CHAPTER X

INFLUENCE OF THE PERSONALITY IN THERAPEUTICS

Though it has seldom been fully realized and has probably never been appreciated as in our time, one of the most important factors in therapeutics, in every period of the history of medicine, has been the personal influence of the physician. Therapeutic fashions have come and gone, new drugs have been introduced, have had their day and then been relegated to the limbo of worn-out ideas. At all times, however, physicians have succeeded in doing good, or at least using, with apparent success, the therapeutic means of their own time, however crude and inadequate these afterwards proved to be. They have succeeded in shortening the progress of disease as well as increasing the patient's resistive vitality and thus enabled him not infrequently to survive where otherwise a fatal termination might have occurred. All unsuspected during most of the time, it was the personal influence of the physician that counted for most in all of the historical vicissitudes of therapeusis. It mattered not that the means he employed might seem absurd to the second succeeding generation, as was so often, indeed almost invariably, the case, his personal influence has at all times overshadowed his available therapeutic auxiliaries. In spite of all our advance in scientific medicine, to a considerable degree this remains true even at the present time, and to fail properly to use this important auxiliary is to cripple medical practice.

Place of Personal Influence.--When the antitoxins and directly curative serums seemed about to make for themselves a place in therapeusis, it looked for a time as though this personal element might be entirely superseded. It seemed that all other therapeutic factors must give way to definitely accurate doses of antitoxic principles, directly opposed to the toxins of disease and {70} capable of conquering it. With the success of diphtheria serum, the prospects for scientific therapeutics from the biological standpoint became very promising. Unfortunately, our further experience with antitoxins and therapeutic sera of various kinds has not been satisfactory, and now the medical world is looking elsewhere for progress in therapeutics.

This throws us back once more on the old-time therapeutics, and we have to learn to use all their elements. One of the most important of these, if not, as we have suggested, absolutely the most important, the one that in all the many variations of therapeusis has maintained itself, is the personal influence of the physician by which he is able to soothe the patient's fears, allay his anxieties, make him face the situation calmly so that he may not use up any of his vital force in useless worry, but on the contrary employ all his available psychic energy in helping nature to overcome whatever disturbance there is within the organism. This personal influence was for several centuries spoken of as personal magnetism, not merely in the figurative sense in which we now employ that term, but in a literal sense. The implication was that some men possessed within themselves a reservoir of superfluous energy, vital in character, but thought to be related to the force exhibited by the magnet, when it attracted bodies to itself, and made metals for a time magnetic like itself, and which actually passed over from the physician to his patient. We have gotten away from the idea of any physical force flowing from physician to patient, but we know very well that certain physicians are much more capable than others of arousing the vital energies of the patient, sometimes to the extent of making him feel, after treatment, that he has more force than before. The patient feels that something must have been added to his natural powers, though he has only been brought into a state of mind where he can better use his own powers.

It is the men whose presence created this impression in patients, an impression that is justified by the fact that somehow he enabled them to vitalize themselves better than before, who have been most successful in the treatment of patients. In all ages the men of reputation for healing have had this. A careful study of their lives shows that this counted for more in many of the experiences of their healing than the drugs and remedies which they employed. The men who have been the most sought by patients have not as a rule left us great therapeutic secrets; on the contrary, they have only employed the conventional remedies of their times with reasonable common-sense and have added to them their own personal influences. On the other hand, the men who have made discoveries in therapeutics, and in medicine, have not always been popular as physicians. They have known too much of their own lack of knowledge to be quite confident in their use of remedies, and this has hurt something of their personal influence over patients.

IMPRESSIVE PERSONALITY

As a matter of fact, it is easy to comprehend, even from the comparatively scanty details that we have of habits and methods of the great physicians, that their effect upon their patients was always largely a matter of impressive personality. Any one who, from a pharmaceutical standpoint, knows how {71} inefficient were many of the remedies that great physicians depended on, yet how effective they seemed to be to their patients, and even to themselves, will appreciate the factor of personal magnetism that entered into their employment. It is not alone in the olden time that great physicians have been almost worshiped. For their patients they have at all times been men of exalted knowledge, masters of secrets and comforters of the afflicted, just as was the first great physician of whom we have any account, I-em-Hetep, in Egypt nearly six thousand years ago. Such men as Hippocrates, as Galen, as Sydenham and Boerhaave, and Van Swieten, accomplished curative results far beyond the therapeutics of their time. The loving admiration of patients and of their disciples shows how strong were their personalities and gives us, almost better than the writings they have left to us, the secret of their successes as practitioners of medicine.

