THE PLACE OF PSYCHOTHERAPY
XII
PSYCHOTHERAPY AND THE CHURCH
The belief in supernatural energies has cured diseases at all times and
among all peoples. Everywhere the patient sought help through the agents
of higher forces and everywhere these agents themselves utilized their
therapeutic success for strengthening the belief in their over-natural
power. The psychologist would say that it was always the same story, the
influence of suggestion on the imagination of those who suffer. Yet the
variety of forms is abundant. Not only the special symbols but the whole
attitude may take most varied character, and every special appearance is
intimately related to the whole mystical background and to the
religious, scientific, and social ideas of the time. If nevertheless,
even at the same time in the same country, very different forms of
religious suggestion are at work, it must not be forgotten that those
who live together in any nation and are united in many common purposes
represent, after all, different stages in the development of
civilization. It has always been true that those whose minds are
saturated with the real culture of their time are working together with
those whose culture belongs to earlier centuries and with others whose
minds are essentially of the type of the primitive peoples.
Let us glance at the life of the savages. In darkest Africa, we find a
special caste with its professional secrets which accepts new members
only after long tests. They are evidently persons with over-sensitive
nervous systems and liable to hallucinations. As soon as they have their
attacks of abnormal excitement, they are conceived to be agents of
superhuman powers, and on account of this they are able to prescribe the
cure of any diseases. In Australia, therapeutic power belongs to the
koonkie, a man who as a child had a vision of a demonic god. From him he
received the power to heal the sick. He goes to the patient, touches the
painful parts and rubs them and after a few minutes, he shows a little
piece of wood which he had hidden in his hand and which he claims to
have extracted from the body of the sufferer. The native feels actually
cured after such manipulation of the koonkie, who evidently believes
himself in his power. In Siberia, we find shamanism. The shaman stands
between man and the gods. These shamans are excitable persons with
epileptic tendencies, or at least over-suggestible men or women who by
autosuggestion and imitation can bring themselves into ecstatic
convulsions. They alone know from the gods the means to treat diseases
and their personal influence overcomes the ailment. In early America,
before the European discovery, the cure of disease belonged in the same
way to the middleman between the gods and human beings. In the Antilles,
for instance, the bohuti heals the diseases which are regarded as
punishments of the gods for human neglect. The priest by inhaling a
certain powder brings himself into an ecstatic condition, then presses
the painful organs of the patient, sucks at various parts of his body
until he finally produces some little bone or piece of meat which until
then he kept hidden in his mouth. The disease disappears, and the
extracted bone is used as an amulet which secures good harvests. Other
Indians had their piachas. They were selected from among the boys of
about ten years old and were then sent to lonely forests where they had
to live for years upon plants and water without any friends, seeing only
at night the older priests from whom they learned the ceremonies for
curing the sick. Here too their art consisted mostly in touching the
painful parts of the body with the lips and sucking them to bring the
evil saps out of the body by their supernatural power. In short, at the
most primitive stages in Africa and Asia, in America and Australia,
therapy was acknowledged to be a special power of men who had superhuman
forces derived from good or evil gods.
All this repeats itself in the so-called half-civilizations. Among the
masses of China, mental and bodily diseases were ascribed to the fox,
which plays such a large part in the superstitions of eastern Asia. The
priest has the power to banish the fox by mystical writings which he
pastes on the wall of the sick-room, and the patient recovers, as the
fox has to leave his body. In old Japan the mountain monks, who
inherited their superhuman powers from a martyr of the fifth century,
can remove the diseases which have magical origin or which are induced
by the devil. They also supply the magical papers covered with writings
and pictures of birds, to prevent the appearance of smallpox and
pestilence and to cure a number of diseases. India, the classical land
of suggestion and hypnosis, shows the most extensive connection between
religious and magical powers among which the cure of diseases is only
one feature. Such cure may be with medicaments or without, but the
essential part always belongs to the prayers which make the good and
evil spirits obedient to the healer. These prayers were often spoken in
Sanscrit, which the people did not understand and which thus added to
the mystic solemnity of the procedure. This suggestive influence of the
use of older languages for religious solemnities, known only to the
priests, repeats itself also at all times and among all nations. In
Assyria and Babylonia, too, medicine was exclusively a branch of
mysticism and essentially in the hands of the priests, who by words and
magical beverages annihilated the influence of the malevolent demons. It
is well known how the Old Testament reports the same traits of belief
among the Jewish nation. We hear there that Miriam became leprous,
white as snow, and Moses cried unto the Lord, saying: "Heal her now, oh
God, I beseech thee." And after seven days Miriam was cured in
consequence of Moses' prayer. And again, "The Lord sent fiery serpents
among the people and they bit the people and much people of Israel
died.--And Moses prayed for the people.--And Moses made a serpent of
brass and put it upon a pole and it came to pass that if a serpent had
bitten any man, when he beheld the serpent of brass, he lived."
Among the old Egyptians, it was especially Isis who discovered many
remedies and had been much experienced in medicine, and after having
become immortal, it was her greatest pleasure to cure the sick and to
announce the right remedies in dreams to those who came to sleep in her
temples. Many who could not be cured by any physician, and who had lost
their sight and hearing or could not move their limbs, became well again
when they took refuge in her temples. The same holds true for the
Serapis temple; even the best known men go there to sleep to get from
the goddess cures for themselves or for their friends. It is well known
again that in other ways the old Greeks attached medical influence to
temples and sacred springs and rivers and tombs. There were sacred
springs which cured everybody who drank from them, there were statues
which removed every disease when offerings were brought to them. Here
again the most frequent is the cure of paralytic symptoms and of
obsessions. The Orphic priests of old Greece most nearly resembled the
shamans of the savages.
Those who are inclined to give to the life of Christ a rationalistic
interpretation have often pointed out that the therapeutic effects
described in the Gospels might also be understood as effects of
suggestion by word and tactual impressions, produced especially on
hysterics, epileptics, paralytics, and psychasthenics. Such
rationalistic interpretations could also explain in the same way through
the suggestive influence in the minds of the sick, those cures which
Christ effected through others without being present himself. Here
belongs perhaps the cure of the servant of the centurion in Capernaum or
the cure of the daughter of the woman of Canaan. "And when he had called
unto him his twelve disciples, he gave them power against unclean
spirits to cast them out and to heal all manner of sickness and all
manner of disease." The Acts give us the full details of how Peter and
Paul cured the lame and how special miracles were performed by their
hands. No doubt this belief in the curative effect of the disciples and
their successors fills the first centuries after Christ. Eusebius tells
us how they healed the sick by laying on of hands. The forms were
frequently changing through the history of Christianity but the essence
remains the same. Sometimes more emphasis is laid on the personal factor
of the priest, sometimes more on the sacred origin of the symbol as in
the case of the relics, sometimes more on prayer and godly works, but it
is always the religious belief which cures. Typical are the therapeutic
wonders of Francis de Assisi. He banishes devils, cures gout, lameness,
and blindness. The traditional means of suggestion, prayer and the
laying on of hands, had in the meantime been supplemented by the sign of
the cross which the church had added. Moreover whatever he had only
touched became a remedy for the sick. Protestantism brought no change in
this respect. Martin Luther writes: "The physicians consider in the
diseases only the natural causes from which a disease results and want
to remove them by their medicines, and they are quite right in it. But
they do not see that the devil often sends to one a disease which has no
natural causes. Therefore there must exist a higher medicine, namely,
the religious belief and the prayer through which the spiritual medicine
can be found in the word of God."
