The highly educated and refined lady had lost her husband by an

accident in Switzerland, which had been misrepresented by some of

the newspapers as suicide. Two years later she wrote to me: "I feel

as if I had received indelible photographs on my brain which have

since greatly affected my health and from which I may never

recover. This winter the symptoms I have been able to control

returned and I have been ill. I unfortunately saw the newspaper

headlines with my husband's supposed suicide. Though I exclaimed

then, 'how outrageous,' I felt as if I had been struck and since

then I can seldom read a paper without dread and apprehension, and

the hearing of anyone's suicide fills me with terror. When I

hurried to Europe, on the ocean a week from the day of my husband's

death, I had a curious and overwhelming shock. On opening a drawer

and seeing a pair of scissors, they looked to me like a dagger and

suddenly the whole cabin seemed filled with implements of death.

The doctors said that I would find it hard to get over such

impressions but I told them I would, as I had courage and will. But

I have been realizing in these two years that I may be suffering

from something that may be beyond the control of will. I often

become so nervously sensitive that scissors are unbearable for me

to see, or a steel knife or anything that might express death. Our

family physicians are still against hypnotism, and if I should go

to a neurologist of my own selection, it might be to one who

believed still only in nerve foods, baths, or a sanitarium."

The lady came from the South, with her nurse, to Boston and

insisted on being hypnotized by me. I cannot say whether a really

deep hypnotic state was produced at once as I refrained from

testing it. There was certainly no amnesia. Probably it began only

with a slight drowsiness but at the fifth treatment I found a

relatively deep hypnosis. It was a capricious case in which the

improvement was fluctuating but clearly setting in from the first

day. I trained her in hearing and seeing words like death and

suicide with a reenforced feeling of strength and calmness; I

forced her to see and touch scissors with an artificial attitude of

strength and indifference. At the same time I reenforced her good

mood and her enjoyment in life. When she left for England a few

weeks later, she felt herself mentally cured, and throughout the

summer her letters testified the wonderful change which the

treatment had brought about. Half a year later, as the result of

an exhausting physical local treatment, the psychophysiological

symptoms came back to a certain degree. She requested me by a

letter from England to give her some help by suggestion to suppress

again the recurring intrusions. As I had observed her strong

suggestibility, I sent her over the ocean a little pencil of

mother-of-pearl which she had seen in my hand, and advised her to

look at it until she counted twenty slowly and then to close her

eyes and simply to sleep. The autosuggestive effect was unusually

strong. She writes from London: "When I saw the enclosure of your

letter I felt as if it would burn through my hand and the feeling

became so overpowering that I locked it away with my jewels, but as

the days ran into a week I felt I could not live with it in my

apartment any more, and I felt almost ill, until it occurred to me

I could seal it and take it to my bankers. I felt as dreamy and

absent-minded and paralyzed as if you had just treated me."

Nevertheless the effect was on the whole the desired one and she

returned to America with a wholesome freedom of mind. I hypnotized

her twice again and she writes in her last letter: "I can never

repay you for what you have done for me. You have given me back my

courage and my love of life in its vividness and interest and

color, all that through the last years I had so entirely lost."

Even in cases where the disease itself is inaccessible to

psychotherapeutic treatment, the superadded grief and worry brought on

by the disease might yield to the mental influence and the whole

situation would to a high degree be transformed for the better by it. I

have often been asked to hypnotize in such cases, where the depression

was wrongly taken as a part of the nervous disease; sometimes I agreed

to do it in spite of feeling sure that the disease itself could not be

removed. I quote an instance.

A young woman afflicted with epilepsy was brought up in the belief

that she had only from time to time fainting attacks from overwork,

and with them secondarily neurasthenic symptoms, especially spells

of depression colored by a constant fear of the next fainting. She

had heard voices all her life and they frightened her in an

intolerable way. I produced a very slight hypnotic state. I

concentrated my effort entirely on suggestions which were to give

her new interest in life, and diminished the emotional character of

the voices without even trying to make them disappear. I proceeded

for several months. The young woman herself believed that the

fainting attacks came less frequently afterwards; yet I am inclined

to think that that is an illusion. But there was no doubt that her

whole personality became almost a different one with the new share

in the world. The epilepsy remained probably unchanged but all the

superadded emotions were annihilated and she felt an entirely new

courage which allowed her to control herself between her regular

attacks. She had been unable to undertake any regular work before

for a long while, but all that improved. More than a year

afterward, she wrote me: "I have really worked most of the time

this past winter and spring and I think I can see a steady though

slow gain. I am reading quite a little and doing it for the most

part easily. To be sure I have, after I have read, hard times with

the voices but their character is usually less determined and

fearful than formerly. Several times I have thought I must come

again to you but each time I have started again to fight it out for

myself, but now, as I am gaining, I can better estimate the great

help your influence was to me at a juncture when everything seemed

so hopeless and helpless."

Even in slight psychasthenic disturbances, the psychotherapeutic

influence is not always successful, especially if there is no time for

full treatment. But it is very interesting to see how even in such cases

the symptom is somehow changing, almost breaking to pieces. It becomes

clear that a protracted effort in the same direction would destroy the

trouble completely. Typical is a case like the following.

An elderly woman has been troubled her life long by a

disproportionate fear of thunderstorms with almost hysterical

symptoms. As she had no other complaint, I hardly found it worth

while to enter into a systematic treatment and could not expect

much of a change from a short treatment, considering that her

hysteric response had lasted through half a century. As she begged

for some treatment, I brought her into a drowsy state and told her

that she would in future enjoy the thunderstorms as noble

expressions of nature. The whole procedure took a few minutes. Yet

after some summer months she wrote me a letter which clearly

indicated this characteristic compromise between the habitual dread

and the reenforced counter idea. "I have the same sick dread at the

sight of thunder clouds that I have always had, but I seem to have

gotten somehow a most desperate determination to control my fear. I

have done this to the extent of keeping my eyes open and looking at

the storm. Is that hypnotism or pride?"

Another thunderstorm case may lead us to other methods of treatment.

Here again in the field of emotional response, we may consider the

methods of going back to primary experience, known or forgotten.

A young married woman of the West had suffered always from

hysterical attacks in response to any sharp sudden impressions,

especially sudden loud noises. The banging of a door, but worst of

all a thunderstorm, could produce hours of weeping and crying and

desperate mental condition with all expressions of excitement. Her

husband wanted me to hypnotize her but I preferred another way. I

tried to get her memory back to the earliest case of which she

could think of this hysterical response. As long as we were in

ordinary conversation, she could not trace it beyond about her

twelfth year. But when I brought her into a drowsy state, her

memory revived older experiences and finally settled at a school

experience in her seventh year of age. She then had an excitable

country school-teacher who relied on whipping the children. Once

her neighbor in the class did something forbidden. Her teacher

mistook her for the culprit and began to whip her most forcibly

before she could explain anything; and while the punishment was

going on and she began to bleed from a wound, she all the time felt

that she wanted to express her innocence and could not speak. After

that, evidently the first attack of hysteric character followed.

From that time on any sudden impression released the same group of

reactions. The suppressed emotion had evidently become a

psychophysical "complex." As soon as I had reached this starting

point of her pathological history, I asked her to bring back to

consciousness as many details as possible of that first incident.

She told me all the names and described the classroom and brought

herself vividly into the whole situation. Then I asked her to tell

me the whole story once more and to express strongly her innocence

and the wrongness of the punishment, and when she had completed her

account, brought out with fullest indignation, I had her tell the

whole thing once more and then a third and a fourth time, until she

was quite tired out from it. That was all I did. Very soon after,

the husband reported that there was a great improvement in every

respect, no hysteric attacks, only slight discomfort. Most of the

stimuli which had previously produced strong reactions now passed

without any disturbance and even thunderstorms were experienced

with relative ease. A year later they came once more to Cambridge,

and she simply passed once more through the same process of

discharge which seems now to have removed the symptoms still

further.

By far more reliable, however, is the method of side-tracking the

starting experience into a new associational track.

A gentleman with a decidedly psychasthenic constitution developed a

tendency to hesitate in walking on the street. It was not a

complete stumbling but a disturbing inhibition, which set in when

he was walking alone and his attention was not absorbed by

something on the street. He believed that it came on most strongly

when he looked down at the pavement. He suffered from it vehemently

and avoided going on the street alone. He was unable to connect it

with any starting point. He interpreted it as merely a symptom of

overwork. But going with him through all kinds of experiences which

he had had on the street in previous years, we finally found that

once he was running to catch a street car, when he suddenly saw

almost immediately before him a big hole dug out for laying gas

pipes. He was able to stop himself quickly enough not to fall into

the hole but he got a strong emotional shock from the experience.