A Great Modern Physician's Influence.--It is interesting to study in the lives of great physicians the details which illustrate their personal influence, their consciousness of it and how deliberately they used it. A typical example very close to us, whose reputation was still fresh while I was at the University of Paris, was Professor Charcot. He had made great discoveries in nervous pathology. To a great extent he had revolutionized our knowledge of nervous diseases and added many new chapters to this rather obscure department of medicine. Far from making the treatment of nervous diseases easier than before, or giving more assurance to the physician who dealt with them, his discoveries, however, had just the opposite effect. His work emphasized that practically all of the so-called nervous diseases were due to degenerations in the central nervous system, which no medicine could be expected to relieve in any way, and which nothing short of the impossible re-creation of damaged parts could ever cure. His studies included organic degenerations of other organs, and in his treatise on "Diseases of the Old" it is made clear that many of the symptoms of old age are due to organic lesions for which no cure can ever be expected. This would seem to discourage treatment, yet somehow Charcot became a great practicing physician as well as a medical scientist and pathologist.

His success was due to his personal influence over his patients. In spite of the unfavorable prognosis that he had to give in so many cases, he was able by suggestion to help many patients with regard to their course of life, and to reassure them, so that many adventitious neurotic symptoms not due to their underlying nervous disease, but to their solicitude about themselves, disappeared. Very few people who came to him went away without feeling that his advice had been very valuable to them and without experiencing, as a rule, after they had followed his advice, that they were much better than they had been before. It was for the neurotic conditions associated with nervous affections that Charcot's personal influence over patients was of the greatest therapeutic significance.

He himself recognized this and did not hesitate to use it to its fullest extent. Towards the end of his life, the method by which his patients were presented to him was calculated to make their relation to him, above all, a very personal one, and to give his influence the fullest weight. Nervous patients who came to see him, were each in his turn invited from the general waiting-room into a small ante-room just outside of Charcot's office and {72} there, in silence and dim light, asked to await the summons of the physician himself. When the time came for him to call them in, the folding doors between the rooms opened and he stood in a blaze of light inviting them to enter. Many a neurotic patient despairing of relief for symptoms that had lasted long in spite of the treatment of many other physicians, felt at once that here, in this kindly, gentle-voiced man standing so prominently in the light, was surely the long looked-for physician who would heal whatever ills there were. They came fully impressed with his power to heal, and all the valuable influence of auto-suggestion was enlisted on the side of their physician.

What is true in the regular practice of medicine can be seen much more clearly in the history of those who were not physicians, but who, nevertheless, by personal magnetism, succeeded in curing various ills, or at least in lifting up patients so that they used their own natural powers of recovery to much better advantage than would have been possible if left unaided.

Every successful healer has had this same personal influence, personal magnetism, call it what we will, which his patients have thought helpful to them through some direct communication, but which he himself, if he seriously studied it, and which every other thorough student of the question must realize, was due only to his power to call out the latent vitality of his patients. The mystery is not one of teledynamics, a transfer of energy from the operator, but one of awakening dormant faculties in the subject. Just why they should be dormant, since the patient so much wants to use them if he only could, is hard to understand. They do, however, lie dormant until the call of another strong personality wakens them to activity. Many people are so constituted that they cannot do effective work except under the direction of others. They lack initiative, though they may fill secondary places very well, indeed, much better often than the man of initiative who so frequently lacks capacity for details. In the same way many people are not able to bring out to the full all their own energies, even for their own bodily needs, unless under the guidance and influence of others; hence the stories of the healers that we have all down the centuries, and who have a definite place in the history of humanity and of medicine.

A Modern Healer.--A typical instance of the really marvelous power of mental influence over the minds of sufferers from many kinds of ills, is found in the career of the well-known Father Kneipp. For more than twenty-five years he had attracted the attention of Europe, and had made the little town of Woerishofen well known all over the world because of the cures effected there by him. The exactly proper phrase is effected _by him_ because it is clear to anyone who has studied the therapeutic methods he employed, that it was not these, or at least not these alone, that enabled him to cure so many ailments which had resisted the efforts of some of the best physicians in Europe. It was his magnetic personality which won patients to the persuasion that they must get better because he said so, and then to the following out of certain very simple natural rules of life, and certain quite as simple remedial measures, which acted as alteratives and enabled patients to tap reservoirs of vitality, of which they themselves were unconscious, but which, supplying energies to overcome tendencies to various symptomatic conditions, brought about cures.