The broad undercurrent of religious cures, especially in the Catholic
Church and in the Greek Church, but with fewer symbols also outside of
them, has up to the present time never ceased to flow. But independent
of it the therapeutic belief has again and again been focused on certain
individuals or certain sects or certain schools, in the midst of the
steady progress of scientific medicine and sometimes synthesizing the
religious claims with new-fashioned scholarly ideas. In the seventeenth
century, for instance, the Irish nobleman Greatrakes became a famous
center of attraction. He felt himself to be the bearer of a divine
mission and healed the sick, appealing to their belief by laying on of
hands and by movements which we nowadays call passes. Much more
influential in the eighteenth century was Pastor Gassner in Germany.
Gassner succeeded in producing with his religious psychotherapy such a
tremendous stir that many thousands who needed cure from functional
diseases, and thousands of curious people, too, streamed to his church
in Ellwangen, and his methods of cure spread almost contagiously among
the ministers of the country: an Emmanuel Church Movement of the
eighteenth century. Gassner, too, discriminated between the diseases
which have natural causes, that is the organic diseases, which he did
not treat, and the functional ones, which were obsessions of the devil.
To determine to which group the disease belonged, he ordered the devil
to produce the symptoms of the sickness. When in this way the
obsessional character of the disease was recognized, the minister began
with his suggestive influences to banish the devil. He demanded firm
confidence in the name of Christ, reenforced his effectiveness by
narration of the cures he had perfected, used further certain
manipulations such as the rubbing of the skin and passes on the head,
and finally gave his suggestions with authoritative firmness. Many
ministers who became his pupils treated like him with skillful
combination of religion and hypnoid influences the spasms, catalepsies,
neurasthenias, paralysis, and deafness, of neurotic patients.
There is no need to follow in detail the frequent similar occurrences
between Gassner's time and our own. We all know where we are to-day.
The medical profession and the medical science with its bacteriology
and serum therapy, its Roentgen rays and its organic chemistry is far
away from the church and without concession to religious aspects. On the
other hand there are the yearly processions of thousands and thousands
who make their pilgrimage to the sacred waters of Lourdes, guided by the
Catholic priests, half-hypnotized by the hope that the Virgin will cure
them. In every niche of the Catholic churches in all Europe, there are
kneeling before the burning candles those who pray for nothing but their
health; and their belief will sometimes yield almost miraculous cures.
In England the Society of Emmanuel was founded by men and women to whom
it seemed necessary to bring back to the minds of Christians the
undoubted fact that Christ taught and worked for physical heath and to
revive this sense of power over disease. Thousands were treated and the
results have been "most encouraging." Among the cases successfully
treated may be mentioned "one of cancer in which case the specialist
called in had given the sufferer only three months to live while by
means of the laying on of hands in prayer, a complete cure was
effected."
Not dissimilar in its proceedings, though much more elaborate in its
metaphysics than this movement in the midst of the Church of England, we
find in America the Christian Science movement started by Mrs. Eddy. It
was new as a therapeutic system, however old its philosophic elements.
Mrs. Mary Baker Eddy writes: "In the year 1866 I discovered the Christ
science or divine laws of life and named them Christian Science. God had
been graciously fitting me during many years for the reception of a
final revelation of the absolute divine principle of scientific being
and healing." The disease is cured for the Christian Scientist by the
belief in God because a true belief in God includes the insight that God
is all reality and that reality therefore cannot include the ungodlike,
that is, error and sin and disease. Disease is thus recognized as unreal
and if it has become unreal, of course it has disappeared as part of our
real life. Thousands and thousands have been cured under this symbol.
And as the latest chapter of this history of five thousand years, we
find the movement which Dr. Worcester has started in Boston and which,
too, spreads rapidly over the continent and awakens the ambition of many
a minister in every denomination in the land. The aim is to cure the
patient by reenforcing in him through religious persuasion, through the
contact with the symbols of the church and with godly men and through
religious suggestion, a confident belief which gives new unity and
through it new strength to the mind of the sufferer until it overcomes
the functional disease of the body. The physician at first examines
whether or not an irreparable organic disease has attacked the body, but
if he does not find such organic destruction, then the patient is to be
handed over to the minister, who will take care that through his
religious belief and inspiration the mind will triumph over the weakness
of the body.
Whoever looks in this way over the history of mankind can no longer
doubt that belief in supernatural powers is really an agency for the
overcoming of disease. We may be interested in it from the standpoint of
religion or from the standpoint of psychology or from the standpoint of
ethnology. In every case we have to acknowledge that he who believes may
be cured. If we abstract first from the religious point of view and
consider the problem as a scientific one, we have to interpret all those
curative effects of belief as results of suggestion. The attitude of the
one who gives the suggestion has gone in the history of mankind through
all possible variations. He may have been filled with fervent belief,
rejecting any interpretation except the religious one, or he may have
produced the suggestion of belief almost with the intentions of a
physician who simply relies on the physiological effects of any
suggestion; and between these two extremes any number of steps is
possible. Moreover the suggestion may have been detached from any
personality and may have belonged to any symbol of religious energies,
like the relics of the Catholic Church. Even the most skeptical of
ethnologists ought to acknowledge that very little in this history of
religious psychotherapy points to a conscious fraud. Those shamans of
the savages from Siberia to South Africa, from Australia to Mexico, are
in ecstasies which make them really believe in the mysterious power of
their manipulations. The ethnologist finds indeed as most common
characteristics of all those primitive movements that those who cure
are chosen from among neurotics who by epileptic attacks or
hallucinations and obsessions are predisposed to feel themselves as
bearers of a higher mission.
Yet whether the attitude of the transmitter is religious or
half-scientific, is inspired or insincere, the receiver of the
suggestion is always in the same condition: he is believing in his cure
through religious influence and through his belief he is helped, if he
is helped at all. This uniformity does not exclude the fact that the
patients too may show a manifoldness of mental states. They may remain
in a completely waking state with reenforced suggestibility, or they may
go over into a drowsy or hypnoid state or deeply into a hypnotic state,
or may receive the suggestions as we saw even in sleep. Further their
minds may be entirely filled with fine religious emotions and the
therapeutic effect be only an appendix or, on the other hand, this
confident expectation of the relief from pain may be their central
content of consciousness and may control the whole mental interplay. The
practical problem of the scientist is to consider how far these
religious energies ought to be used today in the interests of the cure
of diseases.
From a scientific standpoint such a discussion can hardly be fruitful
with those who consistently take the religious point of view only. A
view of the world which demands the faith that religious belief moves an
almighty power to cure a diseased organ, or that the disease has no
reality for one who lives in God, is invulnerable to merely scientific
arguments. The sick woman who kneels between the candles before the
picture of the Virgin, praying that her heart, which the physicians
declare incurable on account of a valvular disease, be cured, moves in a
sphere of thought which lies entirely outside of the medical study of
causes and effects. The same holds true, for instance, of Christian
Science. This statement is in itself no criticism and no argument; it
only acknowledges that any possible exchange of opinions has to be
carried over from the scientific psychological ground to that of
metaphysics and philosophy. It is quite different with modern movements
of the type of the Emmanuel Church Movement, where the religious thought
is intertwined with the psychological theory and where an actual
cooeperation of physician and minister is sought. Here church and science
really meet on common ground, and it is important to examine objectively
whether it is wise and beneficial to encourage the spreading of this
tempting enterprise. The movement has reached the large cities between
the Atlantic and the Pacific and is beginning to captivate the ministers
of the small towns and villages. It seems as if an epoch has come for
the church--the church which too long has ministered only to the
spiritual needs of the community will at last remember again that Christ
healed the sick, that mind and body are one, that the personality must
be understood in its unity, and that endless fields of blessed influence
may again be opened to the church when the minister becomes the
physician of his congregation. Whoever knows the suggestive power of
such a social movement, and considers the ease with which triumphant
successes may be reached in this field and the disappointing and
discouraging reduction of power which the church shows everywhere in its
purely spiritual hold on the community, can foresee that all the
conditions are favorable for a rapid spread and that the church clinics
will become the American fashion of the near future.
