be any doubt that this revival of the
+first experience and its improved discharge works directly towards the
+removal of the troublesome symptom.</p>
+
+<p>Abnormal fear is also the essential factor in most cases of stammering.
+The patients usually know it themselves. For instance, a lawyer writes
+to me:</p>
+
+<div class="blockquot"><p>"I have been a stammerer the greater part of my life and have
+visited every stammering school in the country, but the relief
+obtained has been temporary and in most cases I was not benefited
+at all. I am convinced that stammering is due wholly to an abnormal
+mental condition, which consists of an unreasoning fear that takes
+possession of the individual when he attempts to utter certain
+sounds. It is simply a lack of confidence inspired by numberless
+failures to articulate properly and is not caused by any organic
+trouble, because, taking my own case for example, I can at times
+talk as fluently and easily as anyone. I am firmly con<span class='pagenum'><a name="Page_275" id="Page_275">[Pg 275]</a></span>vinced that
+stammering can be cured by hypnotic suggestion. If you could get me
+in the hypnotic state and suggest to me repeatedly that from
+thenceforth I would have easy fluent speech, I feel absolutely
+certain that such would be the case."</p></div>
+
+<p>Or an engineer writes to me:</p>
+
+<div class="blockquot"><p>"At times I stammer very badly. In an ordinary conversation it is
+scarcely perceptible, but it is almost impossible for me to make an
+explanation or relate an incident or tell an anecdote. I began to
+stammer when I was about seven years of age&mdash;I am twenty-nine
+now&mdash;and continued until I was seventeen, when I broke myself of it
+by reading aloud. It came back on me about a year ago, at which
+time I was laboring under a very severe nervous strain on account
+of business matters. I have since tried to break myself of it in
+the way that I did at first, reading aloud, but have been unable to
+do so. Can it be cured by hypnotic treatment or suggestion? Can any
+hypnotist of ordinary ability do it?"</p></div>
+
+<p>I should affirm this question, which is one of the most frequent put to
+the psychotherapist. And yet, if I myself have entirely given up the
+cure of stammerers in recent years, it was not only because there was
+little chance to learn anything new scientifically from it but also
+because it was ultimately disappointing, as the severe cases cannot be
+cured entirely. Every hypnotist can quickly secure a strong improvement.
+In even new cases I found an almost surprising improvement in the first
+two weeks, an improvement which stirs up the most vivid hopes of the
+sufferers. Then the improvement becomes slower<span class='pagenum'><a name="Page_276" id="Page_276">[Pg 276]</a></span> and finally it stops
+before a complete cure is reached. The patient notices it and it easily
+works back on his emotion and thus begins again to disturb the speech,
+unless a very careful continuous counter-suggestion is given. Slight
+disturbances, to be sure, can be removed entirely. The essential point
+will always be to suggest to the stammerer the full belief that he is
+able to speak every word and that he is able to speak it in every
+situation. But where there is a limit for improvement, we must take for
+granted that the disturbing fear is only superadded to an organic
+trouble. In such cases, probably the inability of certain nervous paths
+was primarily irreparable. These inabilities then became the source of
+discomfort and of fear and this fear added greatly to the disturbance.
+Hypnotism then quickly removes that part of the disturbance which had
+been superadded by the mental emotion but it cannot remove that primary
+factor, the objective inability, and every cure thus finds its limit
+there.</p>
+
+<p>Near the field of emotions stand also the many varieties of sexual
+abnormities and perversities. I abstain from discussing any special
+cases but it may be said that suggestive treatment is in this region
+powerful to an almost surprising degree. Even homosexual tendencies
+which go back to the beginnings of the memory of the individual yield,
+as my experience shows, in a few weeks, if again the suggestion is not
+so much directed towards the suppression as to the creation of the
+antagonistic reaction, that means in this case, of the normal sexual
+desire.</p>
+
+<p><span class='pagenum'><a name="Page_277" id="Page_277">[Pg 277]</a></span>Both ideas and emotions, of course, lead to actions. Moreover we always
+insisted that the resulting action is an essential part of the
+psychophysical situation and that every mental experience has to be
+characterized as a starting point for action. Yet this factor of
+activity and of attitude sometimes stands in the foreground. The
+controlling idea is then the idea of an end of action, the predominant
+emotion, the emotion anticipated from a certain activity. Typical for
+that are those disturbances in which an abnormal impulse or an abnormal
+desire awakes perhaps a desire for ruinous drugs like morphine or
+cocaine or an impulse to criminal deeds, like stealing. But the
+disturbances of the psychomotor factor are not less present when the
+central complaint is a lack of energy, the most frequent symptom of the
+neurasthenic; and our whole discussion has made it clear that a mere
+lack of attention belongs to the same category.</p>
+
+<p>Of course, the abnormal impulse is psychophysically not different,
+whether it leads to a legally important result like the impulse to kill
+or leads to an indifferent result. The subjective suffering may be the
+same in both cases. The starting point of the impulse may be any chance
+experience. The psychasthenic may pick up such impulses from any model
+for imitation or from any haphazard report. It may be entirely freakish
+and yet beyond conscious control.</p>
+
+<div class="blockquot"><p>A physician had read in a well-known book on hysteria about a case
+in which a girl was troubled by a constant effort to move the big
+toe in her shoes. This idea worked<span class='pagenum'><a name="Page_278" id="Page_278">[Pg 278]</a></span> on him as a suggestion for
+several months. At my advice he fought it by auto-suggestion. He
+brought himself into a slightly drowsy state by staring into a
+crystal ball and assuring himself by spoken sentences with
+monotonous repetition for a long while that he has perfectly the
+power to hold the toe at rest. From the second day only a slight
+kin&aelig;sthetic sensation remained; the movement itself disappeared.</p></div>
+
+<p>Or a more unusual case.</p>
+
+<div class="blockquot"><p>A young lady once noticed in a man a different color in the two
+eyes. It gave her an uncanny feeling, together with the natural
+impulse to compare the two eyes. Accordingly she shifted her own
+eyes from one eyeball to the other in the man's face. The accent
+which this shifting impulse had received by the disagreeable
+feeling evidently forced her to repeat this movement with everyone.
+At first it became half a play, but soon a disturbing habit and
+finally an intolerable impulse. Whenever she talked with anyone,
+she lost control of her eyes and was obliged to enter into a kind
+of pendulum movement from eye to eye. The situation became so
+unendurable that the thought of suicide began to occur to her. I
+hypnotized her four times, suggesting to her complete indifference
+as to the face of those with whom she spoke and at the same time
+certain new habits of fixation. The impulse lost its hold and when
+I saw her last, it had completely disappeared.</p></div>
+
+<p>By far more frequent than such neutral impulses are the desires, for
+instance, of the alcoholist. On the whole it may be said that
+psychotherapy can gain its easiest triumphs in the field of alcoholism
+and a wide propagation of psychotherapeutic methods and of a thorough
+understanding of psychotherapy would<span class='pagenum'><a name="Page_279" id="Page_279">[Pg 279]</a></span> be fully justified, even if no
+other field were accessible but that of the desire for alcoholic
+intemperance. The moral disaster and economic ruin resulting from
+alcoholic intemperance, the physical harm to the drinker and to his
+offspring is so enormous, and the temporary cure of the victim is so
+probable that the movement certainly deserves most serious interest. Yet
+I speak of temporary cure and I refer here especially to the restriction
+with which I introduced the psychotherapeutic methods in general. They
+do not deal with diseases but with symptoms; and they certainly do not
+deal with constitutions, but with results of the co&ouml;peration of
+constitution and circumstances. That the given constitution may be
+brought anew under conditions which again stir up similar symptoms is
+always possible, and just with alcoholism the danger lies near unless
+beneficial influences remain in power. Certainly no one has a right to
+neglect such psychotherapeutic aid simply because relapses are possible.
+Even a temporary relief can be a great blessing. Moreover, the temporary
+relief is the safest basis to work towards the prevention of a
+recurrence of the evil. Only in two directions is further restriction
+needed. Psychotherapeutic methods are in my opinion of very small avail
+in cases of periodic drinkers. Such periodic attacks of patients who
+have not even a desire for alcohol in intervals between the attacks,
+intervals which may last a quarter of a year, are related to epilepsy.
+It seems that constant hypnotic influence during the interval has a
+certain power to reduce the periodic impulse. I personally have not<span class='pagenum'><a name="Page_280" id="Page_280">[Pg 280]</a></span>
+seen any special improvement from it. The second restriction would be
+that the drinker has to be under constant supervision during the first
+days of hypnotic treatment. No patient, not even the morphinist, is so
+skillful in deceiving his friends and even the physician. Even the most
+emphatic gestures of sincerity ought to be distrusted.</p>
+
+<div class="blockquot"><p>Only a short time ago I dealt with a young man whom his parents and
+a chauffeur had accompanied to Boston, exclusively for the purpose
+of watching him constantly while I was to attempt to cure him from
+excessive whiskey drinking. The chauffeur accompanied him from his
+room in the Boston hotel to the threshold of my laboratory. All
+through the day he was with his parents, and at the hotel the
+management had given the strictest orders not to sell any drink to
+the young spendthrift. He was an earlier student of mine and had
+attached himself to me with such an apparent sincerity as removed
+every possible doubt of his pledge. Intentionally I had not even
+asked him for a pledge not to drink but only for a pledge to
+confess to me the next day if he ever should take any alcohol. In a
+tentative way I suggested to him in a half hypnotic state on the
+first day that he would feel disgust for whiskey. I did not expect
+much of an improvement before at least three or four treatments. I
+was therefore most surprised when he most solemnly assured me the
+next day that he awoke in the morning with an assured feeling that
+he should never touch whiskey again and that he had not the
+slightest desire for it. Instead of a systematic development of
+suggestions, I confined myself therefore to a mere repetition of
+the treatment of the first day and as every morning the same
+assurance came forth, there seemed to be no need for any
+varia<span class='pagenum'><a name="Page_281" id="Page_281">[Pg 281]</a></span>tion. It was not before the fifth day that I discovered that
+he had taken from the start a pint of whiskey every day. When he
+first arrived he had bribed a laundress of the hotel to bring to
+his room every day the whiskey hidden in the laundry and he drank
+it during the night. Then I declined any further participation.</p></div>
+
+<p>The danger of deceit is of course less imminent when not the family but
+the patient himself takes the initiative. Yet even here distrust is
+wise. The patient has sometimes the most sincere intention to be cured,
+but under pressure of his craving he admits compromises which he hides
+from the physician. Having reduced the large quantity of alcohol to
+which he was accustomed, he hides the fact that he yet takes a few
+drinks, which he thinks cannot prevent the cure. Yet inasmuch as a
+complete cure has to rely on psychical factors, this consciousness of
+deceiving even with small transgressions interferes badly with progress
+and, inasmuch as the cunningness of the patient is itself a symptom of
+the disturbance, the strongest possible precaution is advisable at the
+beginning. For that reason it is also not best to begin at once with
+complete prohibition, but to lead to a total abstinence in about one
+week. But certainly in the case of every drunkard, total abstinence is
+the only desirable goal. A pronounced drinker ought never to be
+transformed simply into a moderate one. The return to intemperance would
+result rapidly. On the other hand it would be unfair to deny that
+psychotherapy has cured the symptom if the desire really once
+disappeared completely, even if, after years,<span class='pagenum'><a name="Page_282" id="Page_282">[Pg 282]</a></span> new temptations develop a
+new desire. I myself had diphtheria three times in my life; my
+constitution is thus probably especially favorable to that disease but I
+do not estimate less the fact that I was perfectly cured the second
+time, in spite of the fact that I caught it a few years later a third
+time. To be sure, such experiences of relapse cannot be spared any
+psychotherapist. I may give a typical instance.</p>
+
+<div class="blockquot"><p>A well-known professional man of fifty years, through a long
+bachelorhood, was accustomed to close his work at four o'clock and
+then to sit comfortably in his study with a book and an unlimited
+supply of brandy. He took one cognac after another and every
+evening he was completely intoxicated. He married a young wife and
+felt the need of changing his habits, the more as he himself saw
+symptoms of his excess which alarmed him. When he came to me, I saw
+that he was seriously wishing to give up, and he understood himself
+that there was only the one way, namely, complete abstinence. He
+felt that he could not reach it by his own will power alone and
+sought my aid. I hypnotized him six times, suggesting at first a
+reduction to four drinks, then to two, then to one and then to pure
+mineral water. I concentrated my effort on stirring up the
+antagonistic attitude, the dislike of the smell of brandy and the
+aversion to its taste. The effect was excellent. After the fifth
+time the mental torture which he had felt in the first afternoons
+had completely disappeared. I considered further hypnotizing
+superfluous and felt sure after the sixth time that the man was
+cured. For about a year he remained abstinent, but in the meantime
+his professional life brought severe disappointments, and with cool
+considera<span class='pagenum'><a name="Page_283" id="Page_283">[Pg 283]</a></span>tion he decided that he might have at least some pleasure
+from life and forget its miseries. Accordingly after a year he
+determined again to take some brandy in his study, and of course,
+that led rapidly to an increase of the dose and today he is
+probably at the old point. And yet it may be said with correctness
+that psychotherapy had done its duty. If at the right moment before
+he took the first step again, even the slightest counter-suggestion
+had been applied, the disastrous second development could have been
+easily avoided.</p></div>
+
+<p>My experience indicates the best results where the suggestions are from
+the start directed as much against the unfavorable social conditions,
+with their temptations and impulses to imitation, as against the
+alcoholic beverages themselves. On the whole it is easier to break the
+vicious drinking habits of the social drinker than those of the lonely
+drinker, a point which ought to be well considered in settling the
+complex problem of prohibition versus the temperance movement.</p>
+
+<p>The situation of alcoholism repeats itself in still more ruinous forms
+with morphinism and cocainism, vices which grow in this country to an
+alarming degree. The psychotherapeutic treatment of such drug habits
+demands much patience and much skillful adjustment to the psychological
+conditions. Its general difference from the treatment of alcoholism is
+given by the circumstance that any too rapid withdrawing of the drug is
+certainly dangerous, if the organism is adjusted to a relatively strong
+dose. On the other hand, I may say that I have not seen a single case<span class='pagenum'><a name="Page_284" id="Page_284">[Pg 284]</a></span>
+in which a really patient and insistent treatment of morphinism has not
+been successful, even if the destructive dose of forty grains a day had
+become habitual. The condition is only that the patient himself have the
+best will, a will which yet is not strong enough to win the fight
+without psychotherapeutic help. But no one ought to expect that the
+psychotherapist can secure miracles like some of the pill cures which
+treat the drug fiend in three days. Moreover neither physician nor
+patient ought to believe that the worst is to come at the beginning. On
+the contrary, it is the end which is hardest, the reduction of the small
+dose to nothing. As illustration, I give an extreme case.</p>
+
+<div class="blockquot"><p>A man who was formerly station master on a railroad had been
+operated on in a hospital after an accident, and as some pain in
+the hip remained which disturbed his sleep, the physician of the
+hospital gave him some morphine and provided him with the material
+for morphine injection after leaving the hospital. Then began the
+usual story. He became more and more dependent upon his injection,
+the dose was steadily increased, he found unscrupulous physicians
+who yielded to his demand for morphine prescriptions; he lost his
+position with the railway by the growing effects of the morphine
+poisoning, he became divorced, sank lower and lower, his daily dose
+fluctuating between thirty-five and forty grains a day, and when he
+came to me, he presented a picture of the lowest type of hopeless
+manhood. He spent practically the whole day in bed and was only
+able to totter slowly along with a cane. He assured me that life
+was hell for him. He could not sleep, he could not eat, he<span class='pagenum'><a name="Page_285" id="Page_285">[Pg 285]</a></span> could
+not think, he had made up his mind to commit suicide if I could not
+help him. I foresaw that it would in the best case demand months of
+insistent energy to make a man out of that unfortunate wreck. He
+had gone through three different morphine cures in three
+sanitariums and none had helped him, and every physician whom he
+had consulted had declared his case as beyond any physical cure. I
+decided to make the somewhat disproportionate sacrifice of time in
+order to study whether even such an extreme case of morphinism is
+accessible to psychotherapeutic treatment. Four months later, he
+left my laboratory looking like an athlete, strong and vigorous,
+joyful and energetic. For three weeks he had not received any
+morphine, had good appetite, slept well, and had happily married.
+As his wife was a trained nurse, she will take good care that no
+new slip shall ever occur.</p>
+
+<p>There was nothing remarkable in those four months of treatment. He
+was easily hypnotized, and I hypnotized him at first every day,
+then every second day, then every week. It was without difficulty
+that I reduced the forty grains to about six grains a day. Then the
+struggle began. To test the case as a strictly psychological
+problem I left the effort entirely to his own will, that is, I did
+not deprive him of the morphine supply but left the regulation in
+his own hands. During that whole winter he had a bottle with a
+thousand morphine tablets standing on his desk. Thus he would have
+been entirely able to satisfy any craving, but by his own will he
+followed my suggestions and never took more than I permitted. It
+meant a terrible struggle. The tortures which he had to pass
+through were perhaps worse than those which he had experienced at
+the time of his lowest downfall. They came to a focus when he tried
+to go from five grains to three grains a day and then again when
+he<span class='pagenum'><a name="Page_286" id="Page_286">[Pg 286]</a></span> approached half a grain. From there he had to move to a fourth
+of a grain, then to an eighth, and even that had still to be
+divided into four different doses which were then reduced to three,
+to two, and finally to one dose and ultimately to injections of
+warm water. A rapid increase in general strength and a return of
+appetite for food began when he had reached the five grain limit. I
+did not allow on any occasion the introduction of a substitute. On
+the other hand, I added every day suggestions covering the various
+secondary symptoms, especially the pains in the stomach and the
+feelings of faintness and the emotional depression.</p></div>
+
+<p>There, is no doubt that under favorable conditions, especially if the
+dose of morphine is not too strong, autosuggestion can bring about a
+similar effect. A reduction of ten per cent every week can be carried
+through, if a pledge is given to one's self in a drowsy state. The great
+value of autosuggestion showed itself not seldom in the fact that
+morphinists who had applied to me by mail for a cure in the mistaken
+belief that I do work in a professional way for payment and who got from
+me a written reply that I could not receive them, but that they can help
+themselves, wrote to me that my letter gave them strength to reduce
+their dose considerably.</p>
+
+<p>Quite similar is the situation with cocainism or with the combination of
+morphine and cocaine which is so frequent nowadays with young
+physicians. I have repeatedly seen cures where the case already gave the
+impression of insanity. Again I give a rather extreme case.<span class='pagenum'><a name="Page_287" id="Page_287">[Pg 287]</a></span></p>
+
+<div class="blockquot"><p>A physician had acquired the habit of using and misusing cocaine
+for the treatment of a disease of his nose. The habit grew to a
+craving for cocaine while the cocaine itself poisoned the brain.
+Acoustical hallucinations began; he heard voices from every corner
+of the room, and on the street the voices took persecutory
+character. He connected them with his brother living in Europe,
+heard his voice in the denunciations, and developed a pathological
+system of ideas around the central thought that his brother had a
+telepathic influence on him. His reason succumbed, he lost all
+consciousness of delusion, and believed himself really to be under
+the control of the absent brother. When he came to me he had been
+without sleep and without food for several days, and he was not
+seeking my help to get rid of the mental disturbance but to
+overcome the power of his older brother. He did not connect the
+fear at all with his misuse of cocaine. When I discovered the r&ocirc;le
+which the cocaine played, I determined to try the suggestive
+influence, the more as I found that he was in a half-hypnotic state
+as soon as he had entered my room. I suggested to him to sleep and
+to take food and to reduce the cocaine dose by a fourth. The next
+day he was an entirely different man by the effect of ten hours'
+sleep and a large breakfast. Now I concentrated my efforts on the
+reduction of the cocaine. After ten days of hypnotic treatment he
+gave up cocaine entirely, after three weeks the voices disappeared
+and slowly the other symptoms faded away. The pathological idea of
+the telepathic influence lasted a while after the voices had gone
+until this idea, too, yielded to suggestion. It still took six
+weeks before he himself felt that he was entirely normal.</p></div>
+
+<p>The way in which the average physician nowadays neglects the simple tool
+of suggestive treatment,<span class='pagenum'><a name="Page_288" id="Page_288">[Pg 288]</a></span> when it can be used for the protection of
+society, is perhaps nowhere so reckless as in the case of the morphinist
+and cocainist. To give a typical case of this neglect I may mention that
+of a highly intelligent young man who had been in the habit of using
+both cocaine and morphine for ten years when at his own request he was
+sent to a New York hospital. He had been taking alternately morphine for
+a year or two, then cocaine for a year or two, and had sometimes
+alternated and sometimes combined both in an irregular way. When he
+entered the hospital in May, 1908, he was in a cocaine period and was
+taking the enormous dose of one hundred and eighty grains of cocaine
+every day. In the hospital they withdrew the drug altogether. During the
+first weeks, he was entirely sleepless. They energetically refused him
+any substitutes and after six weeks he began to feel comfortable. He
+gained steadily in weight and after three months, when he left, he had
+gained fifty pounds, felt entirely comfortable, and seemed in all
+respects normal again. Before twelve hours had passed after leaving the
+hospital, he had again taken thirty grains of cocaine and ten grains of
+morphine, and this dose rapidly grew until after a few weeks it again
+reached a hundred grains of cocaine and up to sixty grains of morphine a
+day. Then came the complete breakdown. If that man in the last two or
+three weeks of the hospital treatment, when he felt entirely comfortable
+and normal and had gained his normal weight, had received even a slight
+suggestive treatment suppress<span class='pagenum'><a name="Page_289" id="Page_289">[Pg 289]</a></span>ing any desire for cocaine or morphine, he
+would easily have been saved. To let such a man after a drug career of
+ten years go out again to the places of his old associations, where the
+desire had to be stirred up, is inexcusable at a time when
+psychotherapeutics has won its triumphs in this field. It might have
+been sufficient to give him preventive treatment at least for the first
+three days of his freedom. And such a case is typical of hundreds.</p>
+
+<p>The overstrong impulse and overstrong desire finds its counterpart in
+the abnormal lack of energy and lack of attention. The patient&mdash;and it
+is especially the neurasthenic patient&mdash;has lost his usual strength, he
+shrinks from every undertaking, he cannot decide upon any action, he
+needs a disproportionate effort for the smallest task, and cannot
+concentrate his attention in spite of his best will. The varieties of
+this lack of power and inertia are familiar to every physician. They
+certainly often need much more than merely psychotherapeutic treatment,
+although on the physical side no schematic method is admissible. The
+laziness of the an&aelig;mic needs a different treatment from the laziness of
+the exhausted but in every case psychological factors can be of decisive
+influence, whatever the physical and chemical treatment besides them may
+be. A few letters may again illustrate the varieties. Here again there
+is no sharp demarcation line between the normal and the abnormal.
+Letters like the two following, for instance, are hardly letters of
+patients. They show a variation which is still entirely within normal
+limits and yet a source<span class='pagenum'><a name="Page_290" id="Page_290">[Pg 290]</a></span> of suffering; it is a disturbance which usually
+can be removed by psychotherapeutic means.</p>
+
+<div class="blockquot"><p>"I do almost everything with effort, nothing spontaneously. I have
+been writing for five years but am a mood writer of the worst type.
+The mood comes at such uncertain times that I seem to be absolutely
+at the mercy of caprice. This might not in itself be a misfortune
+but writing is my only calling and I suffer the proverbial torments
+of lost spirits when I am idle. The necessity of driving myself to
+every piece of work, aggravated by the fact that my parents allowed
+my constitutional inertness to have full play, has hitherto
+prevented me from forming any regular habit of labor. I am now
+thirty-eight. Would you suppose that if I kept my nose to the
+grindstone for one, two or three years, I might yet hope to work
+with some ease and regularity? That is, if I compelled myself to
+write a certain number of hours every day as a discipline,
+regardless of the quality of matter I produce, is there any
+probability that I might ultimately overcome the fearful paralysis
+that so often grips my faculties? Can constitutional indolence be
+overcome by determination? I put in a little time on a couch every
+day. When worried I get neurasthenia and all kinds of phobias. Just
+now I am afraid to look at the newspapers on account of the cholera
+in St. Petersburg, and I have seen the time when I found it
+difficult to drink water after I had boiled it myself."</p></div>
+
+<p>Also the next man is familiar to all of us.</p>
+
+<div class="blockquot"><p>"Plainly we are told every man is born into the world to fill some
+purpose, or at least be of some benefit to himself or his
+fellowmen. For some reason I do not make friends among men. I have
+not the zeal or ambition to<span class='pagenum'><a name="Page_291" id="Page_291">[Pg 291]</a></span> carry or even begin a conversation
+that will interest the individual man. I worry a great deal. I have
+never been able to concentrate my mind to study and figure out
+problems. I can read them zealously but apparently do not get to
+the bottom and cannot retain what I do read. If I could just get
+hold of the power of thinking and dig out that tangible something
+that holds me back, I could go forward and make myself what I know
+I should be. But I feel that so far I am a total failure. If I only
+had that one great gift, the power of concentration and will power,
+I would make what I so much desire, a success of myself."</p></div>
+
+<p>A similar effect and yet psychologically a different condition exists
+where the lack of energy results from the suggestive power of the
+opposite, producing a constant indecision.</p>
+
+<div class="blockquot"><p>"I am thirty years old and nearly all my life since childhood I
+have been fearfully troubled with the habit of indecision and
+regretting whatever I do. It has grown into a habit so fixed that
+at times I am fearful of losing my mind. I feel anxious to do
+something and decide to do it, then as soon as it is done, I nearly
+go wild with regrets until I have to undo it, if possible, and then
+only to regret that. I am this way about the most trifling things
+and about the most serious. I can't perform any duty well. In
+business and in social affairs, it is always with me. It has me in
+its clutches, a horrible monster dragging me down. My friends
+misinterpret me and wonder what I mean by doing so when all the
+time I want to do what is for the best and cannot for this tyrant
+who is ever present with me. I will plod for hours and hours at a
+time, and at every<span class='pagenum'><a name="Page_292" id="Page_292">[Pg 292]</a></span> turn I am handicapped. I am intelligent
+naturally and appear a perfect fool."</p></div>
+
+<p>From the report of such chronic cases we may turn to the acute ones.
+Here a characteristic letter of, a typical neurasthenic young modern
+poet.</p>
+
+<div class="blockquot"><p>"These are my plans but I hardly think that I can carry them
+through, although perhaps you can help me by suggestion. I have the
+feeling that through the whole of last year my development did not
+go forward but backward. It is as if by a mental or physical
+overstrain, my whole personality has entered into a transition. I
+have no joy in life, no sensation in love, no satisfaction in
+labor. My will has become weak where it was strong. I am lazy, up
+to an absolute dislike of everything, while I have been energy
+itself. Often I have only the one desire, to end my life from mere
+fatigue. If there had been any external reason for ending my life,
+I should perhaps have done it long ago. I am so apathetic that I no
+longer take myself seriously. My successes do not please me; the
+idea of writing anything gives me anxiety. I have become less
+resisting, more sweet, more soft, I should almost like to say, more
+feminine. I became infatuated with a girl, simply because I knew
+that she hates all men. The inaccessible is still the only thing
+which can stimulate me somewhat. I have even written a poem on her,
+but nothing can satisfy me in love. I consider my state a disease
+of the will as a result of nervous exhaustion. I must find some one
+who, with kindly power, re&euml;nforces my will system. I need a strong
+mind&mdash;it may be a man or a woman. It would even be possible in the
+latter case that I might marry her.</p>
+
+<p>"Even the writing of this letter has fatigued me so much that I
+should like best to sleep. In moments like the pres<span class='pagenum'><a name="Page_293" id="Page_293">[Pg 293]</a></span>ent I should
+like best to throw myself down on the street or ... quickly ...
+sink ... into the ocean. (I regret having made the little points.
+They look as if my expressions are a pose.) Yet there are moods in
+which I am entirely normal and no one fancies what I am passing
+through. I have even become superstitious lately. Are there perhaps
+beings which can absorb our energy? Perhaps another being has drunk
+up my energy."</p></div>
+
+<p>Authors run easily into such states. Here is another.</p>
+
+<div class="blockquot"><p>"I am a neurasthenic, and I am beginning to believe, a professional
+one. My object in writing is to ask concerning the advisability of
+my visiting you for treatment. I am ready to take the next train if
+you say the word, if you believe you can help me. It seems that the
+regular practitioner, who is very irregular, cannot. If there is
+one good doctor I have not consulted, I would like to know his
+name. I was doing editorial work in X and broke down. Still the
+doctor said that if I liked my work, I should go back to it and
+pitch in. I did. It lasted a few days and then I had to give up
+altogether, couldn't grind out another word. Then to another
+doctor&mdash;&mdash;also the best in the city. He told me to give up all
+work, which I did, and then I went on a farm for six months. That
+did not help me either. Later I went west and spent some time in
+the mountains. I felt no better there. Then I went to Arizona and
+lived in a tent out on the desert; that did not help me. There was
+always a sensation of exhaustion and any physical exertion put me
+on my back, even when it was light and pleasant exercise. Then I
+went to California; it did me little good. It is a perfect paradise
+for anyone who has not got neurasthenia. I still have not got
+myself in<span class='pagenum'><a name="Page_294" id="Page_294">[Pg 294]</a></span> hand. I cannot do or say or write just what I wish, and
+cannot concentrate my thoughts. To try to read a book is punishment
+because I forget as fast as I read." And so on.</p>
+
+<p>I answered him certainly not to come but tried to induce some
+autosuggestions. A few weeks later, he wrote me: "Ever since you
+wrote me, I am now feeling somewhat improved." Yet I cannot judge
+how far the improvement belonged to the psychical factor only,
+inasmuch as I had advised him also to take some bromides. The
+really effective treatment would have been heterosuggestion and I
+had no time to enter into the case.</p></div>
+
+<p>Where direct suggestion is used, the effect is often surprising.</p>
+
+<div class="blockquot"><p>A young lawyer after a period of overwork had come to a state of
+complete lack of energy. He could not find strength to write a
+letter and he came to me at a day when he did not see any way but
+suicide open for himself. He complained that, as soon as he began
+to grasp a thought, it was evaporating. He stared absently about
+the room and felt sure that he would never again achieve anything.
+He had not even the energy to read the newspaper. I hypnotized him
+three times, each time waking in him the pleasure in a definite
+piece of work, at first simply in a novel which he was to read,
+then in some letters which he was to write, and then in his
+professional work. There was always an interval of three days. The
+fourth time he declared himself that the hypnotic influence was
+unnecessary, as he felt that he was again in the midst of his work.</p></div>
+
+<p>As a rule the effect is a much slower one, but if all personal factors
+are well considered and especially physical disturbances are excluded,
+the result is usually satisfactory.</p>
+
+<p><span class='pagenum'><a name="Page_295" id="Page_295">[Pg 295]</a></span>Very different from such neurasthenics, of course, is the lack of
+attention in the feeble-minded, and suggestion of the ordinary type is
+hardly advisable, but it is surprising how much can be reached by a
+systematic psychical r&eacute;gime. I give one typical instance, representative
+of many.</p>
+
+<div class="blockquot"><p>A boy of twelve years when he was brought to me showed the mental
+powers of a stupid child of four. In a silly way he repeated every
+question which he heard without answering it; he talked steadily to
+himself in a nonsensical manner, mostly repeating nursery rhymes
+without end, never holding his attention to anything in the room,
+giving the impression that there was no attention whatever. The boy
+was a child of rich parents; he had his own teachers, but was for a
+large part of the year under the influence of the parents only, who
+very naturally yielded to every desire of the unfortunate child. I
+insisted on a complete change of the education. It was my effort to
+build up the mind by a rigorous training and by development of the
+power of inhibition. I absolutely forbade any meaningless material
+like the nursery rhymes, insisted that the child should never be
+allowed to talk to himself, and whenever he began to speak to
+himself he was to be addressed sharply, and if he yet went on, to
+be slapped on his hands. In the same way he was not allowed to
+repeat a question, but the question was repeated until he answered
+it, the question always formulated in simple words. He was forced
+to go through simple reading and writing without being allowed to
+make his silly diversions. His whole life was brought under strict
+discipline and no parental indulgence was permitted. Six months
+later the child was completely changed. It seemed as if he had gone
+through an improvement of three years. I<span class='pagenum'><a name="Page_296" id="Page_296">[Pg 296]</a></span> regulated the whole of
+his elementary studies in accordance with the successful principle.
+The training of inhibition stood in the foreground and every
+haphazard reaction was severely rebuked. The summer vacations spent
+with the parents in the fashionable surroundings, to be sure, had
+always a retarding influence, but the main part of the year in
+which it was possible to carry through the strict discipline showed
+such steady and inspiring progress that the boy, while of course
+feeble-minded for life, can yet live externally a harmonious life.</p></div>
+
+<p>A systematic training of the power of inhibition is indeed the
+fundamental factor in all psychotherapeutic treatment when the
+disturbance is in the volitional sphere, but the inhibition is secured
+most safely by re&euml;nforcement of the antagonistic attitude. From these
+volitional variations on the one side, from the ideational disturbances
+on the other, only a few steps lead to those dissociations of the
+personality which are characteristic of many graver cases of hysteria.
+But to give to them any adequate analysis, it would be insufficient to
+refer in this brief way to particular cases. Psychopathological
+literature possesses some excellent analyses of such complex
+disturbances. As I said before, I abstain entirely here from such
+complex phenomena, as they enter too seldom into the sphere of the
+practitioner and as the bewildering manifoldness of their symptoms does
+not allow us so easily to recognize the fundamental principles which
+alone were to be illustrated by our short survey of practical cases.<span class='pagenum'><a name="Page_297" id="Page_297">[Pg 297]</a></span></p>
+
+
+
+
+<hr class="section" />
+
+<h2><a name="XI" id="XI"></a>XI<br /><br />
+<span class="sub">THE BODILY SYMPTOMS</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>The discussion of the bodily symptoms which may yield to
+psychotherapeutic treatment, naturally forms only a short appendix to
+our discussion of the mental symptoms. Our interest was from the
+beginning essentially a psychological one. I shall have to be the more
+brief as my personal experience in the treatment of bodily diseases
+through mental therapy is entirely secondary and accidental. The
+psychological laboratory would, of course, be an entirely unfit place to
+struggle with diseases of which the chief symptoms are not
+psychophysical. Yet in spite of frequent testimonies of well-known
+physicians to the contrary, I am still inclined to think that this is
+also the situation at large. I think that in medicine in general the
+psychophysical effect of mental treatment is by far more important and
+by far more extended than the healing effect on diseased peripheral
+organs. Of course these peripheral parts of the body may be favorably
+influenced in an indirect way by the mental treatment; we shall have to
+take notice of this important result but that is strictly not a
+therapeutic effect on the bodily symptoms. Moreover, purely<span class='pagenum'><a name="Page_298" id="Page_298">[Pg 298]</a></span> psychical
+effects may give an impression as if the bodily symptom itself has been
+removed.</p>
+
+<p>To begin with the latter case, it is especially the inhibition of pain
+which easily makes one believe that a bodily disturbance is successfully
+treated. I have repeatedly seen cases in which I tried by suggestion to
+soften the pain resulting from a peripheral disturbance like
+inflammations, rheumatism, decayed teeth and so on. The effect was often
+such a total disappearance of the pain that the patient himself was
+inclined to believe that the objective disease had been ended, while in
+reality the state of the diseased organ was not changed at all. It has
+often happened that I tried to cure a person of certain mental symptoms
+by suggestion, ignoring entirely the existence of some pain resulting
+from a bodily disease with which I had nothing to do. Yet the suggestion
+of improvement seemed almost to irradiate and the pain disappeared in
+spite of having been ignored by the hypnotizer. For instance, I treated
+a woman who suffered from psychasthenic obsessions, fearing all the time
+that something would happen to her child. I did not give any direct
+attention to the fact that she had had for years a painful disease of
+the bladder for which she was constantly treated by a specialist. But
+while I did not mention the bladder in my hypnotic suggestion, yet the
+abdominal pain disappeared together with the obsession and the situation
+might easily have suggested that the bladder trouble was a nervous one
+which had been cured by the hypnotic sleep. The fact was that the
+bladder disease was<span class='pagenum'><a name="Page_299" id="Page_299">[Pg 299]</a></span> not influenced by the mental treatment at all, and
+needed a continuation of the same local treatment. It was only the
+psychophysical pain in the brain which had been inhibited.</p>
+
+<p>Quite parallel to the disappearance of the organic pain sensation is the
+arising of a general feeling of improvement. This organic sensation of
+general betterment may again be a strictly mental occurrence without any
+objective reference to a real improvement in the bodily conditions. Yet
+again that easily gives the impression of an important change in the
+bodily conditions themselves. The miraculous cures of various diseases
+through mystic agencies generally belong to this category. There is no
+doubt that often the migrating charlatans who advertise themselves by a
+free treatment of the sick and invalids on the theater stage of small
+towns, produce momentary effects which are sufficient to deceive. The
+quack handles the diseased organ, perhaps a goiter or a leg crippled by
+rheumatism, with a cruel rudeness and overwhelms the suggestible mind so
+completely that the first autosuggestion is that of a complete change,
+and that means cure. The disastrous results follow later. But from such
+barbarisms we come by gradual steps to the suggestion of improvement
+where the feeling of betterment can be in itself an important factor for
+the cure. Yet even there we must not mistake the possible secondary
+effect of a mental change from a psychotherapeutic cure of the bodily
+disease.</p>
+
+<p>Not seldom the removal of physical disability<span class='pagenum'><a name="Page_300" id="Page_300">[Pg 300]</a></span> seems secured as soon as
+certain mental disturbances are removed. There is no reason to believe
+for instance that suggestion can have an important influence on a
+diseased sense organ, and yet hypnotic influence and even autosuggestive
+influence can under certain circumstances greatly improve seeing and
+hearing. Especially in the field of hearing the central factor is of
+enormous importance. Hyper&aelig;mic and an&aelig;mic conditions in the brain
+centers of hearing control the vividness of the received sound. The
+patient who cannot hear a certain watch more than one foot distant may
+be able to hear it after some glasses of wine at a distance of three or
+four feet. Thus it is only natural that a hypnotic influence can produce
+similar changes on the psychophysical centers in such cases in which the
+source of the trouble is a psychophysical laziness in the acoustical
+center. Sometimes even this laziness itself is the result of psychical
+autosuggestion which can be fought by counter-suggestion. I saw, for
+instance, a distinct improvement in hearing in the case of a young woman
+who had increasing deafness while the aurists declared that the ears
+were in proper condition. I found that she lived with a father who
+suffered from a severe middle-ear catarrh and that she was simply
+controlled by a hidden fear that she might have inherited the ear
+disease of her father. I removed this fear, partly by reasoning, partly
+by suggestion, and partly by tricks which surprised her, for instance,
+making her hear her watch with unaccustomed strength when she took it
+between her teeth and<span class='pagenum'><a name="Page_301" id="Page_301">[Pg 301]</a></span> closed both ears. The autosuggestive fear was
+uprooted by these and the central ear organs slowly came to normal
+functioning.</p>
+
+<p>The purely psychical character is still more evident in the frequent
+hysterical an&aelig;sthesias. No one doubts that here the sensations are
+inhibited only and that the mental influence removes this inhibition
+without any influence on the sense organs proper. Frequently also
+organic troubles like stomach diseases appear cured when in reality
+hysterical disturbances are at the bottom. The stomach may be sensitive
+to any pressure and may produce severe pains and vomiting on taking any
+food and everything may indicate a serious local disturbance. Yet
+hypnotic treatment may quickly remove the symptoms because the whole
+reaction may have resulted from the shock which perhaps a too hot piece
+of potato caused. The removal of this mental starting point results in a
+cure of the apparent stomach disease. Again in other cases, the
+appearance of a physical cure is given by the creation of psychophysical
+substitutes. I do not believe that hypnotism or suggestive treatment can
+influence the brain parts which have suffered from a hemorrhage. Yet the
+paralysis of the arm, for instance, which resulted from such a breaking
+of a blood-vessel in the brain may be to a high degree repaired by
+building up new motor images in the psychophysical system, which become
+starting points for a new learning of movements. The patient did not
+understand how to make the most out of those motor paths which had been
+left. The destruction<span class='pagenum'><a name="Page_302" id="Page_302">[Pg 302]</a></span> of the chief channels of discharge had inhibited
+in his mind the idea of possible movement. He no longer believes that he
+can move and it needs new suggestions to overcome this inhibition. The
+curative effect on bodily disabilities is thus often an illusory one.</p>
+
+<p>That does not mean that the field in which psychotherapeutics may work
+directly on the body is not after all a large and interesting one.
+Theoretically it is still little open to real understanding. The
+explanation has essentially to rest on the acceptance of a given
+physiological apparatus. A certain psychophysical excitement produces by
+existing nerve connections a certain effect, for instance, on the
+blood-vessels or on the glands of a certain region, or on a certain
+lower nervous center. That such apparatus exists, the physiological
+experiment with persons who are hypnotized to a high degree can easily
+demonstrate. Their nose bleeds at a command; a blister may arise on a
+part of the skin which is simply covered with a penny, when the
+suggestion is given that the penny is glowing hot. With some subjects,
+the pulse can become slower and quicker in accordance with the
+suggestion; with some even the bodily temperature can change on order.
+Our understanding of these indubitable facts indeed does not go further
+than the acknowledgment that the paths for such central connections
+exist. That means we simply describe the facts once more in the terms of
+anatomy. But after all in the same way we rely on the nervous
+connections, if a thought makes us blush and ulti<span class='pagenum'><a name="Page_303" id="Page_303">[Pg 303]</a></span>mately if our will
+moves our arm or if our ideas move our speech apparatus. We do not
+choose the muscles of our arm, we hardly know them; we know still less
+in speaking, of the movements of our vocal cords, and in blushing of the
+dilated blood-vessels. That ideas work on the lower centers of our
+central nervous system, centers which regulate the actions of our
+muscles and blood-vessels and glands, must simply be accepted as the
+machinery of our physiological theory. The connection of such theories
+with purely physical facts is given by the experience that an electrical
+stimulation of the nerve may have the same influence as ideas. The
+electric current, too, can regulate the beat of the heart, or contract
+and dilate the vessels, or re&euml;nforce and relax the contraction of the
+muscles, or strengthen and weaken the functions of the glands.</p>
+
+<p>Nearest to the psychophysical processes stands the bodily symptom of
+insomnia. There is no doubt possible that the work of the
+psychotherapist can be very beneficial in producing sleep by suggestion.
+That autosuggestions for sleep play an important r&ocirc;le is popularly
+accepted. Next to the most immediate means such as lying down, or
+cutting off sense stimuli, or trying not to think, or avoiding
+movements, certainly the most well known factor is the expectation of
+sleep with the belief that sleep will come. This belief may be
+re&euml;nforced to strong autosuggestion which may then overcome other
+factors that hinder sleep. For instance, I have repeatedly received
+letters from strangers containing<span class='pagenum'><a name="Page_304" id="Page_304">[Pg 304]</a></span> expressions of gratitude with news
+which under other circumstances would at least not flatter an author.
+They wrote to me that immediately after reading one or another essay of
+mine on hypnotism, they fell into deep sleep. Yet as they were always
+patients who had suffered from insomnia, I was pleased with this
+unintended effect of my writings. But in most cases a real cure demands
+heterosuggestion.</p>
+
+<p>There is room for any variety of effects; often they enter immediately.
+The other day I gave sleep suggestion to a young woman who had
+overworked herself in literary production. For months she had not slept
+more than three or four hours a night and even that only after taking
+narcotics. I intentionally did not allow her to come into a hypnotic
+sleep but kept her fully awake, increasing her suggestibility while her
+eyes were wide open. I suggested to her to take a walk, then to eat her
+dinner, and after that to go to bed at once. She went to bed at seven
+o'clock and slept without waking until ten o'clock the next morning, and
+after fifteen hours' sleep she was like a different being. A regular
+eight hour sleep is sometimes secured, even where no immediate direction
+has been given for it. On the other hand, I cannot deny that I have
+sometimes been entirely unsuccessful in securing better sleep by the
+first three hypnotic treatments. When the first three treatments were
+unsuccessful, I always gave it up on account of lack of time. Yet the
+experience of others shows that in such cases, often after a long
+continued hypnotic treatment insomnia yields to suggestion.<span class='pagenum'><a name="Page_305" id="Page_305">[Pg 305]</a></span> One of the
+great factors which work against the mental treatment is the habit of so
+many sufferers of relying on their sleeping powders which, to be sure,
+remain effective only by increasing the dose and thus finally by making
+them dangerous. Every chemical narcotic has in itself suggestive power
+and strengthens the belief of the sleep-seeker that he cannot find rest
+without his dose. To overcome the monopoly of the opiates is one of the
+most important functions of psychotherapy.</p>
+
+<p>It is not surprising that the relations of psychotherapy to sleep show
+such a great variety. The factors which co&ouml;perate in normal sleep are
+many and the disturbance can have very different character. We had to
+speak of the psychophysics of sleep when we discussed the theoretical
+relation of sleep to hypnotism and insisted that it is misleading to
+consider hypnosis simply as partial sleep. We claimed a fundamental
+difference between the selective inhibition in hypnotism and the general
+reduction of functions in sleep. To understand sleep, we have to
+recognize it as one of the fundamental instincts, comparable with the
+instinct for food or for sexual satisfaction. Every one of such
+instincts has a circular character. Mental processes, subcortical
+processes, and physical effects are involved in such a way that each
+re&euml;nforces the others. The physical effect of the sleep instinct,
+comparable with the pepsin secretion in the food instinct, or with the
+hyper&aelig;mia of the sexual organs in the sexual instinct, is a change in
+the cortex by which the sensory and motor brain centers<span class='pagenum'><a name="Page_306" id="Page_306">[Pg 306]</a></span> are put out of
+action. What kind of a change that is, is quite indifferent. It may be a
+chemical one but more probably it is a circulatory one. Let us say it is
+a contraction of blood-vessels which by the resulting an&aelig;mia makes the
+sensory centers unfit for perception and the motor centers unfit for
+action. In this way the brain becomes protected by sleep against the
+demands of the surroundings. The mental reactions are eliminated and the
+central nervous substance has an opportunity to build itself up. This
+protective physical activity is now evidently itself controlled by a
+subcortical center, just as secretion and sexual hyper&aelig;mia are
+controlled. This center probably lies in the medulla oblongata.</p>
+
+<p>Some theorists, to be sure, are inclined to think that the fatigued
+brain cells enter directly through their exhaustion into the protective
+sleep state. But that simplifies the situation too much. It is quite
+true, as these theorists claim, that monotonous stimulation of the
+senses produces sleep. But it is evident that the sleep occurs even then
+not only in the particular overtired brain cells. A monotonous
+stimulation of the acoustical center raises the threshold of perception
+for all the senses and brings sleep to the whole brain. This control of
+the whole apparatus is thus surely regulated by one definite center. But
+this lower center, which controls the an&aelig;mia of the cortex, is itself
+directly dependent again upon a mental condition, the mental experience
+of fatigue. The fatigue sensation, which is possibly the result of toxic
+processes, works on that lower sleep center, just as<span class='pagenum'><a name="Page_307" id="Page_307">[Pg 307]</a></span> the appetizing
+impression or the sensual images work on the centers of the other two
+instincts. On the other hand this protective blood-vessel contraction
+creates again as in the other cases a characteristic organic sensation,
+the sensation of rest which arises when the threshold of perception and
+activity is raised. The world begins to appear dim and far away, no
+impulse for action excites us. This organic feeling of rest associates
+itself with the fatigue feeling. The fatigue sensation, the subcortical
+sleep center, the contraction of the vessels in the cortex, and finally
+the rest sensation form together the complete circle. The difficulty
+which arises in this case lies only in the fact that the cortex gone to
+sleep annihilates also, of course, the fatigue sensation and the rest
+sensation. For that reason the real circle can appear only in the
+preparatory stages of sleep. As soon as sleep itself sets in, the circle
+is broken. The circle character of every instinct must lead the physical
+effect upward to a higher and higher degree. Not to become excessive,
+the physical effect must be checked somehow. In all other spheres, it
+finds its end in satisfaction, for instance, by eating or by the sexual
+act. In sleep the circular process ends automatically by its own effect
+as soon as complete sleep is reached. Its causes, the fatigue and the
+rest feeling, are stopped, as soon as the effect, the an&aelig;mia, is
+secured.</p>
+
+<p>We see now how widely different starting points can lead to sleep and
+can understand from it how widely different disturbances can prevent
+sleep.<span class='pagenum'><a name="Page_308" id="Page_308">[Pg 308]</a></span> Sleep must result when fatigue is coming, but sleep must also
+result when the elements of the rest feeling are produced, and as we saw
+that the components of the rest feeling were the sensations of decreased
+sensitiveness and decreased activity, sleep must result when either the
+sensations and associations are absent and actions are suppressed, or
+when monotonous sensations and automatic actions raise the threshold.
+Sleep must arise further if our will associates the mere idea of such
+rest, and finally physical or chemical means may produce a sleep
+bringing effect either on the lower center or on the blood-vessels and
+cells of the cortex. Correspondingly sleep may be prevented by
+disturbances in any one of these spheres. There may be no normal
+fatigue, there may be no fatigue sensation, there may be no rest feeling
+on account of perceptions, or on account of associations, or on account
+of impulses to action; there may be no normal response in the
+subcortical center, there may be no physical effect in the cortex on
+account of an existing hyper&aelig;mia or on account of an abnormal condition
+of the cells. The psychotherapeutic treatment must carefully analyze
+which element would be fit to supply the last link in the circular
+chain. Sometimes we need the suggestion of fatigue, sometimes the
+inhibition of ideas, sometimes the suppression of impulses, sometimes
+the suggestion of rest, and so on. A mere general suggestion of sleep is
+on the whole effective only in the cases of those persons in whom this
+idea in itself awakens those various components. Very often it<span class='pagenum'><a name="Page_309" id="Page_309">[Pg 309]</a></span> is
+entirely ineffective in this general form. Sometimes it is possible to
+carry the hypnotic state itself directly over into sleep, but it seems
+more in the interest of the patient to separate those two states
+distinctly.</p>
+
+<p>We are still confined to processes in the brain itself if we turn to
+headache. If it were only a question of inhibiting the pain by mental
+suggestion, the case would not be different from inhibiting the pain of
+a peripheral organ without attempting to cure the diseased organ itself.
+But in the case of headaches, it seems justified to claim that in
+certain varieties of this multifold symptom, not only the pain is
+suppressed but the disturbance itself is removed. Especially where the
+headache seems to result from hyper&aelig;mia, the trouble seems to be
+accessible to psychotherapeutics. On the other hand I have never seen
+any lasting effect on the so-called sick headache or migraine. While
+continuous headaches or headaches which occur daily yielded to my
+influence, sometimes completely, I was unable to prevent even by
+preparatory hypnotization any migraine which appears periodically, for
+instance, simultaneously with menstruation.</p>
+
+<p>A few words only as to the general diseases and disturbances for which a
+very strong therapeutic effect has been claimed by masters of the craft
+like Wetterstrand, Moll, Dubois, and others. From my own experience I
+can affirm the often lasting effect in the disturbances of the functions
+of the digestive apparatus. The stomach and the intestines seem to a<span class='pagenum'><a name="Page_310" id="Page_310">[Pg 310]</a></span>
+high degree under nervous influences which can be changed through
+hypnotic suggestion. If we consider what intimate connection exists
+between the functions of these organs and the normal emotions, it seems
+hardly surprising that mental factors can regulate their disturbances.
+Vomiting, diarrhea, and especially constipation, often yield to slight
+suggestions, even in a superficial hypnotic state. Here, too, I have
+seen repeatedly a complete regulation of a long-standing disturbance as
+an unintended by-product of hypnotic suggestion directed towards the
+cure of psychical troubles. Much value is claimed for hypnotic method in
+the treatment of an&aelig;mic conditions. It is said that an&aelig;mia improves
+after a few hypnotic treatments, the appetite becomes better, the cold
+hands and feet grow warmer, the headaches disappear, the capacity for
+work increases rapidly, and most surprising of all the leucorrhea
+ceases. As to heart disease, we ought to think in the first place of the
+disturbances of nervous innervation. I have seen repeatedly a remarkable
+decrease of nervous palpitation of the heart through direct mental
+influence, abstracting here from the secondary effect of suppressing
+mental excitement and fear. Where organic heart diseases are surely
+present, it seems that hypnotism can sometimes act beneficially if the
+heart trouble is accompanied by an&aelig;mia and general debility; of course a
+developed valvular disease cannot be removed. In the same way it seems
+that in Bright's disease, certain painful symptoms may be suppressed,
+but the kidneys certainly cannot be influenced. At<span class='pagenum'><a name="Page_311" id="Page_311">[Pg 311]</a></span> least open to
+serious suspicion are the insistent claims that diabetes can be cured by
+suggestion. Dr. Quackenbos of New York, for instance, gives to some of
+his diabetes patients a hypnotic suggestion by the following words: "If
+your pancreas be crippled in its production of the natural ferment which
+is given off to blood and lymph and which conditions the normal
+condition of sugar in the body or restrains the output of sugar from the
+liver tissues, you will see that it forthwith pours into your blood or
+lymph the sufficient quantity of sugar oxidizing ferments." It certainly
+transcends our present understanding if we are to believe that a
+suggestion of this type will change the action of the pancreas. It is
+hardly worth while to enter into the still more extravagant claims from
+other sides like those for curing cancer and phthisis. On the other
+hand, in the light of all that we have discussed, there is no difficulty
+in understanding the easily observable influence in the regulation of
+menstruation, in the cure of contractions, local congestions, and
+incontinency of urine. I may mention finally the use of hypnotism for
+helping in a safe and quick confinement.</p>
+
+<p>But in addition to all this, we have the great help which psychotherapy
+may bring indirectly in the treatment of physical diseases. I said, for
+instance, that I do not believe in a real help by mere suggestion in
+cases of diabetes. But no one ought to underestimate the value which may
+result for the treatment from a suggestion of a well-adapted diet. The
+patient who feels a craving for bread and potatoes and<span class='pagenum'><a name="Page_312" id="Page_312">[Pg 312]</a></span> perhaps sweets,
+and is too weak to resist it, is indeed brought into safety if
+suggestion liberates him from such desires. The same holds true for
+every other diet and for any medical r&eacute;gime of life which does not
+harmonize with the natural instincts of the patient. For not a few
+sufferers, re&euml;nforcement of the interdict against coffee and tea or
+alcohol and tobacco is more important than any medicine. Hypnotic
+suggestion can easily create dislike of the prohibited material and can
+build up new desires and inclinations. In the same way it is indirectly
+most important to stir up, for instance, the sensations and feelings of
+appetite and thus to make normal nutrition possible. Also in cases of
+an&aelig;mia or tuberculosis, such indirect assistance can produce some
+beneficial consequences.</p>
+
+<p>The same holds true of the power of the psychotherapist to secure sleep.
+The fight against insomnia which we discussed referred only to that
+sleeplessness which is itself an expression of the disease. But as a
+matter of course, the loss of sleep can accompany most different
+diseases, as an almost accidental result. To secure sleep means then not
+to treat the symptoms of the disease but a by-product; and yet every
+physician knows how much is gained if the lost energies are restituted
+by a sound sleep. And finally we have the indirect help towards the cure
+by the suggestive removal of pain. We have no right to say that it is a
+pure advantage for the treatment of the disease if the pain is centrally
+inhibited. Pain surely has its<span class='pagenum'><a name="Page_313" id="Page_313">[Pg 313]</a></span> great biological significance and is in
+itself to a certain degree helpful towards the cure, inasmuch as it
+indicates clearly the seat and character of the trouble and warns
+against the misuse of the damaged organ which needs rest and protection.
+To annihilate pain may mean to remove the warning signal and thus to
+increase the chance for an injury. If we had no pain, our body would be
+much more rapidly destroyed in the struggle for existence. But that does
+not contradict the other fact that pain is exhausting and that the fight
+against the pain decreases the resistance of the organism. As soon as
+the disease is well recognized through the medium of pain and the
+correct treatment is inaugurated, not only the subjective comfort of the
+patient but the objective interest of his cure makes a removal of pain
+most desirable. While it would be absurd to say that hypnotism can cure
+tuberculosis or cancer, it is fully justifiable to say that hypnotic
+treatment in tuberculosis or cancer is to a high degree beneficial,
+inasmuch as it can secure sleep, appetite, and freedom from pain, three
+factors which indirectly help to fight the disease. The elimination of
+pain may sometimes also play its r&ocirc;le in slight operations where other
+methods of narcosis seem for any reason undesirable, and very frequently
+hypnotic suggestion has been used for this purpose at childbirth.</p>
+
+<p>The same importance which belongs to the removal of bodily pain in the
+treatment of a peripheral disease may be given to its mental
+counterpart, to the<span class='pagenum'><a name="Page_314" id="Page_314">[Pg 314]</a></span> worry, excitement, and emotional shock. They all
+stand in the way of a real success in any cure. Even the chances of a
+dangerous operation are entirely different for the patient who goes to
+it with free mind and a happy mood, with full confidence in its success,
+from those of a patient who has worked himself into a state of fear and
+anxiety. Here again the depression and the excitement are not in
+question as symptoms of a disease, as they were when we discussed the
+phobias and despondencies of the neurasthenic and of the hysteric. They
+are merely normal side-effects of the bodily disease, accentuated
+perhaps by a suggestible temperament. To eliminate all these emotions
+means to change most helpfully the whole atmosphere of the sick-room and
+to deprive invalidism of its saddest feature. This negative factor
+corresponds of course most directly to the positive feature of building
+up new hope and joyful expectation. He who creates confidence makes
+convalescence rapid and strengthens the power to overcome disease.</p>
+
+<p>It would be medical narrowness if the physician were strictly to deny
+that the effect of such emotional change may sometimes lead far beyond
+the ordinary suggestive influences and that in this sense the miraculous
+really happens. When out of a despondent mood in a suggestible brain an
+absorbing emotion of confidence breaks through, a completely new
+equilibrium of the psychophysical system may indeed result. In such
+cases, improvements may set in which no sober physician can determine
+beforehand.<span class='pagenum'><a name="Page_315" id="Page_315">[Pg 315]</a></span> Central inhibitions which may have interfered a life long
+with the normal functioning of the organism may suddenly be broken down
+and in an entirely unexpected way the mental influence gives to the
+forces of the body a new chance to help themselves. The reasoning of the
+scientific physician may easily stand in the way there. He may be afraid
+of such overstrong emotion because he knows too well that such
+unregulated powers may just as well destroy the good as in another case
+the bad; in short, that ruin may result just as well as health. But that
+does not exclude the fact that indeed almost mysterious cures can be
+made without really contradicting the scientific theories. Such are the
+means by which the mystical cults earn their laurels. A chance letter of
+the type which often swells the mail of the psychologist may illustrate
+this effect. I choose it because it is evidently written by a skeptic. A
+short quotation from the lengthy epistle is sufficient.</p>
+
+<p>"My condition was horrible in the extreme. I had consumption of the
+lungs and other supposedly fatal troubles, complicated by wrecked
+nerves. At the present writing, I am robust and splendidly healthy,
+looking twenty years younger than I did at the period previously
+described. The Christian Scientist saw my condition but appeared
+unconcerned and unafraid, I being absolutely hopeless, skeptical, and
+deeply contemptuous meanwhile. On the third day of her treatment I was
+desperate for sleep, she having forbidden drugs, and I deliberately took
+an overdose of chloral, thinking to die at once and end<span class='pagenum'><a name="Page_316" id="Page_316">[Pg 316]</a></span> it. My
+condition justified the act. She brought me out of the coma of the
+chloral after three hours of mental work, and the next day I felt
+decidedly calmer and less afraid of the coming of night, should I live
+to meet it, which seemed doubtful. At noon she left me to go to her home
+to lunch. I was pondering seriously on her reiterated 'God is love and
+fills the universe and there is nothing beside Him,' when I suddenly had
+a sensation of being lifted up or rising slowly and becoming lighter in
+body. A rush of power that I have no way of describing to you filled me.
+I seemed to be a tremendous dynamo in the air several inches above the
+ground and still ascending. When I noticed everything around me becoming
+prismatic and more or less translucent, I could have walked on water
+without sinking, and I had distinct understanding that matters seemed to
+be disintegrating and dissolving around me. I was frightened but
+self-conscious and quiet. I remained in this state for about three
+hours, my consciousness seeming to have reached almost cosmic greatness.
+I could have cured, I felt, any human ill, was filled with an absorbing
+altruistic desire to help suffering. It was tremendous and totally
+foreign to my everyday attitude. At the end of the day, towards
+twilight, I became wearied of the tremendous throbbing and exalted state
+in which I still remained and gave utterance to the thought aloud.
+Almost before I had formulated it the condition left me, and like the
+sudden dropping of a weight, I struck the ground, the same dull,
+ordinary person of everyday experience, but<span class='pagenum'><a name="Page_317" id="Page_317">[Pg 317]</a></span> with the vast difference of
+perfect health, radiant and lasting to the present writing. My father
+like myself is baffled and wondering. We are both pretty hard skeptics.
+I want the truth, whether it be terrible or otherwise. I am profoundly
+grateful to the Christian Scientist, if I regained my health through her
+ministrations, but I have not so far been able to label myself and rise
+in their church services to tell what has been done on me. The
+performance repels me as crude and rather bad taste. I swear to you on
+my honor as an American woman and a mother that what I have written you
+is true, absolutely. If you can give me any light or if my experience
+may perchance give you a helping ray, my renewed lease on life may have
+had some purpose after all, which I have often questioned in my cynical
+moods."</p>
+
+<p>The unprejudiced psychotherapist will be perfectly able to find room for
+such cures and, if it is the duty of the scientific physician to make
+use of every natural energy in the interest of the patient's health, he
+has no right to neglect the overwhelming powers of the apparently
+mysterious states. Some of this power ought to irradiate from his eye
+and his voice whenever he crosses the threshold of a sick-room. Some of
+that power ought to emanate from him with every pill and drug which he
+prescribes. The psychotherapeutic energies which work for real health
+outside of the medical profession form a stream of vast power, but
+without solid bed and without dam. That stream when it overfloods will
+devastate its borders and destroy its bridges. The physicians are the
+engi<span class='pagenum'><a name="Page_318" id="Page_318">[Pg 318]</a></span>neers whose duty it is to direct that stream into safe channels, to
+distribute it so that it may work under control wherever it is needed,
+and to take care that its powerful energy is not lost for suffering
+mankind.<span class='pagenum'><a name="Page_319" id="Page_319">[Pg 319]</a></span></p>
+
+
+
+<hr class="section" />
+<h2><br /><br /><a name="PART_III" id="PART_III"></a>PART III</h2>
+
+<h3>THE PLACE OF PSYCHOTHERAPY<br /><br /></h3>
+
+
+
+<hr class="section" />
+
+<h2><a name="XII" id="XII"></a>XII<br /><br />
+<span class="sub">PSYCHOTHERAPY AND THE CHURCH</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+
+<p>The belief in supernatural energies has cured diseases at all times and
+among all peoples. Everywhere the patient sought help through the agents
+of higher forces and everywhere these agents themselves utilized their
+therapeutic success for strengthening the belief in their over-natural
+power. The psychologist would say that it was always the same story, the
+influence of suggestion on the imagination of those who suffer. Yet the
+variety of forms is abundant. Not only the special symbols but the whole
+attitude may take most varied character, and every special appearance is
+intimately related to the whole mystical background and to the
+religious, scientific, and social ideas of the time. If nevertheless,
+even at the same time in the same country, very different forms of
+religious suggestion are at work, it must not be forgotten that those
+who live together in any nation and are united in many common pur<span class='pagenum'><a name="Page_320" id="Page_320">[Pg 320]</a></span>poses
+represent, after all, different stages in the development of
+civilization. It has always been true that those whose minds are
+saturated with the real culture of their time are working together with
+those whose culture belongs to earlier centuries and with others whose
+minds are essentially of the type of the primitive peoples.</p>
+
+<p>Let us glance at the life of the savages. In darkest Africa, we find a
+special caste with its professional secrets which accepts new members
+only after long tests. They are evidently persons with over-sensitive
+nervous systems and liable to hallucinations. As soon as they have their
+attacks of abnormal excitement, they are conceived to be agents of
+superhuman powers, and on account of this they are able to prescribe the
+cure of any diseases. In Australia, therapeutic power belongs to the
+koonkie, a man who as a child had a vision of a demonic god. From him he
+received the power to heal the sick. He goes to the patient, touches the
+painful parts and rubs them and after a few minutes, he shows a little
+piece of wood which he had hidden in his hand and which he claims to
+have extracted from the body of the sufferer. The native feels actually
+cured after such manipulation of the koonkie, who evidently believes
+himself in his power. In Siberia, we find shamanism. The shaman stands
+between man and the gods. These shamans are excitable persons with
+epileptic tendencies, or at least over-suggestible men or women who by
+autosuggestion and imitation can bring themselves into ecstatic
+convulsions. They alone know<span class='pagenum'><a name="Page_321" id="Page_321">[Pg 321]</a></span> from the gods the means to treat diseases
+and their personal influence overcomes the ailment. In early America,
+before the European discovery, the cure of disease belonged in the same
+way to the middleman between the gods and human beings. In the Antilles,
+for instance, the bohuti heals the diseases which are regarded as
+punishments of the gods for human neglect. The priest by inhaling a
+certain powder brings himself into an ecstatic condition, then presses
+the painful organs of the patient, sucks at various parts of his body
+until he finally produces some little bone or piece of meat which until
+then he kept hidden in his mouth. The disease disappears, and the
+extracted bone is used as an amulet which secures good harvests. Other
+Indians had their piachas. They were selected from among the boys of
+about ten years old and were then sent to lonely forests where they had
+to live for years upon plants and water without any friends, seeing only
+at night the older priests from whom they learned the ceremonies for
+curing the sick. Here too their art consisted mostly in touching the
+painful parts of the body with the lips and sucking them to bring the
+evil saps out of the body by their supernatural power. In short, at the
+most primitive stages in Africa and Asia, in America and Australia,
+therapy was acknowledged to be a special power of men who had superhuman
+forces derived from good or evil gods.</p>
+
+<p>All this repeats itself in the so-called half-civilizations. Among the
+masses of China, mental and bodily diseases were ascribed to the fox,
+which plays<span class='pagenum'><a name="Page_322" id="Page_322">[Pg 322]</a></span> such a large part in the superstitions of eastern Asia. The
+priest has the power to banish the fox by mystical writings which he
+pastes on the wall of the sick-room, and the patient recovers, as the
+fox has to leave his body. In old Japan the mountain monks, who
+inherited their superhuman powers from a martyr of the fifth century,
+can remove the diseases which have magical origin or which are induced
+by the devil. They also supply the magical papers covered with writings
+and pictures of birds, to prevent the appearance of smallpox and
+pestilence and to cure a number of diseases. India, the classical land
+of suggestion and hypnosis, shows the most extensive connection between
+religious and magical powers among which the cure of diseases is only
+one feature. Such cure may be with medicaments or without, but the
+essential part always belongs to the prayers which make the good and
+evil spirits obedient to the healer. These prayers were often spoken in
+Sanscrit, which the people did not understand and which thus added to
+the mystic solemnity of the procedure. This suggestive influence of the
+use of older languages for religious solemnities, known only to the
+priests, repeats itself also at all times and among all nations. In
+Assyria and Babylonia, too, medicine was exclusively a branch of
+mysticism and essentially in the hands of the priests, who by words and
+magical beverages annihilated the influence of the malevolent demons. It
+is well known how the Old Testament reports the same traits of belief
+among the Jewish nation. We hear there that Miriam became leprous,<span class='pagenum'><a name="Page_323" id="Page_323">[Pg 323]</a></span>
+white as snow, and Moses cried unto the Lord, saying: "Heal her now, oh
+God, I beseech thee." And after seven days Miriam was cured in
+consequence of Moses' prayer. And again, "The Lord sent fiery serpents
+among the people and they bit the people and much people of Israel
+died.&mdash;And Moses prayed for the people.&mdash;And Moses made a serpent of
+brass and put it upon a pole and it came to pass that if a serpent had
+bitten any man, when he beheld the serpent of brass, he lived."</p>
+
+<p>Among the old Egyptians, it was especially Isis who discovered many
+remedies and had been much experienced in medicine, and after having
+become immortal, it was her greatest pleasure to cure the sick and to
+announce the right remedies in dreams to those who came to sleep in her
+temples. Many who could not be cured by any physician, and who had lost
+their sight and hearing or could not move their limbs, became well again
+when they took refuge in her temples. The same holds true for the
+Serapis temple; even the best known men go there to sleep to get from
+the goddess cures for themselves or for their friends. It is well known
+again that in other ways the old Greeks attached medical influence to
+temples and sacred springs and rivers and tombs. There were sacred
+springs which cured everybody who drank from them, there were statues
+which removed every disease when offerings were brought to them. Here
+again the most frequent is the cure of paralytic symptoms and of
+obsessions. The Orphic<span class='pagenum'><a name="Page_324" id="Page_324">[Pg 324]</a></span> priests of old Greece most nearly resembled the
+shamans of the savages.</p>
+
+<p>Those who are inclined to give to the life of Christ a rationalistic
+interpretation have often pointed out that the therapeutic effects
+described in the Gospels might also be understood as effects of
+suggestion by word and tactual impressions, produced especially on
+hysterics, epileptics, paralytics, and psychasthenics. Such
+rationalistic interpretations could also explain in the same way through
+the suggestive influence in the minds of the sick, those cures which
+Christ effected through others without being present himself. Here
+belongs perhaps the cure of the servant of the centurion in Capernaum or
+the cure of the daughter of the woman of Canaan. "And when he had called
+unto him his twelve disciples, he gave them power against unclean
+spirits to cast them out and to heal all manner of sickness and all
+manner of disease." The Acts give us the full details of how Peter and
+Paul cured the lame and how special miracles were performed by their
+hands. No doubt this belief in the curative effect of the disciples and
+their successors fills the first centuries after Christ. Eusebius tells
+us how they healed the sick by laying on of hands. The forms were
+frequently changing through the history of Christianity but the essence
+remains the same. Sometimes more emphasis is laid on the personal factor
+of the priest, sometimes more on the sacred origin of the symbol as in
+the case of the relics, sometimes more on prayer and godly works, but it
+is always the religious belief which cures. Typical are the thera<span class='pagenum'><a name="Page_325" id="Page_325">[Pg 325]</a></span>peutic
+wonders of Francis de Assisi. He banishes devils, cures gout, lameness,
+and blindness. The traditional means of suggestion, prayer and the
+laying on of hands, had in the meantime been supplemented by the sign of
+the cross which the church had added. Moreover whatever he had only
+touched became a remedy for the sick. Protestantism brought no change in
+this respect. Martin Luther writes: "The physicians consider in the
+diseases only the natural causes from which a disease results and want
+to remove them by their medicines, and they are quite right in it. But
+they do not see that the devil often sends to one a disease which has no
+natural causes. Therefore there must exist a higher medicine, namely,
+the religious belief and the prayer through which the spiritual medicine
+can be found in the word of God."</p>
+
+<p>The broad undercurrent of religious cures, especially in the Catholic
+Church and in the Greek Church, but with fewer symbols also outside of
+them, has up to the present time never ceased to flow. But independent
+of it the therapeutic belief has again and again been focused on certain
+individuals or certain sects or certain schools, in the midst of the
+steady progress of scientific medicine and sometimes synthesizing the
+religious claims with new-fashioned scholarly ideas. In the seventeenth
+century, for instance, the Irish nobleman Greatrakes became a famous
+center of attraction. He felt himself to be the bearer of a divine
+mission and healed the sick, appealing to their belief by laying on of
+hands and by move<span class='pagenum'><a name="Page_326" id="Page_326">[Pg 326]</a></span>ments which we nowadays call passes. Much more
+influential in the eighteenth century was Pastor Gassner in Germany.
+Gassner succeeded in producing with his religious psychotherapy such a
+tremendous stir that many thousands who needed cure from functional
+diseases, and thousands of curious people, too, streamed to his church
+in Ellwangen, and his methods of cure spread almost contagiously among
+the ministers of the country: an Emmanuel Church Movement of the
+eighteenth century. Gassner, too, discriminated between the diseases
+which have natural causes, that is the organic diseases, which he did
+not treat, and the functional ones, which were obsessions of the devil.
+To determine to which group the disease belonged, he ordered the devil
+to produce the symptoms of the sickness. When in this way the
+obsessional character of the disease was recognized, the minister began
+with his suggestive influences to banish the devil. He demanded firm
+confidence in the name of Christ, re&euml;nforced his effectiveness by
+narration of the cures he had perfected, used further certain
+manipulations such as the rubbing of the skin and passes on the head,
+and finally gave his suggestions with authoritative firmness. Many
+ministers who became his pupils treated like him with skillful
+combination of religion and hypnoid influences the spasms, catalepsies,
+neurasthenias, paralysis, and deafness, of neurotic patients.</p>
+
+<p>There is no need to follow in detail the frequent similar occurrences
+between Gassner's time and our own. We all know where we are to-day.
+The<span class='pagenum'><a name="Page_327" id="Page_327">[Pg 327]</a></span> medical profession and the medical science with its bacteriology
+and serum therapy, its Roentgen rays and its organic chemistry is far
+away from the church and without concession to religious aspects. On the
+other hand there are the yearly processions of thousands and thousands
+who make their pilgrimage to the sacred waters of Lourdes, guided by the
+Catholic priests, half-hypnotized by the hope that the Virgin will cure
+them. In every niche of the Catholic churches in all Europe, there are
+kneeling before the burning candles those who pray for nothing but their
+health; and their belief will sometimes yield almost miraculous cures.
+In England the Society of Emmanuel was founded by men and women to whom
+it seemed necessary to bring back to the minds of Christians the
+undoubted fact that Christ taught and worked for physical heath and to
+revive this sense of power over disease. Thousands were treated and the
+results have been "most encouraging." Among the cases successfully
+treated may be mentioned "one of cancer in which case the specialist
+called in had given the sufferer only three months to live while by
+means of the laying on of hands in prayer, a complete cure was
+effected."</p>
+
+<p>Not dissimilar in its proceedings, though much more elaborate in its
+metaphysics than this movement in the midst of the Church of England, we
+find in America the Christian Science movement started by Mrs. Eddy. It
+was new as a therapeutic system, however old its philosophic elements.
+Mrs. Mary Baker Eddy writes: "In the year 1866 I discovered<span class='pagenum'><a name="Page_328" id="Page_328">[Pg 328]</a></span> the Christ
+science or divine laws of life and named them Christian Science. God had
+been graciously fitting me during many years for the reception of a
+final revelation of the absolute divine principle of scientific being
+and healing." The disease is cured for the Christian Scientist by the
+belief in God because a true belief in God includes the insight that God
+is all reality and that reality therefore cannot include the ungodlike,
+that is, error and sin and disease. Disease is thus recognized as unreal
+and if it has become unreal, of course it has disappeared as part of our
+real life. Thousands and thousands have been cured under this symbol.
+And as the latest chapter of this history of five thousand years, we
+find the movement which Dr. Worcester has started in Boston and which,
+too, spreads rapidly over the continent and awakens the ambition of many
+a minister in every denomination in the land. The aim is to cure the
+patient by re&euml;nforcing in him through religious persuasion, through the
+contact with the symbols of the church and with godly men and through
+religious suggestion, a confident belief which gives new unity and
+through it new strength to the mind of the sufferer until it overcomes
+the functional disease of the body. The physician at first examines
+whether or not an irreparable organic disease has attacked the body, but
+if he does not find such organic destruction, then the patient is to be
+handed over to the minister, who will take care that through his
+religious belief and inspiration the mind will triumph over the weakness
+of the body.</p>
+
+<p><span class='pagenum'><a name="Page_329" id="Page_329">[Pg 329]</a></span>Whoever looks in this way over the history of mankind can no longer
+doubt that belief in supernatural powers is really an agency for the
+overcoming of disease. We may be interested in it from the standpoint of
+religion or from the standpoint of psychology or from the standpoint of
+ethnology. In every case we have to acknowledge that he who believes may
+be cured. If we abstract first from the religious point of view and
+consider the problem as a scientific one, we have to interpret all those
+curative effects of belief as results of suggestion. The attitude of the
+one who gives the suggestion has gone in the history of mankind through
+all possible variations. He may have been filled with fervent belief,
+rejecting any interpretation except the religious one, or he may have
+produced the suggestion of belief almost with the intentions of a
+physician who simply relies on the physiological effects of any
+suggestion; and between these two extremes any number of steps is
+possible. Moreover the suggestion may have been detached from any
+personality and may have belonged to any symbol of religious energies,
+like the relics of the Catholic Church. Even the most skeptical of
+ethnologists ought to acknowledge that very little in this history of
+religious psychotherapy points to a conscious fraud. Those shamans of
+the savages from Siberia to South Africa, from Australia to Mexico, are
+in ecstasies which make them really believe in the mysterious power of
+their manipulations. The ethnologist finds indeed as most common
+characteristics of all those primitive movements that those<span class='pagenum'><a name="Page_330" id="Page_330">[Pg 330]</a></span> who cure
+are chosen from among neurotics who by epileptic attacks or
+hallucinations and obsessions are predisposed to feel themselves as
+bearers of a higher mission.</p>
+
+<p>Yet whether the attitude of the transmitter is religious or
+half-scientific, is inspired or insincere, the receiver of the
+suggestion is always in the same condition: he is believing in his cure
+through religious influence and through his belief he is helped, if he
+is helped at all. This uniformity does not exclude the fact that the
+patients too may show a manifoldness of mental states. They may remain
+in a completely waking state with re&euml;nforced suggestibility, or they may
+go over into a drowsy or hypnoid state or deeply into a hypnotic state,
+or may receive the suggestions as we saw even in sleep. Further their
+minds may be entirely filled with fine religious emotions and the
+therapeutic effect be only an appendix or, on the other hand, this
+confident expectation of the relief from pain may be their central
+content of consciousness and may control the whole mental interplay. The
+practical problem of the scientist is to consider how far these
+religious energies ought to be used today in the interests of the cure
+of diseases.</p>
+
+<p>From a scientific standpoint such a discussion can hardly be fruitful
+with those who consistently take the religious point of view only. A
+view of the world which demands the faith that religious belief moves an
+almighty power to cure a diseased organ, or that the disease has no
+reality for one who lives in God, is invulnerable to merely scientific
+arguments.<span class='pagenum'><a name="Page_331" id="Page_331">[Pg 331]</a></span> The sick woman who kneels between the candles before the
+picture of the Virgin, praying that her heart, which the physicians
+declare incurable on account of a valvular disease, be cured, moves in a
+sphere of thought which lies entirely outside of the medical study of
+causes and effects. The same holds true, for instance, of Christian
+Science. This statement is in itself no criticism and no argument; it
+only acknowledges that any possible exchange of opinions has to be
+carried over from the scientific psychological ground to that of
+metaphysics and philosophy. It is quite different with modern movements
+of the type of the Emmanuel Church Movement, where the religious thought
+is intertwined with the psychological theory and where an actual
+co&ouml;peration of physician and minister is sought. Here church and science
+really meet on common ground, and it is important to examine objectively
+whether it is wise and beneficial to encourage the spreading of this
+tempting enterprise. The movement has reached the large cities between
+the Atlantic and the Pacific and is beginning to captivate the ministers
+of the small towns and villages. It seems as if an epoch has come for
+the church&mdash;the church which too long has ministered only to the
+spiritual needs of the community will at last remember again that Christ
+healed the sick, that mind and body are one, that the personality must
+be understood in its unity, and that endless fields of blessed influence
+may again be opened to the church when the minister becomes the
+physician of his congregation. Whoever knows the suggestive<span class='pagenum'><a name="Page_332" id="Page_332">[Pg 332]</a></span> power of
+such a social movement, and considers the ease with which triumphant
+successes may be reached in this field and the disappointing and
+discouraging reduction of power which the church shows everywhere in its
+purely spiritual hold on the community, can foresee that all the
+conditions are favorable for a rapid spread and that the church clinics
+will become the American fashion of the near future.</p>
+
+<p>It cannot be denied that the Christian church takes in hand there once
+more a work which belonged to it through centuries. But they were
+centuries in which the priest was in a certain degree the physician,
+just as he was the educator and teacher, simply because in the church
+there was centered all cultural influences which the community knew. The
+complexity of modern times has for centuries demanded the opposite
+system. Centralization is allowed only to the purely administrative
+influence of the state, while all the active functions are divided among
+specialists. We rely on the expert in education, we demand the expert in
+medicine: is more gained or lost if the religious leader now again
+suddenly undertakes a part of the functions which belong to the
+physician? It is true that the ministers of this school do not propose
+to undertake the physician's work to its full extent. They leave to him
+the first and in some respects most important step, the diagnosis, and
+abstain from the treatment of such cases as the physician declares
+inaccessible to psychical influences. They do not heal cancer and
+phthisis like the Em<span class='pagenum'><a name="Page_333" id="Page_333">[Pg 333]</a></span>manuel Movement in England or like the mental
+healers in America.</p>
+
+<p>But is not perhaps just this compromise dangerous in another direction,
+inasmuch as it awakens a feeling of safety in those who feel in sympathy
+with scientific medicine? They have passed the hand of the physician and
+believe accordingly that because their illness is recognized as
+functional, the minister can really perform all that ought to be done.
+Is this belief justified? At the threshold, it occurs to every one that
+such a diagnosis by physicians may be erroneous and that the chances for
+such error are under the conditions of the church clinic much greater
+than under the conditions of a regular medical treatment. The
+diagnostician who treats the patient himself has ever new chances to
+remodel his diagnosis and to correct it under the influence of
+therapeutic effects. The danger is great that under the proposed
+conditions, the activity of the physician will be superficial, because
+he is deprived of his chief means, the constant observation. But we may
+abstract from this possibility of error. Does the fact that the disease
+is one the symptoms of which may yield to psychical treatment really
+make it advisable that the further treatment be handed over to the
+clergyman? To begin at the beginning, the usefulness of psychical
+treatment does not at all exclude the strong desirability of physical
+treatment at the same time. The emphasis which is laid on religious
+persuasion and inspiration, on prayer and spiritual uplift practically
+excludes the use of baths and douches, of massage<span class='pagenum'><a name="Page_334" id="Page_334">[Pg 334]</a></span> and electricity, of
+tonics and sedatives. And yet it is not caprice or sham when every
+well-schooled medical specialist applies such means in the treatment of
+these so-called functional diseases of the nervous system. The minister
+applies and can apply only one of many possible methods for cure and
+yet, if we really want to make use of the resources of modern knowledge,
+we have to adapt most carefully all possible means to the individual
+case. If we take the strictly religious standpoint the situation is of
+course different, but if we speak of psychophysiological effects, we may
+acknowledge the healing influence of prayer and yet rely in the special
+case still more on bromide or strychnine. Yet the religious
+psychotherapists not only neglect the physical help but usually
+emphasize the antagonism. Some of the strongest supporters proclaim it
+as a non-drug healing, thus deciding adversely about a medical method
+regarding which they have no means at all to judge.</p>
+
+<p>Parallel to this neglect of physical theory goes, of course, the neglect
+of the physical factors in the disease. The physician may have justly
+diagnosed that the case is "merely" neurasthenia or hysteria and not a
+brain tumor or paralysis of the brain. Yet that does not mean in the
+least that a real treatment which remains in harmony with the progress
+of modern medicine ought to ignore the hundred physical elements which
+enter daily into the disease. There are the most complex digestive
+problems involved which demand a thorough understanding of chemical
+metabolism, there are still more complex problems of the<span class='pagenum'><a name="Page_335" id="Page_335">[Pg 335]</a></span> sexual organs
+which the minister certainly ought not to discuss with his female
+parishioners, there are bacteriological questions, there are questions
+of the peripheral nervous system and sense organs; in short, questions
+which belong to a world into which the minister as minister has never
+looked. Even if he believes he might gather in an amateurish way some
+information as to those questions which lie so far from his experience
+as student of divinity, how can his half-baked knowledge compare with
+the experienced study of the regular physician? Such physical questions
+cannot be settled by the preparatory examination of the physician; they
+come up every day during the treatment and what the spiritual diet which
+the minister offers may help, may at the same time be ruined by the
+physical diet about which the minister without chemistry cannot judge.</p>
+
+<p>But let us abstract from the bodily aspect. Is the situation really very
+different for the mental one? The appeal to the religious emotion, the
+re&euml;nforcement of religious faith is from the religious point of view
+certainly the one central effort from which everything has to irradiate.
+The unity of this controlling thought is the glory of such inspiration.
