Psychotherapy

The chilly stage in malaria is a typical example of a physical condition having an effect upon sensory nerves that more or less necessarily produces a delusion. The patient is actually at the height of his fever when the chilliness and shivering come on and when he demands a larger amount of covers in order to protect himself from the cold he will often have a temperature of 104 degrees Fahrenheit, or even higher. What has happened is that the little blood vessels at the surface of the body are shut up by the effect of the plasmodium upon the system. Whenever we are cold these little blood vessels shut up in order to protect the blood from being chilled by the external atmosphere. The shutting up of the little blood vessels deprives, for the time being, the terminal nerves in the neighborhood of some of their nourishment. Their response is to set up a tremor or shivering, which will mechanically tend to open the blood vessels so that they may have their nourishment once more. Whenever we have a set of sensations that correspond to this connected set of events, we translate them as feeling cold. The outer air does feel cold to the body because the blood is not flowing through to the surface as it would normally in order to warm it. Hence the chilliness. This is not an hallucination; but an illusion with something of a delusion in it; until we know how things are. Nervousness may set our teeth chattering just as it may cause tremor through our sympathetic nervous system, disturbing the flow of blood through muscles and so disturbing control of them. Vehement emotion, anger, fright, and even those of less violence may cause similar effects. All these phenomena illustrate the close relation between mind and body.

APPENDIX II

RELIGION AND PSYCHOTHERAPY

Religion and psychotherapy have, of late, come to have many relations to each other and many interests in common, at least in the minds of a number of clergymen, and in popular estimation. There is no doubt but that religion can do much to soothe troubled men and women, even when their troubles are entirely physical in nature and origin. It at least lessens the unfavorable effect of worry in exaggerating such pathological processes as are at work. All diseases, functional and organic, are rendered worse by solicitude, while many troublesome symptoms become quite bearable if only the patient does not dwell on them too much but takes them as they come, carefully refraining from emphasizing them by over-attention. That is the very essence of psychotherapy. Religion, in the sense of trust in divine wisdom, can do much to originate and maintain this imperturbed frame of mind. People who are without religion, that is, without the feeling that somehow all their ills are a part of the great plan of the universe, the mystery of which is insoluble, but the recognition of which is demanded by reason, and who lack the assurance that somehow, in Browning's phrase:

  "God's in His Heaven-  All's right with the world!"

—are more prone to give way to over-anxiety and consequently to make themselves suffer more in all their ills, than is necessary or even likely in the more favorable state of mind of those whose trust in Providence is thorough and efficient.

In recent years there has been in the general population a distinct loss of faith in the great religious truths that are so helpful in engendering a peaceful state of mind in suffering. Many have come, if not to doubt of the Providence of the Creator, at least to feel that we do not know enough about it to place any such supreme dependence on it in the trials of life as would make it a source of relief, or at least consolation, in suffering. This same spirit of doubt has paralyzed faith in the hereafter and in all that trust in it brings, to sufferers, of consolation to come for their ills if these are borne as becomes rational creatures whose suffering has a purpose, though we may not comprehend it. Some people are destined by their physical make-up or by accidental conditions to considerable suffering. There are many ailments that are incurable and are definitely known to be incurable. Some of these entail great suffering of body and even more suffering of mind. Such suffering becomes quite unbearable unless the patient is of a very stoic disposition, or unless the thought of a hereafter in which the sufferings of this life will have a meaning is present to console.

Great scientists in the midst of all our advance in science—one need but mention here such men as Lord Kelvin, Clerk Maxwell, Johann Müller, Laennec, Pasteur, Claude Bernard, though the number might easily be multiplied—have insisted that the existence of a Creator is absolutely demanded by what we know of the physical universe. "Science demonstrates the existence of a Creator," is Lord Kelvin's expression. The existence of a Creator implies, also, the existence of laws made by Him, by which His universe is regulated in every detail, nothing being left to chance. Chance is indeed only a term which indicates that we do not know the causes at work. If somehow the Creator's power has been sufficient to bring the manifold things of the universe into existence according to a plan in which there is no such interference with one another as would cause serious disturbance of the universal order around us, then He can be trusted also to care for even the minutest details of creation and of human life.