He, himself, did not think that his walking troubles set in

immediately after this shock. Yet the hypothesis seemed to me

sufficiently justified that there existed a connection, even though

some weeks lay between that first experience and the first

observation of the abnormal inhibition in walking. On that basis I

tried to train a new associative connection. I made him drowsy and

asked him to think himself once more into the situation of his run

for the car but as soon as he reached the hole to jump over it. He

went through this motor feature on ten successive days with new and

ever new energy and from that time up to the present the trouble on

the street has disappeared entirely.

To mention at least one case of the large group in which suppressed

sexual emotion was the evident source of an anxiety-neurosis, I mention

the case of a woman who showed very strong symptoms of anxiety and

oppression and who was cured by a simple advice.

The woman, aged thirty-two, was a saleswoman in a large store

selling gentlemen's gloves and ties. She suffered from time to time

by attacks of vague anxiety in which her heart showed vehement

palpitation. There were paleness and perspiration and at the height

a nervous trembling together with a feeling of despair. These

attacks were not frequent, separated sometimes by weeks, sometimes

by months, but troubling her exceedingly. She had been assured by a

physician that her heart was normal and that she was probably

overworked. She could find absolutely no source of the disturbance.

After a long conversation, I was also unable to discover any direct

or indirect causes until I worked on the basis of those theories

which we have discussed, the theories which connect hysteric

symptoms with chance intrusions which stand in relations to past

suppressed emotions of sexual character. The patient absolutely

denied any present sexual emotions. She had been engaged about

eight years before and acknowledged that at that time there were

strong sexual feelings connected with her fiance, who broke the

engagement. Psychoanalytic methods now brought it to full clearness

that she had her first attack after selling a pair of gloves and

fitting them to the hand of a male customer who had a certain

similarity to her fiance. It was not possible to trace this in the

same way for later cases too, but it seems that bodily contact with

a man by fitting gloves preceded every attack. All this was brought

out partly by questions, partly by free ascending associations

while she, herself, believed that she simply pronounced nonsense

words as they came to her mind, and partly it was secured in a

half-hypnotic state. I came to the conclusion that the suppressed

sexual emotions at the breaking of the engagement were the primary

cause of the disease. The similarity of the first customer together

with the tactual sensations had evidently touched that complex and

brought the suppressed emotion to an explosion which frequently

takes the form of palpitation and similar symptoms. Later the mere

tactual sensation alone produced by the contact with the hand of a

man, possibly with a similar optical impression, perhaps also with

the sound of the voice, brought back the reaction. Instead of

giving treatment, I insisted that she change stores, and become

saleswoman in a house where she would have to do only with women,

and to sell articles which did not bring her into personal contact

with customers. After more than six months of work in her new

place, she reported that the attacks had not come back again.

Of course it may readily be acknowledged that this method does not allow

a sharp demarcation line between its various factors. It cannot be

denied that an element of straight suggestion may be included. The man

whom I train in the forming of a new antagonistic motor response feels

it of course all the time also as a silent suggestion to overcome the

old disturbance. It is thus to a certain degree impossible to say where

the effect of the discharge ends and where that of the hidden suggestion

begins. Yet there certainly cannot be any doubt that this revival of the

first experience and its improved discharge works directly towards the

removal of the troublesome symptom.

Abnormal fear is also the essential factor in most cases of stammering.

The patients usually know it themselves. For instance, a lawyer writes

to me:

"I have been a stammerer the greater part of my life and have

visited every stammering school in the country, but the relief

obtained has been temporary and in most cases I was not benefited

at all. I am convinced that stammering is due wholly to an abnormal

mental condition, which consists of an unreasoning fear that takes

possession of the individual when he attempts to utter certain

sounds. It is simply a lack of confidence inspired by numberless

failures to articulate properly and is not caused by any organic

trouble, because, taking my own case for example, I can at times

talk as fluently and easily as anyone. I am firmly convinced that

stammering can be cured by hypnotic suggestion. If you could get me

in the hypnotic state and suggest to me repeatedly that from

thenceforth I would have easy fluent speech, I feel absolutely

certain that such would be the case."

Or an engineer writes to me:

"At times I stammer very badly. In an ordinary conversation it is

scarcely perceptible, but it is almost impossible for me to make an

explanation or relate an incident or tell an anecdote. I began to

stammer when I was about seven years of age--I am twenty-nine

now--and continued until I was seventeen, when I broke myself of it

by reading aloud. It came back on me about a year ago, at which

time I was laboring under a very severe nervous strain on account

of business matters. I have since tried to break myself of it in

the way that I did at first, reading aloud, but have been unable to

do so. Can it be cured by hypnotic treatment or suggestion? Can any

hypnotist of ordinary ability do it?"

I should affirm this question, which is one of the most frequent put to

the psychotherapist. And yet, if I myself have entirely given up the

cure of stammerers in recent years, it was not only because there was

little chance to learn anything new scientifically from it but also

because it was ultimately disappointing, as the severe cases cannot be

cured entirely. Every hypnotist can quickly secure a strong improvement.

In even new cases I found an almost surprising improvement in the first

two weeks, an improvement which stirs up the most vivid hopes of the

sufferers. Then the improvement becomes slower and finally it stops

before a complete cure is reached. The patient notices it and it easily

works back on his emotion and thus begins again to disturb the speech,

unless a very careful continuous counter-suggestion is given. Slight

disturbances, to be sure, can be removed entirely. The essential point

will always be to suggest to the stammerer the full belief that he is

able to speak every word and that he is able to speak it in every

situation. But where there is a limit for improvement, we must take for

granted that the disturbing fear is only superadded to an organic

trouble. In such cases, probably the inability of certain nervous paths

was primarily irreparable. These inabilities then became the source of

discomfort and of fear and this fear added greatly to the disturbance.

Hypnotism then quickly removes that part of the disturbance which had

been superadded by the mental emotion but it cannot remove that primary

factor, the objective inability, and every cure thus finds its limit

there.

Near the field of emotions stand also the many varieties of sexual

abnormities and perversities. I abstain from discussing any special

cases but it may be said that suggestive treatment is in this region

powerful to an almost surprising degree. Even homosexual tendencies

which go back to the beginnings of the memory of the individual yield,

as my experience shows, in a few weeks, if again the suggestion is not

so much directed towards the suppression as to the creation of the

antagonistic reaction, that means in this case, of the normal sexual

desire.

Both ideas and emotions, of course, lead to actions. Moreover we always

insisted that the resulting action is an essential part of the

psychophysical situation and that every mental experience has to be

characterized as a starting point for action. Yet this factor of

activity and of attitude sometimes stands in the foreground. The

controlling idea is then the idea of an end of action, the predominant

emotion, the emotion anticipated from a certain activity. Typical for

that are those disturbances in which an abnormal impulse or an abnormal

desire awakes perhaps a desire for ruinous drugs like morphine or

cocaine or an impulse to criminal deeds, like stealing. But the

disturbances of the psychomotor factor are not less present when the

central complaint is a lack of energy, the most frequent symptom of the

neurasthenic; and our whole discussion has made it clear that a mere

lack of attention belongs to the same category.

Of course, the abnormal impulse is psychophysically not different,

whether it leads to a legally important result like the impulse to kill

or leads to an indifferent result. The subjective suffering may be the

same in both cases. The starting point of the impulse may be any chance

experience. The psychasthenic may pick up such impulses from any model

for imitation or from any haphazard report. It may be entirely freakish

and yet beyond conscious control.

A physician had read in a well-known book on hysteria about a case

in which a girl was troubled by a constant effort to move the big

toe in her shoes. This idea worked on him as a suggestion for

several months. At my advice he fought it by auto-suggestion. He

brought himself into a slightly drowsy state by staring into a

crystal ball and assuring himself by spoken sentences with

monotonous repetition for a long while that he has perfectly the

power to hold the toe at rest. From the second day only a slight

kinaesthetic sensation remained; the movement itself disappeared.

Or a more unusual case.

A young lady once noticed in a man a different color in the two

eyes. It gave her an uncanny feeling, together with the natural

impulse to compare the two eyes. Accordingly she shifted her own

eyes from one eyeball to the other in the man's face. The accent

which this shifting impulse had received by the disagreeable

feeling evidently forced her to repeat this movement with everyone.