+But as soon as we handle this thought as a psychotherapeutic remedy,
+destined to restitute the disturbed psychological equilibrium, it
+becomes evident that the very uniformity of it makes it a clumsy,
+inadjustable pattern. If there is anything which impresses the careful
+student of psychology, it is the over-rich manifoldness, the complexity
+of mental life. Even the<span class='pagenum'><a name="Page_336" id="Page_336">[Pg 336]</a></span> simplest content of consciousness is a tissue
+woven from millions of threads and any stereotyped influence means
+crudeness and destruction. The minister's attitude towards inner life is
+there directly opposite to that of the psychologist. He cannot enter
+into those endless interplays of associations and memories, or
+inhibitions and sensations and impulses, he cannot examine from which
+remote psychological sources those ideas have arisen, how the feelings
+become disturbed and the judgments sidetracked. He should not analyze
+even if he could, because his whole aim is to synthesize. He asks for
+the meaning and not for the structure, for the aims and not for the
+elements. His therapeutic effort is therefore not even directed towards
+a careful rebuilding of the injured parts of the mind, but it is nothing
+more than a general stimulation to the mind to help itself. By touching
+on one of the deepest emotional layers of the mind, the layer of
+religious ideas, the minister gives to the soul an intense shock and
+expects that in the resulting perturbation, everything will be shaken
+and may then settle itself by its own energies in a healthful way. It is
+a fact that that can sometimes happen and under certain conditions the
+chances for it are even favorable. Under many other conditions the
+chances are unfavorable and the result does not happen at all.</p>
+
+<p>But whether or not a cure results, in any case it is certainly not an
+effort which can be said to be in harmony with modern science. The idea
+of science is always to understand the complex from its elements<span class='pagenum'><a name="Page_337" id="Page_337">[Pg 337]</a></span> and to
+restore the disturbed complex object by recognizing the disturbances in
+the elements and by bringing those disturbed elements into right shape
+again. Certainly the psychologist, too, in examining carefully the
+injured mental mechanism may discover emotional injuries which might be
+cured by the introduction of religious ideas, but he will not give to
+them a value different from the introduction of any other ideas and
+emotions, for instance, those of art and music and poetry, those of
+social company or civic interest, of travel or sport or politics. Each
+may have its particular value and to cure every mind with religious
+emotion would be from a psychological point of view as one-sided as it
+would be to cure every disturbed stomach by milk alone. Moreover in very
+frequent cases, for instance, of neurasthenia or hysteria or
+psychasthenia, such wholesale remedies can form only the background of
+the treatment, but all the details have to be furnished with reference
+to a most subtle analysis of the special symptoms, and a particular
+organic symptom or a particular memory idea or a special inhibition by a
+well-selected counter-idea will do much more than any great emotional
+revival.</p>
+
+<p>Stereotyped religious appeal is not only insufficient in an abundance of
+cases&mdash;it must never be forgotten that those who nowadays go to the
+minister for their health are already selected cases more open to
+religious suggestion than the average&mdash;but can easily be decidedly
+harmful. Of course that holds true for every physical remedy too, and
+the judgment of the<span class='pagenum'><a name="Page_338" id="Page_338">[Pg 338]</a></span> exact limit is one of the chief duties of the
+physician. It holds also for the other mental factors like sympathy. A
+certain amount of sympathy may save a neurasthenic from despair, and
+only a little more may make his disease much worse and may develop in
+him a consciousness of misery which makes him a complete invalid. Still
+more is it true for the religious emotion, from the standpoint of
+nervous physiology the strongest next to the sexual emotion, that it can
+be the healing drug or the destructive poison. Everything depends upon
+the degree of the intrusion and upon the resistance of the
+psychophysical system. From a purposive point of view there cannot be
+faith enough, from a causal point of view there can easily be too much
+of the faith emotion. Religious fervor has at all times helped to create
+hysteria and to develop psychasthenias. It cannot be otherwise. A group
+of ideas which has such tremendous power over man must easily be able to
+produce inhibitions and exertions which become dangerous to a nervous
+system the constitution of which is pathological. To leave such a
+dangerous and powerful remedy entirely in the hands of men who by their
+profession must aim towards a maximum dose of religious influence can
+certainly not be in the interests of the patients or of the community.</p>
+
+<p>Even the whole technique of this movement awakens the fear of possible
+harmful consequences. On the one hand we have the movement itself as a
+popular suggestion for the suggestible masses. The patient who seeks the
+help of a scientific neurologist<span class='pagenum'><a name="Page_339" id="Page_339">[Pg 339]</a></span> hardly becomes a center of psychical
+contagion, but the church services for the sick offer favorable
+conditions for an epidemic development of hysterical symptoms. But more
+important are the influences on the individual patient. The whole
+purpose of the treatment demands the highest possible degree of
+suggestibility brought about by the ministerial persuasion. But it is
+evident that this degree of suggestibility means at the same time the
+most fertile soil for every chance suggestion and for influences which
+are perhaps entirely unintended. The physician and the psychologist,
+considering the mental state with reference to its elements, will make
+most careful use of those accessory influences. The minister, who
+necessarily has his spiritual aim in mind, cannot even become aware of
+all the involuntary influences which reach the mind in its most
+suggestible state. There can be no doubt that it would often need
+psychological art to avoid the creation of new pathological symptoms in
+such half-hypnotized patients. Yet the minister even goes so far as to
+make use of the sleeping mind without any consideration of the possible
+damage which may be done to his subject. He goes to the bedside of a
+sleeping girl and whispers his suggestions and is satisfied when they
+show their effects the next day. It does not lie in his horizon to
+consider the grave consequences which such suggestions during sleep may
+produce during future years in the brain the sleep of which has been
+transformed into such half-somnambulic relations. Hysterias may be
+created by such methods. No one can blame the<span class='pagenum'><a name="Page_340" id="Page_340">[Pg 340]</a></span> minister for his
+remoteness from such doubts and problems, but the physician is to be
+blamed if he encourages the belief that all this still belongs to the
+proper sphere of the ministerial worker in abnormal psychology.</p>
+
+<p>Those engaged in such work were not long in finding out that the mere
+emotional inspiration is often no sufficient remedy, and the development
+went along the same lines in which it has gone everywhere for some
+thousands of years. Not to disappoint the sufferers, the religion had to
+become in very many cases simply an inactive side issue and the real
+cure was performed by the same methods with which any worldly
+neuropathologist would go to work. If the woman who cannot sleep is
+cured from her insomnia by being made to listen to the beats of a
+metronome, it may sometimes be effective, however crude, but it is
+certainly no longer religion, even though the metronome stands in a
+minister's room. The more the movement spreads to those who have no
+psychological training and knowledge, the more it must be necessary for
+them to import the whole claptrap of the quack hypnotist and soon the
+minister may discover that in certain cases physical means and drugs
+help still better. Thus he simply enters into competition with the
+regular physician, only with the difference that he has never studied
+medicine. The chances are great that in his hands even such remedies and
+drugs may do harm and finally, even if they were effective, is not the
+question justified: will not religion suffer?</p>
+
+<p><span class='pagenum'><a name="Page_341" id="Page_341">[Pg 341]</a></span>Indeed we have so far considered the question from one side only. We
+have confined ourselves to the question of how far such a movement is
+sound for the interests of the patient; but can we be blind to the other
+side and overlook the not less important problem of whether it lies in
+the interests of religion and of the church to amalgamate its spiritual
+work with a medical one? We are not thinking of those widespread, unfair
+arguments to the effect that this whole movement is undignified because
+it is instituted by the desire to fill the empty pews or to make
+competition with the success of Christian Science. That is utterly
+unjust. But there are intrinsic factors in the movement which interfere
+with the true aims of religion. First of all it cheapens religion by
+putting the accent in the meaning of life on personal comfort and
+absence of pain. The originators of the Emmanuel Movement stand well
+above such error, but their national congregations do not. Certainly the
+longing for pleasure and a well feeling and the abhorrence of pain and
+illness pervades our practical life and keeps in motion all our
+utilitarian efforts. But if there is one power in our life which ought
+to develop in us a conviction that pleasure is not the highest goal and
+that pain is not the worst evil, then it ought to be philosophy and
+religion. It is only the surface appearance if it seems as if the
+religious therapeutics minimizes the importance of pain; in truth it
+does the opposite. It tries to abolish pain, but not because it thinks
+little of pain; on the contrary, because it thinks so much of pain that
+it is<span class='pagenum'><a name="Page_342" id="Page_342">[Pg 342]</a></span> willing even to put the whole of religion into the service of
+this strife for bodily comfort. The longing for freedom from pain
+becomes the one aim for which we are to be religious. In a time which
+denies all absolute ideals, which seeks the meaning of truth only in a
+pragmatic usefulness, it may be quite consistent to seek the meaning of
+religion in its service for removal of pain, and personal enjoyment. But
+in that case the ideal of both religion and truth is lost. It is finally
+not less undignified for religion to seek support for the religious
+belief in effects which it shares and knows that it shares with any
+superstitious belief on earth. Granted that the church can cure: the
+shaman of Siberia can cure too, and the amulets of Thibet not less. The
+psychologizing church knows, therefore, that it is not the value of the
+religion which restores the unbalanced nervous system; and yet it wants
+to provide for the spreading of true belief by the miraculous cures
+which it exhibits.</p>
+
+<p>This situation naturally produces the desire of the church to substitute
+a religious explanation for a psychological one. It is claimed that
+after all it is not the mental effect of the prayer, but the prayer
+itself, not the psychophysical emotion of religion, but the value of
+religion which determines the cure. Yet in that moment the whole
+movement in its modern shape comes into a still more precarious
+position. If the cure results from the inner value of the religion how
+can we confine it to the so-called functional diseases and abstain from
+any hope in organic diseases?<span class='pagenum'><a name="Page_343" id="Page_343">[Pg 343]</a></span> Luther, from his religious point of view,
+still had the right to separate the two groups because only those
+functional diseases were effects of the devil, obsessions which could be
+banished by the minister and by prayer, while the other diseases did not
+result from the devil, but merely from natural causes. Such a definition
+does not fit into the modern system. To-day from a really religious
+point of view, both groups of diseases must be acknowledged to be
+natural or with Mrs. Eddy, as the work of the unholy spirit. Christian
+Science is indeed by far more consistent. If the cure results through
+the meaning and value of religion, there is no reason whatever why
+cancer and diphtheria and paralysis should not be cured as well as
+psychasthenia. And if, on the other hand, organic diseases cannot be
+cured because the psychophysical process of the religious emotion has no
+influence over diphtheria bacilli, then the whole process is removed to
+the causal sphere and it is acknowledged that the purposive meaning of
+religion is not in question at all. The whole system of such religious
+psychotherapeutics is therefore in its inner structure contradictory. It
+contains causal and purposive elements without any possibility of
+unifying them. They are loosely mixed, and the power of prayer means on
+one page something entirely different from what it means on another. In
+these respects Christian Science is by far more unified and in harmony
+with itself; its therapeutics is really anchored in a system.</p>
+
+<p>From a scientific point of view, its dangerousness<span class='pagenum'><a name="Page_344" id="Page_344">[Pg 344]</a></span> is of course much
+greater inasmuch as it extends its methods over every organic disease
+and thus applies merely psychical treatment where from a standpoint of
+scientific medicine, physical treatment would be absolutely necessary.
+Moreover its philosophy is after all only a pseudophilosophy; its
+tempting equations of disease and error and sin and unreality are
+ultimately a mere playing with conceptions. If we were to point to the
+root of the misunderstanding in Christian Science, we should say that
+everything depends on the philosophical commonplace that the objects
+with which we deal in our life are ideas and that our whole experience
+is mind. "Christian Science reveals incontrovertibly that Mind is
+All-in-All, that the only realities are the divine mind and idea." But
+now silently this mental character of the real world is identified with
+the mental experience which stands in contrast to the physical
+experience. There results the impression that physical experience
+therefore, does not belong to the world of reality. It is evident,
+however, that mental in contrast to physical means something entirely
+different from mental in the philosophical sense. In the latter meaning
+of the word, we all agree that the world is mental; the word mental
+indicates there that the world has reality not in itself but only as
+experience of subjects. In the second sense, mental or psychical means
+that it is experience for one particular subject only and not for every
+possible subject. The physical thing, for instance this table, is indeed
+different from my mental memory idea of a table, inasmuch as<span class='pagenum'><a name="Page_345" id="Page_345">[Pg 345]</a></span> every
+possible subject can experience this table while my mental memory image
+belongs to me alone. The physical table and the mental memory image of
+it are both equally mental in the philosophical sense, inasmuch as the
+physical which is object for every possible subject and in this sense
+not mental is therefore not less given to subjects. Every physical body
+with its disease is thus in one sense taken as something not mental
+while in another sense as mental; if we use the same word in two
+entirely different meanings, it indeed cannot be difficult to
+demonstrate any metaphysical consequences.</p>
+
+<p>But we do not have to deal here with the metaphysics of "Science and
+Health." If it is brought down to the concrete application, we stand
+before the same confusion which characterizes all compromises. Causal
+effects are sought in a sphere which belongs to purposive values. The
+psychological effects of the emotion of faith are sought and are
+misinterpreted as the emanations of religious powers. Religious
+psychotherapeutics in all its forms seeks to demonstrate to us the
+triumph of the soul over the body, while in reality it deals only with
+the mental mechanism which as such belongs to the chain of causal events
+in the same natural way as the organism. The soul, as spiritual agency
+in its sphere of purposes and ideals, does not enter the machinery of
+psychotherapy, and the psychological material on which psychotherapy is
+applied is not freer and not better and does not stand higher than the
+material of the bodily cells and tissues. The Emmanuel Move<span class='pagenum'><a name="Page_346" id="Page_346">[Pg 346]</a></span>ment
+deserves the highest credit for bringing about a systematic contact
+between religious faith cure and scientific medicine, but the time in
+which the minister himself undertook the medical treatment had to be a
+time of transition. It had to lead to a new relation in which the
+ministerial function is confined to the spiritual task of upbuilding a
+mind while the therapeutic function remains entirely in the hands of the
+physician. Where the physician believes that the psychomedical treatment
+demands a new equilibrium of the patient to be secured by religion,
+there the minister should be called for assistance. Psychotherapeutic
+hospitals would offer the most favorable conditions for such
+co&ouml;peration. But the minister ought to enter even such a hospital with a
+strictly spiritual aim, and he should never forget that the task of the
+church stands much higher than the utilitarian task of removing pain
+from the sick room. But if those psychotherapeutic hospitals will
+flourish and the physicians will at last make use of psychical factors
+in their regular practice, they ought not to forget on their part that
+the important step forward was taken under the pressure of popular
+religious movements. The ministers first saw what the physicians ought
+to have seen before, but the physicians will see it more fully and more
+correctly.<span class='pagenum'><a name="Page_347" id="Page_347">[Pg 347]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="XIII" id="XIII"></a>XIII<br /><br />
+<span class="sub">PSYCHOTHERAPY AND THE PHYSICIAN</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>Every thought of the physician moves in a world the structure of which
+is determined by the thought forms of cause and effect. He knows the
+effect which he wants to produce; it is the restitution of the organic
+equilibrium. He studies the causes which can secure that end. And again
+the disturbance of the equilibrium itself, the disease, is for him an
+effect which he seeks to understand by an analysis of the preceding
+causes. The means which he applies can therefore be valued only in
+reference to their efficiency; no other point of view belongs to his
+world. The religiously valuable may be indifferent or even undesirable
+in the interplay of causes, and the morally indifferent may be most
+important for the physician's interests. The religious emotion
+accordingly has to stand in line with any other mental excitement or
+with a hundred physical means which the laboratory and the drug store
+supply. The physician will welcome the methods of treatment without
+reference to metaphysical systems or to religious beliefs. To him it is
+an empirical fact that many disturbances of mind and body which
+interfere with<span class='pagenum'><a name="Page_348" id="Page_348">[Pg 348]</a></span> the equilibrium of life can be repaired by influences on
+certain psychophysical organs. A part of these repairing influences he
+finds in the sense stimuli, for instance, of spoken or written words
+which reach the brain and awaken associative and reactive processes. He
+finds further that these influences can be re&euml;nforced in their
+effectiveness by certain general conditions of the nervous system and
+again finds that these can be secured partly by sense impressions, and
+once more especially by words.</p>
+
+<p>It is a matter of course to the physician that application of any sense
+influence on the brain demands a most subtle analysis of the
+psychophysical situation. Therefore he gives no less attention to the
+disentangling of the whole history of the individual brain, to its
+stored-up energies and to its mental possibilities. If he knows the
+psychophysical status, and finally if he knows the means of influencing
+those psychophysical organs which stimulate or inhibit the disturbed
+central parts, he can foresee the psychophysical effects with a certain
+definiteness. Thus everything depends upon the sharpest possible, almost
+microscopic, mental analysis, together with a most thorough examination
+of the whole nervous system and the most careful calculation of the
+mental influences applied. The vagueness of the religious appeal
+transforms itself into an exact calculation and the unity of the soul
+which seeks spiritual uplift transforms itself into a mental mechanism
+of bewildering complexity, and yet not more complex than the physical
+organism, to which for instance, the chemical<span class='pagenum'><a name="Page_349" id="Page_349">[Pg 349]</a></span> means of the physician
+administer. To-day medical science is certainly only in the beginning of
+this great movement. Especially the analysis of the psychophysical
+conditions still lacks a sufficient refinement of method. But at least
+the causal principle is now fully recognized and the scientific man of
+today no longer doubts that this whole play of psychotherapeutic
+processes goes on as a causal process in the psychophysical system of
+the individual without any mysteriousness, without any magnetic
+influences, without any miraculous interference, without any agencies
+except those which are working in our ordinary mental life in attention
+and reaction, in memory and sleep.</p>
+
+<p>It is surprising how late this recognition appeared in the history of
+human knowledge. It occurred here as in so many places in the history of
+human civilization that the simple is the late outcome of the complex.
+Just as in technique the apparatus often began in a complex, cumbersome
+way and then became steadily simplified, so it is with explanations. The
+complex machinery of cosmic influences and obsessions by demons and
+magnetic mysteries was at first necessary until the simple explanation
+was found that all the results depend upon the working of the mind
+itself. Yet in technique and explanation alike, such progress to the
+simpler means always at the same time the making use of much richer
+knowledge. To explain an obsession or a sleep state by the agencies of
+evil spirits or magnetic fluids is certainly an unnecessary side
+conception. But to understand it from the<span class='pagenum'><a name="Page_350" id="Page_350">[Pg 350]</a></span> working of the mind
+presupposes after all the whole modern physiological psychology, and
+thus had to be the latest step.</p>
+
+<p>The effects themselves were certainly observed in all times. Even the
+phenomena of hypnotism date probably back some thousands of years,
+however difficult it may sometimes be to discriminate between the
+artificial hypnotic states and hysteric or hystero-epileptic occurrences
+in the past. Certainly it may be acknowledged that the Yogi in India
+cultivated in the most remote times the methods of autosuggestion which
+evidently led to hypnotic states, and everywhere around the
+Mediterranean, antiquity knew the hypnotizing effect of staring on
+polished metals and crystals. So in Egypt, so in Greece and Rome; and it
+has often been claimed that the priestesses of Delphi and the sibyls of
+the Romans were in states of hystero-hypnotic character. As to the
+therapeutic use, especially the Greek physicians applied hypnotic means.
+Excited patients were brought to repose by methods of stroking. The
+efforts to explain scientifically the mysterious powers which men can
+gain over the mind and will of another begin at the end of the Middle
+Age and were developed quite naturally from the prevailing astrological
+doctrines. Astrology worked on the theory that the human fate depends
+upon the stars. These stars have an effect on the human organism. That
+proves that an influence can exist between distant bodies. It is,
+therefore, not more surprising that one organism can also have an
+influence on another organism. Well known since antiquity<span class='pagenum'><a name="Page_351" id="Page_351">[Pg 351]</a></span> were such
+influences from one object to another, as in the case of the magnet.
+Thus there may be a kind of magnetic power which creates relations
+between all objects in the universe.</p>
+
+<p>Pomponnazi explained thus at the end of the fifteenth century the
+therapeutic effects of the human soul by the mutual influence which
+stars and men have on each other. This theory comes to much more
+important development in the writings of the physician Paracelsus. One
+individual by the power of his effort can influence the will of another
+individual, can fight with it, and suppress it; and all through energies
+which are analogous to the magnetic power which binds stars and men. In
+the middle of the seventeenth century, Helmont connects this power of
+magnetic attraction and repulsion with an ethereal element which
+penetrates all bodies and keeps them in motion. Through it man, too, can
+by his mere imagination work on other men. This will can also be
+effective on drugs which get through it a special therapeutic power.
+Somewhat different was the theory of a Scotch physician, Maxwell, in the
+second half of the seventeenth century. The ethereal spirit, which is
+identical with light, can be artificially cumulated in any organism and
+that secures its health. As one man can influence this vivifying ether
+in any other man, he can produce cures even from a great distance. All
+diseases are merely reductions of this ethereal spirit in the organism.</p>
+
+<p>But the general stream of the explanation continued in the direction of
+the magnetic doctrine. It<span class='pagenum'><a name="Page_352" id="Page_352">[Pg 352]</a></span> was especially Mesmer in the eighteenth
+century who, in a long life of fantastic mysticism and yet of universal
+serious study, surely contributed much to the development of the theory.
+He had started to use, like others, the magnet in his medical practice.
+But he discovered that the same therapeutic successes could be gained
+without applying the magnet itself, but by simply using his own hands.
+The patients became cured when he moved his hands slowly from their
+heads to their feet. The magnetic power was therefore evidently in man
+himself. It was an animal magnetism in opposition to the mineral one
+which belonged to the magnet and to the stars. He believed further that
+he was able to infuse this magnetic power into any lifeless thing, which
+would then have curative influence on the nerves. There can be no doubt
+that, whatever may have been the value of his theories, he cured a large
+number of patients, evidently producing a state which we would call
+today a hypnoid state and often simply appealing to the natural
+suggestibility of the impressionable minds. Among his pupils, usually
+called mesmerists, was Puys&egrave;yur, who discovered, in 1784, the state
+which was called artificial somnambulism, a kind of sleep in which the
+ideas and feelings of the magnetized can be guided by the magnetizer.
+Here evidently was the first recognition of the psychotherapeutic
+variation which we call today hypnotism. There followed a period in
+which the scientific interest of the physicians was somewhat sidetracked
+by an unsound connection of these studies with mystic speculations and<span class='pagenum'><a name="Page_353" id="Page_353">[Pg 353]</a></span>
+with clairvoyance. But especially in Germany animal magnetism in
+Mesmer's form and in the form of artificial somnambulism grew in
+influence through the first decades of the nineteenth century and
+succeeded in entering the medical schools. The reaction came through
+popular misuse. At about the third decade of the century, interest
+ceased everywhere.</p>
+
+<p>The Portuguese Faria insisted in 1819, practically as the first, that
+all those so-called magnetic influences, including the delusions, the
+amnesias after awaking, and the actions at a command, did not result
+from a magnetic power but from the imagination of the subject himself.
+He believed that the effect depended upon a disposition of the
+individual which resulted from a special thinness of blood. He abstained
+therefore from the magnetic manipulations and produced the somnambulic
+state by making the patients simply fixate his hands and by ordering
+them to sleep. Thus he is the first who understood these changes as
+results of mental suggestion. The next great step was due to the English
+surgeon, Braid, who in the forties studied the magnetic phenomena and
+like Faria insisted on the merely mental origin of the abnormal state.
+He proved that a person can bring himself into such an artificial state
+and that it is therefore entirely independent of energies from without.
+He examined especially the influence of staring at a shining object, a
+method which not seldom was called Braidism. He also introduced the word
+hypnotism. In America mesmerism was generally known under the name of
+electrobiology; and Grimes in par<span class='pagenum'><a name="Page_354" id="Page_354">[Pg 354]</a></span>ticular came to results similar to
+those of Braid. Yet the influence of these movements on the medical
+world remained insignificant until a new great wave of
+psychotherapeutics by means of suggestion began in France in the
+sixties.</p>
+
+<p>Of course this development from astrology to magnetism and from
+magnetism to hypnotism represented only one side of psychotherapy.
+Parallel to it goes the progress in the treatment of the insane. In the
+first half of the eighteenth century, they are still on the whole thrown
+together with the criminals but the more the disease character of the
+disturbance is acknowledged, and the more special hospitals for the
+insane are created, and finally the more the humane treatment in them
+supersedes the brutal, the more psychotherapy enters into the work.
+England showed the way. Especially Arnold, Crichton, and Perfect became
+influential; and soon Pinel and Esquirol followed in France; and Reil
+and Langermann in Germany. Reil recognized clearly at the threshold of
+the nineteenth century that "Both psychical and physical diseases may be
+cured by psychical means, but at the same time psychical diseases may
+also be cured by physical means." And in his "Rhapsodies," rhapsodies on
+the application of psychical methods in the treatment of mental
+disturbances, he declared, "that the medical Faculties will soon be
+obliged to add to the two existing medical degrees still a third,
+namely, the doctorate in psychotherapy." This stream became broader and
+broader and every new development of psychiatry in the last hundred
+years<span class='pagenum'><a name="Page_355" id="Page_355">[Pg 355]</a></span> did new justice to the influence of psychological means in the
+treatment of mental diseases; to be sure, without allowing up to the
+present day the hope that mental factors as such can cure the grave
+forms of insanity. The borderland cases and the incipient mild forms
+alone allow the hope of a cure. Outside of them the work of
+psychotherapy in the insane asylum meant essentially improvement and
+relief only. Again, in another direction, the general dietetic influence
+of sound mental life may be called a part of psychotherapy and this
+engaged not a few of the leading medical thinkers in all countries
+during the last century, especially the nerve physicians who gave
+serious attention to the wholesome engagements of the mind. Finally,
+might not much be attributed to psychotherapy, which offically belongs
+to the doctrines of homeopathy?</p>
+
+<p>But we may return to the new heralds of suggestion. Li&eacute;beault's book on
+the artificial sleep in 1866 became the starting point of the new great
+movement. Yet at first it remained unnoticed. It is claimed that for a
+long time only one copy was sold. But he continued to make his hypnotic
+experiments on the poor population of Nancy and they finally attracted
+the attention of some of the leading medical men there. Bernheim became
+convinced and Dumont, the physiologist Beaunis joined the movement, and
+in the eighties we find Nancy the center of hypnotic interest to which
+medical men from everywhere made their pilgrimage. This latter phase was
+paralleled by Charcot's studies in Paris, who brought hyp<span class='pagenum'><a name="Page_356" id="Page_356">[Pg 356]</a></span>notism into
+nearest neighborhood with hysteria. And also the later development of
+the Paris school by Richer, and especially the brilliant work of Janet,
+kept hysteria in the foreground of the therapeutic interest. Li&eacute;beault's
+experiment had brought the psychology of suggestion entirely into the
+center of this whole circle of phenomena and this view controlled the
+development of the last few decades, which was essentially an
+elaboration of the special treatment of diseases. Forel in Switzerland,
+Moll and Vogt in Germany, Wetterstrand in Sweden became the chief
+exponents of therapy by hypnotism. Others, like Dubois, in Switzerland,
+emphasized more the suggestive treatment through persuasion. In England
+at first Carpenter, later Hack-Tuke gave serious attention to hypnotism,
+in Russia Bechterew, and in the last few years the literature on therapy
+by suggestion became developed in practically all countries. In America
+Beard, Hammond, and others belong to the older school; Osgood, Prince,
+Peterson, Putnam, Sidis, and others to the most recent years. At the
+same time, under the leadership of Kraepelin, Ziehen, Sommer, and
+others, the methods of the psychological laboratory, especially the
+reaction and association methods, were made useful for the purposes of
+psychopathology.</p>
+
+<p>But interest in suggestion does not represent to-day the last step of
+psychotherapy. The latest movement, which is entirely in its beginning,
+the development of which no one can foresee, but which promises wide
+perspectives, is connected with the name of Freud in Vienna. The
+entirely new turn of psycho<span class='pagenum'><a name="Page_357" id="Page_357">[Pg 357]</a></span>therapy is given by the fact that his aim is
+not to overcome a symptom by suggestion but to make it disappear by
+removing the ultimate mental cause. He found that large groups of mental
+disturbances result from a psychical trauma, a disagreeable idea which,
+inhibited in the mind, becomes the source of mischief and produces
+phobias and obsessions and hysterical motions. The cure of the symptoms
+demands the recognition of this first mental accident, which may lie
+back for years and which may no longer be in the memory of the patient.
+As soon as this earlier experience is brought to consciousness again, it
+needs only a natural discharge and a normal expression and the symptoms
+which it brought about will disappear. Thus the cure itself needs no
+hypnotism and no persuasion or suggestion but the reawakening of
+forgotten situations, and only in the service of this effort hypnotism
+may be used to re&euml;nforce the memory. Yet this represents only the first
+period of Freud's activity, in which he collaborated with Breuer, a
+phase which is represented by their book on hysteria, in 1895. But there
+followed a further development which is still more essential. The
+hysterical disturbance may indeed have started with such an accidental
+traumatic impression but that does not explain why just this impression
+had such a strong effect. Other impressions of equal strength and
+emotional vividness may have passed without leaving any damaging result.
+And therefore there must be some prior cause in the subject which makes
+just this particular impression so injurious; and here is the point of<span class='pagenum'><a name="Page_358" id="Page_358">[Pg 358]</a></span>
+Freud's fundamental discovery, which for the layman appears on the
+surface to have little probability but which has proved of greatest
+consequence for clinical work. It was found that only those situations
+become injurious and become starting points for hysterical symptoms
+which touch on repressed and artificially inhibited ideas of the sexual
+sphere.</p>
+
+<p>Entirely new perspectives have been opened by these studies. Above all,
+now for the first time there is in sight a psychotherapy which not only
+aims to remove symptoms but which really uproots the disease itself.
+That earlier method of bringing the trauma to consciousness and making
+it discharge, the so-called cathartic method, removes only the
+particular group of disturbances but the patient remains a hysteric, and
+if ever new accidents should happen which would touch again those inmost
+repressed ideas, new hysterical symptoms would develop. But if we can go
+back to that starting point, if we can discover those first suppressions
+of desired gratifications which often most indirectly are related to the
+sexual sphere, and if we can liberate the mind from those primary
+strangulated affections, then the patient is really cured. Freud himself
+practically abstained from the help which hypnotism can give for the
+reawakening of forgotten experiences, while some of his pupils still
+prefer this short way to the forgotten memories. His way is, on the
+whole, to let the imagination bring up any chance material of associated
+ideas and then to study their connections and follow the hints they
+give. He calls it the psychoanalytic<span class='pagenum'><a name="Page_359" id="Page_359">[Pg 359]</a></span> method. Others prefer the methods
+of association tests, again others tap the lower layers by automatic
+writing, but the chief problem remains always to discover those
+repressed desires and to understand through them the injurious effects
+of accidental experiences. The whole field of hysteria, and perhaps
+still more that of the anxiety neurosis, has come into new perspective
+through this pioneer work which men like Bleuler, Jung, and Stekel have
+developed in various directions.</p>
+
+<p>Thus in recent decades the thorough work of scientific physicians has
+developed a psychotherapy of considerable extent and of indubitable
+usefulness, far removed from the simultaneous efforts of the churches
+and of the popular mental healing cures. A number of eminent men in all
+countries have tested the methods and have published the results. But
+the curious side of it is that all this is essentially a movement of
+leaders while the masses of the profession hesitate to follow. It is a
+set of officers without an army. Every large city has one or another
+specialist who applies suggestive therapy, one or another nerve
+specialist who hypnotizes, but the average physician moves on without
+any serious effort to utilize psychotherapy. It is as if the
+prescription of the modern chemical drugs were confined to some leading
+scholars in the country, while the thousands abstained from it in their
+office work and in their family practice. In reality psychotherapy ought
+to be used by every physician, as it fits perfectly the needs of the
+whole suffering community. Its almost exceptional use in the<span class='pagenum'><a name="Page_360" id="Page_360">[Pg 360]</a></span> hands of a
+few scholarly leaders deprives it of its true importance. It is the
+village doctor who needs psychotherapy much more than he needs the knife
+and the electric current.</p>
+
+<p>Why does the medical profession on the whole show this shyness in the
+face of such surprising results? In other fields they do not show any
+reluctance in taking up the newer developments of method. Even the
+Roentgen ray apparatus has quickly won its way, and psychotherapy is
+less expensive. To be sure, the most important reason is probably one
+which is most honorable. The physicians do not like to touch a tool
+which has been misused so badly. Psychotherapy has come too much into
+the neighborhood of superstition and humbug. Where miracles are
+performed, the man of science prefers to leave the field. The less one
+knows about those groups of problems, the less one is able to see the
+sharp demarcation line between true scientific studies, for instance, in
+hypnotism, and the pseudo-scientific fancies of psychical research.
+Experiments in suggestibility are then easily mixed with experiments in
+telepathy, and those go over by gradual degrees to clairvoyance and
+premonitory apparitions, and from there the way is not far to the
+reappearance of the dead and the routine performances of the spiritists.
+It seems to many as if there is no point where they have a reason to
+stop. If they begin with such abnormal phenomena at all, it seems as if
+they are necessarily carried over to all the mysteries of supernatural
+energies. Even the competition with Christian Science, and other<span class='pagenum'><a name="Page_361" id="Page_361">[Pg 361]</a></span> mental
+healers whose judgment is not hampered by any previous study of
+medicine, might seem rather unattractive to the serious physician.</p>
+
+<p>Further not a few have the impression that such suggestive treatment
+directly demands from them that they also begin to humbug their patients
+or to throw out suggestions which they themselves do not believe, in
+short, that they be brought down to the level of the miracle performer.
+Yet, however much all that speaks in favor of the conscientious instinct
+in the physician, it is ultimately based upon a misinterpretation. The
+line between real science and its counterfeit is here as everywhere a
+distinct one, and the true man of science ought not to hesitate in doing
+his duty from fear that he might not be discriminated from the
+charlatan. A well-conducted psychotherapeutic treatment as a scientific
+physician ought to carry it out, is entirely different in meaning and
+appearance, from the first step of diagnosis to the last treatment of
+after-effects, from every unscientific faith cure. It is also in no way
+necessary that the psychotherapist ever leave the path of complete
+sincerity. There is no reason at all for promising that the patient will
+be entirely cured if the physician believes that a real cure through
+suggestion is impossible. The more the true physicians undertake
+psychotherapeutic work, the more it will carry with it that dignity
+which is now too often lost by the predominance of those who treat
+without diagnosis and cure by mere appeal to superstition.</p>
+
+<p>All that does not mean that other motives do not<span class='pagenum'><a name="Page_362" id="Page_362">[Pg 362]</a></span> hold the physician
+back. Not seldom he is afraid of unfavorable consequences. He does not
+feel sure that, for instance, a deep hypnosis is without dangerous
+results or that he will be able to produce it in the technically correct
+way. But all these objections mean nothing but insufficient acquaintance
+with the facts. Of course every technique needs its period of
+preparation for the task, but it is now sufficiently demonstrated that
+hypnotism carried through in a scientific spirit will never have any
+injurious consequences. The morphine injection and the Roentgen rays are
+by far more dangerous. Those who think that for hypnotizing especially
+inborn power is needed stand, of course, outside of a serious
+discussion. They do not even know the elements of the modern theories.
+Every physician has in himself the necessary means for a
+psychotherapeutic treatment in every form.</p>
+
+<p>More scientific insight belongs to the argument that most of these
+psychotherapeutic schemes are essentially for treatment of symptoms. We
+have acknowledged that throughout. The possibility of a relapse or of a
+new obsession is thus to a high degree open, and that is certainly a
+discouraging feature. Yet we have seen sufficiently that as soon as the
+symptoms are removed, there is no lack of means, also by psychotherapy,
+to prevent the recurrence. Moreover, to remove the present symptoms is
+in any case a great gain and in many cases a decisive gain. And whatever
+can be secured by such methods is of such a character that hardly any
+other method could have<span class='pagenum'><a name="Page_363" id="Page_363">[Pg 363]</a></span> been substituted. It can be said with certainty
+that hundreds of thousands leave the offices of their doctors every year
+without relief where relief could be secured by psychotherapeutic means.</p>
+
+<p>To be sure, one reply of the physicians is not infrequent and carries
+some weight. Psychotherapeutic methods demand much time and patience and
+skill. To relieve a cocainist of his desire by mere suggestion may
+demand an assiduity which the average physician simply cannot afford;
+and nothing requires more time than a real use of Freud's psychoanalytic
+method. Hours and hours of conversation about the most trivial
+occurrences have to be spent to relieve the repressed ideas and to give
+them a chance for a free ascension. It cannot be denied that most of the
+really illuminating work in all these fields has been done by scholars
+who combine a strong theoretical interest with their effort to cure the
+patients, and who therefore examine and treat the individual case
+primarily from the wish to get new insight into the laws of nature. The
+average physician whose time is his income may be the less willing to
+enter into such time-devouring schemes, as the patients too easily may
+think that the physician did not do much for them when he simply was
+sitting down and gossiping with them.</p>
+
+<p>Yet after all, behind all of it stands one motive which has held back
+the development of psychotherapy in the medical profession more than
+anything else. The physician feels instinctively that a real success can
+be reached in every one of these fields, only<span class='pagenum'><a name="Page_364" id="Page_364">[Pg 364]</a></span> if he possesses a
+reasonable amount of knowledge of psychology. He feels that wherever he
+touches the patient's body, examines his lungs or his heart or his
+reflexes, that a large background of anatomical knowledge and of general
+pathology gives meaning to every single observation. But in the field of
+mental abnormities, in the whole world of ideas and emotions and
+volitions, he simply lacks that background. Everything seems to him
+without reference to real knowledge. He feels as amateurish as if he
+were to operate on the abdomen without knowing its anatomy. He is
+instinctively aware that even the simplest mental life represents a
+bewildering complexity and that to stimulate ideas or feelings or to
+suppress emotions, to inhibit volitions, must demand always a most
+subtle disentanglement of the most widely different components. He
+abstains from approaching that ground at all rather than to blunder by
+his ignorance of psychology. And after all, he is right. But is he right
+in allowing that ignorance? Can the medical profession afford to send
+into the world every year thousands of young doctors who are unable to
+use some of the most effective tools of modern medicine, and tools which
+do not belong to the specialist but just to the average practitioner,
+simply because they have not learned any psychology?</p>
+
+<p>Indeed the times seem ripe for a systematic introduction of
+psychological studies into every regular medical course. It is not a
+question of mental research in the psychological laboratory where
+advanced work is carried on, but a solid foundation in empir<span class='pagenum'><a name="Page_365" id="Page_365">[Pg 365]</a></span>ical
+psychology can be demanded of everyone. He ought to have as much
+psychology as he has physiology. Moreover the psychological study ought
+not to be confined to the normal mental life. Again we do not speak of
+psychiatry. What is needed is abnormal psychology, entirely independent
+of the therapeutic interests of the alienist. The mental variations
+within the limits of normal life and the borderland cases ought to be
+studied there as well as the complete derangements. The ideal demand
+would be that the future physician should spend at least a year of his
+undergraduate time on empirical psychology, especially on experimental
+and physiological psychology. He would take perhaps half a year's
+lecture course on the whole field of psychology as covered in the
+English language by the well-known text-books of James, Wundt,
+Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus,
+Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the
+course ought to be either advanced psychology entering into the more
+complex phenomena or a practical training course in elementary
+laboratory psychology as indicated for instance by Titchener's
+"Experimental Psychology. A Manual of Laboratory Practice." If the
+undergraduate can possibly afford the time in his college course, he
+ought to add courses which either lead him towards the philosophical
+problems of psychology or towards the comparative aspect of psychology.
+If he can find time for a year of post-graduate work between college and
+medical school, he could hardly spend it<span class='pagenum'><a name="Page_366" id="Page_366">[Pg 366]</a></span> more profitably than by a year
+of research in a well-conducted psychological laboratory to become
+really acquainted with an independent analysis of mental states. On the
+other hand in the medical school, room must be found for a course in
+abnormal psychology, which of course presupposes a thorough knowledge of
+normal psychology and, if possible, follows the courses on nervous
+diseases and precedes the course on psychiatry.</p>
+
+<p>For the average future physician, it would be wiser to omit even the
+psychiatry studies than those in abnormal psychology. The latter ought
+to lead him far enough to discriminate early between a mere
+neurasthenia, for instance, and a beginning of insanity. As soon as the
+discrimination is perfected and insanity is found, he has to give the
+case out of his care anyhow and hand it over to the specialist and to
+the asylum. The knowledge of psychiatric treatment is, therefore, not
+essential for the average practitioner. But no one can relieve him from
+the responsibility for those borderland cases, for the hysterias and
+psychasthenias and neurasthenias, and he can never master them without
+normal and abnormal psychology. Moreover it must not be forgotten that
+mental factors may enter into every disease. The psychology of pain, for
+instance, and of comfort feeling, the psychology of hunger and thirst,
+of nausea and dizziness, the psychology of the sexual feelings, the
+psychology of hope and fear, of confidence and discouragement, of
+laziness and energy, of sincerity and cunningness play their r&ocirc;le in
+almost every sick<span class='pagenum'><a name="Page_367" id="Page_367">[Pg 367]</a></span> room. And if the physician haughtily declares that he
+does not care for the methods of suggestion, it might justly be asked
+whether he can be a physician at all if he does not apply some
+suggestions; yes, if his very entrance into the sick room does not
+suggest relief and improvement from the start. The introduction of a
+serious study of psychology is the most immediate need of the medical
+curriculum. Instructorships in abnormal psychology must be created in
+every medical school; institutes for psychotherapy should soon follow.
+But in all this, there is nowhere to appear any artificial antithesis
+between mind and body, any more than between organic and functional
+diseases; we have discussed all that with full detail. Only the
+physician who has a thorough psychological preparation can fulfill the
+manifold demands which modern life must raise; he alone is prepared to
+co&ouml;perate with the other factors of the community in the development of
+a sound and healthful nation, to work towards the hygiene of the nervous
+system and of the mental life; and to correct the injuries which the
+perversities of our civilization inflict.</p>
+
+<p>In all that he will not avoid the comradeship of the clergyman. He will,
+of course, not forget the fundamental difference of attitude between
+them, he will not forget that the minister seeks for the meaning and
+values of inner life while he, the physician, has to consider that same
+inner life from a causal point of view and thus has to work with it as
+with natural material for the normal functioning of the organism. But
+the interrelation between them can<span class='pagenum'><a name="Page_368" id="Page_368">[Pg 368]</a></span> be intimate in spite of the
+difference of their standpoints. The minister, to be sure, ought not to
+consider health as such as the greatest good, but he will not forget
+that a wholesome devotion to ideals cannot be carried through when the
+attention is absorbed by the sufferings of the body and the mental
+powers are debilitated. Only in a sound mind the full ideal meanings of
+life can be realized. The minister must therefore seek the health of his
+congregation not because health is the ideal of life but because the
+true ideals cannot be appreciated by the mental cripple. On the other
+hand, the physician from his standpoint should in no way feel it his
+duty to play the amateur minister and to put emphasis on the spiritual
+uplifting of his patients. But he knows well that not a few of the
+suggestive influences which are needed for the relief from disease are
+most effective when an emotional emphasis can be given to the
+suggestions and that this emphasis is for large numbers most powerfully
+supplied by the religious emotion. Thus the minister will be a very
+important assistant to him and the church will most successfully do for
+many patients what for other patients perhaps travel or music or the
+theatre, sport or social life, may do.</p>
+
+<p>Just in the relation to the church, the physician will need subtlest
+discrimination, and he will not forget that while even a strong
+religious emotion may be without damage for a normal man, it may well be
+injurious to the unstable brain. But if the physician uses tact and
+wisdom, he will be surprised to find how often the religious stimulation
+can indeed be helpful<span class='pagenum'><a name="Page_369" id="Page_369">[Pg 369]</a></span> for his purposes and the division of labor
+demands that this be supplied not by himself but by the minister. He
+will advise the consulting sufferer to seek the influence of a godly man
+who awakens in him upbuilding wholesome emotions and volitions. The
+minister may in this way very well become the assistant of the
+physician. But whether this co&ouml;peration is looked on from the one or
+from the other point of view, in every case it needs absolute clearness.
+Nothing is gained and too much is lost if the two functions are
+carelessly mixed together. It is never the task of the minister to heal
+a mind and never the task of a physician to uplift a mind. One moves in
+the purposive sphere, the other in the causal sphere. Their friendship
+can seriously endure only as long as they remain conscious of the fact
+that they have two entirely different functions in the service of
+mankind.<span class='pagenum'><a name="Page_370" id="Page_370">[Pg 370]</a></span></p>
+
+
+
+<hr class="section" />
+
+<h2><a name="XIV" id="XIV"></a>XIV<br /><br />
+<span class="sub">PSYCHOTHERAPY AND THE COMMUNITY</span><span class="totoc"><a href="#toc">Contents</a></span></h2>
+
+
+<p>Both the physician and the patient find their place in the community the
+life interests of which are superior to the interests of the individual.
+It is an unavoidable question how far from the higher point of view of
+the social mind the psychotherapeutic efforts should be encouraged or
+suppressed. Are there any conditions which suggest suspicion of or
+direct opposition to such curative work?</p>
+
+<p>Of course society has to be sure that no possible misuse and damage are
+to result from such practice. Fears in that direction have been uttered
+repeatedly, but from very different standpoints. One which is perhaps
+most often heard in popular circles results from an entire
+misunderstanding and deserves hardly any discussion after our detailed
+study of the processes involved. It is claimed that suggestive power,
+especially in the form of hypnotization, may be secretly misused to make
+anyone without his knowledge and against his will a passive instrument
+of the hypnotist's intent. Often this is coupled with telepathic
+fancies. The hypnotist is believed to have mystic power to bring any
+person in a distant region<span class='pagenum'><a name="Page_371" id="Page_371">[Pg 371]</a></span> under his mental control and thus to be able
+to carry out any sinister plans by the help of his innocent victim. All
+hypnotizing therefore ought to be interdicted by the state. The
+presuppositions of such a view are, as we know now, entirely absurd. We
+know that hypnotism is not based on any special power of the hypnotizer;
+there is no magnetic fluid in the sense of the old mesmerism. The
+imagination of the hypnotized person is the only hypnotizing agency.
+Thus no one can be hypnotized without his knowledge or against his will.
+The story of telepathic mysteries which is often brought before the
+public is probably always the outcome of a diseased brain. It is indeed
+a frequent symptom in paranoia and other insanities that the patient who
+feels abnormal organic sensations and abnormal unaccountable impulses
+interprets them as influences of a distant enemy. Whole pamphlets have
+been written with elaboration of such insane misinterpretations and
+requests to legislatures have been made in that spirit, but the
+physician recognizes easily throughout the whole argumentation the
+well-known phenomena of the mental disease.</p>
+
+<p>To be sure, while no one can be hypnotized against his will, many a
+person is liable to accept suggestions from others and thus to carry out
+the wishes of others almost without knowing and certainly without
+willing that the other mind interfere with the interplay of the own
+motives. But if we were to strike out all suggestive influences from
+social life, we should give up social life itself. Suggestion is given
+wherever<span class='pagenum'><a name="Page_372" id="Page_372">[Pg 372]</a></span> men come in contact; in itself it is neither good nor bad. The
+good resolution and the bad one can be suggested, the good example and
+the bad can be effective; both encouragement of the noble and imitation
+of the evil may work with the same mental technique. Certainly there are
+some persons who have a stronger influence than others on the
+imagination of those with whom they come in contact; their expression
+awakens confidence, their voice and their words reach deeper layers of
+the mind, their calmness and firmness overwhelm more easily the
+antagonistic ideas. But the chief difference lies after all in the
+different degrees of suggestibility among those who receive such
+impressions. The easily suggestible person cannot be protected by any
+interdict; he may catch suggestions everywhere, any advertisement in the
+newspaper and any display in the shop-window may overrun his own
+intentions. What he needs is training in firmness. The application of
+re&euml;nforced suggestion or even of hypnotism in the doctor's office is
+even for him no possible source of danger.</p>
+
+<p>On a higher level are objections which come from serious quarters and
+which are not without sympathy with true science. In recent times this
+opposition has repeatedly found eloquent expression. It is an objection
+from the standpoint of morality, belonging therefore entirely to the
+purposive view of the mind, but we have now reached a point where it is
+our duty to do justice to this purposive view too. As long as we
+discussed the problem entirely from the stand<span class='pagenum'><a name="Page_373" id="Page_373">[Pg 373]</a></span>point of the physician, no
+other view of mental life except the causal one could be in question. As
+soon as we look at it from the standpoint of the community, it becomes
+our duty to bring the causal and the purposive view into harmony, and it
+would be narrow and short-sighted simply to draw the practical
+consequences of a naturalistic view of the mind without inquiring
+whether or not serious interests in the purposive sphere are injured. If
+there is moral criticism against suggestive therapy, it is the duty of
+the community to consider it. This opposition argues as follows:
+Hypnotic influence brings the patient under the will control of the
+hypnotizer and thus destroys his own freedom. Whatever the patient may
+reach in the altered states is reached without his own effort, while he
+is the passive receiver of the other man's will. His achievement has
+therefore no moral value, and if he is really cured of his drunkenness
+or of his perverse habits, of his misuse of cocaine or of his criminal
+tendencies, he has lost the right to be counted a moral agent. It would
+be better if there were more suffering in the world than that the
+existence of the moral will should be undermined.</p>
+
+<p>No one ought to take such arguments lightly. The spirit which directs
+them is needed more than anything else in our time of reaching out for
+superficial goods. No one can insist too earnestly that life is worth
+living only if it serves moral duties and moral freedom and is not
+determined by pleasures and absence of pain only. Those who set forth
+this argument are entirely willing to acknowledge the pro<span class='pagenum'><a name="Page_374" id="Page_374">[Pg 374]</a></span>found effect
+which suggestive therapeutics may create. More than this, they have to
+acknowledge it to gain a basis for their attack. Just because the
+hypnotizer can entirely change the desires and passions, the habits and
+perversities of the suffering victim, he seems to them a moral wrongdoer
+who negates the principle of human freedom. A forcible book of recent
+days calls the suggestive power of the psychotherapist "The Great
+Psychological Crime." It says to the hypnotist: "By your own testimony,
+you stand convicted of applying a process which deprives your subjects
+of the inalienable right and power of individual self-control. In
+proportion as you deprive him of the power of self-control, you deprive
+him of that upon which his individual responsibility and moral status
+depend. In proportion as you deprive him of the free control and
+exercise of those powers of the soul upon which his individual
+responsibility and moral status depend, you thereby rob him of those
+powers upon which he must depend for the achievement of individual
+immortality."</p>
+
+<p>But this censure too is entirely mistaken, not because it urges the
+purposive views against the causal but because it is in error as to the
+facts. Such critics are fully under the influence of the startling
+results which are reached; they do not take the trouble to examine the
+long and difficult way which has had to be traversed with patience and
+energy. It is quite true that if I hypnotize a man and suggest to him to
+take up after awaking the book which lies on my table, he follows my
+suggestion without conflict and in a<span class='pagenum'><a name="Page_375" id="Page_375">[Pg 375]</a></span> certain sense without freedom. He
+feels a simple impulse to go to the table and lift the book and, as no
+stronger natural desire and no moral objection stand in the way, he
+carries out that meaningless impulse and perhaps even invents a foolish
+motive to explain to himself why he wanted to look at that book. But
+after a long experience, I have my doubts as to whether a man was ever
+cured in such a way by hypnotism of serious disturbances and of those
+anomalous actions which the critics want to see overcome by the
+patient's own moral efforts. On the contrary, every suggestion has to
+rely on the efforts and struggles of the patient himself and all that
+the psychotherapists can give him is help in his own moral fight. His
+own will is presupposition for being hypnotized and for realizing the
+suggestion. If again and again I hesitate to undertake new cases, it is
+just because I have to see during the treatment too much of this daily
+and hourly striving against overpowering impulses. The joy of removing
+some obstacles from the way of the patients is too much overshadowed by
+the deep pity and sympathy with their suffering and craving during the
+whole period of successive treatments. To make a man fight where despair
+is inevitable, and where the enemy is necessarily stronger than his own
+powers, can certainly not be the moral demand. Morality postulates that
+everyone find conditions in which he can be victorious if he puts his
+strongest efforts to the task.</p>
+
+<p>In our discussion of the mental symptoms I re<span class='pagenum'><a name="Page_376" id="Page_376">[Pg 376]</a></span>ported as an illustration
+of the suggestive treatment of the drug passion the case of a
+morphinist. To make clear this purposive side of the case as against the
+causal one which alone interested the physician, I may add a few
+features to the short report as a typical example. When that man left my
+laboratory for the last time to go out to work and happiness, you might
+well have believed from his joyful face that it had been an easy and
+pleasant time in which hypnotic influence smoothly removed from him the
+dangerous desire for morphine. In truth it was the result of four months
+of the most noble and courageous suffering and struggling. He had been
+for years a slave to his passion. To quote from his little
+autobiography: "When I realized that I was addicted to morphine, I was
+at first not at all worried as I did not then understand the real horror
+of the thing, and did not then realize all the future suffering and
+misery that is coming to anyone who is the user of opium or any of its
+alkaloids. For the first few months, I found great relief after every
+injection of morphine, but soon I could not get the same easy feeling
+and could eat but very little and what sleep I got was in the daytime. I
+finally went to the sanitarium of a doctor but it was simply a
+money-making business for him; if he ever cured anyone, I never heard of
+it. I then tried another one; it was the same kind of a place as the
+former. When I first went to see the professor in the Harvard
+Psychological Laboratory, I was using between thirty-two and
+thirty-eight grains of morphine daily. He put me<span class='pagenum'><a name="Page_377" id="Page_377">[Pg 377]</a></span> under his treatment
+October 6th and that day cut me down by hypnotic treatment to nine
+grains a day or three doses of three grains a day. I took my hypodermic
+as directed, but on the following day I lay on the bed too exhausted to
+get up even to get around the room, and I could not eat and only drank a
+very little water. The desire for the drug was something terrible. But
+in about four days I got used to the loss of so much morphine and stayed
+on this amount for a week, seeing the professor every other day for
+hypnotic treatment and then returning to my room where I spent
+twenty-two hours of the twenty-four on the bed, but did not sleep more
+than two or three hours a day. At the end of the week I was cut off by
+hypnotic suggestion half a grain and this put me to fighting the desire
+again. This lasted two or three days and then I began to feel better and
+began to sleep a little more. But at the end of the week I was cut off
+another half grain, and the whole fight would have to be begun over.
+These reductions of the dose were made a week apart and sometimes only
+two days. The worst time of all was a cut from four injections of a
+fourth of a grain each to four of one eighth of a grain each, which was
+about January 10th. At this time I had the worst two days of my life. I
+tried whiskey, but it gave relief only for about half an hour and then
+the desire was worse than ever."</p>
+
+<p>In this way every few days I gave the poor fellow under hypnotic
+influence the suggestion to reduce the dose of morphine in a prescribed
+way, and with<span class='pagenum'><a name="Page_378" id="Page_378">[Pg 378]</a></span> enormous effort he withstood his craving for more, in
+spite of the fact that he had during all this winter a bottle with a
+thousand tablets of morphine, prescribed by an unscrupulous physician,
+in his writing desk. He was thus at every moment during the day and
+night in full possession of the deadly poison with which he could have
+fully satisfied his craving. It was a moral victory when he finally
+reached the point at which he went for several weeks without any desire
+for morphine and finally presented the remaining tablets to a hospital.
+And yet there would not have been the least chance for his winning this
+ethical victory without the outer help of the hypnotist. We do not
+eliminate the moral will but we remove some unfair obstacles from its
+path. We have no mystic power by which our will simply takes hold of the
+other man's will, but we inhibit and suppress by influence on the
+imagination those abnormal impulses which resist the sound desires. If
+that were immoral, we should have to make up our minds that all
+education and training were perverted with such immoral elements. Every
+sound respect for authority which makes a child willing to accept the
+advice and maxims of his elders is just such an influence. If it were
+really a moral demand that the will be left to its own resources and
+that no outside influence come to strengthen its power or remove its
+hindrances or smooth its path, then we ought to let the children grow up
+as nature created them and ought not to try to suppress from without by
+discipline and training, by love and encouragement, the willful
+impulses<span class='pagenum'><a name="Page_379" id="Page_379">[Pg 379]</a></span> and the ugly habits. Even every good model for imitation is
+such a suggestive influence from without and every solemn appeal to
+loyalty and friendship, to patriotism and religion, increases the degree
+of suggestibility. That is the glory of life that the suggestive power
+may belong to moral values instead of mere pleasures, but it is not the
+aim of life to remain untouched by suggestion. And he who by suggestion
+helps the weak mind to overcome obstacles which the strong mind can
+overthrow from its inborn resources works for the good of the individual
+and of the community in the spirit of truest morality.</p>
+
+<p>Much more justified than such ethical objections are the fears which
+move entirely in the causal sphere. It must be acknowledged that a
+method which has such powerful influence over the mind that it can
+secure ideas and emotions and impulses which the own will of the patient
+cannot produce, ought to be allowed only to those who are prepared for
+its skillful use. To hypnotize or to perform any persistent
+psychotherapeutic treatment may thus be dangerous, if it is done by the
+unfit. We have discussed before the injuries which might result from the
+administration of such powerful psychotherapeutic effects through the
+best meaning minister, but we can extend this fear to anyone who has not
+systematically studied medicine and to a certain degree normal and
+abnormal psychology. The possibilities of overlooking symptoms which
+ought to suggest an entirely different treatment, or of adjusting the
+treatment badly to the special physical conditions, or of ignoring the<span class='pagenum'><a name="Page_380" id="Page_380">[Pg 380]</a></span>
+desirable physical supplement by drugs, or of creating unintentionally
+by suggestion injurious effects, are always open when medical amateurs
+undertake such work. Certainly there is no physician who is not liable
+to make mistakes, and a physician who has never given any attention to
+psychology and psychiatry would also be a rather poor agent of
+psychotherapeutic methods, but the probability is that such a physician
+would simply abstain by principle from all psychotherapeutic methods;
+his mistake only begins if from his lack of acquaintance with the
+subject he draws the conclusion that the method itself is undesirable.
+That his real preparation ought to include psychological studies we have
+pointed out before, and the time seems ripe for the community to urge
+such a reform of the studies.</p>
+
+<p>All that involves the conviction that even the experimental psychologist
+as such is not prepared to enter into medical treatment; and a
+"Psychological Clinic," managed by a psychologist who is not a doctor of
+medicine, is certainly not better than a church clinic. I cannot even
+acknowledge the right of psychologists to make hypnotic experiments
+merely for the psychological experiment's sake. Nobody ought to be
+brought into a hypnotic or otherwise abnormal state of mind if it is not
+suggested by the interests of the subject himself. Science has the right
+to make hypnotic experiments, or experiments with abnormal mental
+states, only under the one condition that a physician has hypnotized the
+subject in the interests of his health and that the patient has agreed
+before<span class='pagenum'><a name="Page_381" id="Page_381">[Pg 381]</a></span>hand to allow in the presence of witnesses certain psychological
+studies. Needless to say that any hypnotization for mere amusement and
+as a parlor trick ought to be considered as criminal.</p>
+
+<p>On some other objections which interest the community as such we had to
+touch before, and there is no need of returning to them with any
+fullness of argument. We spoke of the danger which the mental cures
+carry with them when they are based on any particular creed, and
+especially when they are tied up with a semi-religious arbitrary
+metaphysics. What is gained if some nervous disorders are helped by
+belief, if the belief itself devastates our intellectual culture and
+brings the masses down again to a view of the world which has all the
+earmarks of barbarism? That is indeed one of the central dangers of all
+non-medical suggestive cures, that while any belief may cure through the
+mere emotional power of the act of believing, the content of the belief
+gains an undeserved appearance of truth. Any absurd superstition can
+become accredited because its curative value may be equal to a truly
+valuable suggestion. The intellectual life of the community would have
+to suffer greatly if the way to be freed from bodily suffering had to be
+the belief in the metaphysical doctrines of Mrs. Eddy's "Science and
+Health." From a cultural viewpoint, too, suggestive therapeutics must
+stand the higher, the more sharply it is separated from special
+philosophical or religious doctrines. No theory of the world and of God
+ought to gain authority over the mind from such<span class='pagenum'><a name="Page_382" id="Page_382">[Pg 382]</a></span> an external motive as a
+belief in its curative effects. Freest from such implications is
+certainly the hypnotic method of the physician who does not need the
+strong religious re&euml;nforcement of the suggestion because he re&euml;nforces
+instead the suggestibility of the patient by slight influences on his
+senses.</p>
+
+<p>Even where sound religion without superstition and without
+pseudophilosophy stands behind the therapeutic work, the community will
+not give up the question whether the church does not necessarily neglect
+by it the interests which are superior. The community becomes more and
+more strongly aware that too many factors of our modern society urge the
+church to undertake non-religious work. Social aid and charity work
+ought to be filled with religious spirit, but to perform it is not
+itself religion. Still more that is true of the healing of the sick.
+Whether or not such expansion of church activity in different directions
+saps the vital strength of religion itself is indeed a problem for the
+whole community. The fear suggests itself that the spiritual achievement
+may become hampered, that in the competition of the church with the
+other agencies of social life the particular church task may be pushed
+to the background, and that thus the church in imitating that which
+others can do just as well or better loses the power to do that which
+the church alone can do. The final outcome is therefore practically in
+every way the same. From whatever starting point we may come, we are led
+to the conviction that the physician alone is called to administer
+psychothera<span class='pagenum'><a name="Page_383" id="Page_383">[Pg 383]</a></span>peutic work, but that he needs a thorough psychological
+training besides his medical one.</p>
+
+<p>But the interest of the community is not only a negative one. Society
+does not only ask where psychical treatment can be dangerous, but asks
+with not less right whether the scheme and the method might not be
+fructified for other social ends besides the mere healing of the sick.
+If psychotherapy demonstrates that for instance hypnotism makes possible
+the reshaping of a pathological mind, it is a natural thought to use the
+same power for remodeling perhaps the lazy or the intemperate, the
+careless or the inattentive, the dishonest or the criminal mind. Both
+educators and criminologists have indeed often raised such questions,
+and social reformers have not seldom seen there wide perspectives for
+social movements in future times.</p>
+
+<p>There can be no doubt that the possibility of such remodeling activity
+is given, but as far as education is concerned certainly grave
+misgivings ought to be felt. When we spoke of the treatment of the sick,
+we had always to emphasize that the suggestion cures symptoms but not
+diseases. In the same way hypnotic suggestion might re&euml;nforce a single
+trait but would not reform the personality of the child. Yes, the
+artificial re&euml;nforcement of such special features would deprive
+education of that which is the most essential, namely, the development
+of the power to overcome difficulties by own energy. Wherever a
+reasonable amount of own will force and attention can be expected to
+overcome the antagonistic influ<span class='pagenum'><a name="Page_384" id="Page_384">[Pg 384]</a></span>ence, there artificial hypnotic
+influence ought to be avoided. Everything ought to be left in that case
+to suggestions within normal limits, in the form of good example and
+persuasions, authority and discipline, love and sympathy. That holds
+true even for very slight abnormalities which seem still within the
+limits where the own energies can bring about the cure. For instance, I
+have steadily refused requests of students and others to use hypnotism
+for the purpose of overcoming merely bad habits, such as the habit of
+biting the nails. A child who finds some difficulty in sticking
+seriously to his tasks might learn now this and now that under the
+influence of hypnotic suggestions but he would remain entirely untrained
+for mastering the next lesson. In the same way some naughty traits might
+be artificially removed but the child would not gain anything towards
+the much more important power of suppressing an ugly tendency by his own
+effort. All that finds its limits where the inhibitions or obstacles in
+the brain of the child are too strong possibly to be overcome by the own
+good will, but in that case we already stand in the field of abnormal
+mental life and then of course psychotherapy has its right. The
+feeble-minded and the retarded child, the perverse child and the
+emotionally unstable child, belong under the care of the physician, and
+in such a case he ought not to hesitate to use the whole supply of
+psychotherapeutic methods which are at his disposal.</p>
+
+<p>Still more complex is the criminological problem. It sounds like an easy
+remedy for the greatest social<span class='pagenum'><a name="Page_385" id="Page_385">[Pg 385]</a></span> calamity, if it is proposed simply to
+hypnotize the criminal and to supplant his antisocial will by a moral
+one. And if the absurdity of such a proposal is recognized it seems to
+many justified to demand such an intrusion at least in the case of the
+born criminal, even if the occasional criminal cannot be reached. But
+the conception of the born criminal is also only a label which is
+superficially used for a great variety of minds. That men are born with
+a brain which necessarily produces criminal actions is not indicated by
+any facts. The varieties which nature really produces are brains which
+are more liable than others to produce antisocial actions. We recognized
+from the start that the abnormal mind never introduces any new elements
+but is characterized only by a change of proportions. There is too much
+or too little of a certain mental process and just for that reason there
+must be a steady and continuous transition from the normal to the
+entirely abnormal. Here again we have not a special class of brains
+which are criminal; but we have an endless variety of brains with a
+greater or smaller predisposition for antisocial outbreaks. The
+variations which produce this criminal effect may lie in most different
+directions.</p>
+
+<p>The brain may be for instance inclined to overstrong impulses, so that
+any desire rushes to action before the inhibiting counter-idea gets to
+work. Or, on the other hand, the brain may have unusually weak
+counter-ideas so that even a normal impulse does not find its normal
+checking. The fact that selfish and thus antisocial desires awake in the
+mind<span class='pagenum'><a name="Page_386" id="Page_386">[Pg 386]</a></span> is not abnormal at all; only if they are not normally inhibited,
+the disturbance sets in. Furthermore the associative apparatus of the
+brain may work especially slowly; it may thus bring it about that the
+counteracting ideas do not arise in time. Or the emotions of a person
+may be unusually strong. Or there may be strong suggestibility, by which
+a bad example or a strong temptation has especially easy access. Or
+there may be negative suggestibility, by which a moral admonition stirs
+up a vivid idea of the opposite. In short, there may be a large number
+of factors, sometimes even in combination, each one of which increases
+the chances that the individual may come in danger in the midst of
+developed society. Yet no one of those factors involves just the
+necessity of crime. The same kinds of brains might simply show stupidity
+or credulity or inconsiderateness or brutality or stubbornness or
+egotism, and might by each of those factors decrease their chances in
+the community without directly running into conflict with the law. The
+criminal is therefore never born as such. He is only born with a brain
+which is in some directions inefficient and which thus, under certain
+unfavorable conditions, will more easily come to criminal deeds than the
+normal brain.</p>
+
+<p>With the idea of a stereotyped born criminal there disappears also the
+idea of a uniform treatment against criminal tendencies. That men are
+different in their power of resistance or in their power of efficiency
+or in their intellect or in their emotions, we have to accept as the
+fundamental condition with<span class='pagenum'><a name="Page_387" id="Page_387">[Pg 387]</a></span> which every society starts. It would be
+absurd to remodel them artificially after a pattern. The result would be
+without value anyhow, inasmuch as our appreciation is relative. No
+character is perfect. The more the differences were reduced, the more we
+should become sensitive even for the smaller variations. All that
+society can do is, therefore, not to remodel the manifoldness of brains,
+but to shape the conditions of life in such a way that the weak and
+unstable brains also have a greater chance to live their lives without
+conflicts with the community.</p>
+
+<p>The situation is different as soon as the particular surroundings have
+brought it about that such a brain with reduced powers has entered a
+criminal career. The thought of crime now becomes a sort of obsession or
+rather an autosuggestion. The way to this idea has become a path of
+least resistance, and as soon as such an unfortunate situation has
+settled itself, the chances are overwhelming that a criminal career has
+been started. If such cases should come early to suggestive treatment
+which really would close the channels of the antisocial autosuggestion,
+much harm might be averted. Yet again the liability of the brain to
+become antisocial would not have been removed, and thus not much would
+be secured unless such a person after the treatment could be kept under
+favorable conditions. With young boys who through unfortunate influence
+have caught a tendency, for instance, to steal, and where the fault does
+not yield to sympathetic reasoning and to punishment, an early hypnotic
+treatment might certainly be tried. I my<span class='pagenum'><a name="Page_388" id="Page_388">[Pg 388]</a></span>self have seen promising
+results. But if the impulse has irresistible character in such a way
+that the good will is powerless, we are again in the field of disease
+and the point of view of the physician has to be substituted for that of
+the criminologist.</p>
+
+<p>Whether pedagogy and criminology are to make use of the services of
+psychotherapy is thus certainly an open question. It would be
+short-sighted to overlook the serious obstacles which stand in the way.
+But while the social life outside of the circle of real disease may
+better go on without direct interference by psychotherapeutic
+influences, it is certainly the duty of the community to make the
+underlying principles of psychotherapy useful for the sound development
+of society. The artificial over-suggestions which are needed to overcome
+the pathological disturbances of mental equilibrium may be left for the
+cases of illness. But we saw that every mental symptom of disease was
+only an exaggeration of abnormal variations which occurred within the
+limit of health. To reduce these abnormalities means to secure a more
+stable equilibrium and thus to avoid social damages, and at the same
+time to prevent the growth of the abnormality to pathological
+dimensions. To counteract these slighter variations, these abnormalities
+which have not yet reached the degree of disease, will demand the same
+principles of treatment, only in a weaker form. It is in a way not
+psychical therapy but psychical hygiene. And this is no longer confined
+to the physician but must be intrusted to all organs of the community.
+And here more<span class='pagenum'><a name="Page_389" id="Page_389">[Pg 389]</a></span> than in the case of disease, the causal point of view of
+the physician ought to be brought into harmony with the purposive view
+of the social reformer, of the educator and of the moralist.</p>
+
+<p>The ideal of such mental hygiene is the complete equilibrium of all
+mental energies together with their fullest possible development. To
+work towards this end does not mean to aim towards the impossible and
+undesirable end of making all men alike, but to give to all, in spite of
+the differences which nature and society condition, the greatest
+possible inner completeness and outer usefulness. The efforts in that
+direction have to begin with the earliest infancy and are at no age to
+be considered as finished; the whole school work and to a high degree
+the professional work has to be subordinated to such endeavor. Society
+has further to take care that those spheres of life which stand less
+under systematic principles, such as the home life of the child and the
+social life of the man, his family life and his public life, are
+steadily under the pressure of influences which urge in the same
+direction.</p>
+
+<p>Harmonious development without one-sidedness, and yet with full justice
+to the individual talents and equipments, should be secured. That means
+from the start an effort to secure balance between general education and
+particular development. The latter has to strengthen those powers by
+which the boy or girl by special natural fitness promises to be
+especially efficient and happy. It has to be supplemented later by a
+wise and deliberate choice of such a vocation as<span class='pagenum'><a name="Page_390" id="Page_390">[Pg 390]</a></span> brings these
+particular abilities most strongly to a focus. Yet this alone would mean
+a one-sidedness in which the equilibrium would be lost. More important,
+it would leave undeveloped that power which the youth especially needs
+to acquire by serious education, the power to master what does not
+appeal to the personal likings and interests. An equilibrium is secured
+only if at the same time full emphasis is given to the learning and
+training in all which is the common ground of our social existence. From
+the multiplication table to the highest cultural studies in college, the
+youth is to be adjusted to the material of our civilization without any
+concession to the emasculating desire to adjust civilization simply to
+the particular youth. He has to learn learning and not only to play with
+knowledge, he has to learn to force his attention in adjustment to those
+factors of civilization which are foreign to his personal tendencies and
+perhaps unsympathetic. Free election of life's work and unyielding
+mental discipline in the service of the common demands should thus
+steadily co&ouml;perate. The one without the other creates a lack of mental
+balance which is the most favorable condition for a pathological
+disturbance.</p>
+
+<p>The mere learning is of course on both sides only a fraction of what the
+community has to develop in the youth. Mental hygiene begins with
+physiological hygiene. The nourishment of the child, the care for the
+child's sense organs, the recesses and the rest from fatigue, and
+especially the undisturbed sleep are essential conditions. The
+interferences with suf<span class='pagenum'><a name="Page_391" id="Page_391">[Pg 391]</a></span>ficient sleep are to a high degree responsible
+for the later disturbances of the mental life. It must not be forgotten
+that the decomposition of the brain molecules can never be restituted by
+anything but rest, and ultimately by sleep. Physical exercise is
+certainly not such restitution. In the best case it brings a certain
+rest to some brain centers by engaging other brain parts. The child
+needs sleep and fresh air and healthful food more than anything else, if
+his mind is active. The careful examination of the sense organs and of
+the unhindered breathing through the nose is most important. Even a
+slight defect in hearing may become the cause of an under-development of
+attention.</p>
+
+<p>More important than mere physical hygiene is the demand that a sound
+character and a sound temperament are also to be built up, at the side
+of a sound interest. Here again everything depends upon a wise balance
+between the development of that which is given by nature to the
+particular individual and the re&euml;nforcement of that which society
+demands and which belongs therefore to the common equipment. The
+emotional stability and emotional enlargement of the mind is perhaps
+most neglected in our educational schemes. On the one side it demands a
+systematic discipline of the emotions, on the other a healthy
+stimulation of emotions. Here is the place where imagination in play and
+later in art come in. The biological value of play always lies in the
+training for the functions of later life, and especially for the
+emotional functions. The play of our children<span class='pagenum'><a name="Page_392" id="Page_392">[Pg 392]</a></span> is too little adjusted to
+this task. For this reason it leaves too many unprepared for the world
+of art and for the emotional experiences of real life. Both lack of
+emotional discipline and narrow one-sidedness of emotions interfere with
+the harmonious development. Destructive emotions like terror ought to be
+kept away and not needlessly brought near by uncanny stories and mystic
+superstitions. It is the healthy love and sympathy of the home which
+contributes most strongly to the normal development of emotions. Again
+in the field of will, we want the strong, spontaneous, independent will
+which is not frightened by discomfort and not discouraged by obstacles,
+and yet we want the will which is not stubborn and selfish but which
+subordinates itself to the larger will of the social group and to the
+eternal will of the norm. There is no balance where independence and
+subordination do not supplement each other. A wide education not only
+trains for both but also secures habits which work as autosuggestions in
+both directions.</p>
+
+<p>But all this harmonious development of intellect and temperament and
+character has to go on when the school days are over and just here
+begins the duty of the community as a whole. The special functions of
+the teachers have to be taken up by the public institutions. The whole
+social life must shape itself in such a way that everyone finds the best
+possible chances to perfect this harmonious growth. In the field of the
+intellect, the community must take care that thoroughness of training
+and accuracy of infor<span class='pagenum'><a name="Page_393" id="Page_393">[Pg 393]</a></span>mation is rigidly demanded and not thrust out by
+an easy-going superficiality. The expert ought to replace the amateur in
+every field. Every society which allows successes to superficiality
+diminishes its chances for mental health. Yet while thoroughness demands
+concentration in one direction, society must with the same earnestness
+insist on well-rounded general education and continuity of general
+interests through life. Literature and the libraries, the newspapers and
+the magazines play there a foremost r&ocirc;le, and again the mental health of
+the community has to pay the penalty if its newspapers work against
+general culture. In the emotional field art and music, fiction and the
+theater on the one side, the church on the other side, remain the great
+schools for a development of sound emotions. Where literature becomes
+trivial, where the stage becomes degraded, and where the church becomes
+utilitarian and uninspiring, great powers for possible good in emotional
+education are lost. But with this enrichment of feelings the
+disciplinary influence too has to go through the whole social life.
+Where art is sensational and the church hysterical,&mdash;in short, where the
+community stirs up overstrong feelings,&mdash;the wholesome balance is lost
+again. In a similar way the public demands should throughout stimulate
+the energy and ambitions and initiative of the man, and yet should keep
+his desires and impulses in control.</p>
+
+<p>Few factors are more influential in all these directions than the
+administration of law. Sound sober lawmaking and fair judgment in court
+secure to the<span class='pagenum'><a name="Page_394" id="Page_394">[Pg 394]</a></span> community a feeling of safety which gives stability to
+emotions and feelings. The disorganization which results from arbitrary
+laws, from habitual violation of laws, from corruption and injustice
+works like a poison on the psychophysical system. A similar unbalancing
+influence emanates from overstrong contrasts of poverty and comfort. A
+poverty which discourages and leaves no chances and a wealth which
+annihilates the energies and effaces the consciousness of moral
+equality, create alike pernicious conditions for mental balance.</p>
+
+<p>Unlimited furthermore are the influences which depend upon the sexual
+ideas of the society. It is the sphere in which it may be most difficult
+to indicate the way towards a development without dangers. There is no
+doubt the arbitrary suppression of the sexual instinct must be
+acknowledged as the source of nervous injury while indulgence may lead
+to disease and misery. But in any case frivolous habits and easy divorce
+contribute much to the unbalanced life which ruins the unstable
+individual. Not less difficult and not less connected with the mental
+hygiene is the alcohol problem. For normal adult men mild doses have
+through their power to relieve the inhibitions undeniable value for the
+sound development of the community. Its intemperate use or its use by
+young people and by pathological persons is one of the gravest dangers.
+Whether intemperance ought to be fought by prohibition or rather by an
+education to temperance is a difficult question in which the
+enthusiastic women and ministers, backed by the<span class='pagenum'><a name="Page_395" id="Page_395">[Pg 395]</a></span> well justified fears of
+psychiatrists, will hardly be on the same side as the sober judgment of
+scientists, unprejudiced physicians, and historians. In any case the
+saloon and its humiliating indecency must disappear and every temptation
+to intemperance should be removed. Above all, from early childhood the
+self-control has to be strengthened, the child has to learn from the
+beginning to know the limits to the gratification of his desires and to
+abstain from reckless over-indulgence. With such a training later on
+even the temptations of alcoholic beverages would lose their danger. Not
+less injurious than the strong drinks are the cards. All gambling from
+the child's play to the stock exchange is ruinous for the psychophysical
+equilibrium. The same is true of any overuse of coffee and tea and
+tobacco, and as a matter of course still more the habitual use of the
+drugs like the popular headache powders and sleeping medicines. The life
+at home and in public ought to be manifold and expansive but ought to
+avoid over-excitement and over-anxiety. A good conscience, a congenial
+home, and a serious purpose are after all the safest conditions for a
+healthy mind, and the community works in preventive psychotherapy
+wherever it facilitates the securing of these three factors.</p>
+
+<p>For that end society may take over directly from the workshop of the
+psychotherapist quite a number of almost technical methods. Suggestion
+is one of them. The means of suggestion through education and art,
+through the church and through public opinion, through example and
+tradition, and even through<span class='pagenum'><a name="Page_396" id="Page_396">[Pg 396]</a></span> fashion and prejudices, are millionfold,
+but not less numerous are the channels for antisocial and antihygienic
+suggestions. No one can measure the injury done to the psychophysical
+balance of the weaker brains, for instance, by the sensational court
+gossip and reports of murder trials in the newspapers for the masses.
+But while the influence of suggestion is on the whole familiar to public
+opinion, the community is much less aware of another factor which we
+found important in the hands of the psychotherapist. We recognized that
+mental disturbances were often the result of suppressed emotion and
+repressed wishes. For the cure the psychotherapist has to aim toward the
+cathartic result. The suppressed ideas had to be brought to
+consciousness again and then to be discharged through vivid expression.
+Society ought to learn from it that few factors are more disturbing for
+the mental balance than feelings and emotions which do not come to a
+normal expression. It is no chance that in countries of mixed Protestant
+and Catholic civilization, the number of suicides is larger in
+Protestant regions than in the Catholic ones where the confessional
+relieves the suppressed emotions of the masses. This is also the most
+destructive effect of social and legal injustice; emotions are
+strangulated and then begin to work mischief. The community should take
+care early that secret feelings are avoided, that the child is cured
+from all sullenness which stores up the emotion instead of discharging
+it. Certainly all education and social life demands inhibition and also
+the child has to learn not to give ex<span class='pagenum'><a name="Page_397" id="Page_397">[Pg 397]</a></span>pression to every passing feeling.
+To find there the sound middle way is again the real hygienic ideal. Too
+much in our social life and especially in the sphere of sexuality forces
+on the individual a hypocrisy and secrecy which is among the most
+powerful conditions of later mental instability.</p>
+
+<p>Of course the background of a hygienic life of the community remains the
+philosophy of life which gives unity to the scattered energies and
+consequently steadiness to the individual through all his hazards of
+fate. It might seem doubtful whether society could get the prescription
+for such a steady view of the world also from the workshop of the
+psychotherapist. To the superficial observer the opposite might seem
+evident, as every word of our psychotherapeutic study indicated that
+that is a view of life which makes man's inner experience simply an
+effect of foregoing causes. All life becomes a psychophysical mechanism
+and from that point of view man's thinking and acting become the
+necessary outcome of the foregoing conditions. Nothing seems more unfit
+to give a deeper meaning to life and a higher value. And yet if there
+was one thought which controlled our discussion from the beginning, it
+was certainly the conviction that this causal view itself is only an
+instrument in the service of idealistic endeavors; the reality of man's
+life is the reality of will and freedom directed towards ideals. One of
+these ideals is the reconstruction of the world in the thought forms of
+causality. In the service of our ideals we may thus transform the world
+into a mechanism: out of our<span class='pagenum'><a name="Page_398" id="Page_398">[Pg 398]</a></span> freedom we desire to conceive ourselves as
+necessary products. Whenever we aim to produce changes in the world, we
+must calculate the effects through the means of this causal
+construction, but we never have a right to forget that this calculation
+itself is therefore only a tool and that our reality, in which our
+duties and our real aims lie, is itself outside of this construction.