It cannot be denied that the Christian church takes in hand there once
more a work which belonged to it through centuries. But they were
centuries in which the priest was in a certain degree the physician,
just as he was the educator and teacher, simply because in the church
there was centered all cultural influences which the community knew. The
complexity of modern times has for centuries demanded the opposite
system. Centralization is allowed only to the purely administrative
influence of the state, while all the active functions are divided among
specialists. We rely on the expert in education, we demand the expert in
medicine: is more gained or lost if the religious leader now again
suddenly undertakes a part of the functions which belong to the
physician? It is true that the ministers of this school do not propose
to undertake the physician's work to its full extent. They leave to him
the first and in some respects most important step, the diagnosis, and
abstain from the treatment of such cases as the physician declares
inaccessible to psychical influences. They do not heal cancer and
phthisis like the Emmanuel Movement in England or like the mental
healers in America.
But is not perhaps just this compromise dangerous in another direction,
inasmuch as it awakens a feeling of safety in those who feel in sympathy
with scientific medicine? They have passed the hand of the physician and
believe accordingly that because their illness is recognized as
functional, the minister can really perform all that ought to be done.
Is this belief justified? At the threshold, it occurs to every one that
such a diagnosis by physicians may be erroneous and that the chances for
such error are under the conditions of the church clinic much greater
than under the conditions of a regular medical treatment. The
diagnostician who treats the patient himself has ever new chances to
remodel his diagnosis and to correct it under the influence of
therapeutic effects. The danger is great that under the proposed
conditions, the activity of the physician will be superficial, because
he is deprived of his chief means, the constant observation. But we may
abstract from this possibility of error. Does the fact that the disease
is one the symptoms of which may yield to psychical treatment really
make it advisable that the further treatment be handed over to the
clergyman? To begin at the beginning, the usefulness of psychical
treatment does not at all exclude the strong desirability of physical
treatment at the same time. The emphasis which is laid on religious
persuasion and inspiration, on prayer and spiritual uplift practically
excludes the use of baths and douches, of massage and electricity, of
tonics and sedatives. And yet it is not caprice or sham when every
well-schooled medical specialist applies such means in the treatment of
these so-called functional diseases of the nervous system. The minister
applies and can apply only one of many possible methods for cure and
yet, if we really want to make use of the resources of modern knowledge,
we have to adapt most carefully all possible means to the individual
case. If we take the strictly religious standpoint the situation is of
course different, but if we speak of psychophysiological effects, we may
acknowledge the healing influence of prayer and yet rely in the special
case still more on bromide or strychnine. Yet the religious
psychotherapists not only neglect the physical help but usually
emphasize the antagonism. Some of the strongest supporters proclaim it
as a non-drug healing, thus deciding adversely about a medical method
regarding which they have no means at all to judge.
Parallel to this neglect of physical theory goes, of course, the neglect
of the physical factors in the disease. The physician may have justly
diagnosed that the case is "merely" neurasthenia or hysteria and not a
brain tumor or paralysis of the brain. Yet that does not mean in the
least that a real treatment which remains in harmony with the progress
of modern medicine ought to ignore the hundred physical elements which
enter daily into the disease. There are the most complex digestive
problems involved which demand a thorough understanding of chemical
metabolism, there are still more complex problems of the sexual organs
which the minister certainly ought not to discuss with his female
parishioners, there are bacteriological questions, there are questions
of the peripheral nervous system and sense organs; in short, questions
which belong to a world into which the minister as minister has never
looked. Even if he believes he might gather in an amateurish way some
information as to those questions which lie so far from his experience
as student of divinity, how can his half-baked knowledge compare with
the experienced study of the regular physician? Such physical questions
cannot be settled by the preparatory examination of the physician; they
come up every day during the treatment and what the spiritual diet which
the minister offers may help, may at the same time be ruined by the
physical diet about which the minister without chemistry cannot judge.
But let us abstract from the bodily aspect. Is the situation really very
different for the mental one? The appeal to the religious emotion, the
reenforcement of religious faith is from the religious point of view
certainly the one central effort from which everything has to irradiate.
The unity of this controlling thought is the glory of such inspiration.
But as soon as we handle this thought as a psychotherapeutic remedy,
destined to restitute the disturbed psychological equilibrium, it
becomes evident that the very uniformity of it makes it a clumsy,
inadjustable pattern. If there is anything which impresses the careful
student of psychology, it is the over-rich manifoldness, the complexity
of mental life. Even the simplest content of consciousness is a tissue
woven from millions of threads and any stereotyped influence means
crudeness and destruction. The minister's attitude towards inner life is
there directly opposite to that of the psychologist. He cannot enter
into those endless interplays of associations and memories, or
inhibitions and sensations and impulses, he cannot examine from which
remote psychological sources those ideas have arisen, how the feelings
become disturbed and the judgments sidetracked. He should not analyze
even if he could, because his whole aim is to synthesize. He asks for
the meaning and not for the structure, for the aims and not for the
elements. His therapeutic effort is therefore not even directed towards
a careful rebuilding of the injured parts of the mind, but it is nothing
more than a general stimulation to the mind to help itself. By touching
on one of the deepest emotional layers of the mind, the layer of
religious ideas, the minister gives to the soul an intense shock and
expects that in the resulting perturbation, everything will be shaken
and may then settle itself by its own energies in a healthful way. It is
a fact that that can sometimes happen and under certain conditions the
chances for it are even favorable. Under many other conditions the
chances are unfavorable and the result does not happen at all.
But whether or not a cure results, in any case it is certainly not an
effort which can be said to be in harmony with modern science. The idea
of science is always to understand the complex from its elements and to
restore the disturbed complex object by recognizing the disturbances in
the elements and by bringing those disturbed elements into right shape
again. Certainly the psychologist, too, in examining carefully the
injured mental mechanism may discover emotional injuries which might be
cured by the introduction of religious ideas, but he will not give to
them a value different from the introduction of any other ideas and
emotions, for instance, those of art and music and poetry, those of
social company or civic interest, of travel or sport or politics. Each
may have its particular value and to cure every mind with religious
emotion would be from a psychological point of view as one-sided as it
would be to cure every disturbed stomach by milk alone. Moreover in very
frequent cases, for instance, of neurasthenia or hysteria or
psychasthenia, such wholesale remedies can form only the background of
the treatment, but all the details have to be furnished with reference
to a most subtle analysis of the special symptoms, and a particular
organic symptom or a particular memory idea or a special inhibition by a
well-selected counter-idea will do much more than any great emotional
revival.