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Pfarrer Kneipp had himself suffered from consumption, had been practically given up and then, as is the case of many another, had taken himself in hand, had secured much more outdoor air than before, and more abundant nutrition, until gradually his ailment was overcome. It is true that he used various hydrotherapeutic measures, some of them, as he confessed afterwards, to an excess, both as regards the temperature of water and the length of the application of it, that might have seriously hurt him if he had been less robust, but it was not so much his hydrotherapy as his own determination to get better and to live a little closer to nature that led to his cure. Then he became the apostle of cold water and of many natural remedial measures, and as a consequence, healer of all forms of ills in the many thousands who flocked to consult him in the little South German town. He made his patients get up early in the morning, get out in the air shortly after rising, the excuse, or, as he declared it, the reason being that they were to walk with bare feet in the dewy grass. After this he had them eat heartily of simple food, of such variety and in such quantity as relieved them of constipation, made them use water, internally and externally, in abundance, and after a time, sent most of them on their way rejoicing that they had been cured from chronic ills.

Some of the highest in Europe came to him; the Empress of Austria was his patient, and he was asked to prescribe for the Pope; reigning princes and all the lesser order of the nobility were included among his patients. Several of the Rothschild family went to him and where they went, of course, others flocked. Very few failed to be benefited. People less educated, and less rich in the world's goods than these, came also, and went away relieved. After a time Kneipp societies were founded all over Europe and even spread through America. These consisted of organizations of men and women who encouraged each other to keep up the Kneipp practices. With his death there has come a decline in interest in Kneipp methods. He, himself, was sure that his remedies and recommendations were the important curative factors. Now it has become clear that it was mainly his forceful personality, his power to lift patients above their ills, and enable them to use mental resources or vital forces that they could not use until encouraged by him with the thought that they would surely get better. In the atmosphere he thus created, they seemed to borrow something of his overmastering personality. It can not be too often repeated that this is the secret of the success of the great world healers. They do not transfer force to others, but they enable others to use their _own_ forces more successfully.

An Ancient Healer.--Let us compare some of the details of the career of Father Kneipp with the story we have of one Aristides, who, as the result of dreams that came to him while practicing the cult of AEsculapius and the injunctions contained in these dreams, was cured of many ills, and afterward delivered a series of sacred orations. Aristides is one of the first of the large group of literary men, much interested in their own health and their own ills, whose writings have been preserved for us. He was intensely proud of the number and variety of his ills, and he was perhaps conceited about the curious ways in which some of them had been cured. Traveling in the winter time he caught a chill; then he suffered from earache and in the midst of a storm developed fever, asthma and toothache. Arrived in Rome, he had severe internal sufferings, shivering fits and want of breath. Treatment by the Roman {74} doctor only aggravated his sufferings. A stormy voyage home made him worse. When, at last, he arrived in Smyrna, the doctors gathered round him, and were astonished at the manifold nature of the disease. They could do nothing for him.

Suffering from all these ills (which remind one of a modern literary man who has got his mind on his stomach and his body on his mind), Aristides went to a number of the old temple hospitals and received suggestions in sleep from AEsculapius. These he has described in what are called his sacred orations. In them we have every phase of modern therapy that has the strong element of suggestion in it. Like Pfarrer Kneipp, he tried very cold baths and was benefited by them. Walking in the dewy grass in his bare feet was another recommendation that had come to him in a dream. Occasionally he would run rapidly for a considerable distance, and then when heated plunge into a cold bath. We have many complaints of his fever and stomach troubles. Mud-baths were also recommended to him and, of course, tried with benefit for a time. Sand baths later proved to be beneficial. For rheumatism a cold bath, after running almost naked in the cold north wind, proved successful when other remedies failed. Aristides wrote out his experiences, and his writings had great influence over generations of patients and maintained the influence of the old Greek temples as cure houses long after the general acceptance of Christianity. As the result of his writings, no matter how bizarre a dream might be, some interpretation of a therapeutic nature was found from it.