+The psychotherapist wants to produce effects inasmuch as he wants to
+cure disease. He is therefore obliged to adjust his work as such
+entirely to the causal aspect of man, as soon as he wants to seek the
+means by which he can reach the end. But even the fact that he decides
+in favor of those ends, that he aims towards their realization, binds
+him to a world of purposes, and therefore, he, too, with his whole
+psychophysical work, stands with both feet in a reality of will which is
+controlled not by causes but by purposes, not by natural laws but by
+ideals.<span class='pagenum'><a name="Page_399" id="Page_399">[Pg 399]</a></span></p>
+
+
+
+
+<hr class="section" />
+<h2><a name="INDEX" id="INDEX"></a>INDEX</h2>
+
+
+<ul class="none"><li>Abnormal, <a href='#Page_75'><b>75</b></a></li>
+
+<li>Abstinence, <a href='#Page_281'><b>281</b></a></li>
+
+<li>Action, <a href='#Page_34'><b>34</b></a>, <a href='#Page_101'><b>101</b></a>, <a href='#Page_276'><b>276</b></a></li>
+
+<li>Adenoids, <a href='#Page_189'><b>189</b></a></li>
+
+<li>Adjustment, <a href='#Page_102'><b>102</b></a></li>
+
+<li>&AElig;sthetic, <a href='#Page_63'><b>63</b></a></li>
+
+<li>Alcohol, <a href='#Page_198'><b>198</b></a></li>
+
+<li>Alcoholism, <a href='#Page_278'><b>278</b></a></li>
+
+<li>Alternation, <a href='#Page_154'><b>154</b></a>, <a href='#Page_174'><b>174</b></a></li>
+
+<li>An&aelig;mia, <a href='#Page_310'><b>310</b></a></li>
+
+<li>An&aelig;sthesia, <a href='#Page_174'><b>174</b></a>, <a href='#Page_301'><b>301</b></a></li>
+
+<li>Analysis, <a href='#Page_21'><b>21</b></a></li>
+
+<li>Antagonistic, <a href='#Page_24'><b>24</b></a></li>
+
+<li>Anxiety, <a href='#Page_272'><b>272</b></a></li>
+
+<li>Appeal, <a href='#Page_93'><b>93</b></a></li>
+
+<li>Applied Psychology, <a href='#Page_60'><b>60</b></a></li>
+
+<li>Appreciation, <a href='#Page_10'><b>10</b></a></li>
+
+<li>Art, <a href='#Page_87'><b>87</b></a></li>
+
+<li>Association, <a href='#Page_29'><b>29</b></a>, <a href='#Page_32'><b>32</b></a>, <a href='#Page_42'><b>42</b></a></li>
+
+<li>Association Experiment, <a href='#Page_72'><b>72</b></a>, <a href='#Page_233'><b>233</b></a>, <a href='#Page_359'><b>359</b></a></li>
+
+<li>Associationism, <a href='#Page_44'><b>44</b></a></li>
+
+<li>Astrology, <a href='#Page_350'><b>350</b></a></li>
+
+<li>Assurance, <a href='#Page_215'><b>215</b></a></li>
+
+<li>Assyria, <a href='#Page_322'><b>322</b></a></li>
+
+<li>Ataxia, <a href='#Page_179'><b>179</b></a></li>
+
+<li>Atoms, <a href='#Page_27'><b>27</b></a></li>
+
+<li>Attention, <a href='#Page_46'><b>46</b></a>, <a href='#Page_95'><b>95</b></a>, <a href='#Page_99'><b>99</b></a>, <a href='#Page_113'><b>113</b></a>, <a href='#Page_200'><b>200</b></a>, <a href='#Page_244'><b>244</b></a></li>
+
+<li>Attitudes, <a href='#Page_13'><b>13</b></a></li>
+
+<li>Authority, <a href='#Page_222'><b>222</b></a></li>
+
+<li>Automatic, <a href='#Page_144'><b>144</b></a>, <a href='#Page_237'><b>237</b></a></li>
+
+<li>Autosuggestion, <a href='#Page_122'><b>122</b></a>, <a href='#Page_172'><b>172</b></a>, <a href='#Page_219'><b>219</b></a>, <a href='#Page_255'><b>255</b></a>, <a href='#Page_266'><b>266</b></a></li>
+
+<li>Awareness, <a href='#Page_133'><b>133</b></a>, <a href='#Page_149'><b>149</b></a><br /><br /></li>
+
+<li>Beauty, <a href='#Page_197'><b>197</b></a></li>
+
+<li>Belief, <a href='#Page_100'><b>100</b></a>, <a href='#Page_329'><b>329</b></a></li>
+
+<li>Blood-vessels, <a href='#Page_302'><b>302</b></a></li>
+
+<li>Blushing, <a href='#Page_262'><b>262</b></a></li>
+
+<li>Braidism, <a href='#Page_353'><b>353</b></a></li>
+
+<li>Brain, <a href='#Page_29'><b>29</b></a>, <a href='#Page_34'><b>34</b></a>, <a href='#Page_67'><b>67</b></a>, <a href='#Page_139'><b>139</b><br /><br /></a></li>
+
+
+<li>Cancer, <a href='#Page_178'><b>178</b></a></li>
+
+<li>Cathartic, <a href='#Page_233'><b>233</b></a>, <a href='#Page_358'><b>358</b></a></li>
+
+<li>Causality, <a href='#Page_14'><b>14</b></a>, <a href='#Page_32'><b>32</b></a>, <a href='#Page_57'><b>57</b></a></li>
+
+<li>Cell, <a href='#Page_44'><b>44</b></a>, <a href='#Page_81'><b>81</b></a>, <a href='#Page_89'><b>89</b></a></li>
+
+<li>China, <a href='#Page_321'><b>321</b></a></li>
+
+<li>Church, <a href='#Page_319'><b>319</b></a></li>
+
+<li>Christianity, <a href='#Page_324'><b>324</b></a></li>
+
+<li>Christian Science, <a href='#Page_7'><b>7</b></a>, <a href='#Page_55'><b>55</b></a>, <a href='#Page_317'><b>317</b></a>, <a href='#Page_327'><b>327</b></a>, <a href='#Page_343'><b>343</b></a>, <a href='#Page_344'><b>344</b></a></li>
+
+<li>Chronoscope, <a href='#Page_71'><b>71</b></a></li>
+
+<li>Circulation, <a href='#Page_79'><b>79</b></a></li>
+
+<li>Clairvoyant, <a href='#Page_128'><b>128</b></a></li>
+
+<li>Clearness, <a href='#Page_103'><b>103</b></a></li>
+
+<li>Cocainism, <a href='#Page_283'><b>283</b></a></li>
+
+<li>Coconscious, <a href='#Page_156'><b>156</b></a></li>
+
+<li>Communication, <a href='#Page_22'><b>22</b></a></li>
+
+<li>Community, <a href='#Page_370'><b>370</b></a></li>
+
+<li>Company, <a href='#Page_197'><b>197</b></a></li>
+
+<li>Comparative Anatomy, <a href='#Page_38'><b>38</b></a></li>
+
+<li>Complex, <a href='#Page_232'><b>232</b></a>, <a href='#Page_249'><b>249</b></a>, <a href='#Page_270'><b>270</b></a></li>
+
+<li>Confidence, <a href='#Page_221'><b>221</b></a>, <a href='#Page_230'><b>230</b></a></li>
+
+<li>Conscience, <a href='#Page_219'><b>219</b></a></li>
+
+<li>Consciousness, <a href='#Page_11'><b>11</b></a>, <a href='#Page_125'><b>125</b></a>, <a href='#Page_130'><b>130</b></a>, <a href='#Page_134'><b>134</b></a></li>
+
+<li>Contact, <a href='#Page_223'><b>223</b></a></li>
+
+<li>Cortex, <a href='#Page_47'><b>47</b></a></li>
+
+<li>Cretinism, <a href='#Page_168'><b>168</b></a></li>
+
+<li>Crime, <a href='#Page_112'><b>112</b></a></li>
+
+<li>Criminology, <a href='#Page_383'><b>383</b><br /><br /></a></li>
+
+
+<li>Dementia, <a href='#Page_168'><b>168</b></a></li>
+
+<li>Depression, <a href='#Page_178'><b>178</b></a>, <a href='#Page_267'><b>267</b></a>, <a href='#Page_314'><b>314</b></a></li>
+
+<li>Description, <a href='#Page_19'><b>19</b></a></li>
+
+<li>Diabetes, <a href='#Page_311'><b>311</b></a></li>
+
+<li>Diagnosis, <a href='#Page_66'><b>66</b></a>, <a href='#Page_184'><b>184</b></a>, <a href='#Page_241'><b>241</b></a></li>
+
+<li>Digestive, <a href='#Page_177'><b>177</b></a>, <a href='#Page_309'><b>309</b></a></li>
+
+<li>Dilettanteism, <a href='#Page_2'><b>2</b></a></li>
+
+<li>Discharge, <a href='#Page_49'><b>49</b></a>, <a href='#Page_90'><b>90</b></a>, <a href='#Page_218'><b>218</b></a>, <a href='#Page_232'><b>232</b></a>, <a href='#Page_252'><b>252</b></a>, <a href='#Page_396'><b>396</b></a></li>
+
+<li>Discipline, <a href='#Page_202'><b>202</b></a></li>
+
+<li>Disposition, <a href='#Page_138'><b>138</b></a>, <a href='#Page_143'><b>143</b></a></li>
+
+<li>Dissociation, <a href='#Page_135'><b>135</b></a>, <a href='#Page_152'><b>152</b></a></li>
+
+<li>Dream, <a href='#Page_114'><b>114</b></a></li>
+
+<li>Drugs, <a href='#Page_163'><b>163</b></a>, <a href='#Page_334'><b>334</b></a><br /><br /></li>
+
+
+<li>Education, <a href='#Page_389'><b>389</b></a></li>
+
+<li>Effort, <a href='#Page_289'><b>289</b></a></li>
+
+<li>Efficiency, <a href='#Page_194'><b>194</b></a></li>
+
+<li>Egyptians, <a href='#Page_323'><b>323</b></a></li>
+
+<li>Electrobiology, <a href='#Page_353'><b>353</b></a></li>
+
+<li>Emmanuel Church, <a href='#Page_326'><b>326</b></a>, <a href='#Page_328'><b>328</b></a>, <a href='#Page_331'><b>331</b></a>, <a href='#Page_341'><b>341</b></a></li>
+
+<li>Emotion, <a href='#Page_88'><b>88</b></a>, <a href='#Page_123'><b>123</b></a>, <a href='#Page_235'><b>235</b></a>, <a href='#Page_259'><b>259</b></a>, <a href='#Page_314'><b>314</b></a>, <a href='#Page_392'><b>392</b></a></li>
+
+<li>Encouragement, <a href='#Page_206'><b>206</b></a></li>
+
+<li>Energy, <a href='#Page_276'><b>276</b></a>, <a href='#Page_288'><b>288</b></a></li>
+
+<li>Epidemic, <a href='#Page_193'><b>193</b></a></li>
+
+<li>Epilepsy, <a href='#Page_80'><b>80</b></a>, <a href='#Page_207'><b>207</b></a></li>
+
+<li>Equilibrium, <a href='#Page_160'><b>160</b></a></li>
+
+<li>Ergograph, <a href='#Page_71'><b>71</b></a></li>
+
+<li>Ethics, <a href='#Page_16'><b>16</b></a></li>
+
+<li>Ethnology, <a href='#Page_329'><b>329</b></a></li>
+
+<li>Examination, <a href='#Page_186'><b>186</b></a></li>
+
+<li>Exhaustion, <a href='#Page_196'><b>196</b></a></li>
+
+<li>Experimental Psychology, <a href='#Page_5'><b>5</b></a>, <a href='#Page_61'><b>61</b></a></li>
+
+<li>Explanation, <a href='#Page_19'><b>19</b></a>, <a href='#Page_28'><b>28</b></a>, <a href='#Page_41'><b>41</b></a><br /><br /></li>
+
+
+<li>Faith, <a href='#Page_6'><b>6</b></a>, <a href='#Page_335'><b>335</b></a></li>
+
+<li>Fascination, <a href='#Page_116'><b>116</b></a>, <a href='#Page_230'><b>230</b></a></li>
+
+<li>Fear, <a href='#Page_172'><b>172</b></a>, <a href='#Page_259'><b>259</b></a>, <a href='#Page_263'><b>263</b></a></li>
+
+<li>Feeble-minded, <a href='#Page_72'><b>72</b></a>, <a href='#Page_295'><b>295</b></a></li>
+
+<li>Feelings, <a href='#Page_23'><b>23</b></a></li>
+
+<li>Freedom, <a href='#Page_51'><b>51</b></a>, <a href='#Page_146'><b>146</b></a></li>
+
+<li>Functional Diseases, <a href='#Page_81'><b>81</b></a>, <a href='#Page_343'><b>343</b></a><br /><br /></li>
+
+
+<li>Galvanoscope, <a href='#Page_71'><b>71</b></a></li>
+
+<li>Genetic Psychology, <a href='#Page_39'><b>39</b></a></li>
+
+<li>Gospels, <a href='#Page_324'><b>324</b></a></li>
+
+<li>Greeks, <a href='#Page_323'><b>323</b></a>, <a href='#Page_350'><b>350</b></a><br /><br /></li>
+
+
+<li>Half-sleep, <a href='#Page_226'><b>226</b></a></li>
+
+<li>Hallucination, <a href='#Page_246'><b>246</b></a></li>
+
+<li>Hastiness, <a href='#Page_200'><b>200</b></a></li>
+
+<li>Headache, <a href='#Page_309'><b>309</b></a></li>
+
+<li>Hearing, <a href='#Page_300'><b>300</b></a></li>
+
+<li>Heart Disease, <a href='#Page_310'><b>310</b></a></li>
+
+<li>Heterosuggestion, <a href='#Page_122'><b>122</b></a></li>
+
+<li>History, <a href='#Page_16'><b>16</b></a></li>
+
+<li>Hygiene, <a href='#Page_389'><b>389</b></a></li>
+
+<li>Hypnoid, <a href='#Page_116'><b>116</b></a>, <a href='#Page_227'><b>227</b></a></li>
+
+<li>Hypnotism, <a href='#Page_74'><b>74</b></a>, <a href='#Page_85'><b>85</b></a>, <a href='#Page_109'><b>109</b></a>, <a href='#Page_122'><b>122</b></a>, <a href='#Page_227'><b>227</b></a>, <a href='#Page_243'><b>243</b></a>, <a href='#Page_350'><b>350</b></a></li>
+
+<li>Hysteria, <a href='#Page_122'><b>122</b></a>, <a href='#Page_174'><b>174</b></a>, <a href='#Page_269'><b>269</b></a>, <a href='#Page_356'><b>356</b></a><br /><br /></li>
+
+
+<li>Idealism, <a href='#Page_2'><b>2</b></a>, <a href='#Page_33'><b>33</b></a>, <a href='#Page_397'><b>397</b></a></li>
+
+<li>Illness, <a href='#Page_67'><b>67</b></a></li>
+
+<li>Imagination, <a href='#Page_111'><b>111</b></a></li>
+
+<li>Impulse, <a href='#Page_89'><b>89</b></a></li>
+
+<li>Improvement, <a href='#Page_299'><b>299</b></a></li>
+
+<li>Indecision, <a href='#Page_290'><b>290</b></a></li>
+
+<li>Indians, <a href='#Page_321'><b>321</b></a></li>
+
+<li>Inherited, <a href='#Page_171'><b>171</b></a></li>
+
+<li>Inhibition, <a href='#Page_86'><b>86</b></a>, <a href='#Page_95'><b>95</b></a>, <a href='#Page_113'><b>113</b></a>, <a href='#Page_295'><b>295</b></a>, <a href='#Page_305'><b>305</b></a>, <a href='#Page_315'><b>315</b></a></li>
+
+<li>Insanity, <a href='#Page_165'><b>165</b></a>, <a href='#Page_256'><b>256</b></a></li>
+
+<li>Insomnia, <a href='#Page_303'><b>303</b></a>, <a href='#Page_312'><b>312</b></a></li>
+
+<li>Instinct, <a href='#Page_305'><b>305</b></a></li>
+
+<li>Intemperance, <a href='#Page_281'><b>281</b></a></li>
+
+<li>Intensity, <a href='#Page_194'><b>194</b></a></li>
+
+<li>Interruption, <a href='#Page_191'><b>191</b></a><br /><br /></li>
+
+
+<li>Japan, <a href='#Page_322'><b>322</b></a></li>
+
+<li>Jews, <a href='#Page_322'><b>322</b></a><br /><br /></li>
+
+
+<li>Kymograph, <a href='#Page_71'><b>71</b></a></li>
+
+<li>Knowledge, <a href='#Page_11'><b>11</b></a><br /><br /></li>
+
+
+<li>Lawyer, <a href='#Page_87'><b>87</b></a></li>
+
+<li>Learning, <a href='#Page_390'><b>390</b></a><br /><br /></li>
+
+
+<li>Magnetism, <a href='#Page_351'><b>351</b></a></li>
+
+<li>Make-believe, <a href='#Page_216'><b>216</b></a></li>
+
+<li>Memory, <a href='#Page_138'><b>138</b></a></li>
+
+<li>Mesmerism, <a href='#Page_128'><b>128</b></a>, <a href='#Page_253'><b>253</b></a></li>
+
+<li>Minister, <a href='#Page_57'><b>57</b></a>, <a href='#Page_207'><b>207</b></a>, <a href='#Page_332'><b>332</b></a>, <a href='#Page_340'><b>340</b></a>, <a href='#Page_367'><b>367</b></a></li>
+
+<li>Monotony, <a href='#Page_203'><b>203</b></a></li>
+
+<li>Moral, <a href='#Page_65'><b>65</b></a>, <a href='#Page_84'><b>84</b></a></li>
+
+<li>Morality, <a href='#Page_372'><b>372</b></a></li>
+
+<li>Morphinism, <a href='#Page_283'><b>283</b></a>, <a href='#Page_376'><b>376</b></a></li>
+
+<li>Motor Process, <a href='#Page_46'><b>46</b></a>, <a href='#Page_97'><b>97</b></a>, <a href='#Page_218'><b>218</b></a></li>
+
+<li>Movement Sensation, <a href='#Page_24'><b>24</b></a></li>
+
+<li>Mystic, <a href='#Page_224'><b>224</b></a>, <a href='#Page_315'><b>315</b></a><br /><br /></li>
+
+
+<li>Naturalism, <a href='#Page_4'><b>4</b></a></li>
+
+<li>Negativism, <a href='#Page_220'><b>220</b></a></li>
+
+<li>Nervousness, <a href='#Page_193'><b>193</b></a></li>
+
+<li>Neurasthenia, <a href='#Page_169'><b>169</b></a>, <a href='#Page_246'><b>246</b></a>, <a href='#Page_290'><b>290</b></a>, <a href='#Page_292'><b>292</b></a></li>
+
+<li>Neuron, <a href='#Page_164'><b>164</b></a></li>
+
+<li>Nutrition, <a href='#Page_79'><b>79</b></a>, <a href='#Page_312'><b>312</b></a><br /><br /></li>
+
+
+<li>Obedience, <a href='#Page_201'><b>201</b></a></li>
+
+<li>Object, <a href='#Page_13'><b>13</b></a>, <a href='#Page_18'><b>18</b></a></li>
+
+<li>Obsession, <a href='#Page_246'><b>246</b></a></li>
+
+<li>Opposite Idea, <a href='#Page_97'><b>97</b></a></li>
+
+<li>Oppression, <a href='#Page_272'><b>272</b></a></li>
+
+<li>Organic Diseases, <a href='#Page_81'><b>81</b></a>, <a href='#Page_343'><b>343</b></a></li>
+
+<li>Organism, <a href='#Page_23'><b>23</b></a><br /><br /></li>
+
+
+<li>Pain, <a href='#Page_69'><b>69</b></a>, <a href='#Page_167'><b>167</b></a>, <a href='#Page_298'><b>298</b></a>, <a href='#Page_309'><b>309</b></a>, <a href='#Page_313'><b>313</b></a>, <a href='#Page_342'><b>342</b></a></li>
+
+<li>Parallelism, <a href='#Page_33'><b>33</b></a>, <a href='#Page_37'><b>37</b></a>, <a href='#Page_40'><b>40</b></a></li>
+
+<li>Passes, <a href='#Page_117'><b>117</b></a></li>
+
+<li>Pathology, <a href='#Page_36'><b>36</b></a></li>
+
+<li>Pauses, <a href='#Page_190'><b>190</b></a></li>
+
+<li>Pedagogy, <a href='#Page_63'><b>63</b></a></li>
+
+<li>Perception, <a href='#Page_20'><b>20</b></a>, <a href='#Page_34'><b>34</b></a>, <a href='#Page_133'><b>133</b></a></li>
+
+<li>Personality, <a href='#Page_11'><b>11</b></a>, <a href='#Page_25'><b>25</b></a>, <a href='#Page_154'><b>154</b></a></li>
+
+<li>Persuasion, <a href='#Page_214'><b>214</b></a></li>
+
+<li>Perversity, <a href='#Page_176'><b>176</b></a></li>
+
+<li>Phobia, <a href='#Page_94'><b>94</b></a></li>
+
+<li>Physical, <a href='#Page_18'><b>18</b></a></li>
+
+<li>Physician, <a href='#Page_57'><b>57</b></a>, <a href='#Page_347'><b>347</b></a></li>
+
+<li>Physicotherapy, <a href='#Page_1'><b>1</b></a></li>
+
+<li>Pneumograph, <a href='#Page_71'><b>71</b></a>, <a href='#Page_235'><b>235</b></a></li>
+
+<li>Poet, <a href='#Page_59'><b>59</b></a></li>
+
+<li>Posthypnotic, <a href='#Page_120'><b>120</b></a>, <a href='#Page_231'><b>231</b></a></li>
+
+<li>Postulate, <a href='#Page_41'><b>41</b></a></li>
+
+<li>Prayer, <a href='#Page_207'><b>207</b></a></li>
+
+<li>Prohibition, <a href='#Page_198'><b>198</b></a></li>
+
+<li>Protestantism, <a href='#Page_325'><b>325</b></a></li>
+
+<li>Psychasthenia, <a href='#Page_172'><b>172</b></a>, <a href='#Page_264'><b>264</b></a>, <a href='#Page_277'><b>277</b></a></li>
+
+<li>Psychiatry, <a href='#Page_70'><b>70</b></a></li>
+
+<li>Psychical, <a href='#Page_18'><b>18</b></a></li>
+
+<li>Psychoanalytic, <a href='#Page_236'><b>236</b></a>, <a href='#Page_272'><b>272</b></a></li>
+
+<li>Psychological Laboratory, <a href='#Page_5'><b>5</b></a>, <a href='#Page_36'><b>36</b></a>, <a href='#Page_60'><b>60</b></a>, <a href='#Page_72'><b>72</b></a>, <a href='#Page_356'><b>356</b></a></li>
+
+<li>Psychology, <a href='#Page_5'><b>5</b></a>, <a href='#Page_8'><b>8</b></a>, <a href='#Page_25'><b>25</b></a>, <a href='#Page_39'><b>39</b></a>, <a href='#Page_364'><b>364</b></a></li>
+
+<li>Pulse, <a href='#Page_235'><b>235</b></a>, <a href='#Page_294'><b>294</b></a></li>
+
+<li>Purposes, <a href='#Page_11'><b>11</b></a>, <a href='#Page_17'><b>17</b></a></li>
+
+<li>Purposive, <a href='#Page_13'><b>13</b></a>, <a href='#Page_33'><b>33</b></a>, <a href='#Page_65'><b>65</b></a>, <a href='#Page_145'><b>145</b></a>, <a href='#Page_338'><b>338</b></a><br /><br /></li>
+
+
+<li>Reactions, <a href='#Page_50'><b>50</b></a>, <a href='#Page_143'><b>143</b></a></li>
+
+<li>Realism, <a href='#Page_2'><b>2</b></a></li>
+
+<li>Reality, <a href='#Page_15'><b>15</b></a></li>
+
+<li>Reasoning, <a href='#Page_212'><b>212</b></a></li>
+
+<li>Recklessness, <a href='#Page_201'><b>201</b></a></li>
+
+<li>Recuperation, <a href='#Page_191'><b>191</b></a></li>
+
+<li>Relapse, <a href='#Page_281'><b>281</b></a></li>
+
+<li>Relativity, <a href='#Page_195'><b>195</b></a></li>
+
+<li>Religion, <a href='#Page_84'><b>84</b></a>, <a href='#Page_207'><b>207</b></a>, <a href='#Page_329'><b>329</b></a>, <a href='#Page_341'><b>341</b></a></li>
+
+<li>Reparable, <a href='#Page_165'><b>165</b></a></li>
+
+<li>Reservoir, <a href='#Page_209'><b>209</b></a></li>
+
+<li>Resistance, <a href='#Page_105'><b>105</b></a></li>
+
+<li>Rest, <a href='#Page_191'><b>191</b></a></li>
+
+<li>Retardation, <a href='#Page_169'><b>169</b></a>, <a href='#Page_202'><b>202</b></a></li>
+
+<li>Revival, <a href='#Page_337'><b>337</b></a><br /><br /></li>
+
+
+<li>Savages, <a href='#Page_320'><b>320</b></a></li>
+
+<li>Secrets, <a href='#Page_185'><b>185</b></a></li>
+
+<li>Self, <a href='#Page_24'><b>24</b></a>, <a href='#Page_131'><b>131</b></a></li>
+
+<li>Self-consciousness, <a href='#Page_136'><b>136</b></a></li>
+
+<li>Sensation, <a href='#Page_22'><b>22</b></a>, <a href='#Page_28'><b>28</b></a></li>
+
+<li>Sense Organ, <a href='#Page_300'><b>300</b></a></li>
+
+<li>Shamanism, <a href='#Page_320'><b>320</b></a></li>
+
+<li>Sidetracking, <a href='#Page_236'><b>236</b></a>, <a href='#Page_249'><b>249</b></a>, <a href='#Page_271'><b>271</b></a></li>
+
+<li>Sleep, <a href='#Page_112'><b>112</b></a>, <a href='#Page_177'><b>177</b></a>, <a href='#Page_226'><b>226</b></a>, <a href='#Page_303'><b>303</b></a>, <a href='#Page_307'><b>307</b></a></li>
+
+<li>Somnambulism, <a href='#Page_114'><b>114</b></a>, <a href='#Page_153'><b>153</b></a>, <a href='#Page_352'><b>352</b></a></li>
+
+<li>Sphygmograph, <a href='#Page_71'><b>71</b></a>, <a href='#Page_235'><b>235</b></a></li>
+
+<li>Stammering, <a href='#Page_175'><b>175</b></a>, <a href='#Page_274'><b>274</b></a></li>
+
+<li>Stomach, <a href='#Page_309'><b>309</b></a></li>
+
+<li>Subconscious, <a href='#Page_125'><b>125</b></a>, <a href='#Page_161'><b>161</b></a></li>
+
+<li>Subcortical, <a href='#Page_143'><b>143</b></a>, <a href='#Page_306'><b>306</b></a></li>
+
+<li>Subject, <a href='#Page_13'><b>13</b></a></li>
+
+<li>Suggestibility, <a href='#Page_88'><b>88</b></a>, <a href='#Page_107'><b>107</b></a>, <a href='#Page_221'><b>221</b></a></li>
+
+<li>Suggestion, <a href='#Page_85'><b>85</b></a>, <a href='#Page_100'><b>100</b></a>, <a href='#Page_213'><b>213</b></a>, <a href='#Page_273'><b>273</b></a>, <a href='#Page_395'><b>395</b></a></li>
+
+<li>Superficiality, <a href='#Page_200'><b>200</b></a></li>
+
+<li>Supervision, <a href='#Page_279'><b>279</b></a></li>
+
+<li>Surroundings, <a href='#Page_189'><b>189</b></a></li>
+
+<li>Sympathy, <a href='#Page_205'><b>205</b></a></li>
+
+<li>Symptoms, <a href='#Page_80'><b>80</b></a>, <a href='#Page_186'><b>186</b></a><br /><br /></li>
+
+
+<li>Temperance, <a href='#Page_198'><b>198</b></a></li>
+
+<li>Tones, <a href='#Page_44'><b>44</b></a></li>
+
+<li>Toxic, <a href='#Page_167'><b>167</b></a><br /><br /></li>
+
+
+<li>Unity, <a href='#Page_52'><b>52</b></a>, <a href='#Page_135'><b>135</b></a><br /><br /></li>
+
+
+<li>Vacation, <a href='#Page_197'><b>197</b></a></li>
+
+<li>Vividness, <a href='#Page_50'><b>50</b></a><br /><br /></li>
+
+
+<li>Will, <a href='#Page_11'><b>11</b></a>, <a href='#Page_31'><b>31</b></a></li>
+
+<li>Witness, <a href='#Page_107'><b>107</b></a></li>
+
+<li>Worry, <a href='#Page_259'><b>259</b></a><br /><br /></li>
+
+
+<li>Yogi, <a href='#Page_350'><b>350</b></a></li></ul>
+
+<div class="trans-note">
+<p class="center">Transcriber's note:</p>
+
+<p>Inconsistencies in hyphenation reflect the original text.</p>
+      </div>
+
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of Psychotherapy, by Hugo Münsterberg
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+The Project Gutenberg EBook of Psychotherapy, by Hugo Muensterberg
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Psychotherapy
+
+Author: Hugo Muensterberg
+
+Release Date: September 27, 2007 [EBook #22775]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK PSYCHOTHERAPY ***
+
+
+
+
+Produced by Audrey Longhurst and the Online Distributed
+Proofreading Team at https://www.pgdp.net
+
+
+
+
+
+
+
+  +--------------------------------------------------------+
+  |This book has been transcribed for Project Gutenberg by |
+  |                 Distributed Proofreaders,              |
+  |                                                        |
+  | in memory of our friend and colleague Laura Wisewell   |
+  |                                                        |
+  |             --Champion of Accessibility--              |
+  +--------------------------------------------------------+
+
+
+
+
+  PSYCHOTHERAPY
+
+  BY
+
+  HUGO MUeNSTERBERG
+
+  M.D., PH.D., LITT.D., LL.D.
+  PROFESSOR OF PSYCHOLOGY IN HARVARD UNIVERSITY
+
+
+  NEW YORK
+  MOFFAT, YARD AND COMPANY
+  1909
+
+
+  COPYRIGHT, 1909, BY
+  MOFFAT, YARD AND COMPANY
+
+  _All Rights Reserved_
+
+  Published, April, 1909
+  Second Printing, May, 1909
+
+
+       *       *       *       *       *
+
+
+  RECENT BOOKS BY THE SAME AUTHOR
+
+  Psychology and Life, Boston, 1899
+
+  Grundzuege der Psychologie, Leipzig, 1900
+
+  American Traits, Boston, 1902
+
+  Die Amerikaner, Berlin, 1904
+
+  Principles of Art Education, New York, 1905
+
+  The Eternal Life, Boston, 1905
+
+  Science and Idealism, Boston, 1906
+
+  Philosophie der Werte, Leipzig, 1907
+
+  On the Witness Stand, New York, 1908
+
+  Aus Deutsch-Amerika, Berlin, 1908
+
+  The Eternal Values, Boston, 1909
+
+
+       *       *       *       *       *
+
+
+  TO
+
+  MY FRIEND AND COLLEAGUE
+
+  DR. FRANZ PFAFF
+
+  PROFESSOR OF THERAPEUTICS IN
+  HARVARD UNIVERSITY
+
+
+       *       *       *       *       *
+
+
+PREFACE
+
+
+This volume on psychotherapy belongs to a series of books which I am
+writing to discuss for a wider public the practical applications of
+modern psychology. The first book, called "On the Witness Stand,"
+studied the relations of scientific psychology to crime and the law
+courts. This new book deals with the relations of psychology to
+medicine. Others discussing its relations to education, to social
+problems, to commerce and industry will follow soon.
+
+For popular treatment I divide applied psychology into such various,
+separated books because they naturally address very different audiences.
+That which interests the lawyer does not concern the physician, and
+again the school-teacher has his own sphere of interests. Moreover the
+different subjects demand a different treatment. The problems of
+psychology and law were almost entirely neglected. I was anxious to draw
+wide attention to this promising field and therefore I chose the form of
+loose popular essays without any aim towards systematic presentation of
+the subject. As to psychology and medicine almost the opposite situation
+prevails. There is perhaps too much talk afloat about psychotherapy, the
+widest circles cultivate the discussion, the magazines overflow with
+it. The duty of the scientific psychologist is accordingly not to stir
+up interest in this topic but to help in bringing this interest from
+mere gossip, vague mysticism, and medical amateurishness to a clear
+understanding of principles. What is needed in this time of faith cures
+of a hundred types is to deal with the whole circle of problems in a
+serious, systematic way and to emphasize the aspect of scientific
+psychological theory.
+
+Hence the whole first part of this book is an abstract discussion and
+its first chapters have not even any direct relation to disease. I am
+convinced that both physicians and ministers and all who are in
+practical contact with these important questions ought to be brought to
+such painstaking and perhaps fatiguing inquiry into principles before
+the facts are reached. To those who seek a discussion of life facts
+alone, the whole first part will of course appear to be a tedious way
+around; they may turn directly to the second and third parts.
+
+One word for my personal right to deal with these questions, as too much
+illegitimate psychotherapeutics is heard to-day. For me, the relation
+between psychology and medicine is not a chance chapter of my science to
+which I have turned simply in following up the various sides of applied
+psychology. And still less have I turned to it because it has become the
+fashion in recent years. On the contrary, it has been an important
+factor in all my work since my student days. I have been through five
+years of regular medical studies, three years in Leipzig and two years
+in Heidelberg; I have an M.D. degree from the University of Heidelberg.
+In my first year as docent in a German university twenty years ago, I
+gave throughout the winter semester before several hundred students a
+course in hypnotism and its medical application. It was probably the
+first university course on hypnotism given anywhere. Since that time I
+have never ceased to work psychotherapeutically in the psychological
+laboratory. Yet that must not be misunderstood. I have no clinic, and
+while by principle I have never hypnotized anyone for mere experiment's
+sake but always only for medical purposes, yet I adjust my practical
+work entirely to the interests of my scientific study. The limitations
+of my time force me to refuse the psychotherapeutic treatment of any
+case which has not a certain scientific interest for me, and of the many
+hundreds whom I have helped in the laboratory, no one ever had to pay
+anything. Thus my practical work has strictly the character of
+laboratory research.
+
+The chief aim of this book is twofold. It is a negative one: I want to
+counteract the misunderstandings which overflood the whole field,
+especially by the careless mixing of mental and moral influence. And a
+positive one: I want to strengthen the public feeling that the time has
+come when every physician should systematically study psychology, the
+normal in the college years and the abnormal in the medical school. This
+demand of medical education cannot be postponed any longer. The aim of
+the book is not to fight the Emmanuel Church Movement, or even
+Christian Science or any other psychotherapeutic tendency outside of the
+field of scientific medicine. I see the element of truth in all of them,
+but they ought to be symptoms of transition. Scientific medicine should
+take hold of psychotherapeutics now or a most deplorable disorganization
+will set in, the symptoms of which no one ought to overlook to-day.
+
+                                                       HUGO MUeNSTERBERG.
+
+  HARVARD UNIVERSITY, March 20, 1909.
+
+
+
+
+  CONTENTS
+
+
+  CHAPTER                                                             PAGE
+
+     I. INTRODUCTION                                                     1
+
+
+  PART I
+
+  THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
+
+    II. THE AIM OF PSYCHOLOGY                                            9
+
+   III. MIND AND BRAIN                                                  27
+
+    IV. PSYCHOLOGY AND MEDICINE                                         55
+
+     V. SUGGESTION AND HYPNOTISM                                        85
+
+    VI. THE PSYCHOLOGY OF THE SUBCONSCIOUS                             125
+
+
+  PART II
+
+  THE PRACTICAL WORK OF PSYCHOTHERAPY
+
+   VII. THE FIELD OF PSYCHOTHERAPY                                     158
+
+  VIII. THE GENERAL METHODS OF PSYCHOTHERAPY                           184
+
+    IX. THE SPECIAL METHODS OF PSYCHOTHERAPY                           212
+
+     X. THE MENTAL SYMPTOMS                                            239
+
+    XI. THE BODILY SYMPTOMS                                            297
+
+
+  PART III
+
+  THE PLACE OF PSYCHOTHERAPY
+
+   XII. PSYCHOTHERAPY AND THE CHURCH                                    319
+
+  XIII. PSYCHOTHERAPY AND THE PHYSICIAN                                347
+
+   XIV. PSYCHOTHERAPY AND THE COMMUNITY                                 370
+
+
+
+
+I
+
+INTRODUCTION
+
+
+Psychotherapy is the practice of treating the sick by influencing the
+mental life. It stands at the side of physicotherapy, which attempts to
+cure the sick by influencing the body, perhaps with drugs and medicines,
+or with electricity or baths or diet.
+
+Psychotherapy is sharply to be separated from psychiatry, the treatment
+of mental diseases. Of course to a certain degree, mental illness too,
+is open to mental treatment; but certainly many diseases of the mind lie
+entirely beyond the reach of psychotherapy, and on the other hand
+psychotherapy may be applied also to diseases which are not mental at
+all. That which binds all psychotherapeutic efforts together into unity
+is the method of treatment. The psychotherapist must always somehow set
+levers of the mind in motion and work through them towards the removal
+of the sufferer's ailment; but the disturbances to be treated may show
+the greatest possible variety and may belong to mind or body.
+
+Treatment of diseases by influence on the mind is as old as human
+history, but it has attained at various times very different degrees of
+importance. There is no lack of evidence that we have entered into a
+period in which an especial emphasis will be laid on the too long
+neglected psychical factor. This new movement is probably only in its
+beginning and the loudness with which it presents itself to-day is one
+of the many indications of its immaturity. Whether it will be a blessing
+or a danger, whether it will really lead forward in a lasting way, or
+whether it will soon demand a reaction, will probably depend in the
+first place on the soberness and thoroughness of the discussion. If the
+movement is carried on under the control of science, it may yield
+lasting results. If it keeps the features of dilettanteism and prefers
+association with the antiscientific tendencies, it is pre-destined to
+have a spasmodic character and ultimately to be harmful.
+
+The chaotic character of psychotherapy in this first decade of the
+twentieth century can be easily understood. It results from the fact
+that in our period one great wave of civilization is sinking and a new
+wave rising, while the one has not entirely disappeared and the other is
+still far from its height. The history of civilization has shown at all
+times a wavelike alternation between realism and idealism, that is,
+between an interest in that which is, and an interest in that which
+ought to be. In the realistic periods, the study of facts, especially of
+the facts of nature, is prevalent; in idealistic periods, history and
+literature appeal to the world. In realistic periods, technique enjoys
+its triumphs; in idealistic periods, art and religion prevail. Such a
+realistic movement lies behind us. It began with the incomparable
+development of physics, chemistry, and biology, in the middle of the
+last century, and it brought with it the achievements of modern
+engineering and medicine. We are still fully under the influence of this
+gigantic movement and its real achievements will never leave us; and yet
+this realistic wave is ebbing to-day and a new period of idealism is
+rising. If the signs are not deceitful, this new movement may reach its
+historical climax a few decades hence, when new leaders may give to the
+idealistic view of the world the same classical expression which Darwin
+and others gave to the receding naturalistic age. The signs are clear
+indeed that the days of idealistic philosophy and of art, and of
+religion, are approaching; that the world is tired of merely connecting
+facts without asking what their ultimate meaning is. The world dimly
+feels again that technical civilization alone cannot make life more
+worth living. The aim of the last generation was to explain the world;
+the aim of the next generation will be to interpret the world; the one
+was seeking laws, the other will seek ideals.
+
+Psychotherapy stands in the service of both; it is the last word of the
+passing naturalistic movement, and yet in another way it tries to be the
+first word of the coming idealistic movement; and because it is under
+the influence of both, it speaks sometimes the language of the one, and
+sometimes the language of the other. That brings about a confusion and a
+disorder which must be detrimental. To transform this vagueness into
+clear, distinct relations is the immediate duty of science.
+
+Indeed it may be said that psychotherapy is the last word of a
+naturalistic age, because psychotherapy finds its real stronghold in a
+systematic study of the mental laws, and such study of mental laws,
+psychology, must indeed be the ultimate outcome of a naturalistic view
+of the world. Realism begins with the analysis of lifeless nature,
+begins with the study of the stars and the stones, of masses and of
+atoms. At a higher level, it turns then to the living organism, studies
+plants and animals and even brings the human organism entirely under the
+point of view of natural law. When science has thus mastered the whole
+physical universe, it finally brings even the mental life of man under
+the naturalistic point of view, treats his inner experiences like any
+outer objects, tears them in pieces, analyzes them, and studies them as
+functions of the nervous system. A scientific psychology is thus reached
+which is the climax of realism, because it means that even the ideas and
+emotions and volitions of man are treated as natural phenomena, that
+their causes are sought and that their effects are determined, that
+their laws are found out. To apply this realistic knowledge of the mind
+in the interest of therapy is merely to use it in the same way in which
+the engineer uses his knowledge of physics, when he wants to harness
+outer nature. As that is possible only when theoretical science has
+reached a certain height of development, it can indeed be said that
+practical psychotherapy on a scientific basis can be considered almost
+as the ultimate point of a realistic movement; it cannot set in until
+psychology has reached high development, and psychology cannot set in
+unless biology has preceded it.
+
+There is no doubt that we are still far from this last phase of the
+realistic period. The practical application of scientific psychology is
+still a new problem. Experimental psychology began about twenty-five
+years ago; at that time there existed one psychological laboratory.
+To-day there is no university in the world which does not have a
+psychological workshop. But laboratories for applied psychology are only
+arising in these present days, and the systematic application of
+scientific psychology to education and law and industry and social life
+and medicine is almost at its beginning. While the height of the last
+realistic wave was in the period of the sixties, seventies, and
+eighties, of the last century, its last phase, the practical application
+of physiological psychology, including psychotherapy, is only at its
+commencement.
+
+But while this last great movement has not yet reached its end, the new
+idealistic movement to come has not yet reached a clear self-expression.
+A general philosophical interest can be felt, but a great philosophical
+synthesis seems still lacking. A new sense of duty can vaguely be felt,
+but great new tasks have not yet found common acknowledgment. Above all,
+the unshaped emotionalism of the masses has not yet been brought into
+any real contact with the new idealism which grows up on the higher
+level of scholarly thought. But it is evident, if a new great mood of
+idealism is to come, one of its popular forerunners must be the demand
+that the spirit is real in a higher sense than matter, that the mind
+controls the body, that faith can cure. In such unphilosophic crudeness,
+no definite thought is expressed, as everything would depend on the
+definition of spirit, of faith, of mind, of reality. Moreover, every
+inquiry would prove that the idealistic value of such statements as are
+afloat among the masses to-day is reached only by a juggling with words.
+That faith can cure appears to point towards the higher world, as the
+word faith has there the connotation of the faith in a religious sense;
+and yet the faith which really cures a digestive trouble, for instance,
+is the faith in the final overcoming of the intestinal disturbance, an
+idea which belongs evidently in the region of physiological psychology,
+but not in the region of the church. Yet, however clumsy such statements
+may be, they are surely controlled by the instinctive desire for a new
+idealistic order of our life, and the time will come when their
+unreasoning and unreasonable wisdom will be transformed into sound
+philosophy without losing its deepest impulse. The realistic conviction
+that even the mind is completely controlled by natural laws and the
+idealistic inspiration that the mind of man has in its freedom mastery
+over the body, are thus most curiously mixed in the popular
+psychotherapy of the day, and too few recognize that the real meaning of
+mind is an entirely different one in these two propositions.
+
+Of course the one or the other of these two elements prevails in the
+systematic treatises on the subject; the realistic one in those written
+by the psychiatrists, the idealistic one in those written by clergymen
+or Christian Scientists. The literature indeed is almost entirely
+supplied from these two quarters: and yet it is evident that neither the
+one nor the other party can give to the problem its most natural
+setting. The student of mental diseases naturally emphasizes the
+abnormal features of the situation, and thus brings the
+psychotherapeutic process too much into the neighborhood of pathology.
+Psychotherapy became in such hands essentially a study of hypnotism,
+with especial interest in its relation to hysteria and similar diseases.
+The much more essential relation of psychotherapy to the normal mental
+life, the relation of suggestion and hypnotism to the normal functions
+seemed too often neglected. Whoever wants to influence the mind in the
+interest of the patient, must in the first place be in intimate contact
+with psychology. On the other hand, the minister's spiritual interest
+brings the facts nearer to religion than they really are. That a
+suggestion to get rid of toothache, or to sleep the next night, is given
+by a minister, does not constitute it as a religious suggestion. If the
+belief in religion simply lies alongside of the belief in most trivial
+effects, and both are applied in the same way for curing the sick, it is
+evident that not the spiritual meaning of religion is responsible for
+the cure, but the psychological process of believing. But if that is the
+case, it is clear that here again the psychologist, and not the
+moralist, will give the correct account of the real process involved.
+In short, it is psychology, psychology in its scientific modern form,
+which has to furnish the basis for a full understanding of
+psychotherapy. From psychology it cannot be difficult to bridge over to
+the medical interests, on the one side, to the idealistic ones on the
+other side.
+
+Our task here is, therefore, to lay a broad psychological foundation. We
+must carefully inquire how the modern psychologist looks on mental life
+and how the inner experiences appear from such a psychological
+standpoint. The first chapters of this volume may appear like a long,
+tiresome way around before we come to our goal, the study of the
+psychotherapeutic agencies. And yet it is the only possible way to
+overcome the superficiality with which the discussion is too often
+carried on; we must understand exactly how the psychological analysis
+and explanation of the scientist differ from the popular point of view.
+After studying in this spirit the foundation of psychotherapy, we shall
+carefully examine the practical work, its methods and its results, its
+possibilities and its limitations. We shall inquire finally into the
+place which it has to take, looking back upon its history, criticising
+the present status and outlining the development which has to set in for
+the future, if a haphazard zigzag movement is not to destroy this great
+agency for human welfare by transforming it into a source of
+superstition and bodily danger.
+
+
+
+
+PART I
+
+THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
+
+
+
+
+II
+
+THE AIM OF PSYCHOLOGY
+
+
+The only safe basis of psychotherapy is a thorough psychological
+knowledge of the human personality. Yet such a claim has no value until
+it is entirely clear what is meant by psychological knowledge. We can
+know man in many ways. Not every study of man's inner life is psychology
+and the careless mixing of different ways of dealing with man's inner
+life is largely responsible for the vagueness which characterizes the
+popular literature of psychotherapy. It is not enough to say that a
+statement is true or not true. It may be true under one aspect and
+entirely meaningless under another. For instance, a minister's
+discussion of man's energies may be full of deep truth and may be
+inspiring; and yet it may not contain the slightest contribution to a
+really psychological knowledge of those energies, and would mislead
+entirely the physician were he to base his treatment of human energies
+on such a religious interpretation.
+
+Can we not look from different standpoints even on any part of the
+outer world? I see before me the ocean with its excited waves splashing
+against the rocks and shore, I see the boats tossed on the stormy sea
+and I am fascinated by the new and ever new impulses of the tumultuous
+waves. The whole appears to me like one gigantic energy, like one great
+emotional expression, and I feel deeply how I understand this beautiful
+scenery in appreciating its unity and its meaning. Yet would I ever
+think that it is the only way to understand this turmoil of the waters
+before me? I know there is no unity and no emotion in the excited sea;
+each wave is composed of hundreds of thousands of single drops of water,
+and each drop composed of billions of atoms, and every movement results
+from mechanical laws under the influence of the pressing water and air.
+There is hydrogen and there is oxygen, and there is chloride of sodium,
+and the dark blue color is nothing but the reflection of billions of
+ether vibrations. But have I really to choose between two statements
+concerning the waves, one of which is valuable and the other not? On the
+contrary, both have fundamental value. If I take the attitude of
+appreciation, it would be absurd to say that this wave is composed of
+chemical elements which I do not see; and if I take the attitude of
+physical explanation, it would be equally absurd to deny that such
+elements are all of which the wave is made. From the one standpoint, the
+ocean is really excited; from the other standpoint, the molecules are
+moving according to the laws of hydrodynamics. If I want to understand
+the meaning of this scene every reminiscence of physics will lead me
+astray; if I want to calculate the movement of my boat, physics alone
+can help me.
+
+As long as we deal with outer nature, there is hardly a fear of
+confusing the various attitudes; but it becomes by far more complex when
+we deal with man and his inner life. We might abstract entirely from
+aesthetic appreciation or from moral valuation, we might take man just as
+an object of knowledge; and yet what we know about him may be entirely
+different in accordance with our special attitude. Each kind of
+knowledge may be entirely true, and yet true only from the particular
+standpoint. Let us consider two extremes. If I meet a friend and we
+enter into a talk, I try to understand his thoughts and to share his
+views. I agree or disagree with him; I sympathize with his feelings, I
+estimate his purposes. In short, he is for me a center of aims and
+intentions which I interpret: he comes in question for me as a self
+which has its meaning and has its unity. The more I am interested in his
+opinions, the more I feel in every utterance, in every gesture, the
+expression of his will and his purposes; their whole reality for me lies
+in the fact that they point to something which the speaker intends; his
+personality lies in his attitude towards the surroundings, towards the
+world. Yet I may take an entirely different relation to the same man. I
+may ask myself what processes are going on in his mind, what are the
+real contents of his consciousness, that is, what perceptions and memory
+pictures and imaginative ideas and feelings and emotions and judgments
+and volitions are really present in his consciousness. I watch him to
+find out, I observe his mental states, I do not ask whether I agree or
+disagree; his will is for me now not something which has a meaning, but
+simply something which occurs in his inner experience; his ideas now
+have for me no reference to something in the world, but they are simply
+contents of his consciousness; his memories now are for me not symbols
+of a past to which he refers, but they are present pictures in his mind;
+in short, what I now find is not a self which shows itself in its aims
+and purposes and attitudes, but a complex content of consciousness which
+is composed of numberless elements. I might say in the first place that
+my friend was to me a subject whom I tried to understand by interpreting
+his meaning, and in the second case, an object which I understand by
+describing its structure, its elements, and their connections.
+
+Both ways of looking on man are constantly needed. We might alternate
+between them in any experience. In the heat of argument, my friend will
+certainly be for me the subject with whose meanings I try to agree or
+disagree, whose emotions carry me away, whose ideas open the world to
+me. Yet in the next moment, I may notice that his ideas were shaped and
+determined by certain earlier experiences; that they linked themselves
+in memory according to certain laws of mental flow; that the vividness
+of his ideas made him overlook certain impressions of the surroundings;
+and that may turn my attention to an entirely different aspect of his
+inner life. His feelings and emotions, his volitions and judgments now
+have for me simply the character of processes which go on and which are
+observed, which coincide and which succeed each other, which fuse and
+overlap, and which are composed of smaller parts. My interest is now no
+longer in the meaning and intentions of this self, but it belongs to the
+structure and the connections in this system of mental facts. At first,
+I wanted to understand him by living with him, by participating in his
+attitudes, and by feeling with his will; now I want to understand him by
+examining all the processes which go on in his consciousness, by
+studying their make-up and their behavior, their elements and their
+laws. In one case I wanted to interpret the man, and finally to
+appreciate him; in the other case I wanted to describe his inner life,
+and finally to explain it. The man whose inner life I want to share I
+treat as a subject, the man whose inner life I want to describe and
+explain I treat as an object.
+
+I might express these two standpoints still otherwise. If my neighbor is
+to me a subject, for instance, in the midst of an ordinary conversation,
+he comes in question only with reference to his aims and meanings:
+whatever he utters has a purpose and end. I understand his inner life by
+taking a purposive point of view. On the other hand, the man whose inner
+life is to me an object can satisfy my interest only if I understand
+every particular happening in his mind from its preceding causes. I
+transform his whole life into a chain of causes and effects. My
+standpoint is thus a causal one. No doubt in our daily life, our
+purposive interest and our causal interest may intertwine at any moment.
+I may sympathize with the hopes and fears of my neighbor in a purposive
+way, and may yet in the next moment consider from a causal standpoint
+how these emotions of his are perhaps affected by his fatigue or by some
+glasses of wine, or by a hereditary disposition, or by a suggestion; in
+short, at one time I look out for the meaning of the emotion as a part
+of the expression of a self, and at another time for the structure and
+appearance of the emotion as a part of a causal chain of events. In both
+directions I can go on with entire consistency, and there cannot be any
+part of inner experience which cannot be fully brought under either
+point of view. How far we have a right to mix the two standpoints in
+practical life, we shall carefully examine; but it is clear that if we
+want to understand the true meaning of the study of inner life, we have
+no longer any right carelessly to mix the two standpoints without being
+conscious of their fundamental difference. We must understand exactly
+what the aim of the one and of the other is, and where each has its
+particular value; science certainly has no right to throw together such
+different views of life. And now this may be said at once: the causal
+view only is the view of psychology; the purposive view lies outside of
+psychology.
+
+Such a separation does not at all aim to indicate that the one view is
+more important than the other, or that the one has more scientific
+dignity than the other; both yield us truth, and both may be carried
+from the simplest and most trivial observations of daily life to the
+highest elaborations of scholarship. To those who are inclined to give
+all value and all credit only to the strictly psychological view, it may
+be replied at once that surely our most immediate life experience is
+carried on by the non-psychological attitude. If we love our family and
+like our friends, and deal with the man of the street, we are certainly
+moving in a world of purposive reality. We try to understand each other,
+to agree and to disagree, to be in sympathy and antipathy, without
+asking how those volitions and feelings and ideas of other people are
+built as mental structures, and from what causes they arose; we are
+satisfied to understand what they mean. In the same way with ourselves.
+We live our lives by hinging them on our aims and purposes and ideas,
+and do not ask ourselves what are the causes of our attitudes and of our
+thoughts.
+
+This purposive view has in no respect to disappear if we move on from
+our personal intercourse to a scholarly study of reality. The historian,
+for instance, who tries to understand the will relations of humanity, is
+the more the true historian the more he sticks to this purposive view of
+man. The truth which he seeks is to interpret the personalities, to
+understand them through their attitudes, to make their will living once
+more, and to link it by agreement and disagreement, by love and hate,
+with the will of friends and enemies, groups and parties, nations and
+mankind. It is only a loose popular way of speaking, if this purposive
+analysis of a character is often called psychological. In a stricter
+sense of the word, it is not psychological. If the historian really were
+to take the psychological attitude, he would make of history simply a
+social psychology, seeking the laws of the social mind, and treating the
+individual, the hero, and the leader, merely as the crossing-point of
+psychological law. For such a psychological view the mental life of the
+hero would not be more important or more interesting than the mental
+life of a scoundrel, and the psychology of the king would not draw his
+interest more than the psychology of the beggar. The historian has to
+shape all that from an entirely different standpoint: his scientific
+interest depends upon the importance of men's attitudes and actions, and
+such importance refers to the world of purposes.
+
+In the same way, we have to stick to the non-psychological point of view
+whenever man's life, his thoughts and feelings and volitions, are to be
+measured with reference to ideals; that is in ethics and aesthetics and
+logic, sciences which ask whether the volitions are good or bad, whether
+the feelings are valuable or worthless, whether the thoughts are true or
+false. The psychologist does not care; just as the botanist is
+interested in the weed as much as in the flower, the psychologist is
+interested in the causal connections of the most heinous crime not less
+than in those of the noblest deed, in the structure of the most absurd
+error not less than in that of the maturest wisdom. Truth, beauty, and
+morality are thus expressions of the self in its purposive aspect.
+
+We can go one step further. Those who narrowly seek every truth only in
+the scientific understanding, ought to be reminded that this seeking for
+causal connections is itself, after all, only a life experience which as
+such is not of causal but of purposive character. "Life is bigger than
+thought." In the immediate reality of our purposive life we aim towards
+mastering the world by a causal understanding, and for this end we
+create science; but this aim itself is then a purpose and not an object.
+The first act is thus for us, the thinkers, not a part of the causal
+events, but a purposive intention towards an ideal. Therefore, our
+purposes have the first right; they represent the fundamental reality;
+the value of causal connections and thus of all scientific and
+psychological explanation, depends on the value of the purpose. Causal
+truth can be only the second word; the first word remains to purposive
+truth. From this point of view we may understand why there is no
+conflict between the most consistent causal explanation of mental life
+on the one side, and an idealistic view of life on the other side; yes,
+we can see that the fullest emphasis on a scientific psychology--which
+is necessarily realistic and, to a certain degree, materialistic--is
+fully embedded in an idealistic philosophy of life, and that without
+conflict. And we shall see how this consistency in sharply separating
+the psychological view from the non-psychological, secures much greater
+safety for true idealism than the inconsistent popular mixing of the
+two principles, where scientific psychology is constantly encroached
+upon by demands of faith and religion, and where faith and religion seem
+constantly in danger of being overturned by new discoveries in
+physiological psychology. We may, indeed, remove from the start the
+mistaken fear that a consistent causal aspect of life leads to injustice
+to the higher aims and ideal purposes of mankind. If we want to have
+psychology,--and that means if we want to consider the mental life in a
+system of causes and effects,--we must proceed without prejudices, and
+without side-thoughts.
+
+From a psychological standpoint our own mental life and that of our
+neighbor, that of the man and that of the child, that of the normal and
+that of the insane, that of the human being and that of the animal, are
+to be considered as a series of mental objects. They are to be analyzed,
+and to be described, and to be classified and to be explained, just as
+we deal with the physical objects in the outer world. How are these
+objects of the psychologist different from the objects of the physicist,
+from the pebbles on the way and the stars in the sky? There is only one
+fundamental difference and all other differences result from it. Those
+outer objects which we call physical, are objects for everybody. The
+star which I see is conceived as the same star which you see, the table
+which I touch is the table which you may grasp, too. But every psychical
+object is an object for one particular person only. My visual impression
+of the star, that is, my optical perception, is a content of my own
+consciousness only, and your impression of the star can be a content of
+your consciousness only. We both may mean the same by our ideas, but I
+can never have your perception and you can never have my perception. My
+ideas are enclosed in my mind. I may awaken in your mind ideas which
+have the same purpose and meaning, but they are new copies in your mind.
+We both may be angry, but your anger can never be my anger, and your
+volitions can never enter my mind. Every possible psychical fact thus
+exists in one consciousness only, while every physical fact exists for
+every possible consciousness.
+
+The psychologist's final task is to explain the appearance and
+disappearance, the connections and sequences of these mental objects,
+the contents of consciousness. But before he can start on explanation of
+the facts, he has to describe them, and describing means analyzing them
+into their elements and fixating those elements and their combinations
+for an exact report. Such descriptive work is in a way preparatory for
+the further task of real explanation; yet it is in itself important,
+complicated, and difficult. Of course, it may be easy to separate the
+complex content into some big groups of facts, to point out that this is
+a memory idea and this an imaginative idea and the other an abstract
+idea, and this a perception and that a feeling, this an emotion and that
+a volition. But such clumsy first discrimination does not go further,
+perhaps, than does the naturalist's, who tells us that this is a
+mountain and that a tree, this a pond and that a bird. The real
+description would demand, of course, an exact measurement of the height
+of the mountain and the geological analysis of its structure, or an
+exact classification of the tree and the bird, with a complete
+description of their organs, and in each organ the various tissues have
+to be described, and in each tissue the various cells, and the
+microscopist goes further and describes the structure of the cell.
+Certainly in the same way the psychologist has to go on to resolve every
+one of those complex structures; he has to examine the mental tissues
+and the mental cells of which a volition or a memory idea or a
+perception are composed. And while he cannot use a microscope for these
+mental elements, yet his studies may cause elements to appear which the
+naive observation remains entirely unaware of.
+
+Perhaps he finds in his consciousness the perception of the table before
+him which lingers for a little while in his mind. He finds no difficulty
+in analyzing it into color sensations and tactual sensations; and yet he
+is aware of so much more in it. The table, for instance, has form for
+him and he may find that these form perceptions involve the sensations
+of the eye movements which he makes from one corner of the table to the
+other; he may find that if the idea lasts in him, he becomes aware of
+the time by sensations of tension; he finds that in his perception of
+the table lies an idea of its use, and he discovers that that is made up
+of elements which are partly memory reproductions of earlier
+impressions, partly sensations of movement impulses; he also finds that
+the table feels smooth, and he discovers by his analysis that this
+impression of smoothness results from a special combination of tactual
+sensations and movement sensations; and again those movement sensations
+he analyzes further into sensations of muscle contraction and sensations
+of pressure in the joints and sensations of tension in the tendons.
+Before a zooelogist has completed his description of a bird in the
+landscape, he has given account of hundreds of thousands of things; but
+before the psychologist would complete the enumeration of the mental
+elements which enter into the seeing of the table, he would have to give
+account of by far more psychical elements. Every point in the surface of
+the table has its own light value, perhaps different in its quality and
+intensity and saturation, in its hue and tint and shade from the next
+one, and at whatever point of the table's edge our attention is
+directed, each one involves numberless shades in the vividness of all
+the other points and numberless mental relations of space perception
+among the various parts of the table. In the thorough analysis of the
+describing psychologist, every single idea, and in the same way, every
+single emotion or feeling or judgment becomes complex like a living
+organism, an aggregate of thousands of mental tissues, and yet made up
+from "the stuff that dreams are made of."
+
+But there is one particular difficulty which makes the psychological
+description so much harder than that of the physicist, and which gives
+rise to many disagreements and discussions in psychological literature.
+The psychologist has not only to tear the complex into pieces and thus
+to seek the elements, but he has to fixate those elements for the
+purpose of communication, as, of course, a scientific description
+demands that he be able to give account to others of what he
+experiences. The physicist has no difficulty whatever in that line
+because, as we saw, the world of physical things is the world which all
+men are sharing together. Every element which I find in it, I can show
+to every other person, and if I cannot show that particular thing,
+because I cannot yet carry the mountain to another place, then I can at
+least measure it, as we share those standards of space. Thus natural
+science has in its objective measurements the possibility of describing
+every part of the physical world. The psychical world, on the other
+hand, is as we saw, the world which is private property. Every effort at
+description is thus entirely in vain as long as our mental facts cannot
+somehow be linked with physical happenings. If I say that I have in my
+mind sweetness or sourness, or bitterness or saltness, I cannot carry
+any understanding to anyone else and therefore cannot give any
+description until I have agreed that I mean by sweetness the sensation
+which sugar gives me, and by saltness the sensation of salt. The sugar
+and salt I can point out to my neighbor and only in that way I
+understand what he means if he says that he tastes salt and sweet;
+otherwise I should have no means whatever to discriminate whether that
+which he calls a sweet taste sensation is not just what I call headache.
+Where no such direct relation for a physical thing is known, description
+of the mental element would remain impossible. Of course, every
+perception of the outer world, all our seeing and hearing, and touching
+and tasting, offers us at once such definite connection between the
+inner experience and a piece of the physical universe. Our own organism
+is also such a piece of physical nature: just as I describe my tasting
+or touching, I may describe the perception of my arms and legs or my
+inner organs. Thus everything which is material of perception gives us a
+handle for a real psychological description. Psychology usually calls
+the elements of these perceptions sensations. Whatever is composed of
+sensations is thus describable.
+
+On the other hand, no other way of description is open. If there were
+mental states which are composed of other elements than sensations, they
+would necessarily remain indescribable; we could not grasp them because
+they would not have any definite relation to the common physical world.
+We might say, for instance, that our mental content is made up of
+sensations and feelings, but if such feelings were really entirely
+different from sensations, they would have to remain for all time
+mysterious and unknown. We could not compare notes. The feeling which I
+call joy may feel just like the one which you call despair. The
+consistent development of modern psychology and its emancipation from
+vagueness and superficial analysis became possible only through the fact
+that such recourse to indescribable elements has become unnecessary.
+Modern psychology has been able to demonstrate more and more that the
+same elements which constitute our perceptions are also the elements of
+the other contents of consciousness. In other words modern psychology
+has recognized that the volitions and emotions and feelings and
+judgments, and the whole stream of inner life, are made up of
+sensations. Millions of sensations in all degrees of vividness and
+clearness, of intensity and fusion, in endless manifoldness of rhythms
+and relations constitute their whole content. It is a discovery quite
+similar to the one which chemistry made when it found that the same
+elements which are part of the inorganic substances are also the only
+possible elements of the organic world.
+
+From a strictly psychological standpoint, the ideas and the not-ideas
+contain thus nothing but sensations. Their grouping, their shading,
+their combination, their succession decide whether we have before us a
+perception or an imagination, a volition or an emotion. What are we
+ourselves then for the psychologist? Evidently we ourselves belong also
+to the inner experiences which we know; and psychology has succeeded in
+analyzing this idea of our own self just in the same way as it analyzes
+our idea of the moon. In this analysis, psychology finds its idea of the
+self as a content of consciousness crystallized about the sensations
+from the body. Every one of our bodily activities is represented in our
+consciousness by movement sensations, and these sensations form the core
+of the complex aggregate which develops into the idea of ourselves.
+Organic sensations from our inner organs, pain sensations and pleasure
+sensations fuse with the movement sensations, and the whole complex
+shapes itself slowly into the idea of the personality of the self in
+contrast to the idea of other personalities. We ourselves are for
+ourselves a complex combination of sensations; and yet all our feelings
+and emotions and volitions are only a part of it. Psychology thus
+necessarily considers those experiences of feeling and will and
+character simply as changes in the midst of that central experience of
+personality which is itself made up of bodily sensations. Each bit of
+will and emotion must be decomposed into its finest elements. There is
+no passing mood, and no floating half-thought in our mind, no dream and
+no intuition, no slightest change of attention, no instinct and desire
+which cannot be analyzed thus into its sensation elements or rather
+which must not be analyzed, if we are to describe it at all, and that
+means if we are to give a psychological account. Psychology is endlessly
+far from this ideal to-day. It has been claimed, not without justice,
+that psychology has reached to-day only the level which physics attained
+in the seventeenth century; but psychology must insist that its ideal
+lies in this direction. No one takes a real psychological view of the
+human mind who does not understand this endless complexity of the
+material, and who does not see that even the simplest mental state
+practically presents a most complex problem to scientific analysis. The
+physician who really aims towards scientifically exact influence on the
+human mind has reached the first step of his preparation as soon as he
+understands that the content of consciousness is composed of hundreds
+of thousands of elements. To treat the mind as if there were only a few
+large pieces, one thing called memory and one thing called will and one
+called emotion and so on, is as if a surgeon were to perform an
+operation, knowing that there are arms and legs, but not knowing the
+ramifications of the nerves and blood-vessels which his knife may
+injure. Yet the description of these complex facts is only the beginning
+of psychology. We saw that the real aim is their explanation.
+
+
+
+
+III
+
+MIND AND BRAIN
+
+
+The central aim of the psychologist must be to explain the mental facts.
+It is not sufficient to describe the procession of mental experiences in
+us, we must understand the causes which determine that now this and now
+that appears and disappears, and appears just in this combination of
+elements. The astronomer is not satisfied with describing the stars, he
+wants to explain their movements and to determine which movements are to
+be expected. The psychologist, like the naturalist, aims towards
+explanation, and it is this demand which forces him to look from the
+psychical facts to the physical ones, from the mind to the brain. He is
+under an illusion if he fancies that he can explain mental facts by
+themselves. The purposive mind has its connection in itself, the causal
+psychological mind demands for its connection the body. To understand
+this necessity is the first step towards understanding the relation of
+mind and brain.
+
+The psychologist's problem of explanation is in one way entirely
+different from that of the physicist. The physicist finds a world of an
+unlimited number of atoms which are ultimately conceived as all alike,
+but each one in a different place, and all the changes in the universe,
+the movements of the stars, the waves of the ocean, are to be explained
+by the causal connections of the movements of these atoms. The
+psychologist, on the other hand, finds an endless manifoldness of
+elements which are not in space, and which have no space form whatever.
+My will is neither triangular nor oval; my emotion is neither shorter
+than five feet nor longer; my memory image of a melody has no thickness
+and no tallness; my contents of consciousness are as such not in space;
+their elements cannot pass through any space movements like the atoms of
+the physicist. Instead of it, the psychical atoms, the sensations, have
+different qualities, are blue and green, and cold and warm, and sweet
+and sour, and toothache and headache. The changes which go on in such a
+system are thus not changes of position and movements, but changes in
+kind and strength and vividness and fusion; and exactly such changes are
+the processes which the psychologist wants to explain. He wants to make
+us understand why this idea grows up and the other fades away, why this
+impression stands out with clearness as an attended object while the
+other lacks vividness and disappears, why this volition grows out of
+that emotion, why this feeling leads to this imaginative thought.
+
+The first step towards such explanation is, of course, in psychology, as
+in all other sciences, the careful observation of regularities. It
+quickly leads us to formulate some general laws. Psychology has known,
+for instance, for two thousand years, that if we have perceived two
+things together, and later we see the one again, the new perception
+brings us a memory image of the other thing. If we saw a man's face and
+heard at the same time his name, seeing his face may later awaken in us
+the memory of his name, or the hearing of his name may later awaken in
+us a reproduced memory image of his face. On such a basis, for instance,
+we formulate some general laws of association of ideas, and as soon as
+we have such laws laid down, we consider the appearance of such a memory
+image by association as sufficiently explained. We feel that it gives us
+sufficient basis to predict that in the future this idea will stir up in
+us the other idea. Psychology has formulated plenty of such general
+statements, and they serve well for a first orientation.
+
+Yet can this ever be considered as a last word of scientific explanation
+of psychical facts? Can psychology really in this way reach an ideal
+similar to that of scientific astronomy or chemistry? Would the
+scientist of nature ever be satisfied with this kind of explanation,
+which is nothing but generalization of certain sequences? Does not the
+explanation of the naturalist contain an entirely different element? He
+does not merely want to say that this effect has sometimes been observed
+and that there is thus probability that it will come again, when similar
+causes are given. No, the physicist wants to understand those
+connections of cause and effect as necessary ones. He tries to find
+sequences which cannot be otherwise because they cannot be thought in
+any other way. Therefore he is not satisfied with complex regularities,
+but analyzes them until he can bring them down to simple physical
+connections, and these physical connections finally to mechanical
+processes, which realize for us logical necessities. That matter lasts
+and cannot disappear is such a presupposition, which comes to us with
+the necessity of logical thinking. We simply cannot think it otherwise.
+And the whole idea of natural science is to conceive the physical
+universe in such a way that all changes in the outer world can be
+understood as the movements of its parts in accordance with such
+necessary physical axioms. If we knew all the atoms of the present
+status of the universe, and we knew every present movement of every
+atom, we should be able to foresee the position of every atom in the
+next moment and in the following moment and in all following moments,
+and all that by the necessary continuation of the substance and its
+energies. That alone is the background of all special physical inquiry,
+and we rely on the special laws of physics and chemistry, because we
+trust that this universe, as a whole, could be ultimately understood as
+such a system of necessary changes in the positions of the lasting
+atoms.
+
+For the psychologist there is no hope of finding such necessity in the
+mental processes. The point is not that psychology is to-day too far
+removed from the fulfillment of such an ideal, the point is rather that
+such an ideal would be meaningless for the psychologist. His materials,
+the psychical contents of consciousness, are by their nature unfit to
+enter into such necessary connections; they cannot do it because they
+cannot last. The physical object, we saw, is the object which is common
+property, which we all feel in common, which must thus exist for all
+time. The things in nature may burn down or decay, but no atom of them
+can ever disappear from the universe, each must enter into new and ever
+new combinations and last through all changes. The psychical thing, on
+the other hand, can exist only for the one immediate experience. Every
+sensation which enters into my ideas or volitions or emotions is a new
+creation of the instant which cannot last; each one flashes up and is
+lost with the moment's experience. My will to-day may have the same aim
+as my will of yesterday, but as psychical object, my will to-day is a
+new will, is a new creation in every pulse beat of my life. I must will
+it again, I cannot store it up. And my joy of to-day can never be as
+psychical fact the same joy which I may have to-morrow. Mental objects
+as such, as psychological material, are not destined to last. It has no
+meaning whatever to think of their being kept over until another time.
+It is a coarse materialism to conceive the mental contents like pebbles
+which may remain on the road from one day to another. Our ideas and
+feelings are mental appearances which have their existence in the act of
+the one experience; each new experience must be an entirely new
+creation.
+
+If I remember my last year's perception, I do not dig it out from an
+under-mind, in which it was stored up and buried, but I create an
+entirely new memory picture, just as I may make to-day a speech which
+says the same thing which I said last year, and yet my action of
+speaking is not last year's speech movement. It is a new action, and the
+movement did not lie over somewhere during the interval. Mental life is
+produced anew in every moment. When the first experience is gone and the
+second comes, nothing of the stuff from which the first was made still
+has existence in the content of consciousness. By this fact it becomes
+entirely impossible ever to conceive necessary connections in the sense
+of physical necessity in the world of consciousness. The one idea may
+bring to me another idea by association, but as long as I consider both
+strictly as mental facts, I can never understand why this association
+happens, I can never grasp the real mechanism of the connection, I can
+never see necessity between the disappearance of the one and the
+appearance of the other. It remains a mystery which does not justify any
+expectation that the same sequence will result again. Whatever belongs
+to the psychical world can never be linked by a real insight into
+necessity. Causality there remains an empty name without promise of a
+real explanation.
+
+Only when we have recognized this fundamental difficulty in the efforts
+for psychological explanation, can we understand the way which modern
+psychology has taken most successfully. The end of this way is simply
+this: every psychical fact is to be thought of as an accompaniment of a
+physical process and the necessary connections of these physical
+processes determine, then, the connections of the mental facts. Indeed
+this has become the method of modern psychology. It has brought about
+the intimate relation between psychology and the physiology of the
+brain, and has given us, as foundation, the theory of psychophysical
+parallelism; the theory that there is no psychical process without a
+parallel brain process. But the real center of the theory lies indeed in
+the fact which we discussed; it lies in the fact that we cannot have any
+explanation of mental states as such at all, if we do not link them with
+physical processes.
+
+Is it necessary to express again the assurance that such statements of a
+parallelism between mind and brain in no way interfere with an
+idealistic view of inner life? Have we not seen clearly enough that
+these mental facts which are conceived parallel to physiological brain
+processes do not represent the immediate reality of our inner life, that
+our life reality is purposive and as such outside of all causal
+explanation, and that we have to take a special, almost artificial,
+point of view to consider inner life at all as objects, as contents of
+consciousness, and thus as psychological material? But since we have
+seen that for certain purposes such a point of view is necessary, as
+soon as we have taken it we must be consistent. Our inner life in its
+purposive reality has therefore nothing to do with brain processes, but
+if we are on the psychological track and consider man as a system of
+psychological phenomena, then to be sure, we must see that our only
+possible interest lies in the finding of necessary causal connections.
+But these cannot be found otherwise than by linking the mental facts
+with the physical ones, the psychological material with the processes of
+the brain.
+
+Of course, that mental experience stands in intimate relations to the
+body is a knowledge which does not wait for such philosophical
+arguments. That mind and body come in contact is a conviction which goes
+with every single sense perception. I see and hear because light and
+sound stimulate my sense organs, and the sense organs stimulate my
+brain. The explanation of perception through causes in the physical
+system seems the more natural as it is evident that in such cases there
+are no psychical causes which might have brought forward the perception.
+If I suddenly hear bells ringing, there was on the mental side nothing
+preceding which could be responsible for my sound perception. And the
+same holds true if the physical source lies in my own body, if perhaps
+my tooth begins to ache, although no expectation preceded it.
+
+In the same way it seems a matter of course that mind and body are
+connected wherever an action is performed. I have the will to grasp for
+the book before me, and obediently my arm performs the movement; the
+muscles contract themselves, the whole physical apparatus comes into
+motion through the preceding mental fact. The same holds true where no
+special will act arouses the muscles. If a thought is in my mind and it
+discharges itself in appropriate words, those words are after all as
+physical facts the movements of lips and tongue and vocal cords and
+chest; in short, a whole system of physical responses has set in through
+a mental experience. But the same thought may be the starting-point for
+many other bodily changes; it may make me blush, and that means that
+large groups of blood-vessels become dilated; or I may get pale, the
+blood-vessels are contracted. Or I may cry, the lachrymal gland is
+working; or it may spoil my appetite, the membranes of my stomach cease
+to produce; or my muscles may tremble, or my skin may perspire; in
+short, my whole organism may resound with mental excitement which some
+words may set up.
+
+But it is not only the impression of outer stimuli and the expression of
+inner thoughts in which mind and body come together. Daily life teaches
+us, for instance, how our mental states are dependent upon most various
+bodily influences. If the temperature of the blood is raised in fever,
+the mental processes may go over into far-reaching confusion; if hashish
+is smoked, the mind wanders to paradise, and a few glasses of wine may
+give a new mental optimism and exuberance; a cup of tea may make us
+sociable, a dose of bromide may annihilate the irritation of our mind,
+and when we inhale ether, the whole content of consciousness fades away.
+In every one of these cases, the body received the chemical substance,
+the blood absorbed and carried it to the brain, and the change in the
+brain was accompanied by a change in the mental behavior. Even ordinary
+sleep at night presents itself surely as a bodily state--the fatigued
+brain cells demand their rest, and yet at the same time the whole mental
+life becomes entirely changed. It is not difficult to carry over such
+observations of daily life to the more exact studies of the
+psychological laboratory and to examine with the subtle means of the
+psychological experiment the mental variations which occur with changes
+of physical conditions. We might feel, without instruments, that our
+ideas pass on more easily after a few cups of strong coffee, but the
+laboratory may measure that with its exact methods and study in
+thousandth parts of a second, the quickening or retarding in the flow of
+ideas. Every subjective illusion is then excluded, our electrical
+clocks, which measure the rapidity of mental action and of thought
+association, will show then beyond doubt how every change in the
+organism influences the processes of the mind. Bodily fatigue and
+indigestion, physical health and blood circulation, everything,
+influence our mental make-up. In the same way it is the laboratory
+experiment which shows by the subtlest means that every mental state
+produces bodily effects where we ordinarily ignore them. As soon as we
+apply the equipment of the psychological workshop, it is easy to show
+that even the slightest feeling may have its influence on the pulse and
+the respiration, on the blood circulation and on the glands; or, that
+our thoughts give impulse to our muscles and move our organs when we
+ourselves are entirely unaware of it.
+
+Again we may turn in another direction. Pathology shows us how every
+physical disablement of the brain is accompanied by mental processes.
+If the blood supply to the brain is cut off, we faint; a blow on the
+head may wipe out the memory of the preceding hours, and a hemorrhage in
+the brain, the bursting of a blood vessel which destroys groups of brain
+cells, produces serious defects in the mental content. A tumor in the
+brain may completely change the personality; the bodily disease of
+certain convolutions in the brain brings with it the loss of the power
+of speech; paralysis of the brain dissolves the whole mental
+personality. Physical inhibition in the growth of the brain involves, on
+the mental side, feeble-mindedness and idiocy. Of course, all this is
+not sufficient to bring out a definite parallelism between special
+mental functions and special physical processes, as the phenomena are
+extremely complex. If a patient who has suffered from a mental
+disturbance dies, and his brain is examined, there is no simple
+correlation before us. It may be difficult to diagnose exactly the
+mental symptoms. If we have heard that the man was unable to read, we do
+not know from that what really happened in his brain. He may not have
+read because he did not see the words, or because the letters were
+confusing, or because he had lost memory for the meaning, or because he
+had lost the impulse to speak the words, or because he felt unable to
+turn his attention, or because the impulse to read aloud was not carried
+out by his organism, or because an inner voice told him that it is a sin
+to read, or for many similar reasons; and yet each one represents
+psychologically an entirely different situation. On the other hand, on
+the physical side, the destruction is probably not confined to one
+particular spot. Complications have crept over to other places or the
+disturbance in one part works as inhibitory influence on other brain
+parts, or a tumor may press on a far-removed part, or the disturbance
+may be one which cannot be examined with our present microscopic means.
+In short, we have always a complex mental situation and a complex
+physical one, and to find definite correlations may be possible only by
+the comparison of very many cases.
+
+Other methods, however, may supplement the pathological one. The
+comparative anatomist shows us that the development of the central
+nervous system in the kingdom of animals goes parallel to the
+development of the mental functions, and that it is not only a question
+of progress along all lines. Any special function of the mind may have
+in certain animal groups an especially high development, and we see
+certain parts correspondingly developed. The dog has certainly a keener
+sense of smell than the man--the part of the brain which is in direct
+connection with the olfactory nerve is correspondingly much bulkier in
+the dog's brain than in the human organism. Here too, of course,
+research may be carried to the subtlest details and the microscope has
+to tell the full story. Not the differences in the big structure, but
+the microscopical differences in the brain cells of special parts are to
+be held responsible. But comparison may not be confined to the various
+species of animals; it may refer not less to the various stages of man.
+The genetic psychologist knows how the child's mind develops in a
+regular rhythm, one mental function after another, how the first days
+and first weeks and first months in the infant's life have their
+characteristic mental possibilities, and no mental function can be
+anticipated there. The new-born child can taste milk, but cannot hear
+music. The anatomist shows us that correspondingly only certain nervous
+tracts have the anatomical equipment by which they become ready for
+functioning. Most of the tracts at first lack the so-called medullar
+sheath, and from month to month new paths are provided with this
+physical equipment.
+
+Finally we have the experiment of the physiologist. His vivisectional
+experiments, for instance, demonstrate that the electrical stimulation
+of a definite spot on the surface of a dog's brain produces movements
+which we should ordinarily take as expressions of mental states,
+movements of the front legs or of the tail, movements of barking or
+whining. On the other hand, the dog becomes unable to fulfill the mental
+impulses if certain definite parts of his brain are destroyed. The
+physiologist may show from the monkey down to the pigeon, to the frog,
+to the ant, to the worm, how the behavior of animals is changed as soon
+as certain groups of nervous elements are extirpated. It is the mental
+emotional character of the pigeon which is changed when the physiologist
+cuts off parts of his brain. In short, stimulation and destruction
+demonstrate, by experiments which supplement each other, that mental
+functions correspond to brain functions.
+
+There is thus no lack of demonstration from all quarters that mental
+facts and brain processes belong together; and yet, however much we may
+cumulate such popular and scientific observations, they would never by
+themselves admit of the sweeping generalization that there cannot be any
+mental state which is not accompanied by a process in the central
+nervous system. Someone might say, to be sure, the perceptions and
+memory images, the volitions and instincts and impulses, have their
+physiological basis, but there remain after all acts of attention, or
+decisions, or subtle feelings, or flights of imagination, which are
+independent of any brain action. Here, indeed, observation cannot settle
+such a general principle. Its real hold lies in the fact with which we
+started: there is no causal connection in the mental states as such. If
+we want to understand mental facts as such in a chain, of causal events,
+we have first to conceive them as parallel to physical events. The
+principle of psychophysical parallelism, that is, the principle that
+every psychical process accompanies a physiological change is thus not a
+mere result of observation. It is simply a postulate. Every science
+begins with postulates and only that which fulfills such postulates has
+the dignity of truth in the midst of that scientific realm. The
+astronomer cannot find by observation that there is no star the
+movements of which are not the effects of foregoing causes. He knows it
+beforehand, he demands it, he does not recognize any movement as
+understood until he has found the causes, he presupposes that such
+causes exist, that no star moves simply by a magic power, and that
+nowhere in the astronomical universe is the chain of causality broken.
+He postulates it, and where he does not discover the causes, he is sure
+that he has not solved the real problem.
+
+In the same way the psychologist who aims towards explanation of mental
+facts must postulate that there cannot be any mental state which is not
+an accompaniment of a physical brain process, and is as such connected
+through physical means with the preceding and the following events in
+the psychophysical system. Only when such a general framework of theory
+is built up by a logical postulate, is the way open to make use of all
+those observations of the laboratory and of the clinic, of the zooelogist
+and of the anatomist. It is the theory which has to give the right
+setting to those scattered observations. However far we may be from
+being able to point to the special brain process which lies at the
+bottom of the higher mental state, we know beforehand that there is no
+shadow of an idea, no fringe of a feeling, no suggestion of a desire
+which does not correspond to definite processes in the brain. The
+details may and must be material for diverging theories, but the
+conflict of such hypothetical opinions has nothing to do with the
+certainty of the underlying conviction that if we knew the whole truth,
+we should recognize every single mental happening as parallel to
+physical processes in the nervous system. To explain mental facts means
+to think them as parallel to the brain processes which have their own
+causal connections in the physical world.
+
+We started, for instance, from the old observation that two impressions
+which come to our mind at the same time have a tendency to reawaken one
+another; and we saw that psychology was well able to formulate these
+facts in general statements of the association of ideas. But we realized
+that that in itself is not really explanation. If the odor which we
+smell awakes in us the name of a chemical substance, and if we now bring
+this under the general heading of association of ideas, an explanation
+is not really given by it. That smell sensation itself is not really
+understood as a cause of those sound sensations of the word. We have no
+insight into the connection of those two happenings. But the situation
+is entirely changed, if we consider the smell effect from the point of
+view of the parallelistic theory. Now the association of facts would
+indicate that we got the first two impressions together, because two
+brain processes were going on at the same time. My nose brought me the
+smell stimulus, my ear gave me the sound stimulus, each going on in a
+particular center, or, to express it in a simplified schematic way, each
+reaching particular brain cells, and the excitement of these brain cells
+being accompanied by the particular sensations. The physiologist has
+many possibilities of conceiving the further stages of the process, in
+order to satisfy the demand of explanation. He may say the excitement of
+each of these two brain cells, the one in the olfactory center, the
+other in the auditory center, irradiates in all directions through the
+fine branches of the brain fibers. Each cell has relations to every
+other cell in the brain; thus there is also one connecting path between
+those two cells which were stimulated at once. Now if the two ends of an
+anatomical path are excited at the same time, the path itself becomes
+changed. The connecting way becomes a path of least resistance, and that
+means that if, in future, one of the two brain cells becomes excited
+again, the overflow of the nervous excitement will not now go on easily
+in all directions, but only just along that one channel which leads to
+that other brain cell. A theory like this explains in real explanatory
+terms, in ways which physics and chemistry can demonstrate as necessary,
+that any excitement of the odor cell runs over into the sound cell and
+vice versa. In short, the psychological association of ideas, which we
+should simply have to accept as inexplainable fact, is thus transformed
+into a connection which we understand as necessary; and the fact is
+really explained.
+
+This simple scheme of the physiology of association for a hundred years
+has given a most decided impulse to the progress of psychology. As the
+association process can so easily be expressed in physiological terms,
+the aim was prevalent to understand the interplay of mental life more
+and more as the result of association. The underlying thought of this
+whole association psychology was thus a conviction that whenever two
+mental experiences occur together, either of them keeps the tendency to
+reawaken the other at a later time. Through the endless combination
+which life's impressions awaken in the mind from the first hour after
+birth, the whole stream of memory images and thoughts and aims and
+imaginations is thus to be explained.
+
+The whole theory of physiological associationism works evidently with
+two factors. First, there are millions of brain cells of which each one
+may have its particular quality of sensation, and second, each brain
+cell may work with any degree of energy, to which the intensity of the
+sensation would correspond. If I distinguish ten thousand different
+pitches of tone, they would be located in ten thousand different cell
+groups, each one connected through a special fiber with a special string
+in the ear. And each of these tones may be loud or faint, corresponding
+to the amount of excitement in the particular cell group. Every other
+variation must then result from the millionfold connections between
+these brain cells. Indeed, the brain furnishes all possibilities for
+such a theory. We know how every brain cell resolves itself into
+tree-like branch systems which can take up excitements from all sides,
+and how it can carry its own excitement through long connecting fibers
+to distant places, and how the endings of these fibers clasp into the
+branches of the next cell, allowing the propagation of excitement from
+cell to cell. We know further how large spheres of the brain are
+confined to cells of particular function, that for instance cells which
+serve visual sensations are in the rear part of the brain hemispheres,
+and so on. Finally we know how millions of connecting fibers represent
+paths in all directions, allowing very well a cooeperation by association
+between the most distant parts of the brain. The theories found their
+richest development, when it was recognized that large spheres of our
+brain centers evidently do not serve at all merely sensory states, but
+that their cells have as their function only the intermediating between
+different sensory centers. Such so-called association centers are thus
+like complex switchboards between the various mental centers. Their own
+activity is not accompanied by any mental content, but has only the
+function of regulating transmission of the excitement from the one to
+the other. Above all their operation would make it possible that through
+associative processes, the wonderful complexity of our trains of thought
+may be reached.
+
+Yet even the highest development of the association theories did not
+seem to do justice to the whole richness of the inner life. We may well
+understand through those association processes that a rich supply of
+memory pictures is at our disposal, that ideas stream plentifully to our
+minds and enter into new and ever new combinations. But that alone is
+not an account of our inner experience. If there is anything essential
+for inner life, it is the attention which gives emphasis to certain
+states and neglects others. And that means that certain mental contents
+are growing not only in strength but in vividness and clearness, and
+that others are losing their vividness, are inhibited and suppressed.
+Here were always the real difficulties of the association theories; they
+seemed so entirely unable to explain from their own means why certain
+states become foremost in our minds and others fade away, why some have
+the power to grow and others are neglected. These facts of attention and
+vividness, inhibition and fading, worked almost as a temptation to give
+up the physiological explanation altogether and to rely on some mystical
+power, some mental influence which could pull and push the ideas without
+any interference and help from the side of the brain. Yet since we have
+seen that the truth of psychophysical parallelism has the meaning of a
+postulate which we cannot escape unless we want to give up explanation
+altogether, it is evident that such falling back into un-physiological
+agencies would be just as inconsistent as if the naturalist should posit
+miracles in the midst of chemistry or astronomy. If the facts which
+cluster about attention cannot be understood by the simple scheme of
+associationism, the demand must be for a better physiological theory.
+
+The development of physiological psychology in recent years has indeed
+shown the way to such a wider theory, which furnishes the physiological
+accompaniment also for those experiences of attention and vividness
+which form the weakness of associationism. This new development has come
+up with the growing insight that the brain's mental functions are
+related not only to the sensory impressions, but at the same time to the
+motor expressions. The older view, still prevalent to-day in popular
+writings, made the brain the reservoir of physical stimuli, which come
+from the sense organs to the cortex of the brain hemispheres. There the
+perceptions arose and through associative interplay the memory pictures
+and the ideas of action and the feelings arose, and the whole inner life
+was thus bound up with the processes in these sensorial spheres. When
+the mind had done its work, finally an impulse was sent to some motor
+apparatus in the brain which then sent off the impulse to some acting
+muscles. That whole motor part was thus a kind of appendix to the brain
+process. The psychical life had nothing to do with it but to give the
+command for its action. The process in the motor part thus began when
+the mental proceeding was completed. But it became clear that this view
+was only the outgrowth of the strong interest which physiology took in
+the sense processes. If a neutral fair account of the brain actions is
+attempted, there can hardly be doubt that this whole sensorial view of
+the brain is only half of the story and that the motor half has exactly
+the same right to consideration. The cortex of the brain, the functions
+of which are accompanied by mental processes, is always and everywhere
+not only the recipient of sensory stimuli but at the same time the
+starting point of motor impulses. That which is centripetal, leading to
+the cortex, is therefore not more important for the central process than
+that which is centrifugal, leading from the cortex. The cortex is the
+apparatus of transmission between the incoming and the outgoing
+currents, between the excitements which run to the brain and the
+discharges which go from the brain, and the mental accompaniments are
+thus accompaniments of these transmission processes. If the channels of
+discharge are closed and the transmission is thus impossible, a blockade
+must result at the central station and the accompanying mental processes
+must be entirely different from those which happen there when the
+channels of discharge are wide open. Here too all the special theories
+are still in the midst of tumultuous discord. Yet this new emphasis on
+the motor side of the psychical process seems to influence modern
+psychology more and more.
+
+Nobody can deny that first of all this is the necessary outcome of a
+biological view of the brain. What else can be the brain's function in
+the midst of nature than the transforming of impressions into
+expressions, stimuli into actions? It is the great apparatus by which
+the organism steadily adjusts itself to the surroundings. There would be
+no use whatever biologically in a brain which had connections with the
+sense organs, but which had no connections with the muscular system, and
+on the other hand, a brain which had motor nerves and muscular
+adjustment would be entirely useless if it had not sensory nerves and
+sense organs connected with it. In the one case the world would be
+experienced, but no response would be possible; in the other case, the
+means for response would be given, but no adjustment could set in
+because no experience of the surroundings would be possible. Adjustment
+every moment demands the relation of the brain in both directions.
+Through the sensory nerves the brain receives; through the motor nerves
+the brain directs, and this whole arc from the sense organs through the
+sensory nerves, through the brain, through the motor nerves and finally
+to the muscles, is one unified apparatus of which no part can be thought
+away. The brain in itself would be just as useless for the organism as
+the heart would be without the arteries and veins.
+
+We must keep this intimate and necessary relation between the sensory
+and motor parts constantly in view, and must understand that there
+cannot be any sensory process which does not go over into motor
+response. Then only the ways are open to develop physiological views
+which give a physical basis to the processes of attention and vividness
+and inhibition, just as well as to the processes of memory and
+association. Such motor theories take many forms. Perhaps we shall most
+quickly bring the most essential factors together, if we say that full
+vividness belongs only to those sensations for which the channels of
+motor discharge are open, while those are inhibited for which the
+channels of discharge are closed; and any channel of discharge is
+closed, if action is proceeding in the opposite channel. If I open my
+hand, the motor paths which lead to closing my fist are blocked; and if
+I close my fist, the channels which lead to the opening of the hand are
+closed. Now if only those ideas are vivid which find the channels open,
+it is clear that all the ideas which would lead to the opposite action
+have no chance for development; they remain inhibited, and just this
+relation between the vividness of certain ideas and inhibition for those
+ideas which lead to the opposite action is the characteristic of the
+process of attention.
+
+From such a point of view, the total mental life can be brought into the
+psychophysical scheme. We now have not two variable factors, but three,
+namely, the qualities of the elements, the intensities of the elements,
+and, as a third, the vividness of the elements. The quality corresponds,
+as we saw in the association theory, to the local position and
+connection of the brain cells; the intensity corresponds to the energy
+of the excitement; and the vividness, we may add now, corresponds to the
+relation to motor channels. The whole mental life thus becomes the
+accompaniment of a steady process of transmitting impressions and
+memories into reactions. That every experience involves millions of such
+elements we saw when we spoke of the description of mental life. The
+effort to explain mental life shows us now that this millionfold
+manifoldness belongs to a system of reactions of which all parts are in
+steady correlation: a moving equilibrium of unlimited complexity. Surely
+no one can reduce this wonderful manifoldness to those clumsy concepts
+with which popular psychology is reporting the story of the mind and its
+relations to the brain.
+
+It may seem that such a psychological view of inner life annihilates
+that which we feel as the most essential characteristic of our inner
+experience, its unity and its freedom. In one sense that is certainly
+true. In the real life which we live and fight through, where our duties
+and our happiness lie, we know a unity and freedom of our personality
+which psychology must destroy. Of course that does not mean that
+psychology denies the truth of that freedom and unity. Moreover it would
+condemn itself if it were to deny that which gives meaning to the
+endeavors of our life and thus also to every search for truth.