Stereotyped religious appeal is not only insufficient in an abundance of
cases--it must never be forgotten that those who nowadays go to the
minister for their health are already selected cases more open to
religious suggestion than the average--but can easily be decidedly
harmful. Of course that holds true for every physical remedy too, and
the judgment of the exact limit is one of the chief duties of the
physician. It holds also for the other mental factors like sympathy. A
certain amount of sympathy may save a neurasthenic from despair, and
only a little more may make his disease much worse and may develop in
him a consciousness of misery which makes him a complete invalid. Still
more is it true for the religious emotion, from the standpoint of
nervous physiology the strongest next to the sexual emotion, that it can
be the healing drug or the destructive poison. Everything depends upon
the degree of the intrusion and upon the resistance of the
psychophysical system. From a purposive point of view there cannot be
faith enough, from a causal point of view there can easily be too much
of the faith emotion. Religious fervor has at all times helped to create
hysteria and to develop psychasthenias. It cannot be otherwise. A group
of ideas which has such tremendous power over man must easily be able to
produce inhibitions and exertions which become dangerous to a nervous
system the constitution of which is pathological. To leave such a
dangerous and powerful remedy entirely in the hands of men who by their
profession must aim towards a maximum dose of religious influence can
certainly not be in the interests of the patients or of the community.
Even the whole technique of this movement awakens the fear of possible
harmful consequences. On the one hand we have the movement itself as a
popular suggestion for the suggestible masses. The patient who seeks the
help of a scientific neurologist hardly becomes a center of psychical
contagion, but the church services for the sick offer favorable
conditions for an epidemic development of hysterical symptoms. But more
important are the influences on the individual patient. The whole
purpose of the treatment demands the highest possible degree of
suggestibility brought about by the ministerial persuasion. But it is
evident that this degree of suggestibility means at the same time the
most fertile soil for every chance suggestion and for influences which
are perhaps entirely unintended. The physician and the psychologist,
considering the mental state with reference to its elements, will make
most careful use of those accessory influences. The minister, who
necessarily has his spiritual aim in mind, cannot even become aware of
all the involuntary influences which reach the mind in its most
suggestible state. There can be no doubt that it would often need
psychological art to avoid the creation of new pathological symptoms in
such half-hypnotized patients. Yet the minister even goes so far as to
make use of the sleeping mind without any consideration of the possible
damage which may be done to his subject. He goes to the bedside of a
sleeping girl and whispers his suggestions and is satisfied when they
show their effects the next day. It does not lie in his horizon to
consider the grave consequences which such suggestions during sleep may
produce during future years in the brain the sleep of which has been
transformed into such half-somnambulic relations. Hysterias may be
created by such methods. No one can blame the minister for his
remoteness from such doubts and problems, but the physician is to be
blamed if he encourages the belief that all this still belongs to the
proper sphere of the ministerial worker in abnormal psychology.
Those engaged in such work were not long in finding out that the mere
emotional inspiration is often no sufficient remedy, and the development
went along the same lines in which it has gone everywhere for some
thousands of years. Not to disappoint the sufferers, the religion had to
become in very many cases simply an inactive side issue and the real
cure was performed by the same methods with which any worldly
neuropathologist would go to work. If the woman who cannot sleep is
cured from her insomnia by being made to listen to the beats of a
metronome, it may sometimes be effective, however crude, but it is
certainly no longer religion, even though the metronome stands in a
minister's room. The more the movement spreads to those who have no
psychological training and knowledge, the more it must be necessary for
them to import the whole claptrap of the quack hypnotist and soon the
minister may discover that in certain cases physical means and drugs
help still better. Thus he simply enters into competition with the
regular physician, only with the difference that he has never studied
medicine. The chances are great that in his hands even such remedies and
drugs may do harm and finally, even if they were effective, is not the
question justified: will not religion suffer?
Indeed we have so far considered the question from one side only. We
have confined ourselves to the question of how far such a movement is
sound for the interests of the patient; but can we be blind to the other
side and overlook the not less important problem of whether it lies in
the interests of religion and of the church to amalgamate its spiritual
work with a medical one? We are not thinking of those widespread, unfair
arguments to the effect that this whole movement is undignified because
it is instituted by the desire to fill the empty pews or to make
competition with the success of Christian Science. That is utterly
unjust. But there are intrinsic factors in the movement which interfere
with the true aims of religion. First of all it cheapens religion by
putting the accent in the meaning of life on personal comfort and
absence of pain. The originators of the Emmanuel Movement stand well
above such error, but their national congregations do not. Certainly the
longing for pleasure and a well feeling and the abhorrence of pain and
illness pervades our practical life and keeps in motion all our
utilitarian efforts. But if there is one power in our life which ought
to develop in us a conviction that pleasure is not the highest goal and
that pain is not the worst evil, then it ought to be philosophy and
religion. It is only the surface appearance if it seems as if the
religious therapeutics minimizes the importance of pain; in truth it
does the opposite. It tries to abolish pain, but not because it thinks
little of pain; on the contrary, because it thinks so much of pain that
it is willing even to put the whole of religion into the service of
this strife for bodily comfort. The longing for freedom from pain
becomes the one aim for which we are to be religious. In a time which
denies all absolute ideals, which seeks the meaning of truth only in a
pragmatic usefulness, it may be quite consistent to seek the meaning of
religion in its service for removal of pain, and personal enjoyment. But
in that case the ideal of both religion and truth is lost. It is finally
not less undignified for religion to seek support for the religious
belief in effects which it shares and knows that it shares with any
superstitious belief on earth. Granted that the church can cure: the
shaman of Siberia can cure too, and the amulets of Thibet not less. The
psychologizing church knows, therefore, that it is not the value of the
religion which restores the unbalanced nervous system; and yet it wants
to provide for the spreading of true belief by the miraculous cures
which it exhibits.
This situation naturally produces the desire of the church to substitute
a religious explanation for a psychological one. It is claimed that
after all it is not the mental effect of the prayer, but the prayer
itself, not the psychophysical emotion of religion, but the value of
religion which determines the cure. Yet in that moment the whole
movement in its modern shape comes into a still more precarious
position. If the cure results from the inner value of the religion how
can we confine it to the so-called functional diseases and abstain from
any hope in organic diseases? Luther, from his religious point of view,
still had the right to separate the two groups because only those
functional diseases were effects of the devil, obsessions which could be
banished by the minister and by prayer, while the other diseases did not
result from the devil, but merely from natural causes. Such a definition
does not fit into the modern system. To-day from a really religious
point of view, both groups of diseases must be acknowledged to be
natural or with Mrs. Eddy, as the work of the unholy spirit. Christian
Science is indeed by far more consistent. If the cure results through
the meaning and value of religion, there is no reason whatever why
cancer and diphtheria and paralysis should not be cured as well as
psychasthenia. And if, on the other hand, organic diseases cannot be
cured because the psychophysical process of the religious emotion has no
influence over diphtheria bacilli, then the whole process is removed to
the causal sphere and it is acknowledged that the purposive meaning of
religion is not in question at all. The whole system of such religious
psychotherapeutics is therefore in its inner structure contradictory. It
contains causal and purposive elements without any possibility of
unifying them. They are loosely mixed, and the power of prayer means on
one page something entirely different from what it means on another. In
these respects Christian Science is by far more unified and in harmony
with itself; its therapeutics is really anchored in a system.
From a scientific point of view, its dangerousness is of course much
greater inasmuch as it extends its methods over every organic disease
and thus applies merely psychical treatment where from a standpoint of
scientific medicine, physical treatment would be absolutely necessary.