At first it became half a play, but soon a disturbing habit and

finally an intolerable impulse. Whenever she talked with anyone,

she lost control of her eyes and was obliged to enter into a kind

of pendulum movement from eye to eye. The situation became so

unendurable that the thought of suicide began to occur to her. I

hypnotized her four times, suggesting to her complete indifference

as to the face of those with whom she spoke and at the same time

certain new habits of fixation. The impulse lost its hold and when

I saw her last, it had completely disappeared.

By far more frequent than such neutral impulses are the desires, for

instance, of the alcoholist. On the whole it may be said that

psychotherapy can gain its easiest triumphs in the field of alcoholism

and a wide propagation of psychotherapeutic methods and of a thorough

understanding of psychotherapy would be fully justified, even if no

other field were accessible but that of the desire for alcoholic

intemperance. The moral disaster and economic ruin resulting from

alcoholic intemperance, the physical harm to the drinker and to his

offspring is so enormous, and the temporary cure of the victim is so

probable that the movement certainly deserves most serious interest. Yet

I speak of temporary cure and I refer here especially to the restriction

with which I introduced the psychotherapeutic methods in general. They

do not deal with diseases but with symptoms; and they certainly do not

deal with constitutions, but with results of the cooeperation of

constitution and circumstances. That the given constitution may be

brought anew under conditions which again stir up similar symptoms is

always possible, and just with alcoholism the danger lies near unless

beneficial influences remain in power. Certainly no one has a right to

neglect such psychotherapeutic aid simply because relapses are possible.

Even a temporary relief can be a great blessing. Moreover, the temporary

relief is the safest basis to work towards the prevention of a

recurrence of the evil. Only in two directions is further restriction

needed. Psychotherapeutic methods are in my opinion of very small avail

in cases of periodic drinkers. Such periodic attacks of patients who

have not even a desire for alcohol in intervals between the attacks,

intervals which may last a quarter of a year, are related to epilepsy.

It seems that constant hypnotic influence during the interval has a

certain power to reduce the periodic impulse. I personally have not

seen any special improvement from it. The second restriction would be

that the drinker has to be under constant supervision during the first

days of hypnotic treatment. No patient, not even the morphinist, is so

skillful in deceiving his friends and even the physician. Even the most

emphatic gestures of sincerity ought to be distrusted.

Only a short time ago I dealt with a young man whom his parents and

a chauffeur had accompanied to Boston, exclusively for the purpose

of watching him constantly while I was to attempt to cure him from

excessive whiskey drinking. The chauffeur accompanied him from his

room in the Boston hotel to the threshold of my laboratory. All

through the day he was with his parents, and at the hotel the

management had given the strictest orders not to sell any drink to

the young spendthrift. He was an earlier student of mine and had

attached himself to me with such an apparent sincerity as removed

every possible doubt of his pledge. Intentionally I had not even

asked him for a pledge not to drink but only for a pledge to

confess to me the next day if he ever should take any alcohol. In a

tentative way I suggested to him in a half hypnotic state on the

first day that he would feel disgust for whiskey. I did not expect

much of an improvement before at least three or four treatments. I

was therefore most surprised when he most solemnly assured me the

next day that he awoke in the morning with an assured feeling that

he should never touch whiskey again and that he had not the

slightest desire for it. Instead of a systematic development of

suggestions, I confined myself therefore to a mere repetition of

the treatment of the first day and as every morning the same

assurance came forth, there seemed to be no need for any

variation. It was not before the fifth day that I discovered that

he had taken from the start a pint of whiskey every day. When he

first arrived he had bribed a laundress of the hotel to bring to

his room every day the whiskey hidden in the laundry and he drank

it during the night. Then I declined any further participation.

The danger of deceit is of course less imminent when not the family but

the patient himself takes the initiative. Yet even here distrust is

wise. The patient has sometimes the most sincere intention to be cured,

but under pressure of his craving he admits compromises which he hides

from the physician. Having reduced the large quantity of alcohol to

which he was accustomed, he hides the fact that he yet takes a few

drinks, which he thinks cannot prevent the cure. Yet inasmuch as a

complete cure has to rely on psychical factors, this consciousness of

deceiving even with small transgressions interferes badly with progress

and, inasmuch as the cunningness of the patient is itself a symptom of

the disturbance, the strongest possible precaution is advisable at the

beginning. For that reason it is also not best to begin at once with

complete prohibition, but to lead to a total abstinence in about one

week. But certainly in the case of every drunkard, total abstinence is

the only desirable goal. A pronounced drinker ought never to be

transformed simply into a moderate one. The return to intemperance would

result rapidly. On the other hand it would be unfair to deny that

psychotherapy has cured the symptom if the desire really once

disappeared completely, even if, after years, new temptations develop a

new desire. I myself had diphtheria three times in my life; my

constitution is thus probably especially favorable to that disease but I

do not estimate less the fact that I was perfectly cured the second

time, in spite of the fact that I caught it a few years later a third

time. To be sure, such experiences of relapse cannot be spared any

psychotherapist. I may give a typical instance.

A well-known professional man of fifty years, through a long

bachelorhood, was accustomed to close his work at four o'clock and

then to sit comfortably in his study with a book and an unlimited

supply of brandy. He took one cognac after another and every

evening he was completely intoxicated. He married a young wife and

felt the need of changing his habits, the more as he himself saw

symptoms of his excess which alarmed him. When he came to me, I saw

that he was seriously wishing to give up, and he understood himself

that there was only the one way, namely, complete abstinence. He

felt that he could not reach it by his own will power alone and

sought my aid. I hypnotized him six times, suggesting at first a

reduction to four drinks, then to two, then to one and then to pure

mineral water. I concentrated my effort on stirring up the

antagonistic attitude, the dislike of the smell of brandy and the

aversion to its taste. The effect was excellent. After the fifth

time the mental torture which he had felt in the first afternoons

had completely disappeared. I considered further hypnotizing

superfluous and felt sure after the sixth time that the man was

cured. For about a year he remained abstinent, but in the meantime

his professional life brought severe disappointments, and with cool

consideration he decided that he might have at least some pleasure

from life and forget its miseries. Accordingly after a year he

determined again to take some brandy in his study, and of course,

that led rapidly to an increase of the dose and today he is

probably at the old point. And yet it may be said with correctness

that psychotherapy had done its duty. If at the right moment before

he took the first step again, even the slightest counter-suggestion

had been applied, the disastrous second development could have been

easily avoided.

My experience indicates the best results where the suggestions are from

the start directed as much against the unfavorable social conditions,

with their temptations and impulses to imitation, as against the

alcoholic beverages themselves. On the whole it is easier to break the

vicious drinking habits of the social drinker than those of the lonely

drinker, a point which ought to be well considered in settling the

complex problem of prohibition versus the temperance movement.

The situation of alcoholism repeats itself in still more ruinous forms

with morphinism and cocainism, vices which grow in this country to an

alarming degree. The psychotherapeutic treatment of such drug habits

demands much patience and much skillful adjustment to the psychological

conditions. Its general difference from the treatment of alcoholism is

given by the circumstance that any too rapid withdrawing of the drug is

certainly dangerous, if the organism is adjusted to a relatively strong

dose. On the other hand, I may say that I have not seen a single case

in which a really patient and insistent treatment of morphinism has not

been successful, even if the destructive dose of forty grains a day had

become habitual. The condition is only that the patient himself have the

best will, a will which yet is not strong enough to win the fight

without psychotherapeutic help. But no one ought to expect that the

psychotherapist can secure miracles like some of the pill cures which

treat the drug fiend in three days. Moreover neither physician nor

patient ought to believe that the worst is to come at the beginning. On

the contrary, it is the end which is hardest, the reduction of the small

dose to nothing. As illustration, I give an extreme case.