+Psychology claims only that we must abstract from it, when we take the
+psychological standpoint towards life. Freedom of our real life means
+that we must know ourselves in the midst of our life work as guided by
+aims and obligations, and that in this purposive existence of ourselves
+we do not feel ourselves as determined by causes. I will the fulfillment
+of my ideals only because I will them. That this will itself may be the
+effect of foregoing causes is an aspect which does not belong to my
+naive experience. Our freedom means that in our real life our will is
+not related to causes, that the point of view of causality is thus
+meaningless for the value of our achievements. And the other man's will
+too comes in question for us as something to be interpreted and to be
+appreciated, but not to be explained by connection with causes. As long
+as we move in this sphere of purposive interest, we are free and deal
+with free selves; but if in the midst of these free aims, the will
+arises to consider the actions of others and of ourselves from the
+standpoint of causality, then we have ourselves decided to enter a new
+sphere in which it would be meaningless to seek for any will which is
+not determined by causes. As soon as we have chosen the psychological
+standpoint and are in the midst of the work of causal reconstruction,
+any will which is not understood as determined by causes is simply an
+unsolved problem. In the midst of a causal construction, absence of
+causes would never mean real freedom.
+
+In that purposive world of immediate life experience, we also are
+unities inasmuch as we ourselves know us as the same in every new will
+of ours. We remain identical with ourselves because every purpose is
+posited in the midst of, and bound up with, the general purpose of
+ourselves. And in this internal unity of meaning, nothing breaks
+ourselves into pieces, and the whole manifold of experience is thus
+expressed by a personality which knows itself in its purposive unity.
+But this unity again is denied by our own intention as soon as we decide
+to take the causal view of inner life. The purposive unity must now
+transform itself into an endless complexity, and our own self becomes a
+composite of hundreds of thousands of elements.
+
+On the other hand, all this does not mean that psychology cannot have
+its own consistent conception of the mind's unity and freedom. Our
+psychological mind is a unity because its manifold is a system in which
+all parts hang together. A change in any one part involves changes in
+the whole system. The interrelation, to be sure, is not a strictly
+psychical one, for we have seen that the causal connection as such
+appears at the physical side. But, inasmuch as there is no psychical
+process which does not belong to a physiological one, the
+interconnection of the mental facts is complete and involves the
+totality of neural processes of which after all a small part only has
+its psychological record. We might compare those hundreds of millions of
+neurons in each brain with the hundreds of millions of individuals who
+make up the population of the nations, and the psychical accompaniment
+we might compare with the written historical record of mankind. The
+written records themselves have no direct interconnection, they are only
+accompaniments of what happens in these millions of men. And again only
+the higher layer of the neurons in the population sees its doings
+recorded in the annals of history; and yet whatever those leaders of
+action and thought and emotion may achieve is dependent upon and working
+on the actions of those millions of subcortical population neurons. The
+historical record has its unity through the interrelation of all parts
+of historical mankind.
+
+But after all the psychologist has no less a right to speak of freedom.
+Of course his freedom cannot mean exemption from causality. Whatever
+happens in the psychological system must be perfectly determined by the
+foregoing causes. But the psychologist has good reason to discriminate
+between those actions which result from the normal psychophysical
+factors and such actions as result from broken machinery. If the brain
+is poisoned by alcohol or in fever, if an infectious disease has
+destroyed the brain cells, action is no longer the outcome of the
+normal cooeperation of the organs, and even those clusters of neural
+activities which are accompanied by the consciousness of the own
+personality lose their control of the motor outcome. The man in delirium
+or paralysis acts without causal connection with his past; the action
+is, therefore, not the product of his whole personality, and the
+psychologist is justified in calling the man unfree. But, whenever the
+motor response results from the undisturbed cooeperation of the normal
+brain parts, then the inherited equipment and the whole experience and
+the whole training, the acquired habits and the acquired inhibitions
+will count in bringing about the reaction. This is the psychological
+freedom of man. The unity of an interconnected composite and the freedom
+of causal determination through normal cooeperation of all its parts
+characterize the only personality which the psychologist has to
+recognize.
+
+
+
+
+IV
+
+PSYCHOLOGY AND MEDICINE
+
+
+We are now ready to take the first step towards an examination of the
+problem of curing suffering mankind. So far we have spoken only of the
+meaning of psychology, of its principles and of its fundamental theories
+as to mind and brain. We have moved in an entirely theoretical sphere.
+Now we approach a field in which everything is controlled by a practical
+aim, the treatment of the sick. Yet our discussion of psychology should
+have brought us much nearer to the point where we can enter this realm
+of medicine. Everything depends on the right point of entrance. That an
+influence on the inner life of man may be beneficial for his health is a
+commonplace truth to-day for everybody. Every serious discussion of the
+question has to consider which influences are appropriate, and in which
+cases of illness the influence on inner life is advisable. The popular
+treatises usually start this chapter by speaking of the "mental and
+moral" factors; and this coupling of mental influences and moral
+influences characterizes large parts of the discussions of the Christian
+Scientists and the Christian half-scientists. Yet we must insist that
+the right entrance to psychotherapy is missed if the difference between
+morality and mentality is not clearly recognized from the beginning. The
+confusion of the two harms every statement. To avoid such a fundamental
+mistake, we had to take the long way around and to examine carefully
+what psychology really means and what it does not mean.
+
+We know now that inner life can be looked on from two entirely different
+standpoints: a purposive one and a causal one, and we have seen that
+these two ways of looking on inner life bring about entirely different
+aspects of man's inner experience, serve different aims, and stand in
+different relations to the immediate needs of our real life. We know
+that the one, the causal aspect, belongs to psychology, while the
+non-psychological, the purposive aspect, belongs to our immediate mutual
+understanding in the walks of life. If the physician is to make use of
+inner experience in the interests of overcoming sickness, he must first
+decide whether to take the causal or the purposive point of view in
+dealing with the patient's mind. This problem is too carelessly ignored
+and through that neglect arises much of the popular confusion. Of course
+just this carelessness becomes in some ways the ground for apparent
+strength for many a superstition and prejudice. If the doors of the
+causal mind and of the purposive mind are both open, and the spectator
+does not notice that there are two, any trick on thought and reason can
+easily be played. Whatever cannot pass through the causal door slips in
+through the other, and whatever does not go in through the door of
+purpose marches through the entrance of causality. With such methods
+anything can be proved, and the most unscrupulous doctrines can be
+nicely demonstrated. If we are to avoid such logical smuggling, we must
+see clearly which attitude towards mental life belongs properly to the
+domain of psychotherapy.
+
+But what we have discussed now leaves little doubt as to the necessary
+decision. The physician is interested in the mental life with the aim of
+producing a certain effect, namely, that of health. Thus the mental life
+of the whole personality comes in question for him as belonging to a
+chain of causes and effects; whichever levers he may move, everything is
+to be a cause which, in accordance with causal laws, is to produce a
+certain change. Inner life is thus, in the interests of medical
+treatment, necessarily a part of a causal system. This means the
+standpoint of scientific psychology is the only adequate one. The
+purposive view of inner life ought not to be in question when the
+patient enters the doctor's office.
+
+To characterize the difference, it may be said at once that it is a
+purposive view which belongs to the minister. If the minister says to
+his despairing parishioner, "Be courageous, my friend, and be faithful,"
+nothing but a strictly purposive view gives meaning to the situation.
+The word friend indicates it, that one subject of will approaches
+another subject of will, with the intention of sympathy and
+understanding of the attitude of the other; and the advice to be
+courageous and faithful means an appeal which has its whole meaning in
+the relation to aims and ends. The speaker and the hearer are both
+moving in a sphere of will relations, purposes and ideals, sin and
+virtue, hope and belief. To take the other extreme: if the neurasthenic
+in his state of depression and in his feeling of inability seeks relief
+from the nerve specialist, he too may say: "My friend, be courageous and
+faithful," yet his words have an entirely different purpose. They are
+not appeals to a common interest of belief; they are subtle tools with
+which to touch and to change certain psychophysical processes, certain
+states in mind and brain; there each word is a sound which awakens
+certain mental associations, and these associations are expected to be
+causes of certain effects and these effects are to inhibit those
+disturbing states of emotional depression. If a few grains of sodium
+bromide were to produce the same effect, they would be just as welcome.
+The whole consideration moves in a sphere in which only physiological
+and psychological processes are happening. Thus the physician may work
+with the ideas of religious belief, but those ideas are then no longer
+religious values but natural psychophysical material, which is to be
+applied whenever it appears as the right means to secure a certain
+effect.
+
+On the other hand the minister also knows, of course, that every word
+which he speaks has its psychological effect, but he abstracts from that
+entirely, as his belief should appeal directly to the struggling will of
+the man. As minister, he is thus not a psychologist. He works with
+moral means; the physician, with causal means. The view which the doctor
+has to take of the man before him is therefore thoroughly psychological;
+whereas that of the religious friend is thoroughly unpsychological, or
+better, apsychological. Indeed it is misleading, or at least demands a
+special kind of definition, if people say that the minister has to be a
+good psychologist. It is just as misleading as the claim, which we hear
+so often, that for instance Shakespeare was a great psychologist. No,
+the poet deals with human beings from the purposive standpoint of life
+and the mere resolving of complex purposes into parts of purposes is not
+psychology in the technical sense of the term. The poet makes us
+understand the inner life, but he does not describe or explain it; he
+makes us feel with other people, but he does not make those feelings
+causally understood. The realistic novelists sometimes undertake this
+psychological task, but they are then on the borderland of literature,
+the analysis of their heroes becomes then a psychological one.
+Shakespeare understood human beings better than anyone and therefore the
+men and women whom his imagination created are so fully lifelike that
+the psychologist may feel justified in using them as material for his
+psychological analysis, but Shakespeare himself did not enter into that
+psychological dissection; he kept the purposive point of view. In the
+same way certainly the minister--the same holds true for the lawyer or
+the tradesman or anyone who enters into practical dealings with his
+neighbor--may resolve complex attitudes of will into their components,
+but each part still remains a will attitude which has to be understood
+and to be interpreted and to be appreciated, while the psychologist
+would take every one of those parts as a conscious content to be
+described and to be explained. But here we abstract from the purposive
+relations. Our attention belongs now to the doctor's dealing with man;
+for him cause and effect are the only vehicles of connection. Thus he
+has to exclude the purposive interpretation of inner life and has to
+understand every factor involved from a psychological point of view: his
+psychotherapy must be thoroughly applied psychology.
+
+The day of applied psychology is only dawning. The situation is indeed
+surprising. The last three or four decades have given to the world at
+last a really scientific study of psychology, a study not unworthy of
+being compared with that of physics or chemistry or biology. In the
+center of the whole movement stood the psychological laboratory with its
+equipment for the most subtle analysis and explanatory investigation of
+mental phenomena. The first psychological laboratory was created in
+Leipzig, Germany, in 1878. It became the parent institution for
+laboratories in all countries. At present, America alone has more than
+fifty psychological laboratories, many of them large institutions
+equipped with precious instruments for the study of ideas and emotions,
+memories and feelings, sensations and actions. Still more rapid than
+this external growth of the laboratory psychology was the inner growth
+of the experimental method. It began with simple experiments on
+sensations and impulses, and it seemed as if it would remain impossible
+to attack with the experimental scheme the higher and more complex
+psychical structures. But just as in physics and chemistry the triumphal
+march of the experimental method could not be stopped, one part of the
+psychological field after another was conquered. Attention and memory,
+association and inhibition, emotion and volition, judgment and feeling
+all became subjected to the scientific scheme of experiment. And that
+was all supplemented by the progress of physiological psychology,
+pathological psychology, child psychology, animal psychology. In this
+way the last decades created a science which of course was by principle
+a continuation of the old psychology, but yet which had good reason to
+designate itself as a "new" psychology.
+
+But in this whole development, until yesterday, the curious fact
+remained that it was going on without any narrow contact with practical
+life; it was a science for the scientist and measured by its practical
+achievements in daily life, it seemed barren and unproductive.
+Psychology was studied as palaeontology and Sanscrit were studied,
+without any direct relation to the life which surrounds us. And yet
+after all it deals with the mental facts which have to enter into every
+one of our practical deeds, if we are to consider mental life from a
+psychological point of view. The psychologists were certainly not to be
+blamed for sticking to their theoretical interests. More than that,
+they were certainly justified in their reluctance, as everything was in
+the making, and incomplete theories can easily do more harm than good.
+But slowly a certain consolidation has set in; large sets of facts have
+been secured, and psychology seems better prepared to become serviceable
+to the practical tasks. On the other hand, it has been noticeable for
+some time that not a few of the psychological results have gone over
+into unprofessional hands and have been thrown on the market places and
+have been brought into many a home where no one knew how to deal with
+them rightly. Thus the need seems urgent that the psychologists give up
+their over-reserved attitude and recognize it as their duty to serve the
+needs of the community.
+
+It is not sufficient for that end, simply to take odds and ends of
+psychology and to hand them over to anyone who can see some use for
+them. We must have a systematic scientific work done for the special
+purpose of adjusting psychological knowledge to the definite practical
+tasks and of examining the psychological facts with that practical end
+in view. A science must be developed which is related to psychology as
+engineering is related to physics and chemistry. Just as the
+technological laboratories of the engineer bring out many new problems
+which the physicist would never have approached, in the same way we may
+expect that special institutions for applied psychology will shape the
+psychological inquiry in a new way.
+
+Such a new science of applied psychology of course has before it a
+field just as large and manifold as the field of technology, where
+physical engineering, chemical engineering, mechanical engineering, and
+electrical engineering and so on are separated. Such a future
+psychological technology would deal, for instance, with
+psychopedagogical problems. There belongs everything which refers to the
+psychology of memory or attention, of discipline, of fatigue, of habit,
+of imitation or effort; in short, all those mental factors which have to
+be considered whenever the schoolchild is looked on from a causal point
+of view. Further there is the psycholegal field where the memory and the
+perceptions, the suggestibility and the emotions of the witness are to
+be studied, where the psychological conditions which lead to crime, the
+means to tap the hidden thoughts of the criminal, the inhibitions for
+the prevention of crime, the mental effects of punishment and similar
+causal processes must be determined. There are the psychoscientific
+problems referring to psychological influences on the observations and
+judgments and discriminations of the scholar who watches the stars or
+who translates an inscription. There are the psychoaesthetic problems
+where the task is to examine causally the factors which lead to the
+agreeable effects of beautiful surroundings, and from the height of the
+psychology of aesthetics in painting and sculpture, the inquiry may go to
+the psychology of the pleasant effects in dress-making or cooking. There
+are the large groups of psychotechnical problems where the effort refers
+to the application of psychology in securing the best conditions for
+labor and industry and commerce. It leads from the mental effects of
+signals or the mental fatigue in mills to the secrets of advertisements
+and salesmanship. There are especially important psychodiagnostical
+studies where the aim is to determine the individual differences of man
+by experimental methods and to make use of them for the selection of the
+right man for the right place. There are psychosocial problems where we
+examine the psychological factors which have to enter into public
+movements, into social reforms, into legislation and into politics. In
+this way new and ever new groups may be added; every time the central
+thought is: how far can causal psychological knowledge help us to reach
+a certain end? Together with these forms of applied psychology, we find
+the psychomedical problems; here belongs everything which allows the
+application of causal psychology in the interests of health.
+
+It might be answered that this demand for a strictly causal point of
+view can hardly be fulfilled, because, if I am acting,--it may be in the
+interest of education or law or technique or medicine,--I must always
+have an end in view and to select such an end belongs after all to my
+system of purposes. If I am a teacher and have to deal with children,
+then it may be said that after all, my knowledge of causal psychology
+cannot help me if I am uncertain for which ideals I want to educate
+these children. Psychology can tell me that I need these means, if I
+want to reach certain effects, but I cannot find out by psychology which
+effects are desirable. Psychology may tell me how to make a good
+business man or a good scholar or a good soldier out of my boy, but
+whether I want him to become a soldier or a merchant I must decide for
+myself with reference to general aims, and that leads me back to the
+purposive view of life. Such argument is entirely correct. Yes, it is
+evident that it is in full harmony with our whole understanding of the
+purpose of psychology. We saw that psychology with its causal treatment
+of man's mind does not express the immediate reality, but is a certain
+reconstruction which allows a calculation of certain effects. Thus it is
+itself a system existing for a subject who has certain ends in view. The
+whole causal view of man is thus a tool in the service of the purposive
+man. This is the reason why it is indeed utterly absurd to think that
+psychology can ever help us to determine which end we ought to reach.
+
+In education, for instance, very many different ends might be reached;
+psychology cannot decide anything. The decision as to the aims of
+education must be made by ethics, which indeed takes not a causal but a
+purposive attitude. Only after ethics has selected the aim, psychology
+can teach us how to reach it. Of course this principle must hold for the
+physician too. All his causal dealing with the mind presupposes that he
+has selected a certain end in harmony with his purpose. The only
+difference is that, in the case of the physician, there can be no
+possible doubt as to the desirable end; what he aims at is a matter of
+course, namely, the health of the patient. To desire the health of the
+sufferer is thus itself a function which belongs entirely to the
+purposive view of the world, and only in the interest of this purpose
+does the physician apply his knowledge of psychology or of the causal
+sciences of physics, physiology, and chemistry. Indeed only with this
+limitation have we the right to say that the psychotherapist takes the
+causal,--and that means the psychological,--view of his patient. As far
+as he decides to take care of the health of his patient, this decision
+itself belongs to the purposive world and to his moral system. The
+physician is thus ultimately just like the minister and just like anyone
+who deals with his neighbor, a purposive worker; but while the minister,
+for instance, remains on this purposive track, the physician puts a
+causal system into the service of his purpose. He knows the end, and his
+whole aim is to apply his causal knowledge of the physical and psychical
+world to the one accepted end of restoring the health of the patient. He
+has to ask thus in general: what has psychology to-day to offer which
+can be applied in the interests of medicine?
+
+It would be an inexcusable narrowness to confine that chapter of applied
+psychology which is to deal with the psychomedical problems to the work
+of psychotherapy. Medicine involves diagnosis of illness as well as
+therapeutics. Between the recognition and the treatment of the illness
+lies the observation of its development and all this is preceded by
+steps towards the prevention of illness. In every one of these regions,
+psychology may be serviceable. Psychotherapy is thus only one special
+part of psychomedicine. But the situation becomes still more complex by
+the fact that the illness to be treated or the disturbance to be removed
+may stand in different relations to the psychophysical processes. The
+illness may be a disturbance in the psychophysical brain parts, or it
+may belong to other brain parts which are only in an indirect way under
+the influence of mental states or which are themselves indirectly
+producing changes in the mental life. And finally the disturbance may
+exist outside of the brain in any part of the body, and yet again
+through the medium of brain and nervous system it may produce effects in
+the mind or be open to the influence of the mind. Thus we have entirely
+different groups of medical interests and it would be superficial to
+ignore the differences.
+
+Both psychodiagnostic and psychotherapeutic studies must be devoted to
+cases in which the mind itself is abnormal, further to cases in which
+the normal minds registers the abnormalities in other parts of the body,
+and finally to cases in which the normal mind influences abnormal
+processes in the body. These latter two cases have to be subdivided into
+those where the bodily disturbance still lies in the brain parts and
+those where it lies outside of the brain. But the situation becomes
+still more complex by the mutual relations of those various processes.
+The impulse to take morphine injections may have reached the character
+of a mental obsession and thus represent an abnormality of the mind, but
+yielding to it produces at the same time disturbances in the whole body
+which thus become again external sources for abnormal experiences in
+otherwise normal layers of the mind.
+
+Of course the interest of the psychologist as such remains always
+related to the psychological factor, but the relation of the
+psychological factor itself to the total disturbance may be of most
+different character. If I diagnose or treat the fixed idea of a
+psychasthenic, the psychological factor itself represents the
+disturbance. On the other hand, if I study the pain sensations of a
+patient who suffers from a disease of the spinal cord, then the
+sensations themselves, the only psychological factor in the case, are
+only indications of a disease which belongs to an entirely different
+physical region; the mind itself is normal. Or, on the other hand, if I
+try to educate a sufferer from locomotor ataxia to develop his walking
+by building up in his mind new motor ideas to regulate his cooerdinated
+movements, the mind again is entirely normal but the physician needs his
+psychology on account of the influence which the mind has on the bodily
+system. Again, we must insist that psychomedicine covers this whole
+ground. Wherever a psychical factor enters into the calculations of the
+physician either by reason of its own abnormality or by its relation as
+effect or as cause to a diseased part of the body in the brain or
+without, there we have a psychomedical task, and as far as it is
+therapeutic, we have psychotherapy.
+
+The psychodiagnostic research lies outside of the compass of our book,
+but we cannot emphasize sufficiently the great importance which belongs
+to that work. Moreover, just in the field of psychodiagnostics, the
+methods of the modern experimental psychological laboratory are most
+promising and successful. Let us not forget that we deal with such
+psychological factors even when we test the functions of eye and ear and
+skin and nose by examining the sensations and perceptions. The oculist
+who analyzes the color sensations of a patient and the aurist who finds
+defects in the hearing of the musical scale and discovers that certain
+pitches cannot be discriminated, is certainly dealing, for diagnostic
+purposes, with the material that the psychological laboratory has sifted
+and studied. Even that sensation symptom which enters into so many
+diseases, the sensation of pain, belongs certainly within the compass of
+the psychologist and it is only to be regretted that the systematic
+study of the pain sensations, mostly for evident practical reasons, has
+been much neglected in the psychological laboratory.
+
+The psychologists have been at work all the more eagerly in the fields
+of association and memory, attention and emotion, habit and volition,
+distraction and fatigue. Here subtle methods have been elaborated,
+methods which surely common sense cannot supply, and which showed
+differences of mental behavior with the exactitude with which the
+microscope reveals the hidden differences of form. If physicians are
+slow in accepting the help which the psychological laboratory can
+furnish, it may be in good harmony with the desirable conservative
+policy in medicine, but finally the time must come when this
+instinctive resistance against new methods will be overcome. The recent
+attachment of psychological laboratories to certain leading psychiatric
+clinics is a most promising symptom. Yet the diagnostic studies with the
+means of the psychological laboratory cannot be confined to the cases of
+mental disease. The mild abnormalities of the mind, and especially the
+nervous disturbances which exist outside the field of insanity, demand
+this support of psychology much more. And even the normal personality
+will be more safely protected from disease and from social dangers for
+its mental constitution if the resources of experimental psychology are
+employed. The more we know of the psychological constitution of the
+individual, the more we can foresee the development which is to be hoped
+for or feared and which may be encouraged or retarded.
+
+The psychologist may determine, for instance, the degree of attention
+with its resistance against distracting stimuli, the power of memory
+under various conditions and on various material, the mental
+excitability and power of discrimination, the quickness and correctness
+of perception, the chains of associations, the rapidity of the
+associative process for various groups, the types of reaction, the
+forming of habits and their persistence, the conditions of fatigue and
+of exhaustion, the emotional expressions and the emotional stability,
+the time needed for recreation and the resistance against drugs, the
+degree of suggestibility and the power of inhibition: and every result
+in any of these lines may contribute to the diagnosis and prognosis of
+cases. The chronoscope here measures the reaction times and association
+times in thousandths of a second; the kymograph, by the help of the
+sphygmograph, writes the record of the pulse and its changes in
+emotional states, while the pneumograph records the variations of
+breathing, and the plethysmograph shows the changes in the filling of
+blood vessels in the limbs which is immediately related to the blood
+supply of the brain. Here belongs also the ergograph, which gives the
+exact record of muscular work with all the influences of will and
+attention and fatigue, the automatograph which writes the involuntary
+movements, especially also the galvanoscope which may register the
+influence of ideas and emotions on the glands of the skin, and thus lead
+to an analysis of repressed mental states, and hundreds of other
+instruments which are used in the psychological laboratory.
+
+Yet it would be misleading to think only of complex apparatus when
+experimental psychology is in question. An experiment is given whenever
+the observation is made under conditions which are artificially
+introduced for the purpose of the observation. Thus there is no need of
+the physical instrument. If I bring a spoonful of soup to my mouth at
+dinner and I become interested in the combination of warmth sensation
+and touch sensation and taste sensation and smell sensation, then I have
+performed an experiment if I take one more spoonful of soup just for the
+purpose of the observation. The physician too may carry out important
+psychological experiments, without needing the outfit of a real
+laboratory. Association experiments, for instance, promise to become of
+steadily growing importance. To make them serviceable to the problems of
+his office, nothing but a subtle psychological understanding is needed,
+inasmuch as any routine work schematically applied to every case alike
+would be utterly useless. Give your man perhaps a hundred words and let
+him speak the very first word which comes to his mind when he hears the
+given ones. You call rose, and he may say red or flower or lily or
+thorn; you call frog and he may answer pond or turtle or green or jump,
+and if you choose your hundred words with psychological insight, his
+hundred answers will allow a full view of his mental make-up. This is an
+experiment which does not require any instruments at all but a man's
+subtle analysis of the replies. That is not seldom sufficient to secure
+the diagnosis of complex mental variations. The method yields still more
+if the time for such a reply is measured, but there again not the costly
+chronoscope of the laboratory is indispensable; a simple stop watch
+which gives the fifths of a second would be fully sufficient for all
+practical purposes. From such simple facts of the mental inventory the
+association experiments may lead to complex questions which slowly may
+disentangle the confused ideas, for instance, of a dementia praecox, and
+thus lead to subtle differential diagnosis.
+
+The psychological laboratory alone can also elaborate the methods of
+studying, for instance, the feeble-minded with all the individual
+variations. New and ever new methods have been tried; the memory was
+tested by reading and repeating figures or letters, or colored papers
+were shown or cardboards of different forms or nonsense syllables, and
+the powers of remembering were studied. Or the accuracy of arm movements
+was examined, or the quickness of understanding associated words, or the
+success in planning a complex movement like throwing a ball at a target,
+or the tapping of a key in the rhythm of a metronome, or the
+discrimination and recognition of the pieces in the game of dominoes and
+many another scheme. The laboratory has to analyze the conditions for
+such methods and the psychologist has to prepare the means for the use
+of the physician, just as the chemist has to prepare the sleeping
+powders. In a similar way the laboratory may furnish means to analyze
+the mental disturbances by a comparison with the experimental results of
+artificial influences, for instance, of over-fatigue or half-sleep, of
+drugs or alcohol, of poisons and emotional excitements. The
+psychological resolving of the mental symptoms may of course, in the
+same way, furnish the diagnosis where the mental variation is only a
+distant effect of a bodily ailment. The changes in the emotions, for
+instance, may lead to the recognition of a heart disease; lack of
+attention may be a hint of the overgrowth of the adenoids; irritability
+or apathy or delirious character of the mental behavior may indicate
+whether uraemic acid is in the system or an infectious disease: anaemia
+and undernutrition may be diagnosed and the psychology of fever demands
+too a much closer analysis with the means of the psychological
+laboratory than it has received so far.
+
+We have not spoken as yet about those psychological methods which
+themselves introduce abnormal mental states like hypnotism, and which
+also not seldom are only means for diagnostic purposes. The hypnotic
+state may bring to memory forgotten experiences of which the
+physiological effects may have lasted in the brain and which may have
+brought injury to the psychophysical system. Hypnotic inquiry can thus
+lead to the recognition of the first causes in many hysterical states
+and where hypnotism is not the best adjusted tool, a certain dreamlike
+staring may be more effective. We have to return to much of that later
+in full detail because just for instance in hysteria, the clear
+recognition of the sources and of the character of the disease may at
+the same time prove to be in itself the right starting point for
+curative treatment.
+
+We have spoken so far only about the relations of psychology and
+medicine from the point of view of diagnosis; the relations from the
+point of view of therapy will make up the second part of this book. We
+shall describe the methods and the results, the possibilities and the
+limitations with manifold detail. That is the chief topic of this
+volume. All that is needed to prepare for this principal problem is on
+the one side a preparatory clearing up of some fundamental conceptions,
+especially of those two which have played the chief role in the whole
+discussion, namely the subconscious and suggestion. And on the other
+side, we may consider at first some fundamental discriminations which
+steadily influence the inquiries and controversies in the field. I think
+of the difference between normal and abnormal mental states, between
+psychical and physical facts in psychotherapy, between functional and
+organic diseases, and to return to our starting point, between mental
+and moral influences.
+
+Every curative effort presupposes that the normal state of health has
+been lost and that a diseased state has set in. Yet the mental analysis
+suggests still less than the bodily inquiry, just where the normal
+functioning is really lost. It would be easy to draw a demarcation line
+if the pathology of the mind introduced any mental features which are
+unknown in our normal existence, but the opposite is true. No mental
+disease introduces elements which do not occur in the sphere of health.
+A degenerated brain cell looks differently under the microscope from a
+normal one, but the ideas of a paranoiac, the emotion of a maniac, the
+volition of a hysteric, the memory idea of a paralytic is each in its
+own structure not different from such elements in any one of us. The
+total change lies thus only in the proportion; there is too much or too
+little of it. The pathological mental life is like a caricature of a
+face--each feature is contained, as in the ordinary portrait, but the
+proportion is distorted, there is too much or too little of chin or of
+nose. But who can indicate exactly the point where the distortion of the
+features constitutes a caricature? Every grotesque change in the
+relations ruins the healthy state: what makes us sure that the harmony
+of health is spoiled?
+
+Certainly we cannot settle it by mere statistics. The norm never means
+merely a majority. Even if the overwhelmingly larger part of mankind
+suffered from phthisis, the few who were free from it would be
+recognized as well and all the others would be considered ill. In mental
+life still more, no one ought to propose that the exceptional function
+is the symptom of disease. The few persons who never had a dream in
+their lives differ much in their mental experience from the large
+majority and yet their peculiarity is certainly not a symptom which
+needs curative treatment. The only real test of health is the
+serviceableness to the needs of life. We have an unhealthy state of the
+personality before us wherever the equilibrium of the human functions is
+disturbed in a way which diminishes the chances of existence, and the
+seriousness of the ailment depends upon the degree of this diminishing
+power. Seen from a strictly psychological point of view, we must expect
+thus a broad borderland region between the entirely normal well-balanced
+mental life and that unbalanced disorder of functions which really
+interferes with the chance for self-protection and effectiveness. That
+the melancholic who declines to take any nourishment, or the paranoiac
+who misjudges his surroundings, is unable to secure by his own energies
+the safety of his life cannot be doubted. The balance is completely
+destroyed and the will and the intellect of the physician and of the
+nurse must be substituted for his own mental powers, if his life is to
+be prolonged at all. But the misjudgment and the depression of the
+insane are only an exaggeration of that which may occur in any man.
+
+There are therefore thousands of steps which lead from the normal error
+or regret to the destructive disturbance. Everyone knows persons whose
+pessimistic temperament makes them inclined to an over-frequent
+depression, or others whose silly disposition brings out constantly
+those emotional tendencies which the maniac shows in an exaggerated
+degree. The stupid mind shows those lacks of association and connection
+which reach their maximum degree in the mind of the idiot. We know from
+daily life the timid, undecided man who cannot come to a will impulse;
+the hasty man who rushes towards decisions; the inattentive man who can
+never focus his consciousness; and the overattentive man who can never
+dismiss any subject; the indifferent man on whom nothing produces
+evident impression and feeling; the over-sensitive man who reacts on
+slight impressions with exaggerated emotion; and yet every one of such
+and a thousand similar variations, needs only the projection on a larger
+scale to demonstrate a mental life which is self-destructive. The silly
+girl and the stupid boy, the man who has the blues and the reckless
+creature, are certainly worse equipped for the struggles of existence
+than those who are intellectually and emotionally and volitionally
+well-balanced. They will take wrong steps in life, they may be
+unsuccessful, their stupidity may lead them to the poorhouse, their
+recklessness may lead them to the penitentiary. And yet we do not speak
+of them as patients because their disproportionate mental features may
+be sufficiently corrected by other mental states which are perhaps more
+strongly developed.
+
+Further, inasmuch as human life just in its mental functions is related
+to its social surroundings, much must depend on the external conditions,
+whether the disproportion and abnormality has to be treated as
+pathological. The mind which may find perhaps its way under the most
+simple rural conditions would be unable to protect life under the
+complex conditions of a great city. The man who in certain surroundings
+may appear a crank has to be treated as a patient in a different set of
+life conditions. Wherever psychotherapeutic work is in question, perhaps
+nothing is more important than to keep steadily in mind this continuity
+between normal and abnormal mental features. The mental disturbance must
+constantly be looked upon as a change of proportions between functions
+which, as such, belong to every normal life. We have to train and to
+develop, and thus to reenforce, that which is too weak, and we have to
+drain off and to suppress and to inhibit that which is too strong.
+
+Yet just this functional view of disease must remind us strongly from
+the beginning that it would be utterly in vain to draw any demarcation
+line between psychical disturbances and physical ones. We have seen from
+the start that from the point of view of physiological psychology,
+there can be no psychical process without an accompanying physiological
+process in the brain. Every disturbance in mental actions is thus at the
+same time a disturbance in the equilibrium of nervous functions. Yet
+that alone would not exclude the possibility of considering some
+diseases, for instance, exclusively from the mental side, and we should
+be justified in doing so if those parts of the brain which are the seat
+of the mental processes could remain in the diseased state without
+influence on other parts of the nervous system and of the whole body. In
+such a case it would indeed be sufficient to consider the psychophysical
+disturbance from the psychological point of view only, that is, to speak
+of the disease as a disorder of intellect, of emotion or will, without
+thinking of changes in the brain cells. But such isolation does not
+exist in nature. Not only the bodily factors like nutrition and
+circulation and sexual functions have a thousandfold influence on the
+psychophysical processes, and these in turn change the vegetative
+functions of the body, but especially the other parts of the brain and
+nervous system can be affected in most different ways. If we want to
+consider whether a certain variation of the personality demands curative
+treatment, we certainly cannot confine ourselves to the mental
+variations. They are after all only parts of the whole group of changes
+in the organism and are thus symptoms of a disease which has to be
+studied in its totality. The mental symptoms alone may be relatively
+slight variations, which in themselves might be sufficiently balanced
+not to disturb the equilibrium of life, and yet they may be symptoms of
+a brain disturbance which as a whole must interfere with the safety of
+life. On the other hand, mental life may appear like a chaos and yet the
+disturbance may be the symptom of merely a slight brain affection and
+the treatment of the mental symptoms in their apparent severity would be
+a useless effort. The mental disturbance, for instance, of the
+intoxicated or the hashish smoker, even the delirium of the feverish,
+does not suggest a fight against the mental symptoms during the attack.
+
+On the whole, there is a far-reaching independence between the apparent
+mental variations and the seriousness of the brain affection. Light
+hysteric states may produce a strong absenting of the mind while severe
+epileptic conditions of the brain may be accompanied by very slight
+mental changes. Every neurasthenic state may play havoc with mental
+life, while grave brain destructions may only shade slightly the
+character or the intellect. To deal with the mental changes as if they
+belonged to a sphere by itself, to the soul which is well or ill through
+its own independent alterations without steadily relating the changes to
+the total organism, leads therefore necessarily to failure. The mind
+reflects only symptoms of the disease; the disease itself belongs always
+to the organism. Psychotherapy has suffered too much from the belief
+that the removal of mental symptoms is a cure of disease.
+
+Certainly the psychophysical symptoms may often stand in the foreground
+of the disease, and in that case it may be left to the special needs
+whether we deal with them as psychical or as physical changes. Even the
+patient may be made to see them in one or the other way in accordance
+with his special needs. To tell him that his brain cells are in disorder
+and that they can be cured will be the right thing for him who takes
+only the introspective view of his suffering and is in despair because
+his own will seems powerless to overcome those mental changes. For the
+next patient, the opposite may be wiser. The belief that his brain is
+ill may have induced him to give up effort of the will instead of
+helping along by steady self-suggestion. He will be helped more if he
+understands that his mind is working wrongly. But the full truth is that
+both mind and body are in disorder; the function of the disturbed brain
+cells accompanies the ineffective will, and to reenforce the will means
+to bring into equilibrium again the disturbed brain cells. For the
+psychotherapist the temptation of giving the attention to the mental
+symptoms only is strong. The more firmly the physician sticks to the
+standpoint of psychophysiology, the better he will see ailment and cure
+in their right proportion.
+
+This demand for the consideration of the whole personality, mind and
+body, ought not to be influenced by the popular separation between
+organic and functional diseases. If we call organic diseases of the mind
+those in which the mental disturbance is the accompaniment of a brain
+disturbance, and functional those in which no brain disturbance exists,
+we leave entirely the ground of modern psychology. As soon as we
+believe that the mind can be disturbed without a change in the functions
+of the brain, we give away all that which has brought scientific order
+into the study of psychological existence. Every mental disturbance
+corresponds to a disorder in the brain's functions. But there cannot be
+a change in the functions of the brain without a change in its
+structure. Thus we must claim that all those so-called functional
+disturbances like neurasthenia and hysteria, fixed ideas and obsessions,
+phobias and dissociations of the personality, as well as the typical
+insane states of the maniac or paranoiac have their basis in a
+pathological change of the anatomical structure of the brain. This
+postulate cannot be influenced by the fact that the microscope has been
+unable to detect the character of most of these changes.
+
+Of course all this does not exclude its being perfectly justifiable to
+separate those diseases for which a definite destruction of the brain
+parts can be detected, as in paralysis of the brain, from those where
+that is impossible. We may also expect that those disturbances in the
+brain which we cannot as yet make visible, may allow more easily an
+organic repair and thus a restoration to the normal functions. Just as a
+disjointed arm may be brought to function quickly again, a broken arm
+slowly, an amputated arm never, each brain cell too may suffer lesions
+which are reparable in different degrees. But it is evident that it
+remains then an entirely empirical question whether the invisible damage
+allows repair or not. We have no right to say that where the
+destruction cannot be seen under the microscope there is no organic
+change and the disturbance is therefore only a psychical one and can be
+removed by mental means. All changes are physical and experience has to
+decide whether they are accessible to psychological influences or not.
+States like epilepsy may not allow any recognition of definite brain
+destruction and are yet on the whole inaccessible to mental influence,
+while many a brain disturbance with visible alterations, resulting
+perhaps from anaemia or hyperaemia, may be caused to disappear. If on the
+other hand we say that we can cure with psychotherapeutic means only the
+functional brain diseases and define as functional simply those diseases
+which can be cured by such means, we move, of course, in the most
+obvious circle and yet just that is the too frequent fate of the
+discussions in certain quarters.
+
+Every psychical disturbance is organic inasmuch as it is based on a
+molecular change which deranges the function. Some of these changes are
+beyond restitution; some can be brought back to a well-working structure
+by strictly physical agencies like drugs or electricity; others can be
+repaired by physiological stimuli which reach directly the higher brain
+cells through the sense organs and which we call psychical under one
+aspect, but which certainly remain physiological influences from another
+aspect. And these psychophysiological influences of the spoken words or
+similar agencies are thus indeed for therapeutic effect entirely
+cooerdinated with the douche and the bath and the electric current and
+the opiate. It is a stimulation of certain brain cells, an inhibition of
+certain others: a subtle apparatus which must be handled with careful
+calculation of its microscopical causes and effects. That these words
+from an entirely different point of view may mean a moral appeal and
+have ethical value, point to moral and religious ideas and reenforce the
+spiritual personality, lies entirely outside of the psychotherapeutic
+calculation. As long as the curing of the patient is the aim, the faith
+in God is not more valuable than the faith in the physician and the
+moral appeal of no higher order than the influence through the galvanic
+current. They come in question only as means to an end and they are
+valuable only in so far as they reach the end. That they can be related
+to an entirely different series of purposes, to the system of our moral
+ideas, ought not to withdraw the attention of the psychotherapist from
+his only aim, to cure the patient. The highest moral appeal may be even
+a most unfit method of treatment and the religious emotion may just as
+well do harm as good from the point of view of the physician.
+Psychotherapy has suffered too much from the usual confusion of
+standpoints.
+
+
+
+
+V
+
+SUGGESTION AND HYPNOTISM
+
+
+Psychotherapy has now become for us the effort to repair the disturbed
+equilibrium of human functions by influencing the mental life. It is
+acknowledged on all sides that the most powerful of these influences is
+that of suggestion. This is an influence which is most easily
+misunderstood and which has most often become the starting point for
+misleading theories. Before we enter into the study of the practical
+effects of suggestion and the psychotherapeutic results, we must examine
+this tool in the hand of the psychotherapist from a purely psychological
+viewpoint. The patient may perhaps sometimes profit from suggestion the
+more, the less he understands about its nature, but the physician will
+always secure the better results, the more clearly he apprehends the
+working of this subtle tool. Of course, that does not mean that any
+psychology is able to explain the process of suggestion to a point where
+all difficulties are removed, but at least the mysteries can be removed
+and the effects can be linked with other well-known processes.
+
+Let us be clear from the start that suggestion is certainly nothing
+abnormal and exceptional, nothing which leads us away from our ordinary
+life, nothing which brings us nearer to the great riddles of the
+universe. There is no human life into which suggestion does not enter in
+a hundred forms. Family life and education, law and business, public
+life and politics, art and religion are carried by suggestion. A
+suggestion is, we might say at first, an idea which has a power in our
+mind to suppress the opposite idea. A suggestion is an idea which in
+itself is not different from other ideas, but the way in which it takes
+possession of the mind reduces the chances of any opposite ideas; it
+inhibits them. It is indeed the best result of any successful education,
+that the teachings have taken hold of the mind of the young in such a
+way that all the opposite tendencies and impulses and wishes do not come
+to development. The well-educated person does not need to participate in
+a struggle between good and bad motives, for that which has been
+impressed upon his mind does not allow the other side to come up at all.
+Our life would be crowded with inner conflicts if education had not
+secured for us from the start preponderance for the suggestions of our
+educators.
+
+The love of family and friends, of our country and our party are in the
+same way such suggestions. We may hear arguments for the other side,
+arguments which easily convince the man of the other party, but they do
+not appeal to us: they are emasculated before they enter our minds; they
+have no chance to overcome the resistance because suggestions stand in
+their way. No argument will overwhelm the suggestion which religion has
+settled in our inner life, and from this strongest suggestion which can
+stand against any temptation of life small psychological steps lead down
+to the little bits of suggestion with which our daily chance life is
+over-flooded. Every advertisement in the newspaper, every display in the
+shop-window, every warm intonation in the voice of our neighbor has its
+suggestive power, that is, it brings its content in such a way to our
+minds that the desire to do the opposite is weakened. We do buy the
+object that we do not need, and we do follow the advice which we ought
+to have reconsidered. And what would remain of art if it had not this
+power of suggestion by which it comes to us and wins the victory over
+every opposing idea? We believe the painter and we believe the novelist,
+if their technique is good. We do not remember that the inventions of
+their genius are contrary to our life experience; we feel sympathy with
+the hero and do not care in the least that he has no real life. The
+suggestion of art has inhibited in us every contrary idea.
+
+Such daily experience shows us that suggestive power may belong to
+different men in different degree. There are lawyers whose arguments and
+whose presentation open our mind, it seems, to any suggestion: while
+others leave us indifferent; we understand their idea, we follow their
+thoughts, and yet we remain accessible to opposite influences. There are
+teachers whose authority gives to every word such an impressiveness and
+dignity that every opposite thought disappears, while others throw out
+words which are forgotten. On the other hand, the readiness to accept
+suggestions is evidently also quite different with different
+individuals. From the most credulous to the stubborn, we have every
+degree of suggestibility, the one impressed by the suggestive power of
+any idea which is brought to his mind, the other always inclined to
+distrust and to look over to the opposite argument. Such a stubborn mind
+is indeed not only without inclination for suggestions, but it may
+develop even a negative suggestibility; whatever it receives awakens an
+instinctive impulse towards the opposite. Moreover we are all in
+different degrees suggestible at different times and under various
+conditions. Emotions reenforce our readiness to accept suggestions. Hope
+and fear, love and jealousy give to the impression and the idea a power
+to overwhelm the opposite idea, which otherwise might have influenced
+our deliberation. Fatigue and intoxicants increase suggestibility very
+strongly. To look out on a wider perspective, we may add at once that an
+artificial increase of suggestibility is all which constitutes the state
+of hypnotism.
+
+At first, however, we want to understand the ordinary process of
+suggestion in that normal form in which it enters into every hour of our
+life and into every relation of our social intercourse. But if we begin
+to examine the structure of the process, we can no longer be satisfied
+with the vague reference to ideas and their opposites. What does it mean
+after all if we speak of opposite ideas? Can we not entertain any ideas
+peacefully together in our consciousness? From a logical standpoint,
+ideas may contradict each other, but that refers to their meaning. As
+mere bits of psychological experience, I may have any ideas together in
+my consciousness. I can think summer and winter or day and night or
+right and left or black and white or love and hate in one embracing
+thought. As mere mental stuff, the one idea does not interfere with the
+other. On the other hand, this is evident: I cannot will to turn to the
+right and to turn to the left at the same time. There may be a wrangling
+between those two impulses, but as soon as my will stands for the one,
+the other is really excluded. Any action which I am starting to do thus
+crowds out the impulse to the opposed action.
+
+In the sphere of psychological facts, we have here indeed the only
+relation between two happenings which necessarily involves an
+opposition. We could never understand why one brain cell might not work
+together with any other brain cell, but we do understand that nature
+must provide for an apparatus by which the impulse to one action makes
+the impulse to the opposite action ineffective. There is no action which
+has not its definite opposite. The carrying out of any impulse involves
+the suppression of the contrary impulse, and the impulse not to do an
+action involves the suppression of the impulse to do it. When we spoke
+of the relations of mind and brain, we mentioned that such a corelation
+of mental centers indeed exists. Physiological experiments have
+demonstrated that the activity of those centers which stimulate a
+certain action reduce the excitability of those brain parts which awaken
+the antagonistic action. As far as the world of actions is concerned,
+the mechanism of the process of suggestion thus seems not inaccessible
+to a physiological understanding.
+
+Various ideas of movements to be carried out are struggling for control
+in the cortex of the brain. That is the normal status which precedes any
+decision. The channels of motor discharge are open for both
+possibilities; we may turn to the right or to the left. Then the play of
+associations begins. A larger and larger circle of ideas surrounds the
+idea of the one and of the other goal. Those ideas awaken emotions. On
+the one side may call our duty and on the other side our pleasure.
+Larger and larger parts of the central content of our consciousness, of
+our own personality, become involved; our principles and maxims, our
+memories, our hopes and fears, enter into the battle until deeper strata
+of the idea of ourselves enter into a firm association with the one
+side, reenforcing, perhaps, the idea of the goal at the right. This
+opens wide the channels of discharge for the movement to the right and
+inhibits thereby the excitability of the center which leads to the
+opposite action. The channel of discharge to the movement towards the
+left becomes closed, the idea of that movement fades away and becomes
+inhibited: we are moving towards the right. The outcome was the product
+of our total personality.
+
+But this result would have been different, if from the start the
+channels of discharge had not been equally open for both possible
+movements, and if thus the relative resistance to the impulse had not
+been equal on both sides. If, for instance, we had gone from the given
+point frequently to the left, as a result of the habit and training, the
+impulse to the left would have found less nervous resistance. The
+channels would have become widened by the repetition and the opposite
+channels would have been somewhat closed by the lack of use. Or if
+instead of such previous habit, we should see at the decisive moment
+others turning to the left, the impression would have become the
+starting point for a reaction of mere instinctive imitation. While we
+might not have followed that imitative impulse at once, yet the channels
+would have been widened, the discharge in the direction would have been
+prepared by it, the resistance would have been lowered and the chances
+for the opposite movement would have been decreased. Those people who
+moved to the left gave us by their action the same kind of an impulse
+which they would have furnished if they had begged us with words, or if
+they had ordered us to follow them with authoritative firmness. In each
+of these cases, the influence would have amounted to a suggestion.
+Whether we watched the movements of other people or whether their words
+made an impression on us, in either case the way became prepared for a
+certain line of action and therefore the way for the opposite action
+became blocked. The final outcome was thus no longer an entirely free
+play of motor ideas, but there was a little inequality in play. The one
+had from the start a better chance, the other was from the start
+laboring under difficulties. The suggestion of actions is thus nothing
+but making use of the antagonistic character in the nervous paths which
+start from the motor centers. That all such phrases as the opening and
+the closing, the widening and blocking, of channels of discharge are
+only metaphors hardly needs special emphasis. Instead of such
+comparisons, we ought rather to think of chemical processes which offer
+various degrees of resistance to the propagation of the nervous
+excitement.
+
+We see from here the direction in which many psychotherapeutic efforts
+must lie, efforts which are entirely within the limits of the daily
+normal experience, and belong to the medical practice of every
+physician, yes, to the helpful influence of every man in practical life.
+The intemperate man may suffer from his inability to resist his desire
+for whiskey. The idea of his visit to the saloon finds the channels of
+discharge open. We argue with him, we tempt him by attractions which
+lead to other ways, we suggest to him that he spend those evening hours
+perhaps with friends or with books for which we awaken his interest; we
+do it as impressively as we can, we appeal to his friendly feeling for
+us; and if again the hour comes in which the desire for the artificial
+stimulation sets in with a motor impulse towards the bottle, the
+channels for discharge have now been blocked. The idea of the opposite
+action arises, it associates itself with the emotions which we stirred
+up in his mind, it associates itself with the respect for the adviser,
+and thus new clusters of thought reenforce that idea of action which we
+suggested, and this opposite line of action now finds a minimum
+resistance because our appeal has opened beforehand the gate. The desire
+for the book works itself out into action while the desire for the cup
+finds increased resistance.
+
+Just this is the kind of suggestion with which we correct faulty action
+everywhere in our social circle; and yet small steps lead on from here
+to the case where perhaps the desire for alcohol has reached that
+pathological intensity in which the equilibrium is entirely disturbed
+and cannot be repaired without suggestions of a much more powerful
+character, given in a state of artificially increased suggestibility--in
+hypnotism. The principle of opening certain channels of discharge for
+the purpose of closing the opposite channels remains in the extreme case
+the same as in the more ordinary cases. The impulse to drink is a
+positive one, but the principle is not different where the impulse is
+negative. A friend who comes from the quiet country may feel unable to
+pass the busy square of the city. The fear of an accident holds back his
+steps, he cannot give the impulse to walk through the crowded rush of
+vehicles. Now either by words of advice, by persuasion or by showing the
+way, we may apply our suggestion, we open the channels of discharge for
+the necessary movements and thus decrease the excitability of those
+centers in which nervous fear was playing. And again small steps lead
+from here to the case of the psychasthenic sufferer whose phobia does
+not allow him to cross any square and where reenforced suggestion has to
+break open the ways for the walking movement when the square is reached.
+
+Thus we are not far from a causal understanding of suggestive influences
+wherever actions are concerned, where movements are to be reenforced or
+to be suppressed and where antagonism of the motor paths is involved.
+But that does not seem to lead us nearer to the much larger group of
+states in which the whole suggestive process concerns apparently the
+interplay of ideas alone, where not actions but impressions are
+controlled by suggestion, where not impulses but thoughts are
+strengthened or inhibited. Here lies the real psychophysical problem
+which has been by far too much neglected in scientific psychology and
+has almost been hidden and made to disappear in the wonderful accounts
+of the hypnotists. But all those mysterious stories as to the
+achievements of suggestion cannot help so long as we do not understand
+the working of the process, and we shall have the better chance to
+understand it the more we keep away from the uncanny and mysterious
+results which refer to the most complex conditions, and rather seek to
+analyze the state in its simplest forms and compare it with other simple
+mental processes. The psychology of suggestion has suffered too much by
+the fascination which its most complex forms exert on a trivial
+curiosity.
+
+Yet the problem of suggestion in the field of ideas stands after all not
+isolated. Instead of connecting it with the weird reports of mystic
+influence from man to man, let us rather link it with the simple
+experience of attention. There is no pulse-beat of our life in which
+attention does not play its little role. But does not attention share
+with suggestion the characteristic feature that some contents of
+consciousness are reenforced and others are suppressed? This negative,
+this suppressing character of attention is not a chance by-product, it
+is most essential. There is no attention without it. If I am studying, I
+do not hear the conversation around me, and if I listen to the
+conversation, my studies in hand become inhibited. If I enjoy the play
+on the stage and give to it my full attention, my memories of the day's
+work are suppressed; if I think of the happenings of the day, I am not
+attentive to the play and hardly notice what is going on. The inhibited
+impression may often disappear entirely. While I am reading I am not at
+all aware of the tactual and muscular sensations in my legs, and if I am
+completely absorbed by my book, I may not even notice that the bell
+rings. In short, we have here as the most characteristic relation, just
+as in suggestion, the fact that one mental state becomes vivid, and that
+others are losing ground, become less vivid, are inhibited and perhaps
+disappear entirely.
+
+Of course, to point to the similarity between suggestion and attention
+is not a real explanation. It may be answered that attention simply
+offers the same difficulties once more. How can we explain in the
+attention process the fact that one idea, the one attended to, becomes
+vivid and that others evaporate? The difficulty evidently cannot be
+removed by simply saying that only one sensorial process can be
+developed in the brain at one time. The popular descriptions of
+attention easily make it appear as if such were the solution of the
+problem. If one sensorial brain part is intensely engaged, the remainder
+of the brain is condemned to a kind of inactivity. Yet such a dogma is
+hardly better than the old-fashioned one that the soul can have only one
+idea at a time. We know too well now that the psychophysical system is
+an extremely complex equilibrium of millions of elements. Thus every
+change must be explained with reference to this complex manifold. Above
+all, the facts simply contradict such an over-simple explanation,
+inasmuch as it is not at all true that only one content of consciousness
+can become vivid. Our attention does not focus upon one point at all but
+may illuminate a large field and thus give vividness to various complex
+groups. If I am thinking about a scientific problem, an abundance of
+reminiscences of previous reading and imaginative ideas of possible
+solutions, associative thoughts and conclusions are with equal vividness
+before my mind and the forthcoming thought may be influenced by this
+total combination. I have no right whatever to say that the idea of a
+certain solution excludes there in my mind the consideration of the
+books which I have read and of the discussions which I have heard.
+Emotions may be superadded. In short, a world of mental states may be
+held together by one act of attention. And new and ever new thoughts
+are shooting in, and all still find place there in the field attended
+to, while on the other hand my slight headache is inhibited and an
+appointment is forgotten. At a gay banquet, my attention may be given to
+the whole hall with all its color effects and its flowers, and to all
+that the table offers and to the music from the orchestra and to the
+jokes of my neighbors. It is not true that any one of those parts
+suppresses the vividness of the others, they seem rather to maintain and
+to help one another; and yet in the next moment, my neighbor may bring
+me news which absorbs my mind entirely and leaves no room for the
+flowers and the music and the meal. How far can psychology do justice to
+these characteristics of attention?
+
+There seems to be but one way. The attended-to idea does not exclude
+every other idea, but it does exclude the opposite idea, and opposite to
+each other is here again that pair of ideas which lead to opposite
+actions, to opposite psychophysical attitudes. We must remember here the
+psychomotor character of our brain processes which we so fully
+discussed. We recognized the fundamental truth that there is no
+sensorial state which is not at the same time the starting-point for
+motor reaction. We recognized that the brain is by its whole
+psychological development a great switchboard which transfers incoming
+currents into outgoing ones and that its biological meaning lies in the
+fact that it is the center piece of an arc which leads from the sense
+organs to the muscles. We cannot conceive of those relations as complex
+enough; we know, of course, that millions of nerve fibers lead from the
+periphery to the highest psychophysical apparatus in the cortex of the
+brain and that millions of fibers bring about the interrelation between
+these central stations, but we must never forget that millions of fibers
+also represent the outgoing paths and that they too lead down to lower
+central motor instruments which are again in numberless corelations. Any
+impression is thus a starting point for attitudes and reactions and it
+is an empty abstraction to consider it otherwise. An idea is never,
+psychophysically considered, the end of the process, it is always also a
+beginning. No external action may follow, but the mental impulse to such
+is nevertheless starting in the highest center.
+
+If we look at the landscape, every single spot of color, reaching a
+nerve fiber in our eye and finally a sensory cell in our brain, is there
+the starting point for an impulse to make an eye movement in the
+direction of the seen point. The eye may remain entirely quiet as the
+impulse to move to the right and to the left, to move up and to move
+down, may be equally strong, but those thousands of impulses work in the
+motor paths and only their equilibrium results in the suppression of the
+outer movement. With such motor scheme, we begin to understand the
+selective process in attention. An impression may be accompanied by
+other stimuli and associations, by thoughts and ideas, and thousands of
+sensory excitements may thus arise in the cortex, but only those have a
+chance for full vividness of development which cooeperate in the motor
+action already started. Those impressions which would lead to the
+opposite actions have no chance because their motor paths are blocked
+and their own full development is dependent upon their possibility of
+expression. To close the path means to inhibit the idea which demands
+such action. We can attend to a hundred thoughts together, if they all
+lead to the same attitude and deed. We can look at the opera, can see
+every singer and every singer's gown, can listen to every word, can have
+the whole plot in mind, can hear the thousands of tones which come from
+the orchestra; and yet combine all that in one act of attention, because
+it all belongs to the same setting of our reactive apparatus. Whatever
+the one wants is wanted by the others. But if at the same time our
+neighbor speaks to us, we do not notice it; his words work as a stimulus
+which demands an entirely different motor setting as answer. Therefore
+the words remain unvivid and unnoticed.
+
+To attend means therefore to bring about a motor setting by which the
+object of attention finds open channels for discharge in action. Which
+particular action is needed in the state of attention cannot be
+doubtful. Attention demands those motor responses and those inner steps
+by which the object of attention shows itself more fully and more
+clearly. When we give attention to the picture we want to see more
+details, when we give attention to the problem we want to recognize more
+of the factors involved, when we give attention to the banquet we want
+to grasp more of the pleasurable features. This aim of attention
+involves that, as part of such reactions, the sense organs become
+adjusted; we fixate the eyeball, we listen, and in consequence the
+object itself becomes clearer, and through the easy passage into the
+motor channels the whole impression becomes vivid. At the same time, all
+those associations must be reenforced and become vivid too which lead to
+the same action. On the other hand, the opening of the one passageway
+closes the path to the opposite action and inhibits the impressions
+which would interfere with our interest. Every act of attention becomes,
+therefore, a complex distribution in the reenforcement and inhibition of
+mental states.
+
+Now let us come back to suggestion. It shares, we said, with attention,
+the power to reenforce and to inhibit. But if we examine what is
+involved in the suggestion of an idea, we find surely more than a mere
+turning of the attention towards one idea and turning the attention away
+from another idea. That which characterizes and constitutes suggestion
+is a belief in the idea, an acceptance of the idea as real and the
+dismissal of the opposite idea as unreal. Yes, we may say directly that
+it is meaningless to speak of suggesting an idea; we suggest either an
+action or, if no action is concerned, we suggest belief in an idea. If I
+suggest to the fearful man at twilight that the willow-tree trunk by the
+wayside is a man with a gun, I do not turn his attention to an abstract
+idea of a robber nor do I simply awaken the visual impression of one,
+but I make him believe that such an idea is there realized, that he
+really sees the person. If I suggest to him that he hears distant bells
+ringing or that he feels a slight headache, he may not be suggestible
+enough to accept it, but if he accepts it he is not simply attending to
+the idea which I propose but he is convinced of its real existence. The
+same holds true with the negative; if I suggest to him that the slight
+headache of which he complained has disappeared or that the smell which
+he noticed has stopped, I do not simply invite him to think of the
+absence of such sensations. It becomes for him a suggestion only if he
+becomes convinced that these disturbances have now become unreal. The
+same holds true for all those suggestions of ideas which belong to our
+practical life, the suggestions which art imprints on our minds, or
+which politics and religion impart. As long as we are under the
+suggestion of the novelist, we really believe in the existence of the
+heroine; we really believe in the validity of the political party
+principle; it is not an argument to which we simply give our attention,
+it becomes a suggestion only when the belief in its objective existence
+controls our minds. We may say in general that suggestions which are not
+suggestions of actions are without exception suggestions of belief.
+Actions and beliefs are the only possible material of any suggestion.
+
+Yet what else is a belief than a preparation for action? I may think of
+an object without preparing myself for any particular line of behavior.
+Here in the room I may think of rain or sunshine on the street as a mere
+idea, but to know that it now really rains or shines means something
+entirely different. It means a completely new setting in my present
+attitude, a setting by which I am prepared to act along the one or the
+other line, to take an umbrella or to take a straw hat, when I am to
+leave the house. I may think of the door of this room as locked or
+unlocked without transcending the mere sphere of imagination, but to
+believe that it is the one or the other means a new setting in my motor
+adjustments. If it is locked I know that I cannot leave the room without
+a key. Every belief means the preparation for a definite line of action
+and a new motor adjustment in the whole system of motor paths, an
+adjustment by which my actions in future will be switched off at once
+into particular paths. And there is theoretically no difference whether
+my belief refers to the proposition that the door is locked or that a
+God exists in Heaven.
+
+But if every belief is such a new motor setting, then we are evidently
+brought back to the mechanism which was essential for every suggestion
+of action on the one side and for every process of attention on the
+other side, namely, the mechanism of antagonistic movements. To prepare
+ourselves for one line of action means to close beforehand the channels
+of discharge for the opposite. The suggestible mind sees the man with a
+gun on the wayside because he is preparing himself in his expectation
+for the appropriate action; he is ready for the fight or ready to run
+away, and every line of the tree trunk is apperceived with reference to
+this motor setting. The smell, on the other hand, has disappeared under
+the influence of the suggestion because a new motor adjustment has set
+in, in which he is prepared to act as if there were no smell.
+
+The difference between suggestion and attention lies thus only in this:
+the motor response in attention aims towards a fuller clearness of the
+idea, for instance, by fixating, listening, observing, searching; while
+the motor response in suggestion aims towards the practical action in
+which the object of the idea is accepted as real. In attention, we
+change the object in making it clearer; in suggestion, we change
+ourselves in adapting ourselves to the new situation in which we
+believe. If you consider attention as a psychophysical process open to
+physiological explanation, you have surely no reason to seek anything
+mysterious in the process of suggestion; and no new principle is
+involved, if we come from the effect of the smallest suggestive hint to
+the complex and powerful suggestions which overwhelm the whole
+personality.
+
+The two great types of suggestion, the suggestion of actions and the
+suggestion of ideas, have now come nearer together since we have seen
+that the suggestion of ideas is really a suggestion of the practical
+acceptance of ideas, and that means, of a preparation towards a certain
+line of action. In the one case I suggest the idea of a certain action
+and this motor idea leads to the action itself, and in the other case I
+suggest a certain preparatory setting for action and that will lead to
+the appropriate action whenever the time for action comes. Every
+suggestion is thus ultimately a suggestion of activity. The most
+effective suggestion for an action results, of course, if both methods
+are combined, that is, if we suggest not only the will to perform the
+action, but at the same time the belief that the end of the action will
+be real. Suggestion reaches us usually from without. Yet there is again
+no new principle involved, when the new motor setting results from one's
+own associations and emotions. Then we speak of auto-suggestion. It is
+the same difference which exists between the attention called forth
+through an outer impression and the attention directed by our own will.
+Loud noise demands our attention, and even a whispered word may awaken
+associations which stir up the attention. In both cases the channels for
+adjustment become opened without our intention. But if we are expecting
+something of importance, if we start to watch a certain development and
+to find something which we seek, we open the channels by our own effort
+beforehand and produce our own settings thus through a voluntary
+attention. In this way suggestion too may start from without,--by a
+spoken word, by a movement, by a hint; or may start within us and may
+give us our caprices and our prejudices.
+
+We must not neglect one other feature of the suggestion. Not every
+proposition to action or to belief can be called a suggestion. Essential
+too remains the other side of it, the overcoming of the resistance. A
+mere request, "Please hand me the book on the table," or a mere
+communication, "It rains," may produce and will produce the fit motor
+response, the movement towards handing over the book or opening of the
+umbrella, and yet there may be no suggestive element involved. We have a
+right to speak of suggestion only if a resistance is to be broken down,
+that is, if the antagonistic impulse, or the motor setting for the
+antagonistic action is relatively strong. If I say to the boy, "Hand me
+the book," when he was anxious to hide the book from my eyes and thus
+had the wish not to hand it to me and the tone of my request overwhelmed
+his own intention, then to be sure suggestion is at work. The stronger
+the resistance, the greater the degree of suggestive power which is
+needed to overcome the motor setting. If I say to the normal man, "It
+rains," while he sees the blue sky and the dry street, his impression
+will be stronger than my suggestion; but if he is suggestible and I tell
+him that it will rain, he may accept it and take an umbrella on his
+walk, even if no indication makes a change of weather probable. The
+present impression of the dry street was strong enough to resist the
+suggestion, the imaginative idea of that which is to be expected in the
+next hour was too weak, and was overwhelmed by the suggestion of the
+weather prophecy.
+
+It is clear that the whole suggestive effect, being one of a new motor
+setting, depends thus entirely on the equilibrium of the personality
+which receives the suggestion. Every element which reaches the mind
+through sense organs or through associations must have influence in
+helping the one or the other side, that is, in opening the channels of
+action in the suggested direction or in the antagonistic one. The
+results appear surprising only if we forget how endlessly complex this
+psychomotor apparatus really is. If we disregard this complexity we may
+easily have the feeling that one person has an unexplainable influence
+over another, as if the will of the one could control in a mysterious
+way the will of the other. But as soon as we see that every action is
+the result of the cooeperation of hundreds of thousands of psychomotor
+impulses which are in definite relation to antagonistic energies, and
+that the result depends upon the struggling and balancing of this most
+complex apparatus, then we understand more easily how outer influences
+may help the one or the other side to preponderance: as soon as the
+balance turns to the one side, a completely new adjustment must set in.
+And we understand especially that there is nowhere a sharp demarcation
+line between receiving communications and receiving suggestions. By
+small steps suggestion shades over into the ordinary exchange of ideas,
+propositions, and impressions, just as attention shades over into a
+neutral perception.
+
+To be suggestible means thus to be provided with a psychophysical
+apparatus in which new propositions for actions close easily the
+channels for antagonistic activity. Such an apparatus carries with it
+the disadvantage that the personality may too easily be guided contrary
+to his own knowledge and experience. He will be carried away by every
+new proposition and will accept beliefs which his own thoughts ought to
+reject. On the other hand, it has the advantage that he will be open to
+new ideas, be ready to follow good examples, never stubbornly close his
+mind to the unaccustomed and the uncomfortable. It is easy to determine
+the degree of suggestibility. Take this case. I draw on the blackboard
+of a classroom two circles of an equal size, and write in the one the
+number fourteen and in the other the number eighty-nine, and ask the
+children which is the larger circle. The suggestible ones will believe
+that the circle with the higher number in it is really larger than the
+other, the unsuggestible children will follow the advice of their senses
+and call both equal, and there may be a few children with negative
+suggestibility who would call the circle with the higher number the
+smaller circle. What happened to the suggestible ones was that the
+higher number brought about a motor attitude which faced that whole
+complex as being more imposing and this new motor setting was with them
+strong enough to overcome the motor adjustment which the circles alone
+produced. Such experiments of the psychological laboratory can be varied
+a thousandfold, and it might not be unwise to introduce them into many
+practical fields. Everybody knows for instance how much may depend upon
+the suggestibility of the witness in court. The suggestible witness
+believes himself to have seen and heard what the lawyer suggests. The
+memory picture which such a witness has in mind offers, of course, much
+less resistance to the opposite action and attitude and belief than the
+immediate impression. If I show the witness a colored picture of a room
+and close the book and ask him whether there were three or four chairs
+in the picture and whether the curtain was green or red, the suggestible
+man will decide for one or the other proposition, even if there were
+only two chairs and a blue curtain. The perception would have resisted
+the suggestion, the fading memory image cannot resist it. Thus
+suggestibility is really a practical factor in every walk of life. And
+it is in the highest interests of psychotherapy that this intimate
+connection between suggestion and ordinary talk and intercourse, between
+suggestion and ordinary choice of motives, between suggestion and
+attention be steadily kept in view and that suggestion is not
+transformed into a kind of mysterious agency.
+
+To be sure, the importance of suggestion for psychotherapy is not
+confined to these suggestive processes of daily life. They play a role
+there, as we shall see, and we shall claim that even the mere presence
+of the physician may have its suggestive power and so may every remedy
+which he applies. But no doubt many of his suggestive effects depend on
+a power which far transcends the suggestions of our daily life. Yet the
+psychologist must insist again that no new principle is involved, that
+even in the strongest forms of suggestion, in hypnotism, nothing depends
+upon any special influence emanating from the mind of the hypnotizer or
+upon any special power flowing over from brain to brain; but that
+everything results from the change of equilibrium in the psychomotor
+processes of the hypnotized, and thus upon the interplay of his own
+mental functions. All that is needed is a higher degree of
+suggestibility than is found in the normal life. In a more suggestible
+mind even the direct sense impressions may be overwhelmed by the
+proposition for an untrue belief and the strongest desires may yield to
+the new propositions of action. This library may then become a garden
+where the hypnotized person picks flowers from the floor, and the wise
+man stands on one leg and repeats the alphabet, if the hypnotizer asks
+him to do so. Let us consider at first this extreme case. By a few
+manipulations I have brought a man into a deep hypnotic state. He is now
+unable to resist any suggestion, either suggestion of impulse or
+suggestion of belief, and as every one of the hypnotic phenomena can be
+explained in this way, we may claim that the hypnotic state is in its
+very nature a state of reenforced suggestibility. Whether I say, "You
+will not move your arm," or whether I say, "You cannot move your arm,"
+awakening in the one case the impulse to the suppression of the
+movement, in the other case the belief in the impossibility of the
+movement, in either case the result is the same; the arm remains stiff
+and any effort of his to move it is inhibited. I may go to the extreme
+and tell him that our friend by my side has left the room; he will not
+see him, he will not even hear a word which the friend speaks. If I take
+a hat in my hand and put it on the friend's head, the hat appears to
+hang in the air. Every impression of sound or sight or touch which comes
+from the friend is entirely inhibited. The direct sense impression of
+eye and ear is thus completely overwhelmed by the suggestion.
+
+What has happened? Are the manipulations which I applied sufficient to
+produce the changes by their physical influence? Certainly not; they are
+of the most different kinds and yet all may have the same effect.
+Perhaps I may have used the easy method of making the subject stare at a
+shining button held in front of his forehead. Or I may have used slight
+tactual impressions, while he was lying with closed eyes, or I may have
+produced the abnormal state by monotonous noises of falling waterdrops,
+or I may have simply spoken to him and asked him to think of sleep and
+to relax and to feel tired, while I held my hand on his forehead or
+while I held his hand in mine. Or I may have relied upon mild talking
+without touching him at all; and yet every time the result was reached
+in the same degree. There is thus certainly no special physical energy
+which like a magnetic force flows over. It cannot even be said that my
+will is engaged. I have often hypnotized without even thinking of the
+subject before me, going through adjusted manipulations while my
+thoughts were engaged in something else. I have even hypnotized over the
+telephone; and a written note may be substituted with the same result. I
+write to the patient that two minutes after receiving this letter by
+mail, he will fall into hypnotic sleep. The effect sets in; and yet at
+that time, I may not remember sending the note at all.
+
+It is thus entirely evident that the hypnotic effect results only from
+the mental conditions of the subject. Whatever may stimulate his mind
+to the right kind of reaction will produce the desired result. The
+increased suggestibility thus sets in by his own imagination which may
+be stirred up by slight visual or tactual or acoustic stimuli or by
+monotonous words or by feelings of relaxation and especially by words
+which encourage sleep. But just because it is the play of his own
+imagination, the most essential factor certainly is the will and
+expectation of the subject. No one can really be hypnotized against his
+own will. And to expect strong hypnotic effect from a certain hypnotist
+is often in itself sufficient to produce hypnotic sleep. Thus there is
+no special personal power necessary to produce hypnotism. Everybody can
+hypnotize. And almost with the same sweeping statement it may be said
+everybody can be hypnotized, provided that he is willing to enter into
+this play of imagination. The young child or the insane person is
+therefore unfit.
+
+Of course, not everybody can be hypnotized to the same degree. Just as
+the normal suggestibility showed itself very different with different
+persons, the degree of artificial reenforcement varies still more.
+Practically everybody can be brought to that breakdown of the
+resistance in which he can no longer open the eyes against the order of
+the hypnotist, but rather few can be brought to the point of seeing
+extended hallucinations, or accepting the disappearance of persons who
+are speaking, or of yielding to the impulse to a dangerous action. The
+highest reported degree, in which even criminal actions are performed
+by honest men, exists in my opinion only in the imagination of
+amateurs; it is certainly not difficult to produce sham crimes for
+performance sake, with paper daggers and toy pistols, but that is no
+proof at all that the hypnotized person would commit a crime under
+conditions under which he has the conviction that he faces a real
+criminal situation. But if we abstract from real crime, we certainly
+have to acknowledge that actions can be performed which appear in
+striking contrast with the habits and character of the normal
+personality, upset his knowledge, and are based on beliefs which would
+be immediately rejected under ordinary conditions. These higher degrees
+of hypnotic state are easily followed by complete loss of memory for all
+that happened during the abnormal state.
+
+How have we to interpret such a surprising alteration of mind? It lies
+near to compare it with sleep. The brain seems powerless to produce its
+normal ideas, the associations do not arise, the normal impulses have
+disappeared and a general ineffectiveness has set in; in short, the
+brain cells seem unable to function. Of course, the explanation of sleep
+itself may offer difficulties. Is it a chemical substance which poisons
+the brain during the sleep, or are the brain cells contracted so that
+the excitement cannot run over from the branches of one nerve cell into
+those of another? Or are the blood-vessels contracted so that an anaemic
+state makes their normal function impossible? But whatever the physical
+condition of sleep may be, have we really a right to emphasize the
+similarity between sleep and hypnosis? After all that we have discussed,
+we ought rather to recognize that the hypnotic state too comes much
+nearer to the process of attention than to the process of sleep. We saw
+that in every act of attention the process of inhibition is essential.
+All that is not in harmony with the attended idea is suppressed. Yet we
+should hesitate to say that in attention parts of our brain are asleep.
+
+We should feel reluctance to group such inhibition together with sleep
+because it would be a sleep which at any moment can pass from one part
+of the brain to others and which certainly leaves at every moment most
+of the cell groups unaffected. We saw that attention does not at all
+focus on one narrow point, but that an abundance of impressions, of
+ideas and associations, of thoughts and emotions can enter the field of
+attention, if they all lead to one and the same motor attitude, and that
+only the one part is inhibited which involves the opposite action. Such
+a jumping sleep which at every moment selects a special part would be,
+of course, just the contrary of that which characterizes the sleep state
+of the fatigued brain. But exactly these characteristics of attention
+belong to hypnotism too. It is not true that the mind of the hypnotized
+is asleep and that perhaps only one or the other idea can be pushed into
+his mind. On the contrary, his mind is open to an abundance of ideas,
+just as in the normal state. If I tell him that this is a landscape in
+Switzerland, he sees at once the mountains and the lakes, and his mind
+provides all the details of his reminiscences, and his imagination
+furnishes plenty of additions. His whole mind is awake; the feelings and
+emotions and volitions, the memories and judgments and thoughts are
+rushing on, and only that is excluded which demands a contrary attitude.
+This selective process stands decidedly in the center of the hypnotic
+experience and makes it very doubtful whether we are psychophysically on
+the right track, if we make much of the slight similarity between
+hypnosis and sleep.
+
+This has nothing to do with the fact that hypnosis is best brought about
+by suggesting the idea of sleep, that is, the belief that sleep will
+set in. This belief is indeed effective in removing all the ideas
+which are awake in the mind which would interfere with the willingness
+to submit to the suggestions of the hypnotizer. But the fact that
+belief in sleep and expectation of sleep bring with them the hypnotic
+state is not a proof that the hypnotic state itself is sleep. Even
+the mental experiences which can remain in sleep, the dreams, are
+characteristically different from the hypnotic experience. Thus the
+dreams show that unselective awakening of ideas which is to be expected
+from a general decrease of functioning. The hypnotic variation is
+characterized just by its selective narrowing of consciousness. For the
+same reason, hypnotism is strikingly different from such diseases of the
+mind as dementia. Certainly in dementia too, many associations are cut
+off, but it is not a selective inhibition, it is a haphazard destruction
+resulting from the degeneration in the brain.
+
+The fundamental principle of the hypnotic state lies in its selective
+character. Inhibited and cut off are those states which are antagonistic
+to the beliefs in the suggested ideas, and as their antagonism consists
+in their connection with opposite actions, the whole is again a question
+of motor setting. No doubt, such new motor setting can precede the
+normal sleep too; thus the sleeper may be insensitive to any surrounding
+noises, but perhaps awake at the slightest call from a patient who is
+intrusted to his care. In that case, one special feature of hypnotism is
+superadded to sleep but the sleep itself is not hypnotic. Again sleep
+may go over into a state which shares many characteristic features with
+hypnotism, that is, somnambulism, and it may be said with a certain
+truth that hypnotism is artificial somnambulism. But somnambulism, while
+arising in sleep, is not at all a feature of sleep.
+
+While sleep is characterized by a decrease of sensitiveness and of
+selective powers, the selective process of hypnotism rather reenforces
+sensitiveness and memory in every field which is covered by the
+suggestive influence. Stimuli may become noticeable which the normal man
+is unable to perceive, and long-forgotten experiences which seem
+inaccessible to the search of the waking mind may reproduce themselves
+and may vividly enter consciousness. Again we have there symptoms which
+rather characterize the state of over-attention than the state of sleep.
+We might add further that we know states with all the characteristics of
+hypnotism in which even the subjective idea of sleep is entirely
+absent, for instance, all those which are usually called states of
+fascination. A certain shining light or a glimpse of an uncanny eye may
+startle and upset the imagination of the subject and throw him into a
+state of abnormally increased suggestibility. It is well known that
+whole epidemics of such captivation have occurred and have resulted in
+hysterias of the masses in which the subjects become the slaves of their
+impulse, perhaps to imitate what they see or hear, or to realize ideas
+in which they believe without logical warrant. They surely are not
+asleep, are not even partially asleep. Every center of their brains
+would be ready to work, if the captivated attention were not forcing the
+mind in one direction and selectively suppressing every impulse to
+opposite actions. The developed hypnotism finally shades off into
+innumerable states of hypnoid character in which the sleeplike symptoms
+are entirely in the background.
+
+Thus the increased suggestibility of the hypnotic state will result not
+from a partial sleeplike decrease of functioning but the decrease of
+function is a motor inhibition which results from over-attention. In the
+ordinary attention, our motor setting secures only an increase in
+clearness and vividness of the attended ideas, but in an abnormal
+over-attention the new motor setting produces a complete acceptance with
+all its consequences. Abnormal or heightened attention thus goes
+directly over into the belief and into the impulse without resistance.
+There is no hypnotism which does not contain from the first stage this
+definite relation to certain objects of attention, usually to a
+particular person. All the manipulations, passes, fixation, monotonous
+speaking, and so on narrow the contents of consciousness but hold the
+idea of the hypnotizing person steadily in the center of attention. The
+awakened expectation of sleep, the associated feeling of tiredness all
+help to cut off attention from the remainder of the world, but as no
+real sleep sets in, this cutting off from the remainder reenforces the
+focusing of attention on the one central idea of the hypnotizing
+personality. Every word and every movement of this personality become
+therefore absorbed with that over-attention which leads at once from a
+mere perceiving and grasping to a complete sinking into the suggested
+idea with the suppression of all opposites, and thus to a blind
+acceptance and belief. We saw before that such belief is indeed nothing
+else but a motor setting in which certain ways of action are prepared.
+We are to think in accordance with the belief in the suggested idea and
+the channels for discharge in the opposite direction are closed. Even
+the ordinary life shows us everywhere that the step from attention to
+belief is a short one. The effort to grasp the object clearly works as a
+suggestion to accept that which we are seeking as really existing, and
+that from which we are to abstract and which we are to rule out through
+our attention, we believe to be non-existent. The prestidigitator does
+his tricks in order to sidetrack our attention, but he succeeds in
+making us believe that we see or do not see whatever he wishes.
+
+That the motor setting alone determines those changes and that a real
+sleeplike inability of the centers does not set in, can also be
+demonstrated by the results of later hypnotizations. I ask my hypnotized
+subject not to perceive the friend in the room; he is indeed unable to
+see him or to hear him. Yet his visual and acoustic centers are not
+impaired, the defect is only selective, inasmuch as he sees me, the
+hypnotizer, and not the friend. But even this selection inhibits only
+the attitude and not the sensorial excitement. If I hypnotize him again
+to-morrow and suggest to him now to remember all that the friend did and
+said during yesterday's meeting, he is able to report correctly the
+sense impressions which he got, which were inhibited only as long as
+they contradicted the suggestion, but now rush to consciousness as soon
+as the suggestion is reversed. As a matter of course, he must therefore
+have received impressions through eye and ear in his hypnotic sleep of
+yesterday from all that happened, only he was not aware of it because
+the channels of the accepting attitude were blocked.
+
+As soon as the over-attention has produced the acceptance of the belief,
+all further effects are automatic and necessary. If I tell the
+hypnotized person that he cannot speak and he absorbs this proposition,
+with that completeness in which he accepts it as a fact, not speaking
+itself unavoidably results. The motor ideas with which the speech
+movement has to start are cut off and the subject yields passively to
+the fate that he cannot intonate his voice. Thus a special influence on
+the will is in no way involved. If the idea is accepted, and that means,
+if the preparatory setting for the action has been completed, the ideas
+of opposite activity must remain ineffective; the suggested idea must
+discharge itself in action without resistance. As a matter of course the
+new line of action will then surround itself with its own associations
+and will thus give to the subject the impression that he is acting from
+his own motives. As soon as the psychophysical principles are
+understood, there is indeed no difficulty in going from the simplest
+experience to those spectacular ones where we may suggest to the
+profoundly hypnotized person that he is a little child or that he is
+George Washington. In the one case, he will speak and cry and play and
+write as in his present imagination a child would behave; in the other
+case, he will pose in an attitude which he may have seen in a picture of
+Washington. There is nothing mysterious and his utterances are
+completely dependent upon his own ideas, which may be very different
+from the real wisdom of a Washington and the real unwisdom of a child. I
+may suggest to him to be the Czar, by that he will not become able to
+speak Russian. In the same way I may suggest changes of the
+surroundings; he may take my room for the river upon which he paddles
+his canoe, or for the orchard in which he picks apples from my
+bookshelves.
+
+Finally there is no new principle involved, if the action which is
+prepared by any belief has to set in after the awaking from hypnotic
+sleep, the so-called post-hypnotic suggestion. As a matter of course,
+just these have an eminent value for psychotherapy. I may suggest to-day
+that the subject will overcome to-morrow his desire for the morphine
+injection, or that he will feel to-night the restfulness which will
+overcome his insomnia. But if the suggestion of an idea means belief,
+and if belief means a preparation for action, we have indeed no new
+factor before us if the action for which we prepare the subject is from
+the start related to a definite time. If we do not link it with the
+consciousness of a special time or of a special occasion which will
+occur later, the suggestion soon fades away. That my library is an
+orchard is forgotten perhaps within ten minutes, if I have not come back
+to it in the conversation. But if I say that after awaking as soon as I
+shall knock on my desk three times, you will be in the orchard again,
+the psychophysical apparatus is prepared, a new setting has set in, the
+three knocks will bring about the complete transformation. In short the
+difficulties disappear as soon as we are consistent in interpreting all
+suggestive influences as changes in the motor setting and as the result
+of the antagonistic character of all of our motor paths.
+
+We say the difficulties disappear. Of course, that is meant in a
+relative sense only. It means essentially that we are able to bring the
+complex state of hypnotism down to the similar state of attention and
+motor adjustment, but of course we must not forget that we are far from
+a satisfactory explanation of the process in attention itself. We know
+that the opening of motor channels in one direction somewhat closes the
+channels for discharge in the opposite direction, but what mechanism
+does that work is still very obscure. Whichever principle of
+hypothetical explanation we might prefer, it certainly leads to
+difficulties in view of the extreme complexity of attention in states of
+suggestion and hypnotism. We might think of a mechanism which through
+the medium of the finest blood-vessels should produce a localized anaemia
+in those centers which lead to the antagonistic action. Or we might
+fancy that by extremely subtle machinery the resistance is increased in
+those tissues which lie between the various neurons, or we might even
+think of toxic and antitoxic processes in the cerebral regions; and any
+day may open entirely new ways of explanation. We may add that even if
+the mechanism of attention were completely explained, we are also still
+far from understanding the physiological changes which go on in the
+sphere of the blood-vessels or of the glands and the internal organs. We
+understand easily that the idea of the subject that he cannot move his
+arm keeps the arm stiff; but that his idea to blush really dilates the
+blood-vessels of his cheek is much less open to our causal
+understanding; still less that in very exceptional cases perhaps a part
+of the skin becomes inflamed, if we make believe that we touch it with a
+glowing iron. And yet here too we see that we move in the same direction
+and that we have to explain these exceptional and bewildering results by
+comparing them with the simpler and simpler forms, that the process of
+attention contains all the germs for the whole development.
+
+In claiming that hypnotism depends upon the over-attention to the
+hypnotizing person, we admit that the increased suggestibility belongs
+entirely to suggestions which come from without. Only that which at
+least takes its starting point from the words or the movements of the
+hypnotizer finds over-sensitive suggestibility. Ideas which arise merely
+from the associations of the subject himself have no especially
+favorable chance for acceptance. But surely we also know states in which
+the suggestibility for certain of one's own ideas is abnormally
+increased. Great individual differences exist in that respect in normal
+life. There are normal hypochondriacs who believe that they feel the
+symptoms of widely different diseases under the influence of their own
+ideas, and others who are torturing themselves with fears on account of
+unjustified beliefs. But the abnormal increase of suggestibility
+parallel to that of hypnotism for suggestions from without exists for
+suggestions from within, mainly in nervous diseases, especially in
+neurasthenic, hysteric, and psychasthenic states. Within certain limits,
+we might almost say that this increase of suggestibility for
+autosuggestion is the fundamental characteristic of these diseases, just
+as increase of suggestibility for heterosuggestions characterizes
+hypnotism.
+
+Especially in earlier times, the theory was often proposed that hypnosis
+is an artificial hysteria. Such a view is untenable to-day; but that
+hysteria too shows abundant effects of increased suggestibility is
+correctly indicated by such a theory. The hysteric patient may by any
+chance pick up the idea that her right arm is paralyzed or is
+anaesthetic and the idea at once transforms itself into a belief and the
+belief clings to her like an obsession and produces the effect that she
+is unable to move the arm or that she does not feel a pinprick on the
+skin. These autosuggestions may take a firmer hold of the mind than any
+suggestions from without, but surely such openness to selfimplanted
+beliefs must be acknowledged as symptomatic of disease, while hypnosis
+with its impositions can be broken off at any moment and thus should no
+more be classed among the diseases than are sleep and dreams. The
+hysteric or psychasthenic autosuggestion resists the mere will of
+breaking it off. Here, therefore, is the classical ground for strong
+mental counterinfluences, that is, for psychotherapeutic treatment.
+Experience shows that the strongest chance for the development of such
+autosuggestive beliefs exists wherever an emotional disposition is
+favorable to the arriving belief. But emotion too is after all
+fundamentally a motor reaction. The whole meaning of emotion in the
+biological sense is that it focuses the actions of man into one channel,
+cutting off completely all the other impulses and incipient actions.