Moreover its philosophy is after all only a pseudophilosophy; its
tempting equations of disease and error and sin and unreality are
ultimately a mere playing with conceptions. If we were to point to the
root of the misunderstanding in Christian Science, we should say that
everything depends on the philosophical commonplace that the objects
with which we deal in our life are ideas and that our whole experience
is mind. "Christian Science reveals incontrovertibly that Mind is
All-in-All, that the only realities are the divine mind and idea." But
now silently this mental character of the real world is identified with
the mental experience which stands in contrast to the physical
experience. There results the impression that physical experience
therefore, does not belong to the world of reality. It is evident,
however, that mental in contrast to physical means something entirely
different from mental in the philosophical sense. In the latter meaning
of the word, we all agree that the world is mental; the word mental
indicates there that the world has reality not in itself but only as
experience of subjects. In the second sense, mental or psychical means
that it is experience for one particular subject only and not for every
possible subject. The physical thing, for instance this table, is indeed
different from my mental memory idea of a table, inasmuch as every
possible subject can experience this table while my mental memory image
belongs to me alone. The physical table and the mental memory image of
it are both equally mental in the philosophical sense, inasmuch as the
physical which is object for every possible subject and in this sense
not mental is therefore not less given to subjects. Every physical body
with its disease is thus in one sense taken as something not mental
while in another sense as mental; if we use the same word in two
entirely different meanings, it indeed cannot be difficult to
demonstrate any metaphysical consequences.
But we do not have to deal here with the metaphysics of "Science and
Health." If it is brought down to the concrete application, we stand
before the same confusion which characterizes all compromises. Causal
effects are sought in a sphere which belongs to purposive values. The
psychological effects of the emotion of faith are sought and are
misinterpreted as the emanations of religious powers. Religious
psychotherapeutics in all its forms seeks to demonstrate to us the
triumph of the soul over the body, while in reality it deals only with
the mental mechanism which as such belongs to the chain of causal events
in the same natural way as the organism. The soul, as spiritual agency
in its sphere of purposes and ideals, does not enter the machinery of
psychotherapy, and the psychological material on which psychotherapy is
applied is not freer and not better and does not stand higher than the
material of the bodily cells and tissues. The Emmanuel Movement
deserves the highest credit for bringing about a systematic contact
between religious faith cure and scientific medicine, but the time in
which the minister himself undertook the medical treatment had to be a
time of transition. It had to lead to a new relation in which the
ministerial function is confined to the spiritual task of upbuilding a
mind while the therapeutic function remains entirely in the hands of the
physician. Where the physician believes that the psychomedical treatment
demands a new equilibrium of the patient to be secured by religion,
there the minister should be called for assistance. Psychotherapeutic
hospitals would offer the most favorable conditions for such
cooeperation. But the minister ought to enter even such a hospital with a
strictly spiritual aim, and he should never forget that the task of the
church stands much higher than the utilitarian task of removing pain
from the sick room. But if those psychotherapeutic hospitals will
flourish and the physicians will at last make use of psychical factors
in their regular practice, they ought not to forget on their part that
the important step forward was taken under the pressure of popular
religious movements. The ministers first saw what the physicians ought
to have seen before, but the physicians will see it more fully and more
correctly.
XIII
PSYCHOTHERAPY AND THE PHYSICIAN
Every thought of the physician moves in a world the structure of which
is determined by the thought forms of cause and effect. He knows the
effect which he wants to produce; it is the restitution of the organic
equilibrium. He studies the causes which can secure that end. And again
the disturbance of the equilibrium itself, the disease, is for him an
effect which he seeks to understand by an analysis of the preceding
causes. The means which he applies can therefore be valued only in
reference to their efficiency; no other point of view belongs to his
world. The religiously valuable may be indifferent or even undesirable
in the interplay of causes, and the morally indifferent may be most
important for the physician's interests. The religious emotion
accordingly has to stand in line with any other mental excitement or
with a hundred physical means which the laboratory and the drug store
supply. The physician will welcome the methods of treatment without
reference to metaphysical systems or to religious beliefs. To him it is
an empirical fact that many disturbances of mind and body which
interfere with the equilibrium of life can be repaired by influences on
certain psychophysical organs. A part of these repairing influences he
finds in the sense stimuli, for instance, of spoken or written words
which reach the brain and awaken associative and reactive processes. He
finds further that these influences can be reenforced in their
effectiveness by certain general conditions of the nervous system and
again finds that these can be secured partly by sense impressions, and
once more especially by words.
It is a matter of course to the physician that application of any sense
influence on the brain demands a most subtle analysis of the
psychophysical situation. Therefore he gives no less attention to the
disentangling of the whole history of the individual brain, to its
stored-up energies and to its mental possibilities. If he knows the
psychophysical status, and finally if he knows the means of influencing
those psychophysical organs which stimulate or inhibit the disturbed
central parts, he can foresee the psychophysical effects with a certain
definiteness. Thus everything depends upon the sharpest possible, almost
microscopic, mental analysis, together with a most thorough examination
of the whole nervous system and the most careful calculation of the
mental influences applied. The vagueness of the religious appeal
transforms itself into an exact calculation and the unity of the soul
which seeks spiritual uplift transforms itself into a mental mechanism
of bewildering complexity, and yet not more complex than the physical
organism, to which for instance, the chemical means of the physician
administer. To-day medical science is certainly only in the beginning of
this great movement. Especially the analysis of the psychophysical
conditions still lacks a sufficient refinement of method. But at least
the causal principle is now fully recognized and the scientific man of
today no longer doubts that this whole play of psychotherapeutic
processes goes on as a causal process in the psychophysical system of
the individual without any mysteriousness, without any magnetic
influences, without any miraculous interference, without any agencies
except those which are working in our ordinary mental life in attention
and reaction, in memory and sleep.
It is surprising how late this recognition appeared in the history of
human knowledge. It occurred here as in so many places in the history of
human civilization that the simple is the late outcome of the complex.
Just as in technique the apparatus often began in a complex, cumbersome
way and then became steadily simplified, so it is with explanations. The
complex machinery of cosmic influences and obsessions by demons and
magnetic mysteries was at first necessary until the simple explanation
was found that all the results depend upon the working of the mind
itself. Yet in technique and explanation alike, such progress to the
simpler means always at the same time the making use of much richer
knowledge. To explain an obsession or a sleep state by the agencies of
evil spirits or magnetic fluids is certainly an unnecessary side
conception. But to understand it from the working of the mind
presupposes after all the whole modern physiological psychology, and
thus had to be the latest step.
The effects themselves were certainly observed in all times. Even the
phenomena of hypnotism date probably back some thousands of years,
however difficult it may sometimes be to discriminate between the
artificial hypnotic states and hysteric or hystero-epileptic occurrences
in the past. Certainly it may be acknowledged that the Yogi in India
cultivated in the most remote times the methods of autosuggestion which
evidently led to hypnotic states, and everywhere around the
Mediterranean, antiquity knew the hypnotizing effect of staring on
polished metals and crystals. So in Egypt, so in Greece and Rome; and it
has often been claimed that the priestesses of Delphi and the sibyls of
the Romans were in states of hystero-hypnotic character. As to the
therapeutic use, especially the Greek physicians applied hypnotic means.
Excited patients were brought to repose by methods of stroking. The
efforts to explain scientifically the mysterious powers which men can
gain over the mind and will of another begin at the end of the Middle
Age and were developed quite naturally from the prevailing astrological
doctrines. Astrology worked on the theory that the human fate depends
upon the stars. These stars have an effect on the human organism. That
proves that an influence can exist between distant bodies. It is,
therefore, not more surprising that one organism can also have an
influence on another organism. Well known since antiquity were such
influences from one object to another, as in the case of the magnet.