A man who was formerly station master on a railroad had been

operated on in a hospital after an accident, and as some pain in

the hip remained which disturbed his sleep, the physician of the

hospital gave him some morphine and provided him with the material

for morphine injection after leaving the hospital. Then began the

usual story. He became more and more dependent upon his injection,

the dose was steadily increased, he found unscrupulous physicians

who yielded to his demand for morphine prescriptions; he lost his

position with the railway by the growing effects of the morphine

poisoning, he became divorced, sank lower and lower, his daily dose

fluctuating between thirty-five and forty grains a day, and when he

came to me, he presented a picture of the lowest type of hopeless

manhood. He spent practically the whole day in bed and was only

able to totter slowly along with a cane. He assured me that life

was hell for him. He could not sleep, he could not eat, he could

not think, he had made up his mind to commit suicide if I could not

help him. I foresaw that it would in the best case demand months of

insistent energy to make a man out of that unfortunate wreck. He

had gone through three different morphine cures in three

sanitariums and none had helped him, and every physician whom he

had consulted had declared his case as beyond any physical cure. I

decided to make the somewhat disproportionate sacrifice of time in

order to study whether even such an extreme case of morphinism is

accessible to psychotherapeutic treatment. Four months later, he

left my laboratory looking like an athlete, strong and vigorous,

joyful and energetic. For three weeks he had not received any

morphine, had good appetite, slept well, and had happily married.

As his wife was a trained nurse, she will take good care that no

new slip shall ever occur.

There was nothing remarkable in those four months of treatment. He

was easily hypnotized, and I hypnotized him at first every day,

then every second day, then every week. It was without difficulty

that I reduced the forty grains to about six grains a day. Then the

struggle began. To test the case as a strictly psychological

problem I left the effort entirely to his own will, that is, I did

not deprive him of the morphine supply but left the regulation in

his own hands. During that whole winter he had a bottle with a

thousand morphine tablets standing on his desk. Thus he would have

been entirely able to satisfy any craving, but by his own will he

followed my suggestions and never took more than I permitted. It

meant a terrible struggle. The tortures which he had to pass

through were perhaps worse than those which he had experienced at

the time of his lowest downfall. They came to a focus when he tried

to go from five grains to three grains a day and then again when

he approached half a grain. From there he had to move to a fourth

of a grain, then to an eighth, and even that had still to be

divided into four different doses which were then reduced to three,

to two, and finally to one dose and ultimately to injections of

warm water. A rapid increase in general strength and a return of

appetite for food began when he had reached the five grain limit. I

did not allow on any occasion the introduction of a substitute. On

the other hand, I added every day suggestions covering the various

secondary symptoms, especially the pains in the stomach and the

feelings of faintness and the emotional depression.

There, is no doubt that under favorable conditions, especially if the

dose of morphine is not too strong, autosuggestion can bring about a

similar effect. A reduction of ten per cent every week can be carried

through, if a pledge is given to one's self in a drowsy state. The great

value of autosuggestion showed itself not seldom in the fact that

morphinists who had applied to me by mail for a cure in the mistaken

belief that I do work in a professional way for payment and who got from

me a written reply that I could not receive them, but that they can help

themselves, wrote to me that my letter gave them strength to reduce

their dose considerably.

Quite similar is the situation with cocainism or with the combination of

morphine and cocaine which is so frequent nowadays with young

physicians. I have repeatedly seen cures where the case already gave the

impression of insanity. Again I give a rather extreme case.

A physician had acquired the habit of using and misusing cocaine

for the treatment of a disease of his nose. The habit grew to a

craving for cocaine while the cocaine itself poisoned the brain.

Acoustical hallucinations began; he heard voices from every corner

of the room, and on the street the voices took persecutory

character. He connected them with his brother living in Europe,

heard his voice in the denunciations, and developed a pathological

system of ideas around the central thought that his brother had a

telepathic influence on him. His reason succumbed, he lost all

consciousness of delusion, and believed himself really to be under

the control of the absent brother. When he came to me he had been

without sleep and without food for several days, and he was not

seeking my help to get rid of the mental disturbance but to

overcome the power of his older brother. He did not connect the

fear at all with his misuse of cocaine. When I discovered the role

which the cocaine played, I determined to try the suggestive

influence, the more as I found that he was in a half-hypnotic state

as soon as he had entered my room. I suggested to him to sleep and

to take food and to reduce the cocaine dose by a fourth. The next

day he was an entirely different man by the effect of ten hours'

sleep and a large breakfast. Now I concentrated my efforts on the

reduction of the cocaine. After ten days of hypnotic treatment he

gave up cocaine entirely, after three weeks the voices disappeared

and slowly the other symptoms faded away. The pathological idea of

the telepathic influence lasted a while after the voices had gone

until this idea, too, yielded to suggestion. It still took six

weeks before he himself felt that he was entirely normal.

The way in which the average physician nowadays neglects the simple tool

of suggestive treatment, when it can be used for the protection of

society, is perhaps nowhere so reckless as in the case of the morphinist

and cocainist. To give a typical case of this neglect I may mention that

of a highly intelligent young man who had been in the habit of using

both cocaine and morphine for ten years when at his own request he was

sent to a New York hospital. He had been taking alternately morphine for

a year or two, then cocaine for a year or two, and had sometimes

alternated and sometimes combined both in an irregular way. When he

entered the hospital in May, 1908, he was in a cocaine period and was

taking the enormous dose of one hundred and eighty grains of cocaine

every day. In the hospital they withdrew the drug altogether. During the

first weeks, he was entirely sleepless. They energetically refused him

any substitutes and after six weeks he began to feel comfortable. He

gained steadily in weight and after three months, when he left, he had

gained fifty pounds, felt entirely comfortable, and seemed in all

respects normal again. Before twelve hours had passed after leaving the

hospital, he had again taken thirty grains of cocaine and ten grains of

morphine, and this dose rapidly grew until after a few weeks it again

reached a hundred grains of cocaine and up to sixty grains of morphine a

day. Then came the complete breakdown. If that man in the last two or

three weeks of the hospital treatment, when he felt entirely comfortable

and normal and had gained his normal weight, had received even a slight

suggestive treatment suppressing any desire for cocaine or morphine, he

would easily have been saved. To let such a man after a drug career of

ten years go out again to the places of his old associations, where the

desire had to be stirred up, is inexcusable at a time when

psychotherapeutics has won its triumphs in this field. It might have

been sufficient to give him preventive treatment at least for the first

three days of his freedom. And such a case is typical of hundreds.

The overstrong impulse and overstrong desire finds its counterpart in

the abnormal lack of energy and lack of attention. The patient--and it

is especially the neurasthenic patient--has lost his usual strength, he

shrinks from every undertaking, he cannot decide upon any action, he

needs a disproportionate effort for the smallest task, and cannot

concentrate his attention in spite of his best will. The varieties of

this lack of power and inertia are familiar to every physician. They

certainly often need much more than merely psychotherapeutic treatment,

although on the physical side no schematic method is admissible. The

laziness of the anaemic needs a different treatment from the laziness of

the exhausted but in every case psychological factors can be of decisive

influence, whatever the physical and chemical treatment besides them may

be. A few letters may again illustrate the varieties. Here again there

is no sharp demarcation line between the normal and the abnormal.

Letters like the two following, for instance, are hardly letters of

patients. They show a variation which is still entirely within normal

limits and yet a source of suffering; it is a disturbance which usually

can be removed by psychotherapeutic means.

"I do almost everything with effort, nothing spontaneously. I have

been writing for five years but am a mood writer of the worst type.

The mood comes at such uncertain times that I seem to be absolutely

at the mercy of caprice. This might not in itself be a misfortune

but writing is my only calling and I suffer the proverbial torments

of lost spirits when I am idle. The necessity of driving myself to

every piece of work, aggravated by the fact that my parents allowed

my constitutional inertness to have full play, has hitherto

prevented me from forming any regular habit of labor. I am now

thirty-eight. Would you suppose that if I kept my nose to the

grindstone for one, two or three years, I might yet hope to work

with some ease and regularity? That is, if I compelled myself to

write a certain number of hours every day as a discipline,

regardless of the quality of matter I produce, is there any

probability that I might ultimately overcome the fearful paralysis

that so often grips my faculties? Can constitutional indolence be

overcome by determination? I put in a little time on a couch every

day. When worried I get neurasthenia and all kinds of phobias. Just

now I am afraid to look at the newspapers on account of the cholera

in St. Petersburg, and I have seen the time when I found it

difficult to drink water after I had boiled it myself."

Also the next man is familiar to all of us.

"Plainly we are told every man is born into the world to fill some

purpose, or at least be of some benefit to himself or his

fellowmen. For some reason I do not make friends among men. I have

not the zeal or ambition to carry or even begin a conversation

that will interest the individual man. I worry a great deal. I have

never been able to concentrate my mind to study and figure out

problems. I can read them zealously but apparently do not get to

the bottom and cannot retain what I do read. If I could just get

hold of the power of thinking and dig out that tangible something

that holds me back, I could go forward and make myself what I know

I should be. But I feel that so far I am a total failure. If I only

had that one great gift, the power of concentration and will power,

I would make what I so much desire, a success of myself."