+Emotion is therefore for the expressions of man what attention is for
+the impressions. An emotional disposition means thus in every case a
+certain motor setting by which transition to certain actions is
+facilitated. It is thus only natural that a belief can settle the more
+easily, the more it is favored by an emotional disposition, as the motor
+setting for the one must prepare the other. Hypnosis and hysteria thus
+represent the highest degrees of suggestibility, the one artificial, the
+other pathological; the one for suggestions from without, the other for
+suggestions from within. But between these two and the normal state
+there lie numberless steps of transition. The normal variations
+themselves may go to a limit where they overlap the abnormal artificial
+product, that is, the suggestibility of many normal persons may reach a
+degree in which they accept beliefs hardly acceptable to other persons
+in mild hypnotic condition. Thus there is no sharp demarcation between
+suggestions in a waking state and suggestions in a hypnoid state. And
+the expectation of coming under powerful influence may produce a
+sufficient change in the motor setting to realize any wonders. Moreover
+probably every physician who has a long experience in hypnotizing has
+found that his confidence in the effectiveness of the deep hypnotic
+states has been slowly diminished, while his belief in the surprising
+results of slight hypnotization and of hypnoid states has steadily grown
+and has encouraged him in his psychotherapeutic efforts.
+
+
+
+
+VI
+
+THE SUBCONSCIOUS
+
+
+The story of the subconscious mind can be told in three words: there is
+none. But it may need many more words to make clear what that means, and
+to show where the misunderstanding of those who give to the subconscious
+almost the chief role in the mental performance sets in. The psychology
+of suggestion, for instance, which we have now fully discussed without
+even mentioning the word subconscious, figures in most popular books in
+the treatises of both physicians and ministers as a wonderful dominance
+of the subconscious mind. The subconscious mind alone receives the
+suggestions and makes them effective, the subconscious mind controls the
+suggestive processes in consciousness, and the subconscious mind comes
+into the foreground and takes entire hold of the situation when the
+hypnotic state sets in.
+
+But we are always assured that there is no need of turning to the
+mystery of suggestion and hypnotism to find that uncanny subpersonality
+in us. We try to remember a name, or we think of the solution of a
+problem; what we are seeking does not come to consciousness and now we
+turn to other things; and suddenly the name flashes up in our mind or
+the solution of the problem becomes clear to us. Who can doubt that the
+subconscious mind has performed the act? While our attention was given
+over to other questions, the subconscious mind took up the search and
+troubled itself with the problem and neatly performed what our conscious
+mind was unable to produce. Moreover in every situation we are
+performing a thousand useful and well-adapted acts with our body without
+thinking of the end and aim. What else but the subconscious mind directs
+our steps, controls our movements, and adjusts our life to its
+surroundings? And is not every memory picture, every reminiscence of
+earlier experiences a sufficient proof that the subconscious mind holds
+its own? The poem which we learned years ago did not remain somewhere
+lingering in our consciousness, and if we can repeat it today, it must
+be because our subconscious mind has kept it carefully in its store and
+is ready to supply us when consciousness has need for it.
+
+Surely if we think how this, our subconscious mind, is able to hold all
+our memories and all our learning, and how it transacts all the work of
+controlling our useful actions and of bringing up the right ideas, we
+may well acknowledge that compared with it our conscious life is rather
+a small part. It is as with the iceberg in the ocean; we know that only
+a small part is visible above the surface of the water and a ten times
+larger mountain swims below the sea. It seems, therefore, only logical
+to attach this whole subconscious mental life to a special subconscious
+personality. Then we come to the popular theory of the two minds in us,
+the upper and the lower, of which we can hardly doubt that the lower one
+has on the whole the larger part of the business to perform. And we
+certainly have no right to give to the word lower mind the side-meaning
+that the activity is of a lower order. The most brilliant thoughts of
+the genius are not manufactured in his upper consciousness, they spring
+suddenly into his mind, their whole creation belongs thus to the
+assiduous work of the subconscious neighbor. There the inventor and
+discoverer gets his guidance, there the poet gets his inspiration, there
+the religious mind gets its beliefs. In short, the constitution of the
+mental state allows on the whole to the upper consciousness a rather
+decorative part while the real work is left for the lower house.
+
+Yet it must be acknowledged that the scholars somewhat disagree as to
+the dignity of the lower mind. Considering the usually accepted fact
+that in hypnotism the lower mind comes entirely over the surface, just
+these hypnotic events can indeed suggest two different views of the
+subconscious and this doubleness is reenforced if we still add the
+entertaining material which comes to light by the automatic writing of
+mediums in their trance. The hypnotized person is ready to perform any
+foolishness, is not influenced by any considerations of tact and taste
+and wisdom and respect, and thus some of the chief believers in the
+subconscious personality stick to the diagnosis that the lower mind in
+us which shows up in hypnotism is a rather brutal, stupid, lazy,
+cowardly, immoral creature which ordinarily rather deserves to be
+subdued by our noble and wise upper personality. And the automatic
+writings of the mediums indorse this disrespectful view, for it is
+difficult to gather more idiotic slang than the emanations of these
+letters of the planchette. On the other hand, the hypnotized person
+shows an increase of sensitiveness and hyperaesthesia in which perhaps
+optical impressions or smells may be noticed which the ordinary man
+cannot perceive. Moreover the memory of the hypnotized is, as we saw,
+abnormally sharpened. Entirely forgotten experiences may awake again.
+The same holds true for the hysteric in whom also, of course, the
+subconscious takes hold of the inner life. Thus it seems entirely safe
+to say that the powers of the subconscious personality far surpass those
+of the upper conscious fellow, and that agrees with all those facts as
+to the subconscious origin of the work of the genius. Further, has it
+not been found again and again that the hypnotized and the hysteric
+cannot only remember long-forgotten parts of the past but have
+telepathic knowledge for distant events and even mysterious premonitions
+of the field of occurrences of the future?
+
+Hypnotism is essentially the same as the old mesmerism, and mesmerism
+was widely acknowledged as clairvoyance, and all that harmonizes again
+with the experiences of the mediums whose subconscious mind in trance
+enters into contact with the spirits of the dead. The subconscious
+personality is thus really a metaphysical power which transcends the
+limitations of the earthly person altogether and has steady connection
+with the endless world of spirit and the inner soul of the universe.
+Most popular books, it is true, do not demand from their readers the
+choice between the one or the other type of the lower personality,
+between that brutal, vicious, ignorant creature and that far-seeing,
+inspired, powerful soul. They simply mix the two and adapt the special
+faculties of this underground man to the special requirements of the
+particular chapter, the subconscious being unusually wise or unusually
+stupid in accordance with the special facts which are just then to be
+explained. Even that does not always settle all difficulties. They may
+discover, for instance, that the subconscious mind with which we deal in
+the hypnotized person has again itself a subconsciousness. If we tell
+the hypnotized person not to see a certain picture on the wall, this
+subconscious personality perceives the whole room with the exception of
+the picture. Yet after all someone sees this picture, because if we
+hypnotize him the next time and ask him what the picture contained, he
+now knows its contents. Thus they must have been recognized in a
+sub-subconsciousness, and we therefore come to a personality which lives
+on a floor still below the basement. But experiment can demonstrate that
+even this most hidden personality has still its secrets which are handed
+downwards. In short, we finally have not merely two but a number of
+personalities in us.
+
+But now let us leave these fantasies of psychological fiction. Let us
+turn to the concrete facts, let us see them in the spirit of modern
+scientific psychology, let us try to explain them in harmony with the
+principles of psychological explanation, and let us discriminate the
+various groups of facts which have led to that easy-going hypothesis of
+the subconscious. Discrimination indeed is needed, as it would be
+impossible to bring the whole manifold of facts under one formula, but
+there is certainly no unification reached by simply putting the same
+label on all the varieties and behaving as if they are all at once
+explained when they are called the functions of the subconscious. Two
+large groups may be separated. Facts are referred to the subconscious
+mind which do not belong to the mind at all, neither to a conscious nor
+to a subconscious one, but which are simply processes in the physical
+organism; and secondly, facts are referred to the subconscious mind
+which go on in the conscious mind but which are abnormally connected.
+Thus the subconscious mental facts are either not mental but
+physiological, or mental but not subconscious.
+
+What does the scientific psychologist really mean by consciousness? We
+must now think back to our discussion of the principles which control
+the fundamental conceptions of modern psychology. We saw clearly that
+the psychology which is a descriptive and explanatory science of mental
+phenomena can by no means have the ambition to be a full interpretation
+of the inner reality. Our inner life, we saw, is not a series of
+phenomena, is not a chain of objects which we are aware of and which we
+therefore can describe, and which finally we can explain. But in its
+living reality, we saw that it is purposive, has a meaning and aim, is
+will and intention, and can thus be understood in its true character,
+not by describing and explaining it but by interpreting it and
+appreciating it. This is the life attitude towards personalities when we
+deal man to man. We do not at first consider ourselves or our fellows as
+mental objects to be explained but always as subjects to be understood
+in their meaning. If we pass from this primary attitude to the attitude
+of the scientific psychologist we gain, as we saw, an artificial
+perspective. We must consider then our inner experience of ourselves
+with all our states as a series of objects made up of elements connected
+by law. Instead of the real things which in our real life are objects of
+will and purpose, tools and means for us, the psychologist knows only
+objects of awareness, objects which have no meaning, but which simply
+exist and which are no longer related to a will but are connected with
+other objects as causes and effects. Now we deal no longer with the
+chairs and tables before us but from a psychological point of view they
+become perceptive ideas of chairs and tables, ideas which are not in the
+room but in our own minds. While these objects of our will and of our
+personality become mere ideas, our will and personality themselves
+become, too, a series of phenomena. Our self is now no longer the
+purposive will but is that group of sensations and ideas which clusters
+about the perception of our organism and its actions; in short, our
+self itself becomes an object of awareness.
+
+Our whole inner experience thus becomes a manifold of objects. Our self
+and the actions of our self are thus alike for the psychologist mere
+phenomena, mere objects which are perceived. Will and emotion, memory
+idea and thought--they all are now passing appearances like the sunshine
+and rain, the flowers and waves. By this transformation the immediate
+will character of real life is given up, but instead of it a system of
+objects is gained, that allows description and explanation. If we are to
+deal at all with inner life not from a purposive but from a causal point
+of view, we are obliged to admit this reconstruction. Without it we
+cannot have any science of the mind, without it we can understand the
+intentions of our neighbor and appreciate the truth and morality of his
+meanings but we cannot causally explain his experiences or determine
+which effects are to be expected. It is thus not an arbitrary
+substitution but a procedure just as necessary and logically obligatory
+as the work of the chemist who substitutes trillions of invisible atoms
+for the glass of water which he drinks. The possibility of causal
+explanation of the successive facts demands this remolding of the outer
+and of the inner world. We have discussed that before and now only have
+to draw the consequences.
+
+Thus for the psychologist the mental world is a system of mental
+objects. To be an object means of course to be object of some subject
+which is aware of it. What else could it mean to exist at all as object
+if not that it is given to some possible subject? But the world of
+objects is twofold; we have not only the mental objects of the
+psychologist but also the physical objects of the naturalist. Science
+must characterize the difference between those two and we pointed once
+before to the only fundamental difference. Physical objects are those
+which are possible objects of awareness for every subject; psychical
+objects are those which are possible objects of awareness for one
+subject only. The tree which I see is as physical tree object for every
+man, it is the same tree which you and I see; my psychical perception of
+the tree is object for one subject only. My perception can never be your
+perception. Our perceptions may agree but each has his own. As to the
+physical objects, we can entirely abstract from such reference to the
+subjects. We say simply: the tree exists or is part of nature; and only
+the philosopher is aware that we silently mean by it that it exists for
+every subject and that it is therefore not necessary to refer to any
+particular subject. But the perception of the tree which is either your
+idea or my idea evidently gets its existence only if it is referred and
+attached to a particular subject which is aware of it. Such subject of
+awareness is that which the psychologist calls consciousness and all the
+ideas and volitions and emotions and sensations and images which make up
+the mental life are then contents of the consciousness or objects of the
+consciousness. To have psychical existence at all means thus to be
+object of awareness for a consciousness. Something psychical which
+simply exists but is not object of consciousness is therefore an inner
+contradiction. Consciousness is the presupposition for the existence of
+the psychical objects. Psychical objects which enjoy their existence
+below consciousness are thus as impossible as a wooden piece of iron.
+
+If consciousness is nothing but the subject of awareness for the
+individual objects, we see at once certain consequences which are too
+often forgotten in the popular, haphazard psychology. In the scientific
+system of psychology, consciousness has for instance nothing whatever to
+perform, that is, consciousness itself is in no way active. The active
+personality of real life has been left behind and has itself been
+transformed into that self which is merely content of consciousness. The
+person who acts and performs the deeds of our life is then only a
+central content of our consciousness which is crystallized about the
+idea of our organism. It has thus become one of the contents of which
+consciousness itself is passively aware. Consciousness is an inactive
+spectator for the procession of the contents. Thus consciousness itself
+cannot change anything in the content nor can it connect the contents.
+No other function is left to consciousness but merely that of awareness.
+Every change and every fusion and every process must be explained
+through the relations of the various contents to one another.
+Consciousness has, therefore, not the power to prefer the one idea or to
+reject the other, to reenforce the one sensation and to inhibit the
+other. From a psychological point of view, we have seen before that
+even attention does not mean an activity of consciousness but a change
+in the content of consciousness. Certain sensations become more
+impressive, more clear, and more vivid, and others fade away, become
+indistinct and disappear, but all that goes on in the content of
+consciousness and the spectator, consciousness itself, simply becomes
+aware of those changes. Consciousness has also in itself no special
+span, ideas appear or disappear not because consciousness expands or
+narrows itself but because the causal conditions awaken or suppress the
+various contents.
+
+Consciousness has in itself no limit; all organization belongs to the
+content. Whatever psychical states are attributed to one organism belong
+thus to its consciousness but all the connections are entirely
+connections of the content. We, therefore, have not even the right to
+say that consciousness, as such, has unity. Unity too belongs to the
+organization of the content. One part of the content hangs together with
+the other parts but consciousness is only the constant condition for
+their existence. Where there is no unity, there it cannot have any
+meaning to speak of the double or triple existence. There may be a
+disconnection in the various parts of the content and a dissociation by
+which the normal ties between the various contents may be broken but
+consciousness itself cannot fall asunder. Thus consciousness cannot have
+any different degrees. The same consciousness experiences the distinct
+clear content and the vague fading confused content. Thus also
+consciousness can never be aware of itself and the word
+self-consciousness is easily misleading. In psychology, it can never
+mean that the consciousness which is a subject of all experience is at
+the same time object of any experience. Its whole meaning lies in its
+being the passive spectator. That of which consciousness becomes aware
+in self-consciousness is the idea of the personality, which is certainly
+a content. The personality, the actor of our actions, is thus never
+anything but an object in psychology, and consciousness never anything
+but a subject. Consciousness itself is thus in no way altered when the
+idea of the personality is changing. Only if all this is carelessly
+confused, if consciousness is sometimes treated as meaning subject of
+consciousness, and at another time as meaning the content of
+consciousness, and again at another time the unified organization of the
+content, and at still another time the connection of the content with
+the personality, and if finally all that is confused with the purposive
+reality of the immediate personal life--only then, do we find the way
+open to those tempting theories of the subconscious personality.
+
+       *       *       *       *       *
+
+If, instead, we stick to the scientific view, we find the following
+facts. First, we have everywhere with us the fact that the earlier
+experiences may again enter into consciousness as memory images or as
+imaginative ideas, that is, in the order in which they are experienced a
+long time before or in a new order, either with a feeling of
+acquaintance or without it. Certainly at no time is the millionth part
+of what we may be able to reproduce present in our consciousness. Where
+are those words of the language, those faces of our friends, those
+landscapes, and those thoughts; where have they lingered in the time of
+their seclusion? Scientific psychology has no right to propose any other
+theory as explanation but that no mental states at all remain and that
+all which remained was the disposition of physiological centers. When I
+coupled the impression of a man with the sound of his name, a certain
+excitement of my visual centers occurred together with the excitement of
+my acoustical centers; the connecting paths became paths of least
+resistance, and any subsequent excitement of the one cell group now
+flows over into the other. It is the duty of physiology to elaborate
+such a clumsy scheme and to make us understand in detail how those
+processes in the neurons can occur and it is not the duty of psychology
+to develop detailed physiological hypotheses. Psychology has to be
+satisfied with the fact that all the requirements of the case can be
+furnished by principle through physiological explanation. Least of all
+ought we to be discouraged by the mere complexity of the process. If a
+simple sound and a simple color sensation, or a simple taste and simple
+smell sensation, can associate themselves through mere nervous
+conditions of the brain, then there is nothing changed by going over to
+more and more complex contents of consciousness. We may substitute a
+whole landscape for a color patch or the memory of a book for a word,
+but we do not reach by that a point where the physiological principle of
+explanation, once admitted, begins to lose its value. Complexity is
+certainly in good harmony with the bewildering manifoldness of those
+thousands of millions of possible connections between the brain cells.
+
+Every experience leaves the brain altered. The nerve fibers and the
+cells have gone into new stages of disposition for certain excitements.
+This disposition may be slowly lost. In that case the earlier experience
+cannot be reproduced; we have forgotten it. But as long as the
+disposition lasts--it is quite indifferent whether we conceive it more
+in terms of chemical changes or physical variations, as processes in the
+nerve cells or between the nerve cells--the physiological change alone
+is responsible for the awakening of the memory idea under favoring
+associative conditions. Of course, someone might reply: can we not fancy
+that there remains on the psychical side also a disposition? Each idea
+which we have experienced may have left a psychical trace which alone
+may make it possible that the idea may come back to us again. But what
+is really meant and what is gained by such a hypothesis?
+
+First, do not let us forget that such a proposition could only have one
+possible end in view, namely, the explanation of the reappearance of
+memories. But when we discussed the basis of physiological psychology,
+we convinced ourselves that mental facts as such are not causally
+connected anyhow. Our real inner life has its internal connections,
+connections of will and purpose, but as soon as we have taken that great
+psychological step and look on inner life as merely psychological
+objects, then the material is connected only through the underlying
+physiological processes and we can never explain causally the appearance
+of an idea through the preceding existence of another idea. We may
+expect one after the other, but we have no insight into the mechanism
+which makes the second follow after the first. Such insight into
+necessary connection we find only on the physical side, and we saw that
+just here lies the starting point for the modern view of physiological
+psychology. If that holds true for the connections between idea and
+idea, of course it holds true in the same way for the connection between
+mental disposition and the corresponding memory. We can understand
+causally that a chemical disposition in the nerve fibers brings about a
+chemical excitement in those neurons, but how a mental disposition is to
+create mental experience we could not understand; and to explain it
+casually, we should need again a reference to the underlying
+physiological processes. The hypothesis of mental dispositions would
+thus be an entirely superfluous addition by which we transcend the real
+experience without gaining anything for the explanation.
+
+Secondly, if we really needed a mental disposition for each memory
+picture, in addition to the physiological disposition of the brain
+cells, can we overlook that exactly the same thing would then be
+necessary for every perception also? The outer impression produces,
+perhaps through eye or ear or skin, an excitement of the brain cell and
+this excitement is accompanied by a sensation; and no one fancies that
+the appearance of this sensation is dependent upon a special disposition
+for it on the mental side. No one fancies it, because it is evident that
+such a hypothesis again would be entirely useless. If every new
+perception needed such a special mental disposition, we should have to
+presuppose dispositions for everything which possibly can come into our
+surroundings. Every smell, every word, every face which comes anew to us
+would need its special ready-made disposition. In other words, our mind
+would contain the disposition for every possible idea and that would
+mean that these dispositions would be in no way helps for explanation.
+If the disposition exists for everything, no one particular thing can be
+explained by the existence of that disposition. Again we should have to
+rely entirely upon the physiological brain excitement for explaining
+that this word or that word is perceived by our mind. But if the brain
+excitement alone is sufficient to explain the new perception in the
+mind, then no reason can be found why the renewed brain excitement would
+not be sufficient to renew the mental experience. Thus there is nowhere
+room for mental dispositions below the level of consciousness.
+
+Thirdly, what could we really mean by such mental dispositions? A
+physiological disposition for a physiological action is certainly not
+the action itself. The finger movement in piano playing finds only a
+disposition in my brain centers, in case I am trained; the movement
+itself does not last. But the disposition is at least itself a change
+in the physical world. The molecules are somehow differently placed, the
+disposition has thus as much objective existence as the resulting
+movement. Nothing at all similar can be imagined in the sphere of
+psychical contents. Such mental dispositions would have to exist
+entirely outside the world of concrete mental experiences and, if we
+scrutinize carefully, we soon discover that such theories are only
+lingering reminiscences of the purposive view of life, and do not fit at
+all into the causal one. If we take the purposive attitude, then every
+idea and every will contains indeed all that its meaning involves and
+everything which we can logically develop out of it is by intention
+contained in it. All mathematical calculations are then contained in the
+thought of figures and forms, but they are contained there only by
+intention, they are logically inclosed; psychologically the
+consciousness of the figures and forms does not contain any disposition
+for the development of mathematical systems. We indeed have no right to
+throw into a psychological subconsciousness all that which is not
+present but involved by intention in the ideas and volitions of our
+purposive life.
+
+If thus the memory idea is linked with the past experience entirely by
+the lasting physiological change in the brain, we have no reason to
+alter the principle, when we meet the memory processes of the hypnotized
+person or the hysteric. It is true their memory may bring to light
+earlier experiences which are entirely forgotten by the conscious
+personality, but that ought to mean, of course, only that nerve paths
+have become accessible in which the propagation of the excitement was
+blocked up before. That does not bring us nearer to the demand for a
+subconscious mental memory. The threshold of excitability changes under
+most various conditions. Cells which respond easily in certain states
+may need the strongest stimulation in others. The brain cells which are
+too easily excited perhaps in maniacal exultation would respond too
+slowly in a melancholic depression. Hypnotism, too, by closing the
+opposite channels and opening wide the channels for the suggested
+discharge, may stir up excitements for which the disposition may have
+lingered since the days of childhood and yet which would not have been
+excited by the normal play of the neurons. Quite secondary remains the
+question of how these reproduced images finally appear in consciousness,
+that is, whether they appear with reference to earlier happenings and
+are thus felt as remembrances, or whether they enter as independent
+imaginations, or whether they finally, under special conditions, take
+the character of real, new perceptions. The latter case is well-known in
+crystal-gazing, where long-forgotten memory ideas project themselves
+into the visual field like hallucinations. But for the theory of the
+subconscious, even these uncanny crystal visions do not mean more than
+the simplest awakening of the experience of a landscape image of
+yesterday.
+
+We turn to a second group of facts and again we have no fault to find
+with the observation of the facts, even of the most surprising and
+exceptional ones. Our objection refers to the interpretation of them.
+This second group contains the active results of such physiological
+nervous dispositions. In the first group, the dispositions come in
+question only as conditions for a new excitement which was accompanied
+by mental experience. In this second group, the dispositions are causes
+for other physiological processes which either lead to actions or to
+influences on other mental processes. The dispositions are here working
+like the setting of switches which turn the nervous process into special
+tracks. In the simple cases, of course no one doubts that a purely
+physiological basis is involved. The decapitated frog rubs its skin
+where it is touched with a drop of muriatic acid in a way which is
+ordinarily referred to the trained apparatus of his spinal cord, as no
+brain is left, and the usefulness of the action and its adjustment is
+very well understood as the result of the connecting paths in the
+nervous system.
+
+From such simple adjustment of reactions of the spinal cord, we come
+step by step to the more complex activities of the subcortical brain
+centers, and finally to those which are evidently only short-cuts of the
+higher brain processes. That we react at every change of position with
+the right movements to keep our bodily balance, that we walk without
+thinking of our steps, that we speak without giving conscious impulse
+for the various speech movements, that we write without being aware of
+the motor activity which we had to learn slowly, that we play the piano
+without thinking of the special impulses of the hands, that we select
+the words of a hasty speech, if we have its aim in mind, without
+consciously selecting the appropriate words--all that is by continuous
+transitions connected with those simplest automatic reactions. And from
+here again, we are led over gradually perhaps to the automatic writings
+of the hysteric who writes complex messages without having any idea of
+their content in consciousness. It is in such cases certainly a symptom
+of disease that the activity of these lower brain centers can go over
+into the motor impulse of writing without producing secondary effects in
+the highest conscious brain centers; it is hysterical. But that the
+message of the pencil can be brought about by such operation of lower
+brain centers, or at least with imperfect cooeperation of the higher
+brain centers, is certainly entirely within the limits of the same
+physiological explanation.
+
+On the other hand, nothing is changed in the theoretic principles of the
+case if the effect of these automatic processes in the nervous system is
+not an external muscle action at first, but an influence on other brain
+centers which may furnish the consciousness with new contents. We try to
+remember a name, that is, a large number of neuron processes are setting
+in which normally lead to the excitement of that particular process
+which furnishes us the memory image of the name. But those brain cells
+may not respond, the channels may be blocked somehow or the excitability
+of those cells may be lowered. Now new excitements engage our
+psychophysical system. We are thinking of other problems. In the
+meantime, by the new equilibrium in the brain the blockade in these
+first paths may slowly disappear or the threshold of excitability may be
+changed. The physiological excitement may now be carried effectively
+into those tracts. The cell response sets in and suddenly the name comes
+to our mind. This purely physiological operation in our brain paths must
+thus have exactly the same result which it would have had, if more parts
+of the process had been accompanied by conscious experience. And again
+from mere remembering a forgotten name, we come by slow steps to the
+solution of a problem, to the invention, and finally to the creation of
+the genius.
+
+Superficiality of thought is easily inclined to object to such a
+physiological interpretation and perhaps to denounce it pathetically as
+a crude materialism which lowers the dignity of mental work. Nothing
+shows more clearly the confusion between a purposive and causal view of
+the mind. In the purposive view of our real life, only our will and our
+personality have a meaning and can be related to the ideas and higher
+aims. Nature is there nothing but the dead material which is the tool of
+our will and which has to be mastered by the personality. In that world
+alone lie our duty and our morality. But as soon as we have gone over to
+the causal aspect of our life and have taken the point of view of the
+psychologist, making our inner life a series of contents of
+consciousness, of psychical phenomena, we have transformed our inner
+experience in such a way that it has become itself nothing but nature.
+
+It is mental nature, nature of psychical stuff, but each part of it is
+nothing but a mental element, a mental atom without any meaning and
+without any value; nothing but a link in the chain, nothing but a factor
+in the explanation of the whole, nothing to which any ethical or
+aesthetic or logical or religious significance can any longer be
+attached. The psychical sensations and the physical atoms are equally
+material for naturalistic explanation. To understand causally a certain
+effect, for instance the creation of a work of art, of a discovery or a
+thought or a deed as the product of psychical processes, is thus in no
+way more dignified or more valuable than to understand it as the product
+of physiological brain processes. The one is not more dignified than the
+other because both alike have nothing whatever to do with dignity. Both
+alike are the necessary results of the foregoing processes, and to
+attach a kind of sentimental preference to the explanation through
+conscious factors is nothing but a confused reminiscence again of the
+entirely different purposive view of life. And surely nothing is gained
+for the higher values of life if this confusion sets in, because if the
+popular mind becomes unable to discriminate between the secondary,
+causal, artificial aspect of science and the primary, purposive aspect
+of life, the opposite effect lies still nearer: the values of the real
+life suffer and are crowded out by the knowledge of the scientific
+facts. Man's moral freedom is then wrongly brought in question, as soon
+as it is learned that every action is the product of brain processes.
+Life and science alike will gain the more, the more clearly the
+purposive and the causal point of view are separated and the more it is
+understood that this causal aspect itself is demanded by certain
+purposes of life. The oratory of those who denounce the physiological
+theories as lacking idealism in reality undermines true moral
+philosophy. There is no idealism which can really flourish merely by
+ignoring the progress of science and confusing the issues. The true
+values of the higher life cannot be safely protected by that thoughtless
+idealism which draws its life from vagueness and which therefore has to
+be afraid of every new discovery in scientific psychology. Our real
+ideals do not lie at all in the sphere in which the problem of causally
+explaining the psychological phenomena arises.
+
+Our conscious experiences are thus indeed not only here and there, but
+usually the products of chains of processes which go on entirely on the
+physiological side. We have no reason at all to seek for those preceding
+actions any mental accompaniment outside of consciousness, that means,
+any subconscious mental states. Then, of course, this physiological
+explanation also covers entirely those after-effects of earlier
+experiences, especially emotional experiences, which the physician
+nowadays likes to call subconscious "complexes." We shall see what an
+important role belongs to these facts, especially in the treatment of
+hysteria and psychasthenia, but the interpretation again ought to avoid
+all playing with the conception of the subconscious. Emotional
+experiences may produce there some strong stable dispositions in the
+brain system which become mischievous in reenforcing or inhibiting
+certain thoughts and actions without awakening directly conscious
+experiences. The whole psychological switch system may have been brought
+into disorder by such abnormal setting of certain parts, but the
+connection of each resulting accident with the primary emotional
+disturbances does not contradict the fact that all the causes lie
+entirely in disturbances of the central paths. It is a change in the
+neurons and their connections. To discover it we may have to go back to
+early conscious experiences, but in the process itself there is no
+mental factor, and therefore no subconscious emotion is responsible for
+the mischief carried out.
+
+Both groups of facts which we have studied so far, have dealt with
+processes which were indeed not conscious but which we had no right to
+call subconscious inasmuch as they contained no mental process at all
+but only physiological dispositions and actions. We turn finally to the
+other smaller and more abnormal group of so-called subconscious facts in
+which the facts are mental indeed and not only physiological, but not at
+all outside of consciousness and thus again not subconscious. A
+conscious fact may easily suggest the appeal to subconscious theories to
+those who have accepted such theories for other reasons. There are, for
+instance, plenty of mental experiences which we do not notice or which
+we do not recognize. Yet if we find later that they must have influenced
+our mind, we are easily inclined to refer them to subconscious activity.
+But it is evident that to be content of consciousness means not at all
+necessarily to be object of attention or object of recognition.
+Awareness does not involve interest. If I hear a musical sound, I may
+not recognize at all the overtones which are contained in it. As soon as
+I take resonators and by them reenforce the loudness of those overtones,
+they become vivid for me and I can now notice them well even when the
+resonators are removed. I surely was aware of them, that is, had them in
+consciousness all the time but there were no contrast feelings and no
+associations in consciousness which gave them sufficient clearness to
+attract attention.
+
+In this way I may be again led by gradual stages to more and more
+complex experiences. I may overlook and yet include within my content of
+consciousness most various parts of my surroundings; and yet the
+neglected is not less in consciousness itself than the attended. Much
+that figures in literature as subconscious means indeed nothing else but
+the unattended. But it belongs to the elements of psychological analysis
+to recognize that the full content of consciousness is always larger
+than the narrow field of attention. This narrow field on the other hand
+has certainly no sharp demarcation line. There is a steady shading off
+from the most vivid to the least vivid. We cannot grasp those least
+vivid contents of consciousness, we cannot fixate them as such, because
+as soon as we try to hold them, they move from the periphery of the
+content into its center and become themselves vivid and clear. But as we
+are surely aware of different degrees of clearness and vividness in our
+central mass of contents, we have no difficulty in acknowledging the
+existence of still lower degrees of vividness in those elements which
+are blending and fusing into a general background of conscious
+experiences. Nothing stands out there, nothing can be discriminated in
+its detail. That background is not even made up of whole ideas and whole
+memories and whole emotions and feelings and judgments and volitions,
+but of loose fragments; half ideas and quarter ideas, atoms of feelings
+and incipient impulses and bits of memory images are always mixed in
+that half-dark background. And yet it is by principle not less in
+consciousness, and consciousness itself is not different for these
+contents. It is not half-clear consciousness, not a lower degree of
+awareness, only the objects of awareness are crumbled and fading.
+
+Whether these background objects really exist can only be made out by
+studying carefully the changes which result under different conditions,
+the influences which those loose parts have on the structure of the
+whole, and the effect of their complete disappearance. I may never
+really notice a little thing in my room and yet may be aware that it has
+been taken away. The visual image of it was an element of my mental
+background, when I was sitting at my desk, but it never before moved to
+the center of my conscious content. But this center itself is also
+constantly changing. Sometimes the one, sometimes the other idea may
+enter into it, but in this alternation that which is not in the focus
+either remains in consciousness unattended or when it disappears from it
+it loses its mental character altogether. If I attend a tiresome lecture
+while my mind is engaged with a practical problem of my own life, there
+may be a steady rivalry between the words which come with the force of
+outer stimulus to my brain and make me listen and my inner difficulties
+which claim my attention. I listen for a while, and then suddenly,
+without noticing it, my own thoughts may have taken the center of the
+stage and again without sudden interruption a word may catch my
+attention. While I was thinking of my own problem the sounds of the
+lecturer were really outside of my field of attention, yet some remark
+now pushes itself again into the center. That does not mean that a
+subconscious mind is listening while my lucid mind was thinking, but it
+does mean that those words were unattended and remained in the periphery
+of the field of consciousness. But when some of the sentences stirred up
+in that peripheral field some important associations, they were strong
+enough to produce a new motor reaction by which the mental equilibrium
+became changed again and by which the lecturer overwhelmed my private
+thoughts. Yet even this state of mind, without any break, can go over
+into an absolutely physiological process. I may for a while really
+inhibit the lecturer's voice completely and remain in the thoughts of my
+own imagination. After a minute or two, the resistance against the
+acoustical stimulus will certainly be broken and the sound will again
+enter into my consciousness, but in that interval there was no
+subconscious and not even any unattended mental function; there was no
+mental process at all. The sound reached my brain but as the motor
+setting was adverse, the sounds did not bring about that highest act of
+physiological transmission which is accompanied by mental contents. Thus
+it became entirely physiological. Yet of course every word reached my
+brain and left traces there. If I were hypnotized after the lecture and
+thus the threshold for the real awakening of brain excitements lowered,
+it might not be impossible that some of the thoughts of the lecturer
+which did not enter my consciousness at all, are now afterwards in the
+hypnotic state stirred up in me. Yet even that would not indicate that
+they had become mental and thus subconscious at the time of the lecture.
+
+The so-called subconscious, which in reality is fully in consciousness
+but only unnoticed, easily shades over into that unconscious which is
+also in consciousness but dissociated from the idea of the own
+personality and thus somewhat split off from the interconnected mass of
+conscious contents. Wherever we meet such phenomena, we are in the field
+of the abnormal. The normal mental life is characterized by the
+connectedness of the contents. Yet even that holds true, of course, only
+if we think of those mental states which exist at one and the same
+instant in consciousness. As soon as we consider the succession of
+mental events, we cannot doubt that even normal experience shows breaks,
+lapses, and complete annihilation of that which a moment before was a
+real content in our consciousness. We may have looked at our watch and
+certainly had in glancing at the dial a conscious impression, but in the
+next moment we no longer know how late it is. The impression did not
+connect itself with our continuous personal experience, that is, with
+that chief group of our conscious contents which we associate with the
+perception of our personality. Under abnormal conditions of the brain,
+larger and larger parts of the completely conscious experience may thus
+be cut off from the continuity of conscious life. But to be in
+consciousness, and therefore to be not-subconscious, does not mean to be
+through memory ties connected with the idea of our own personality.
+
+The somnanbulist, for instance, may get up at night time and write a
+letter, then go to bed again and not know anything of the event when he
+awakes in the morning. We have no reason to claim that he had no
+knowledge of the letter in his consciousness when he wrote it. It is
+exactly the same consciousness from a psychological standpoint as the
+one with which he wakes up. Only that special content has in an abnormal
+way entirely disappeared, has not left a possibility of awakening a
+memory image, and the action of the personality in writing has thus
+become separated and cut off from the connected experiences of the man.
+But while the nocturnal episode may be entirely forgotten, it was not
+less in consciousness for the time being, than if a normal man should
+leave his bed hastily to write a letter. Moreover under abnormal
+conditions, as for instance in severe hysteric cases, those dissociated
+contents may form large clusters of mental experiences in the midst of
+which a new idea of the own personality may develop. Considering that
+through such disconnection many channels of discharge are blocked, while
+others are abnormally opened, it seems only natural that the idea of the
+own acting personality becomes greatly changed. Thus we have in such an
+episode a new second personality which may be strikingly different in
+its behavior and in its power, in its memories and in its desires, from
+the continuous normal one, and this secondary personality may now
+develop its own continuity and may arise under special conditions in
+attacks which are connected among one another by their own memory bonds.
+
+The two personalities may even alternate from day to day and the normal
+one may itself become pathologically altered. In that case the two
+alternating personalities would both be different from the original one.
+But again we have even in such most complex and exceptional cases only
+an alternation in the contents, not an alternation in the consciousness
+itself. Different ideas of the own personality with different
+associations and impulses follow each other in consciousness and the
+abnormality of the situation lies in the lack of memory connections and
+of mutual influences, but consciousness remains the same throughout. It
+remains the same, just as we do not change consciousness if we feel
+ourselves in one hour as members of our family, in the next hour as
+professional workers in our office, again later as social personalities
+at a party or as citizens at a political meeting or as aesthetic
+subjects at the theater. Each time we are to a high degree a different
+personality, the idea of our self is each time determined by different
+groups of associations, memories, emotions, and impulses. The
+differentiation is to be considered as normal only because broad memory
+bridges lead over from one to the other. The connection of the various
+contents with the various ideas of the own personality constitutes thus
+in no way a break of consciousness itself and relegates no one content
+into a subconscious sphere.
+
+Finally the same holds true, if the idea of the personality as content
+of consciousness in the patient is split into two simultaneous groups,
+of which each one is furnished with its own associations. Yet the
+interpretation here becomes extremely difficult and arbitrary. Take the
+case that a patient in severe hysteria at our request writes down the
+history of her life. We should not hesitate to say that she is doing it
+consciously but now we begin to talk with her and slowly the
+conversation takes her attention while her pencil is continuing to write
+down the connected story of her youth. Again the conversation by itself
+gives the impression of completely conscious behavior. As both functions
+go on at the same time, the person who converses does not know what the
+person who writes is writing, and the writer is uninfluenced by the
+conversation. Various interpretations are possible. Indeed we might
+think that by such double setting in the pathological brain two
+independent groups in the content of consciousness are formed, each one
+fully in consciousness and yet both without any mutual influence and
+thus without mutual knowledge. In the light of such interpretation, it
+has been correctly proposed to speak of coconscious processes, rather
+than subconscious. Or we may interpret it more in harmony with the
+ordinary automatic writing or with other merely physiological reactions.
+Then we should suppose that as soon as the conversation sets in, the
+brain centers which control the writing movement work through channels
+in which no mental factors are involved. One of the two characteristic
+reaction systems would then be merely physiological. We saw before that
+the complexity of the process is no argument against the strictly
+physiological character of the event. That various activities can
+coexist in such a way that one of them may at any time slide down from
+the conscious centers to the merely physical ones, we all know by daily
+experience. We may go home through the streets of the busy town engaged
+with our thoughts. For a while the idea of our way and of the sidewalk
+is in our consciousness, when suddenly we reach our house and notice
+that for a long while we have no longer had any thought at all of the
+way. We were absorbed by our problems, and the motor activity of walking
+towards our goal was going on entirely in the physiological sphere. But
+whether we prefer the physiological account or insist on the coconscious
+phenomena, in either case is there any chance for the subconscious to
+slip in? That a content of consciousness is to a high degree dissociated
+or that the idea of the personality is split off is certainly a symptom
+of pathological disturbance, but it has nothing to do with the
+constituting of two different kinds of consciousness or with breaking
+the continuous sameness of consciousness itself. The most exceptional
+and most uncanny occurrences of the hospital teach after all the same
+which our daily experience ought to teach us: there is no
+subconsciousness.
+
+
+
+
+PART II
+
+THE PRACTICAL WORK OF PSYCHOTHERAPY
+
+
+
+
+VII
+
+THE FIELD OF PSYCHOTHERAPY
+
+
+We have discussed the psychological tools with which the psychotherapist
+has to work but we have not spoken as yet of psychotherapy itself. All
+that we have studied has been by way of preparation; and yet the right
+preparation is almost the most important factor for the right kind of
+work. To rush into psychotherapy with hastily gathered conceptions of
+mental life may be sometimes successful for the moment, but must always
+be ultimately dangerous. It is often most surprising what a haphazard
+kind of psychology is accepted as a basis for psychotherapy even by
+scientifically schooled physicians who would never believe that common
+sense would be sufficient to settle the problems of anatomy and
+physiology; as soon as the mind is in question, no serious study seems
+needed. Can we be surprised then that in the amateur medicine of the
+country within and without the church any fanciful idea of mental life
+may flourish? If we are to recognize the rights and wrongs of
+psychotherapy in a scientific spirit, a sober analysis of the mental
+facts involved was indeed at the very first most essential. Now we can
+easily draw the conclusions from our findings.
+
+We recognized from the start the fundamental difference between two
+different attitudes which we can take towards the inner life of any
+personality, the purposive view and the causal. We recognized the sphere
+to which each belongs and we saw that all medical treatment demands the
+causal view, thus dealing with inner life as part of the causal chain of
+events. Each inner experience became therefore a series of so-called
+contents of consciousness. These contents can be described and must be
+analyzed into their elements. The basis of psychotherapy is therefore an
+analytic psychology which conceives the inner experience as a
+combination of psychical elements.
+
+But the final aim was the causal connection. The appearance and
+disappearance of those millions of elements and their connection had to
+be explained. We recognized that such an explanation of the contents of
+consciousness was possible only through the connections between the
+accompanying brain processes. Every psychical change had to be conceived
+as parallel to a physiological change. The psychology which is to be the
+basis of psychotherapy had to be therefore a physiological psychology.
+
+We recognized that these psychophysiological processes were processes of
+transmission between impressions and expressions, that is, between
+incoming nervous currents and outgoing nervous currents, between stimuli
+and reactions. Thus we have no central process which is not influenced
+by the surroundings and which is not at the same time the starting point
+of an action. We have normal health of the personality as long as there
+is a complete equilibrium in the functions of the organism which adjusts
+the activities to the surroundings. Every abnormality is a disturbance
+of this equilibrium. A psychology which is the basis of psychotherapy
+thus conceives every mental process in relation to both the ideas and
+the actions; it avoids all one-sidedness by which the mind is cut off
+either from its resources or from its effects. The relations to the
+impressions are usually the less neglected: and we must the more
+emphasize the fact that the psychology needed for psychotherapy knows no
+mental fact which does not start an action and that every change in the
+system of actions involves a change in the central experience. Wherever
+this equilibrium of adjusted functions is disturbed, some therapy of the
+physician has to set in: whether psychotherapy is in order depends upon
+the special conditions.
+
+We have recognized that there are no mental facts outside of those which
+are in consciousness and that from a psychological point of view
+consciousness itself does not have different degrees and different
+levels, that all varieties of experience refer thus only to the special
+content and its organization. There is thus no subconscious. On the
+other hand, we saw that there is no conscious experience which is not
+based on a bodily brain process. By these two fundamental facts of
+scientific psychology, every possible psychotherapy gets from the start
+its clear middle way between two extreme views which are popular today.
+The one school nowadays lives from the contrast between consciousness
+and subconsciousness and makes all psychotherapy work with and through
+and in the subconscious. The other school creates a complete antithesis
+between mind and body and makes psychotherapy a kind of triumph of the
+mind over the body. Practically every popular treatise on
+psychotherapeutic subjects in recent years belongs to the one or the
+other group; and yet both are fundamentally wrong. And while, of course,
+this mistake is one of theoretical interpretation, it evidently has its
+practical consequences. The fantastic position allowed to a subconscious
+mind easily gives to the doctrine a religious or even a mystical turn
+and the artificial separation between the energies of the mind and those
+of the body leads easily to a moral sermon. Whether this amalgamation of
+medicine with religion or with morality may not be finally dangerous to
+true morality and true religion is a question which will interest us
+much later. Here we only have to ask whether it is not harmful to the
+interests of the patient and thus to the rights of medicine, and indeed
+that must be evident here at the very threshold. Both schools must have
+the tendency to extend psychotherapy at the expense of bodily therapy
+and to narrow down psychotherapy itself to a therapy by appeals which
+in the one case are suggestions to the subconscious and in the other
+case persuasions and encouragements to the conscious will. As soon as we
+have overcome the prejudices of those two rival schools and have
+recognized that both are wrong, that there is no subconscious and that
+there is no psychological fact which is not at the same time a
+physiological one, we see at once that this common procedure of both
+schools is unjustified and dangerous. Mental therapy and physical
+therapy ought to be most intimately connected parts of the same
+therapeutic effort and mental therapy includes by far more than mere
+suggestions and appeals. All that involves of course that its systematic
+application belongs in the hands of the well-trained physician and of
+nobody else, but on the other hand, it involves that every physician
+ought to be well schooled in psychology.
+
+As soon as a disturbance to be cured is considered as a lack of
+equilibrium in psychophysical functions, every mental influence, every
+suggestion and appeal becomes itself an excitement or an inhibition of
+nerve cells. The sharp demarcation line between a psychical agency and a
+physical one disappears altogether; the spoken word is then considered
+as physical airwaves which stimulate certain brain centers and in the
+given paths this stimulation is carried to hundreds of thousands of
+neurons. The protracted warm bath or the cold douche influences, too,
+large brain parts by changing the blood circulation which controls the
+activity of those neurons; or the bromides absorbed in the digestive
+apparatus, or the morphine injected, also reach the neurons and again
+have a different kind of influence on them, and the electric current may
+stimulate the nervous system in still a different way. It may be, and
+under many conditions certainly is, essential to influence the brain
+cells just in that particular way which results from the spoken word,
+but there too the causal influence remains a function of the physical
+effect and thus by principle there is no sharp separation from other
+physical means. Thus to believe in psychotherapy ought never to mean
+that we have a right to make light of the other means which, as
+experience shows, may help towards the treatment of disturbances in the
+central equilibrium. Suggestions and bromides together may secure an
+effect which neither of them alone will bring about. It is most
+unfortunate that not without some guilt on the part of the physicians
+themselves, the large public has begun to believe that orthodox
+psychotherapy has to mean a rejection of drugs and a contempt for the
+doctors who prescribe them.
+
+Of course a discussion of psychotherapy cannot enter into the study of
+these physical agencies of treatment, but at the threshold, we have to
+insist that there exists no opposition between psychophysiological and
+physiological means of influencing the brain. It may be true that drugs
+and baths and electricity have no influence on the subconscious, but the
+trouble is not that the drugs are inefficient but that they cannot
+influence what does not exist. In the same way disappears now that new
+boundary line for psychotherapy which wants to limit it to mere
+suggestion and appeal. If psychotherapy employs all the means by which
+we can influence mental states in the interest of the health of the
+personality, we have no reason to confine it either to a persuasion of
+the subconscious through suggestion and hypnotism or a persuasion of the
+conscious, in which it works as a moral appeal. Suggestion and hypnotism
+certainly must play a large part in psychotherapy and that part does not
+become smaller by the fact that we reject the subconscious
+interpretation of them and consider them entirely as psychophysical
+processes. And in the same way undoubtedly we have to acknowledge the
+psychophysiological effect of persuasion and of the appeals to the
+conscious intellect and will. But for us as psychotherapists all those
+factors have no moral value but only a therapeutic one, and thus stand
+in line with any other influence that may help, even though from a
+purposive point of view it stands on a much lower level. A mere mental
+distraction by enjoyment and play and sport, an aesthetic influence
+through art, a mere stimulus to automatic imitation, an enforced mental
+rest, an involuntary discharge of suppressed ideas, and many similar
+schemes and even tricks of the mental physician belong with the same
+right to psychotherapy.
+
+It is really doubtful whether the moral and religious appeals are always
+helpful and not sometimes or often even dangerous for the health of the
+individual; and it is not doubtful that morally and religiously
+indifferent mental influences are often of the highest curative value.
+The more we abstract from everything which suggests either the mysticism
+of the subconscious or the moral issues of a mind which is independent
+of the body, the more we shall be able to answer the question as to the
+means by which health can be restored. This question is neither a moral
+nor a philosophical one but strictly one of experience. In this
+connection, we must remember that we also have had to give up the
+artificial demarcation line between organic and functional diseases. We
+recognized that every so-called functional disease has its organic basis
+too, and that it is entirely secondary whether we are able to find
+visible traces of the organic disturbance. We had to acknowledge, to be
+sure, the difference between reparable and irreparable disturbances, but
+such grouping expresses only in another form the fact that experience
+alone can show whether the methods of treatment which we know so far
+will be successful or not. Not a few disturbances of the equilibrium
+which appeared irreparable to an earlier time yield to the treatment of
+to-day, and no one can determine whether much which appears irreparable
+today may not be accessible either to psychotherapeutic or to physical
+therapeutic means to-morrow. If we were carelessly to identify the
+reparable troubles with those which we cannot recognize visibly, we
+should be at a loss to understand why, for instance, many forms of
+insanity are entirely beyond our psychotherapeutic influences. On the
+other hand, every physician who uses psychotherapeutic means is
+surprised to see the effective bodily readjustment where serious
+disturbances perhaps of the circulatory system or the digestive system
+existed. What the methods can do and what they cannot do must simply be
+left to experience, but of course to an experience which is eager to
+expand itself by ever new experimental curative efforts.
+
+From this point of view we can see clearly the general division of the
+whole field of possible psychotherapy. Psychotherapy influences
+psychophysical states in the interest of health. There are only two
+possibilities open: either the disturbance is in the psychophysical
+system itself or it is outside of it, that is in the other parts of the
+body which are somehow under the influence of the mind. In the first
+case when the disturbance occurs in the mind-brain system itself, we
+ought to separate two large groups, first those cases in which the
+system itself is normal and the disturbance comes from without, and
+second those in which the constitution of the system itself was abnormal
+and led to disturbances under conditions in which a normal system would
+not have suffered. We have to consider both groups somewhat more in
+detail, as each again allows a large variety of cases.
+
+Thus we have before us, first the normal mind-brain system into which a
+disturbance breaks, injuring more or less severely and for a longer or
+shorter time the equilibrium of the psychophysical functions. Here
+belong any bodily processes which produce pain or any bodily defects
+which produce blanks in the content of consciousness; the pain of
+sciatica or of rheumatism, or the defect of the blind or of the deaf,
+certainly interferes in a disturbing way with the perfect harmony of
+psychophysical activities. But here also belongs the suffering which
+results from conditions in the surroundings, the loss of a friend, a
+disappointment in life, any source of worry and grief. Social and bodily
+conditions alike may thus work to break up the equilibrium. The pain
+sensation interferes with the normal flow of mental life and the grief
+may undermine the mental interests. The psychotherapeutic effort may be
+directed toward removing the source of the disturbance, bringing the
+patient under other conditions, curing the diseased organ, and where
+that is not possible, may work directly on the psychophysical state,
+inhibiting the pain, suppressing the emotion, substituting pleasant
+ideas, distracting the whole mind, filling it with agreeable feelings,
+until the normal equilibrium is restored.
+
+The psychophysical system itself was not really harmed by such
+influences. In the following groups, such is no longer the case. We here
+think at first of those severe injuries which have their sources in
+abnormal processes outside of the brain. The anaemia of the patient or
+the low state of his nutrition or the fever heat of his blood impairs
+the harmony of the mental functions. Another and for the psychotherapist
+much more important group is that in which the impairment results from
+toxic influences. Alcohol, morphine, cocaine, tobacco, and many other
+drugs may have been misused and may have produced a most marked
+alteration in the mind-brain system. Desires may have developed which
+completely destroy the balance of the normal functions and yet the
+satisfaction of which increases the poisoning effect. But here belongs
+further the effect of poisons which the body itself produces: the toxic
+disturbance of uraemia or the coma in diabetes, or especially the grave
+disturbances resulting from the abnormal action of the thyroid gland,
+the source of cretinism. Many indications suggest that a near future
+will consider this group much larger than we are really justified in
+doing today, probably soon connecting a number of other mental diseases
+like dementia praecox with toxic effects of bodily origin. Experience
+shows that in this group not a few chances exist for successful
+psychotherapeutic influence. Yet the means may be various in character
+and their effect may be a direct or an indirect one. A psychical shock
+may remove directly the mental disturbance of the alcoholic state, but
+it is more important that mental suggestion can remove the alcoholic
+disturbance indirectly by suppressing the desire for alcoholic excesses.
+Even where cure by psychotherapeutic means is out of the question, as is
+the case with feverish delirium or uraemic excitements, no skilled
+physician ignores the aid which a well-adjusted mental influence can
+offer to the patient.
+
+We come to a third group. Some outside cause has harmed the central
+nervous system directly, and has left it in a disabled state after the
+cause itself has disappeared. Such causes may have been at first purely
+functional: for instance, a neglect of training, or a wrong training, or
+an over-activity, but the ill-adjusted function which involved, of
+course, every time an ill-adjusted organic activity or lack of activity,
+has led to a lasting or at least relatively lasting disturbance in the
+system of paths. The neglect of training, for instance, in periods of
+development may have resulted in the retardation which yields the
+symptoms of a feeble-minded brain, or the wrong training may have
+created vicious habits, firmly established in the mind-brain system and
+gravely disturbing the equilibrium. Above all, the overstrain of
+function, especially of emotional functions, may lead to that exhaustion
+which produces the state of neurasthenia. It is true that not a few
+would doubt whether we have the right to class neurasthenia here where
+we speak of the harm done to the normal brain. Many neurologists are
+inclined to hold that neurasthenia demands a special predisposition and
+is therefore dependent upon a neurotic constitution of the brain itself.
+But if defenders of such a view, as for instance, Dubois, acknowledge
+that "we might say that everybody is more or less neurasthenic," we can
+no longer speak of any special predisposition. Certainly there exists a
+constitutional neurasthenia sometimes but we have hardly a right to deny
+that overstrain in the brain activity may produce a series of
+neurasthenic symptoms in any brain, and the special predisposition is
+responsible rather for the particular selection among the innumerable
+symptoms.
+
+Neurasthenia certainly is the classical ground for the psychotherapist.
+The patient's insomnia and his headache, his feeling of tiredness and
+his disgust with himself, his capricious manias and his absurd phobias,
+his obsessions and his fixed ideas all may yield to the "appeal to the
+subconscious," and as a neurasthenic easily believes in the existence of
+various organic diseases in his body, Christian Science can perform here
+even "miracles." In the case of retardation, the psychical influence
+will have to be in the first place one of training. Yet it would be
+narrow to overlook that in neurasthenia, too, suggestion has to be only
+a part of the psychical treatment. Training and rest, distraction and
+sympathy and many other factors have to enter into the plan.
+Incomparably small, on the other hand, is the aid which psychotherapy
+can offer in cases of real destructions in the brain, as in the case of
+tumors, hemorrhage, paresis or the degeneration by senility. More
+effective may be its work in concussion of the brain and especially with
+traumatic neuroses, as in the case when a railroad accident has put the
+mind-brain system out of gear.
+
+So far we presupposed that the central system itself was normal. No
+sharp separation line, however, lies between all these disturbances and
+the equally large group of psychophysical disabilities resulting from a
+defective constitution of the brain. The normal brain shades over by
+smallest differences into the abnormal one; yes, even the varieties of
+temperament and character and intellectual capacity and industry and
+energy represent, in the midst of our social surroundings, large
+deviations from the standard. That which might still pass as normal
+under certain conditions of life would be unadjusted and thus abnormal
+under other conditions. In the same way, we certainly cannot point out
+where the natural constitution of a brain ceases to be fit for its
+organic purposes and where the structural variations are ill-prepared
+for the struggle for existence. Just as we claimed that an entirely
+normal brain might be brought by an emotional overstrain to a state of
+exhaustion and disability, we may claim on the other side that a brain
+which nature has poorly provided may yet be protected against damage and
+injury. The inborn factor does not alone decide the fate. Psychophysical
+prophylaxis may secure steadiness of equilibrium to a system which
+inherited little resistance. Yet this large borderland region, where an
+ill-adjusted brain may be saved or lost in accordance with favorable or
+unfavorable circumstances, shades off again to the darker regions where
+the inner evolution leads by necessity to disaster even under favorable
+conditions.
+
+We might begin this large group of the constitutional disturbances with
+that neurasthenia which develops on the basis of inherited disability.
+Lack of energy resulting from a feeling of tiredness, a quick
+exhaustion, a mood of depression, an easy irritation, even despair and
+self-accusation, sullenness and fits of anger, cranky inclinations and
+useless brooding over problems, headache and insomnia characterize the
+picture which everyone finds more or less developed in some of his
+acquaintances. If we classify symptoms, we may separate from it that
+which we nowadays are inclined to call psychasthenia. An abnormal
+suggestibility for autosuggestions stands in the foreground. Fixed ideas
+and fixed emotions, especially fears, trouble the patient. He may pick
+up his obsession by any chance experience and no good-will liberates him
+from the intrusion perhaps for years. The patient is perfectly well
+aware that his ideas and his emotions are unjustified, he himself does
+not believe in them, and yet they come with the strength of an outer
+perception and with the vividness of a real attitude, and his whole
+mental equilibrium may be upset by the continuous fight against these
+involuntary interferences. In the light cases, sometimes the one and
+sometimes the other autosuggestion may hold the stage; in the severe
+cases, mental life turns more and more around certain definite fears and
+yet it may all still be in the limits where the daily work can go on and
+the world may not know of the hidden tortures. Here belongs the fear of
+open places or the fear of touching certain objects, the fear of doing
+harm to others or the fear of deciding actions wrongly, the fear of
+destroying valuable things or the fear of being the center of public
+attention, the fear of crowds or of closed doors, of altitudes or of
+bridges. And in all cases emotional reaction may set in with anxieties,
+and bodily symptoms such as palpitation of the heart may result,
+whenever an effort is made to disregard the nervous fear. There is
+perhaps no group of patients which so much deserves the most careful
+efforts of the psychotherapist. Still more than the hysterics they
+suffer from the fate of seeing their ills counted as not real. For them
+everybody has the good advice that they ought to overcome their fancies;
+and yet they feel their life ruined with their endless fight against the
+overpowering enemy. And if anywhere, it is here that the psychotherapist
+is successful. Psychasthenic fear can be removed, while the developed
+melancholic depression, for instance, is entirely beyond the reach of
+psychical influence.
+
+We have after all the same psychasthenic state before us when the
+obsession has impulsive character, from the mere abnormal impulse of
+lying, or making noise in a quiet place or crying in the dark, or
+touching certain places, to that of stealing, indecent speech, arson,
+and perhaps even murder. The symptoms might easily be mistaken for those
+of graver diseases. Yet the fact that the patient himself really does
+not will the effect at which he is aiming separates, mostly without
+difficulty, the diagnosis of psychasthenia from that of insanity. Quite
+nearly related to it are the manifold variations of abnormal and
+perverse sexual tendencies. The psychiatrists are perhaps too much
+inclined to bring all these pathological impulses and desires, fears and
+anxieties, into the nearest neighborhood to real insanity. The
+indisputable success of psychotherapy in these spheres ought to add a
+warning against these expansions of the strictly psychiatric domain. The
+psychologist will be more inclined to emphasize their relation to simple
+neurasthenia which itself imperceptibly shades over into our normal
+life.
+
+All neurasthenic and psychasthenic disabilities show a certain emotional
+continuity and uniformity. It is the emotional instability and the quick
+alternation of symptoms which characterize hysteria or rather the
+hysterias. It seems as if science were near to the point of explaining
+the hysterical disease by one common principle, but certainly the
+symptoms are an inexhaustible manifold. The rapid changes of the intense
+moods of the patient usually stand in the center. Torturing obsessions,
+abnormal impulses, over-suggestibility, hypochondriac depressions,
+paralysis of arms or legs, anaesthesia and paraesthesia, a mental stupor
+and confusion, illusions and perceptions of physiological symptoms may
+work together in spite of his, or rather her clear intelligence. It is
+probably on a hysteric basis also that somnambulic states arise during
+the night, and from them a straight way leads to those mental attacks
+after which the memory is entirely lost, or for which fundamental
+associative connections are cut off. And from here we come to the
+exceptional cases of alternating personality. The more we recognize the
+myriad symptoms in the hysteric patient as products of the emotional
+instability, of autosuggestibility and of inhibition, the more we
+understand the almost miraculous result of psychotherapeutic treatment.
+Autosuggestions can be fought by countersuggestions, anaesthesia and
+paraesthesia can be removed often in an instant, dissociated
+personalities may be built up again through hypnotism, the most severe
+bodily symptoms may disappear by influences in a waking state. Hysteria
+alone would justify the demand that every physician in his student days
+pass with open eyes through the field of psychology. Quite near stand
+chorea and the epidemic impulses to imitative movements. And we might
+bring into this neighborhood also the disturbance in the equilibrium of
+the speech movements through all degrees of stammering and severe
+impairment. Up to a certain degree, though not often completely, they
+too yield easily to psychotherapeutic influence.
+
+We enter now that region of constitutional disturbances in which
+psychotherapy is of small help. It leads from epilepsy to the periodic
+diseases, especially the maniacal depressive insanity, the paranoia
+which develops late, and finally to states of idiocy which cover the
+whole life. We are far from claiming that psychical influences are
+entirely powerless, the more as we insisted that psychotherapy goes much
+beyond mere suggestions and appeals. No psychiatrist will work without
+psychological tools when he deals with the exultations of the maniac and
+the depressions of the melancholic, with the hallucinations of
+persecution or the erotic insanities of the paranoiac. Still more the
+whole register of psychology has to be used, when we are to educate the
+idiot and the imbecile. But the disappearance of the disease or of the
+chief symptoms through the mental agencies is in all these cases out of
+the question. Only in incipient cases, especially of melancholia and
+mania, the psychotherapeutic work seems not entirely hopeless; and for
+epilepsy some distinct successes cannot be denied.
+
+We have reviewed the whole field of psychophysical disturbances, those
+produced through external conditions in the normal brain and those
+resulting from abnormal brain constitution. We have seen that the work
+of the psychotherapist is of very unequal value in different parts of
+the field; in some, as in neurasthenia, in psychasthenia, in hysteria
+and similar regions most effective, in others like paresis or paranoia
+reduced to an almost insignificant factor. Where it can help and where
+not we recognize as a mere question of experience. Certainly the
+severity of the symptoms alone does not decide it. As the treatment is
+entirely empirical, no one can foresee whether or not the situation may
+change to-morrow. We may find psychotherapeutic schemes by which
+epilepsy or maniacal depressive insanity or traumatic neuroses may
+become accessible. We simply do not know why we may remove stammering or
+synthesize a dissociated personality or overcome an inborn sexual
+perversity, while we are unable to remove the depression of the
+melancholic. Certainly the symptoms of the circulatory insanity
+disappear completely in the free intervals; there is no reason to give
+up hope that psychotherapy might find the way to hasten the appearance
+of such a normal period.
+
+But we have emphasized from the start that the psychotherapeutic work
+has not only to set in when the disturbance itself lies in the
+psychophysical system. We may utilize the influence which the
+mind-brain system has for the whole body and thus may apply the
+psychical tool to work on the disturbances in the bodily apparatus. We
+may discriminate a direct and an indirect influence in the psychical
+treatment of bodily diseases. Transition from the foregoing group of
+psychical disturbances offers itself perhaps most easily through the
+state of insomnia.
+
+The causes of sleeplessness may still lie in the psychophysical sphere;
+restless thoughts may inhibit the idea of sleep. The effect of sleep is
+again in the sphere of the mind, the annihilation of conscious contents.
+But the center which regulates and creates the sleep, probably by
+contracting the blood-vessels, lies outside of the psychophysical system
+in the lower centers of the brain. The real disturbance thus lies in the
+inactivity of this purely bodily apparatus and mental influence which is
+to create sleep has therefore to work downwards from the mind to a
+bodily organ. In the same way many other non-psychical centers of the
+brain may be brought to efficiency through psychophysical regulation.
+
+But the therapeutic effect is certainly not confined to the central
+nervous system. Whithersoever the centrifugal nerves lead there the
+mind-brain system may have its curative influence. In the most startling
+way that is true for the digestive apparatus. The secretions of the
+stomach, the activity of the intestines can be influenced to a decree
+which it is difficult to explain. Important also is the relation to the
+circulatory system, especially the disturbances of the heart:
+innervation may be corrected, abnormal dilations and contractions of
+blood-vessels may be regulated. The bladder, uterus, even the pancreas
+and the liver seem to be influenced by the peripheral effects of the
+central excitement. And while no warning can be serious enough against
+the absurd belief that diseases like cancer or tuberculosis can be cured
+by faith, it must be admitted that psychical influences under special
+conditions may have a retarding influence on any pathological process in
+the organism. Much of that certainly is indirect influence but the
+physician would be reckless if he should ignore the aid which may result
+from such indirect assistance. Even if psychotherapy could not do more
+in the treatment of bodily diseases than to secure a joyful obedience to
+the strict demands of the physician, it would yet have to be accredited
+with an extremely important service.
+
+In a parallel line comes the effective aid by the stimulation of hope
+and the suppression of fear, by suggestion of a feeling of encouragement
+and the inhibition of the emotions of worry. This is a field where even
+the average physician is most easily inclined to play the amateur
+psychotherapist. He knows how convalescence is disturbed by psychical
+depression and how much more quickly health returns, if it is
+confidently expected; he knows how many dangerous operations are
+disturbed by despondency and helped by bravery; he knows what a blessed
+change has come into the treatment of tuberculosis since a psychical
+factor of social interest has set in; he knows how many ills disappear
+when regular occupation and interesting work are established or the
+strain of distasteful work removed. Even the mere suppression of the
+pain works backwards on the bodily disease which produces it. The pain
+was a starting point for disturbing reactions; with its disappearance
+through psychotherapeutic influence, the reactions of the irritated
+brain come to rest, the diseased body can carry on its struggle without
+interference and may win the day. Often the psychical influence may not
+even change the symptoms at all but may remove other troublesome
+effects. The sufferer from locomotor ataxia may learn to walk again
+through mental education without any restitution of his spinal cord. In
+short, there are endless ways in which psychical influence may work
+towards the general health and towards the victory over bodily disease;
+and all that may be acknowledged without the slightest concession to the
+metaphysical creeds of mental healers and Christian Scientists. But to
+make use of those means and to harness such influences, it cannot be
+enough to rely on the common-sense of the physician any more than we
+should trust the common-sense of the surgeon to use his knife without
+condescending to the study of anatomy. The psychological study of the
+anatomy of the soul shows a not less complicated system of mental
+tissues and mental elements.
+
+To enter into the full richness of this whole, large field of course
+lies entirely beyond the scope of our short discussion, which seeks as
+its only aim a clear recognition of the principles. Yet it seems
+essential to illustrate at least this sketch of the field by a more
+detailed account of actual developments. Various ways of procedure might
+appear in order and the most natural one would be, of course, to pass
+down from disease to disease and sketch special cases from diagnosis to
+cure. We might go through the various stages of neurasthenia and then
+through psychasthenia and then through hysteria and so on. And if we had
+to write a handbook for physicians, it would certainly be the desirable
+way, in spite of the too frequent repetitions which would become
+necessary. But as our aim is only a discussion of principles of
+psychotherapy, we have no right to use this method. Moreover, such a
+method would suggest the misleading view that the psychotherapist is
+called and is able to treat diseases. All that he treats are symptoms
+and he ought not to pretend that he can do more, as long as he abstracts
+from all other therapeutic agencies. Psychotherapeutic influence may
+remove the phobia of a psychasthenic or the obsession of a neurasthenic
+or the emotion of a hysteric, and thus may bring not only momentary
+relief but a change which may be favorable for general improvement, but
+certainly the neurasthenia and psychasthenia and hysteria are not really
+removed by it. Of course, even the treatment of symptoms demands a
+constant reference to the whole background of the disease. The
+depression of the neurasthenic must not be treated like the depression
+of the melancholic, the obsession of the psychasthenic must not be
+mixed with the fixed ideas of a paranoiac, the hysteric inability to
+walk must not be confused with an injury of the motor nerves; in short,
+each symptom has to be treated as part of a complete situation. The
+efforts of the psychotherapist will move over as large a part of the
+disease as possible and cover, perhaps, the causes of the disturbance as
+far as they are of psychical origin. Yet it would remain dilettanteism
+if we were to accept the popular view that the mere psychotherapeutic
+aid is a sufficient treatment of the whole disease. The physician has to
+be much more than a psychotherapist. Our discussion only seeks to point
+out that whatever else he may be, he must be also a psychotherapist.
+
+The more conservative method which befits us may be, therefore, the
+method of dealing with symptoms only and abstracting from the more
+ambitious plan of discussing the diseases entire. We simply separate the
+mental symptoms and the bodily symptoms which the psychotherapist is to
+remove. And just in order to classify somehow the manifold mental
+symptoms, we might separate those in the sphere of ideas, those in the
+sphere of emotions, and those in the sphere of volitions. Of course,
+nothing is further from such a plan than the old-fashioned belief that
+intellect, feeling, and will represent three independent faculties of
+the soul. Modern psychology has not only substituted the millionfold
+phenomena for the schematic faculties, but emphasizes above all the
+interconnectedness of the mental facts. There is no experience into
+which ideas, and feelings, and impulses do not enter together. And
+correspondingly we emphasized that on the physiological side too, every
+sensory excitement is at the same time the middle point of central
+irradiation and the starting point of motor activity. Thus there can be
+no disturbance of ideas which does not influence feeling and will, and
+vice versa. Yet it would be artificial to deny that any one of those
+various sides of the psychical process may come to prominence, sometimes
+the impulse, sometimes the emotion, and sometimes the interplay of
+ideas. The separation means only an abstraction, but it is an
+abstraction which is justified and suggested by the actual experiences.
+Thus we shall deal with the psychical treatment of ideational,
+emotional, volitional, and bodily symptoms.
+
+Common to our discussions will be only the effort to avoid everything
+which is exceptional and by its unusual complications apparently
+unexplainable and mysterious. The greater complexity of the case
+certainly adds much fascination. Yet since we do not want to stimulate
+mere curiosity but clear understanding of the elements, we avoid every
+startling record. We confine ourselves carefully to those perhaps
+trivial experiences which daily enter into the view of those who come in
+contact with suffering mankind. There will be no startling stories of
+dissociated personalities, such as appear perhaps every few years on the
+horizon of the medical world, but we shall speak of those who every day
+in every town carry their trouble to the waiting room of the doctor and
+who might return more happily if he had more well-trained interest in
+the psychotherapeutic factors. Yet before we analyze some typical
+symptoms, it might be wise to review the whole series of means and tools
+which the psychotherapist finds at his disposal.
+
+
+
+
+VIII
+
+THE GENERAL METHODS OF PSYCHOTHERAPY
+
+
+The psychological work of the physician does not begin with his curative
+efforts. Therapy is always only the last step. Diagnosis and observation
+have to precede, and an inquiry into the causes of the disease is
+essential, and in every one of these steps psychology may play its role.
+The means of psychodiagnostic are not less manifold than those of
+psychotherapy. Moreover there the technique may be more complex and
+subtle. The whole equipment of the modern laboratory ought to be put at
+its disposal. Perceptions and associations, reactions and expressions
+ought to be examined with the same carefulness with which the
+conscientious physician examines the blood and the urine.
+
+A particular difficulty of the task more or less foreign to every other
+medical inquiry is the intentional or unintentional effort of the
+patient to hide the sources of the trouble and to mislead as to their
+true character. Too often he is entirely unconscious of the sources of
+trouble or else he has social reasons to deceive the world and himself,
+and ultimately the physician. And yet no psychical treatment can start
+successfully so long as the patient is brooding on secret thoughts at
+the bottom of his mind. The desire to hide them may often be itself a
+part of the disease. It is surprising how often unsuspected vistas of
+thoughts and impulses and emotions are opened by an inquiring analysis
+where the direct report of the patient does not awaken the least
+suspicion. In the field of insanity, naturally the physician at once
+goes to an examination on his own account, but in the borderland regions
+of the psychasthenics and hysterics and neurasthenics, the intellectual
+clearness of the patient too easily tempts one into trusting the
+sincerity of his story; and yet the most important ideas clustering
+perhaps about love or ambition, about vice or crime, about business
+failure or family secrets, about inherited or acquired diseases may be
+cunningly withheld and may frustrate every psychotherapeutic influence.
+Where suspicion is awake and mere confidential talk and persuasion seem
+insufficient, the physician may feel justified in the interest of his
+patient in drawing the thoughts out of their hiding-place by artificial
+means. Skill, tact, and experience are needed there.
+
+As a matter of course, in the overwhelming mass of cases the frankness
+and the good will of the patient himself will support the physician and
+accordingly his examination is not obliged to trap the patient but
+simply to guide him to important points. But then begins the most
+essential study of diagnostical differentiation. With all the means not
+only of psychology but of neurology and internal medicine, he has to
+separate the particular case from similar ones and to examine whether
+he deals with, for instance, a hysteric or with a paranoiac, with a
+neurasthenic or with a case of dementia praecox; and he will not forget
+that there exist almost no symptoms of serious diseases which the
+nervous system of the hysteric may not imitate for a time. Not ours is
+the task of analyzing special methods of neurological and mental
+differential diagnosis such as are used in the psychiatric clinic and in
+the office of the nerve specialist. There the family history with
+reference to nervous and other diseases, the history of the patient
+himself, the infectious diseases which he has passed through, his habits
+and anomalies, his use of alcohol and of drugs, his experiences in
+social life, the demands of his profession, his recent troubles and
+their first origin are to be recorded carefully. Then begins the
+physical examination, the study of his sense organs and his nerves, of
+the motor inabilities, the pains, the local anaesthesias and
+paraesthesias, the disturbances of the reflexes, of the spasms, tremors,
+convulsions, and incooerdinations, of the vasomotor and trophic
+disorders, and so on. In a similar way the psychical examination tests
+the hallucinations and illusions, the variations and defects of memory
+and attention, of judgment and reasoning, of orientation and
+self-consciousness, of emotions and volitions, of intellectual
+capacities and organized actions. But we do not have to enter here into
+a discussion of such diagnostic means; our chief interest belongs to the
+therapy.
+
+The variety of the psychotherapeutic methods is great and only some
+types are to be characterized here. But one rule is common to all of
+them: never use psychotherapeutic methods in a schematic way like a
+rigid pattern. Schematic treatment is a poor treatment in every
+department of medicine, but in psychotherapeutics it is disastrous.
+There are no two cases alike and not only the easily recognizable
+differences of sex and age, and occupation and education, and financial
+means, and temperament and capacity are decisive, but all the subtle
+variations of prejudices and beliefs, preferences and dislikes, family
+life and social surroundings, ambitions and prospects, memories and
+fancies, diet and habits must carefully be considered. Every element of
+a man's life history, impressions of early childhood, his love and his
+successes, his diseases and his distresses, his acquaintances and his
+reading, his talent, his character, his sincerity, his energy, his
+intelligence--everything--ought to determine the choice of the
+psychotherapeutic steps. As it is entirely impossible to determine all
+those factors by any sufficient inquiry, most of the adjustment of
+method must be left to the instinct of the physician, in which wide
+experience, solid knowledge, tact, and sympathy ought to be blended.
+Even the way in which the patient reacts on the method will often guide
+the instinct of the well-trained psychotherapist.
+
+It is therefore certainly not enough that the knowledge of the physician
+simply decide beforehand on a definite course of psychical treatment and
+leave the carrying out to a well-meaning minister or any other medical
+amateur who schematically follows the indicated path. The finest
+adjustment has to come in during the treatment itself and the response
+of the patient often has to suggest entirely new lines of procedure.
+More than in any other field of medicine, the physician himself has to
+extend his influence far beyond the office hours and the strictly
+medical relations. And yet, on the other hand, there is no department of
+medicine in which the treatment might not profit by the
+psychotherapeutic influence. With a few vague words of encouragement
+mechanically uttered, or with a routine of tricks of suggestion by bread
+pills and colored water and tuning forks, not much will be gained even
+in the ordinary physician's practice. Subtle adjustment to the personal
+needs and to the individual conditions is necessary in every case where
+the psychical factor is to play an important role. It cannot be denied
+that the one great obstacle in the work of the routine physician is the
+lack of time and patience which is needed for successful treatment. To
+prescribe drugs is always quicker than to influence the mind; to cure a
+morphinist by hyoscine needs less effort than to cure him by suggestion.
+
+The first method to bring back the psychophysical equilibrium is of
+course the one which is also demanded by common-sense, namely, to remove
+the external sources of the disturbance. External indicates there not
+only the outer world but also the own body outside the conscious parts
+of the brain. If we take it in the widest meaning, this would evidently
+include every possible medical task from filling a painful tooth to
+operating on a painful appendix, as in every case where pain results,
+the mental equilibrium is disturbed by it and the normal mental life of
+the patient reduced in its efficiency. But in the narrower sense of the
+word, we shall rather think of those sources of trouble in the organism
+itself which interfere directly with the mental functions. The
+examination of any public school quickly leads to the discovery that
+much which is taken for impaired mental activity, for lack of attention,
+for stupidity, or laziness may be the result of defective hearing or
+sight or abnormal growth of the adenoids. Growths in the nose may be
+operated upon, the astigmatic or the short-sighted eye may be corrected
+by glasses, the child who is hard of hearing may at least be seated near
+the teacher; and the backward children quickly reach the average level.
+No doubt in the life of the adult as well, often almost insignificant
+and from a strictly physical point of view unimportant abnormities in
+the bodily system, especially in the digestive and sexual spheres, are
+sources of irritation which slowly influence the whole personality. To
+be sure, the brain disturbance may have reached a point where the mere
+removal of the original affliction is not sufficient to reinstate the
+normal balance of mental energies, but wherever such a bodily irritation
+goes on, it is never too late to abolish it in the interests of
+psychotherapy.
+
+The less evident and yet even more important source of the painful
+intrusions may lie outside of the organism in the social surroundings
+and conditions of life. Most of that has to be accepted. The physician
+cannot bring back the friend who died or the fortune which was lost in
+speculation or the man who married another girl. He will even avoid
+suggesting far-reaching social changes in the private life of the
+patient, changes like divorce in an unhappy marriage or the breaking of
+the home ties, however often he may get the impression that such a
+liberation would stop the source of the mental trouble. He will be the
+more careful not to overstep his medical rights as he seldom has the
+possibility to judge fairly on the basis of the one-sided complaint, and
+the probability is great that the character and temperament of the
+complainant may be a more essential factor of the ailment than the
+personalities which surround him. Yet even the conservative physician
+will find abundant opportunities for advice which will remove disturbing
+energies from the social surroundings of the sufferer. Even a short
+release from the burdening duties, a short vacation from the incessant
+needs of the nursery, a break in the monotony of the office, may often
+do wonders with a neurasthenic. Often within a surprisingly short time
+the brain gathers the energies to overcome the frictions with
+unavoidable surroundings.
+
+Yet here the physician has to adjust the prescribed dose of outing very
+carefully to the special case. We may be guided by the psychological
+experiments which have been made in the interest of testing the fatigue
+induced by mental work. If perhaps four hours of concentrated work are
+done without pauses, experiment shows that the quality of the work
+deteriorates, measured for instance by the number of mistakes in quick
+calculation. If certain relatively long pauses are introduced, the
+standard of work can be kept high all through. But if frequent pauses
+are made, and each short, the result is with many individuals the
+opposite. The experiment indicates that these frequent pauses are
+working as interruptions which hinder the perfect adjustment to the work
+in hand. That is suggestive. Our neurasthenic may complain about the
+life which he has to live and yet after all he is frequently so
+completely adjusted to it that it may not be in his interest to remove
+him far away from the conditions which cannot ultimately be changed but
+to which he has to return. The instinct of the physician has to find the
+middle way between a temporary removal of irritation which really allows
+a development of new energies and a mere interruption which simply
+damages the acquired relative adjustment. Every cause of friction which
+can be permanently annihilated for the patient certainly should be
+removed.
+
+This negative remedy demands its positive supplement. The patient must
+be brought under conditions and influences which give fair chances for
+the recuperation of his energies. Too often from the standpoint of the
+psychologist, the prescription is simply rest. As far as rest involves
+sleep, it is certainly the ideal prescription. There is no other
+influence which builds up the injured central nervous system as safely
+as sound natural sleep, and loss of sleep is certainly one of the most
+pernicious conditions for the brain. Again rest is a great factor in
+those systematic rest cures which for a long while were almost the
+fashion with the neurologist. Experience has shown that their
+stereotyped use is often unsuccessful, and moreover that the advantage
+gained by those months spent in bed completely isolated and overfed is
+perhaps due to the separation and changed nutrition more than to the
+overlong absolute rest. Yet used with discrimination, the physiological
+and the psychical effect of lying in bed for a few weeks has certainly
+often been a marked improvement, especially with young women. But more
+often the idea of rest in bed during daytime is not meant at all when
+the nerve specialist recommends rest to his over-strained patient. It is
+simply meant that he give up his fatiguing daily work, even if that work
+is made up of a round of entertainments and calls and social
+engagements. The neurasthenic and all similar varieties are sent away
+from the noise of the city, away from the rush of their busy life, away
+from telephones and street cars, away from the hustling business and
+politics.
+
+Indeed it is the dogma of most official and unofficial doctors that the
+restlessness and hurry and noise which all are characteristic of the
+technical conditions of our time are the chief sources of the prevailing
+nervousness. There was no time in the history of civilization in which
+the average man was overwhelmed by so many demands on his nerve energy,
+no time which asked such an abundance of interests even from the school
+child. The wild chase for luxury in the higher classes, reenforced by
+the commercialism of our time, the hard and monotonous labor in our
+modern mills and mines for the lower classes, the over-excitement
+brought to everybody by the sensationalism of our newspapers and of our
+public life all injure the brain cells and damage the equilibrium. That
+is a story which we hear a thousand times nowadays. Yet it is doubtful
+whether there is really much truth in such a claim and whether much wise
+psychotherapy can be deduced from it.
+
+We may begin even with the very justifiable doubt whether nervousness
+really has increased in our time. Earlier periods had not so many names
+for those symptoms and were not able to discriminate them with the same
+clearness. Above all, the milder forms of abnormities were not looked on
+as pathological disturbances. If a man has a pessimistic temperament, or
+has fits of temper, or cannot get rid of a sad memory idea, or imagines
+that he feels an illness which he does not have, or has no energy to
+work, even today most people are still without suspicion that a
+neurasthenic or a psychasthenic or a hysteric disturbance of the nervous
+system may be in its beginning. Earlier times surely may have treated
+even the stronger varieties of this kind as troublesome variations in
+the sphere of the normal. On the other hand, there can be no doubt that,
+for instance, the Middle Ages developed severe diseases of the nervous
+system in an almost epidemic way which is nearly unknown to our time.
+
+As to the conditions of life itself, there are certainly many factors at
+work which secure favorable influences for our cerebral activity. The
+progress of scientific hygiene has brought everyone much nearer to a
+harmonious functioning of the organism, and the progress of technique
+has removed innumerable difficulties from the play of life. Of course,
+we stand today before a much more complex surrounding than our ancestors
+but still more quickly than the complexity have grown the means to
+master it. We have to know more: yet the effort has not become greater
+since it has become easier to acquire knowledge. We have to endure much
+disturbing noise, and yet we forget how the sense organs of our
+forefathers must have been maltreated, for instance, by flickering
+light. We are in a rush of work and stand in thousandfold connections;
+and yet the neural energy which is demanded is not large because a
+thousand devices of our technical life have become our obedient
+servants. There is no nation on earth which is more proud of its rush
+and its hurry than the American people; and yet what an abundance of
+time is leisurely wasted that would have to be used for work if the
+country could not live from its richness. Moreover our life has probably
+become cooler, there is less emotionalism, less sentimentality, more
+business-like attitude, and that all means less inner friction and
+excitement; in public life too, less fear of war and less religious
+struggle. All has become a question of administration and efficiency.
+Our time is certainly not worse off on the score of neurasthenia than
+its predecessors.
+
+Above all the intensity of mental stimuli is always relative. The
+psychologist knows the experiments which determine that we perceive the
+difference of impressions as alike when the stimuli are proportional.
+If I have a ten-pound weight in one hand, I may find that I must have
+one pound more in the other hand to discriminate the difference. Now if
+I take twenty pounds in the one hand, then it is not sufficient to have
+one pound more in the other, but I must have twenty-two pounds in the
+other to feel a difference, and if I take thirty pounds, the other
+weight must be thirty-three. We feel equal differences when the weights
+stand in the same relation. The man who owns a hundred dollars will
+enjoy the gain of five and regret the loss of five just as much as the
+owner of a hundred thousand dollars would feel the gain or loss of five
+thousand. This fundamental law of the relativity of psychical
+impressions controls our whole life. The rush of stimuli which might
+mean a source of nervous disturbance for the villager whose quiet
+country life has brought about an adjustment to faint impressions may
+cause very slight stimulation for the metropolitan accustomed for a
+lifetime to the rhythm of the surroundings. Yet that quiet countryman
+may react in his narrow system not less when the modest changes in his
+surroundings provoke him. The gossip of his neighbor may undermine his
+nervous system just as much as a political fight or the struggles of the
+exchange that of the city man.
+
+The same holds true for the purely intellectual engagements. The work
+which the scholar undertakes should not be measured by the effect which
+the same appeal to concentrated attention would make on the average man
+of practical life. There, too, an adjustment to the demand has resulted
+during the whole period of training and professional work. Every effort
+should be estimated with reference to the standard of the particular
+case. This relativity of the mental reaction on the demands of life must
+always be in the foreground of the psychotherapeutic regime. Even the
+best physicians too often sin against this principle and accuse the life
+which a man or woman leads as too exhausting and overstraining simply
+because it would be overstraining and exhausting to others who are not
+adjusted to that special standard. Simply to withdraw a patient from the
+one kind of life and to force on him a new kind with new standards may
+not be a gain at all. A new adjustment begins and smaller differences
+from the standard may bring about the same strong intensities of
+reaction as the large differences brought before. Complete rest, for
+instance, for a hard brain-worker hardly ought to be recommended unless
+a high degree of exhaustion has come on. If routine prescriptions are to
+be admitted at all, they should not be complete rest or complete change
+of life for any length of time but a continuation of the life for which
+adjustment has been learned with a reasonable reduction of the demands
+and stimulations. The intellectual worker ought to decrease his work,
+the overbusy society woman ought to stay in bed one day in the week, the
+man in the midst of the rush of life ought to cut down his obligations,
+but probably each of them does better to go on than simply to swear off
+altogether.
+
+Their rest ought to have the character of vacation; that means
+interruptions without the usual activity ought to be short periods spent
+with the distinct feeling that they are interruptions of that which must
+last and that they are not themselves to become lasting states. Thus the
+inner adjustment to the work ought to be kept up and ought not to be
+substituted by a new adjustment to a less exacting life. In this way the
+episode of the vacation rest ought to be in a way included in the
+strenuous life almost as a part of its programme. Strenuosity must not
+mean an external rush with the gestures of overbusy excitement, but
+certainly the doctrine of the lazy life is wretched psychotherapy, as
+long as no serious illness is in question. By far the best alteration
+is, therefore, even in the periods of interruption, not simply rest but
+new engagements which awaken new interests and stimulate neglected
+mental factors, disburdening the over-strained elements of mental life.
+The most effective agency for this task is contact with beauty, beauty
+in nature and life, beauty in art and literature and music. To enjoy a
+landscape ought to be not merely a negative rest for the man of the
+office building, and good literature or music absorbs the mental
+energies and harmonizes them. In the second place come games and sport,
+which may enter into their right if fatigue can be avoided. Harmonious
+joyful company, as different as possible from the depressing company of
+the sanitariums, will add its pleasantness.