Constancy of the Law of Personal Influence.--Indeed, there has apparently never been a time when some strong character, full of religious enthusiasm and of high purpose, strong in the confidence of men, has not succeeded in accomplishing wonderful curative results by the reassurance that comes from a renewal of faith in the goodness of Providence. There are, for instance, a number of stories which show John Wesley's power to help men to tap the reservoir of surplus energy that all of us have within us, but that somehow we do not succeed in making use of, unless some strong mental influence is brought to bear on us. Practically every religious man who has had the love and the veneration and the respect of those around him has succeeded in accomplishing the cures that many people in recent years have been prone to regard as rather novel phenomena in the history of psychology. Men like St. Philip Neri, St. Francis Xavier, and St. Francis of Assisi, and St. Bernard, have many stories told of them which show how much they were able to help fellow mortals by enabling them to make use, even in a physical way, of their own highest and best powers. Their lives show how much more they did.

Nor is this power confined to men. In nearly every century we have the story, also, of wonderfully strong women, leaders of their time, who inspired the profound confidence and veneration of those around them, and who were enabled, by their own strength of character, to help people physically as well as morally. The Life of St. Catherine of Siena is full of such instances. She spent her life mainly in caring for the sick and the distressed at the hospital in Siena, and the beautiful hospital there was completed largely as a monument to her. During her lifetime marvelous cures occurred that in many cases were evidently due to her power over the minds of people. The {75} life of St. Teresa has a number of similar examples, and Joan of Arc, in her lifetime, lifted many a dispirited man into vigorous strength because of her own abounding personality and the physical reaction which contact with her enthusiasm brought.

Modern Examples.--Nor did such occurrences come only in older and less sophisticated centuries than ours. John Wesley is close enough to our time to negative any such impression, but there are many other examples. There is Pastor Gassner, whose cures remind Prof. Muensterberg of the Emanuel movement at the present time, but there are also a number of strong, religious characters whose influence was exercised in the alleviation of physical ills during the nineteenth century. The name of Father Matthew, the Irish "Apostle of Temperance," as he was called, is mainly connected with wonderful cures of the worst forms of alcoholic addiction. Physicians know how difficult such cases are to cure, yet there are many thousands of what were apparently hopeless cases to Father Matthew's credit. It may be remarked that this is one of the ills that modern mental treatment claims most success with. Besides these morbid habits there are, however, other cases, told in detail, in which Father Matthew's influence enabled people to shake off headaches, to get rid of illusions, to overcome hysteria, and even to relieve other and much more physical affections. Animal magnetism was the subject of much thought in his lifetime (nineteenth century), so that it is not surprising that Mr. John Francis McGuire, a member of the English Parliament, who wrote Father Matthew's life in 1864, declared that "Father Matthew possessed in a large degree the power of animal magnetism, and great relief was afforded by him to people suffering from various affections; and in some cases I was satisfied that permanent good was effected by his administrations."

Another strong man of this same kind was Prince Alexander of Hohenlohe. Though a prince he had become a clergyman and spent his life in the service of the poor. Shortly after he became a priest he went through a great epidemic, fearlessly caring for his poor people, and as a consequence inspired them with so much confidence that ever after they came to him with all their ills. He was able to help, not only the poor, but also many of the nobility. Some of the things reported as accomplished through his influence show extraordinary power. His usual method was to endeavor to inspire in the people who came to him a faith in their cure, and then after a time the cure was actually accomplished.

During the recent troubles in Russia, attention was called to the fact that the famous Father John of Cronstadt, the hero of Bloody Sunday, was looked up to with so much respect and veneration that many people found themselves helped physically by contact with him. There are a number of interesting stories of cures of ills of various kinds, some of them exclusively mental, but many of them fundamentally physical, which took place as a consequence of the new spirit of hope infused into people because of their confidence in Father John. His subsequent history seems to indicate that this was evidently due to the forceful personality of the man rather than to any special religious influence. His influence was not limited to the ignorant masses in Russia, for some of the cures reported occurred in families of the better class, thoroughly capable of judging the character of the man apart from his religion.