A similar effect and yet psychologically a different condition exists

where the lack of energy results from the suggestive power of the

opposite, producing a constant indecision.

"I am thirty years old and nearly all my life since childhood I

have been fearfully troubled with the habit of indecision and

regretting whatever I do. It has grown into a habit so fixed that

at times I am fearful of losing my mind. I feel anxious to do

something and decide to do it, then as soon as it is done, I nearly

go wild with regrets until I have to undo it, if possible, and then

only to regret that. I am this way about the most trifling things

and about the most serious. I can't perform any duty well. In

business and in social affairs, it is always with me. It has me in

its clutches, a horrible monster dragging me down. My friends

misinterpret me and wonder what I mean by doing so when all the

time I want to do what is for the best and cannot for this tyrant

who is ever present with me. I will plod for hours and hours at a

time, and at every turn I am handicapped. I am intelligent

naturally and appear a perfect fool."

From the report of such chronic cases we may turn to the acute ones.

Here a characteristic letter of, a typical neurasthenic young modern

poet.

"These are my plans but I hardly think that I can carry them

through, although perhaps you can help me by suggestion. I have the

feeling that through the whole of last year my development did not

go forward but backward. It is as if by a mental or physical

overstrain, my whole personality has entered into a transition. I

have no joy in life, no sensation in love, no satisfaction in

labor. My will has become weak where it was strong. I am lazy, up

to an absolute dislike of everything, while I have been energy

itself. Often I have only the one desire, to end my life from mere

fatigue. If there had been any external reason for ending my life,

I should perhaps have done it long ago. I am so apathetic that I no

longer take myself seriously. My successes do not please me; the

idea of writing anything gives me anxiety. I have become less

resisting, more sweet, more soft, I should almost like to say, more

feminine. I became infatuated with a girl, simply because I knew

that she hates all men. The inaccessible is still the only thing

which can stimulate me somewhat. I have even written a poem on her,

but nothing can satisfy me in love. I consider my state a disease

of the will as a result of nervous exhaustion. I must find some one

who, with kindly power, reenforces my will system. I need a strong

mind--it may be a man or a woman. It would even be possible in the

latter case that I might marry her.

"Even the writing of this letter has fatigued me so much that I

should like best to sleep. In moments like the present I should

like best to throw myself down on the street or ... quickly ...

sink ... into the ocean. (I regret having made the little points.

They look as if my expressions are a pose.) Yet there are moods in

which I am entirely normal and no one fancies what I am passing

through. I have even become superstitious lately. Are there perhaps

beings which can absorb our energy? Perhaps another being has drunk

up my energy."

Authors run easily into such states. Here is another.

"I am a neurasthenic, and I am beginning to believe, a professional

one. My object in writing is to ask concerning the advisability of

my visiting you for treatment. I am ready to take the next train if

you say the word, if you believe you can help me. It seems that the

regular practitioner, who is very irregular, cannot. If there is

one good doctor I have not consulted, I would like to know his

name. I was doing editorial work in X and broke down. Still the

doctor said that if I liked my work, I should go back to it and

pitch in. I did. It lasted a few days and then I had to give up

altogether, couldn't grind out another word. Then to another

doctor----also the best in the city. He told me to give up all

work, which I did, and then I went on a farm for six months. That

did not help me either. Later I went west and spent some time in

the mountains. I felt no better there. Then I went to Arizona and

lived in a tent out on the desert; that did not help me. There was

always a sensation of exhaustion and any physical exertion put me

on my back, even when it was light and pleasant exercise. Then I

went to California; it did me little good. It is a perfect paradise

for anyone who has not got neurasthenia. I still have not got

myself in hand. I cannot do or say or write just what I wish, and

cannot concentrate my thoughts. To try to read a book is punishment

because I forget as fast as I read." And so on.

I answered him certainly not to come but tried to induce some

autosuggestions. A few weeks later, he wrote me: "Ever since you

wrote me, I am now feeling somewhat improved." Yet I cannot judge

how far the improvement belonged to the psychical factor only,

inasmuch as I had advised him also to take some bromides. The

really effective treatment would have been heterosuggestion and I

had no time to enter into the case.

Where direct suggestion is used, the effect is often surprising.

A young lawyer after a period of overwork had come to a state of

complete lack of energy. He could not find strength to write a

letter and he came to me at a day when he did not see any way but

suicide open for himself. He complained that, as soon as he began

to grasp a thought, it was evaporating. He stared absently about

the room and felt sure that he would never again achieve anything.

He had not even the energy to read the newspaper. I hypnotized him

three times, each time waking in him the pleasure in a definite

piece of work, at first simply in a novel which he was to read,

then in some letters which he was to write, and then in his

professional work. There was always an interval of three days. The

fourth time he declared himself that the hypnotic influence was

unnecessary, as he felt that he was again in the midst of his work.

As a rule the effect is a much slower one, but if all personal factors

are well considered and especially physical disturbances are excluded,

the result is usually satisfactory.

Very different from such neurasthenics, of course, is the lack of

attention in the feeble-minded, and suggestion of the ordinary type is

hardly advisable, but it is surprising how much can be reached by a

systematic psychical regime. I give one typical instance, representative

of many.

A boy of twelve years when he was brought to me showed the mental

powers of a stupid child of four. In a silly way he repeated every

question which he heard without answering it; he talked steadily to

himself in a nonsensical manner, mostly repeating nursery rhymes

without end, never holding his attention to anything in the room,

giving the impression that there was no attention whatever. The boy

was a child of rich parents; he had his own teachers, but was for a

large part of the year under the influence of the parents only, who

very naturally yielded to every desire of the unfortunate child. I

insisted on a complete change of the education. It was my effort to

build up the mind by a rigorous training and by development of the

power of inhibition. I absolutely forbade any meaningless material

like the nursery rhymes, insisted that the child should never be

allowed to talk to himself, and whenever he began to speak to

himself he was to be addressed sharply, and if he yet went on, to

be slapped on his hands. In the same way he was not allowed to

repeat a question, but the question was repeated until he answered

it, the question always formulated in simple words. He was forced

to go through simple reading and writing without being allowed to

make his silly diversions. His whole life was brought under strict

discipline and no parental indulgence was permitted. Six months

later the child was completely changed. It seemed as if he had gone

through an improvement of three years. I regulated the whole of

his elementary studies in accordance with the successful principle.

The training of inhibition stood in the foreground and every

haphazard reaction was severely rebuked. The summer vacations spent

with the parents in the fashionable surroundings, to be sure, had

always a retarding influence, but the main part of the year in

which it was possible to carry through the strict discipline showed

such steady and inspiring progress that the boy, while of course

feeble-minded for life, can yet live externally a harmonious life.

A systematic training of the power of inhibition is indeed the

fundamental factor in all psychotherapeutic treatment when the

disturbance is in the volitional sphere, but the inhibition is secured

most safely by reenforcement of the antagonistic attitude. From these

volitional variations on the one side, from the ideational disturbances

on the other, only a few steps lead to those dissociations of the

personality which are characteristic of many graver cases of hysteria.

But to give to them any adequate analysis, it would be insufficient to

refer in this brief way to particular cases. Psychopathological

literature possesses some excellent analyses of such complex

disturbances. As I said before, I abstain entirely here from such

complex phenomena, as they enter too seldom into the sphere of the

practitioner and as the bewildering manifoldness of their symptoms does

not allow us so easily to recognize the fundamental principles which

alone were to be illustrated by our short survey of practical cases.

XI

THE BODILY SYMPTOMS

The discussion of the bodily symptoms which may yield to

psychotherapeutic treatment, naturally forms only a short appendix to

our discussion of the mental symptoms. Our interest was from the

beginning essentially a psychological one. I shall have to be the more

brief as my personal experience in the treatment of bodily diseases

through mental therapy is entirely secondary and accidental. The

psychological laboratory would, of course, be an entirely unfit place to

struggle with diseases of which the chief symptoms are not

psychophysical. Yet in spite of frequent testimonies of well-known

physicians to the contrary, I am still inclined to think that this is

also the situation at large. I think that in medicine in general the

psychophysical effect of mental treatment is by far more important and

by far more extended than the healing effect on diseased peripheral

organs. Of course these peripheral parts of the body may be favorably

influenced in an indirect way by the mental treatment; we shall have to

take notice of this important result but that is strictly not a

therapeutic effect on the bodily symptoms. Moreover, purely psychical

effects may give an impression as if the bodily symptom itself has been

removed.

