Chapter 6

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.