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SUCCESS IN HEALING

We have any number of examples, then, of this power of the healer in history. Over and over again we find that it was the personality of the man and the suggestive value of the means that he employed that enabled patients to cure themselves, that is, to use all the vital force which they had for curative purposes. This force had hitherto been inhibited by their own doubts of themselves and their doubts of the value of all ordinary means of cure which had been previously employed in their cases. This is the secret of the success of the healer, and this secret is much more valuable for therapeusis than any remedy which has come down to us from the olden time. It has, unfortunately, been neglected, and thus an important benefit to humanity has been lost. Now that we are able to review frankly and deliberately the conditions that obtained in the past, it is time to set about making use of this oldest secret in medicine, now no longer a secret, as a strong factor in the treatment not of disease but of patients.

Healers are at all times strong characters who are helpful to others because of their own superabundant strength. The world is made up of two classes of people, lifters and leaners, and the leaners constitute by far the larger class. Most men and women are the subjects of doubts and dreads and difficulties with regard to their health, and the more time they have for introspection, the more are they likely to suffer. Unable to overcome them by themselves, they need the help of others. What they need, above all, is the reassurance that a trained strong mind can give them. The exercise of this mental influence over them, is only what corresponds to leadership in all the affairs of life. Most people need to be led and to be guided. The place of the physician is that of guide and director. The family physician of the olden time had a precious amount of influence that accrued to him from his character, and it was used to magnificent purpose. Most of his drug treatment would be looked upon as quite absurd at the present time, yet he did a great good work by lifting people up to their own highest possibilities of resistive vitality. That means more for the conquest of disease, even now, in most cases, than any remedies we possess.

Often men do not realize how much their personal influence counts for. They think it is their method of treatment, or some new discovery in drugs or remedial measures, or some new phase of psychology they have hit upon, that is producing results. This makes it difficult to determine, in given cases, just what are the actual influences at work. Many men supposing themselves to be discoverers of some novel force, are merely exploiting that old-time influence of one mind over another that can be observed all down the centuries.

It is interesting to study the careers of men who thought they were employing on their patients some new psychological method, when all they were exploiting was the old-fashioned influence of suggestion from a stronger personality to a weaker. A dozen times in history hypnotism has been announced as a wonderful curative agent. At present no one thinks it so, but, on the contrary, if used frequently, we think that it is much more likely to do harm than good. We went through a phase of interest in hypnotism a quarter of {77} a century ago and there are now signs of the possibility of its return in another form. In recent years we have heard much of psycho-analysis, of dominant ideas, of the auto-suggestion that comes from this, and how much benefit can be conferred on the patient by removing such ideas or revealing their unfavorable influence and so neutralizing them.

The patients that come for treatment and to whom psychotherapy is of special benefit, are not, as a rule, those suffering from acute diseases or injuries, though even in these cases the attitude of mind is always an important therapeutic factor. The patients are mainly those suffering from chronic ailments, and from minor affections which, while they do not confine them to bed, often prove the source of such serious disturbance as makes them very miserable. The suffering in the world is out of all proportion to the actual disease. Many people who have little disease suffer a great deal, partly from over-sensitiveness, partly from concentration of mind on their ailments, and partly from such ignorance of whatever pathological condition is present that they grow discouraged and morbid over it. The role of psychotherapy is particularly to help patients of this kind. This does not mean that its main purpose is to treat imaginary disease, or disease which exists only in the mind of patients, for in nearly all of these cases there is a definite physical element in the affection. Even where the disease is quite imaginary, though that term has been so sadly abused that it is perhaps better to speak of affections as purely mental in origin, psychotherapy is important. As has been well said, a patient not having something physical the matter who thinks that there is something the matter, is in a worse state than one who really has something the matter. There are a great many such cases. If the principles of psychotherapy can relieve them and cure many of them, then it has a large place in human life.

In order that the individual patient may be benefited, a thorough understanding must be established between physician and patient. This must take on the character of a personal relationship. The patient must feel that the physician has a personal interest in him--that there are certain individual features in his ailment which make his case mean something much more than ordinary to his physician. Some physicians have the power to make their patients feel this personal relationship to a marked degree. They are the eminently successful practitioners of medicine. Their patients sound their praises, and even though they may not be distinguished scientists, they acquire a large practice. Some of them are thoroughly scientific men. All of us know them and, while we may not be able to understand just how it is done, we recognize their power.