To begin with the latter case, it is especially the inhibition of pain

which easily makes one believe that a bodily disturbance is successfully

treated. I have repeatedly seen cases in which I tried by suggestion to

soften the pain resulting from a peripheral disturbance like

inflammations, rheumatism, decayed teeth and so on. The effect was often

such a total disappearance of the pain that the patient himself was

inclined to believe that the objective disease had been ended, while in

reality the state of the diseased organ was not changed at all. It has

often happened that I tried to cure a person of certain mental symptoms

by suggestion, ignoring entirely the existence of some pain resulting

from a bodily disease with which I had nothing to do. Yet the suggestion

of improvement seemed almost to irradiate and the pain disappeared in

spite of having been ignored by the hypnotizer. For instance, I treated

a woman who suffered from psychasthenic obsessions, fearing all the time

that something would happen to her child. I did not give any direct

attention to the fact that she had had for years a painful disease of

the bladder for which she was constantly treated by a specialist. But

while I did not mention the bladder in my hypnotic suggestion, yet the

abdominal pain disappeared together with the obsession and the situation

might easily have suggested that the bladder trouble was a nervous one

which had been cured by the hypnotic sleep. The fact was that the

bladder disease was not influenced by the mental treatment at all, and

needed a continuation of the same local treatment. It was only the

psychophysical pain in the brain which had been inhibited.

Quite parallel to the disappearance of the organic pain sensation is the

arising of a general feeling of improvement. This organic sensation of

general betterment may again be a strictly mental occurrence without any

objective reference to a real improvement in the bodily conditions. Yet

again that easily gives the impression of an important change in the

bodily conditions themselves. The miraculous cures of various diseases

through mystic agencies generally belong to this category. There is no

doubt that often the migrating charlatans who advertise themselves by a

free treatment of the sick and invalids on the theater stage of small

towns, produce momentary effects which are sufficient to deceive. The

quack handles the diseased organ, perhaps a goiter or a leg crippled by

rheumatism, with a cruel rudeness and overwhelms the suggestible mind so

completely that the first autosuggestion is that of a complete change,

and that means cure. The disastrous results follow later. But from such

barbarisms we come by gradual steps to the suggestion of improvement

where the feeling of betterment can be in itself an important factor for

the cure. Yet even there we must not mistake the possible secondary

effect of a mental change from a psychotherapeutic cure of the bodily

disease.

Not seldom the removal of physical disability seems secured as soon as

certain mental disturbances are removed. There is no reason to believe

for instance that suggestion can have an important influence on a

diseased sense organ, and yet hypnotic influence and even autosuggestive

influence can under certain circumstances greatly improve seeing and

hearing. Especially in the field of hearing the central factor is of

enormous importance. Hyperaemic and anaemic conditions in the brain

centers of hearing control the vividness of the received sound. The

patient who cannot hear a certain watch more than one foot distant may

be able to hear it after some glasses of wine at a distance of three or

four feet. Thus it is only natural that a hypnotic influence can produce

similar changes on the psychophysical centers in such cases in which the

source of the trouble is a psychophysical laziness in the acoustical

center. Sometimes even this laziness itself is the result of psychical

autosuggestion which can be fought by counter-suggestion. I saw, for

instance, a distinct improvement in hearing in the case of a young woman

who had increasing deafness while the aurists declared that the ears

were in proper condition. I found that she lived with a father who

suffered from a severe middle-ear catarrh and that she was simply

controlled by a hidden fear that she might have inherited the ear

disease of her father. I removed this fear, partly by reasoning, partly

by suggestion, and partly by tricks which surprised her, for instance,

making her hear her watch with unaccustomed strength when she took it

between her teeth and closed both ears. The autosuggestive fear was

uprooted by these and the central ear organs slowly came to normal

functioning.

The purely psychical character is still more evident in the frequent

hysterical anaesthesias. No one doubts that here the sensations are

inhibited only and that the mental influence removes this inhibition

without any influence on the sense organs proper. Frequently also

organic troubles like stomach diseases appear cured when in reality

hysterical disturbances are at the bottom. The stomach may be sensitive

to any pressure and may produce severe pains and vomiting on taking any

food and everything may indicate a serious local disturbance. Yet

hypnotic treatment may quickly remove the symptoms because the whole

reaction may have resulted from the shock which perhaps a too hot piece

of potato caused. The removal of this mental starting point results in a

cure of the apparent stomach disease. Again in other cases, the

appearance of a physical cure is given by the creation of psychophysical

substitutes. I do not believe that hypnotism or suggestive treatment can

influence the brain parts which have suffered from a hemorrhage. Yet the

paralysis of the arm, for instance, which resulted from such a breaking

of a blood-vessel in the brain may be to a high degree repaired by

building up new motor images in the psychophysical system, which become

starting points for a new learning of movements. The patient did not

understand how to make the most out of those motor paths which had been

left. The destruction of the chief channels of discharge had inhibited

in his mind the idea of possible movement. He no longer believes that he

can move and it needs new suggestions to overcome this inhibition. The

curative effect on bodily disabilities is thus often an illusory one.

That does not mean that the field in which psychotherapeutics may work

directly on the body is not after all a large and interesting one.

Theoretically it is still little open to real understanding. The

explanation has essentially to rest on the acceptance of a given

physiological apparatus. A certain psychophysical excitement produces by

existing nerve connections a certain effect, for instance, on the

blood-vessels or on the glands of a certain region, or on a certain

lower nervous center. That such apparatus exists, the physiological

experiment with persons who are hypnotized to a high degree can easily

demonstrate. Their nose bleeds at a command; a blister may arise on a

part of the skin which is simply covered with a penny, when the

suggestion is given that the penny is glowing hot. With some subjects,

the pulse can become slower and quicker in accordance with the

suggestion; with some even the bodily temperature can change on order.

Our understanding of these indubitable facts indeed does not go further

than the acknowledgment that the paths for such central connections

exist. That means we simply describe the facts once more in the terms of

anatomy. But after all in the same way we rely on the nervous

connections, if a thought makes us blush and ultimately if our will

moves our arm or if our ideas move our speech apparatus. We do not

choose the muscles of our arm, we hardly know them; we know still less

in speaking, of the movements of our vocal cords, and in blushing of the

dilated blood-vessels. That ideas work on the lower centers of our

central nervous system, centers which regulate the actions of our

muscles and blood-vessels and glands, must simply be accepted as the

machinery of our physiological theory. The connection of such theories

with purely physical facts is given by the experience that an electrical

stimulation of the nerve may have the same influence as ideas. The

electric current, too, can regulate the beat of the heart, or contract

and dilate the vessels, or reenforce and relax the contraction of the

muscles, or strengthen and weaken the functions of the glands.

Nearest to the psychophysical processes stands the bodily symptom of

insomnia. There is no doubt possible that the work of the

psychotherapist can be very beneficial in producing sleep by suggestion.

That autosuggestions for sleep play an important role is popularly

accepted. Next to the most immediate means such as lying down, or

cutting off sense stimuli, or trying not to think, or avoiding

movements, certainly the most well known factor is the expectation of

sleep with the belief that sleep will come. This belief may be

reenforced to strong autosuggestion which may then overcome other

factors that hinder sleep. For instance, I have repeatedly received

letters from strangers containing expressions of gratitude with news

which under other circumstances would at least not flatter an author.

They wrote to me that immediately after reading one or another essay of

mine on hypnotism, they fell into deep sleep. Yet as they were always

patients who had suffered from insomnia, I was pleased with this

unintended effect of my writings. But in most cases a real cure demands

heterosuggestion.

There is room for any variety of effects; often they enter immediately.