Thus there may be a kind of magnetic power which creates relations
between all objects in the universe.
Pomponnazi explained thus at the end of the fifteenth century the
therapeutic effects of the human soul by the mutual influence which
stars and men have on each other. This theory comes to much more
important development in the writings of the physician Paracelsus. One
individual by the power of his effort can influence the will of another
individual, can fight with it, and suppress it; and all through energies
which are analogous to the magnetic power which binds stars and men. In
the middle of the seventeenth century, Helmont connects this power of
magnetic attraction and repulsion with an ethereal element which
penetrates all bodies and keeps them in motion. Through it man, too, can
by his mere imagination work on other men. This will can also be
effective on drugs which get through it a special therapeutic power.
Somewhat different was the theory of a Scotch physician, Maxwell, in the
second half of the seventeenth century. The ethereal spirit, which is
identical with light, can be artificially cumulated in any organism and
that secures its health. As one man can influence this vivifying ether
in any other man, he can produce cures even from a great distance. All
diseases are merely reductions of this ethereal spirit in the organism.
But the general stream of the explanation continued in the direction of
the magnetic doctrine. It was especially Mesmer in the eighteenth
century who, in a long life of fantastic mysticism and yet of universal
serious study, surely contributed much to the development of the theory.
He had started to use, like others, the magnet in his medical practice.
But he discovered that the same therapeutic successes could be gained
without applying the magnet itself, but by simply using his own hands.
The patients became cured when he moved his hands slowly from their
heads to their feet. The magnetic power was therefore evidently in man
himself. It was an animal magnetism in opposition to the mineral one
which belonged to the magnet and to the stars. He believed further that
he was able to infuse this magnetic power into any lifeless thing, which
would then have curative influence on the nerves. There can be no doubt
that, whatever may have been the value of his theories, he cured a large
number of patients, evidently producing a state which we would call
today a hypnoid state and often simply appealing to the natural
suggestibility of the impressionable minds. Among his pupils, usually
called mesmerists, was Puyseyur, who discovered, in 1784, the state
which was called artificial somnambulism, a kind of sleep in which the
ideas and feelings of the magnetized can be guided by the magnetizer.
Here evidently was the first recognition of the psychotherapeutic
variation which we call today hypnotism. There followed a period in
which the scientific interest of the physicians was somewhat sidetracked
by an unsound connection of these studies with mystic speculations and
with clairvoyance. But especially in Germany animal magnetism in
Mesmer's form and in the form of artificial somnambulism grew in
influence through the first decades of the nineteenth century and
succeeded in entering the medical schools. The reaction came through
popular misuse. At about the third decade of the century, interest
ceased everywhere.
The Portuguese Faria insisted in 1819, practically as the first, that
all those so-called magnetic influences, including the delusions, the
amnesias after awaking, and the actions at a command, did not result
from a magnetic power but from the imagination of the subject himself.
He believed that the effect depended upon a disposition of the
individual which resulted from a special thinness of blood. He abstained
therefore from the magnetic manipulations and produced the somnambulic
state by making the patients simply fixate his hands and by ordering
them to sleep. Thus he is the first who understood these changes as
results of mental suggestion. The next great step was due to the English
surgeon, Braid, who in the forties studied the magnetic phenomena and
like Faria insisted on the merely mental origin of the abnormal state.
He proved that a person can bring himself into such an artificial state
and that it is therefore entirely independent of energies from without.
He examined especially the influence of staring at a shining object, a
method which not seldom was called Braidism. He also introduced the
word hypnotism. In America mesmerism was generally known under the
name of electrobiology; and Grimes in particular came to results
similar to those of Braid. Yet the influence of these movements on
the medical world remained insignificant until a new great wave of
psychotherapeutics by means of suggestion began in France in the
sixties.
Of course this development from astrology to magnetism and from
magnetism to hypnotism represented only one side of psychotherapy.
Parallel to it goes the progress in the treatment of the insane. In the
first half of the eighteenth century, they are still on the whole thrown
together with the criminals but the more the disease character of the
disturbance is acknowledged, and the more special hospitals for the
insane are created, and finally the more the humane treatment in them
supersedes the brutal, the more psychotherapy enters into the work.
England showed the way. Especially Arnold, Crichton, and Perfect became
influential; and soon Pinel and Esquirol followed in France; and Reil
and Langermann in Germany. Reil recognized clearly at the threshold of
the nineteenth century that "Both psychical and physical diseases may be
cured by psychical means, but at the same time psychical diseases may
also be cured by physical means." And in his "Rhapsodies," rhapsodies on
the application of psychical methods in the treatment of mental
disturbances, he declared, "that the medical Faculties will soon be
obliged to add to the two existing medical degrees still a third,
namely, the doctorate in psychotherapy." This stream became broader and
broader and every new development of psychiatry in the last hundred
years did new justice to the influence of psychological means in the
treatment of mental diseases; to be sure, without allowing up to the
present day the hope that mental factors as such can cure the grave
forms of insanity. The borderland cases and the incipient mild forms
alone allow the hope of a cure. Outside of them the work of
psychotherapy in the insane asylum meant essentially improvement and
relief only. Again, in another direction, the general dietetic influence
of sound mental life may be called a part of psychotherapy and this
engaged not a few of the leading medical thinkers in all countries
during the last century, especially the nerve physicians who gave
serious attention to the wholesome engagements of the mind. Finally,
might not much be attributed to psychotherapy, which offically belongs
to the doctrines of homeopathy?
But we may return to the new heralds of suggestion. Liebeault's book on
the artificial sleep in 1866 became the starting point of the new great
movement. Yet at first it remained unnoticed. It is claimed that for a
long time only one copy was sold. But he continued to make his hypnotic
experiments on the poor population of Nancy and they finally attracted
the attention of some of the leading medical men there. Bernheim became
convinced and Dumont, the physiologist Beaunis joined the movement, and
in the eighties we find Nancy the center of hypnotic interest to which
medical men from everywhere made their pilgrimage. This latter phase was
paralleled by Charcot's studies in Paris, who brought hypnotism into
nearest neighborhood with hysteria. And also the later development of
the Paris school by Richer, and especially the brilliant work of Janet,
kept hysteria in the foreground of the therapeutic interest. Liebeault's
experiment had brought the psychology of suggestion entirely into the
center of this whole circle of phenomena and this view controlled the
development of the last few decades, which was essentially an
elaboration of the special treatment of diseases. Forel in Switzerland,
Moll and Vogt in Germany, Wetterstrand in Sweden became the chief
exponents of therapy by hypnotism. Others, like Dubois, in Switzerland,
emphasized more the suggestive treatment through persuasion. In England
at first Carpenter, later Hack-Tuke gave serious attention to hypnotism,
in Russia Bechterew, and in the last few years the literature on therapy
by suggestion became developed in practically all countries. In America
Beard, Hammond, and others belong to the older school; Osgood, Prince,
Peterson, Putnam, Sidis, and others to the most recent years. At the
same time, under the leadership of Kraepelin, Ziehen, Sommer, and
others, the methods of the psychological laboratory, especially the
reaction and association methods, were made useful for the purposes of
psychopathology.