+
+While the advice of the physician ought thus to emphasize the positive
+elements which work, not towards rest, but toward a harmonious mental
+activity, we must not forget some essential negative prescriptions.
+Everything is to be avoided which interferes with the night's sleep.
+Furthermore, in the first place, alcohol must be avoided. There cannot
+be any doubt that alcoholic intemperance is one of the chief sources of
+brain disturbances and that the fight against intemperance, which in
+this country is essentially the fight against the disgusting saloon, is
+a duty of everyone who wants to prevent nervous disaster. There may and
+must be divergence of opinion as to the safest way to overcome
+intemperance. The conservative physician will feel grave doubt whether
+the hasty recommendation of complete prohibition is such a safe way,
+whether it does not contain many conditions of evil, and whether the
+fight against the misuse of alcohol will not be more successful if a
+true education for temperance is accepted as the next goal. But for the
+man of neurasthenic constitution and for any brain of weak resistance,
+the limit for permissible alcoholic beverages ought to be drawn very
+narrow and in such cases temporary abstinence is usually the safest
+advice. Individual cases must indicate where a glass of light beer with
+the meal or a glass of a mild wine may be permissible. Strong drinks
+like cocktails are absolutely to be excluded. In the same way a strong
+reduction is advisable in tobacco, tea, and especially coffee. A
+complete withdrawal of all stimulations to which a nervous system has
+been accustomed for years is not wise, or at least mild substitutes
+ought to be suggested, but if coffee can be ruled out at once, often
+much is gained. In the same way all passionate excitements are to be
+eliminated and sexual life to be wisely regulated. An especial warning
+signal is to be posted before all strong emotions, and if the patient
+cannot be asked to leave his worry at home, he can at least be asked to
+avoid situations which will necessarily lead to excitement and quarrel
+and possible disappointment.
+
+It is one of the surest tests of psychotherapeutic skill to discriminate
+wisely whether one or the other of these features of general treatment
+ought to be emphasized. They usually demand more insight than specific
+forms of psychotherapy like hypnotic suggestions. These general efforts
+are also much more directed against the disease itself where the
+specific methods are merely directed against the symptoms. The
+separation from disturbing surroundings, the reduction of engagements
+and work, the complete rest, the suppression of artificial stimulants,
+the enjoyment of art, of nature, of sport, the distractions of social
+life, each might be in one case a decisive help and indifferent, perhaps
+even harmful in another. All is a matter of choice and adjustment to the
+particular needs in which all the personal factors of inherited
+constitution, acquired adjustments, social surroundings, temperament,
+and education, and the probable later development have to be most
+tactfully weighed. Yet this general treatment may take and very often
+ought to take the opposite direction, not towards rest but towards work,
+not towards light distraction but towards serious effort, not towards
+reduction of engagements but towards energetic regulation. We said that
+it was an exaggeration to blame the external conditions of our life, the
+technical manifoldness of our surroundings as the source of the
+widespread nervousness. The mere complexity of the life, the rapidity of
+the demands, the amount of intellectual effort is in itself not
+dangerous and our time is not more pernicious than the past has been;
+but it is perhaps no exaggeration to say that our time is by many of its
+features more than the past tending towards an unsound inner attitude of
+man.
+
+Much of the present civilization leads the average man and woman to a
+superficiality and inner hastiness which undermines sound mental life
+much more than the external factors. We look with a condescending smile
+at the old-fashioned periods in which the demands of authority and
+discipline controlled the education of the child and after all the
+education of the adult to his last days. We have substituted for it the
+demand of freedom with all its blessings, but instead of the blessings
+we too often get all its vices. A go-as-you-please method characterizes
+our whole society from the kindergarten to the height of life. We
+eulogize the principle of following the paths of own true interest and
+mean by that too often paths of least resistance. Study becomes play,
+the child learns a hundred things but does not learn the most important
+one, to do his duty and to do it accurately and with submission to a
+general purpose. The power of attention thus never becomes trained, the
+energy to concentrate on that which is not interesting by its own
+appeal is slowly lost, a flabby superficiality must set in which is
+moved by nothing but the personal advantage and the zigzag impulses of
+the chance surroundings. He who has never learned obedience can never
+become his own master, and whoever is not his own master through all his
+life lacks the mental soundness and mental balance which a harmonious
+life demands. Flippancy and carelessness, haphazard interests and
+recklessness must result, mediocrity wins the day, cheap aims pervade
+the social life, hasty judgments, superficial emotions, trivial
+problems, sensational excitements, and vulgar pleasures appeal to the
+masses. Yellow papers and vaudeville shows--vaudeville shows on the
+stage, in the courtroom, on the political platform, in the pulpit of the
+church--are welcome, and of all the results, one is the most immediate,
+the disorganization of the brain energies.
+
+A sound mind is a well-organized mind in which a controlling idea is
+able to inhibit the opposites and is in no danger of being overrun by
+any chance intrusion into the mind. This power is the act of attention.
+An attention which is trained and disciplined can hold its ideas against
+chance impulses. An untrained attention is attracted by everything which
+is loud and shining, big and amusing. The trouble is not with the rush
+and hurry of the impressions which demand our attention; the trouble is
+with our attention which seeks a quick change of new and ever new
+impressions because it is not disciplined to hold firmly to one
+important interest. We want the hundred short-cut superficial magazines
+because we lack the energy to study one large volume; we want the
+thousand engagements because we are not concentrated enough to devote
+ourselves fully to one ideal task. The strong mind may find its sound
+adjustment even without such training for concentrated attention through
+obedience and discipline but the weak mind has to pay the penalty. For
+not a few it will mean social disaster. Yet our society is sufficiently
+adapted to this state so that it gives some good social chances to the
+superficial too, and this not only to the rich, but to those on every
+level. Only the nervous system cannot so easily be adjusted to the new
+regime. The loose interplay of the brain cells without the serious
+training of discipline must involve disorganization of the mind-brain
+system which may count often most powerfully in those spheres in which
+the mere needs of life are felt the least. There is only one great
+remedy: discipline, training for concentrated attention, for a work in
+submission of will to a steady purpose. And psychotherapeutic effort
+will often demand such a training for work rather than a reduction of
+work and rest.
+
+The most alarming product of the neglect in training is found in many of
+those retarded children who at fifteen show the intelligence of a boy of
+eight. They are not imbeciles and do not belong in the psychiatric
+domain; their development has simply been suspended by a mistaken
+education. Of course no neglect would have led to it without a
+constitutional, inherited weakness of the central nervous system, but
+the weakness would never have led to the retardation if perhaps a
+mistaken parental indulgence had not allowed a life without forced
+effort and, therefore, without progress. Even such extreme cases may not
+show on the surface. The boy may pass as all right if we meet him at a
+ball; only his tutor knows the whole misery. Still less does the surface
+view of many a grown-up neurasthenic alarm us who seems to live a
+well-ordered, perhaps an enviable life, and yet who suffers the penalty
+of a life without concentrated effort, really without anything to do in
+spite of a thousand engagements. Moreover this lack of important
+activity may often be forced on our patients. Married women without
+children, without household responsibilities, and without interests of
+their own and without strong nervous constitution will soon lose the
+power of effort and their brain will succumb. A dreary monotony is
+dangerous even for the worker; for the non-worker it may be ruinous.
+
+Yet mere flippant excitement and superficial entertainment is nothing
+but a cheap counterfeit of what is needed. Voluntary effort is needed,
+and this is the field where the psychotherapist must put in his most
+intelligent effort. There is no one for whom there is not a chance for
+work in our social fabric. The prescription of work has not only to be
+adjusted to the abilities, the knowledge, and social condition, but has
+to be chosen in such a way that it is full of associations and
+ultimately of joyful emotions. Useless work can never confer the
+greatest benefits; mere physical exercises are therefore
+psychophysically not as valuable as real sport while physically, of
+course, the regulated exercises may be far superior to the haphazard
+work in sport. To solve picture puzzles, even if they absorb the
+attention for a week, can never have the same effect as a real interest
+in a human puzzle. There is a chance for social work for every woman and
+every man, work which can well be chosen in full adjustment to the
+personal preference and likings. Not everybody is fit for charity work,
+and those who are may be entirely unfitted for work in the interest of
+the beautification of the town. Only it has to be work; mere
+automobiling to charity places or talking in meetings on problems which
+have not been studied will, of course, be merely another form of the
+disorganizing superficiality. The hysterical lady on Fifth Avenue and
+the psychasthenic old maid in the New England country town both simply
+have to learn to do useful work with a concentrated effort and a high
+purpose. From a long experience I have to confess that I have seen that
+this unsentimental remedy is the safest and most important prescription
+in the prescription book of the psychotherapist.
+
+There is one more feature of general treatment which seems almost a
+matter of course, and yet which is perhaps the most difficult to apply
+because it cannot simply be prescribed: the sympathy of the
+psychotherapist. The feelings with which an operation is performed or
+drugs given do not determine success, but when we build up a mental
+life, the feelings are a decisive factor. To be sure, we must not forget
+that we have to deal here with a causal and not with a purposive point
+of view. Our sympathy is therefore not in question in its moral value
+but only as a cause of a desired effect. It is therefore not really our
+sympathy which counts but the appearance of sympathy, the impression
+which secures the belief of the patient that sympathy for him exists.
+The physician who, although full of real sympathy, does not understand
+how to express it and make it felt will thus be less successful than his
+colleague who may at heart remain entirely indifferent but has a
+skillful routine of going through the symptoms of sympathy. The
+sympathetic vibration of the voice and skillful words and suggestive
+movements may be all that is needed, but without some power of awakening
+this feeling of personal relation, almost of intimacy, the wisest
+psychotherapeutic treatment may remain ineffective. That reaches its
+extreme in those frequent cases in which social conditions have brought
+about an emotional isolation of the patient and have filled him with an
+instinctive longing to break his mental loneliness, or in the still more
+frequent cases where the patient's psychical sufferings are
+misunderstood or ridiculed as mere fancies or misjudged as merely
+imaginary evils. Again everything depends upon the experience and tact
+of the physician. His sympathy may easily overdo the intention and
+further reenforce the patient's feeling of misery or make him an
+hypochondriac. It ought to be sympathy with authority and sympathy which
+always at the same time shows the way to discipline. Under special
+conditions it is even advisable to group patients with similar diseases
+together and to give them strength through the natural mutual sympathy;
+yet this too can be in question only where this community becomes a
+starting point for common action and common effort, not for mere common
+depression. In this way a certain psychical value must be acknowledged
+for the social classes of tuberculosis as they have recently been
+instituted.
+
+From sympathy it is only one step to encouragement, which indeed is
+effective only where sympathy or at least belief in sympathy exists. He
+who builds up a new confidence in a happy future most easily brings to
+the patient also that self-control and energy which is the greatest of
+helping agencies. The physical and mental efforts of the physician are
+alike deprived of their best efficiency if they are checked by worry and
+fear that the developments of the disease will be disastrous. As soon as
+new faith in life is given, and given even where a sincere prognosis
+must be a sad one, a great and not seldom unexpected improvement is
+secured. There is no doubt that the routine physician is doing by far
+too little in these respects. His instinctive feeling that disease is a
+causal process, and that he should therefore keep away from the
+purposive attitude, leads him too easily to a dangerous narrowness. He
+treats disease as if it were an isolated process and overlooks the
+thousandfold connections in which the nervous system stands with the
+patient's whole life experience in past and future. The physician is
+thus too easily inclined to underestimate the good which may come in the
+fight against disease from the ideas and emotions which form the
+background of the mind of the patient. Even if the disease cannot be
+vanquished, the mental disturbances which result from it, the pains and
+discomforts, may be inhibited, as soon as hopes and joyful purposes gain
+a dominating control of the mind. The nervous patient often needs a
+larger hold upon life, while the routine prescriptions may too easily
+reduce that hold by fixing the attention on the symptoms.
+
+Here then is the right place for the moral appeal and the religious
+stimulation. How psychotherapy is related to the church will interest us
+later. At this moment morality and religion are for us not inspirations
+but medicines. But from such a causal point of view, we should not
+underestimate the manifold good which can come from the causal effect of
+religious and ethical ideas. Those faith curists who bring mutual help
+by impressing each other with the beauty and goodness of the world
+really bring new strength to the wavering mind; and the most natural
+channel for religious help remains, of course, the word of the minister
+and the own prayer. Religion may work there causally in a double way.
+The own personality is submerging into a larger all-embracing hold and
+thus inhibits the small cares and troubles of merely personal origin.
+The consciousness sinks into God, a mental process which reaches its
+maximum in mysticism. The haphazard pains of the personality disappear
+and are suppressed by the joy and glory of the whole. This submission of
+will under a higher will and its inhibitory effect for suppression of
+disturbing symptoms must be wonderfully reenforced by the attitude of
+prayer. Even the physiological conditions of it, the clasping of the
+hands, the kneeling, and monotonous sounds reenforce this inhibition of
+the insignificant dissatisfactions. On the other hand, contact with the
+greater will must open the whole reservoir of suppressed energies, and
+this outbreak of hidden forces may work towards the regeneration of the
+whole psychophysical system. Neglected functions of the brain become
+released and give to the mind an energy and discipline and self-control
+and mastery of difficulties which restitutes the whole equilibrium, and
+with the equilibrium comes a new calmness and serenity which may react
+almost miraculously on the entire nervous system and through it on the
+whole organism and its metabolism.
+
+Seen from a causal point of view, however, there is no miracle in it at
+all. On the contrary, it is a natural psychophysical process which
+demands careful supervision not to become dangerous. It is not the value
+of the religion which determines the improvement, and it is not God who
+makes the cure; or to speak less irreligiously, the physician ought to
+say that if it is God who cures through the prayer, it is not less God
+who cures in other cases through bromide and morphine, and on the other
+side just as God often refuses to cure through the prescribed drugs of
+the drug store, God not less often refuses to cure through prayer and
+church influence. But the real standpoint of the physician will be to
+consider both the drugs and the religious ideas merely as causal
+agencies and to try to understand the conditions of their efficiency
+and the limits which are set for them. From such a point of view, he
+will certainly acknowledge that submission to a greater power is a
+splendid effect of inhibition and at the same time a powerful effect for
+the stimulation of unused energies; but he will recognize also that the
+use of those silent energies is not without dangers.
+
+Certainly nature has supplied us with a reservoir of normally unused
+psychophysical strength, to which we may resort just as the tissues of
+our body may nourish us for a few days when we are deprived of food, but
+such supply, which in exceptional cases may become the last refuge,
+cannot be used without a serious intrusion and interference with the
+normal household of mind and body. To extract these lowest layers of
+energies may mean for the psychophysical system a most exhausting effort
+which may soon bring a reaction of physical and nervous weakness. The
+chances are great that such a religious excitement, if it is really to
+have a deep effect, may go over into a mystic fascination which leads to
+hysteria or into an exhausting eruption of energies which ends in
+neurasthenic after-effects. The immediate successes of the strong
+religious influence on the weakened nervous system, especially on the
+nervous system of a weak inherited constitution, are too often stage
+effects which do not last. From a mere purposive point of view, they may
+be complete successes. They may have turned the immoral man into a moral
+man, the skeptic into a believer, but the physician cannot overlook
+that the result may be a moral man with a crippled nervous system, a
+believer with psychasthenic symptoms. From the point of view of the
+church, there cannot be too much religion; from a therapeutic point of
+view, religion works there like any other nervous remedy of which five
+grains may help and fifty grains may be ruinous.
+
+Moreover this power of inhibiting the little troubles of the body and of
+bringing to work and effectiveness the deepest powers of the mind
+belongs not less to any other important idea and overpowering purpose.
+The soldier in battle does not feel the pain of his wound, and in an
+emergency everybody develops powers of which he was not aware. The same
+effect which religion produces may thus be secured by any other deep
+interest: service for a great human cause, enthusiasm for a gigantic
+plan, even the prospect of a great personal success. Thus in a
+psychotherapeutic system, religion has only to take its place in line
+with many other efforts to inhibit the feeling of misery and to
+reenforce will and self-control by submission under a greater will. That
+in the case of religion this submission, from an entirely different
+purposive point of view, also has a moral and religious value, has in
+itself no relation to the question of its therapeutic character. It
+ought not to lead to any one-sided preference, inasmuch as religiously
+indifferent agencies may be in the particular case a more reliable means
+of improvement. Moreover the psychological symptoms are, after all, only
+a fraction of the disease and very different bodily factors, digestion
+and nutrition, heart and lungs and sexual organs may be most intimately
+connected with the disturbance of the equilibrium. Medicine today no
+longer believes that hysteria originates in the diseases of the uterus
+or that neurasthenia necessarily results from insufficiencies of the
+stomach, but it would be a graver mistake to believe that mental factors
+alone decide the progress of the disease, however prominent the mental
+symptoms may be in it.
+
+From the physician's encouragement and the minister's influence towards
+new faith in life, a short way leads to the influence of suggestion. It
+is on the whole the way which leads from the general psychotherapeutic
+treatment to the specific one directed against particular symptoms.
+
+
+
+
+IX
+
+THE SPECIAL METHODS OF PSYCHOTHERAPY
+
+
+Of course there is no abrupt division between special and general
+methods. Yet the different tendency is easily recognized, if we turn
+only, for instance, from the mere sympathy and encouragement to the
+method of reasoning with the patient about the origin of his special
+complaint. Just now the medical profession moves along this line a great
+deal. Of course no well-trained psychotherapist will make the blunder of
+arguing with the insane. To dispute by argument with the paranoiac and
+to try to convince him would not be only without success, but easily
+irritating. This does not mean that the not less amateurish way ought to
+be taken of accepting his delusions and appearing to be in full
+agreement with him. A tactful middle way, preferably a disciplinary
+ignoring attitude, ought to be taken. But it is entirely different with
+the mental states of the psychasthenic. The mere statement and objective
+proof that his obsession is based on an illusion would be ineffective.
+He knows that himself, but he may take the disturbance as the beginning
+of a brain disease, as a form of insanity, as a lasting damage which
+lies entirely beyond his control. Now the physician explains to him how
+it all came about. He shows to him that the symptoms resulted merely
+from autosuggestion or are the after-effects of a suggestion from
+without or of a forgotten emotional experience of the past. That is a
+new idea to the patient and one which changes the aspect and may have an
+inhibitory influence.
+
+Of course, the patient does not accept the explanation at once. He feels
+sure that he is not accessible to suggestion and that he has least of
+all a tendency to autosuggestions, but the skillful psychotherapist will
+find somewhere an opening for the entering wedge. He may develop to the
+patient the modern theories of the origin of neurotic disturbances, all
+with entire sincerity and yet all shaped in a way which gives to the
+special case an especially harmless appearance. He may even enter into
+experimental proof that the patient is really accessible to
+autosuggestions. A very simple scheme for instance is to put some
+interesting looking apparatus with a few metal rings on the fingers of
+the subject and connect it with a battery and electric keys. The key is
+then pushed down in view of the patient and he is to indicate the time
+when and the place where he begins to feel the galvanic current. The
+feeling will come up probably very soon in the one or the other finger,
+and as soon as he feels sure that the sensation is present, the
+physician can show him that there was no connection in the wires, that
+the whole galvanic sensation was the result of suggestion.
+
+Such a method demands patience and good will. The prejudices and
+deeply-rooted hypochondriac ideas, foolish theories of the patient and
+pessimistic emotions which have become habitual, must be removed piece
+by piece until the central symptoms themselves can be undermined and
+explored. It often takes hours of careful and fatiguing reasoning, in
+which at any time the patient may suddenly slip back to his old ideas.
+Yet if the explanatory arguments have once succeeded in making the
+patient himself believe firmly that his whole trouble resulted from
+suggestion only, the inhibitory effect of this idea may be an excellent
+one. The only serious defect of the method is that it often does not
+work. The credit which neurologists of today give to its effectiveness
+seems to me much too high. Even slight neurasthenic and psychasthenic
+disturbances remain too often in complete power when the patient is
+fully convinced that they originated with an emotional excitement which
+has long since lost its feeling value or that it resulted from a chance
+suggestion picked out from indifferent surroundings. The patient knows
+it and yet goes on suffering from the fruitless fight of his will
+against the intruder. Where mere reasoning is entirely successful, I am
+inclined to suspect that an element of suggestion has always been
+superadded. The authority of the physician has created a state of
+reenforced suggestibility in which the argument convinces, not by its
+logic but by its impressiveness.
+
+This element of suggestion is quite obvious when the argument takes the
+form of persuasion, a psychotherapeutic method which has found its
+independent development. Whoever seeks to persuade relies on the mental
+fringe of his propositions. The idea is not to work by its own meaning
+but by the manner of its presentation, by its impressiveness, by the
+authority, by the warmth of the voice, by the sympathy which stands
+behind it, by the attractiveness with which it is offered, by the
+advantages which are in sight. Thus persuasion relies on personal powers
+to secure conviction where the logic of the argument is insufficient to
+overcome contradictions. But just for that reason persuasion is after
+all only a special kind of suggestion.
+
+Other methods work on the same basis. Prominent among them is the
+psychotherapeutic effect of a formal assurance. The psychotherapist
+assures the patient that he will sleep the next night or that the pain
+will disappear or that he will be able to walk with such firmness that
+the counter-idea is undermined. It depends on the type of patient
+whether such suggestions of belief work better when it is assured with
+an air of condescension, spoken with an authority which simply ignores
+every possible contradiction, or with an air of sympathy and hope.
+Experience shows that it is favorable to connect such assurance with the
+entrance of a definite signal. "You will sleep to-night when the clock
+strikes ten," "The pain will disappear when you enter the door of your
+house," or perhaps, "Read this letter three times quietly in a low
+voice, and at the end of the third reading your fear will suddenly
+stop." Psychological insight will further decide whether it is wiser in
+the particular case to assure the patient of the resulting effect or
+rather of the power to bring about the effect. With some people, it
+works better to insist that the result will happen, with others to
+promise that they themselves can secure it; in the one case they feel
+themselves as passive instruments, in the other as real actors. To some
+hysterics, it is better to say: "You will walk," to others, "You can
+walk."
+
+This belief in the future entrance of a change frequently demands an
+artificial reenforcement. There belongs first the application of
+external factors which awaken in the background of the mind the
+supporting idea that something has been changed in the whole situation
+or that some helpful influence has made the improvement possible.
+Medicines of colored and flavored water, applications of electric
+instruments without currents, in extreme cases even the claptrap of a
+sham operation with a slight cut in the skin, may touch those brain
+cells which words alone cannot reach with sufficient energy and may thus
+secure the desired psychophysical effect. The patient who by merely
+mental inhibition has lost his voice for weeks may get it back as soon
+as the physician has looked into his larynx with a mirror and has held
+an electrode without battery connection on the throat. Another way of
+helping by make-believe methods is to give the impression that a decided
+improvement is noticeable. The uneducated patient believes it easily
+when the physician at his very entrance into the office expresses his
+surprise about the external symptoms of a change for the better, perhaps
+seen in the color of the skin or the shading of the iris in the eye and
+reaffirmed by some pseudotests of the muscle reflexes. All that is not
+very edifying and the decent physician, who justly feels somewhat
+dragged down to the level of the quack in applying such means
+frequently, will abstain from them wherever possible. He knows that in
+the long run, even the psychasthenics are best treated with frankness
+and sincerity and he will therefore only in exceptional cases resort to
+such short-cut treatment by making believe. Yet that it is sometimes
+almost the only way to help the patient cannot be denied.
+
+A neater way to secure the sufferer's belief in the possibility of a
+cure is by securing the desired effect at least once through little
+devices. As soon as it is once reached, the patient knows that it can be
+reached and this knowledge works as a suggestion. The hysteric who
+cannot speak when he thinks of his words, or who cannot walk when he
+thinks of his legs, may by the skillful physician be brought to a few
+words or steps before he himself is aware of it by completely turning
+his attention to something else and producing the stimulus toward the
+movement in a reflex-like way. Still more successful is the effort to
+resolve the inhibited action into its component parts and to show to the
+patient who cannot perform the action as a whole that he can go through
+the parts of it after all. As soon as he has passed through a few times,
+a new tactual-visual image of the whole complex is secured for his
+consciousness and this image works then as a new cue for the entire
+voluntary action, overcoming the associated counter-idea.
+
+Another excellent way to overpower a troublesome idea or impulse or
+emotion is to reenforce the opposite idea by breaking open the paths for
+its motor expression. The effort to hold the counter-idea before
+consciousness may be unsuccessful so long as it is only an idea which
+tries in vain to produce any motor effect; but if the action itself has
+been repeatedly gone through, the idea will find it easier to settle and
+it becomes vivid in proportion to the openness of the channels of motor
+discharge. This holds true even for emotional states. A certain word
+perhaps picked up by the psychasthenic in a particular experience may
+produce whenever it is seen a shock and a depressing emotion. If we ask
+the patient to go artificially through the movements which express joy
+and hilarity, make him intentionally grin and open wide the eyes and
+expand the arms and inhale deeply, and after training this movement
+complex of joyful expression, speak the dreaded word at the height of
+the movement a new feeling combination clusters about the sound and may
+overcome the antagonism. Sometimes you will give to the desirable idea
+sufficient strength by mere repetition, sometimes you force the
+attention better by unusual accentuation, connecting the suggestion with
+a kind of shock. From here it is only one step to the suggestion in the
+form of a sharp order which breaks down the resistance just by its
+suddenness and loudness, supported perhaps by a quick arm movement which
+gives a cue for imitative reflexes. In the case of a youngster even a
+slap may add to the nervous shock; also a sudden clapping of the hands
+may favor effectiveness of the suggestive order.
+
+Often it is wise to give the suggestion, not from without but to
+prescribe it in the form of autosuggestions. For instance, advise the
+patient not only to have the good will and intention of suppressing a
+certain fixed idea or by producing a certain inhibited impulse but to
+speak to himself in an audible voice, every morning and every evening,
+saying that he will overcome it now. Here, too, the autosuggestion may
+become effective by the frequency of the repetition or by the urgency of
+the expression or by the accompanying motor reactions. As a matter of
+course any associations which reenforce the idea may be used for
+assistance. Especially near-lying is the appeal to the man's conscience,
+but just such associations which touch the idea of the own personality
+and its deepest layers of feelings are always risky. They may touch and
+stir up old memories which interfere with success or they may awaken a
+feeling of contrast between duty and fulfillment which may disturb the
+whole equilibrium. If the physician knows that the good-will of the
+patient is insufficient to overcome the pathological disturbance, he
+ought not to make him feel ashamed or guilty, and that not only for
+moral reasons but also for strictly psychotherapeutic reasons.
+
+In certain easily recognizable cases, it is essential to give the
+suggestion with avoidance of any emphasis, only as a hint, passing as if
+the suggestion almost slipped from the tongue of the doctor without his
+real intention. The hysteric who is resisting the suggestion which is
+intentionally given to her is sometimes surprisingly trapped by a
+half-hidden suggestion, perhaps not spoken to the patient herself at all
+but spoken in a low voice to a colleague in the room. Sometimes we have
+to trick those who suffer by "negativism," that is by an obstinacy which
+exaggerates that of the ordinary stubborn man. In such cases the
+suggestion not to perform an action works best if we want the action
+performed. There is hardly an end to the list of such methods for
+bringing beliefs and attitudes with suggestive power to the mind of the
+sufferer. Definitely to describe the conditions under which the one or
+the other form ought to be applied would be no wiser than to tell a
+statesman what steps are to be taken in every possible diplomatic
+situation. The instinctive selection of the right means among the many
+possible ones characterizes both the true statesman and the true doctor.
+
+So far we have spoken only about the character of the suggestion,
+presupposing that the receiver remains in his natural state. This
+presupposition is certainly often entirely correct, but as far as it is
+correct, the results of the suggestion vary greatly with the different
+individuals. On the whole, we might say that such suggestions given to
+the subject in his normal state are effective only when the subject is
+by nature a suggestible being. In considering the psychology of
+suggestion, we recognized at once that the degree of natural
+suggestibility varies excessively. The non-suggestible mind is only to a
+slight degree influenced by any of these proposed forms of suggestion as
+long as the suggestibility itself is not heightened. To be sure, the
+question whether the person is suggestible by nature or not cannot be
+settled simply by his own impression. Many of the most suggestible
+persons believe firmly that they are superior to any suggestive
+influence.
+
+To bring suggestions to greater effectiveness and to exert their
+influence practically upon every possible subject, we have thus not only
+to give suggestions or to advise autosuggestion but in both cases we
+have to secure, especially for the naturally less suggestible patients,
+a somewhat heightened suggestibility. Yet no one can overlook that some
+of the methods which we described have in themselves the tendency to
+reenforce the mental suggestibility. Those methods of emphasis and
+order, of assurance and make-believe, of practical training and of
+awakening counter-ideas, of persuasion and even of reasoning, wherever
+they are in a high degree successful probably always gain a certain part
+of their success by the increased suggestibility which the whole
+situation brings with it.
+
+This reenforcement of the psychophysical readiness for suggestions
+results indeed quite directly both from expectation of the unknown and
+of the half-way mysterious, and from the confidence in the doctor. Of
+course it can work very differently. The expectation can upset the
+nervous system and produce unrest instead of suggestibility and, instead
+of confidence, the patient may feel that discouraging diffidence which
+settles easily upon those who have tried one fashionable physician after
+another. But where there is real confidence, based perhaps on the fame
+of the doctor and on the reports of his powerful achievements, there the
+conditions for effective suggestions are greatly strengthened. Still
+better is it if this confidence in the man is combined with a sincere
+hope for recovery. To lie down on a lounge on which hundreds have been
+cured fascinates the imagination sufficiently to give to every
+suggestion a much better chance to overcome the counter-idea. The
+expectation that something wonderful will happen can even produce an
+almost hypnoid state. The effect will be the greater, the less the
+barriers of systematic knowledge hinder the entrance of suggested ideas.
+The uneducated will on the whole offer less resistance to suggestions,
+just as superstitions find the freest play in the minds of the
+untrained. It is not by chance that the earlier epidemics of
+pathological suggestibility have on the whole disappeared with the
+better popular education. In a similar way work fatigue and exhaustion.
+The resistance has grown weaker, the suggested idea goes automatically
+into activity.
+
+Skillful artificial means can still surpass the effect of these natural
+conditions. Here belongs everything which accentuates the authority and
+dignity of the originator of the suggestion. The psychologically trained
+physician has no difficulty in heightening the effect by simple
+surprises, if he cares for such tricks. If the patient for whom a mental
+treatment is recognized as necessary shows himself too skeptical to
+submit to the powers of the psychotherapist, such captivation of his
+belief can easily be secured. Let the man perhaps fixate a penny on the
+table with his right eye, while the left is closed and you show him that
+you can make another penny suddenly disappear when you move it a certain
+distance to the right and appear again when you move it still further.
+As the man has never heard of the blind spot in the retina, he accredits
+you with a special power. Many similar psychological illusions can well
+be used to prepare the mind for unsuspected healing powers.
+
+Still stronger is the effect of personal contact. The psychophysiology
+of love indicates the most complex influence which contact sensations
+have on the whole nervous system and especially on the vasomotor
+apparatus of the body. Probably such vasomotor effect enters in,
+changing the blood circulation in the brain, when a personal contact
+between the transmitter and receiver of the suggestion is brought about.
+If the physician's hand rests quietly on the forehead of the patient who
+lies with closed eyes, or if he holds for a long while the hand of the
+patient, he may secure a nervous repose and submission which gives to
+the suggestions the most fertile soil. Needless to say that here again
+everything depends upon the accessories. An unsympathetic doctor may be
+entirely powerless where his neighbor has complete success. Neither a
+lifeless hand nor an agitating one will bring the desired repose,
+neither a cold nor a rough one. There must be strength and energy and
+even discipline, and yet sympathy in the pressure of the fingers. Again
+a psychologically different effect and yet one often to be preferred
+results from mild stroking movements, the stroke always to be repeated
+in the same direction, never up and down. The slow change in the
+position of the tactual sensations evidently produces a rather strong
+influence on the equilibrium of nervous impulses, and here again
+vasomotor reflexes seem to arise easily. Another variety of such bodily
+influences is given by artificial changes of the positions, for instance
+by bending the head of the subject backward while the eyes are closed.
+It may be that a certain lack of balance sets in in which the
+self-equilibrium is disturbed and an external influence can thus more
+easily get control of the psychophysical system. Again a certain
+monotony of speaking may easily add to the increase of the
+suggestibility.
+
+Everyone knows that another most fruitful cause of this change is any
+mystic inspiration, any emotion in which the individual feels himself in
+contact with something higher or larger or stronger. Of course, the
+church can secure this effect easily, and here again the maximum will be
+reached if a bodily contact with the symbol of religious exaltation can
+be established. The patient who can touch the relics of the saints or
+bathe in the waters of Lourdes or at least feel on his forehead the hand
+of the minister, is wrought up to a state of suggestibility which makes
+suggestions easily effective. The objective value of religion again has
+nothing to do with it, as exactly the same effect can result from the
+most barbarous superstition. The amulets of a gypsy might secure the
+same resetting of the psychophysical system which the most sacred
+symbols awaken, and even many an educated person is unable to cross the
+threshold of a palmist or an astrologist, or to attend the performance
+of a spiritist, or to sit down with a purchasable trance medium without
+feeling an uncanny mental state which is objectively characterized by an
+increased suggestibility. But finally, the same effect sets in when the
+symbols of other emotional spheres are applied, perhaps for the
+patriotic soldier the flag of his country.
+
+All the states of increased suggestibility which we have characterized
+so far still remain within the limit of normal wakefulness. We may turn
+now to the methods of the psychotherapist which produce in the interest
+of the suggestions an artificial state. However we have no right
+superficially to claim that the effectiveness of the suggestions is
+always greater in such unnatural states. On the contrary, we know that
+sometimes well applied suggestions work on wide-awake persons with
+increased suggestibility more strongly than on hypnotized subjects. Here
+even the instinct of the experienced physician may easily go astray, and
+it may need practical tests to find out which way will be the most
+accessible to the particular case. Often a certain role belongs even to
+natural sleep. It cannot be denied that some people can be influenced to
+some degree by words spoken to them during sleep. Most adults either
+wake up or show no signs of influence beyond effects on their dreams.
+But some absorb especially whispered words in such a way that their
+power becomes evident after the waking of the sleeper. Much more is this
+true of children. A suggestion to give up vicious habits, perhaps in the
+sexual sphere, or to speak fluently and no longer stammer may thus be
+beneficial. Yet the danger of this method is not small and extensive use
+of it is certainly not advisable. The more easily it can be carried into
+every bedchamber and can thus give to every mother and nurse the tools
+of a rather powerful therapy, the more a danger signal ought to be
+displayed. Interference with the natural sleep by outer influences
+creates abnormal conditions which cannot be removed at will. The chances
+are great that many unintended bad effects slip in and that not a few
+hysterias may be created by a method at the first glance so startling.
+Much less objectionable is it to make use of the effect of that period
+of half-sleep which precedes the natural sleep, and which is for many a
+period of increased suggestibility for autosuggestions. A resolution or
+the formulation of a belief which would be ineffective in a wide-awake
+state seems to get an accentuated effect on the mind, if it is
+repeatedly expressed in this transitional state. The psychasthenic who
+in such a half-dozing stage assures himself that he will no longer be
+afraid of going over a bridge or hearing a thunderstorm or will feel a
+disgust for whiskey or will have the energy for work, has a certain
+chance that such autosuggestions become reality the next morning. With
+many others there seems no effect to be obtained and not a few seem
+unable to catch the right moment. As soon as they begin to speak they
+become wide awake or fall asleep before they talk.
+
+Incomparably more value belongs to the artificial sleep, the mesmeric
+state of earlier days, the hypnotism of our time. We have discussed its
+theory and recognized that an abnormally increased suggestibility is
+indeed its chief feature. We know hypnotism in most various degrees; the
+lowest can be reached practically by everyone, the highest by rather
+few. It is almost arbitrary to decide where those waking states with
+high tension of suggestibility end and the hypnotic states begin, and
+not less arbitrary to call the higher degrees only hypnotism and to
+designate the lower degrees as hypnoid states. If we do it, we certainly
+should acknowledge from the start that the hypnoid states are for
+therapeutic purposes not a bit less important than the full hypnotic
+states. Certainly the hypnoid states do not allow complex hallucinations
+and absurd post-hypnotic actions, but they offer excellent starting
+points for the removal of light obsessions and phobias and for the
+reenforcement of desirable impulses, volitions, and emotions. Many
+persons cannot under any circumstances be brought beyond such a hypnoid
+degree. The physician who has not theoretical experiments but practical
+success in view ought therefore never to trouble himself with the
+inquiry exactly which degree has been reached. This advice is given
+because nothing interferes with the progress of hypnotic influence so
+badly as the constant testing. It must naturally often lead to a point
+where the subject finds that he can very well still do what the
+hypnotizer told him not to do. If the doctor assures him that he can no
+longer move his arm and the patient is yet able to move it, the doctor
+secures the very superfluous knowledge that this special degree of
+suggestibility has not been reached, but the patient is sliding backward
+and the lower degree which actually had been reached will be less
+accessible later. The physician might rather resort to the opposite
+course and assure the patient, even after the first treatment which
+might have been a slight success, that he saw from definite symptoms
+that hypnosis had set in. That will greatly smooth the way for real
+hypnotic effects the next time.
+
+The best method of hypnotizing is the one which relies essentially on
+the spoken word, awakening through speech the idea of the approach of
+sleep. If the hypnotizer assures the subject in monotonous words that a
+feeling of fatigue is setting in, that he is feeling a tiredness
+creeping over his shoulders and arms and legs, that his memories are
+fading away and that he is now hypnotized, for not a few all is done
+that is needed. The hypnotic state will come and will hold until the
+verbal suggestion takes it off again. Perhaps the hypnotizer says that
+he will count three and at three the subject is to open his eyes and
+feel perfectly comfortable. It is wise to tell the patient beforehand
+that he will not lose consciousness and that he will remember afterward
+whatever happens as many people believe that loss of memory belongs to
+the hypnotic state, and that they were not hypnotized if they can
+remember what happened. Such a skeptical after-attitude can seriously
+interfere with the success of the treatment.
+
+Yet in most cases, it will be safer not to rely on words only but to
+supplement them by manipulations which all converge towards the effect
+of increasing the suggestibility and thus of overcoming the resistance
+to the suggestions introduced. It is well known that for this purpose it
+is advisable to begin the influence with some slight fatiguing
+stimulations. The effect is most easily reached when the patient fixates
+perhaps a shining button held over his eyes or listens to monotonous
+sounds. A particularly strong effect belongs again to very slight touch
+stimuli. If the subject with his eyes closed is touched perhaps by two
+pencils at various and unexpected points of the face and hands, a
+skillful playing on his tactual senses soon produces a half-dozing state
+of hypnoid character. In the same group belong those so-called passes
+which evidently have a reflex influence in the blood-vessel system. It
+is advisable to combine the various elements in such a way that at first
+physical stimuli upon eye or skin produce an over-suggestible state and
+that only as soon as this state is reached the verbal suggestion sets
+in, perhaps with the words, "I shall hypnotize you now." Under such
+conditions every subject may soon be brought to that degree of
+hypnotization which is accessible to him. Yet more than one treatment is
+usually necessary for the higher degrees. Much less importance for
+therapeutic purposes belongs to that hypnoid state which is reached
+without the idea of sleep where the subject comes with open eyes into a
+kind of fascination, produced perhaps by a sudden flash of light or by
+the firm eye of the hypnotizer. It is a state which can lead to a strong
+submission of will and which has its legal importance. Therapeutically
+it can hardly secure an effect which cannot better be secured through
+the real sleeplike hypnotism. Under certain conditions, chemical
+substances may well prepare for the hypnotic treatment, for instance
+bromides or alcohol. Others rely on the suggestive effect of flavored
+water. But all that is unwise. The confidence of the patient is the best
+preparation for the securing of the helpful degree of hypnotism.
+
+Of course only a small part of the therapeutic usefulness is secured
+during the hypnotic state itself. A pain may be removed, sleep be
+secured, an idea be inhibited, a movement be reenforced in cases where
+non-hypnotic suggestions would have found insurmountable obstacles.
+During the hypnosis we may also open the storehouse of memory and bring
+to light the ideas which disturbed the equilibrium of the suffering
+mind. Further in those most complex hysteric cases of dissociated
+personality, new memory connections may be formed during the hypnosis
+by which a synthesis of the double or triple personalities into the old
+one may be secured. Yet the general effect which the physician has to
+hope for from hypnotic treatment is the post-hypnotic one. Not what
+happens during the hypnosis but what the suggestion will produce after
+hypnosis is essential to him. The fixed idea is to disappear forever,
+the paralyzed limb is under control, the desire for morphine and cocaine
+is gone for all future time, the perverse longing is annihilated, the
+old energy is to remain again for all time. It is the post-hypnotic
+after-effectiveness which gives to the hypnoid and to the hypnotic
+states their importance for the treatment of the most exasperating
+symptoms. To be sure, the treatment often must be a prolonged one. A man
+who for years has used thirty grains of morphine a day cannot be rid of
+the desire after two or three hypnotic sittings. In such a case the
+treatment may cover three or four months, if it is to be of lasting
+value and without any damage during the treatment.
+
+Still we are not at the end of the psychotherapeutic methods and we may
+turn to a fascinating group of curative efforts which has especially
+come to the foreground in recent years. We mentioned before that
+mischief cannot seldom be traced back to earlier experiences with a
+strong unpleasurable feeling. In certain cases, the subject remembers
+such particular experiences as the beginning of his discomfort; in
+others, especially those of hysteric character, the starting point may
+have long been forgotten, and yet that early impression evidently left
+traces in the brain which produce disturbances in conscious life. The
+psychotherapist nowadays calls these groups of traces "complexes." We
+recognized clearly that there is no reason to refer such forgotten
+remainders of the past to any subconscious mind; they are physical
+after-effects which keep their influence over the equilibrium of the
+psychophysical system. Now modern psychotherapy finds that the entire
+disturbances which arise from such emotional disagreeable experiences,
+forgotten or not forgotten, can often be removed by psychical means. Two
+ways in particular seem open. As soon as the idea is fully brought back
+to consciousness again, the patient must be made to express the primary
+emotion with full intensity. Subtle analysis has repeatedly shown that
+many of the gravest hysteric symptoms result from such a suppression of
+emotions at the beginning and disappear as soon as the primary
+experience comes to its right motor discharge and gains its normal
+outlet in action. The whole irritation becomes eliminated, the emotion
+is relieved from suppression and the source of the cortical uproar is
+removed forever.
+
+Practically still more important seems the other case which refers alike
+to hysterics and psychasthenics and which is applicable for the
+forgotten experience not less than for the well-remembered ones. This
+second way demands that the psychotherapist bring this primary
+experience strongly to consciousness and then by a new training link it
+with new and more desirable associations and reactions. The disturbing
+idea is thus not to be discharged but to be sidetracked so that in
+future it leads to harmless results. The new setting works towards an
+entirely new equilibrium. What was a starting point for abnormal fears
+now becomes an indifferent object of interest and all its evil
+consequences are cut off. It may be acknowledged that the full
+elaboration of these methods still belongs to the future. Both methods,
+the discharging, or the so-called cathartic one, and the side-tracking
+method evidently demand the discovery of the starting point in the
+service of the therapy and here again several methods are at the
+disposal of the psychologist.
+
+A promising way to this end is the inexhaustible association test which
+we mentioned when we discussed the contributions of the psychological
+laboratory to the medical diagnosis. A series of short words are spoken
+to the patient and, as soon as he hears one, he is to pronounce as
+quickly as possible the first word which comes to his mind. If we use
+fifty words, we should be able to learn something as to the inner states
+of the man and as to the working of his mind, if we analyze carefully
+his particular choices. But two further conditions ought to be
+fulfilled. The time of the association ought to be measured. Of course
+there will be wide differences. A word which is often in a certain
+connection will quickly bring the habitual association. Abstract words
+will call forth their associations more slowly than concrete words,
+familiar words more rapidly than unfamiliar words. To measure such
+association time with fullest accuracy, as it is necessary for the
+purpose of scientific investigations, delicate electrical instruments
+are needed that indicate thousandths parts of a second. For the purpose
+of the practical physician such accuracy would be superfluous. His
+examination will be perfectly successful if it is carefully done with a
+stop-watch which shows the fifth part of a second, like those which are
+used at races. He speaks a word, presses at the same time the button of
+the watch, and presses the stopper when he sees the lips of the patient
+moving. He is thus able to examine not only the involuntary choice of
+association but also the time of every associative process. But a second
+condition ought also to be fulfilled. After some indifferent words,
+others ought to be mixed into the series which touch in a tentative way
+on various spheres corresponding to the possible suspicions. The groups
+to which the hidden thoughts of psychasthenics, for instance, belong are
+not many. As soon as our series of words strikes such a group, the
+reaction of the mind may be discriminated. The effect may be a general
+perturbation resulting either in an unusual delay of the fitting
+association or in an effort to cover the sore spot by an unfitting
+association. Sometimes the dangerous association may rush forward even
+with unusual rapidity but, as soon as it is uttered, it gives a shock to
+the mental system, brings the whole associative process into disorder,
+and the result is that the next following associations are abnormally
+delayed. The skilled psychologist will quickly take such a change as a
+cue for the selection of the later words in his series. Of course, he
+will at first return to neutral words, but as soon as he has found a
+danger spot, he will approach it from various sides, perhaps in every
+fourth or fifth word, and may then find out which particular experiences
+are disquieting the patient. Words like women or money or career or
+family or disease are often sufficient to get the first inkling of a
+mental story.
+
+With less diagnostic elegance we sometimes reach the same end by taking
+careful records of pulse and breathing and involuntary movements during
+an apparently harmless conversation. The instruments at the disposal of
+the psychologist are those familiar to every psychological laboratory:
+the pneumograph, which registers the movements of respiration; the
+sphygmograph, which writes the pulsation of the artery in the wrist; the
+automatograph, or other instruments, which register the slight
+unintentional movements of the arm. If the examiner is skillful, he will
+not fail to discover the changes in breathing and pulse and reaction as
+soon as the painful groups of ideas are approached. More of theoretic
+interest and too cumbersome for practical diagnosis is the unfailing
+galvanic reaction from the skin in which the glands change their
+activity and their resistance to the galvanic current under the
+influence of hidden emotions. Yet all these methods, with exception of
+the last, are essentially useful only if the starting experience is
+still accessible to the memory of the patient. He may be unaware that it
+had anything to do with his nervous symptoms but he recognizes the
+experience still as soon as his attention is directed towards it. The
+psychologically more interesting but probably more exceptional situation
+is the one in which it is not only forgotten but cannot be recognized
+when it is brought to consciousness. The shortest way to get hold of
+such past impressions is the hypnotic one. The hypnotic state sharpens
+the memory and experiences of early childhood or apparently
+insignificant experiences of later life may be brought back when they
+would have been inaccessible to any intentional effort of the attention.
+Even still more surprising is the success if the association is left to
+a dreamy play of ideas suggested perhaps by gazing into a crystal ball
+or by a meaningless talking. Perhaps the patient lies with closed eyes
+on the couch while the physician holds his hand. A few words are given
+to him as a starting point and then he is thoughtlessly to pronounce
+whatever comes to his mind, not only unfinished sentences but loose
+phrases, single words, apparently without meaning and slowly ideas arise
+which betray the original intrusion. At last memories and lost emotions
+come again to the surface, and the watchful psychotherapist may discover
+the complex, which is then to be removed by discharge or by
+side-tracking. This is the so-called psychoanalytic method.
+
+Finally the psychotherapist may go still one step further. After all it
+often seems inexplainable that just this or that emotional experience
+made such a deep and lasting impression while a thousand other
+experiences passed by without leaving any mischievous after-effect. It
+seems that indeed the conditions are still more complicated. That
+emotional disturbance operated dangerously perhaps only because it
+itself appealed to a suppressed desire and this seems to hold true
+especially for suppressed emotions of the sexual sphere. The desire for
+gratification in normal or abnormal channels was perhaps attached by the
+mind to some group of objects. It was completely suppressed but it left
+an abnormal tension in the central system. If now a chance experience
+touches on this group of ideas, there results an explosive reaction; and
+movements, convulsions, spasms, obsessions, and fears set in which get
+their particular character not through the secondary intrusion but from
+the primary desire. To discharge that intrusion leads therefore only to
+the elimination of those symptoms which resulted from it, but the
+primary disturbance goes on and any new chance intrusion will produce
+new explosions. The psychotherapist should therefore go deeper and
+relieve the mind from those primary desires which may belong to early
+youth and which are entirely forgotten. Even the method of automatic
+writing may here sometimes lead to an unveiling of those deepest layers
+of suppressed desires. In the same way a careful, subtle analysis of
+dreams may support the search for the hidden source of interference.
+
+We have spoken of the technical methods of the psychotherapist. It would
+be short-sighted to ignore the great manifoldness of secondary methods
+which he shares with the ordinary intercourse between man and man, the
+methods which the teacher uses in the schoolroom, which the parents use
+in the nursery, which the neighbor uses with his neighbor, methods which
+build up the mind, methods which train the mind, methods which reenforce
+good habits and suppress unwholesome ones, methods which stimulate sound
+emotions and inhibit a quarrelsome temper, methods which indeed are not
+less important in the psychiatric clinic and in the hospital than in our
+daily life, and which certainly have central importance in that
+borderland region which is the particular working field of the
+psychotherapist.
+
+
+
+
+X
+
+THE MENTAL SYMPTOMS
+
+
+We have discussed both the psychological theory and the practical work
+of psychotherapy in a systematic order without any reference to personal
+chance experience. After studying the fundamental principles, we have
+sketched the whole field of disturbances in which psychotherapeutic
+influence might be possible and all the methods available. It seems
+natural that our next step should be an illustrating of such work by a
+number of typical cases. Here it seems advisable to leave the track of
+an objective system and to turn to the record of personal observation.
+As this is not a handbook for the physician, dealing with the special
+forms of disease, we emphasized before that we avoid even any attempt in
+such a direction because it would have to introduce not only the
+questions of diagnosis, but above all the highly important questions of
+treatment by physical agencies. We saw that for us nothing else can be
+desirable, but to show the way in which the various symptoms which
+suggest mental treatment occur, and how they yield to the psychical
+methods. We had also agreed beforehand that for a first survey we might
+separate the mental from the bodily symptoms and group the mental ones
+with reference to the predominance of ideational, emotional, and
+volitional factors. And finally it may be said that we abstain from
+everything which is exceptional or even unusual, and confine ourselves
+to the routine observations with which the psychotherapist comes in
+contact every day and the simplest country physician surely every week.
+
+Thus I turn from systematic objectivity to my unsystematic reminiscences
+of many years. Of course, they abound with eccentric abnormities and
+startling phenomena. As I have devoted myself to psychotherapeutics,
+always and only from scientific interest, as a part of my laboratory
+studies and therefore have refused to spend any time on cases which
+offered no special psychological interest to me, the striking and
+sensational cases have prevailed in my practice even to an unusual
+degree. Yet they are unessential for our purposes here, the more as
+their interest lies mostly in the complex structure of the mental state
+while the curative features are in the background. Our purpose of
+demonstrating practical cases as they occur in every village, and as
+they ought to be understood and treated by every doctor, thus rules out
+just those experiences which would be prominent in a theoretical study
+of abnormal psychology. We want to select only simple commonplace cases.
+Only those who have not learned to see are unaware that such cases are
+everywhere about them.
+
+As a matter of course, I also leave out everything which refers to
+insanity, that is, every mental disturbance which lies essentially
+outside of the domain of psychotherapy. The helpful influence which
+psychical factors can exert in the asylums for the insane is, as we
+emphasized, entirely secondary. The psychotherapeutic methods in the
+narrower sense of the word are in the present state of our knowledge
+ineffective in the insane asylum. I should also be unable to speak of
+laboratory experience with insanity, as I insist on sanitarium treatment
+in every such case. The question of how to differentiate the diagnosis
+of insanity from that of the other mental abnormities is not our
+question at this moment. I select the few illustrations which seem to me
+desirable for the purpose of making more concrete our abstract
+discussion of methods, essentially from the class of neurasthenics,
+psychasthenics, hysterics, and so on.
+
+In all these reports, I shall confine the account to the few points
+which are to illustrate the psychical factors, thus abstaining entirely
+from the further details which any medical history of the cases would
+demand and from all results of further examination and other
+particulars. As a matter of course, I exclude the possibility of
+identifying the patient. I may start with a typical case of obsessing
+ideas of simplest character and with simple routine treatment
+illustrating the emphasis on antagonistic ideas.
+
+     A man of mature age, well educated, well built and in every respect
+     in good health, without nervous history and without other nervous
+     symptoms, suffered vehemently by the persistent recurrence of a
+     visual image which entirely absorbed his attention. He knew
+     exactly the development of his trouble. A woman acquaintance of his
+     had committed suicide by poisoning herself. He knew her slightly
+     and the emotion of personal loss played hardly any role in the
+     case. But he had met her at a gay dinner a short time before her
+     death. The news of the suicide came to him when he was overtired
+     from work. The idea of the contrast between seeing his friend
+     partaking of the dinner and imagining her drinking the poison gave
+     him a strong shock. There was hardly any grief mixed in. He
+     remembers that he shivered at the thought of the contrast, and in
+     that moment the visual image of the woman raising a glass of poison
+     to her mouth flashed into his mind and thus became almost a part of
+     the shock. From that time on, the memory image of this scene
+     returned more and more frequently. At first it associated itself
+     with any chance mentioning of death or suicide and to a very slight
+     degree with the idea of a meal. More and more any element of a meal
+     and of social life, the word soup or meat, the word gown or dance,
+     brought up at once the picture of the woman, which had in the
+     meantime lost every element of personal relation. Any sad thought
+     of her ending had faded away. It remained merely a troublesome
+     impression. The man fought against it by trying to suppress the
+     idea but the more he fought against it, the more insistently it
+     rushed forward through new and ever new association paths. Any
+     advertisement in the newspaper referring to food, anything in a
+     shop window referring to ladies' dresses, any household utensils
+     related to a meal, and especially the meals themselves, forced the
+     visual image into the centre and captured the attention to such a
+     degree that a confusing distraction from the real surroundings
+     resulted. The struggle against the idea became more and more
+     exasperating, made life a torture, almost suggested despair, even
+     faint thoughts of suicide, and especially a growing fear that it
+     was a symptom of the beginning of insanity.
+
+     When he came to me, a number of physical cures, especially bromides
+     and electricity, had been tried in vain by the physician. Some
+     weeks in the country had not changed the distress. He came to me
+     with the direct request as a last resort to try hypnotic treatment.
+     I found in spite of the fact that he and his physician had
+     constantly spoken of visual hallucinations that the visual image
+     had no hallucinatory character at all, that is, he never believed
+     that he saw the image of that woman as if it were actually present,
+     he never took the product of his imagination for reality, nor had
+     it the vividness and character of reality. It was hardly more vivid
+     than any landscape which he tried to remember, only that it
+     controlled the interplay of ideas in such a persistent way. I found
+     that he was a strong visualizer and easily suggestible. I told him
+     beforehand that I should hypnotize him only to a slight degree,
+     that he would not lose consciousness, that he would remember
+     everything which I told him. Then I asked him to lie down and had
+     him gaze on a crystal only for half a minute, then close the eyes.
+     I asked him to relax and to think of sleep. With the two blunt
+     points of a compass, I touched his two cheeks at corresponding
+     places, then his forehead. And now I told him that I would begin
+     with the hypnotic influence. I put my hand on his forehead and
+     spoke to him in a monotonous way, saying that he felt a fatigue in
+     his shoulders, and in his arms, creeping over his whole body and
+     assured him that he was now fully hypnotized. To what degree he
+     really was hypnotized cannot be said as no effort was made to test
+     it by any experiments, thus avoiding any possible reaction against
+     the feeling of submission. Expression and breathing indicated a
+     slight hypnoid state. Then I removed my hand and spoke to him in a
+     warm and assuring way.
+
+     I told him that in future he would give his full attention to his
+     meal, and not give the slightest attention to any image of his
+     friend. If he should think of the friend the memory would appear
+     indifferent, he would not even notice the image and would give his
+     whole mind to the objects with which he was engaged. In the same
+     way, when he should be reading newspapers or looking in
+     shopwindows, his whole attention would belong to that which he
+     really perceived. Any passing inner image would be ignored. Then I
+     awoke him from his sleep. He was unwilling to believe that he had
+     been in hypnosis at all. I told him that the effect would prove it
+     and in his fully wakeful state I explained to him why there was not
+     the slightest fear of insanity justified, that it was a
+     psychasthenic state resulting from fatigue and shock and from a
+     wrong attitude of his attention during the past months, and then I
+     asked him to return the next day. Intentionally I had not given the
+     suggestion that the image would disappear. I could not expect it
+     would disappear entirely after a first treatment and even a faint
+     appearance of it would have at once fascinated the attention and
+     brought about the whole disturbance of the equilibrium which might
+     become habitual. Instead of it I gave the impulse to the
+     counter-idea, that is, I reenforced the attention towards that
+     which he really saw around him and thus withdrew the attention from
+     the rival image in the mind. The success was complete. He came the
+     next day in a much happier frame of mind, reporting that he still
+     had seen the image of the woman every few minutes, especially
+     strongly at the breakfast table, but it had no longer troubled him.
+     It was more in the background of consciousness, sometimes it
+     appeared transparent, it no longer held his attention, and he felt
+     free to give his full attention to the actual surroundings.
+
+     On that basis I hypnotized him the second day and he had hardly
+     heard me saying that he ought to try to sleep when he was evidently
+     in a much deeper hypnotic state than the first time. Again I
+     suggested only the opposite attitude, the positive turning to the
+     surroundings and the complete neglect and indifference for the
+     possible memory image. This time the effect was still stronger. On
+     the third day he reported that he still saw the image but he no
+     longer minded it, as it was like a veil through which he looked at
+     real objects and that left him entirely indifferent. His mind was
+     hardly engaged with it any more. The real spell of the attention
+     was broken. On the basis of this situation, I took the last step
+     and suggested that the image of the woman would disappear
+     altogether and would not trouble him any more. In the next
+     twenty-four hours, it still returned two or three times, but
+     colorless and faint. The following day I was able to eliminate it
+     altogether. Even when the last trace of the inner struggle between
+     the memory and the perceived surroundings had disappeared, I went
+     on with two hypnotic sittings to give stability to the new
+     equilibrium, to insist that the image would not come back and to
+     settle completely that inner repose with which every fear of
+     possible disease evaporated. I feel sure that the cure would not
+     have been reached so quickly, possibly not at all, if the second
+     suggestion, the disappearance of the image, had been given at the
+     first step. The improvement was secured because the antagonistic
+     process itself was used for the suggestion. On the other hand,
+     there was no doubt that in this case the strong will of the patient
+     or suggestion in a normal state would not alone have been
+     sufficient. The hypnotic treatment was indicated by the symptoms
+     and justified by the results.
+
+I may take another typical case in which also the obsession was brought
+about by an idea without emotional value or at least by an idea which
+had lost its emotional character; the idea came somewhat nearer to
+hallucination, but had its chief elements on tactual ground where the
+transition from image to hallucinatory perception is easier. I add this
+case to demonstrate that hypnosis is not the only open way of treatment
+in such cases and that the variations must always be adjusted to the
+special conditions. The case gains importance by the fact that the
+patient was himself a physician well trained in mental observation.
+
+     The patient is a highly educated physician of middle age. He
+     reports that he had been neurasthenic all his life with slight
+     ever-changing symptoms. He has always been troubled by the
+     "perseveration" of tactual images which had a strong feeling tone
+     and which were associated with seen or heard reports of the
+     experiences of others. For instance, when he read in a newspaper
+     that someone had hurt his hand with a pin, or that someone had cut
+     his foot on a nail, he immediately felt a not directly painful but
+     uncomfortable sensation at the particular place in the hand or in
+     the foot, together with a shrinking of the whole body and such
+     tactual sensation usually returned during the following days in
+     fainter and fainter form until it faded away. Most troublesome had
+     always been the reading of any torture processes in historical
+     books or in fiction. Yet there had never been a case in which the
+     sensations really had the vividness of hallucinations and never a
+     case in which the after effects had not disappeared at least in a
+     few weeks.
+
+     This time the effect had already lasted four months and it became
+     more and more troublesome. The patient had not the slightest fear
+     of mental disease and no anxiety, but he felt a very serious
+     disturbance by the instinctive effort to get rid of the intrusion.
+     The place of the disturbance was the wrists. The starting point was
+     a definite experience. On an unusually hot summer day the physician
+     had listened for a long time to the complaints of a female patient
+     who suffered vehemently from a nervous fear of scissors and knives
+     and who was afraid that she would cut her artery at the wrist. He
+     believes that it was the exhausting heat of the day which weakened
+     him to a point where the story of his patient affected him very
+     strongly and made him think of it all the time. Yet there was no
+     sensation element involved. A few hours later, he sat in a hotel at
+     his dinner. Just in front of him a butler started to carve a duck
+     with a long, sharp knife. In that moment he felt as if the knife
+     passed through the wrists of both arms. He felt for a moment almost
+     faint; arms and legs were contracted and an almost painful
+     sensation lingered in the skin, and did not disappear for hours.
+
+     From that day at the sight of knives or razors, not only in his
+     hands or his direct neighborhood, but also in a store and finally
+     in a picture, stirred up at once the optical image of that carving
+     knife cutting into the skin of the wrist, only with the difference
+     that it seldom was found in both arms, usually in the one or the
+     other. The sensation became a strictly tactual one with optical
+     overtone, but there was no emotion in it. The pain element had
+     disappeared. Also the shock, which still recurred in the first days
+     slowly disappeared. The longer the symptom lasted, the more the
+     optical factor faded away, and the tactual factor came into the
+     foreground after three or four weeks. Perhaps seeing a razor in a
+     store window or a pocket knife open no longer stirred up the image
+     of cutting the wrist, but simply a strong tactual sensation, as if
+     the skin of the wrist was scratched and pinched. Finally, after
+     about two months, the association character disappeared to a high
+     degree and the scratching and cutting sensation in the skin became
+     independent and automatic. The patient awoke in the morning with a
+     vivid tactual hallucination of being cut without associating with
+     it any picture of a knife. Throughout the day, in the midst of work
+     and in the midst of conversation, sometimes one and sometimes the
+     other wrist became the center of the exasperating sensation, easily
+     bringing with it involuntary reactions as if to withdraw the arm.
+     This became more and more frequent and more and more vivid.
+
+     The doctor, fully aware of the borderland character of this
+     experience, felt sure that his inner fight against the disturbance
+     would get control of it. The usual tonics did not show any
+     influence. On the other hand, there were no other nervous symptoms
+     and, with his most acute analysis, he did not find the slightest
+     trace of emotion any longer. When the symptoms reached a point at
+     which they seriously interfered with his comfort, he asked me for
+     psychotherapeutic treatment, under the condition that I was not to
+     apply hypnotism. He was absolutely averse to the use of hypnotism
+     in his own case because he was afraid that to be hypnotized would
+     mean for him a certain disposition to fall into hypnotic sleep by
+     auto-suggestion, as he knew the vividness of his imaginative
+     sensations. He wanted to avoid that the more as his own
+     professional work might sometimes demand hypnotizing in his own
+     practice. In any case he had an aversion to it and asked for other
+     means.
+
+     Under these circumstances, it seemed to me the most logical
+     conclusion that the counter idea with its antagonistic reactions
+     might be reenforced by direct perception. The abnormal tactual
+     sensation forced on consciousness the idea of the cutting of the
+     wrist. The necessary counter action would be to force to
+     consciousness the idea of the uninjured wrist and the corresponding
+     reactions. As the wrist can be easily made accessible to sight and
+     as I anticipated that the visual sensations would be more forceful
+     than the tactual ones, I told him to look straight at his own
+     wrists for ten minutes three times a day after waking, after
+     luncheon, and before going to bed. He had to hold his two forearms
+     close in front of his eyes and stare at them, giving his full
+     attention to the visual impression of the smooth, uninjured skin of
+     the wrist. If during this process, the tactual counter-sensations
+     were vivid, he had to go on with the staring at both arms, both
+     held near together until the perception had crowded out the rival
+     touch sensation. When this performance had been carried out six
+     times, he did not notice the coming up of the tactual sensation
+     with vividness any longer. From the third day it had disappeared
+     entirely. I told him to go on with the process still every morning
+     for some weeks. The physician himself considered the cure as
+     complete.
+
+Our first case dealt with hypnosis, our second case removed the
+intruding idea by a perception in a waking state. To point at once to
+the variety of methods which we sketched, we may turn again to a case of
+emotionless idea removed by the method of switching off and
+side-tracking the originating and physiological "complex."
+
+     The patient is a school-teacher in the Middle West, a nervous,
+     thin-looking woman of about twenty-five. Her only complaint is a
+     persistent idea that she may at any time get a child. She has had
+     this idea "as long as she can remember," according to her first
+     expression. She never had any intimate acquaintance with any man,
+     she was never engaged, she hated bitterly every thought of
+     immorality, she knows and has assured herself by much reading that
+     it is entirely impossible that she might get a child without sexual
+     contact. Yet this thought recurs to her all the time, even when she
+     is talking with other people. It embarrasses her in school, in
+     spite of her teaching only girls in a private institution. This
+     thought keeps her away from company and the effect of its
+     embarrassing occurrence depresses her, but she is sure that the
+     thought itself does not include any emotion. It is a mere thinking
+     of it with a full consciousness that it is absurd, and yet she
+     cannot suppress it.
+
+     I began at once to try to find the origin of her queer obsession.
+     After some efforts to pierce into her memories, we came to an
+     experience of her youth. When she was about thirteen years of age,
+     a young girl whom she had admired much for her beauty, living in
+     the neighborhood of her parents, suddenly got a child which died
+     after a few days. At that time no thought of immorality seems to
+     have entered into that news. It was evidently mere sadness about
+     the quick death of the child which gave to the experience its
+     emotional tone. She was at that time completely naive. She received
+     an intense shock in the thought that an unmarried girl may suddenly
+     get a child which would then quickly die. She cannot tell whether
+     the thought that she herself would get a child had ever entered her
+     mind before this occurrence in her neighborhood, nor can she say
+     that it occurred immediately or very soon after it. She now knows
+     only that she has always had that thought, but whether that means
+     more than ten years, she does not know.
+
+     I considered it a justifiable hypothesis that this strong emotional
+     experience early in life had become the starting point for that
+     secondary absurd thought. I considered that primary experience as
+     cause for a deep physiological brain excitement which had
+     irradiated towards the ideas of her personality. It had stirred up
+     there associations which kept their psychological character while
+     the primary disturbance had long lost its psychical accompaniment.
+     It worked its mischief in a physiological sphere but was probably
+     still the starting point for the persistent obsession. My aim was
+     to remove this cause. It would have brought little improvement
+     simply to suppress the freak idea as long as that physiological
+     source was active. On the other hand I should not have the means to
+     stop the physiological after-effects of that real experience: I had
+     to sidetrack it and to secure thus a reduction. I decided therefore
+     to work on the basis of that hypothesis, to accept that
+     physiological complex as existing, but to switch it off by linking
+     it with appropriate associations, thus setting it right in the
+     whole system of her thoughts.
+
+     For that purpose I brought her into a hypnoid state, bending her
+     head backwards and speaking to her with slow voice until I saw that
+     a slight drowsy state was reached. In this state I asked her to
+     think back as vividly as she could of that experience of her youth,
+     to fancy herself meeting that pretty girl, her neighbor, once more.
+     She is to imagine that she speaks with her. Now I make her talk
+     with me and she assures me that she sees the scene distinctly. She
+     believes she sees the girl on the street. I ask her to tell the
+     girl how indignant she feels over her behavior; she is to tell her
+     that she understands now all which she did not understand in her
+     childhood, that she knows now that she must have lived an immoral
+     life; that she must have had a friend and that a pure girl like
+     herself could never under any circumstances come into such a
+     situation, that no pure girl could suddenly have a child. She is to
+     express to the other girl her deepest disapproval of such conduct
+     and her own feeling of happiness that anything like that could
+     never happen to her. In accordance with my demands, she worked
+     herself entirely into the scene: without using audible voice, she
+     internally spoke with great vividness to her neighbor. When I awoke
+     her from her drowsy state, she was quite exhausted from the
+     excitement. I repeated that scene with her four times. She assured
+     me that she felt it every time more dramatically. The power of the
+     obsession weakened from the first day. After the fourth time, it
+     had disappeared. The subcortical complex had evidently found its
+     normal channels of discharge.
+
+In discussing this method of side-tracking the complex, we mentioned
+that in other cases the result is reached by bringing the memory of that
+first experience to a vivid motor discharge, without substituting any
+other ideas. For that purpose no direct personal influence is necessary.
+Treatment might just as well be performed "by correspondence," provided
+that the right starting point is discovered and that right suggestions
+are given. As an illustration, I may choose a case which shows at least
+the maximum distance treatment by mail, from Boston to Seattle. This
+particular case presented no difficulty in getting hold of the starting
+point as my correspondent, whom I have never seen, himself at once
+pointed to the original source of his obsessing idea.
+
+     The patient who lived with his family in Seattle wrote to me the
+     following: "----I shall undertake to describe in a few words a
+     condition which the writer has fought against for about eight years
+     and which has subjected him to untold mental anguish.----I was
+     backward in a social way but altogether happy. After working in a
+     bank about a year, was discovered one evening by the cashier
+     smoking a cigar in the basement, was unable to look him in the face
+     at the time. Went home that night and thought very little about it,
+     but on the following morning during the regular course of business,
+     I stepped up to him to ask some question, and as usual,
+     unconsciously looked him in the face. His glance was questioning
+     and suspicious, and that was the beginning of a life of anguish for
+     me. At first I could not look him in the eyes, then when looking at
+     some other person, I happened to think of it and so on, until in
+     two or three days it was impossible to look at anyone who came to
+     my window. The cashier did everything he could for me. No use: I
+     quit my position, lost most of my friends, had to leave a happy
+     home and came to Seattle to work for an old school friend. In the
+     first year, owing to new environments, I managed to conceal my
+     mental condition to a certain degree. All of a sudden, I was again
+     plunged into the depths of black despair. It took me about two
+     years to (partially) forget it, when the same thing occurred again,
+     and I lost my grip. The last time about eighteen months ago was
+     almost more than I could stand. These three or four instances I
+     speak of were cases of extreme despondency, but my usual mental
+     condition is extremely unhappy. If occasions arise where I have to
+     sit and talk to anyone for ten minutes, controlling myself is such
+     an effort that it leaves me with a case of the blues.... I shall
+     come and see you as the relief would give me a new lease on life."
+
+     This letter was written on the twenty-third of January, 1908. I
+     replied to him at once that he certainly ought not to come from the
+     Pacific to the Atlantic, but that I wanted him to write to me much
+     more about that first occurrence. As he was evidently right in
+     considering that episode as the starting point of his troublesome
+     associations, I supposed that these associated ideas had not yet
+     become independent but were still the effect of that first
+     "complex." Therefore I wanted to bring that to complete discharge.
+     Accordingly I wrote him to think himself once more into that
+     happening of years ago, to pass through it with all the power of
+     his imagination, to describe it to me then in as full a statement
+     as possible and to express in the letter also his conviction that
+     there was no reason to avoid the eyes of his superior, that he
+     might have looked straight into his face. As soon as he got my
+     reply, he wrote to me on the sixth of February a description of
+     that first episode, filling nineteen pages, telling me all about
+     his relations to those various men and every minute detail was
+     brought clearly to consciousness again. I did not add anything
+     further, but the expected occurred. On the eighteenth of February,
+     he writes to me: "In the last week or ten days, the writer has
+     noted a decided improvement regarding mental condition. The result
+     is a new interest in life. If you can spare the time, would like to
+     have you write me a few lines. Gratefully yours." At the end of the
+     month he writes: "Received your letter about half an hour ago.
+     Hasten to assure you with a great deal of pleasure that I am
+     feeling much better. Since sending you the letter regarding the
+     first case, I have noticed day by day an improvement." On the
+     eighth of March: "Since writing you last I have noticed a gradual
+     improvement. It has given me wonderful encouragement." On the tenth
+     of March: "Just a line to say that I am still improving." On the
+     twelfth of April: "I desire to say that since the taking up of
+     treatment with you, life has had a far different appearance to me
+     than it has had for the last ten years." On the twenty-first of
+     April: "Since my first letter to you, there has been such an
+     improvement that I have accepted a position which carries with it
+     much responsibility."
+
+This case leads over to the large group in which the obsessing idea
+involves the relation to a particular person. I find in such cases
+autosuggestion more liberating than heterosuggestion if the development
+has not gone too far. Of course autosuggestion can never take hypnotic
+character, but makes use with profit of the transition state before
+normal sleep. The type of these cases which are everywhere about us may
+be indicated by the following letter.
+
+     The writer is a young woman of twenty-four, whom I did not know
+     personally. She wrote to me as follows: "I am a writer by
+     profession and during the last year and a half have been connected
+     with a leading magazine. In my work, I was constantly associated
+     with one man, the managing editor. This man exerted a very peculiar
+     influence over me. With everyone else connected with the magazine,
+     I was my natural self and at ease, but the minute this man came
+     into the room, I became an entirely different person, timid,
+     nervous, and awkward, always placing myself and my work in a bad
+     light. But under this man's influence, I did a great deal of
+     literary work, my own and his too. I felt that he willed me to do
+     it. The effect of this influence was that I suffered constantly
+     from deep fits of depression almost amounting to melancholia. This
+     lasted until last fall, when I felt that I should lose my mind if I
+     stayed under his influence any longer. So I resigned my position
+     and broke away. Then I felt like a person who, having a drug to
+     stimulate him to do a certain amount of work, has that drug
+     suddenly taken away, and without it I am unable to write at
+     all...." I wrote to the young lady that she could cure herself
+     without hypnotism and without my personal participation. I urged
+     her simply to speak to herself early in the morning and especially
+     in the evening before going to sleep, and to say to herself that
+     the man had never helped her at her work, but that she did it
+     entirely of her own power, and that he had never had any influence
+     on it, and that she can write splendidly since she has left the
+     place, and much better than before. A few months later, she came to
+     Cambridge and thanked me for the complete success which the
+     auto-suggestive treatment had secured. She was completely herself
+     again and was fully successful in filling a literary position in
+     which she had to write the editorials, the book reviews, the
+     dramatic criticisms, and the social news. As a matter of course,
+     such treatment had removed only the symptom. The over-suggestible
+     constitution had not been and could not be changed. Thus it was not
+     surprising that in the meantime, while her full literary strength
+     had come back, she had developed some entirely different symptoms
+     of bodily character which I had to remove by hypnotism.
+
+As soon as the obsessing idea of the influence of another person takes
+still a stronger hold and develops systems, the suspicion of insanity
+always lies near; especially when hallucinations are superadded, the
+probability is great that we then have to do with the delusions of a
+paranoiac, and thus no case for psychotherapeutic treatment. Yet it is
+always wise to keep a psychasthenic interpretation in view as long as
+the insanity is not evident. I may mention such an extreme case.
+
+     The patient, a man of middle age, highly educated, for years had
+     heard voices calling his name. A man with whom he had some personal
+     quarrel, had, as he believed, hypnotized him from a distance and
+     made him act queerly or do things which he really did not want to
+     do, by telepathic influence. It is a development which is found
+     quite frequently. Abnormal organic sensations or abnormal impulses
+     and inhibitions which the patient cannot account for by his own
+     motives become connected with some vague ideas which are in the
+     air, like wireless telegraphy or telepathy or hypnotism from a
+     distance or electrical influence, or magnetism or telephoning,
+     these then attached to an acquaintance who stands in a certain
+     emotional relation. Here, too, some organic sensations evidently
+     had been the starting point and the idea of the man with whom he
+     quarreled had been secondarily attached. From this starting point
+     more and more detail was reached. Every action was brought into
+     connection with the powerful enemy who controlled more and more
+     even the normal and reasonable doings of the patient. My first
+     impression was decidedly that of a paranoiac. Yet in some ways the
+     case suggested another view. There had remained an insight into the
+     unreality of the obsession. The patient did not really believe the
+     theory of the telepathic hypnotic influence. He felt it more as an
+     idea which he could not get rid of and he did not know clearly
+     himself whether he requested hypnotic treatment on my part for the
+     purpose of counteracting the hypnotic power of his enemy or for the
+     purpose of liberating him from his exasperating fixed idea.
+     Moreover, I found that his voices had no hallucinatory character,
+     but were merely sound images. I decided to make the experiment
+     without great hope of success.
+
+     I hypnotized the man deeply and suggested that no one can have
+     power over his actions, that he is the responsible originator of
+     everything that he does and that no one can influence him and that
+     from that hour he would feel free from any telepathic intrigue. The
+     effect of the very insistent and urgently repeated hypnotic
+     suggestion during the first rather long treatment was such a
+     surprisingly good one that I decided to continue the
+     psychotherapeutic cure. I hypnotized him daily for two weeks. The
+     belief in the real wrong doings of an enemy disappeared entirely
+     from the first. It was at once apprehended as a mere obsessing idea
+     in the own mind and this idea itself began to be resolved. It lost
+     its unity; the absurd impulses were still felt but they became less
+     and less connected with the idea of another man, and as soon as
+     they were rightly understood as doings of the own mind, the
+     opposite motives gained in strength. A stronger and stronger appeal
+     to his own power made these motives more and more influential.
+     Slowly the association of the influence of the other man faded away
+     entirely. I intentionally had not given any attention to the
+     pseudo-voices, inasmuch as they had not taken any relation to the
+     ideational delusion. I therefore did not include them in my
+     suggestions, as I consider it wise to confine hypnotic suggestions
+     always to as few points as possible. Yet these voices decreased
+     too. At a certain point in the cure I substituted--to save my own
+     time--an autosuggestive influence, or rather a mixed one, inasmuch
+     as I had him read ten times a day a letter of mine which contained
+     appropriate suggestions. After about six weeks, all the
+     disturbances for which he had sought my advice had disappeared.
+
+Obsessing ideas of such personal influence involve of course always a
+certain amount of emotional excitement and they may lead us to the
+unlimited field of disturbances in which the persecuting idea is
+surrounded by emotional attitudes. Analysis shows easily that the
+emotion is an essential factor and that it persists in the disease while
+the ideas to which it clings may change. Central is the emotion of fear;
+nearest to it that of worry, but any emotion may give color to the
+particular case. Again any number of methods may be applied and a few
+illustrations with quite different ways of treatment may indicate more
+fully the character of the trouble. There is no doctor in the city and
+none in the remotest village who may not find such cases in his near
+neighborhood. Of course slight degrees are easily hidden by the
+patient's own inhibition of external expression. If such suppression by
+the own will secures a real overcoming of the unjustified emotion, this
+is surely better than to begin any medical treatment. But as the
+suppression usually means simply lack of discharge and thus offers all
+the conditions for an unhealthy inner growth of the trouble, the neglect
+of such disturbances is most regrettable, and frankness of the patient
+must be encouraged. Such situation demands a careful observation of the
+whole case and a subtle adjustment of the treatment to the individual
+needs. It may perhaps be helpful at first simply to indicate the
+varieties of the more frequent disturbances of this kind by quoting from
+various letters. Each case belongs to a type which can easily be removed
+by psychotherapeutic influence, generally even by a skillfully directed
+autosuggestion.
+
+The writer is a young man.
+
+     "I have always, as long as I can remember, been very nervous and
+     sensitive. When about seven years of age, I was attacked by St.
+     Vitus' Dance. Before that I cannot say whether I was particularly
+     nervous or not. Afterward it was impressed upon me by the remarks
+     of relatives that I was nervous, so that I soon took note of this
+     condition myself. The manner in which this weakness has been
+     especially troublesome is that it has caused me to be very shy. I
+     shrank from new acquaintances and disliked being observed. Often in
+     walking along on the street, I imagined myself closely noticed by
+     the passerby and I always felt uncomfortable.
+
+     "About three years ago I suffered from typhoid fever and after
+     recovering, a new form of the old trouble showed itself. This time
+     I imagined that when eating I chewed my food in a manner that was
+     ridiculous and which made people hardly keep from laughter in
+     observing me. Often I had to leave the table when half through
+     because I felt I could not bear having critical eyes upon me any
+     longer. About three months ago I determined to be troubled no
+     further by my own foolish fancies and by constantly schooling
+     myself I have improved very much. Still, however, when I walk alone
+     along the street, I must fortify myself mentally before passing
+     each group of people. If once I allow myself to think that they are
+     looking at me, I feel almost paralyzed, my feet seem too heavy to
+     lift, my arms do not seem to swing naturally, and in attempting to
+     look placid and unconcerned, I feel that I am failing utterly. Also
+     when at table, I must still tell myself before each mouthful that I
+     have no need for fear, that my manner at table is equal and perhaps
+     superior to the others beside me. I have gone a certain length in
+     my self-training, and have relieved myself of a great deal of the
+     mental distress, but now I believe I can advance no further. What
+     seems needful now is to do away with the self-consciousness which
+     brought on my worries, though whether this is possible is hard to
+     say."
+
+Here the letter of a young woman, the type which fills the army of the
+mind healers and faith curists.
+
+     "For years I have been seeking, or perhaps to be more accurate I
+     should say waiting, for a mind to drift toward me; a mind that
+     would understand my particular case of fear brought on by the
+     constant bullying and nagging from my earliest childhood by those
+     in my home. This fear of brutality has greatly depleted my nervous
+     system and has unfitted me for the strong, useful, forceful life I
+     should have expressed. If I could only rid my mind of the thought
+     that I am always displeasing, or rather, going to displease people,
+     for I hardly do displease them; if I could get rid of the fear of
+     caring what the attitude of other minds toward me is, I feel that I
+     should then strike out into a strong life of helpfulness to others.
+     In other words I have always felt behind me a great force pressing
+     me out into public work. When I was a child, it was so strong that
+     I was sat down upon brutally, to so great an extent that I feared
+     to voice my convictions and that fear still clings to me like a
+     nemesis. It seems that every individual personality in a public or
+     private audience rises up to overwhelm me, causing my tongue to
+     grow heavy and my mind to become a blank. This enervating fear
+     blends into every thought I have, whether sleeping or waking. I
+     have fought with all my might to rid myself of it but so far in
+     vain."
+
+Here an expression of a very frequent variety. The writer is a
+middle-aged man.
+
+     "I am possessed of a fear that is constantly with me that something
+     dreadful is going to happen and I do not seem to be able to
+     overcome it. I am told by physicians that I am bodily sound,
+     although very nervous, and that the fear is generated entirely by
+     autosuggestion. When at its worst, it weakens and terrorizes me and
+     in my better moments I am tormented with a fear of a recurrence of
+     a bad spell. It is fear of a fear. A year ago at this time I had a
+     very bad spell but got along fairly well through the summer, but I
+     am afraid that I will soon again be in a bad condition and lose all
+     that I may have gained."
+
+The "fear of a fear" is indeed a symptom which the psychotherapist has
+to fight extremely often, but as soon as he has really recognized it and
+analyzed the whole mental condition, he will hardly have any difficulty
+in uprooting it. I add a letter of a school-teacher in New York. He
+writes:
+
+     "I am teaching in a high school. I am of a nervous temperament and
+     constitutionally limited in endurance. Often my work is done in a
+     condition of greater or less exhaustion. I find that I blush very
+     easily in purely freakish ways, when there is no occasion for it. I
+     find this blushing connecting itself with certain of the girl
+     pupils of my classes in a conspicuous way. It occurs hardly ever
+     except when my class is facing me and I seem to be powerless to
+     overcome it. I have always tried to live a careful moral life, but
+     my early life was very much secluded. I lacked entirely the free
+     intercourse young people usually have together and I felt awkward
+     with others for a long time. In the matter of the blushing, it
+     sometimes occurs in the case of girls who are especially pleasing
+     to me but also not infrequently in the case of some who are not at
+     all so. The whole thing might be passed over were it not that it
+     has considerable effect in causing constraint toward my students
+     and in some cases affecting them very strongly in an emotional way
+     at the very time of life when such things can do most harm. I
+     regard the matter as being so serious that it brings directly in
+     question my right to teach, but I do not feel at all sure I could
+     find other work that I could do if I give up my present position.
+     The very thought that on a particular occasion it would be
+     extremely awkward to blush makes it almost impossible for me to
+     avoid it."
+
+But we have rather now to consider the therapeutic side, and we may
+begin again with a routine method of a simple hypnotic treatment.
+
+     The patient is a young university professor. His intellectual work
+     is perfect in all directions. There are no nervous symptoms, though
+     there are some slight disturbances of digestion. He suffers as soon
+     as he comes into a crowd of people and as soon as he is on any high
+     place, where he has to look down; the worst when both conditions
+     are combined, as for instance, at a concert or a theatre in a
+     balcony seat. But every meeting of many persons, even at church,
+     produces all the symptoms of nervous excitement. He was easily
+     brought into hypnotic state by verbal suggestions. When he was in
+     hypnosis, I reenforced the conditions for an opposite attitude. I
+     told him that as soon as he was in a crowd of persons he would feel
+     especially comfortable, would enjoy himself, would fully enter into
+     the spirit of the occasion and feel especially secure in their
+     presence. Whenever he should be on a high place, he would enjoy the
+     safety of the ground on which he was standing or the seat on which
+     he was sitting. I assured him that he would neglect entirely
+     whatever he saw and would rely completely on his safe feeling
+     resulting from his tactual impressions. After having hypnotized him
+     three times the disturbance disappeared completely, and even an
+     evening at the theatre in an exposed box on the balcony was enjoyed
+     without any discomfort. After about a year, at a period of
+     fatiguing work, some traces of the anxiety appeared again. This
+     time two hypnotic sittings were sufficient to remove the
+     disturbance of the equilibrium, which as far as I know has not come
+     back. The same hypnotic treatments were used in a secondary way to
+     remove the digestive trouble.
+
+I again quote the case of a teacher, a profession in which the
+psychasthenics are unusually frequent. It is a case of a young woman
+from the Middle West.
+
+     The young lady wrote me: "I come of a race of strong women and am
+     not hysterical or easily frightened by many things that disturb
+     women. Since my fifteenth year I have been seized by hallucinations
+     of absurd or serious nature which no reasoning could explain away
+     and which have gradually undermined my power of resistance to them.
+     At the age of twenty-two, after a year of unusually hard work, my
+     nervous endurance gave way, and with this breakdown came a sense of
+     fear and a horror of crime that I have been unable to overcome. I
+     have never felt the slightest inclination toward wrongdoing. It is
+     a feeling rather that my shrinking from any mention of evil makes
+     it impossible for me to listen or think rationally when such things
+     are discussed. This feeling has seemed to change my whole attitude
+     toward life and has left me without power to control my facial
+     expression or carriage when it takes possession of me. I have been
+     able to teach more successfully than I could hope, but it is only
+     by cutting myself off from the friendships and pleasures incident
+     to my life that I am able to accomplish my work. I have fought this
+     trouble alone and will still do so if there is no help, but the
+     thought that it is the source of great distress to those dear to me
+     makes it very hard."