The other day I gave sleep suggestion to a young woman who had

overworked herself in literary production. For months she had not slept

more than three or four hours a night and even that only after taking

narcotics. I intentionally did not allow her to come into a hypnotic

sleep but kept her fully awake, increasing her suggestibility while her

eyes were wide open. I suggested to her to take a walk, then to eat her

dinner, and after that to go to bed at once. She went to bed at seven

o'clock and slept without waking until ten o'clock the next morning, and

after fifteen hours' sleep she was like a different being. A regular

eight hour sleep is sometimes secured, even where no immediate direction

has been given for it. On the other hand, I cannot deny that I have

sometimes been entirely unsuccessful in securing better sleep by the

first three hypnotic treatments. When the first three treatments were

unsuccessful, I always gave it up on account of lack of time. Yet the

experience of others shows that in such cases, often after a long

continued hypnotic treatment insomnia yields to suggestion. One of the

great factors which work against the mental treatment is the habit of so

many sufferers of relying on their sleeping powders which, to be sure,

remain effective only by increasing the dose and thus finally by making

them dangerous. Every chemical narcotic has in itself suggestive power

and strengthens the belief of the sleep-seeker that he cannot find rest

without his dose. To overcome the monopoly of the opiates is one of the

most important functions of psychotherapy.

It is not surprising that the relations of psychotherapy to sleep show

such a great variety. The factors which cooeperate in normal sleep are

many and the disturbance can have very different character. We had to

speak of the psychophysics of sleep when we discussed the theoretical

relation of sleep to hypnotism and insisted that it is misleading to

consider hypnosis simply as partial sleep. We claimed a fundamental

difference between the selective inhibition in hypnotism and the general

reduction of functions in sleep. To understand sleep, we have to

recognize it as one of the fundamental instincts, comparable with the

instinct for food or for sexual satisfaction. Every one of such

instincts has a circular character. Mental processes, subcortical

processes, and physical effects are involved in such a way that each

reenforces the others. The physical effect of the sleep instinct,

comparable with the pepsin secretion in the food instinct, or with the

hyperaemia of the sexual organs in the sexual instinct, is a change in

the cortex by which the sensory and motor brain centers are put out of

action. What kind of a change that is, is quite indifferent. It may be a

chemical one but more probably it is a circulatory one. Let us say it is

a contraction of blood-vessels which by the resulting anaemia makes the

sensory centers unfit for perception and the motor centers unfit for

action. In this way the brain becomes protected by sleep against the

demands of the surroundings. The mental reactions are eliminated and the

central nervous substance has an opportunity to build itself up. This

protective physical activity is now evidently itself controlled by a

subcortical center, just as secretion and sexual hyperaemia are

controlled. This center probably lies in the medulla oblongata.

Some theorists, to be sure, are inclined to think that the fatigued

brain cells enter directly through their exhaustion into the protective

sleep state. But that simplifies the situation too much. It is quite

true, as these theorists claim, that monotonous stimulation of the

senses produces sleep. But it is evident that the sleep occurs even then

not only in the particular overtired brain cells. A monotonous

stimulation of the acoustical center raises the threshold of perception

for all the senses and brings sleep to the whole brain. This control of

the whole apparatus is thus surely regulated by one definite center. But

this lower center, which controls the anaemia of the cortex, is itself

directly dependent again upon a mental condition, the mental experience

of fatigue. The fatigue sensation, which is possibly the result of toxic

processes, works on that lower sleep center, just as the appetizing

impression or the sensual images work on the centers of the other two

instincts. On the other hand this protective blood-vessel contraction

creates again as in the other cases a characteristic organic sensation,

the sensation of rest which arises when the threshold of perception and

activity is raised. The world begins to appear dim and far away, no

impulse for action excites us. This organic feeling of rest associates

itself with the fatigue feeling. The fatigue sensation, the subcortical

sleep center, the contraction of the vessels in the cortex, and finally

the rest sensation form together the complete circle. The difficulty

which arises in this case lies only in the fact that the cortex gone to

sleep annihilates also, of course, the fatigue sensation and the rest

sensation. For that reason the real circle can appear only in the

preparatory stages of sleep. As soon as sleep itself sets in, the circle

is broken. The circle character of every instinct must lead the physical

effect upward to a higher and higher degree. Not to become excessive,

the physical effect must be checked somehow. In all other spheres, it

finds its end in satisfaction, for instance, by eating or by the sexual

act. In sleep the circular process ends automatically by its own effect

as soon as complete sleep is reached. Its causes, the fatigue and the

rest feeling, are stopped, as soon as the effect, the anaemia, is

secured.

We see now how widely different starting points can lead to sleep and

can understand from it how widely different disturbances can prevent

sleep. Sleep must result when fatigue is coming, but sleep must also

result when the elements of the rest feeling are produced, and as we saw

that the components of the rest feeling were the sensations of decreased

sensitiveness and decreased activity, sleep must result when either the

sensations and associations are absent and actions are suppressed, or

when monotonous sensations and automatic actions raise the threshold.

Sleep must arise further if our will associates the mere idea of such

rest, and finally physical or chemical means may produce a sleep

bringing effect either on the lower center or on the blood-vessels and

cells of the cortex. Correspondingly sleep may be prevented by

disturbances in any one of these spheres. There may be no normal

fatigue, there may be no fatigue sensation, there may be no rest feeling

on account of perceptions, or on account of associations, or on account

of impulses to action; there may be no normal response in the

subcortical center, there may be no physical effect in the cortex on

account of an existing hyperaemia or on account of an abnormal condition

of the cells. The psychotherapeutic treatment must carefully analyze

which element would be fit to supply the last link in the circular

chain. Sometimes we need the suggestion of fatigue, sometimes the

inhibition of ideas, sometimes the suppression of impulses, sometimes

the suggestion of rest, and so on. A mere general suggestion of sleep is

on the whole effective only in the cases of those persons in whom this

idea in itself awakens those various components. Very often it is

entirely ineffective in this general form. Sometimes it is possible to

carry the hypnotic state itself directly over into sleep, but it seems

more in the interest of the patient to separate those two states

distinctly.

We are still confined to processes in the brain itself if we turn to

headache. If it were only a question of inhibiting the pain by mental

suggestion, the case would not be different from inhibiting the pain of

a peripheral organ without attempting to cure the diseased organ itself.

But in the case of headaches, it seems justified to claim that in

certain varieties of this multifold symptom, not only the pain is

suppressed but the disturbance itself is removed. Especially where the

headache seems to result from hyperaemia, the trouble seems to be

accessible to psychotherapeutics. On the other hand I have never seen

any lasting effect on the so-called sick headache or migraine. While

continuous headaches or headaches which occur daily yielded to my

influence, sometimes completely, I was unable to prevent even by

preparatory hypnotization any migraine which appears periodically, for

instance, simultaneously with menstruation.

A few words only as to the general diseases and disturbances for which a

very strong therapeutic effect has been claimed by masters of the craft

like Wetterstrand, Moll, Dubois, and others. From my own experience I

can affirm the often lasting effect in the disturbances of the functions

of the digestive apparatus. The stomach and the intestines seem to a

high degree under nervous influences which can be changed through

hypnotic suggestion. If we consider what intimate connection exists

between the functions of these organs and the normal emotions, it seems

hardly surprising that mental factors can regulate their disturbances.

Vomiting, diarrhea, and especially constipation, often yield to slight

suggestions, even in a superficial hypnotic state. Here, too, I have

seen repeatedly a complete regulation of a long-standing disturbance as

an unintended by-product of hypnotic suggestion directed towards the

cure of psychical troubles. Much value is claimed for hypnotic method in

the treatment of anaemic conditions. It is said that anaemia improves

after a few hypnotic treatments, the appetite becomes better, the cold

hands and feet grow warmer, the headaches disappear, the capacity for

work increases rapidly, and most surprising of all the leucorrhea

ceases. As to heart disease, we ought to think in the first place of the

disturbances of nervous innervation. I have seen repeatedly a remarkable

decrease of nervous palpitation of the heart through direct mental

influence, abstracting here from the secondary effect of suppressing

mental excitement and fear. Where organic heart diseases are surely

present, it seems that hypnotism can sometimes act beneficially if the

heart trouble is accompanied by anaemia and general debility; of course a

developed valvular disease cannot be removed. In the same way it seems

that in Bright's disease, certain painful symptoms may be suppressed,

but the kidneys certainly cannot be influenced. At least open to

serious suspicion are the insistent claims that diabetes can be cured by

suggestion. Dr. Quackenbos of New York, for instance, gives to some of

his diabetes patients a hypnotic suggestion by the following words: "If

your pancreas be crippled in its production of the natural ferment which

is given off to blood and lymph and which conditions the normal

condition of sugar in the body or restrains the output of sugar from the

liver tissues, you will see that it forthwith pours into your blood or

lymph the sufficient quantity of sugar oxidizing ferments." It certainly

transcends our present understanding if we are to believe that a

suggestion of this type will change the action of the pancreas. It is

hardly worth while to enter into the still more extravagant claims from

other sides like those for curing cancer and phthisis. On the other

hand, in the light of all that we have discussed, there is no difficulty

in understanding the easily observable influence in the regulation of

menstruation, in the cure of contractions, local congestions, and

incontinency of urine. I may mention finally the use of hypnotism for

helping in a safe and quick confinement.