But interest in suggestion does not represent to-day the last step of
psychotherapy. The latest movement, which is entirely in its beginning,
the development of which no one can foresee, but which promises wide
perspectives, is connected with the name of Freud in Vienna. The
entirely new turn of psychotherapy is given by the fact that his aim is
not to overcome a symptom by suggestion but to make it disappear by
removing the ultimate mental cause. He found that large groups of mental
disturbances result from a psychical trauma, a disagreeable idea which,
inhibited in the mind, becomes the source of mischief and produces
phobias and obsessions and hysterical motions. The cure of the symptoms
demands the recognition of this first mental accident, which may lie
back for years and which may no longer be in the memory of the patient.
As soon as this earlier experience is brought to consciousness again, it
needs only a natural discharge and a normal expression and the symptoms
which it brought about will disappear. Thus the cure itself needs no
hypnotism and no persuasion or suggestion but the reawakening of
forgotten situations, and only in the service of this effort hypnotism
may be used to reenforce the memory. Yet this represents only the first
period of Freud's activity, in which he collaborated with Breuer, a
phase which is represented by their book on hysteria, in 1895. But there
followed a further development which is still more essential. The
hysterical disturbance may indeed have started with such an accidental
traumatic impression but that does not explain why just this impression
had such a strong effect. Other impressions of equal strength and
emotional vividness may have passed without leaving any damaging result.
And therefore there must be some prior cause in the subject which makes
just this particular impression so injurious; and here is the point of
Freud's fundamental discovery, which for the layman appears on the
surface to have little probability but which has proved of greatest
consequence for clinical work. It was found that only those situations
become injurious and become starting points for hysterical symptoms
which touch on repressed and artificially inhibited ideas of the sexual
sphere.
Entirely new perspectives have been opened by these studies. Above all,
now for the first time there is in sight a psychotherapy which not only
aims to remove symptoms but which really uproots the disease itself.
That earlier method of bringing the trauma to consciousness and making
it discharge, the so-called cathartic method, removes only the
particular group of disturbances but the patient remains a hysteric, and
if ever new accidents should happen which would touch again those inmost
repressed ideas, new hysterical symptoms would develop. But if we can go
back to that starting point, if we can discover those first suppressions
of desired gratifications which often most indirectly are related to the
sexual sphere, and if we can liberate the mind from those primary
strangulated affections, then the patient is really cured. Freud himself
practically abstained from the help which hypnotism can give for the
reawakening of forgotten experiences, while some of his pupils still
prefer this short way to the forgotten memories. His way is, on the
whole, to let the imagination bring up any chance material of associated
ideas and then to study their connections and follow the hints they
give. He calls it the psychoanalytic method. Others prefer the methods
of association tests, again others tap the lower layers by automatic
writing, but the chief problem remains always to discover those
repressed desires and to understand through them the injurious effects
of accidental experiences. The whole field of hysteria, and perhaps
still more that of the anxiety neurosis, has come into new perspective
through this pioneer work which men like Bleuler, Jung, and Stekel have
developed in various directions.
Thus in recent decades the thorough work of scientific physicians has
developed a psychotherapy of considerable extent and of indubitable
usefulness, far removed from the simultaneous efforts of the churches
and of the popular mental healing cures. A number of eminent men in all
countries have tested the methods and have published the results. But
the curious side of it is that all this is essentially a movement of
leaders while the masses of the profession hesitate to follow. It is a
set of officers without an army. Every large city has one or another
specialist who applies suggestive therapy, one or another nerve
specialist who hypnotizes, but the average physician moves on without
any serious effort to utilize psychotherapy. It is as if the
prescription of the modern chemical drugs were confined to some leading
scholars in the country, while the thousands abstained from it in their
office work and in their family practice. In reality psychotherapy ought
to be used by every physician, as it fits perfectly the needs of the
whole suffering community. Its almost exceptional use in the hands of a
few scholarly leaders deprives it of its true importance. It is the
village doctor who needs psychotherapy much more than he needs the knife
and the electric current.
Why does the medical profession on the whole show this shyness in the
face of such surprising results? In other fields they do not show any
reluctance in taking up the newer developments of method. Even the
Roentgen ray apparatus has quickly won its way, and psychotherapy is
less expensive. To be sure, the most important reason is probably one
which is most honorable. The physicians do not like to touch a tool
which has been misused so badly. Psychotherapy has come too much into
the neighborhood of superstition and humbug. Where miracles are
performed, the man of science prefers to leave the field. The less one
knows about those groups of problems, the less one is able to see the
sharp demarcation line between true scientific studies, for instance, in
hypnotism, and the pseudo-scientific fancies of psychical research.
Experiments in suggestibility are then easily mixed with experiments in
telepathy, and those go over by gradual degrees to clairvoyance and
premonitory apparitions, and from there the way is not far to the
reappearance of the dead and the routine performances of the spiritists.
It seems to many as if there is no point where they have a reason to
stop. If they begin with such abnormal phenomena at all, it seems as if
they are necessarily carried over to all the mysteries of supernatural
energies. Even the competition with Christian Science, and other mental
healers whose judgment is not hampered by any previous study of
medicine, might seem rather unattractive to the serious physician.
Further not a few have the impression that such suggestive treatment
directly demands from them that they also begin to humbug their patients
or to throw out suggestions which they themselves do not believe, in
short, that they be brought down to the level of the miracle performer.
Yet, however much all that speaks in favor of the conscientious instinct
in the physician, it is ultimately based upon a misinterpretation. The
line between real science and its counterfeit is here as everywhere a
distinct one, and the true man of science ought not to hesitate in doing
his duty from fear that he might not be discriminated from the
charlatan. A well-conducted psychotherapeutic treatment as a scientific
physician ought to carry it out, is entirely different in meaning and
appearance, from the first step of diagnosis to the last treatment of
after-effects, from every unscientific faith cure. It is also in no way
necessary that the psychotherapist ever leave the path of complete
sincerity. There is no reason at all for promising that the patient will
be entirely cured if the physician believes that a real cure through
suggestion is impossible. The more the true physicians undertake
psychotherapeutic work, the more it will carry with it that dignity
which is now too often lost by the predominance of those who treat
without diagnosis and cure by mere appeal to superstition.
All that does not mean that other motives do not hold the physician
back. Not seldom he is afraid of unfavorable consequences. He does not
feel sure that, for instance, a deep hypnosis is without dangerous
results or that he will be able to produce it in the technically correct
way. But all these objections mean nothing but insufficient acquaintance
with the facts. Of course every technique needs its period of
preparation for the task, but it is now sufficiently demonstrated that
hypnotism carried through in a scientific spirit will never have any
injurious consequences. The morphine injection and the Roentgen rays are
by far more dangerous. Those who think that for hypnotizing especially
inborn power is needed stand, of course, outside of a serious
discussion. They do not even know the elements of the modern theories.
Every physician has in himself the necessary means for a
psychotherapeutic treatment in every form.
More scientific insight belongs to the argument that most of these
psychotherapeutic schemes are essentially for treatment of symptoms. We
have acknowledged that throughout. The possibility of a relapse or of a
new obsession is thus to a high degree open, and that is certainly a
discouraging feature. Yet we have seen sufficiently that as soon as the
symptoms are removed, there is no lack of means, also by psychotherapy,
to prevent the recurrence. Moreover, to remove the present symptoms is
in any case a great gain and in many cases a decisive gain. And whatever
can be secured by such methods is of such a character that hardly any
other method could have been substituted. It can be said with certainty
that hundreds of thousands leave the offices of their doctors every year
without relief where relief could be secured by psychotherapeutic means.