+
+     A few weeks later the lady insisted on coming to Cambridge. I found
+     that there had never been any hallucinations and that she used the
+     word in her letter only to indicate some insistent memory images
+     which had never taken the vividness of real impressions. In the
+     presence of her friend, I hypnotized her deeply and strengthened
+     through urgent suggestions her consciousness of her having done the
+     morally right thing at every situation in her life and her
+     conviction that she never did and never would commit a crime. Here
+     as always, if possible, I left alone the emotional idea but
+     reenforced the opposite. The effect was an immediate one. She felt
+     freer the next day than she had felt for years. I repeated the
+     treatment a few times and she assured me that the feeling had
+     disappeared entirely.
+
+I take the rather severe case of a woman of fifty.
+
+     The highly educated and refined lady had lost her husband by an
+     accident in Switzerland, which had been misrepresented by some of
+     the newspapers as suicide. Two years later she wrote to me: "I feel
+     as if I had received indelible photographs on my brain which have
+     since greatly affected my health and from which I may never
+     recover. This winter the symptoms I have been able to control
+     returned and I have been ill. I unfortunately saw the newspaper
+     headlines with my husband's supposed suicide. Though I exclaimed
+     then, 'how outrageous,' I felt as if I had been struck and since
+     then I can seldom read a paper without dread and apprehension, and
+     the hearing of anyone's suicide fills me with terror. When I
+     hurried to Europe, on the ocean a week from the day of my husband's
+     death, I had a curious and overwhelming shock. On opening a drawer
+     and seeing a pair of scissors, they looked to me like a dagger and
+     suddenly the whole cabin seemed filled with implements of death.
+     The doctors said that I would find it hard to get over such
+     impressions but I told them I would, as I had courage and will. But
+     I have been realizing in these two years that I may be suffering
+     from something that may be beyond the control of will. I often
+     become so nervously sensitive that scissors are unbearable for me
+     to see, or a steel knife or anything that might express death. Our
+     family physicians are still against hypnotism, and if I should go
+     to a neurologist of my own selection, it might be to one who
+     believed still only in nerve foods, baths, or a sanitarium."
+
+     The lady came from the South, with her nurse, to Boston and
+     insisted on being hypnotized by me. I cannot say whether a really
+     deep hypnotic state was produced at once as I refrained from
+     testing it. There was certainly no amnesia. Probably it began only
+     with a slight drowsiness but at the fifth treatment I found a
+     relatively deep hypnosis. It was a capricious case in which the
+     improvement was fluctuating but clearly setting in from the first
+     day. I trained her in hearing and seeing words like death and
+     suicide with a reenforced feeling of strength and calmness; I
+     forced her to see and touch scissors with an artificial attitude of
+     strength and indifference. At the same time I reenforced her good
+     mood and her enjoyment in life. When she left for England a few
+     weeks later, she felt herself mentally cured, and throughout the
+     summer her letters testified the wonderful change which the
+     treatment had brought about. Half a year later, as the result of
+     an exhausting physical local treatment, the psychophysiological
+     symptoms came back to a certain degree. She requested me by a
+     letter from England to give her some help by suggestion to suppress
+     again the recurring intrusions. As I had observed her strong
+     suggestibility, I sent her over the ocean a little pencil of
+     mother-of-pearl which she had seen in my hand, and advised her to
+     look at it until she counted twenty slowly and then to close her
+     eyes and simply to sleep. The autosuggestive effect was unusually
+     strong. She writes from London: "When I saw the enclosure of your
+     letter I felt as if it would burn through my hand and the feeling
+     became so overpowering that I locked it away with my jewels, but as
+     the days ran into a week I felt I could not live with it in my
+     apartment any more, and I felt almost ill, until it occurred to me
+     I could seal it and take it to my bankers. I felt as dreamy and
+     absent-minded and paralyzed as if you had just treated me."
+     Nevertheless the effect was on the whole the desired one and she
+     returned to America with a wholesome freedom of mind. I hypnotized
+     her twice again and she writes in her last letter: "I can never
+     repay you for what you have done for me. You have given me back my
+     courage and my love of life in its vividness and interest and
+     color, all that through the last years I had so entirely lost."
+
+Even in cases where the disease itself is inaccessible to
+psychotherapeutic treatment, the superadded grief and worry brought on
+by the disease might yield to the mental influence and the whole
+situation would to a high degree be transformed for the better by it. I
+have often been asked to hypnotize in such cases, where the depression
+was wrongly taken as a part of the nervous disease; sometimes I agreed
+to do it in spite of feeling sure that the disease itself could not be
+removed. I quote an instance.
+
+     A young woman afflicted with epilepsy was brought up in the belief
+     that she had only from time to time fainting attacks from overwork,
+     and with them secondarily neurasthenic symptoms, especially spells
+     of depression colored by a constant fear of the next fainting. She
+     had heard voices all her life and they frightened her in an
+     intolerable way. I produced a very slight hypnotic state. I
+     concentrated my effort entirely on suggestions which were to give
+     her new interest in life, and diminished the emotional character of
+     the voices without even trying to make them disappear. I proceeded
+     for several months. The young woman herself believed that the
+     fainting attacks came less frequently afterwards; yet I am inclined
+     to think that that is an illusion. But there was no doubt that her
+     whole personality became almost a different one with the new share
+     in the world. The epilepsy remained probably unchanged but all the
+     superadded emotions were annihilated and she felt an entirely new
+     courage which allowed her to control herself between her regular
+     attacks. She had been unable to undertake any regular work before
+     for a long while, but all that improved. More than a year
+     afterward, she wrote me: "I have really worked most of the time
+     this past winter and spring and I think I can see a steady though
+     slow gain. I am reading quite a little and doing it for the most
+     part easily. To be sure I have, after I have read, hard times with
+     the voices but their character is usually less determined and
+     fearful than formerly. Several times I have thought I must come
+     again to you but each time I have started again to fight it out for
+     myself, but now, as I am gaining, I can better estimate the great
+     help your influence was to me at a juncture when everything seemed
+     so hopeless and helpless."
+
+Even in slight psychasthenic disturbances, the psychotherapeutic
+influence is not always successful, especially if there is no time for
+full treatment. But it is very interesting to see how even in such cases
+the symptom is somehow changing, almost breaking to pieces. It becomes
+clear that a protracted effort in the same direction would destroy the
+trouble completely. Typical is a case like the following.
+
+     An elderly woman has been troubled her life long by a
+     disproportionate fear of thunderstorms with almost hysterical
+     symptoms. As she had no other complaint, I hardly found it worth
+     while to enter into a systematic treatment and could not expect
+     much of a change from a short treatment, considering that her
+     hysteric response had lasted through half a century. As she begged
+     for some treatment, I brought her into a drowsy state and told her
+     that she would in future enjoy the thunderstorms as noble
+     expressions of nature. The whole procedure took a few minutes. Yet
+     after some summer months she wrote me a letter which clearly
+     indicated this characteristic compromise between the habitual dread
+     and the reenforced counter idea. "I have the same sick dread at the
+     sight of thunder clouds that I have always had, but I seem to have
+     gotten somehow a most desperate determination to control my fear. I
+     have done this to the extent of keeping my eyes open and looking at
+     the storm. Is that hypnotism or pride?"
+
+Another thunderstorm case may lead us to other methods of treatment.
+Here again in the field of emotional response, we may consider the
+methods of going back to primary experience, known or forgotten.
+
+     A young married woman of the West had suffered always from
+     hysterical attacks in response to any sharp sudden impressions,
+     especially sudden loud noises. The banging of a door, but worst of
+     all a thunderstorm, could produce hours of weeping and crying and
+     desperate mental condition with all expressions of excitement. Her
+     husband wanted me to hypnotize her but I preferred another way. I
+     tried to get her memory back to the earliest case of which she
+     could think of this hysterical response. As long as we were in
+     ordinary conversation, she could not trace it beyond about her
+     twelfth year. But when I brought her into a drowsy state, her
+     memory revived older experiences and finally settled at a school
+     experience in her seventh year of age. She then had an excitable
+     country school-teacher who relied on whipping the children. Once
+     her neighbor in the class did something forbidden. Her teacher
+     mistook her for the culprit and began to whip her most forcibly
+     before she could explain anything; and while the punishment was
+     going on and she began to bleed from a wound, she all the time felt
+     that she wanted to express her innocence and could not speak. After
+     that, evidently the first attack of hysteric character followed.
+     From that time on any sudden impression released the same group of
+     reactions. The suppressed emotion had evidently become a
+     psychophysical "complex." As soon as I had reached this starting
+     point of her pathological history, I asked her to bring back to
+     consciousness as many details as possible of that first incident.
+     She told me all the names and described the classroom and brought
+     herself vividly into the whole situation. Then I asked her to tell
+     me the whole story once more and to express strongly her innocence
+     and the wrongness of the punishment, and when she had completed her
+     account, brought out with fullest indignation, I had her tell the
+     whole thing once more and then a third and a fourth time, until she
+     was quite tired out from it. That was all I did. Very soon after,
+     the husband reported that there was a great improvement in every
+     respect, no hysteric attacks, only slight discomfort. Most of the
+     stimuli which had previously produced strong reactions now passed
+     without any disturbance and even thunderstorms were experienced
+     with relative ease. A year later they came once more to Cambridge,
+     and she simply passed once more through the same process of
+     discharge which seems now to have removed the symptoms still
+     further.
+
+By far more reliable, however, is the method of side-tracking the
+starting experience into a new associational track.
+
+     A gentleman with a decidedly psychasthenic constitution developed a
+     tendency to hesitate in walking on the street. It was not a
+     complete stumbling but a disturbing inhibition, which set in when
+     he was walking alone and his attention was not absorbed by
+     something on the street. He believed that it came on most strongly
+     when he looked down at the pavement. He suffered from it vehemently
+     and avoided going on the street alone. He was unable to connect it
+     with any starting point. He interpreted it as merely a symptom of
+     overwork. But going with him through all kinds of experiences which
+     he had had on the street in previous years, we finally found that
+     once he was running to catch a street car, when he suddenly saw
+     almost immediately before him a big hole dug out for laying gas
+     pipes. He was able to stop himself quickly enough not to fall into
+     the hole but he got a strong emotional shock from the experience.
+     He, himself, did not think that his walking troubles set in
+     immediately after this shock. Yet the hypothesis seemed to me
+     sufficiently justified that there existed a connection, even though
+     some weeks lay between that first experience and the first
+     observation of the abnormal inhibition in walking. On that basis I
+     tried to train a new associative connection. I made him drowsy and
+     asked him to think himself once more into the situation of his run
+     for the car but as soon as he reached the hole to jump over it. He
+     went through this motor feature on ten successive days with new and
+     ever new energy and from that time up to the present the trouble on
+     the street has disappeared entirely.
+
+To mention at least one case of the large group in which suppressed
+sexual emotion was the evident source of an anxiety-neurosis, I mention
+the case of a woman who showed very strong symptoms of anxiety and
+oppression and who was cured by a simple advice.
+
+     The woman, aged thirty-two, was a saleswoman in a large store
+     selling gentlemen's gloves and ties. She suffered from time to time
+     by attacks of vague anxiety in which her heart showed vehement
+     palpitation. There were paleness and perspiration and at the height
+     a nervous trembling together with a feeling of despair. These
+     attacks were not frequent, separated sometimes by weeks, sometimes
+     by months, but troubling her exceedingly. She had been assured by a
+     physician that her heart was normal and that she was probably
+     overworked. She could find absolutely no source of the disturbance.
+     After a long conversation, I was also unable to discover any direct
+     or indirect causes until I worked on the basis of those theories
+     which we have discussed, the theories which connect hysteric
+     symptoms with chance intrusions which stand in relations to past
+     suppressed emotions of sexual character. The patient absolutely
+     denied any present sexual emotions. She had been engaged about
+     eight years before and acknowledged that at that time there were
+     strong sexual feelings connected with her fiance, who broke the
+     engagement. Psychoanalytic methods now brought it to full clearness
+     that she had her first attack after selling a pair of gloves and
+     fitting them to the hand of a male customer who had a certain
+     similarity to her fiance. It was not possible to trace this in the
+     same way for later cases too, but it seems that bodily contact with
+     a man by fitting gloves preceded every attack. All this was brought
+     out partly by questions, partly by free ascending associations
+     while she, herself, believed that she simply pronounced nonsense
+     words as they came to her mind, and partly it was secured in a
+     half-hypnotic state. I came to the conclusion that the suppressed
+     sexual emotions at the breaking of the engagement were the primary
+     cause of the disease. The similarity of the first customer together
+     with the tactual sensations had evidently touched that complex and
+     brought the suppressed emotion to an explosion which frequently
+     takes the form of palpitation and similar symptoms. Later the mere
+     tactual sensation alone produced by the contact with the hand of a
+     man, possibly with a similar optical impression, perhaps also with
+     the sound of the voice, brought back the reaction. Instead of
+     giving treatment, I insisted that she change stores, and become
+     saleswoman in a house where she would have to do only with women,
+     and to sell articles which did not bring her into personal contact
+     with customers. After more than six months of work in her new
+     place, she reported that the attacks had not come back again.
+
+Of course it may readily be acknowledged that this method does not allow
+a sharp demarcation line between its various factors. It cannot be
+denied that an element of straight suggestion may be included. The man
+whom I train in the forming of a new antagonistic motor response feels
+it of course all the time also as a silent suggestion to overcome the
+old disturbance. It is thus to a certain degree impossible to say where
+the effect of the discharge ends and where that of the hidden suggestion
+begins. Yet there certainly cannot be any doubt that this revival of the
+first experience and its improved discharge works directly towards the
+removal of the troublesome symptom.
+
+Abnormal fear is also the essential factor in most cases of stammering.
+The patients usually know it themselves. For instance, a lawyer writes
+to me:
+
+     "I have been a stammerer the greater part of my life and have
+     visited every stammering school in the country, but the relief
+     obtained has been temporary and in most cases I was not benefited
+     at all. I am convinced that stammering is due wholly to an abnormal
+     mental condition, which consists of an unreasoning fear that takes
+     possession of the individual when he attempts to utter certain
+     sounds. It is simply a lack of confidence inspired by numberless
+     failures to articulate properly and is not caused by any organic
+     trouble, because, taking my own case for example, I can at times
+     talk as fluently and easily as anyone. I am firmly convinced that
+     stammering can be cured by hypnotic suggestion. If you could get me
+     in the hypnotic state and suggest to me repeatedly that from
+     thenceforth I would have easy fluent speech, I feel absolutely
+     certain that such would be the case."
+
+Or an engineer writes to me:
+
+     "At times I stammer very badly. In an ordinary conversation it is
+     scarcely perceptible, but it is almost impossible for me to make an
+     explanation or relate an incident or tell an anecdote. I began to
+     stammer when I was about seven years of age--I am twenty-nine
+     now--and continued until I was seventeen, when I broke myself of it
+     by reading aloud. It came back on me about a year ago, at which
+     time I was laboring under a very severe nervous strain on account
+     of business matters. I have since tried to break myself of it in
+     the way that I did at first, reading aloud, but have been unable to
+     do so. Can it be cured by hypnotic treatment or suggestion? Can any
+     hypnotist of ordinary ability do it?"
+
+I should affirm this question, which is one of the most frequent put to
+the psychotherapist. And yet, if I myself have entirely given up the
+cure of stammerers in recent years, it was not only because there was
+little chance to learn anything new scientifically from it but also
+because it was ultimately disappointing, as the severe cases cannot be
+cured entirely. Every hypnotist can quickly secure a strong improvement.
+In even new cases I found an almost surprising improvement in the first
+two weeks, an improvement which stirs up the most vivid hopes of the
+sufferers. Then the improvement becomes slower and finally it stops
+before a complete cure is reached. The patient notices it and it easily
+works back on his emotion and thus begins again to disturb the speech,
+unless a very careful continuous counter-suggestion is given. Slight
+disturbances, to be sure, can be removed entirely. The essential point
+will always be to suggest to the stammerer the full belief that he is
+able to speak every word and that he is able to speak it in every
+situation. But where there is a limit for improvement, we must take for
+granted that the disturbing fear is only superadded to an organic
+trouble. In such cases, probably the inability of certain nervous paths
+was primarily irreparable. These inabilities then became the source of
+discomfort and of fear and this fear added greatly to the disturbance.
+Hypnotism then quickly removes that part of the disturbance which had
+been superadded by the mental emotion but it cannot remove that primary
+factor, the objective inability, and every cure thus finds its limit
+there.
+
+Near the field of emotions stand also the many varieties of sexual
+abnormities and perversities. I abstain from discussing any special
+cases but it may be said that suggestive treatment is in this region
+powerful to an almost surprising degree. Even homosexual tendencies
+which go back to the beginnings of the memory of the individual yield,
+as my experience shows, in a few weeks, if again the suggestion is not
+so much directed towards the suppression as to the creation of the
+antagonistic reaction, that means in this case, of the normal sexual
+desire.
+
+Both ideas and emotions, of course, lead to actions. Moreover we always
+insisted that the resulting action is an essential part of the
+psychophysical situation and that every mental experience has to be
+characterized as a starting point for action. Yet this factor of
+activity and of attitude sometimes stands in the foreground. The
+controlling idea is then the idea of an end of action, the predominant
+emotion, the emotion anticipated from a certain activity. Typical for
+that are those disturbances in which an abnormal impulse or an abnormal
+desire awakes perhaps a desire for ruinous drugs like morphine or
+cocaine or an impulse to criminal deeds, like stealing. But the
+disturbances of the psychomotor factor are not less present when the
+central complaint is a lack of energy, the most frequent symptom of the
+neurasthenic; and our whole discussion has made it clear that a mere
+lack of attention belongs to the same category.
+
+Of course, the abnormal impulse is psychophysically not different,
+whether it leads to a legally important result like the impulse to kill
+or leads to an indifferent result. The subjective suffering may be the
+same in both cases. The starting point of the impulse may be any chance
+experience. The psychasthenic may pick up such impulses from any model
+for imitation or from any haphazard report. It may be entirely freakish
+and yet beyond conscious control.
+
+     A physician had read in a well-known book on hysteria about a case
+     in which a girl was troubled by a constant effort to move the big
+     toe in her shoes. This idea worked on him as a suggestion for
+     several months. At my advice he fought it by auto-suggestion. He
+     brought himself into a slightly drowsy state by staring into a
+     crystal ball and assuring himself by spoken sentences with
+     monotonous repetition for a long while that he has perfectly the
+     power to hold the toe at rest. From the second day only a slight
+     kinaesthetic sensation remained; the movement itself disappeared.
+
+Or a more unusual case.
+
+     A young lady once noticed in a man a different color in the two
+     eyes. It gave her an uncanny feeling, together with the natural
+     impulse to compare the two eyes. Accordingly she shifted her own
+     eyes from one eyeball to the other in the man's face. The accent
+     which this shifting impulse had received by the disagreeable
+     feeling evidently forced her to repeat this movement with everyone.
+     At first it became half a play, but soon a disturbing habit and
+     finally an intolerable impulse. Whenever she talked with anyone,
+     she lost control of her eyes and was obliged to enter into a kind
+     of pendulum movement from eye to eye. The situation became so
+     unendurable that the thought of suicide began to occur to her. I
+     hypnotized her four times, suggesting to her complete indifference
+     as to the face of those with whom she spoke and at the same time
+     certain new habits of fixation. The impulse lost its hold and when
+     I saw her last, it had completely disappeared.
+
+By far more frequent than such neutral impulses are the desires, for
+instance, of the alcoholist. On the whole it may be said that
+psychotherapy can gain its easiest triumphs in the field of alcoholism
+and a wide propagation of psychotherapeutic methods and of a thorough
+understanding of psychotherapy would be fully justified, even if no
+other field were accessible but that of the desire for alcoholic
+intemperance. The moral disaster and economic ruin resulting from
+alcoholic intemperance, the physical harm to the drinker and to his
+offspring is so enormous, and the temporary cure of the victim is so
+probable that the movement certainly deserves most serious interest. Yet
+I speak of temporary cure and I refer here especially to the restriction
+with which I introduced the psychotherapeutic methods in general. They
+do not deal with diseases but with symptoms; and they certainly do not
+deal with constitutions, but with results of the cooeperation of
+constitution and circumstances. That the given constitution may be
+brought anew under conditions which again stir up similar symptoms is
+always possible, and just with alcoholism the danger lies near unless
+beneficial influences remain in power. Certainly no one has a right to
+neglect such psychotherapeutic aid simply because relapses are possible.
+Even a temporary relief can be a great blessing. Moreover, the temporary
+relief is the safest basis to work towards the prevention of a
+recurrence of the evil. Only in two directions is further restriction
+needed. Psychotherapeutic methods are in my opinion of very small avail
+in cases of periodic drinkers. Such periodic attacks of patients who
+have not even a desire for alcohol in intervals between the attacks,
+intervals which may last a quarter of a year, are related to epilepsy.
+It seems that constant hypnotic influence during the interval has a
+certain power to reduce the periodic impulse. I personally have not
+seen any special improvement from it. The second restriction would be
+that the drinker has to be under constant supervision during the first
+days of hypnotic treatment. No patient, not even the morphinist, is so
+skillful in deceiving his friends and even the physician. Even the most
+emphatic gestures of sincerity ought to be distrusted.
+
+     Only a short time ago I dealt with a young man whom his parents and
+     a chauffeur had accompanied to Boston, exclusively for the purpose
+     of watching him constantly while I was to attempt to cure him from
+     excessive whiskey drinking. The chauffeur accompanied him from his
+     room in the Boston hotel to the threshold of my laboratory. All
+     through the day he was with his parents, and at the hotel the
+     management had given the strictest orders not to sell any drink to
+     the young spendthrift. He was an earlier student of mine and had
+     attached himself to me with such an apparent sincerity as removed
+     every possible doubt of his pledge. Intentionally I had not even
+     asked him for a pledge not to drink but only for a pledge to
+     confess to me the next day if he ever should take any alcohol. In a
+     tentative way I suggested to him in a half hypnotic state on the
+     first day that he would feel disgust for whiskey. I did not expect
+     much of an improvement before at least three or four treatments. I
+     was therefore most surprised when he most solemnly assured me the
+     next day that he awoke in the morning with an assured feeling that
+     he should never touch whiskey again and that he had not the
+     slightest desire for it. Instead of a systematic development of
+     suggestions, I confined myself therefore to a mere repetition of
+     the treatment of the first day and as every morning the same
+     assurance came forth, there seemed to be no need for any
+     variation. It was not before the fifth day that I discovered that
+     he had taken from the start a pint of whiskey every day. When he
+     first arrived he had bribed a laundress of the hotel to bring to
+     his room every day the whiskey hidden in the laundry and he drank
+     it during the night. Then I declined any further participation.
+
+The danger of deceit is of course less imminent when not the family but
+the patient himself takes the initiative. Yet even here distrust is
+wise. The patient has sometimes the most sincere intention to be cured,
+but under pressure of his craving he admits compromises which he hides
+from the physician. Having reduced the large quantity of alcohol to
+which he was accustomed, he hides the fact that he yet takes a few
+drinks, which he thinks cannot prevent the cure. Yet inasmuch as a
+complete cure has to rely on psychical factors, this consciousness of
+deceiving even with small transgressions interferes badly with progress
+and, inasmuch as the cunningness of the patient is itself a symptom of
+the disturbance, the strongest possible precaution is advisable at the
+beginning. For that reason it is also not best to begin at once with
+complete prohibition, but to lead to a total abstinence in about one
+week. But certainly in the case of every drunkard, total abstinence is
+the only desirable goal. A pronounced drinker ought never to be
+transformed simply into a moderate one. The return to intemperance would
+result rapidly. On the other hand it would be unfair to deny that
+psychotherapy has cured the symptom if the desire really once
+disappeared completely, even if, after years, new temptations develop a
+new desire. I myself had diphtheria three times in my life; my
+constitution is thus probably especially favorable to that disease but I
+do not estimate less the fact that I was perfectly cured the second
+time, in spite of the fact that I caught it a few years later a third
+time. To be sure, such experiences of relapse cannot be spared any
+psychotherapist. I may give a typical instance.
+
+     A well-known professional man of fifty years, through a long
+     bachelorhood, was accustomed to close his work at four o'clock and
+     then to sit comfortably in his study with a book and an unlimited
+     supply of brandy. He took one cognac after another and every
+     evening he was completely intoxicated. He married a young wife and
+     felt the need of changing his habits, the more as he himself saw
+     symptoms of his excess which alarmed him. When he came to me, I saw
+     that he was seriously wishing to give up, and he understood himself
+     that there was only the one way, namely, complete abstinence. He
+     felt that he could not reach it by his own will power alone and
+     sought my aid. I hypnotized him six times, suggesting at first a
+     reduction to four drinks, then to two, then to one and then to pure
+     mineral water. I concentrated my effort on stirring up the
+     antagonistic attitude, the dislike of the smell of brandy and the
+     aversion to its taste. The effect was excellent. After the fifth
+     time the mental torture which he had felt in the first afternoons
+     had completely disappeared. I considered further hypnotizing
+     superfluous and felt sure after the sixth time that the man was
+     cured. For about a year he remained abstinent, but in the meantime
+     his professional life brought severe disappointments, and with cool
+     consideration he decided that he might have at least some pleasure
+     from life and forget its miseries. Accordingly after a year he
+     determined again to take some brandy in his study, and of course,
+     that led rapidly to an increase of the dose and today he is
+     probably at the old point. And yet it may be said with correctness
+     that psychotherapy had done its duty. If at the right moment before
+     he took the first step again, even the slightest counter-suggestion
+     had been applied, the disastrous second development could have been
+     easily avoided.
+
+My experience indicates the best results where the suggestions are from
+the start directed as much against the unfavorable social conditions,
+with their temptations and impulses to imitation, as against the
+alcoholic beverages themselves. On the whole it is easier to break the
+vicious drinking habits of the social drinker than those of the lonely
+drinker, a point which ought to be well considered in settling the
+complex problem of prohibition versus the temperance movement.
+
+The situation of alcoholism repeats itself in still more ruinous forms
+with morphinism and cocainism, vices which grow in this country to an
+alarming degree. The psychotherapeutic treatment of such drug habits
+demands much patience and much skillful adjustment to the psychological
+conditions. Its general difference from the treatment of alcoholism is
+given by the circumstance that any too rapid withdrawing of the drug is
+certainly dangerous, if the organism is adjusted to a relatively strong
+dose. On the other hand, I may say that I have not seen a single case
+in which a really patient and insistent treatment of morphinism has not
+been successful, even if the destructive dose of forty grains a day had
+become habitual. The condition is only that the patient himself have the
+best will, a will which yet is not strong enough to win the fight
+without psychotherapeutic help. But no one ought to expect that the
+psychotherapist can secure miracles like some of the pill cures which
+treat the drug fiend in three days. Moreover neither physician nor
+patient ought to believe that the worst is to come at the beginning. On
+the contrary, it is the end which is hardest, the reduction of the small
+dose to nothing. As illustration, I give an extreme case.
+
+     A man who was formerly station master on a railroad had been
+     operated on in a hospital after an accident, and as some pain in
+     the hip remained which disturbed his sleep, the physician of the
+     hospital gave him some morphine and provided him with the material
+     for morphine injection after leaving the hospital. Then began the
+     usual story. He became more and more dependent upon his injection,
+     the dose was steadily increased, he found unscrupulous physicians
+     who yielded to his demand for morphine prescriptions; he lost his
+     position with the railway by the growing effects of the morphine
+     poisoning, he became divorced, sank lower and lower, his daily dose
+     fluctuating between thirty-five and forty grains a day, and when he
+     came to me, he presented a picture of the lowest type of hopeless
+     manhood. He spent practically the whole day in bed and was only
+     able to totter slowly along with a cane. He assured me that life
+     was hell for him. He could not sleep, he could not eat, he could
+     not think, he had made up his mind to commit suicide if I could not
+     help him. I foresaw that it would in the best case demand months of
+     insistent energy to make a man out of that unfortunate wreck. He
+     had gone through three different morphine cures in three
+     sanitariums and none had helped him, and every physician whom he
+     had consulted had declared his case as beyond any physical cure. I
+     decided to make the somewhat disproportionate sacrifice of time in
+     order to study whether even such an extreme case of morphinism is
+     accessible to psychotherapeutic treatment. Four months later, he
+     left my laboratory looking like an athlete, strong and vigorous,
+     joyful and energetic. For three weeks he had not received any
+     morphine, had good appetite, slept well, and had happily married.
+     As his wife was a trained nurse, she will take good care that no
+     new slip shall ever occur.
+
+     There was nothing remarkable in those four months of treatment. He
+     was easily hypnotized, and I hypnotized him at first every day,
+     then every second day, then every week. It was without difficulty
+     that I reduced the forty grains to about six grains a day. Then the
+     struggle began. To test the case as a strictly psychological
+     problem I left the effort entirely to his own will, that is, I did
+     not deprive him of the morphine supply but left the regulation in
+     his own hands. During that whole winter he had a bottle with a
+     thousand morphine tablets standing on his desk. Thus he would have
+     been entirely able to satisfy any craving, but by his own will he
+     followed my suggestions and never took more than I permitted. It
+     meant a terrible struggle. The tortures which he had to pass
+     through were perhaps worse than those which he had experienced at
+     the time of his lowest downfall. They came to a focus when he tried
+     to go from five grains to three grains a day and then again when
+     he approached half a grain. From there he had to move to a fourth
+     of a grain, then to an eighth, and even that had still to be
+     divided into four different doses which were then reduced to three,
+     to two, and finally to one dose and ultimately to injections of
+     warm water. A rapid increase in general strength and a return of
+     appetite for food began when he had reached the five grain limit. I
+     did not allow on any occasion the introduction of a substitute. On
+     the other hand, I added every day suggestions covering the various
+     secondary symptoms, especially the pains in the stomach and the
+     feelings of faintness and the emotional depression.
+
+There, is no doubt that under favorable conditions, especially if the
+dose of morphine is not too strong, autosuggestion can bring about a
+similar effect. A reduction of ten per cent every week can be carried
+through, if a pledge is given to one's self in a drowsy state. The great
+value of autosuggestion showed itself not seldom in the fact that
+morphinists who had applied to me by mail for a cure in the mistaken
+belief that I do work in a professional way for payment and who got from
+me a written reply that I could not receive them, but that they can help
+themselves, wrote to me that my letter gave them strength to reduce
+their dose considerably.
+
+Quite similar is the situation with cocainism or with the combination of
+morphine and cocaine which is so frequent nowadays with young
+physicians. I have repeatedly seen cures where the case already gave the
+impression of insanity. Again I give a rather extreme case.
+
+     A physician had acquired the habit of using and misusing cocaine
+     for the treatment of a disease of his nose. The habit grew to a
+     craving for cocaine while the cocaine itself poisoned the brain.
+     Acoustical hallucinations began; he heard voices from every corner
+     of the room, and on the street the voices took persecutory
+     character. He connected them with his brother living in Europe,
+     heard his voice in the denunciations, and developed a pathological
+     system of ideas around the central thought that his brother had a
+     telepathic influence on him. His reason succumbed, he lost all
+     consciousness of delusion, and believed himself really to be under
+     the control of the absent brother. When he came to me he had been
+     without sleep and without food for several days, and he was not
+     seeking my help to get rid of the mental disturbance but to
+     overcome the power of his older brother. He did not connect the
+     fear at all with his misuse of cocaine. When I discovered the role
+     which the cocaine played, I determined to try the suggestive
+     influence, the more as I found that he was in a half-hypnotic state
+     as soon as he had entered my room. I suggested to him to sleep and
+     to take food and to reduce the cocaine dose by a fourth. The next
+     day he was an entirely different man by the effect of ten hours'
+     sleep and a large breakfast. Now I concentrated my efforts on the
+     reduction of the cocaine. After ten days of hypnotic treatment he
+     gave up cocaine entirely, after three weeks the voices disappeared
+     and slowly the other symptoms faded away. The pathological idea of
+     the telepathic influence lasted a while after the voices had gone
+     until this idea, too, yielded to suggestion. It still took six
+     weeks before he himself felt that he was entirely normal.
+
+The way in which the average physician nowadays neglects the simple tool
+of suggestive treatment, when it can be used for the protection of
+society, is perhaps nowhere so reckless as in the case of the morphinist
+and cocainist. To give a typical case of this neglect I may mention that
+of a highly intelligent young man who had been in the habit of using
+both cocaine and morphine for ten years when at his own request he was
+sent to a New York hospital. He had been taking alternately morphine for
+a year or two, then cocaine for a year or two, and had sometimes
+alternated and sometimes combined both in an irregular way. When he
+entered the hospital in May, 1908, he was in a cocaine period and was
+taking the enormous dose of one hundred and eighty grains of cocaine
+every day. In the hospital they withdrew the drug altogether. During the
+first weeks, he was entirely sleepless. They energetically refused him
+any substitutes and after six weeks he began to feel comfortable. He
+gained steadily in weight and after three months, when he left, he had
+gained fifty pounds, felt entirely comfortable, and seemed in all
+respects normal again. Before twelve hours had passed after leaving the
+hospital, he had again taken thirty grains of cocaine and ten grains of
+morphine, and this dose rapidly grew until after a few weeks it again
+reached a hundred grains of cocaine and up to sixty grains of morphine a
+day. Then came the complete breakdown. If that man in the last two or
+three weeks of the hospital treatment, when he felt entirely comfortable
+and normal and had gained his normal weight, had received even a slight
+suggestive treatment suppressing any desire for cocaine or morphine, he
+would easily have been saved. To let such a man after a drug career of
+ten years go out again to the places of his old associations, where the
+desire had to be stirred up, is inexcusable at a time when
+psychotherapeutics has won its triumphs in this field. It might have
+been sufficient to give him preventive treatment at least for the first
+three days of his freedom. And such a case is typical of hundreds.
+
+The overstrong impulse and overstrong desire finds its counterpart in
+the abnormal lack of energy and lack of attention. The patient--and it
+is especially the neurasthenic patient--has lost his usual strength, he
+shrinks from every undertaking, he cannot decide upon any action, he
+needs a disproportionate effort for the smallest task, and cannot
+concentrate his attention in spite of his best will. The varieties of
+this lack of power and inertia are familiar to every physician. They
+certainly often need much more than merely psychotherapeutic treatment,
+although on the physical side no schematic method is admissible. The
+laziness of the anaemic needs a different treatment from the laziness of
+the exhausted but in every case psychological factors can be of decisive
+influence, whatever the physical and chemical treatment besides them may
+be. A few letters may again illustrate the varieties. Here again there
+is no sharp demarcation line between the normal and the abnormal.
+Letters like the two following, for instance, are hardly letters of
+patients. They show a variation which is still entirely within normal
+limits and yet a source of suffering; it is a disturbance which usually
+can be removed by psychotherapeutic means.
+
+     "I do almost everything with effort, nothing spontaneously. I have
+     been writing for five years but am a mood writer of the worst type.
+     The mood comes at such uncertain times that I seem to be absolutely
+     at the mercy of caprice. This might not in itself be a misfortune
+     but writing is my only calling and I suffer the proverbial torments
+     of lost spirits when I am idle. The necessity of driving myself to
+     every piece of work, aggravated by the fact that my parents allowed
+     my constitutional inertness to have full play, has hitherto
+     prevented me from forming any regular habit of labor. I am now
+     thirty-eight. Would you suppose that if I kept my nose to the
+     grindstone for one, two or three years, I might yet hope to work
+     with some ease and regularity? That is, if I compelled myself to
+     write a certain number of hours every day as a discipline,
+     regardless of the quality of matter I produce, is there any
+     probability that I might ultimately overcome the fearful paralysis
+     that so often grips my faculties? Can constitutional indolence be
+     overcome by determination? I put in a little time on a couch every
+     day. When worried I get neurasthenia and all kinds of phobias. Just
+     now I am afraid to look at the newspapers on account of the cholera
+     in St. Petersburg, and I have seen the time when I found it
+     difficult to drink water after I had boiled it myself."
+
+Also the next man is familiar to all of us.
+
+     "Plainly we are told every man is born into the world to fill some
+     purpose, or at least be of some benefit to himself or his
+     fellowmen. For some reason I do not make friends among men. I have
+     not the zeal or ambition to carry or even begin a conversation
+     that will interest the individual man. I worry a great deal. I have
+     never been able to concentrate my mind to study and figure out
+     problems. I can read them zealously but apparently do not get to
+     the bottom and cannot retain what I do read. If I could just get
+     hold of the power of thinking and dig out that tangible something
+     that holds me back, I could go forward and make myself what I know
+     I should be. But I feel that so far I am a total failure. If I only
+     had that one great gift, the power of concentration and will power,
+     I would make what I so much desire, a success of myself."
+
+A similar effect and yet psychologically a different condition exists
+where the lack of energy results from the suggestive power of the
+opposite, producing a constant indecision.
+
+     "I am thirty years old and nearly all my life since childhood I
+     have been fearfully troubled with the habit of indecision and
+     regretting whatever I do. It has grown into a habit so fixed that
+     at times I am fearful of losing my mind. I feel anxious to do
+     something and decide to do it, then as soon as it is done, I nearly
+     go wild with regrets until I have to undo it, if possible, and then
+     only to regret that. I am this way about the most trifling things
+     and about the most serious. I can't perform any duty well. In
+     business and in social affairs, it is always with me. It has me in
+     its clutches, a horrible monster dragging me down. My friends
+     misinterpret me and wonder what I mean by doing so when all the
+     time I want to do what is for the best and cannot for this tyrant
+     who is ever present with me. I will plod for hours and hours at a
+     time, and at every turn I am handicapped. I am intelligent
+     naturally and appear a perfect fool."
+
+From the report of such chronic cases we may turn to the acute ones.
+Here a characteristic letter of, a typical neurasthenic young modern
+poet.
+
+     "These are my plans but I hardly think that I can carry them
+     through, although perhaps you can help me by suggestion. I have the
+     feeling that through the whole of last year my development did not
+     go forward but backward. It is as if by a mental or physical
+     overstrain, my whole personality has entered into a transition. I
+     have no joy in life, no sensation in love, no satisfaction in
+     labor. My will has become weak where it was strong. I am lazy, up
+     to an absolute dislike of everything, while I have been energy
+     itself. Often I have only the one desire, to end my life from mere
+     fatigue. If there had been any external reason for ending my life,
+     I should perhaps have done it long ago. I am so apathetic that I no
+     longer take myself seriously. My successes do not please me; the
+     idea of writing anything gives me anxiety. I have become less
+     resisting, more sweet, more soft, I should almost like to say, more
+     feminine. I became infatuated with a girl, simply because I knew
+     that she hates all men. The inaccessible is still the only thing
+     which can stimulate me somewhat. I have even written a poem on her,
+     but nothing can satisfy me in love. I consider my state a disease
+     of the will as a result of nervous exhaustion. I must find some one
+     who, with kindly power, reenforces my will system. I need a strong
+     mind--it may be a man or a woman. It would even be possible in the
+     latter case that I might marry her.
+
+     "Even the writing of this letter has fatigued me so much that I
+     should like best to sleep. In moments like the present I should
+     like best to throw myself down on the street or ... quickly ...
+     sink ... into the ocean. (I regret having made the little points.
+     They look as if my expressions are a pose.) Yet there are moods in
+     which I am entirely normal and no one fancies what I am passing
+     through. I have even become superstitious lately. Are there perhaps
+     beings which can absorb our energy? Perhaps another being has drunk
+     up my energy."
+
+Authors run easily into such states. Here is another.
+
+     "I am a neurasthenic, and I am beginning to believe, a professional
+     one. My object in writing is to ask concerning the advisability of
+     my visiting you for treatment. I am ready to take the next train if
+     you say the word, if you believe you can help me. It seems that the
+     regular practitioner, who is very irregular, cannot. If there is
+     one good doctor I have not consulted, I would like to know his
+     name. I was doing editorial work in X and broke down. Still the
+     doctor said that if I liked my work, I should go back to it and
+     pitch in. I did. It lasted a few days and then I had to give up
+     altogether, couldn't grind out another word. Then to another
+     doctor----also the best in the city. He told me to give up all
+     work, which I did, and then I went on a farm for six months. That
+     did not help me either. Later I went west and spent some time in
+     the mountains. I felt no better there. Then I went to Arizona and
+     lived in a tent out on the desert; that did not help me. There was
+     always a sensation of exhaustion and any physical exertion put me
+     on my back, even when it was light and pleasant exercise. Then I
+     went to California; it did me little good. It is a perfect paradise
+     for anyone who has not got neurasthenia. I still have not got
+     myself in hand. I cannot do or say or write just what I wish, and
+     cannot concentrate my thoughts. To try to read a book is punishment
+     because I forget as fast as I read." And so on.
+
+     I answered him certainly not to come but tried to induce some
+     autosuggestions. A few weeks later, he wrote me: "Ever since you
+     wrote me, I am now feeling somewhat improved." Yet I cannot judge
+     how far the improvement belonged to the psychical factor only,
+     inasmuch as I had advised him also to take some bromides. The
+     really effective treatment would have been heterosuggestion and I
+     had no time to enter into the case.
+
+Where direct suggestion is used, the effect is often surprising.
+
+     A young lawyer after a period of overwork had come to a state of
+     complete lack of energy. He could not find strength to write a
+     letter and he came to me at a day when he did not see any way but
+     suicide open for himself. He complained that, as soon as he began
+     to grasp a thought, it was evaporating. He stared absently about
+     the room and felt sure that he would never again achieve anything.
+     He had not even the energy to read the newspaper. I hypnotized him
+     three times, each time waking in him the pleasure in a definite
+     piece of work, at first simply in a novel which he was to read,
+     then in some letters which he was to write, and then in his
+     professional work. There was always an interval of three days. The
+     fourth time he declared himself that the hypnotic influence was
+     unnecessary, as he felt that he was again in the midst of his work.
+
+As a rule the effect is a much slower one, but if all personal factors
+are well considered and especially physical disturbances are excluded,
+the result is usually satisfactory.
+
+Very different from such neurasthenics, of course, is the lack of
+attention in the feeble-minded, and suggestion of the ordinary type is
+hardly advisable, but it is surprising how much can be reached by a
+systematic psychical regime. I give one typical instance, representative
+of many.
+
+     A boy of twelve years when he was brought to me showed the mental
+     powers of a stupid child of four. In a silly way he repeated every
+     question which he heard without answering it; he talked steadily to
+     himself in a nonsensical manner, mostly repeating nursery rhymes
+     without end, never holding his attention to anything in the room,
+     giving the impression that there was no attention whatever. The boy
+     was a child of rich parents; he had his own teachers, but was for a
+     large part of the year under the influence of the parents only, who
+     very naturally yielded to every desire of the unfortunate child. I
+     insisted on a complete change of the education. It was my effort to
+     build up the mind by a rigorous training and by development of the
+     power of inhibition. I absolutely forbade any meaningless material
+     like the nursery rhymes, insisted that the child should never be
+     allowed to talk to himself, and whenever he began to speak to
+     himself he was to be addressed sharply, and if he yet went on, to
+     be slapped on his hands. In the same way he was not allowed to
+     repeat a question, but the question was repeated until he answered
+     it, the question always formulated in simple words. He was forced
+     to go through simple reading and writing without being allowed to
+     make his silly diversions. His whole life was brought under strict
+     discipline and no parental indulgence was permitted. Six months
+     later the child was completely changed. It seemed as if he had gone
+     through an improvement of three years. I regulated the whole of
+     his elementary studies in accordance with the successful principle.
+     The training of inhibition stood in the foreground and every
+     haphazard reaction was severely rebuked. The summer vacations spent
+     with the parents in the fashionable surroundings, to be sure, had
+     always a retarding influence, but the main part of the year in
+     which it was possible to carry through the strict discipline showed
+     such steady and inspiring progress that the boy, while of course
+     feeble-minded for life, can yet live externally a harmonious life.
+
+A systematic training of the power of inhibition is indeed the
+fundamental factor in all psychotherapeutic treatment when the
+disturbance is in the volitional sphere, but the inhibition is secured
+most safely by reenforcement of the antagonistic attitude. From these
+volitional variations on the one side, from the ideational disturbances
+on the other, only a few steps lead to those dissociations of the
+personality which are characteristic of many graver cases of hysteria.
+But to give to them any adequate analysis, it would be insufficient to
+refer in this brief way to particular cases. Psychopathological
+literature possesses some excellent analyses of such complex
+disturbances. As I said before, I abstain entirely here from such
+complex phenomena, as they enter too seldom into the sphere of the
+practitioner and as the bewildering manifoldness of their symptoms does
+not allow us so easily to recognize the fundamental principles which
+alone were to be illustrated by our short survey of practical cases.
+
+
+
+
+XI
+
+THE BODILY SYMPTOMS
+
+
+The discussion of the bodily symptoms which may yield to
+psychotherapeutic treatment, naturally forms only a short appendix to
+our discussion of the mental symptoms. Our interest was from the
+beginning essentially a psychological one. I shall have to be the more
+brief as my personal experience in the treatment of bodily diseases
+through mental therapy is entirely secondary and accidental. The
+psychological laboratory would, of course, be an entirely unfit place to
+struggle with diseases of which the chief symptoms are not
+psychophysical. Yet in spite of frequent testimonies of well-known
+physicians to the contrary, I am still inclined to think that this is
+also the situation at large. I think that in medicine in general the
+psychophysical effect of mental treatment is by far more important and
+by far more extended than the healing effect on diseased peripheral
+organs. Of course these peripheral parts of the body may be favorably
+influenced in an indirect way by the mental treatment; we shall have to
+take notice of this important result but that is strictly not a
+therapeutic effect on the bodily symptoms. Moreover, purely psychical
+effects may give an impression as if the bodily symptom itself has been
+removed.
+
+To begin with the latter case, it is especially the inhibition of pain
+which easily makes one believe that a bodily disturbance is successfully
+treated. I have repeatedly seen cases in which I tried by suggestion to
+soften the pain resulting from a peripheral disturbance like
+inflammations, rheumatism, decayed teeth and so on. The effect was often
+such a total disappearance of the pain that the patient himself was
+inclined to believe that the objective disease had been ended, while in
+reality the state of the diseased organ was not changed at all. It has
+often happened that I tried to cure a person of certain mental symptoms
+by suggestion, ignoring entirely the existence of some pain resulting
+from a bodily disease with which I had nothing to do. Yet the suggestion
+of improvement seemed almost to irradiate and the pain disappeared in
+spite of having been ignored by the hypnotizer. For instance, I treated
+a woman who suffered from psychasthenic obsessions, fearing all the time
+that something would happen to her child. I did not give any direct
+attention to the fact that she had had for years a painful disease of
+the bladder for which she was constantly treated by a specialist. But
+while I did not mention the bladder in my hypnotic suggestion, yet the
+abdominal pain disappeared together with the obsession and the situation
+might easily have suggested that the bladder trouble was a nervous one
+which had been cured by the hypnotic sleep. The fact was that the
+bladder disease was not influenced by the mental treatment at all, and
+needed a continuation of the same local treatment. It was only the
+psychophysical pain in the brain which had been inhibited.
+
+Quite parallel to the disappearance of the organic pain sensation is the
+arising of a general feeling of improvement. This organic sensation of
+general betterment may again be a strictly mental occurrence without any
+objective reference to a real improvement in the bodily conditions. Yet
+again that easily gives the impression of an important change in the
+bodily conditions themselves. The miraculous cures of various diseases
+through mystic agencies generally belong to this category. There is no
+doubt that often the migrating charlatans who advertise themselves by a
+free treatment of the sick and invalids on the theater stage of small
+towns, produce momentary effects which are sufficient to deceive. The
+quack handles the diseased organ, perhaps a goiter or a leg crippled by
+rheumatism, with a cruel rudeness and overwhelms the suggestible mind so
+completely that the first autosuggestion is that of a complete change,
+and that means cure. The disastrous results follow later. But from such
+barbarisms we come by gradual steps to the suggestion of improvement
+where the feeling of betterment can be in itself an important factor for
+the cure. Yet even there we must not mistake the possible secondary
+effect of a mental change from a psychotherapeutic cure of the bodily
+disease.
+
+Not seldom the removal of physical disability seems secured as soon as
+certain mental disturbances are removed. There is no reason to believe
+for instance that suggestion can have an important influence on a
+diseased sense organ, and yet hypnotic influence and even autosuggestive
+influence can under certain circumstances greatly improve seeing and
+hearing. Especially in the field of hearing the central factor is of
+enormous importance. Hyperaemic and anaemic conditions in the brain
+centers of hearing control the vividness of the received sound. The
+patient who cannot hear a certain watch more than one foot distant may
+be able to hear it after some glasses of wine at a distance of three or
+four feet. Thus it is only natural that a hypnotic influence can produce
+similar changes on the psychophysical centers in such cases in which the
+source of the trouble is a psychophysical laziness in the acoustical
+center. Sometimes even this laziness itself is the result of psychical
+autosuggestion which can be fought by counter-suggestion. I saw, for
+instance, a distinct improvement in hearing in the case of a young woman
+who had increasing deafness while the aurists declared that the ears
+were in proper condition. I found that she lived with a father who
+suffered from a severe middle-ear catarrh and that she was simply
+controlled by a hidden fear that she might have inherited the ear
+disease of her father. I removed this fear, partly by reasoning, partly
+by suggestion, and partly by tricks which surprised her, for instance,
+making her hear her watch with unaccustomed strength when she took it
+between her teeth and closed both ears. The autosuggestive fear was
+uprooted by these and the central ear organs slowly came to normal
+functioning.
+
+The purely psychical character is still more evident in the frequent
+hysterical anaesthesias. No one doubts that here the sensations are
+inhibited only and that the mental influence removes this inhibition
+without any influence on the sense organs proper. Frequently also
+organic troubles like stomach diseases appear cured when in reality
+hysterical disturbances are at the bottom. The stomach may be sensitive
+to any pressure and may produce severe pains and vomiting on taking any
+food and everything may indicate a serious local disturbance. Yet
+hypnotic treatment may quickly remove the symptoms because the whole
+reaction may have resulted from the shock which perhaps a too hot piece
+of potato caused. The removal of this mental starting point results in a
+cure of the apparent stomach disease. Again in other cases, the
+appearance of a physical cure is given by the creation of psychophysical
+substitutes. I do not believe that hypnotism or suggestive treatment can
+influence the brain parts which have suffered from a hemorrhage. Yet the
+paralysis of the arm, for instance, which resulted from such a breaking
+of a blood-vessel in the brain may be to a high degree repaired by
+building up new motor images in the psychophysical system, which become
+starting points for a new learning of movements. The patient did not
+understand how to make the most out of those motor paths which had been
+left. The destruction of the chief channels of discharge had inhibited
+in his mind the idea of possible movement. He no longer believes that he
+can move and it needs new suggestions to overcome this inhibition. The
+curative effect on bodily disabilities is thus often an illusory one.
+
+That does not mean that the field in which psychotherapeutics may work
+directly on the body is not after all a large and interesting one.
+Theoretically it is still little open to real understanding. The
+explanation has essentially to rest on the acceptance of a given
+physiological apparatus. A certain psychophysical excitement produces by
+existing nerve connections a certain effect, for instance, on the
+blood-vessels or on the glands of a certain region, or on a certain
+lower nervous center. That such apparatus exists, the physiological
+experiment with persons who are hypnotized to a high degree can easily
+demonstrate. Their nose bleeds at a command; a blister may arise on a
+part of the skin which is simply covered with a penny, when the
+suggestion is given that the penny is glowing hot. With some subjects,
+the pulse can become slower and quicker in accordance with the
+suggestion; with some even the bodily temperature can change on order.
+Our understanding of these indubitable facts indeed does not go further
+than the acknowledgment that the paths for such central connections
+exist. That means we simply describe the facts once more in the terms of
+anatomy. But after all in the same way we rely on the nervous
+connections, if a thought makes us blush and ultimately if our will
+moves our arm or if our ideas move our speech apparatus. We do not
+choose the muscles of our arm, we hardly know them; we know still less
+in speaking, of the movements of our vocal cords, and in blushing of the
+dilated blood-vessels. That ideas work on the lower centers of our
+central nervous system, centers which regulate the actions of our
+muscles and blood-vessels and glands, must simply be accepted as the
+machinery of our physiological theory. The connection of such theories
+with purely physical facts is given by the experience that an electrical
+stimulation of the nerve may have the same influence as ideas. The
+electric current, too, can regulate the beat of the heart, or contract
+and dilate the vessels, or reenforce and relax the contraction of the
+muscles, or strengthen and weaken the functions of the glands.
+
+Nearest to the psychophysical processes stands the bodily symptom of
+insomnia. There is no doubt possible that the work of the
+psychotherapist can be very beneficial in producing sleep by suggestion.
+That autosuggestions for sleep play an important role is popularly
+accepted. Next to the most immediate means such as lying down, or
+cutting off sense stimuli, or trying not to think, or avoiding
+movements, certainly the most well known factor is the expectation of
+sleep with the belief that sleep will come. This belief may be
+reenforced to strong autosuggestion which may then overcome other
+factors that hinder sleep. For instance, I have repeatedly received
+letters from strangers containing expressions of gratitude with news
+which under other circumstances would at least not flatter an author.
+They wrote to me that immediately after reading one or another essay of
+mine on hypnotism, they fell into deep sleep. Yet as they were always
+patients who had suffered from insomnia, I was pleased with this
+unintended effect of my writings. But in most cases a real cure demands
+heterosuggestion.
+
+There is room for any variety of effects; often they enter immediately.
+The other day I gave sleep suggestion to a young woman who had
+overworked herself in literary production. For months she had not slept
+more than three or four hours a night and even that only after taking
+narcotics. I intentionally did not allow her to come into a hypnotic
+sleep but kept her fully awake, increasing her suggestibility while her
+eyes were wide open. I suggested to her to take a walk, then to eat her
+dinner, and after that to go to bed at once. She went to bed at seven
+o'clock and slept without waking until ten o'clock the next morning, and
+after fifteen hours' sleep she was like a different being. A regular
+eight hour sleep is sometimes secured, even where no immediate direction
+has been given for it. On the other hand, I cannot deny that I have
+sometimes been entirely unsuccessful in securing better sleep by the
+first three hypnotic treatments. When the first three treatments were
+unsuccessful, I always gave it up on account of lack of time. Yet the
+experience of others shows that in such cases, often after a long
+continued hypnotic treatment insomnia yields to suggestion. One of the
+great factors which work against the mental treatment is the habit of so
+many sufferers of relying on their sleeping powders which, to be sure,
+remain effective only by increasing the dose and thus finally by making
+them dangerous. Every chemical narcotic has in itself suggestive power
+and strengthens the belief of the sleep-seeker that he cannot find rest
+without his dose. To overcome the monopoly of the opiates is one of the
+most important functions of psychotherapy.
+
+It is not surprising that the relations of psychotherapy to sleep show
+such a great variety. The factors which cooeperate in normal sleep are
+many and the disturbance can have very different character. We had to
+speak of the psychophysics of sleep when we discussed the theoretical
+relation of sleep to hypnotism and insisted that it is misleading to
+consider hypnosis simply as partial sleep. We claimed a fundamental
+difference between the selective inhibition in hypnotism and the general
+reduction of functions in sleep. To understand sleep, we have to
+recognize it as one of the fundamental instincts, comparable with the
+instinct for food or for sexual satisfaction. Every one of such
+instincts has a circular character. Mental processes, subcortical
+processes, and physical effects are involved in such a way that each
+reenforces the others. The physical effect of the sleep instinct,
+comparable with the pepsin secretion in the food instinct, or with the
+hyperaemia of the sexual organs in the sexual instinct, is a change in
+the cortex by which the sensory and motor brain centers are put out of
+action. What kind of a change that is, is quite indifferent. It may be a
+chemical one but more probably it is a circulatory one. Let us say it is
+a contraction of blood-vessels which by the resulting anaemia makes the
+sensory centers unfit for perception and the motor centers unfit for
+action. In this way the brain becomes protected by sleep against the
+demands of the surroundings. The mental reactions are eliminated and the
+central nervous substance has an opportunity to build itself up. This
+protective physical activity is now evidently itself controlled by a
+subcortical center, just as secretion and sexual hyperaemia are
+controlled. This center probably lies in the medulla oblongata.
+
+Some theorists, to be sure, are inclined to think that the fatigued
+brain cells enter directly through their exhaustion into the protective
+sleep state. But that simplifies the situation too much. It is quite
+true, as these theorists claim, that monotonous stimulation of the
+senses produces sleep. But it is evident that the sleep occurs even then
+not only in the particular overtired brain cells. A monotonous
+stimulation of the acoustical center raises the threshold of perception
+for all the senses and brings sleep to the whole brain. This control of
+the whole apparatus is thus surely regulated by one definite center. But
+this lower center, which controls the anaemia of the cortex, is itself
+directly dependent again upon a mental condition, the mental experience
+of fatigue. The fatigue sensation, which is possibly the result of toxic
+processes, works on that lower sleep center, just as the appetizing
+impression or the sensual images work on the centers of the other two
+instincts. On the other hand this protective blood-vessel contraction
+creates again as in the other cases a characteristic organic sensation,
+the sensation of rest which arises when the threshold of perception and
+activity is raised. The world begins to appear dim and far away, no
+impulse for action excites us. This organic feeling of rest associates
+itself with the fatigue feeling. The fatigue sensation, the subcortical
+sleep center, the contraction of the vessels in the cortex, and finally
+the rest sensation form together the complete circle. The difficulty
+which arises in this case lies only in the fact that the cortex gone to
+sleep annihilates also, of course, the fatigue sensation and the rest
+sensation. For that reason the real circle can appear only in the
+preparatory stages of sleep. As soon as sleep itself sets in, the circle
+is broken. The circle character of every instinct must lead the physical
+effect upward to a higher and higher degree. Not to become excessive,
+the physical effect must be checked somehow. In all other spheres, it
+finds its end in satisfaction, for instance, by eating or by the sexual
+act. In sleep the circular process ends automatically by its own effect
+as soon as complete sleep is reached. Its causes, the fatigue and the
+rest feeling, are stopped, as soon as the effect, the anaemia, is
+secured.
+
+We see now how widely different starting points can lead to sleep and
+can understand from it how widely different disturbances can prevent
+sleep. Sleep must result when fatigue is coming, but sleep must also
+result when the elements of the rest feeling are produced, and as we saw
+that the components of the rest feeling were the sensations of decreased
+sensitiveness and decreased activity, sleep must result when either the
+sensations and associations are absent and actions are suppressed, or
+when monotonous sensations and automatic actions raise the threshold.
+Sleep must arise further if our will associates the mere idea of such
+rest, and finally physical or chemical means may produce a sleep
+bringing effect either on the lower center or on the blood-vessels and
+cells of the cortex. Correspondingly sleep may be prevented by
+disturbances in any one of these spheres. There may be no normal
+fatigue, there may be no fatigue sensation, there may be no rest feeling
+on account of perceptions, or on account of associations, or on account
+of impulses to action; there may be no normal response in the
+subcortical center, there may be no physical effect in the cortex on
+account of an existing hyperaemia or on account of an abnormal condition
+of the cells. The psychotherapeutic treatment must carefully analyze
+which element would be fit to supply the last link in the circular
+chain. Sometimes we need the suggestion of fatigue, sometimes the
+inhibition of ideas, sometimes the suppression of impulses, sometimes
+the suggestion of rest, and so on. A mere general suggestion of sleep is
+on the whole effective only in the cases of those persons in whom this
+idea in itself awakens those various components. Very often it is
+entirely ineffective in this general form. Sometimes it is possible to
+carry the hypnotic state itself directly over into sleep, but it seems
+more in the interest of the patient to separate those two states
+distinctly.
+
+We are still confined to processes in the brain itself if we turn to
+headache. If it were only a question of inhibiting the pain by mental
+suggestion, the case would not be different from inhibiting the pain of
+a peripheral organ without attempting to cure the diseased organ itself.
+But in the case of headaches, it seems justified to claim that in
+certain varieties of this multifold symptom, not only the pain is
+suppressed but the disturbance itself is removed. Especially where the
+headache seems to result from hyperaemia, the trouble seems to be
+accessible to psychotherapeutics. On the other hand I have never seen
+any lasting effect on the so-called sick headache or migraine. While
+continuous headaches or headaches which occur daily yielded to my
+influence, sometimes completely, I was unable to prevent even by
+preparatory hypnotization any migraine which appears periodically, for
+instance, simultaneously with menstruation.
+
+A few words only as to the general diseases and disturbances for which a
+very strong therapeutic effect has been claimed by masters of the craft
+like Wetterstrand, Moll, Dubois, and others. From my own experience I
+can affirm the often lasting effect in the disturbances of the functions
+of the digestive apparatus. The stomach and the intestines seem to a
+high degree under nervous influences which can be changed through
+hypnotic suggestion. If we consider what intimate connection exists
+between the functions of these organs and the normal emotions, it seems
+hardly surprising that mental factors can regulate their disturbances.
+Vomiting, diarrhea, and especially constipation, often yield to slight
+suggestions, even in a superficial hypnotic state. Here, too, I have
+seen repeatedly a complete regulation of a long-standing disturbance as
+an unintended by-product of hypnotic suggestion directed towards the
+cure of psychical troubles. Much value is claimed for hypnotic method in
+the treatment of anaemic conditions. It is said that anaemia improves
+after a few hypnotic treatments, the appetite becomes better, the cold
+hands and feet grow warmer, the headaches disappear, the capacity for
+work increases rapidly, and most surprising of all the leucorrhea
+ceases. As to heart disease, we ought to think in the first place of the
+disturbances of nervous innervation. I have seen repeatedly a remarkable
+decrease of nervous palpitation of the heart through direct mental
+influence, abstracting here from the secondary effect of suppressing
+mental excitement and fear. Where organic heart diseases are surely
+present, it seems that hypnotism can sometimes act beneficially if the
+heart trouble is accompanied by anaemia and general debility; of course a
+developed valvular disease cannot be removed. In the same way it seems
+that in Bright's disease, certain painful symptoms may be suppressed,
+but the kidneys certainly cannot be influenced. At least open to
+serious suspicion are the insistent claims that diabetes can be cured by
+suggestion. Dr. Quackenbos of New York, for instance, gives to some of
+his diabetes patients a hypnotic suggestion by the following words: "If
+your pancreas be crippled in its production of the natural ferment which
+is given off to blood and lymph and which conditions the normal
+condition of sugar in the body or restrains the output of sugar from the
+liver tissues, you will see that it forthwith pours into your blood or
+lymph the sufficient quantity of sugar oxidizing ferments." It certainly
+transcends our present understanding if we are to believe that a
+suggestion of this type will change the action of the pancreas. It is
+hardly worth while to enter into the still more extravagant claims from
+other sides like those for curing cancer and phthisis. On the other
+hand, in the light of all that we have discussed, there is no difficulty
+in understanding the easily observable influence in the regulation of
+menstruation, in the cure of contractions, local congestions, and
+incontinency of urine. I may mention finally the use of hypnotism for
+helping in a safe and quick confinement.
+
+But in addition to all this, we have the great help which psychotherapy
+may bring indirectly in the treatment of physical diseases. I said, for
+instance, that I do not believe in a real help by mere suggestion in
+cases of diabetes. But no one ought to underestimate the value which may
+result for the treatment from a suggestion of a well-adapted diet. The
+patient who feels a craving for bread and potatoes and perhaps sweets,
+and is too weak to resist it, is indeed brought into safety if
+suggestion liberates him from such desires. The same holds true for
+every other diet and for any medical regime of life which does not
+harmonize with the natural instincts of the patient. For not a few
+sufferers, reenforcement of the interdict against coffee and tea or
+alcohol and tobacco is more important than any medicine. Hypnotic
+suggestion can easily create dislike of the prohibited material and can
+build up new desires and inclinations. In the same way it is indirectly
+most important to stir up, for instance, the sensations and feelings of
+appetite and thus to make normal nutrition possible. Also in cases of
+anaemia or tuberculosis, such indirect assistance can produce some
+beneficial consequences.
+
+The same holds true of the power of the psychotherapist to secure sleep.
+The fight against insomnia which we discussed referred only to that
+sleeplessness which is itself an expression of the disease. But as a
+matter of course, the loss of sleep can accompany most different
+diseases, as an almost accidental result. To secure sleep means then not
+to treat the symptoms of the disease but a by-product; and yet every
+physician knows how much is gained if the lost energies are restituted
+by a sound sleep. And finally we have the indirect help towards the cure
+by the suggestive removal of pain. We have no right to say that it is a
+pure advantage for the treatment of the disease if the pain is centrally
+inhibited. Pain surely has its great biological significance and is in
+itself to a certain degree helpful towards the cure, inasmuch as it
+indicates clearly the seat and character of the trouble and warns
+against the misuse of the damaged organ which needs rest and protection.
+To annihilate pain may mean to remove the warning signal and thus to
+increase the chance for an injury. If we had no pain, our body would be
+much more rapidly destroyed in the struggle for existence. But that does
+not contradict the other fact that pain is exhausting and that the fight
+against the pain decreases the resistance of the organism. As soon as
+the disease is well recognized through the medium of pain and the
+correct treatment is inaugurated, not only the subjective comfort of the
+patient but the objective interest of his cure makes a removal of pain
+most desirable. While it would be absurd to say that hypnotism can cure
+tuberculosis or cancer, it is fully justifiable to say that hypnotic
+treatment in tuberculosis or cancer is to a high degree beneficial,
+inasmuch as it can secure sleep, appetite, and freedom from pain, three
+factors which indirectly help to fight the disease. The elimination of
+pain may sometimes also play its role in slight operations where other
+methods of narcosis seem for any reason undesirable, and very frequently
+hypnotic suggestion has been used for this purpose at childbirth.
+
+The same importance which belongs to the removal of bodily pain in the
+treatment of a peripheral disease may be given to its mental
+counterpart, to the worry, excitement, and emotional shock. They all
+stand in the way of a real success in any cure. Even the chances of a
+dangerous operation are entirely different for the patient who goes to
+it with free mind and a happy mood, with full confidence in its success,
+from those of a patient who has worked himself into a state of fear and
+anxiety. Here again the depression and the excitement are not in
+question as symptoms of a disease, as they were when we discussed the
+phobias and despondencies of the neurasthenic and of the hysteric. They
+are merely normal side-effects of the bodily disease, accentuated
+perhaps by a suggestible temperament. To eliminate all these emotions
+means to change most helpfully the whole atmosphere of the sick-room and
+to deprive invalidism of its saddest feature. This negative factor
+corresponds of course most directly to the positive feature of building
+up new hope and joyful expectation. He who creates confidence makes
+convalescence rapid and strengthens the power to overcome disease.
+
+It would be medical narrowness if the physician were strictly to deny
+that the effect of such emotional change may sometimes lead far beyond
+the ordinary suggestive influences and that in this sense the miraculous
+really happens. When out of a despondent mood in a suggestible brain an
+absorbing emotion of confidence breaks through, a completely new
+equilibrium of the psychophysical system may indeed result. In such
+cases, improvements may set in which no sober physician can determine
+beforehand. Central inhibitions which may have interfered a life long
+with the normal functioning of the organism may suddenly be broken down
+and in an entirely unexpected way the mental influence gives to the
+forces of the body a new chance to help themselves. The reasoning of the
+scientific physician may easily stand in the way there. He may be afraid
+of such overstrong emotion because he knows too well that such
+unregulated powers may just as well destroy the good as in another case
+the bad; in short, that ruin may result just as well as health. But that
+does not exclude the fact that indeed almost mysterious cures can be
+made without really contradicting the scientific theories. Such are the
+means by which the mystical cults earn their laurels. A chance letter of
+the type which often swells the mail of the psychologist may illustrate
+this effect. I choose it because it is evidently written by a skeptic. A
+short quotation from the lengthy epistle is sufficient.
+
+"My condition was horrible in the extreme. I had consumption of the
+lungs and other supposedly fatal troubles, complicated by wrecked
+nerves. At the present writing, I am robust and splendidly healthy,
+looking twenty years younger than I did at the period previously
+described. The Christian Scientist saw my condition but appeared
+unconcerned and unafraid, I being absolutely hopeless, skeptical, and
+deeply contemptuous meanwhile. On the third day of her treatment I was
+desperate for sleep, she having forbidden drugs, and I deliberately took
+an overdose of chloral, thinking to die at once and end it. My
+condition justified the act. She brought me out of the coma of the
+chloral after three hours of mental work, and the next day I felt
+decidedly calmer and less afraid of the coming of night, should I live
+to meet it, which seemed doubtful. At noon she left me to go to her home
+to lunch. I was pondering seriously on her reiterated 'God is love and
+fills the universe and there is nothing beside Him,' when I suddenly had
+a sensation of being lifted up or rising slowly and becoming lighter in
+body. A rush of power that I have no way of describing to you filled me.
+I seemed to be a tremendous dynamo in the air several inches above the
+ground and still ascending. When I noticed everything around me becoming
+prismatic and more or less translucent, I could have walked on water
+without sinking, and I had distinct understanding that matters seemed to
+be disintegrating and dissolving around me. I was frightened but
+self-conscious and quiet. I remained in this state for about three
+hours, my consciousness seeming to have reached almost cosmic greatness.
+I could have cured, I felt, any human ill, was filled with an absorbing
+altruistic desire to help suffering. It was tremendous and totally
+foreign to my everyday attitude. At the end of the day, towards
+twilight, I became wearied of the tremendous throbbing and exalted state
+in which I still remained and gave utterance to the thought aloud.
+Almost before I had formulated it the condition left me, and like the
+sudden dropping of a weight, I struck the ground, the same dull,
+ordinary person of everyday experience, but with the vast difference of
+perfect health, radiant and lasting to the present writing. My father
+like myself is baffled and wondering. We are both pretty hard skeptics.
+I want the truth, whether it be terrible or otherwise. I am profoundly
+grateful to the Christian Scientist, if I regained my health through her
+ministrations, but I have not so far been able to label myself and rise
+in their church services to tell what has been done on me. The
+performance repels me as crude and rather bad taste. I swear to you on
+my honor as an American woman and a mother that what I have written you
+is true, absolutely. If you can give me any light or if my experience
+may perchance give you a helping ray, my renewed lease on life may have
+had some purpose after all, which I have often questioned in my cynical
+moods."
+
+The unprejudiced psychotherapist will be perfectly able to find room for
+such cures and, if it is the duty of the scientific physician to make
+use of every natural energy in the interest of the patient's health, he
+has no right to neglect the overwhelming powers of the apparently
+mysterious states. Some of this power ought to irradiate from his eye
+and his voice whenever he crosses the threshold of a sick-room. Some of
+that power ought to emanate from him with every pill and drug which he
+prescribes. The psychotherapeutic energies which work for real health
+outside of the medical profession form a stream of vast power, but
+without solid bed and without dam. That stream when it overfloods will
+devastate its borders and destroy its bridges. The physicians are the
+engineers whose duty it is to direct that stream into safe channels, to
+distribute it so that it may work under control wherever it is needed,
+and to take care that its powerful energy is not lost for suffering
+mankind.
+
+
+
+
+PART III
+
+THE PLACE OF PSYCHOTHERAPY
+
+
+
+
+XII
+
+PSYCHOTHERAPY AND THE CHURCH
+
+
+The belief in supernatural energies has cured diseases at all times and
+among all peoples. Everywhere the patient sought help through the agents
+of higher forces and everywhere these agents themselves utilized their
+therapeutic success for strengthening the belief in their over-natural
+power. The psychologist would say that it was always the same story, the
+influence of suggestion on the imagination of those who suffer. Yet the
+variety of forms is abundant. Not only the special symbols but the whole
+attitude may take most varied character, and every special appearance is
+intimately related to the whole mystical background and to the
+religious, scientific, and social ideas of the time. If nevertheless,
+even at the same time in the same country, very different forms of
+religious suggestion are at work, it must not be forgotten that those
+who live together in any nation and are united in many common purposes
+represent, after all, different stages in the development of
+civilization. It has always been true that those whose minds are
+saturated with the real culture of their time are working together with
+those whose culture belongs to earlier centuries and with others whose
+minds are essentially of the type of the primitive peoples.
+
+Let us glance at the life of the savages. In darkest Africa, we find a
+special caste with its professional secrets which accepts new members
+only after long tests. They are evidently persons with over-sensitive
+nervous systems and liable to hallucinations. As soon as they have their
+attacks of abnormal excitement, they are conceived to be agents of
+superhuman powers, and on account of this they are able to prescribe the
+cure of any diseases. In Australia, therapeutic power belongs to the
+koonkie, a man who as a child had a vision of a demonic god. From him he
+received the power to heal the sick. He goes to the patient, touches the
+painful parts and rubs them and after a few minutes, he shows a little
+piece of wood which he had hidden in his hand and which he claims to
+have extracted from the body of the sufferer. The native feels actually
+cured after such manipulation of the koonkie, who evidently believes
+himself in his power. In Siberia, we find shamanism. The shaman stands
+between man and the gods. These shamans are excitable persons with
+epileptic tendencies, or at least over-suggestible men or women who by
+autosuggestion and imitation can bring themselves into ecstatic
+convulsions. They alone know from the gods the means to treat diseases
+and their personal influence overcomes the ailment. In early America,
+before the European discovery, the cure of disease belonged in the same
+way to the middleman between the gods and human beings. In the Antilles,
+for instance, the bohuti heals the diseases which are regarded as
+punishments of the gods for human neglect. The priest by inhaling a
+certain powder brings himself into an ecstatic condition, then presses
+the painful organs of the patient, sucks at various parts of his body
+until he finally produces some little bone or piece of meat which until
+then he kept hidden in his mouth. The disease disappears, and the
+extracted bone is used as an amulet which secures good harvests. Other
+Indians had their piachas. They were selected from among the boys of
+about ten years old and were then sent to lonely forests where they had
+to live for years upon plants and water without any friends, seeing only
+at night the older priests from whom they learned the ceremonies for
+curing the sick. Here too their art consisted mostly in touching the
+painful parts of the body with the lips and sucking them to bring the
+evil saps out of the body by their supernatural power. In short, at the
+most primitive stages in Africa and Asia, in America and Australia,
+therapy was acknowledged to be a special power of men who had superhuman
+forces derived from good or evil gods.
+
+All this repeats itself in the so-called half-civilizations. Among the
+masses of China, mental and bodily diseases were ascribed to the fox,
+which plays such a large part in the superstitions of eastern Asia. The
+priest has the power to banish the fox by mystical writings which he
+pastes on the wall of the sick-room, and the patient recovers, as the
+fox has to leave his body. In old Japan the mountain monks, who
+inherited their superhuman powers from a martyr of the fifth century,
+can remove the diseases which have magical origin or which are induced
+by the devil. They also supply the magical papers covered with writings
+and pictures of birds, to prevent the appearance of smallpox and
+pestilence and to cure a number of diseases. India, the classical land
+of suggestion and hypnosis, shows the most extensive connection between
+religious and magical powers among which the cure of diseases is only
+one feature. Such cure may be with medicaments or without, but the
+essential part always belongs to the prayers which make the good and
+evil spirits obedient to the healer. These prayers were often spoken in
+Sanscrit, which the people did not understand and which thus added to
+the mystic solemnity of the procedure. This suggestive influence of the
+use of older languages for religious solemnities, known only to the
+priests, repeats itself also at all times and among all nations. In
+Assyria and Babylonia, too, medicine was exclusively a branch of
+mysticism and essentially in the hands of the priests, who by words and
+magical beverages annihilated the influence of the malevolent demons. It
+is well known how the Old Testament reports the same traits of belief
+among the Jewish nation. We hear there that Miriam became leprous,
+white as snow, and Moses cried unto the Lord, saying: "Heal her now, oh
+God, I beseech thee." And after seven days Miriam was cured in
+consequence of Moses' prayer. And again, "The Lord sent fiery serpents
+among the people and they bit the people and much people of Israel
+died.--And Moses prayed for the people.--And Moses made a serpent of
+brass and put it upon a pole and it came to pass that if a serpent had
+bitten any man, when he beheld the serpent of brass, he lived."
+
+Among the old Egyptians, it was especially Isis who discovered many
+remedies and had been much experienced in medicine, and after having
+become immortal, it was her greatest pleasure to cure the sick and to
+announce the right remedies in dreams to those who came to sleep in her
+temples. Many who could not be cured by any physician, and who had lost
+their sight and hearing or could not move their limbs, became well again
+when they took refuge in her temples. The same holds true for the
+Serapis temple; even the best known men go there to sleep to get from
+the goddess cures for themselves or for their friends. It is well known
+again that in other ways the old Greeks attached medical influence to
+temples and sacred springs and rivers and tombs. There were sacred
+springs which cured everybody who drank from them, there were statues
+which removed every disease when offerings were brought to them. Here
+again the most frequent is the cure of paralytic symptoms and of
+obsessions. The Orphic priests of old Greece most nearly resembled the
+shamans of the savages.
+
+Those who are inclined to give to the life of Christ a rationalistic
+interpretation have often pointed out that the therapeutic effects
+described in the Gospels might also be understood as effects of
+suggestion by word and tactual impressions, produced especially on
+hysterics, epileptics, paralytics, and psychasthenics. Such
+rationalistic interpretations could also explain in the same way through
+the suggestive influence in the minds of the sick, those cures which
+Christ effected through others without being present himself. Here
+belongs perhaps the cure of the servant of the centurion in Capernaum or
+the cure of the daughter of the woman of Canaan. "And when he had called
+unto him his twelve disciples, he gave them power against unclean
+spirits to cast them out and to heal all manner of sickness and all
+manner of disease." The Acts give us the full details of how Peter and
+Paul cured the lame and how special miracles were performed by their
+hands. No doubt this belief in the curative effect of the disciples and
+their successors fills the first centuries after Christ. Eusebius tells
+us how they healed the sick by laying on of hands. The forms were
+frequently changing through the history of Christianity but the essence
+remains the same. Sometimes more emphasis is laid on the personal factor
+of the priest, sometimes more on the sacred origin of the symbol as in
+the case of the relics, sometimes more on prayer and godly works, but it
+is always the religious belief which cures. Typical are the therapeutic
+wonders of Francis de Assisi. He banishes devils, cures gout, lameness,
+and blindness. The traditional means of suggestion, prayer and the
+laying on of hands, had in the meantime been supplemented by the sign of
+the cross which the church had added. Moreover whatever he had only
+touched became a remedy for the sick. Protestantism brought no change in
+this respect. Martin Luther writes: "The physicians consider in the
+diseases only the natural causes from which a disease results and want
+to remove them by their medicines, and they are quite right in it. But
+they do not see that the devil often sends to one a disease which has no
+natural causes. Therefore there must exist a higher medicine, namely,
+the religious belief and the prayer through which the spiritual medicine
+can be found in the word of God."
+
+The broad undercurrent of religious cures, especially in the Catholic
+Church and in the Greek Church, but with fewer symbols also outside of
+them, has up to the present time never ceased to flow. But independent
+of it the therapeutic belief has again and again been focused on certain
+individuals or certain sects or certain schools, in the midst of the
+steady progress of scientific medicine and sometimes synthesizing the
+religious claims with new-fashioned scholarly ideas. In the seventeenth
+century, for instance, the Irish nobleman Greatrakes became a famous
+center of attraction. He felt himself to be the bearer of a divine
+mission and healed the sick, appealing to their belief by laying on of
+hands and by movements which we nowadays call passes. Much more
+influential in the eighteenth century was Pastor Gassner in Germany.
+Gassner succeeded in producing with his religious psychotherapy such a
+tremendous stir that many thousands who needed cure from functional
+diseases, and thousands of curious people, too, streamed to his church
+in Ellwangen, and his methods of cure spread almost contagiously among
+the ministers of the country: an Emmanuel Church Movement of the
+eighteenth century. Gassner, too, discriminated between the diseases
+which have natural causes, that is the organic diseases, which he did
+not treat, and the functional ones, which were obsessions of the devil.
+To determine to which group the disease belonged, he ordered the devil
+to produce the symptoms of the sickness. When in this way the
+obsessional character of the disease was recognized, the minister began
+with his suggestive influences to banish the devil. He demanded firm
+confidence in the name of Christ, reenforced his effectiveness by
+narration of the cures he had perfected, used further certain
+manipulations such as the rubbing of the skin and passes on the head,
+and finally gave his suggestions with authoritative firmness. Many
+ministers who became his pupils treated like him with skillful
+combination of religion and hypnoid influences the spasms, catalepsies,
+neurasthenias, paralysis, and deafness, of neurotic patients.
+
+There is no need to follow in detail the frequent similar occurrences
+between Gassner's time and our own. We all know where we are to-day.
+The medical profession and the medical science with its bacteriology
+and serum therapy, its Roentgen rays and its organic chemistry is far
+away from the church and without concession to religious aspects. On the
+other hand there are the yearly processions of thousands and thousands
+who make their pilgrimage to the sacred waters of Lourdes, guided by the
+Catholic priests, half-hypnotized by the hope that the Virgin will cure
+them. In every niche of the Catholic churches in all Europe, there are
+kneeling before the burning candles those who pray for nothing but their
+health; and their belief will sometimes yield almost miraculous cures.
+In England the Society of Emmanuel was founded by men and women to whom
+it seemed necessary to bring back to the minds of Christians the
+undoubted fact that Christ taught and worked for physical heath and to
+revive this sense of power over disease. Thousands were treated and the
+results have been "most encouraging." Among the cases successfully
+treated may be mentioned "one of cancer in which case the specialist
+called in had given the sufferer only three months to live while by
+means of the laying on of hands in prayer, a complete cure was
+effected."
+
+Not dissimilar in its proceedings, though much more elaborate in its
+metaphysics than this movement in the midst of the Church of England, we
+find in America the Christian Science movement started by Mrs. Eddy. It
+was new as a therapeutic system, however old its philosophic elements.
+Mrs. Mary Baker Eddy writes: "In the year 1866 I discovered the Christ
+science or divine laws of life and named them Christian Science. God had
+been graciously fitting me during many years for the reception of a
+final revelation of the absolute divine principle of scientific being
+and healing." The disease is cured for the Christian Scientist by the
+belief in God because a true belief in God includes the insight that God
+is all reality and that reality therefore cannot include the ungodlike,
+that is, error and sin and disease. Disease is thus recognized as unreal
+and if it has become unreal, of course it has disappeared as part of our
+real life. Thousands and thousands have been cured under this symbol.
+And as the latest chapter of this history of five thousand years, we
+find the movement which Dr. Worcester has started in Boston and which,
+too, spreads rapidly over the continent and awakens the ambition of many
+a minister in every denomination in the land. The aim is to cure the
+patient by reenforcing in him through religious persuasion, through the
+contact with the symbols of the church and with godly men and through
+religious suggestion, a confident belief which gives new unity and
+through it new strength to the mind of the sufferer until it overcomes
+the functional disease of the body. The physician at first examines
+whether or not an irreparable organic disease has attacked the body, but
+if he does not find such organic destruction, then the patient is to be
+handed over to the minister, who will take care that through his
+religious belief and inspiration the mind will triumph over the weakness
+of the body.
+
+Whoever looks in this way over the history of mankind can no longer
+doubt that belief in supernatural powers is really an agency for the
+overcoming of disease. We may be interested in it from the standpoint of
+religion or from the standpoint of psychology or from the standpoint of
+ethnology. In every case we have to acknowledge that he who believes may
+be cured. If we abstract first from the religious point of view and
+consider the problem as a scientific one, we have to interpret all those
+curative effects of belief as results of suggestion. The attitude of the
+one who gives the suggestion has gone in the history of mankind through
+all possible variations. He may have been filled with fervent belief,
+rejecting any interpretation except the religious one, or he may have
+produced the suggestion of belief almost with the intentions of a
+physician who simply relies on the physiological effects of any
+suggestion; and between these two extremes any number of steps is
+possible. Moreover the suggestion may have been detached from any
+personality and may have belonged to any symbol of religious energies,
+like the relics of the Catholic Church. Even the most skeptical of
+ethnologists ought to acknowledge that very little in this history of
+religious psychotherapy points to a conscious fraud. Those shamans of
+the savages from Siberia to South Africa, from Australia to Mexico, are
+in ecstasies which make them really believe in the mysterious power of
+their manipulations. The ethnologist finds indeed as most common
+characteristics of all those primitive movements that those who cure
+are chosen from among neurotics who by epileptic attacks or
+hallucinations and obsessions are predisposed to feel themselves as
+bearers of a higher mission.
+
+Yet whether the attitude of the transmitter is religious or
+half-scientific, is inspired or insincere, the receiver of the
+suggestion is always in the same condition: he is believing in his cure
+through religious influence and through his belief he is helped, if he
+is helped at all. This uniformity does not exclude the fact that the
+patients too may show a manifoldness of mental states. They may remain
+in a completely waking state with reenforced suggestibility, or they may
+go over into a drowsy or hypnoid state or deeply into a hypnotic state,
+or may receive the suggestions as we saw even in sleep. Further their
+minds may be entirely filled with fine religious emotions and the
+therapeutic effect be only an appendix or, on the other hand, this
+confident expectation of the relief from pain may be their central
+content of consciousness and may control the whole mental interplay. The
+practical problem of the scientist is to consider how far these
+religious energies ought to be used today in the interests of the cure
+of diseases.
+
+From a scientific standpoint such a discussion can hardly be fruitful
+with those who consistently take the religious point of view only. A
+view of the world which demands the faith that religious belief moves an
+almighty power to cure a diseased organ, or that the disease has no
+reality for one who lives in God, is invulnerable to merely scientific
+arguments. The sick woman who kneels between the candles before the
+picture of the Virgin, praying that her heart, which the physicians
+declare incurable on account of a valvular disease, be cured, moves in a
+sphere of thought which lies entirely outside of the medical study of
+causes and effects. The same holds true, for instance, of Christian
+Science. This statement is in itself no criticism and no argument; it
+only acknowledges that any possible exchange of opinions has to be
+carried over from the scientific psychological ground to that of
+metaphysics and philosophy. It is quite different with modern movements
+of the type of the Emmanuel Church Movement, where the religious thought
+is intertwined with the psychological theory and where an actual
+cooeperation of physician and minister is sought. Here church and science
+really meet on common ground, and it is important to examine objectively
+whether it is wise and beneficial to encourage the spreading of this
+tempting enterprise. The movement has reached the large cities between
+the Atlantic and the Pacific and is beginning to captivate the ministers
+of the small towns and villages. It seems as if an epoch has come for
+the church--the church which too long has ministered only to the
+spiritual needs of the community will at last remember again that Christ
+healed the sick, that mind and body are one, that the personality must
+be understood in its unity, and that endless fields of blessed influence
+may again be opened to the church when the minister becomes the
+physician of his congregation. Whoever knows the suggestive power of
+such a social movement, and considers the ease with which triumphant
+successes may be reached in this field and the disappointing and
+discouraging reduction of power which the church shows everywhere in its
+purely spiritual hold on the community, can foresee that all the
+conditions are favorable for a rapid spread and that the church clinics
+will become the American fashion of the near future.
+
+It cannot be denied that the Christian church takes in hand there once
+more a work which belonged to it through centuries. But they were
+centuries in which the priest was in a certain degree the physician,
+just as he was the educator and teacher, simply because in the church
+there was centered all cultural influences which the community knew. The
+complexity of modern times has for centuries demanded the opposite
+system. Centralization is allowed only to the purely administrative
+influence of the state, while all the active functions are divided among
+specialists. We rely on the expert in education, we demand the expert in
+medicine: is more gained or lost if the religious leader now again
+suddenly undertakes a part of the functions which belong to the
+physician? It is true that the ministers of this school do not propose
+to undertake the physician's work to its full extent. They leave to him
+the first and in some respects most important step, the diagnosis, and
+abstain from the treatment of such cases as the physician declares
+inaccessible to psychical influences. They do not heal cancer and
+phthisis like the Emmanuel Movement in England or like the mental
+healers in America.