But in addition to all this, we have the great help which psychotherapy

may bring indirectly in the treatment of physical diseases. I said, for

instance, that I do not believe in a real help by mere suggestion in

cases of diabetes. But no one ought to underestimate the value which may

result for the treatment from a suggestion of a well-adapted diet. The

patient who feels a craving for bread and potatoes and perhaps sweets,

and is too weak to resist it, is indeed brought into safety if

suggestion liberates him from such desires. The same holds true for

every other diet and for any medical regime of life which does not

harmonize with the natural instincts of the patient. For not a few

sufferers, reenforcement of the interdict against coffee and tea or

alcohol and tobacco is more important than any medicine. Hypnotic

suggestion can easily create dislike of the prohibited material and can

build up new desires and inclinations. In the same way it is indirectly

most important to stir up, for instance, the sensations and feelings of

appetite and thus to make normal nutrition possible. Also in cases of

anaemia or tuberculosis, such indirect assistance can produce some

beneficial consequences.

The same holds true of the power of the psychotherapist to secure sleep.

The fight against insomnia which we discussed referred only to that

sleeplessness which is itself an expression of the disease. But as a

matter of course, the loss of sleep can accompany most different

diseases, as an almost accidental result. To secure sleep means then not

to treat the symptoms of the disease but a by-product; and yet every

physician knows how much is gained if the lost energies are restituted

by a sound sleep. And finally we have the indirect help towards the cure

by the suggestive removal of pain. We have no right to say that it is a

pure advantage for the treatment of the disease if the pain is centrally

inhibited. Pain surely has its great biological significance and is in

itself to a certain degree helpful towards the cure, inasmuch as it

indicates clearly the seat and character of the trouble and warns

against the misuse of the damaged organ which needs rest and protection.

To annihilate pain may mean to remove the warning signal and thus to

increase the chance for an injury. If we had no pain, our body would be

much more rapidly destroyed in the struggle for existence. But that does

not contradict the other fact that pain is exhausting and that the fight

against the pain decreases the resistance of the organism. As soon as

the disease is well recognized through the medium of pain and the

correct treatment is inaugurated, not only the subjective comfort of the

patient but the objective interest of his cure makes a removal of pain

most desirable. While it would be absurd to say that hypnotism can cure

tuberculosis or cancer, it is fully justifiable to say that hypnotic

treatment in tuberculosis or cancer is to a high degree beneficial,

inasmuch as it can secure sleep, appetite, and freedom from pain, three

factors which indirectly help to fight the disease. The elimination of

pain may sometimes also play its role in slight operations where other

methods of narcosis seem for any reason undesirable, and very frequently

hypnotic suggestion has been used for this purpose at childbirth.

The same importance which belongs to the removal of bodily pain in the

treatment of a peripheral disease may be given to its mental

counterpart, to the worry, excitement, and emotional shock. They all

stand in the way of a real success in any cure. Even the chances of a

dangerous operation are entirely different for the patient who goes to

it with free mind and a happy mood, with full confidence in its success,

from those of a patient who has worked himself into a state of fear and

anxiety. Here again the depression and the excitement are not in

question as symptoms of a disease, as they were when we discussed the

phobias and despondencies of the neurasthenic and of the hysteric. They

are merely normal side-effects of the bodily disease, accentuated

perhaps by a suggestible temperament. To eliminate all these emotions

means to change most helpfully the whole atmosphere of the sick-room and

to deprive invalidism of its saddest feature. This negative factor

corresponds of course most directly to the positive feature of building

up new hope and joyful expectation. He who creates confidence makes

convalescence rapid and strengthens the power to overcome disease.

It would be medical narrowness if the physician were strictly to deny

that the effect of such emotional change may sometimes lead far beyond

the ordinary suggestive influences and that in this sense the miraculous

really happens. When out of a despondent mood in a suggestible brain an

absorbing emotion of confidence breaks through, a completely new

equilibrium of the psychophysical system may indeed result. In such

cases, improvements may set in which no sober physician can determine

beforehand. Central inhibitions which may have interfered a life long

with the normal functioning of the organism may suddenly be broken down

and in an entirely unexpected way the mental influence gives to the

forces of the body a new chance to help themselves. The reasoning of the

scientific physician may easily stand in the way there. He may be afraid

of such overstrong emotion because he knows too well that such

unregulated powers may just as well destroy the good as in another case

the bad; in short, that ruin may result just as well as health. But that

does not exclude the fact that indeed almost mysterious cures can be

made without really contradicting the scientific theories. Such are the

means by which the mystical cults earn their laurels. A chance letter of

the type which often swells the mail of the psychologist may illustrate

this effect. I choose it because it is evidently written by a skeptic. A

short quotation from the lengthy epistle is sufficient.

"My condition was horrible in the extreme. I had consumption of the

lungs and other supposedly fatal troubles, complicated by wrecked

nerves. At the present writing, I am robust and splendidly healthy,

looking twenty years younger than I did at the period previously

described. The Christian Scientist saw my condition but appeared

unconcerned and unafraid, I being absolutely hopeless, skeptical, and

deeply contemptuous meanwhile. On the third day of her treatment I was

desperate for sleep, she having forbidden drugs, and I deliberately took

an overdose of chloral, thinking to die at once and end it. My

condition justified the act. She brought me out of the coma of the

chloral after three hours of mental work, and the next day I felt

decidedly calmer and less afraid of the coming of night, should I live

to meet it, which seemed doubtful. At noon she left me to go to her home

to lunch. I was pondering seriously on her reiterated 'God is love and

fills the universe and there is nothing beside Him,' when I suddenly had

a sensation of being lifted up or rising slowly and becoming lighter in

body. A rush of power that I have no way of describing to you filled me.

I seemed to be a tremendous dynamo in the air several inches above the

ground and still ascending. When I noticed everything around me becoming

prismatic and more or less translucent, I could have walked on water

without sinking, and I had distinct understanding that matters seemed to

be disintegrating and dissolving around me. I was frightened but

self-conscious and quiet. I remained in this state for about three

hours, my consciousness seeming to have reached almost cosmic greatness.

I could have cured, I felt, any human ill, was filled with an absorbing

altruistic desire to help suffering. It was tremendous and totally

foreign to my everyday attitude. At the end of the day, towards

twilight, I became wearied of the tremendous throbbing and exalted state

in which I still remained and gave utterance to the thought aloud.

Almost before I had formulated it the condition left me, and like the

sudden dropping of a weight, I struck the ground, the same dull,

ordinary person of everyday experience, but with the vast difference of

perfect health, radiant and lasting to the present writing. My father

like myself is baffled and wondering. We are both pretty hard skeptics.

I want the truth, whether it be terrible or otherwise. I am profoundly

grateful to the Christian Scientist, if I regained my health through her

ministrations, but I have not so far been able to label myself and rise

in their church services to tell what has been done on me. The

performance repels me as crude and rather bad taste. I swear to you on

my honor as an American woman and a mother that what I have written you

is true, absolutely. If you can give me any light or if my experience

may perchance give you a helping ray, my renewed lease on life may have

had some purpose after all, which I have often questioned in my cynical

moods."

The unprejudiced psychotherapist will be perfectly able to find room for

such cures and, if it is the duty of the scientific physician to make

use of every natural energy in the interest of the patient's health, he

has no right to neglect the overwhelming powers of the apparently

mysterious states. Some of this power ought to irradiate from his eye

and his voice whenever he crosses the threshold of a sick-room. Some of

that power ought to emanate from him with every pill and drug which he

prescribes. The psychotherapeutic energies which work for real health

outside of the medical profession form a stream of vast power, but

without solid bed and without dam. That stream when it overfloods will

devastate its borders and destroy its bridges. The physicians are the

engineers whose duty it is to direct that stream into safe channels, to

distribute it so that it may work under control wherever it is needed,

and to take care that its powerful energy is not lost for suffering

mankind.