To be sure, one reply of the physicians is not infrequent and carries
some weight. Psychotherapeutic methods demand much time and patience and
skill. To relieve a cocainist of his desire by mere suggestion may
demand an assiduity which the average physician simply cannot afford;
and nothing requires more time than a real use of Freud's psychoanalytic
method. Hours and hours of conversation about the most trivial
occurrences have to be spent to relieve the repressed ideas and to give
them a chance for a free ascension. It cannot be denied that most of the
really illuminating work in all these fields has been done by scholars
who combine a strong theoretical interest with their effort to cure the
patients, and who therefore examine and treat the individual case
primarily from the wish to get new insight into the laws of nature. The
average physician whose time is his income may be the less willing to
enter into such time-devouring schemes, as the patients too easily may
think that the physician did not do much for them when he simply was
sitting down and gossiping with them.
Yet after all, behind all of it stands one motive which has held back
the development of psychotherapy in the medical profession more than
anything else. The physician feels instinctively that a real success can
be reached in every one of these fields, only if he possesses a
reasonable amount of knowledge of psychology. He feels that wherever he
touches the patient's body, examines his lungs or his heart or his
reflexes, that a large background of anatomical knowledge and of general
pathology gives meaning to every single observation. But in the field of
mental abnormities, in the whole world of ideas and emotions and
volitions, he simply lacks that background. Everything seems to him
without reference to real knowledge. He feels as amateurish as if he
were to operate on the abdomen without knowing its anatomy. He is
instinctively aware that even the simplest mental life represents a
bewildering complexity and that to stimulate ideas or feelings or to
suppress emotions, to inhibit volitions, must demand always a most
subtle disentanglement of the most widely different components. He
abstains from approaching that ground at all rather than to blunder by
his ignorance of psychology. And after all, he is right. But is he right
in allowing that ignorance? Can the medical profession afford to send
into the world every year thousands of young doctors who are unable to
use some of the most effective tools of modern medicine, and tools which
do not belong to the specialist but just to the average practitioner,
simply because they have not learned any psychology?
Indeed the times seem ripe for a systematic introduction of
psychological studies into every regular medical course. It is not a
question of mental research in the psychological laboratory where
advanced work is carried on, but a solid foundation in empirical
psychology can be demanded of everyone. He ought to have as much
psychology as he has physiology. Moreover the psychological study ought
not to be confined to the normal mental life. Again we do not speak of
psychiatry. What is needed is abnormal psychology, entirely independent
of the therapeutic interests of the alienist. The mental variations
within the limits of normal life and the borderland cases ought to be
studied there as well as the complete derangements. The ideal demand
would be that the future physician should spend at least a year of his
undergraduate time on empirical psychology, especially on experimental
and physiological psychology. He would take perhaps half a year's
lecture course on the whole field of psychology as covered in the
English language by the well-known text-books of James, Wundt,
Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus,
Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the
course ought to be either advanced psychology entering into the more
complex phenomena or a practical training course in elementary
laboratory psychology as indicated for instance by Titchener's
"Experimental Psychology. A Manual of Laboratory Practice." If the
undergraduate can possibly afford the time in his college course, he
ought to add courses which either lead him towards the philosophical
problems of psychology or towards the comparative aspect of psychology.
If he can find time for a year of post-graduate work between college and
medical school, he could hardly spend it more profitably than by a year
of research in a well-conducted psychological laboratory to become
really acquainted with an independent analysis of mental states. On the
other hand in the medical school, room must be found for a course in
abnormal psychology, which of course presupposes a thorough knowledge of
normal psychology and, if possible, follows the courses on nervous
diseases and precedes the course on psychiatry.
For the average future physician, it would be wiser to omit even the
psychiatry studies than those in abnormal psychology. The latter ought
to lead him far enough to discriminate early between a mere
neurasthenia, for instance, and a beginning of insanity. As soon as the
discrimination is perfected and insanity is found, he has to give the
case out of his care anyhow and hand it over to the specialist and to
the asylum. The knowledge of psychiatric treatment is, therefore, not
essential for the average practitioner. But no one can relieve him from
the responsibility for those borderland cases, for the hysterias and
psychasthenias and neurasthenias, and he can never master them without
normal and abnormal psychology. Moreover it must not be forgotten that
mental factors may enter into every disease. The psychology of pain, for
instance, and of comfort feeling, the psychology of hunger and thirst,
of nausea and dizziness, the psychology of the sexual feelings, the
psychology of hope and fear, of confidence and discouragement, of
laziness and energy, of sincerity and cunningness play their role in
almost every sick room. And if the physician haughtily declares that he
does not care for the methods of suggestion, it might justly be asked
whether he can be a physician at all if he does not apply some
suggestions; yes, if his very entrance into the sick room does not
suggest relief and improvement from the start. The introduction of a
serious study of psychology is the most immediate need of the medical
curriculum. Instructorships in abnormal psychology must be created in
every medical school; institutes for psychotherapy should soon follow.
But in all this, there is nowhere to appear any artificial antithesis
between mind and body, any more than between organic and functional
diseases; we have discussed all that with full detail. Only the
physician who has a thorough psychological preparation can fulfill the
manifold demands which modern life must raise; he alone is prepared to
cooeperate with the other factors of the community in the development of
a sound and healthful nation, to work towards the hygiene of the nervous
system and of the mental life; and to correct the injuries which the
perversities of our civilization inflict.
In all that he will not avoid the comradeship of the clergyman. He will,
of course, not forget the fundamental difference of attitude between
them, he will not forget that the minister seeks for the meaning and
values of inner life while he, the physician, has to consider that same
inner life from a causal point of view and thus has to work with it as
with natural material for the normal functioning of the organism. But
the interrelation between them can be intimate in spite of the
difference of their standpoints. The minister, to be sure, ought not to
consider health as such as the greatest good, but he will not forget
that a wholesome devotion to ideals cannot be carried through when the
attention is absorbed by the sufferings of the body and the mental
powers are debilitated. Only in a sound mind the full ideal meanings of
life can be realized. The minister must therefore seek the health of his
congregation not because health is the ideal of life but because the
true ideals cannot be appreciated by the mental cripple. On the other
hand, the physician from his standpoint should in no way feel it his
duty to play the amateur minister and to put emphasis on the spiritual
uplifting of his patients. But he knows well that not a few of the
suggestive influences which are needed for the relief from disease are
most effective when an emotional emphasis can be given to the
suggestions and that this emphasis is for large numbers most powerfully
supplied by the religious emotion. Thus the minister will be a very
important assistant to him and the church will most successfully do for
many patients what for other patients perhaps travel or music or the
theatre, sport or social life, may do.
Just in the relation to the church, the physician will need subtlest
discrimination, and he will not forget that while even a strong
religious emotion may be without damage for a normal man, it may well be
injurious to the unstable brain. But if the physician uses tact and
wisdom, he will be surprised to find how often the religious stimulation
can indeed be helpful for his purposes and the division of labor
demands that this be supplied not by himself but by the minister. He
will advise the consulting sufferer to seek the influence of a godly man
who awakens in him upbuilding wholesome emotions and volitions. The
minister may in this way very well become the assistant of the
physician. But whether this cooeperation is looked on from the one or
from the other point of view, in every case it needs absolute clearness.
Nothing is gained and too much is lost if the two functions are
carelessly mixed together. It is never the task of the minister to heal
a mind and never the task of a physician to uplift a mind. One moves in
the purposive sphere, the other in the causal sphere. Their friendship
can seriously endure only as long as they remain conscious of the fact
that they have two entirely different functions in the service of
mankind.
XIV
PSYCHOTHERAPY AND THE COMMUNITY