+
+But is not perhaps just this compromise dangerous in another direction,
+inasmuch as it awakens a feeling of safety in those who feel in sympathy
+with scientific medicine? They have passed the hand of the physician and
+believe accordingly that because their illness is recognized as
+functional, the minister can really perform all that ought to be done.
+Is this belief justified? At the threshold, it occurs to every one that
+such a diagnosis by physicians may be erroneous and that the chances for
+such error are under the conditions of the church clinic much greater
+than under the conditions of a regular medical treatment. The
+diagnostician who treats the patient himself has ever new chances to
+remodel his diagnosis and to correct it under the influence of
+therapeutic effects. The danger is great that under the proposed
+conditions, the activity of the physician will be superficial, because
+he is deprived of his chief means, the constant observation. But we may
+abstract from this possibility of error. Does the fact that the disease
+is one the symptoms of which may yield to psychical treatment really
+make it advisable that the further treatment be handed over to the
+clergyman? To begin at the beginning, the usefulness of psychical
+treatment does not at all exclude the strong desirability of physical
+treatment at the same time. The emphasis which is laid on religious
+persuasion and inspiration, on prayer and spiritual uplift practically
+excludes the use of baths and douches, of massage and electricity, of
+tonics and sedatives. And yet it is not caprice or sham when every
+well-schooled medical specialist applies such means in the treatment of
+these so-called functional diseases of the nervous system. The minister
+applies and can apply only one of many possible methods for cure and
+yet, if we really want to make use of the resources of modern knowledge,
+we have to adapt most carefully all possible means to the individual
+case. If we take the strictly religious standpoint the situation is of
+course different, but if we speak of psychophysiological effects, we may
+acknowledge the healing influence of prayer and yet rely in the special
+case still more on bromide or strychnine. Yet the religious
+psychotherapists not only neglect the physical help but usually
+emphasize the antagonism. Some of the strongest supporters proclaim it
+as a non-drug healing, thus deciding adversely about a medical method
+regarding which they have no means at all to judge.
+
+Parallel to this neglect of physical theory goes, of course, the neglect
+of the physical factors in the disease. The physician may have justly
+diagnosed that the case is "merely" neurasthenia or hysteria and not a
+brain tumor or paralysis of the brain. Yet that does not mean in the
+least that a real treatment which remains in harmony with the progress
+of modern medicine ought to ignore the hundred physical elements which
+enter daily into the disease. There are the most complex digestive
+problems involved which demand a thorough understanding of chemical
+metabolism, there are still more complex problems of the sexual organs
+which the minister certainly ought not to discuss with his female
+parishioners, there are bacteriological questions, there are questions
+of the peripheral nervous system and sense organs; in short, questions
+which belong to a world into which the minister as minister has never
+looked. Even if he believes he might gather in an amateurish way some
+information as to those questions which lie so far from his experience
+as student of divinity, how can his half-baked knowledge compare with
+the experienced study of the regular physician? Such physical questions
+cannot be settled by the preparatory examination of the physician; they
+come up every day during the treatment and what the spiritual diet which
+the minister offers may help, may at the same time be ruined by the
+physical diet about which the minister without chemistry cannot judge.
+
+But let us abstract from the bodily aspect. Is the situation really very
+different for the mental one? The appeal to the religious emotion, the
+reenforcement of religious faith is from the religious point of view
+certainly the one central effort from which everything has to irradiate.
+The unity of this controlling thought is the glory of such inspiration.
+But as soon as we handle this thought as a psychotherapeutic remedy,
+destined to restitute the disturbed psychological equilibrium, it
+becomes evident that the very uniformity of it makes it a clumsy,
+inadjustable pattern. If there is anything which impresses the careful
+student of psychology, it is the over-rich manifoldness, the complexity
+of mental life. Even the simplest content of consciousness is a tissue
+woven from millions of threads and any stereotyped influence means
+crudeness and destruction. The minister's attitude towards inner life is
+there directly opposite to that of the psychologist. He cannot enter
+into those endless interplays of associations and memories, or
+inhibitions and sensations and impulses, he cannot examine from which
+remote psychological sources those ideas have arisen, how the feelings
+become disturbed and the judgments sidetracked. He should not analyze
+even if he could, because his whole aim is to synthesize. He asks for
+the meaning and not for the structure, for the aims and not for the
+elements. His therapeutic effort is therefore not even directed towards
+a careful rebuilding of the injured parts of the mind, but it is nothing
+more than a general stimulation to the mind to help itself. By touching
+on one of the deepest emotional layers of the mind, the layer of
+religious ideas, the minister gives to the soul an intense shock and
+expects that in the resulting perturbation, everything will be shaken
+and may then settle itself by its own energies in a healthful way. It is
+a fact that that can sometimes happen and under certain conditions the
+chances for it are even favorable. Under many other conditions the
+chances are unfavorable and the result does not happen at all.
+
+But whether or not a cure results, in any case it is certainly not an
+effort which can be said to be in harmony with modern science. The idea
+of science is always to understand the complex from its elements and to
+restore the disturbed complex object by recognizing the disturbances in
+the elements and by bringing those disturbed elements into right shape
+again. Certainly the psychologist, too, in examining carefully the
+injured mental mechanism may discover emotional injuries which might be
+cured by the introduction of religious ideas, but he will not give to
+them a value different from the introduction of any other ideas and
+emotions, for instance, those of art and music and poetry, those of
+social company or civic interest, of travel or sport or politics. Each
+may have its particular value and to cure every mind with religious
+emotion would be from a psychological point of view as one-sided as it
+would be to cure every disturbed stomach by milk alone. Moreover in very
+frequent cases, for instance, of neurasthenia or hysteria or
+psychasthenia, such wholesale remedies can form only the background of
+the treatment, but all the details have to be furnished with reference
+to a most subtle analysis of the special symptoms, and a particular
+organic symptom or a particular memory idea or a special inhibition by a
+well-selected counter-idea will do much more than any great emotional
+revival.
+
+Stereotyped religious appeal is not only insufficient in an abundance of
+cases--it must never be forgotten that those who nowadays go to the
+minister for their health are already selected cases more open to
+religious suggestion than the average--but can easily be decidedly
+harmful. Of course that holds true for every physical remedy too, and
+the judgment of the exact limit is one of the chief duties of the
+physician. It holds also for the other mental factors like sympathy. A
+certain amount of sympathy may save a neurasthenic from despair, and
+only a little more may make his disease much worse and may develop in
+him a consciousness of misery which makes him a complete invalid. Still
+more is it true for the religious emotion, from the standpoint of
+nervous physiology the strongest next to the sexual emotion, that it can
+be the healing drug or the destructive poison. Everything depends upon
+the degree of the intrusion and upon the resistance of the
+psychophysical system. From a purposive point of view there cannot be
+faith enough, from a causal point of view there can easily be too much
+of the faith emotion. Religious fervor has at all times helped to create
+hysteria and to develop psychasthenias. It cannot be otherwise. A group
+of ideas which has such tremendous power over man must easily be able to
+produce inhibitions and exertions which become dangerous to a nervous
+system the constitution of which is pathological. To leave such a
+dangerous and powerful remedy entirely in the hands of men who by their
+profession must aim towards a maximum dose of religious influence can
+certainly not be in the interests of the patients or of the community.
+
+Even the whole technique of this movement awakens the fear of possible
+harmful consequences. On the one hand we have the movement itself as a
+popular suggestion for the suggestible masses. The patient who seeks the
+help of a scientific neurologist hardly becomes a center of psychical
+contagion, but the church services for the sick offer favorable
+conditions for an epidemic development of hysterical symptoms. But more
+important are the influences on the individual patient. The whole
+purpose of the treatment demands the highest possible degree of
+suggestibility brought about by the ministerial persuasion. But it is
+evident that this degree of suggestibility means at the same time the
+most fertile soil for every chance suggestion and for influences which
+are perhaps entirely unintended. The physician and the psychologist,
+considering the mental state with reference to its elements, will make
+most careful use of those accessory influences. The minister, who
+necessarily has his spiritual aim in mind, cannot even become aware of
+all the involuntary influences which reach the mind in its most
+suggestible state. There can be no doubt that it would often need
+psychological art to avoid the creation of new pathological symptoms in
+such half-hypnotized patients. Yet the minister even goes so far as to
+make use of the sleeping mind without any consideration of the possible
+damage which may be done to his subject. He goes to the bedside of a
+sleeping girl and whispers his suggestions and is satisfied when they
+show their effects the next day. It does not lie in his horizon to
+consider the grave consequences which such suggestions during sleep may
+produce during future years in the brain the sleep of which has been
+transformed into such half-somnambulic relations. Hysterias may be
+created by such methods. No one can blame the minister for his
+remoteness from such doubts and problems, but the physician is to be
+blamed if he encourages the belief that all this still belongs to the
+proper sphere of the ministerial worker in abnormal psychology.
+
+Those engaged in such work were not long in finding out that the mere
+emotional inspiration is often no sufficient remedy, and the development
+went along the same lines in which it has gone everywhere for some
+thousands of years. Not to disappoint the sufferers, the religion had to
+become in very many cases simply an inactive side issue and the real
+cure was performed by the same methods with which any worldly
+neuropathologist would go to work. If the woman who cannot sleep is
+cured from her insomnia by being made to listen to the beats of a
+metronome, it may sometimes be effective, however crude, but it is
+certainly no longer religion, even though the metronome stands in a
+minister's room. The more the movement spreads to those who have no
+psychological training and knowledge, the more it must be necessary for
+them to import the whole claptrap of the quack hypnotist and soon the
+minister may discover that in certain cases physical means and drugs
+help still better. Thus he simply enters into competition with the
+regular physician, only with the difference that he has never studied
+medicine. The chances are great that in his hands even such remedies and
+drugs may do harm and finally, even if they were effective, is not the
+question justified: will not religion suffer?
+
+Indeed we have so far considered the question from one side only. We
+have confined ourselves to the question of how far such a movement is
+sound for the interests of the patient; but can we be blind to the other
+side and overlook the not less important problem of whether it lies in
+the interests of religion and of the church to amalgamate its spiritual
+work with a medical one? We are not thinking of those widespread, unfair
+arguments to the effect that this whole movement is undignified because
+it is instituted by the desire to fill the empty pews or to make
+competition with the success of Christian Science. That is utterly
+unjust. But there are intrinsic factors in the movement which interfere
+with the true aims of religion. First of all it cheapens religion by
+putting the accent in the meaning of life on personal comfort and
+absence of pain. The originators of the Emmanuel Movement stand well
+above such error, but their national congregations do not. Certainly the
+longing for pleasure and a well feeling and the abhorrence of pain and
+illness pervades our practical life and keeps in motion all our
+utilitarian efforts. But if there is one power in our life which ought
+to develop in us a conviction that pleasure is not the highest goal and
+that pain is not the worst evil, then it ought to be philosophy and
+religion. It is only the surface appearance if it seems as if the
+religious therapeutics minimizes the importance of pain; in truth it
+does the opposite. It tries to abolish pain, but not because it thinks
+little of pain; on the contrary, because it thinks so much of pain that
+it is willing even to put the whole of religion into the service of
+this strife for bodily comfort. The longing for freedom from pain
+becomes the one aim for which we are to be religious. In a time which
+denies all absolute ideals, which seeks the meaning of truth only in a
+pragmatic usefulness, it may be quite consistent to seek the meaning of
+religion in its service for removal of pain, and personal enjoyment. But
+in that case the ideal of both religion and truth is lost. It is finally
+not less undignified for religion to seek support for the religious
+belief in effects which it shares and knows that it shares with any
+superstitious belief on earth. Granted that the church can cure: the
+shaman of Siberia can cure too, and the amulets of Thibet not less. The
+psychologizing church knows, therefore, that it is not the value of the
+religion which restores the unbalanced nervous system; and yet it wants
+to provide for the spreading of true belief by the miraculous cures
+which it exhibits.
+
+This situation naturally produces the desire of the church to substitute
+a religious explanation for a psychological one. It is claimed that
+after all it is not the mental effect of the prayer, but the prayer
+itself, not the psychophysical emotion of religion, but the value of
+religion which determines the cure. Yet in that moment the whole
+movement in its modern shape comes into a still more precarious
+position. If the cure results from the inner value of the religion how
+can we confine it to the so-called functional diseases and abstain from
+any hope in organic diseases? Luther, from his religious point of view,
+still had the right to separate the two groups because only those
+functional diseases were effects of the devil, obsessions which could be
+banished by the minister and by prayer, while the other diseases did not
+result from the devil, but merely from natural causes. Such a definition
+does not fit into the modern system. To-day from a really religious
+point of view, both groups of diseases must be acknowledged to be
+natural or with Mrs. Eddy, as the work of the unholy spirit. Christian
+Science is indeed by far more consistent. If the cure results through
+the meaning and value of religion, there is no reason whatever why
+cancer and diphtheria and paralysis should not be cured as well as
+psychasthenia. And if, on the other hand, organic diseases cannot be
+cured because the psychophysical process of the religious emotion has no
+influence over diphtheria bacilli, then the whole process is removed to
+the causal sphere and it is acknowledged that the purposive meaning of
+religion is not in question at all. The whole system of such religious
+psychotherapeutics is therefore in its inner structure contradictory. It
+contains causal and purposive elements without any possibility of
+unifying them. They are loosely mixed, and the power of prayer means on
+one page something entirely different from what it means on another. In
+these respects Christian Science is by far more unified and in harmony
+with itself; its therapeutics is really anchored in a system.
+
+From a scientific point of view, its dangerousness is of course much
+greater inasmuch as it extends its methods over every organic disease
+and thus applies merely psychical treatment where from a standpoint of
+scientific medicine, physical treatment would be absolutely necessary.
+Moreover its philosophy is after all only a pseudophilosophy; its
+tempting equations of disease and error and sin and unreality are
+ultimately a mere playing with conceptions. If we were to point to the
+root of the misunderstanding in Christian Science, we should say that
+everything depends on the philosophical commonplace that the objects
+with which we deal in our life are ideas and that our whole experience
+is mind. "Christian Science reveals incontrovertibly that Mind is
+All-in-All, that the only realities are the divine mind and idea." But
+now silently this mental character of the real world is identified with
+the mental experience which stands in contrast to the physical
+experience. There results the impression that physical experience
+therefore, does not belong to the world of reality. It is evident,
+however, that mental in contrast to physical means something entirely
+different from mental in the philosophical sense. In the latter meaning
+of the word, we all agree that the world is mental; the word mental
+indicates there that the world has reality not in itself but only as
+experience of subjects. In the second sense, mental or psychical means
+that it is experience for one particular subject only and not for every
+possible subject. The physical thing, for instance this table, is indeed
+different from my mental memory idea of a table, inasmuch as every
+possible subject can experience this table while my mental memory image
+belongs to me alone. The physical table and the mental memory image of
+it are both equally mental in the philosophical sense, inasmuch as the
+physical which is object for every possible subject and in this sense
+not mental is therefore not less given to subjects. Every physical body
+with its disease is thus in one sense taken as something not mental
+while in another sense as mental; if we use the same word in two
+entirely different meanings, it indeed cannot be difficult to
+demonstrate any metaphysical consequences.
+
+But we do not have to deal here with the metaphysics of "Science and
+Health." If it is brought down to the concrete application, we stand
+before the same confusion which characterizes all compromises. Causal
+effects are sought in a sphere which belongs to purposive values. The
+psychological effects of the emotion of faith are sought and are
+misinterpreted as the emanations of religious powers. Religious
+psychotherapeutics in all its forms seeks to demonstrate to us the
+triumph of the soul over the body, while in reality it deals only with
+the mental mechanism which as such belongs to the chain of causal events
+in the same natural way as the organism. The soul, as spiritual agency
+in its sphere of purposes and ideals, does not enter the machinery of
+psychotherapy, and the psychological material on which psychotherapy is
+applied is not freer and not better and does not stand higher than the
+material of the bodily cells and tissues. The Emmanuel Movement
+deserves the highest credit for bringing about a systematic contact
+between religious faith cure and scientific medicine, but the time in
+which the minister himself undertook the medical treatment had to be a
+time of transition. It had to lead to a new relation in which the
+ministerial function is confined to the spiritual task of upbuilding a
+mind while the therapeutic function remains entirely in the hands of the
+physician. Where the physician believes that the psychomedical treatment
+demands a new equilibrium of the patient to be secured by religion,
+there the minister should be called for assistance. Psychotherapeutic
+hospitals would offer the most favorable conditions for such
+cooeperation. But the minister ought to enter even such a hospital with a
+strictly spiritual aim, and he should never forget that the task of the
+church stands much higher than the utilitarian task of removing pain
+from the sick room. But if those psychotherapeutic hospitals will
+flourish and the physicians will at last make use of psychical factors
+in their regular practice, they ought not to forget on their part that
+the important step forward was taken under the pressure of popular
+religious movements. The ministers first saw what the physicians ought
+to have seen before, but the physicians will see it more fully and more
+correctly.
+
+
+
+
+XIII
+
+PSYCHOTHERAPY AND THE PHYSICIAN
+
+
+Every thought of the physician moves in a world the structure of which
+is determined by the thought forms of cause and effect. He knows the
+effect which he wants to produce; it is the restitution of the organic
+equilibrium. He studies the causes which can secure that end. And again
+the disturbance of the equilibrium itself, the disease, is for him an
+effect which he seeks to understand by an analysis of the preceding
+causes. The means which he applies can therefore be valued only in
+reference to their efficiency; no other point of view belongs to his
+world. The religiously valuable may be indifferent or even undesirable
+in the interplay of causes, and the morally indifferent may be most
+important for the physician's interests. The religious emotion
+accordingly has to stand in line with any other mental excitement or
+with a hundred physical means which the laboratory and the drug store
+supply. The physician will welcome the methods of treatment without
+reference to metaphysical systems or to religious beliefs. To him it is
+an empirical fact that many disturbances of mind and body which
+interfere with the equilibrium of life can be repaired by influences on
+certain psychophysical organs. A part of these repairing influences he
+finds in the sense stimuli, for instance, of spoken or written words
+which reach the brain and awaken associative and reactive processes. He
+finds further that these influences can be reenforced in their
+effectiveness by certain general conditions of the nervous system and
+again finds that these can be secured partly by sense impressions, and
+once more especially by words.
+
+It is a matter of course to the physician that application of any sense
+influence on the brain demands a most subtle analysis of the
+psychophysical situation. Therefore he gives no less attention to the
+disentangling of the whole history of the individual brain, to its
+stored-up energies and to its mental possibilities. If he knows the
+psychophysical status, and finally if he knows the means of influencing
+those psychophysical organs which stimulate or inhibit the disturbed
+central parts, he can foresee the psychophysical effects with a certain
+definiteness. Thus everything depends upon the sharpest possible, almost
+microscopic, mental analysis, together with a most thorough examination
+of the whole nervous system and the most careful calculation of the
+mental influences applied. The vagueness of the religious appeal
+transforms itself into an exact calculation and the unity of the soul
+which seeks spiritual uplift transforms itself into a mental mechanism
+of bewildering complexity, and yet not more complex than the physical
+organism, to which for instance, the chemical means of the physician
+administer. To-day medical science is certainly only in the beginning of
+this great movement. Especially the analysis of the psychophysical
+conditions still lacks a sufficient refinement of method. But at least
+the causal principle is now fully recognized and the scientific man of
+today no longer doubts that this whole play of psychotherapeutic
+processes goes on as a causal process in the psychophysical system of
+the individual without any mysteriousness, without any magnetic
+influences, without any miraculous interference, without any agencies
+except those which are working in our ordinary mental life in attention
+and reaction, in memory and sleep.
+
+It is surprising how late this recognition appeared in the history of
+human knowledge. It occurred here as in so many places in the history of
+human civilization that the simple is the late outcome of the complex.
+Just as in technique the apparatus often began in a complex, cumbersome
+way and then became steadily simplified, so it is with explanations. The
+complex machinery of cosmic influences and obsessions by demons and
+magnetic mysteries was at first necessary until the simple explanation
+was found that all the results depend upon the working of the mind
+itself. Yet in technique and explanation alike, such progress to the
+simpler means always at the same time the making use of much richer
+knowledge. To explain an obsession or a sleep state by the agencies of
+evil spirits or magnetic fluids is certainly an unnecessary side
+conception. But to understand it from the working of the mind
+presupposes after all the whole modern physiological psychology, and
+thus had to be the latest step.
+
+The effects themselves were certainly observed in all times. Even the
+phenomena of hypnotism date probably back some thousands of years,
+however difficult it may sometimes be to discriminate between the
+artificial hypnotic states and hysteric or hystero-epileptic occurrences
+in the past. Certainly it may be acknowledged that the Yogi in India
+cultivated in the most remote times the methods of autosuggestion which
+evidently led to hypnotic states, and everywhere around the
+Mediterranean, antiquity knew the hypnotizing effect of staring on
+polished metals and crystals. So in Egypt, so in Greece and Rome; and it
+has often been claimed that the priestesses of Delphi and the sibyls of
+the Romans were in states of hystero-hypnotic character. As to the
+therapeutic use, especially the Greek physicians applied hypnotic means.
+Excited patients were brought to repose by methods of stroking. The
+efforts to explain scientifically the mysterious powers which men can
+gain over the mind and will of another begin at the end of the Middle
+Age and were developed quite naturally from the prevailing astrological
+doctrines. Astrology worked on the theory that the human fate depends
+upon the stars. These stars have an effect on the human organism. That
+proves that an influence can exist between distant bodies. It is,
+therefore, not more surprising that one organism can also have an
+influence on another organism. Well known since antiquity were such
+influences from one object to another, as in the case of the magnet.
+Thus there may be a kind of magnetic power which creates relations
+between all objects in the universe.
+
+Pomponnazi explained thus at the end of the fifteenth century the
+therapeutic effects of the human soul by the mutual influence which
+stars and men have on each other. This theory comes to much more
+important development in the writings of the physician Paracelsus. One
+individual by the power of his effort can influence the will of another
+individual, can fight with it, and suppress it; and all through energies
+which are analogous to the magnetic power which binds stars and men. In
+the middle of the seventeenth century, Helmont connects this power of
+magnetic attraction and repulsion with an ethereal element which
+penetrates all bodies and keeps them in motion. Through it man, too, can
+by his mere imagination work on other men. This will can also be
+effective on drugs which get through it a special therapeutic power.
+Somewhat different was the theory of a Scotch physician, Maxwell, in the
+second half of the seventeenth century. The ethereal spirit, which is
+identical with light, can be artificially cumulated in any organism and
+that secures its health. As one man can influence this vivifying ether
+in any other man, he can produce cures even from a great distance. All
+diseases are merely reductions of this ethereal spirit in the organism.
+
+But the general stream of the explanation continued in the direction of
+the magnetic doctrine. It was especially Mesmer in the eighteenth
+century who, in a long life of fantastic mysticism and yet of universal
+serious study, surely contributed much to the development of the theory.
+He had started to use, like others, the magnet in his medical practice.
+But he discovered that the same therapeutic successes could be gained
+without applying the magnet itself, but by simply using his own hands.
+The patients became cured when he moved his hands slowly from their
+heads to their feet. The magnetic power was therefore evidently in man
+himself. It was an animal magnetism in opposition to the mineral one
+which belonged to the magnet and to the stars. He believed further that
+he was able to infuse this magnetic power into any lifeless thing, which
+would then have curative influence on the nerves. There can be no doubt
+that, whatever may have been the value of his theories, he cured a large
+number of patients, evidently producing a state which we would call
+today a hypnoid state and often simply appealing to the natural
+suggestibility of the impressionable minds. Among his pupils, usually
+called mesmerists, was Puyseyur, who discovered, in 1784, the state
+which was called artificial somnambulism, a kind of sleep in which the
+ideas and feelings of the magnetized can be guided by the magnetizer.
+Here evidently was the first recognition of the psychotherapeutic
+variation which we call today hypnotism. There followed a period in
+which the scientific interest of the physicians was somewhat sidetracked
+by an unsound connection of these studies with mystic speculations and
+with clairvoyance. But especially in Germany animal magnetism in
+Mesmer's form and in the form of artificial somnambulism grew in
+influence through the first decades of the nineteenth century and
+succeeded in entering the medical schools. The reaction came through
+popular misuse. At about the third decade of the century, interest
+ceased everywhere.
+
+The Portuguese Faria insisted in 1819, practically as the first, that
+all those so-called magnetic influences, including the delusions, the
+amnesias after awaking, and the actions at a command, did not result
+from a magnetic power but from the imagination of the subject himself.
+He believed that the effect depended upon a disposition of the
+individual which resulted from a special thinness of blood. He abstained
+therefore from the magnetic manipulations and produced the somnambulic
+state by making the patients simply fixate his hands and by ordering
+them to sleep. Thus he is the first who understood these changes as
+results of mental suggestion. The next great step was due to the English
+surgeon, Braid, who in the forties studied the magnetic phenomena and
+like Faria insisted on the merely mental origin of the abnormal state.
+He proved that a person can bring himself into such an artificial state
+and that it is therefore entirely independent of energies from without.
+He examined especially the influence of staring at a shining object, a
+method which not seldom was called Braidism. He also introduced the
+word hypnotism. In America mesmerism was generally known under the
+name of electrobiology; and Grimes in particular came to results
+similar to those of Braid. Yet the influence of these movements on
+the medical world remained insignificant until a new great wave of
+psychotherapeutics by means of suggestion began in France in the
+sixties.
+
+Of course this development from astrology to magnetism and from
+magnetism to hypnotism represented only one side of psychotherapy.
+Parallel to it goes the progress in the treatment of the insane. In the
+first half of the eighteenth century, they are still on the whole thrown
+together with the criminals but the more the disease character of the
+disturbance is acknowledged, and the more special hospitals for the
+insane are created, and finally the more the humane treatment in them
+supersedes the brutal, the more psychotherapy enters into the work.
+England showed the way. Especially Arnold, Crichton, and Perfect became
+influential; and soon Pinel and Esquirol followed in France; and Reil
+and Langermann in Germany. Reil recognized clearly at the threshold of
+the nineteenth century that "Both psychical and physical diseases may be
+cured by psychical means, but at the same time psychical diseases may
+also be cured by physical means." And in his "Rhapsodies," rhapsodies on
+the application of psychical methods in the treatment of mental
+disturbances, he declared, "that the medical Faculties will soon be
+obliged to add to the two existing medical degrees still a third,
+namely, the doctorate in psychotherapy." This stream became broader and
+broader and every new development of psychiatry in the last hundred
+years did new justice to the influence of psychological means in the
+treatment of mental diseases; to be sure, without allowing up to the
+present day the hope that mental factors as such can cure the grave
+forms of insanity. The borderland cases and the incipient mild forms
+alone allow the hope of a cure. Outside of them the work of
+psychotherapy in the insane asylum meant essentially improvement and
+relief only. Again, in another direction, the general dietetic influence
+of sound mental life may be called a part of psychotherapy and this
+engaged not a few of the leading medical thinkers in all countries
+during the last century, especially the nerve physicians who gave
+serious attention to the wholesome engagements of the mind. Finally,
+might not much be attributed to psychotherapy, which offically belongs
+to the doctrines of homeopathy?
+
+But we may return to the new heralds of suggestion. Liebeault's book on
+the artificial sleep in 1866 became the starting point of the new great
+movement. Yet at first it remained unnoticed. It is claimed that for a
+long time only one copy was sold. But he continued to make his hypnotic
+experiments on the poor population of Nancy and they finally attracted
+the attention of some of the leading medical men there. Bernheim became
+convinced and Dumont, the physiologist Beaunis joined the movement, and
+in the eighties we find Nancy the center of hypnotic interest to which
+medical men from everywhere made their pilgrimage. This latter phase was
+paralleled by Charcot's studies in Paris, who brought hypnotism into
+nearest neighborhood with hysteria. And also the later development of
+the Paris school by Richer, and especially the brilliant work of Janet,
+kept hysteria in the foreground of the therapeutic interest. Liebeault's
+experiment had brought the psychology of suggestion entirely into the
+center of this whole circle of phenomena and this view controlled the
+development of the last few decades, which was essentially an
+elaboration of the special treatment of diseases. Forel in Switzerland,
+Moll and Vogt in Germany, Wetterstrand in Sweden became the chief
+exponents of therapy by hypnotism. Others, like Dubois, in Switzerland,
+emphasized more the suggestive treatment through persuasion. In England
+at first Carpenter, later Hack-Tuke gave serious attention to hypnotism,
+in Russia Bechterew, and in the last few years the literature on therapy
+by suggestion became developed in practically all countries. In America
+Beard, Hammond, and others belong to the older school; Osgood, Prince,
+Peterson, Putnam, Sidis, and others to the most recent years. At the
+same time, under the leadership of Kraepelin, Ziehen, Sommer, and
+others, the methods of the psychological laboratory, especially the
+reaction and association methods, were made useful for the purposes of
+psychopathology.
+
+But interest in suggestion does not represent to-day the last step of
+psychotherapy. The latest movement, which is entirely in its beginning,
+the development of which no one can foresee, but which promises wide
+perspectives, is connected with the name of Freud in Vienna. The
+entirely new turn of psychotherapy is given by the fact that his aim is
+not to overcome a symptom by suggestion but to make it disappear by
+removing the ultimate mental cause. He found that large groups of mental
+disturbances result from a psychical trauma, a disagreeable idea which,
+inhibited in the mind, becomes the source of mischief and produces
+phobias and obsessions and hysterical motions. The cure of the symptoms
+demands the recognition of this first mental accident, which may lie
+back for years and which may no longer be in the memory of the patient.
+As soon as this earlier experience is brought to consciousness again, it
+needs only a natural discharge and a normal expression and the symptoms
+which it brought about will disappear. Thus the cure itself needs no
+hypnotism and no persuasion or suggestion but the reawakening of
+forgotten situations, and only in the service of this effort hypnotism
+may be used to reenforce the memory. Yet this represents only the first
+period of Freud's activity, in which he collaborated with Breuer, a
+phase which is represented by their book on hysteria, in 1895. But there
+followed a further development which is still more essential. The
+hysterical disturbance may indeed have started with such an accidental
+traumatic impression but that does not explain why just this impression
+had such a strong effect. Other impressions of equal strength and
+emotional vividness may have passed without leaving any damaging result.
+And therefore there must be some prior cause in the subject which makes
+just this particular impression so injurious; and here is the point of
+Freud's fundamental discovery, which for the layman appears on the
+surface to have little probability but which has proved of greatest
+consequence for clinical work. It was found that only those situations
+become injurious and become starting points for hysterical symptoms
+which touch on repressed and artificially inhibited ideas of the sexual
+sphere.
+
+Entirely new perspectives have been opened by these studies. Above all,
+now for the first time there is in sight a psychotherapy which not only
+aims to remove symptoms but which really uproots the disease itself.
+That earlier method of bringing the trauma to consciousness and making
+it discharge, the so-called cathartic method, removes only the
+particular group of disturbances but the patient remains a hysteric, and
+if ever new accidents should happen which would touch again those inmost
+repressed ideas, new hysterical symptoms would develop. But if we can go
+back to that starting point, if we can discover those first suppressions
+of desired gratifications which often most indirectly are related to the
+sexual sphere, and if we can liberate the mind from those primary
+strangulated affections, then the patient is really cured. Freud himself
+practically abstained from the help which hypnotism can give for the
+reawakening of forgotten experiences, while some of his pupils still
+prefer this short way to the forgotten memories. His way is, on the
+whole, to let the imagination bring up any chance material of associated
+ideas and then to study their connections and follow the hints they
+give. He calls it the psychoanalytic method. Others prefer the methods
+of association tests, again others tap the lower layers by automatic
+writing, but the chief problem remains always to discover those
+repressed desires and to understand through them the injurious effects
+of accidental experiences. The whole field of hysteria, and perhaps
+still more that of the anxiety neurosis, has come into new perspective
+through this pioneer work which men like Bleuler, Jung, and Stekel have
+developed in various directions.
+
+Thus in recent decades the thorough work of scientific physicians has
+developed a psychotherapy of considerable extent and of indubitable
+usefulness, far removed from the simultaneous efforts of the churches
+and of the popular mental healing cures. A number of eminent men in all
+countries have tested the methods and have published the results. But
+the curious side of it is that all this is essentially a movement of
+leaders while the masses of the profession hesitate to follow. It is a
+set of officers without an army. Every large city has one or another
+specialist who applies suggestive therapy, one or another nerve
+specialist who hypnotizes, but the average physician moves on without
+any serious effort to utilize psychotherapy. It is as if the
+prescription of the modern chemical drugs were confined to some leading
+scholars in the country, while the thousands abstained from it in their
+office work and in their family practice. In reality psychotherapy ought
+to be used by every physician, as it fits perfectly the needs of the
+whole suffering community. Its almost exceptional use in the hands of a
+few scholarly leaders deprives it of its true importance. It is the
+village doctor who needs psychotherapy much more than he needs the knife
+and the electric current.
+
+Why does the medical profession on the whole show this shyness in the
+face of such surprising results? In other fields they do not show any
+reluctance in taking up the newer developments of method. Even the
+Roentgen ray apparatus has quickly won its way, and psychotherapy is
+less expensive. To be sure, the most important reason is probably one
+which is most honorable. The physicians do not like to touch a tool
+which has been misused so badly. Psychotherapy has come too much into
+the neighborhood of superstition and humbug. Where miracles are
+performed, the man of science prefers to leave the field. The less one
+knows about those groups of problems, the less one is able to see the
+sharp demarcation line between true scientific studies, for instance, in
+hypnotism, and the pseudo-scientific fancies of psychical research.
+Experiments in suggestibility are then easily mixed with experiments in
+telepathy, and those go over by gradual degrees to clairvoyance and
+premonitory apparitions, and from there the way is not far to the
+reappearance of the dead and the routine performances of the spiritists.
+It seems to many as if there is no point where they have a reason to
+stop. If they begin with such abnormal phenomena at all, it seems as if
+they are necessarily carried over to all the mysteries of supernatural
+energies. Even the competition with Christian Science, and other mental
+healers whose judgment is not hampered by any previous study of
+medicine, might seem rather unattractive to the serious physician.
+
+Further not a few have the impression that such suggestive treatment
+directly demands from them that they also begin to humbug their patients
+or to throw out suggestions which they themselves do not believe, in
+short, that they be brought down to the level of the miracle performer.
+Yet, however much all that speaks in favor of the conscientious instinct
+in the physician, it is ultimately based upon a misinterpretation. The
+line between real science and its counterfeit is here as everywhere a
+distinct one, and the true man of science ought not to hesitate in doing
+his duty from fear that he might not be discriminated from the
+charlatan. A well-conducted psychotherapeutic treatment as a scientific
+physician ought to carry it out, is entirely different in meaning and
+appearance, from the first step of diagnosis to the last treatment of
+after-effects, from every unscientific faith cure. It is also in no way
+necessary that the psychotherapist ever leave the path of complete
+sincerity. There is no reason at all for promising that the patient will
+be entirely cured if the physician believes that a real cure through
+suggestion is impossible. The more the true physicians undertake
+psychotherapeutic work, the more it will carry with it that dignity
+which is now too often lost by the predominance of those who treat
+without diagnosis and cure by mere appeal to superstition.
+
+All that does not mean that other motives do not hold the physician
+back. Not seldom he is afraid of unfavorable consequences. He does not
+feel sure that, for instance, a deep hypnosis is without dangerous
+results or that he will be able to produce it in the technically correct
+way. But all these objections mean nothing but insufficient acquaintance
+with the facts. Of course every technique needs its period of
+preparation for the task, but it is now sufficiently demonstrated that
+hypnotism carried through in a scientific spirit will never have any
+injurious consequences. The morphine injection and the Roentgen rays are
+by far more dangerous. Those who think that for hypnotizing especially
+inborn power is needed stand, of course, outside of a serious
+discussion. They do not even know the elements of the modern theories.
+Every physician has in himself the necessary means for a
+psychotherapeutic treatment in every form.
+
+More scientific insight belongs to the argument that most of these
+psychotherapeutic schemes are essentially for treatment of symptoms. We
+have acknowledged that throughout. The possibility of a relapse or of a
+new obsession is thus to a high degree open, and that is certainly a
+discouraging feature. Yet we have seen sufficiently that as soon as the
+symptoms are removed, there is no lack of means, also by psychotherapy,
+to prevent the recurrence. Moreover, to remove the present symptoms is
+in any case a great gain and in many cases a decisive gain. And whatever
+can be secured by such methods is of such a character that hardly any
+other method could have been substituted. It can be said with certainty
+that hundreds of thousands leave the offices of their doctors every year
+without relief where relief could be secured by psychotherapeutic means.
+
+To be sure, one reply of the physicians is not infrequent and carries
+some weight. Psychotherapeutic methods demand much time and patience and
+skill. To relieve a cocainist of his desire by mere suggestion may
+demand an assiduity which the average physician simply cannot afford;
+and nothing requires more time than a real use of Freud's psychoanalytic
+method. Hours and hours of conversation about the most trivial
+occurrences have to be spent to relieve the repressed ideas and to give
+them a chance for a free ascension. It cannot be denied that most of the
+really illuminating work in all these fields has been done by scholars
+who combine a strong theoretical interest with their effort to cure the
+patients, and who therefore examine and treat the individual case
+primarily from the wish to get new insight into the laws of nature. The
+average physician whose time is his income may be the less willing to
+enter into such time-devouring schemes, as the patients too easily may
+think that the physician did not do much for them when he simply was
+sitting down and gossiping with them.
+
+Yet after all, behind all of it stands one motive which has held back
+the development of psychotherapy in the medical profession more than
+anything else. The physician feels instinctively that a real success can
+be reached in every one of these fields, only if he possesses a
+reasonable amount of knowledge of psychology. He feels that wherever he
+touches the patient's body, examines his lungs or his heart or his
+reflexes, that a large background of anatomical knowledge and of general
+pathology gives meaning to every single observation. But in the field of
+mental abnormities, in the whole world of ideas and emotions and
+volitions, he simply lacks that background. Everything seems to him
+without reference to real knowledge. He feels as amateurish as if he
+were to operate on the abdomen without knowing its anatomy. He is
+instinctively aware that even the simplest mental life represents a
+bewildering complexity and that to stimulate ideas or feelings or to
+suppress emotions, to inhibit volitions, must demand always a most
+subtle disentanglement of the most widely different components. He
+abstains from approaching that ground at all rather than to blunder by
+his ignorance of psychology. And after all, he is right. But is he right
+in allowing that ignorance? Can the medical profession afford to send
+into the world every year thousands of young doctors who are unable to
+use some of the most effective tools of modern medicine, and tools which
+do not belong to the specialist but just to the average practitioner,
+simply because they have not learned any psychology?
+
+Indeed the times seem ripe for a systematic introduction of
+psychological studies into every regular medical course. It is not a
+question of mental research in the psychological laboratory where
+advanced work is carried on, but a solid foundation in empirical
+psychology can be demanded of everyone. He ought to have as much
+psychology as he has physiology. Moreover the psychological study ought
+not to be confined to the normal mental life. Again we do not speak of
+psychiatry. What is needed is abnormal psychology, entirely independent
+of the therapeutic interests of the alienist. The mental variations
+within the limits of normal life and the borderland cases ought to be
+studied there as well as the complete derangements. The ideal demand
+would be that the future physician should spend at least a year of his
+undergraduate time on empirical psychology, especially on experimental
+and physiological psychology. He would take perhaps half a year's
+lecture course on the whole field of psychology as covered in the
+English language by the well-known text-books of James, Wundt,
+Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus,
+Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the
+course ought to be either advanced psychology entering into the more
+complex phenomena or a practical training course in elementary
+laboratory psychology as indicated for instance by Titchener's
+"Experimental Psychology. A Manual of Laboratory Practice." If the
+undergraduate can possibly afford the time in his college course, he
+ought to add courses which either lead him towards the philosophical
+problems of psychology or towards the comparative aspect of psychology.
+If he can find time for a year of post-graduate work between college and
+medical school, he could hardly spend it more profitably than by a year
+of research in a well-conducted psychological laboratory to become
+really acquainted with an independent analysis of mental states. On the
+other hand in the medical school, room must be found for a course in
+abnormal psychology, which of course presupposes a thorough knowledge of
+normal psychology and, if possible, follows the courses on nervous
+diseases and precedes the course on psychiatry.
+
+For the average future physician, it would be wiser to omit even the
+psychiatry studies than those in abnormal psychology. The latter ought
+to lead him far enough to discriminate early between a mere
+neurasthenia, for instance, and a beginning of insanity. As soon as the
+discrimination is perfected and insanity is found, he has to give the
+case out of his care anyhow and hand it over to the specialist and to
+the asylum. The knowledge of psychiatric treatment is, therefore, not
+essential for the average practitioner. But no one can relieve him from
+the responsibility for those borderland cases, for the hysterias and
+psychasthenias and neurasthenias, and he can never master them without
+normal and abnormal psychology. Moreover it must not be forgotten that
+mental factors may enter into every disease. The psychology of pain, for
+instance, and of comfort feeling, the psychology of hunger and thirst,
+of nausea and dizziness, the psychology of the sexual feelings, the
+psychology of hope and fear, of confidence and discouragement, of
+laziness and energy, of sincerity and cunningness play their role in
+almost every sick room. And if the physician haughtily declares that he
+does not care for the methods of suggestion, it might justly be asked
+whether he can be a physician at all if he does not apply some
+suggestions; yes, if his very entrance into the sick room does not
+suggest relief and improvement from the start. The introduction of a
+serious study of psychology is the most immediate need of the medical
+curriculum. Instructorships in abnormal psychology must be created in
+every medical school; institutes for psychotherapy should soon follow.
+But in all this, there is nowhere to appear any artificial antithesis
+between mind and body, any more than between organic and functional
+diseases; we have discussed all that with full detail. Only the
+physician who has a thorough psychological preparation can fulfill the
+manifold demands which modern life must raise; he alone is prepared to
+cooeperate with the other factors of the community in the development of
+a sound and healthful nation, to work towards the hygiene of the nervous
+system and of the mental life; and to correct the injuries which the
+perversities of our civilization inflict.
+
+In all that he will not avoid the comradeship of the clergyman. He will,
+of course, not forget the fundamental difference of attitude between
+them, he will not forget that the minister seeks for the meaning and
+values of inner life while he, the physician, has to consider that same
+inner life from a causal point of view and thus has to work with it as
+with natural material for the normal functioning of the organism. But
+the interrelation between them can be intimate in spite of the
+difference of their standpoints. The minister, to be sure, ought not to
+consider health as such as the greatest good, but he will not forget
+that a wholesome devotion to ideals cannot be carried through when the
+attention is absorbed by the sufferings of the body and the mental
+powers are debilitated. Only in a sound mind the full ideal meanings of
+life can be realized. The minister must therefore seek the health of his
+congregation not because health is the ideal of life but because the
+true ideals cannot be appreciated by the mental cripple. On the other
+hand, the physician from his standpoint should in no way feel it his
+duty to play the amateur minister and to put emphasis on the spiritual
+uplifting of his patients. But he knows well that not a few of the
+suggestive influences which are needed for the relief from disease are
+most effective when an emotional emphasis can be given to the
+suggestions and that this emphasis is for large numbers most powerfully
+supplied by the religious emotion. Thus the minister will be a very
+important assistant to him and the church will most successfully do for
+many patients what for other patients perhaps travel or music or the
+theatre, sport or social life, may do.
+
+Just in the relation to the church, the physician will need subtlest
+discrimination, and he will not forget that while even a strong
+religious emotion may be without damage for a normal man, it may well be
+injurious to the unstable brain. But if the physician uses tact and
+wisdom, he will be surprised to find how often the religious stimulation
+can indeed be helpful for his purposes and the division of labor
+demands that this be supplied not by himself but by the minister. He
+will advise the consulting sufferer to seek the influence of a godly man
+who awakens in him upbuilding wholesome emotions and volitions. The
+minister may in this way very well become the assistant of the
+physician. But whether this cooeperation is looked on from the one or
+from the other point of view, in every case it needs absolute clearness.
+Nothing is gained and too much is lost if the two functions are
+carelessly mixed together. It is never the task of the minister to heal
+a mind and never the task of a physician to uplift a mind. One moves in
+the purposive sphere, the other in the causal sphere. Their friendship
+can seriously endure only as long as they remain conscious of the fact
+that they have two entirely different functions in the service of
+mankind.
+
+
+
+
+XIV
+
+PSYCHOTHERAPY AND THE COMMUNITY
+
+
+Both the physician and the patient find their place in the community the
+life interests of which are superior to the interests of the individual.
+It is an unavoidable question how far from the higher point of view of
+the social mind the psychotherapeutic efforts should be encouraged or
+suppressed. Are there any conditions which suggest suspicion of or
+direct opposition to such curative work?
+
+Of course society has to be sure that no possible misuse and damage are
+to result from such practice. Fears in that direction have been uttered
+repeatedly, but from very different standpoints. One which is perhaps
+most often heard in popular circles results from an entire
+misunderstanding and deserves hardly any discussion after our detailed
+study of the processes involved. It is claimed that suggestive power,
+especially in the form of hypnotization, may be secretly misused to make
+anyone without his knowledge and against his will a passive instrument
+of the hypnotist's intent. Often this is coupled with telepathic
+fancies. The hypnotist is believed to have mystic power to bring any
+person in a distant region under his mental control and thus to be able
+to carry out any sinister plans by the help of his innocent victim. All
+hypnotizing therefore ought to be interdicted by the state. The
+presuppositions of such a view are, as we know now, entirely absurd. We
+know that hypnotism is not based on any special power of the hypnotizer;
+there is no magnetic fluid in the sense of the old mesmerism. The
+imagination of the hypnotized person is the only hypnotizing agency.
+Thus no one can be hypnotized without his knowledge or against his will.
+The story of telepathic mysteries which is often brought before the
+public is probably always the outcome of a diseased brain. It is indeed
+a frequent symptom in paranoia and other insanities that the patient who
+feels abnormal organic sensations and abnormal unaccountable impulses
+interprets them as influences of a distant enemy. Whole pamphlets have
+been written with elaboration of such insane misinterpretations and
+requests to legislatures have been made in that spirit, but the
+physician recognizes easily throughout the whole argumentation the
+well-known phenomena of the mental disease.
+
+To be sure, while no one can be hypnotized against his will, many a
+person is liable to accept suggestions from others and thus to carry out
+the wishes of others almost without knowing and certainly without
+willing that the other mind interfere with the interplay of the own
+motives. But if we were to strike out all suggestive influences from
+social life, we should give up social life itself. Suggestion is given
+wherever men come in contact; in itself it is neither good nor bad. The
+good resolution and the bad one can be suggested, the good example and
+the bad can be effective; both encouragement of the noble and imitation
+of the evil may work with the same mental technique. Certainly there are
+some persons who have a stronger influence than others on the
+imagination of those with whom they come in contact; their expression
+awakens confidence, their voice and their words reach deeper layers of
+the mind, their calmness and firmness overwhelm more easily the
+antagonistic ideas. But the chief difference lies after all in the
+different degrees of suggestibility among those who receive such
+impressions. The easily suggestible person cannot be protected by any
+interdict; he may catch suggestions everywhere, any advertisement in the
+newspaper and any display in the shop-window may overrun his own
+intentions. What he needs is training in firmness. The application of
+reenforced suggestion or even of hypnotism in the doctor's office is
+even for him no possible source of danger.
+
+On a higher level are objections which come from serious quarters and
+which are not without sympathy with true science. In recent times this
+opposition has repeatedly found eloquent expression. It is an objection
+from the standpoint of morality, belonging therefore entirely to the
+purposive view of the mind, but we have now reached a point where it is
+our duty to do justice to this purposive view too. As long as we
+discussed the problem entirely from the standpoint of the physician, no
+other view of mental life except the causal one could be in question. As
+soon as we look at it from the standpoint of the community, it becomes
+our duty to bring the causal and the purposive view into harmony, and it
+would be narrow and short-sighted simply to draw the practical
+consequences of a naturalistic view of the mind without inquiring
+whether or not serious interests in the purposive sphere are injured. If
+there is moral criticism against suggestive therapy, it is the duty of
+the community to consider it. This opposition argues as follows:
+Hypnotic influence brings the patient under the will control of the
+hypnotizer and thus destroys his own freedom. Whatever the patient may
+reach in the altered states is reached without his own effort, while he
+is the passive receiver of the other man's will. His achievement has
+therefore no moral value, and if he is really cured of his drunkenness
+or of his perverse habits, of his misuse of cocaine or of his criminal
+tendencies, he has lost the right to be counted a moral agent. It would
+be better if there were more suffering in the world than that the
+existence of the moral will should be undermined.
+
+No one ought to take such arguments lightly. The spirit which directs
+them is needed more than anything else in our time of reaching out for
+superficial goods. No one can insist too earnestly that life is worth
+living only if it serves moral duties and moral freedom and is not
+determined by pleasures and absence of pain only. Those who set forth
+this argument are entirely willing to acknowledge the profound effect
+which suggestive therapeutics may create. More than this, they have to
+acknowledge it to gain a basis for their attack. Just because the
+hypnotizer can entirely change the desires and passions, the habits and
+perversities of the suffering victim, he seems to them a moral wrongdoer
+who negates the principle of human freedom. A forcible book of recent
+days calls the suggestive power of the psychotherapist "The Great
+Psychological Crime." It says to the hypnotist: "By your own testimony,
+you stand convicted of applying a process which deprives your subjects
+of the inalienable right and power of individual self-control. In
+proportion as you deprive him of the power of self-control, you deprive
+him of that upon which his individual responsibility and moral status
+depend. In proportion as you deprive him of the free control and
+exercise of those powers of the soul upon which his individual
+responsibility and moral status depend, you thereby rob him of those
+powers upon which he must depend for the achievement of individual
+immortality."
+
+But this censure too is entirely mistaken, not because it urges the
+purposive views against the causal but because it is in error as to the
+facts. Such critics are fully under the influence of the startling
+results which are reached; they do not take the trouble to examine the
+long and difficult way which has had to be traversed with patience and
+energy. It is quite true that if I hypnotize a man and suggest to him to
+take up after awaking the book which lies on my table, he follows my
+suggestion without conflict and in a certain sense without freedom. He
+feels a simple impulse to go to the table and lift the book and, as no
+stronger natural desire and no moral objection stand in the way, he
+carries out that meaningless impulse and perhaps even invents a foolish
+motive to explain to himself why he wanted to look at that book. But
+after a long experience, I have my doubts as to whether a man was ever
+cured in such a way by hypnotism of serious disturbances and of those
+anomalous actions which the critics want to see overcome by the
+patient's own moral efforts. On the contrary, every suggestion has to
+rely on the efforts and struggles of the patient himself and all that
+the psychotherapists can give him is help in his own moral fight. His
+own will is presupposition for being hypnotized and for realizing the
+suggestion. If again and again I hesitate to undertake new cases, it is
+just because I have to see during the treatment too much of this daily
+and hourly striving against overpowering impulses. The joy of removing
+some obstacles from the way of the patients is too much overshadowed by
+the deep pity and sympathy with their suffering and craving during the
+whole period of successive treatments. To make a man fight where despair
+is inevitable, and where the enemy is necessarily stronger than his own
+powers, can certainly not be the moral demand. Morality postulates that
+everyone find conditions in which he can be victorious if he puts his
+strongest efforts to the task.
+
+In our discussion of the mental symptoms I reported as an illustration
+of the suggestive treatment of the drug passion the case of a
+morphinist. To make clear this purposive side of the case as against the
+causal one which alone interested the physician, I may add a few
+features to the short report as a typical example. When that man left my
+laboratory for the last time to go out to work and happiness, you might
+well have believed from his joyful face that it had been an easy and
+pleasant time in which hypnotic influence smoothly removed from him the
+dangerous desire for morphine. In truth it was the result of four months
+of the most noble and courageous suffering and struggling. He had been
+for years a slave to his passion. To quote from his little
+autobiography: "When I realized that I was addicted to morphine, I was
+at first not at all worried as I did not then understand the real horror
+of the thing, and did not then realize all the future suffering and
+misery that is coming to anyone who is the user of opium or any of its
+alkaloids. For the first few months, I found great relief after every
+injection of morphine, but soon I could not get the same easy feeling
+and could eat but very little and what sleep I got was in the daytime. I
+finally went to the sanitarium of a doctor but it was simply a
+money-making business for him; if he ever cured anyone, I never heard of
+it. I then tried another one; it was the same kind of a place as the
+former. When I first went to see the professor in the Harvard
+Psychological Laboratory, I was using between thirty-two and
+thirty-eight grains of morphine daily. He put me under his treatment
+October 6th and that day cut me down by hypnotic treatment to nine
+grains a day or three doses of three grains a day. I took my hypodermic
+as directed, but on the following day I lay on the bed too exhausted to
+get up even to get around the room, and I could not eat and only drank a
+very little water. The desire for the drug was something terrible. But
+in about four days I got used to the loss of so much morphine and stayed
+on this amount for a week, seeing the professor every other day for
+hypnotic treatment and then returning to my room where I spent
+twenty-two hours of the twenty-four on the bed, but did not sleep more
+than two or three hours a day. At the end of the week I was cut off by
+hypnotic suggestion half a grain and this put me to fighting the desire
+again. This lasted two or three days and then I began to feel better and
+began to sleep a little more. But at the end of the week I was cut off
+another half grain, and the whole fight would have to be begun over.
+These reductions of the dose were made a week apart and sometimes only
+two days. The worst time of all was a cut from four injections of a
+fourth of a grain each to four of one eighth of a grain each, which was
+about January 10th. At this time I had the worst two days of my life. I
+tried whiskey, but it gave relief only for about half an hour and then
+the desire was worse than ever."
+
+In this way every few days I gave the poor fellow under hypnotic
+influence the suggestion to reduce the dose of morphine in a prescribed
+way, and with enormous effort he withstood his craving for more, in
+spite of the fact that he had during all this winter a bottle with a
+thousand tablets of morphine, prescribed by an unscrupulous physician,
+in his writing desk. He was thus at every moment during the day and
+night in full possession of the deadly poison with which he could have
+fully satisfied his craving. It was a moral victory when he finally
+reached the point at which he went for several weeks without any desire
+for morphine and finally presented the remaining tablets to a hospital.
+And yet there would not have been the least chance for his winning this
+ethical victory without the outer help of the hypnotist. We do not
+eliminate the moral will but we remove some unfair obstacles from its
+path. We have no mystic power by which our will simply takes hold of the
+other man's will, but we inhibit and suppress by influence on the
+imagination those abnormal impulses which resist the sound desires. If
+that were immoral, we should have to make up our minds that all
+education and training were perverted with such immoral elements. Every
+sound respect for authority which makes a child willing to accept the
+advice and maxims of his elders is just such an influence. If it were
+really a moral demand that the will be left to its own resources and
+that no outside influence come to strengthen its power or remove its
+hindrances or smooth its path, then we ought to let the children grow up
+as nature created them and ought not to try to suppress from without by
+discipline and training, by love and encouragement, the willful
+impulses and the ugly habits. Even every good model for imitation is
+such a suggestive influence from without and every solemn appeal to
+loyalty and friendship, to patriotism and religion, increases the degree
+of suggestibility. That is the glory of life that the suggestive power
+may belong to moral values instead of mere pleasures, but it is not the
+aim of life to remain untouched by suggestion. And he who by suggestion
+helps the weak mind to overcome obstacles which the strong mind can
+overthrow from its inborn resources works for the good of the individual
+and of the community in the spirit of truest morality.
+
+Much more justified than such ethical objections are the fears which
+move entirely in the causal sphere. It must be acknowledged that a
+method which has such powerful influence over the mind that it can
+secure ideas and emotions and impulses which the own will of the patient
+cannot produce, ought to be allowed only to those who are prepared for
+its skillful use. To hypnotize or to perform any persistent
+psychotherapeutic treatment may thus be dangerous, if it is done by the
+unfit. We have discussed before the injuries which might result from the
+administration of such powerful psychotherapeutic effects through the
+best meaning minister, but we can extend this fear to anyone who has not
+systematically studied medicine and to a certain degree normal and
+abnormal psychology. The possibilities of overlooking symptoms which
+ought to suggest an entirely different treatment, or of adjusting the
+treatment badly to the special physical conditions, or of ignoring the
+desirable physical supplement by drugs, or of creating unintentionally
+by suggestion injurious effects, are always open when medical amateurs
+undertake such work. Certainly there is no physician who is not liable
+to make mistakes, and a physician who has never given any attention to
+psychology and psychiatry would also be a rather poor agent of
+psychotherapeutic methods, but the probability is that such a physician
+would simply abstain by principle from all psychotherapeutic methods;
+his mistake only begins if from his lack of acquaintance with the
+subject he draws the conclusion that the method itself is undesirable.
+That his real preparation ought to include psychological studies we have
+pointed out before, and the time seems ripe for the community to urge
+such a reform of the studies.
+
+All that involves the conviction that even the experimental psychologist
+as such is not prepared to enter into medical treatment; and a
+"Psychological Clinic," managed by a psychologist who is not a doctor of
+medicine, is certainly not better than a church clinic. I cannot even
+acknowledge the right of psychologists to make hypnotic experiments
+merely for the psychological experiment's sake. Nobody ought to be
+brought into a hypnotic or otherwise abnormal state of mind if it is not
+suggested by the interests of the subject himself. Science has the right
+to make hypnotic experiments, or experiments with abnormal mental
+states, only under the one condition that a physician has hypnotized the
+subject in the interests of his health and that the patient has agreed
+beforehand to allow in the presence of witnesses certain psychological
+studies. Needless to say that any hypnotization for mere amusement and
+as a parlor trick ought to be considered as criminal.
+
+On some other objections which interest the community as such we had to
+touch before, and there is no need of returning to them with any
+fullness of argument. We spoke of the danger which the mental cures
+carry with them when they are based on any particular creed, and
+especially when they are tied up with a semi-religious arbitrary
+metaphysics. What is gained if some nervous disorders are helped by
+belief, if the belief itself devastates our intellectual culture and
+brings the masses down again to a view of the world which has all the
+earmarks of barbarism? That is indeed one of the central dangers of all
+non-medical suggestive cures, that while any belief may cure through the
+mere emotional power of the act of believing, the content of the belief
+gains an undeserved appearance of truth. Any absurd superstition can
+become accredited because its curative value may be equal to a truly
+valuable suggestion. The intellectual life of the community would have
+to suffer greatly if the way to be freed from bodily suffering had to be
+the belief in the metaphysical doctrines of Mrs. Eddy's "Science and
+Health." From a cultural viewpoint, too, suggestive therapeutics must
+stand the higher, the more sharply it is separated from special
+philosophical or religious doctrines. No theory of the world and of God
+ought to gain authority over the mind from such an external motive as a
+belief in its curative effects. Freest from such implications is
+certainly the hypnotic method of the physician who does not need the
+strong religious reenforcement of the suggestion because he reenforces
+instead the suggestibility of the patient by slight influences on his
+senses.
+
+Even where sound religion without superstition and without
+pseudophilosophy stands behind the therapeutic work, the community will
+not give up the question whether the church does not necessarily neglect
+by it the interests which are superior. The community becomes more and
+more strongly aware that too many factors of our modern society urge the
+church to undertake non-religious work. Social aid and charity work
+ought to be filled with religious spirit, but to perform it is not
+itself religion. Still more that is true of the healing of the sick.
+Whether or not such expansion of church activity in different directions
+saps the vital strength of religion itself is indeed a problem for the
+whole community. The fear suggests itself that the spiritual achievement
+may become hampered, that in the competition of the church with the
+other agencies of social life the particular church task may be pushed
+to the background, and that thus the church in imitating that which
+others can do just as well or better loses the power to do that which
+the church alone can do. The final outcome is therefore practically in
+every way the same. From whatever starting point we may come, we are led
+to the conviction that the physician alone is called to administer
+psychotherapeutic work, but that he needs a thorough psychological
+training besides his medical one.
+
+But the interest of the community is not only a negative one. Society
+does not only ask where psychical treatment can be dangerous, but asks
+with not less right whether the scheme and the method might not be
+fructified for other social ends besides the mere healing of the sick.
+If psychotherapy demonstrates that for instance hypnotism makes possible
+the reshaping of a pathological mind, it is a natural thought to use the
+same power for remodeling perhaps the lazy or the intemperate, the
+careless or the inattentive, the dishonest or the criminal mind. Both
+educators and criminologists have indeed often raised such questions,
+and social reformers have not seldom seen there wide perspectives for
+social movements in future times.
+
+There can be no doubt that the possibility of such remodeling activity
+is given, but as far as education is concerned certainly grave
+misgivings ought to be felt. When we spoke of the treatment of the sick,
+we had always to emphasize that the suggestion cures symptoms but not
+diseases. In the same way hypnotic suggestion might reenforce a single
+trait but would not reform the personality of the child. Yes, the
+artificial reenforcement of such special features would deprive
+education of that which is the most essential, namely, the development
+of the power to overcome difficulties by own energy. Wherever a
+reasonable amount of own will force and attention can be expected to
+overcome the antagonistic influence, there artificial hypnotic
+influence ought to be avoided. Everything ought to be left in that case
+to suggestions within normal limits, in the form of good example and
+persuasions, authority and discipline, love and sympathy. That holds
+true even for very slight abnormalities which seem still within the
+limits where the own energies can bring about the cure. For instance, I
+have steadily refused requests of students and others to use hypnotism
+for the purpose of overcoming merely bad habits, such as the habit of
+biting the nails. A child who finds some difficulty in sticking
+seriously to his tasks might learn now this and now that under the
+influence of hypnotic suggestions but he would remain entirely untrained
+for mastering the next lesson. In the same way some naughty traits might
+be artificially removed but the child would not gain anything towards
+the much more important power of suppressing an ugly tendency by his own
+effort. All that finds its limits where the inhibitions or obstacles in
+the brain of the child are too strong possibly to be overcome by the own
+good will, but in that case we already stand in the field of abnormal
+mental life and then of course psychotherapy has its right. The
+feeble-minded and the retarded child, the perverse child and the
+emotionally unstable child, belong under the care of the physician, and
+in such a case he ought not to hesitate to use the whole supply of
+psychotherapeutic methods which are at his disposal.
+
+Still more complex is the criminological problem. It sounds like an easy
+remedy for the greatest social calamity, if it is proposed simply to
+hypnotize the criminal and to supplant his antisocial will by a moral
+one. And if the absurdity of such a proposal is recognized it seems to
+many justified to demand such an intrusion at least in the case of the
+born criminal, even if the occasional criminal cannot be reached. But
+the conception of the born criminal is also only a label which is
+superficially used for a great variety of minds. That men are born with
+a brain which necessarily produces criminal actions is not indicated by
+any facts. The varieties which nature really produces are brains which
+are more liable than others to produce antisocial actions. We recognized
+from the start that the abnormal mind never introduces any new elements
+but is characterized only by a change of proportions. There is too much
+or too little of a certain mental process and just for that reason there
+must be a steady and continuous transition from the normal to the
+entirely abnormal. Here again we have not a special class of brains
+which are criminal; but we have an endless variety of brains with a
+greater or smaller predisposition for antisocial outbreaks. The
+variations which produce this criminal effect may lie in most different
+directions.
+
+The brain may be for instance inclined to overstrong impulses, so that
+any desire rushes to action before the inhibiting counter-idea gets to
+work. Or, on the other hand, the brain may have unusually weak
+counter-ideas so that even a normal impulse does not find its normal
+checking. The fact that selfish and thus antisocial desires awake in the
+mind is not abnormal at all; only if they are not normally inhibited,
+the disturbance sets in. Furthermore the associative apparatus of the
+brain may work especially slowly; it may thus bring it about that the
+counteracting ideas do not arise in time. Or the emotions of a person
+may be unusually strong. Or there may be strong suggestibility, by which
+a bad example or a strong temptation has especially easy access. Or
+there may be negative suggestibility, by which a moral admonition stirs
+up a vivid idea of the opposite. In short, there may be a large number
+of factors, sometimes even in combination, each one of which increases
+the chances that the individual may come in danger in the midst of
+developed society. Yet no one of those factors involves just the
+necessity of crime. The same kinds of brains might simply show stupidity
+or credulity or inconsiderateness or brutality or stubbornness or
+egotism, and might by each of those factors decrease their chances in
+the community without directly running into conflict with the law. The
+criminal is therefore never born as such. He is only born with a brain
+which is in some directions inefficient and which thus, under certain
+unfavorable conditions, will more easily come to criminal deeds than the
+normal brain.
+
+With the idea of a stereotyped born criminal there disappears also the
+idea of a uniform treatment against criminal tendencies. That men are
+different in their power of resistance or in their power of efficiency
+or in their intellect or in their emotions, we have to accept as the
+fundamental condition with which every society starts. It would be
+absurd to remodel them artificially after a pattern. The result would be
+without value anyhow, inasmuch as our appreciation is relative. No
+character is perfect. The more the differences were reduced, the more we
+should become sensitive even for the smaller variations. All that
+society can do is, therefore, not to remodel the manifoldness of brains,
+but to shape the conditions of life in such a way that the weak and
+unstable brains also have a greater chance to live their lives without
+conflicts with the community.
+
+The situation is different as soon as the particular surroundings have
+brought it about that such a brain with reduced powers has entered a
+criminal career. The thought of crime now becomes a sort of obsession or
+rather an autosuggestion. The way to this idea has become a path of
+least resistance, and as soon as such an unfortunate situation has
+settled itself, the chances are overwhelming that a criminal career has
+been started. If such cases should come early to suggestive treatment
+which really would close the channels of the antisocial autosuggestion,
+much harm might be averted. Yet again the liability of the brain to
+become antisocial would not have been removed, and thus not much would
+be secured unless such a person after the treatment could be kept under
+favorable conditions. With young boys who through unfortunate influence
+have caught a tendency, for instance, to steal, and where the fault does
+not yield to sympathetic reasoning and to punishment, an early hypnotic
+treatment might certainly be tried. I myself have seen promising
+results. But if the impulse has irresistible character in such a way
+that the good will is powerless, we are again in the field of disease
+and the point of view of the physician has to be substituted for that of
+the criminologist.
+
+Whether pedagogy and criminology are to make use of the services of
+psychotherapy is thus certainly an open question. It would be
+short-sighted to overlook the serious obstacles which stand in the way.
+But while the social life outside of the circle of real disease may
+better go on without direct interference by psychotherapeutic
+influences, it is certainly the duty of the community to make the
+underlying principles of psychotherapy useful for the sound development
+of society. The artificial over-suggestions which are needed to overcome
+the pathological disturbances of mental equilibrium may be left for the
+cases of illness. But we saw that every mental symptom of disease was
+only an exaggeration of abnormal variations which occurred within the
+limit of health. To reduce these abnormalities means to secure a more
+stable equilibrium and thus to avoid social damages, and at the same
+time to prevent the growth of the abnormality to pathological
+dimensions. To counteract these slighter variations, these abnormalities
+which have not yet reached the degree of disease, will demand the same
+principles of treatment, only in a weaker form. It is in a way not
+psychical therapy but psychical hygiene. And this is no longer confined
+to the physician but must be intrusted to all organs of the community.
+And here more than in the case of disease, the causal point of view of
+the physician ought to be brought into harmony with the purposive view
+of the social reformer, of the educator and of the moralist.
+
+The ideal of such mental hygiene is the complete equilibrium of all
+mental energies together with their fullest possible development. To
+work towards this end does not mean to aim towards the impossible and
+undesirable end of making all men alike, but to give to all, in spite of
+the differences which nature and society condition, the greatest
+possible inner completeness and outer usefulness. The efforts in that
+direction have to begin with the earliest infancy and are at no age to
+be considered as finished; the whole school work and to a high degree
+the professional work has to be subordinated to such endeavor. Society
+has further to take care that those spheres of life which stand less
+under systematic principles, such as the home life of the child and the
+social life of the man, his family life and his public life, are
+steadily under the pressure of influences which urge in the same
+direction.
+
+Harmonious development without one-sidedness, and yet with full justice
+to the individual talents and equipments, should be secured. That means
+from the start an effort to secure balance between general education and
+particular development. The latter has to strengthen those powers by
+which the boy or girl by special natural fitness promises to be
+especially efficient and happy. It has to be supplemented later by a
+wise and deliberate choice of such a vocation as brings these
+particular abilities most strongly to a focus. Yet this alone would mean
+a one-sidedness in which the equilibrium would be lost. More important,
+it would leave undeveloped that power which the youth especially needs
+to acquire by serious education, the power to master what does not
+appeal to the personal likings and interests. An equilibrium is secured
+only if at the same time full emphasis is given to the learning and
+training in all which is the common ground of our social existence. From
+the multiplication table to the highest cultural studies in college, the
+youth is to be adjusted to the material of our civilization without any
+concession to the emasculating desire to adjust civilization simply to
+the particular youth. He has to learn learning and not only to play with
+knowledge, he has to learn to force his attention in adjustment to those
+factors of civilization which are foreign to his personal tendencies and
+perhaps unsympathetic. Free election of life's work and unyielding
+mental discipline in the service of the common demands should thus
+steadily cooeperate. The one without the other creates a lack of mental
+balance which is the most favorable condition for a pathological
+disturbance.
+
+The mere learning is of course on both sides only a fraction of what the
+community has to develop in the youth. Mental hygiene begins with
+physiological hygiene. The nourishment of the child, the care for the
+child's sense organs, the recesses and the rest from fatigue, and
+especially the undisturbed sleep are essential conditions. The
+interferences with sufficient sleep are to a high degree responsible
+for the later disturbances of the mental life. It must not be forgotten
+that the decomposition of the brain molecules can never be restituted by
+anything but rest, and ultimately by sleep. Physical exercise is
+certainly not such restitution. In the best case it brings a certain
+rest to some brain centers by engaging other brain parts. The child
+needs sleep and fresh air and healthful food more than anything else, if
+his mind is active. The careful examination of the sense organs and of
+the unhindered breathing through the nose is most important. Even a
+slight defect in hearing may become the cause of an under-development of
+attention.
+
+More important than mere physical hygiene is the demand that a sound
+character and a sound temperament are also to be built up, at the side
+of a sound interest. Here again everything depends upon a wise balance
+between the development of that which is given by nature to the
+particular individual and the reenforcement of that which society
+demands and which belongs therefore to the common equipment. The
+emotional stability and emotional enlargement of the mind is perhaps
+most neglected in our educational schemes. On the one side it demands a
+systematic discipline of the emotions, on the other a healthy
+stimulation of emotions. Here is the place where imagination in play and
+later in art come in. The biological value of play always lies in the
+training for the functions of later life, and especially for the
+emotional functions. The play of our children is too little adjusted to
+this task. For this reason it leaves too many unprepared for the world
+of art and for the emotional experiences of real life. Both lack of
+emotional discipline and narrow one-sidedness of emotions interfere with
+the harmonious development. Destructive emotions like terror ought to be
+kept away and not needlessly brought near by uncanny stories and mystic
+superstitions. It is the healthy love and sympathy of the home which
+contributes most strongly to the normal development of emotions. Again
+in the field of will, we want the strong, spontaneous, independent will
+which is not frightened by discomfort and not discouraged by obstacles,
+and yet we want the will which is not stubborn and selfish but which
+subordinates itself to the larger will of the social group and to the
+eternal will of the norm. There is no balance where independence and
+subordination do not supplement each other. A wide education not only
+trains for both but also secures habits which work as autosuggestions in
+both directions.
+
+But all this harmonious development of intellect and temperament and
+character has to go on when the school days are over and just here
+begins the duty of the community as a whole. The special functions of
+the teachers have to be taken up by the public institutions. The whole
+social life must shape itself in such a way that everyone finds the best
+possible chances to perfect this harmonious growth. In the field of the
+intellect, the community must take care that thoroughness of training
+and accuracy of information is rigidly demanded and not thrust out by
+an easy-going superficiality. The expert ought to replace the amateur in
+every field. Every society which allows successes to superficiality
+diminishes its chances for mental health. Yet while thoroughness demands
+concentration in one direction, society must with the same earnestness
+insist on well-rounded general education and continuity of general
+interests through life. Literature and the libraries, the newspapers and
+the magazines play there a foremost role, and again the mental health of
+the community has to pay the penalty if its newspapers work against
+general culture. In the emotional field art and music, fiction and the
+theater on the one side, the church on the other side, remain the great
+schools for a development of sound emotions. Where literature becomes
+trivial, where the stage becomes degraded, and where the church becomes
+utilitarian and uninspiring, great powers for possible good in emotional
+education are lost. But with this enrichment of feelings the
+disciplinary influence too has to go through the whole social life.
+Where art is sensational and the church hysterical,--in short, where the
+community stirs up overstrong feelings,--the wholesome balance is lost
+again. In a similar way the public demands should throughout stimulate
+the energy and ambitions and initiative of the man, and yet should keep
+his desires and impulses in control.
+
+Few factors are more influential in all these directions than the
+administration of law. Sound sober lawmaking and fair judgment in court
+secure to the community a feeling of safety which gives stability to
+emotions and feelings. The disorganization which results from arbitrary
+laws, from habitual violation of laws, from corruption and injustice
+works like a poison on the psychophysical system. A similar unbalancing
+influence emanates from overstrong contrasts of poverty and comfort. A
+poverty which discourages and leaves no chances and a wealth which
+annihilates the energies and effaces the consciousness of moral
+equality, create alike pernicious conditions for mental balance.
+
+Unlimited furthermore are the influences which depend upon the sexual
+ideas of the society. It is the sphere in which it may be most difficult
+to indicate the way towards a development without dangers. There is no
+doubt the arbitrary suppression of the sexual instinct must be
+acknowledged as the source of nervous injury while indulgence may lead
+to disease and misery. But in any case frivolous habits and easy divorce
+contribute much to the unbalanced life which ruins the unstable
+individual. Not less difficult and not less connected with the mental
+hygiene is the alcohol problem. For normal adult men mild doses have
+through their power to relieve the inhibitions undeniable value for the
+sound development of the community. Its intemperate use or its use by
+young people and by pathological persons is one of the gravest dangers.
+Whether intemperance ought to be fought by prohibition or rather by an
+education to temperance is a difficult question in which the
+enthusiastic women and ministers, backed by the well justified fears of
+psychiatrists, will hardly be on the same side as the sober judgment of
+scientists, unprejudiced physicians, and historians. In any case the
+saloon and its humiliating indecency must disappear and every temptation
+to intemperance should be removed. Above all, from early childhood the
+self-control has to be strengthened, the child has to learn from the
+beginning to know the limits to the gratification of his desires and to
+abstain from reckless over-indulgence. With such a training later on
+even the temptations of alcoholic beverages would lose their danger. Not
+less injurious than the strong drinks are the cards. All gambling from
+the child's play to the stock exchange is ruinous for the psychophysical
+equilibrium. The same is true of any overuse of coffee and tea and
+tobacco, and as a matter of course still more the habitual use of the
+drugs like the popular headache powders and sleeping medicines. The life
+at home and in public ought to be manifold and expansive but ought to
+avoid over-excitement and over-anxiety. A good conscience, a congenial
+home, and a serious purpose are after all the safest conditions for a
+healthy mind, and the community works in preventive psychotherapy
+wherever it facilitates the securing of these three factors.
+
+For that end society may take over directly from the workshop of the
+psychotherapist quite a number of almost technical methods. Suggestion
+is one of them. The means of suggestion through education and art,
+through the church and through public opinion, through example and
+tradition, and even through fashion and prejudices, are millionfold,
+but not less numerous are the channels for antisocial and antihygienic
+suggestions. No one can measure the injury done to the psychophysical
+balance of the weaker brains, for instance, by the sensational court
+gossip and reports of murder trials in the newspapers for the masses.
+But while the influence of suggestion is on the whole familiar to public
+opinion, the community is much less aware of another factor which we
+found important in the hands of the psychotherapist. We recognized that
+mental disturbances were often the result of suppressed emotion and
+repressed wishes. For the cure the psychotherapist has to aim toward the
+cathartic result. The suppressed ideas had to be brought to
+consciousness again and then to be discharged through vivid expression.
+Society ought to learn from it that few factors are more disturbing for
+the mental balance than feelings and emotions which do not come to a
+normal expression. It is no chance that in countries of mixed Protestant
+and Catholic civilization, the number of suicides is larger in
+Protestant regions than in the Catholic ones where the confessional
+relieves the suppressed emotions of the masses. This is also the most
+destructive effect of social and legal injustice; emotions are
+strangulated and then begin to work mischief. The community should take
+care early that secret feelings are avoided, that the child is cured
+from all sullenness which stores up the emotion instead of discharging
+it. Certainly all education and social life demands inhibition and also
+the child has to learn not to give expression to every passing feeling.
+To find there the sound middle way is again the real hygienic ideal. Too
+much in our social life and especially in the sphere of sexuality forces
+on the individual a hypocrisy and secrecy which is among the most
+powerful conditions of later mental instability.
+
+Of course the background of a hygienic life of the community remains the
+philosophy of life which gives unity to the scattered energies and
+consequently steadiness to the individual through all his hazards of
+fate. It might seem doubtful whether society could get the prescription
+for such a steady view of the world also from the workshop of the
+psychotherapist. To the superficial observer the opposite might seem
+evident, as every word of our psychotherapeutic study indicated that
+that is a view of life which makes man's inner experience simply an
+effect of foregoing causes. All life becomes a psychophysical mechanism
+and from that point of view man's thinking and acting become the
+necessary outcome of the foregoing conditions. Nothing seems more unfit
+to give a deeper meaning to life and a higher value. And yet if there
+was one thought which controlled our discussion from the beginning, it
+was certainly the conviction that this causal view itself is only an
+instrument in the service of idealistic endeavors; the reality of man's
+life is the reality of will and freedom directed towards ideals. One of
+these ideals is the reconstruction of the world in the thought forms of
+causality. In the service of our ideals we may thus transform the world
+into a mechanism: out of our freedom we desire to conceive ourselves as
+necessary products. Whenever we aim to produce changes in the world, we
+must calculate the effects through the means of this causal
+construction, but we never have a right to forget that this calculation
+itself is therefore only a tool and that our reality, in which our
+duties and our real aims lie, is itself outside of this construction.
+The psychotherapist wants to produce effects inasmuch as he wants to
+cure disease. He is therefore obliged to adjust his work as such
+entirely to the causal aspect of man, as soon as he wants to seek the
+means by which he can reach the end. But even the fact that he decides
+in favor of those ends, that he aims towards their realization, binds
+him to a world of purposes, and therefore, he, too, with his whole
+psychophysical work, stands with both feet in a reality of will which is
+controlled not by causes but by purposes, not by natural laws but by
+ideals.
+
+
+
+
+INDEX
+
+
+Abnormal, 75
+
+Abstinence, 281
+
+Action, 34, 101, 276
+
+Adenoids, 189
+
+Adjustment, 102
+
+AEsthetic, 63
+
+Alcohol, 198
+
+Alcoholism, 278
+
+Alternation, 154, 174
+
+Anaemia, 310
+
+Anaesthesia, 174, 301
+
+Analysis, 21
+
+Antagonistic, 24
+
+Anxiety, 272
+
+Appeal, 93
+
+Applied Psychology, 60
+
+Appreciation, 10
+
+Art, 87
+
+Association, 29, 32, 42
+
+Association Experiment, 72, 233, 359
+
+Associationism, 44
+
+Astrology, 350
+
+Assurance, 215
+
+Assyria, 322
+
+Ataxia, 179
+
+Atoms, 27
+
+Attention, 46, 95, 99, 113, 200, 244
+
+Attitudes, 13
+
+Authority, 222
+
+Automatic, 144, 237
+
+Autosuggestion, 122, 172, 219, 255, 266
+
+Awareness, 133, 149
+
+
+Beauty, 197
+
+Belief, 100, 329
+
+Blood-vessels, 302
+
+Blushing, 262
+
+Braidism, 353
+
+Brain, 29, 34, 67, 139
+
+
+Cancer, 178
+
+Cathartic, 233, 358
+
+Causality, 14, 32, 57
+
+Cell, 44, 81, 89
+
+China, 321
+
+Church, 319
+
+Christianity, 324
+
+Christian Science, 7, 55, 317, 327, 343, 344
+
+Chronoscope, 71
+
+Circulation, 79
+
+Clairvoyant, 128
+
+Clearness, 103
+
+Cocainism, 283
+
+Coconscious, 156
+
+Communication, 22
+
+Community, 370
+
+Company, 197
+
+Comparative Anatomy, 38
+
+Complex, 232, 249, 270
+
+Confidence, 221, 230
+
+Conscience, 219
+
+Consciousness, 11, 125, 130, 134
+
+Contact, 223
+
+Cortex, 47
+
+Cretinism, 168
+
+Crime, 112
+
+Criminology, 383
+
+
+Dementia, 168
+
+Depression, 178, 267, 314
+
+Description, 19
+
+Diabetes, 311
+
+Diagnosis, 66, 184, 241
+
+Digestive, 177, 309
+
+Dilettanteism, 2
+
+Discharge, 49, 90, 218, 232, 252, 396
+
+Discipline, 202
+
+Disposition, 138, 143
+
+Dissociation, 135, 152
+
+Dream, 114
+
+Drugs, 163, 334
+
+
+Education, 389
+
+Effort, 289
+
+Efficiency, 194
+
+Egyptians, 323
+
+Electrobiology, 353
+
+Emmanuel Church, 326, 328, 331, 341
+
+Emotion, 88, 123, 235, 259, 314, 392
+
+Encouragement, 206
+
+Energy, 276, 288
+
+Epidemic, 193
+
+Epilepsy, 80, 207
+
+Equilibrium, 160
+
+Ergograph, 71
+
+Ethics, 16
+
+Ethnology, 329
+
+Examination, 186
+
+Exhaustion, 196
+
+Experimental Psychology, 5, 61
+
+Explanation, 19, 28, 41
+
+
+Faith, 6, 335
+
+Fascination, 116, 230
+
+Fear, 172, 259, 263
+
+Feeble-minded, 72, 295
+
+Feelings, 23
+
+Freedom, 51, 146
+
+Functional Diseases, 81, 343
+
+
+Galvanoscope, 71
+
+Genetic Psychology, 39
+
+Gospels, 324
+
+Greeks, 323, 350
+
+
+Half-sleep, 226
+
+Hallucination, 246
+
+Hastiness, 200
+
+Headache, 309
+
+Hearing, 300
+
+Heart Disease, 310
+
+Heterosuggestion, 122
+
+History, 16
+
+Hygiene, 389
+
+Hypnoid, 116, 227
+
+Hypnotism, 74, 85, 109, 122, 227, 243, 350
+
+Hysteria, 122, 174, 269, 356
+
+
+Idealism, 2, 33, 397
+
+Illness, 67
+
+Imagination, 111
+
+Impulse, 89
+
+Improvement, 299
+
+Indecision, 290
+
+Indians, 321
+
+Inherited, 171
+
+Inhibition, 86, 95, 113, 295, 305, 315
+
+Insanity, 165, 256
+
+Insomnia, 303, 312
+
+Instinct, 305
+
+Intemperance, 281
+
+Intensity, 194
+
+Interruption, 191
+
+
+Japan, 322
+
+Jews, 322
+
+
+Kymograph, 71
+
+Knowledge, 11
+
+
+Lawyer, 87
+
+Learning, 390
+
+
+Magnetism, 351
+
+Make-believe, 216
+
+Memory, 138
+
+Mesmerism, 128, 253
+
+Minister, 57, 207, 332, 340, 367
+
+Monotony, 203
+
+Moral, 65, 84
+
+Morality, 372
+
+Morphinism, 283, 376
+
+Motor Process, 46, 97, 218
+
+Movement Sensation, 24
+
+Mystic, 224, 315
+
+
+Naturalism, 4
+
+Negativism, 220
+
+Nervousness, 193
+
+Neurasthenia, 169, 246, 290, 292
+
+Neuron, 164
+
+Nutrition, 79, 312
+
+
+Obedience, 201
+
+Object, 13, 18
+
+Obsession, 246
+
+Opposite Idea, 97
+
+Oppression, 272
+
+Organic Diseases, 81, 343
+
+Organism, 23
+
+
+Pain, 69, 167, 298, 309, 313, 342
+
+Parallelism, 33, 37, 40
+
+Passes, 117
+
+Pathology, 36
+
+Pauses, 190
+
+Pedagogy, 63
+
+Perception, 20, 34, 133
+
+Personality, 11, 25, 154
+
+Persuasion, 214
+
+Perversity, 176
+
+Phobia, 94
+
+Physical, 18
+
+Physician, 57, 347
+
+Physicotherapy, 1
+
+Pneumograph, 71, 235
+
+Poet, 59
+
+Posthypnotic, 120, 231
+
+Postulate, 41
+
+Prayer, 207
+
+Prohibition, 198
+
+Protestantism, 325
+
+Psychasthenia, 172, 264, 277
+
+Psychiatry, 70
+
+Psychical, 18
+
+Psychoanalytic, 236, 272
+
+Psychological Laboratory, 5, 36, 60, 72, 356
+
+Psychology, 5, 8, 25, 39, 364
+
+Pulse, 235, 294
+
+Purposes, 11, 17
+
+Purposive, 13, 33, 65, 145, 338
+
+
+Reactions, 50, 143
+
+Realism, 2
+
+Reality, 15
+
+Reasoning, 212
+
+Recklessness, 201
+
+Recuperation, 191
+
+Relapse, 281
+
+Relativity, 195
+
+Religion, 84, 207, 329, 341
+
+Reparable, 165
+
+Reservoir, 209
+
+Resistance, 105
+
+Rest, 191
+
+Retardation, 169, 202
+
+Revival, 337
+
+
+Savages, 320
+
+Secrets, 185
+
+Self, 24, 131
+
+Self-consciousness, 136
+
+Sensation, 22, 28
+
+Sense Organ, 300
+
+Shamanism, 320
+
+Sidetracking, 236, 249, 271
+
+Sleep, 112, 177, 226, 303, 307
+
+Somnambulism, 114, 153, 352
+
+Sphygmograph, 71, 235
+
+Stammering, 175, 274
+
+Stomach, 309
+
+Subconscious, 125, 161
+
+Subcortical, 143, 306
+
+Subject, 13
+
+Suggestibility, 88, 107, 221
+
+Suggestion, 85, 100, 213, 273, 395
+
+Superficiality, 200
+
+Supervision, 279
+
+Surroundings, 189
+
+Sympathy, 205
+
+Symptoms, 80, 186
+
+
+Temperance, 198
+
+Tones, 44
+
+Toxic, 167
+
+
+Unity, 52, 135
+
+
+Vacation, 197
+
+Vividness, 50
+
+
+Will, 11, 31
+
+Witness, 107
+
+Worry, 259
+
+
+Yogi, 350
+
+
+
++----------------------------------------------------+
+|Transcriber's note:                                 |
+|                                                    |
+|Inconsistencies in hyphenation reflect the original |
+| text.                                              |
++----------------------------------------------------+
+
+
+
+
+
+
+End of the Project Gutenberg EBook of Psychotherapy, by Hugo Muensterberg
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