In the gradual disintegration of the religious sense which has come as a consequence of certain materialistic tendencies in nineteenth century education and science, these religious sources of consolation have been shut off from a great many people. They have come to the feeling of being portions of a machine that moves hopelessly on, somehow, on the old principle, "The mills of the gods grind slow, but they grind exceeding fine." The sufferings of humanity then, are, for these people, only a portion of a great universe of suffering that is constantly going on but for which they can see no reason and no purpose. Lucretius's lines which make human sufferings the butt of the jokes of the gods who look gleefully on from their Elysian happiness, would represent the feelings of these doubters better than any religious expression. We have come back in this age, when evolution has so much influenced the thought of the time, after the curious cyclic fashion in which human thought repeats itself from era to era, to the attitude of mind of the old Roman poet who almost singly among his contemporaries, had been deeply affected by the same doctrine of evolution. The pessimism he was prone to as to the significance of human life has become once more the fashion.

Such pessimistic thoughts do not come, as a rule, while people are in good health, but they assert themselves with double emphasis in moments of trial and suffering. Lucretius himself is said to have committed suicide. The result of the diffusion of this materialistic pessimism in our time has been a gradual preparation for a revulsion of feeling in many minds. One manifestation of this reaction has been seen in a form of religion which denies entirely the existence of evil. God the Creator is good and therefore there can be no evil in His world. Whatever of evil there is, is only due to man's failure to see the entirety of things. Evil is an error of mortal mind—only that and nothing more. In spite of the manifest absurdity of the underlying principle, if people can only be brought to persuade themselves that there is no such thing as evil or suffering, then many of their discomforts disappear, all of their symptoms grow less and a sense of well-being results. It is, indeed, surprising how many even physical ills will be relieved by this state of mind if sincerely accepted. It is the highest possible tribute to psychotherapy and the curative influence of mind over body.

Another phase of this revulsion of feeling has been the institution of a church movement that would make sufferers realize once more all the consolations there are in religion. The sufferer is brought to a renewed lively sense of the presence of the Creator in the universe and of His care for His creatures. The great purpose of suffering in making people better and stripping them of their meanness and selfishness is brought out. Anyone who has ever had called to his attention the difference between two brothers, one of whom has been chastened by suffering above which he has risen by character development, and another who has enjoyed good health and prosperity all his life, will realize how much of good suffering means in the world. Pain is not in itself an evil, but a warning, and most of the trials of life can rather readily be shown to partake of this character. A man who can be made to submit himself, then, to the will of the Creator and be persuaded to acknowledge that somehow we must try to work out our part in the great scheme of things behind which the Creator stands, is somewhat like the soldier ready even when tired and worn out, to go in on a forlorn hope, because he has confidence that he is executing a part of the plan of his general for his country's welfare, though he does not know how, and he is quite well aware that it is going to cost him much in pain and suffering, and perhaps his life.

There is no doubt that an abiding sense of religion does much for people in the midst of their ailments and, above all, keeps them from developing those symptoms due to nervous worry and solicitude which so often are more annoying to the patient than the actual sufferings he or she may have to bear. While religion is often said to predispose to certain mental troubles, it is now well appreciated by psychiatrists that it is not religion that has the tendency to disturb the mind, but a disequilibrated mind has a tendency to exaggerate out of all reason its interests in anything that it takes up seriously. Whether the object of the attention be business, or pleasure, or sexuality, or religion, the unbalanced mind pays too much attention to it, becomes too exclusively occupied with it, and this over-indulgence helps to form a vicious circle of unfavorable influence. While many people in their insanity, then, show exaggerated interest in religion, this is only like other exaggerated interests of the disequilibrated, and religion itself is not the cause but only a coincidence in the matter.

Clouston, in his book on "Unsoundness of Mind" (Methuen, London, 1911), put this very well when he said, "It is true that religion, touching as it does, in the most intense way the emotional nature, and the spiritual instincts of mankind, sometimes appears to cause and is often mixed up with insanity. But in nearly all such cases the brain of the individual was originally unstable, specially emotional, over-sensitive, hyperconscientious, and often somewhat weak in the intellectual and inhibitory faculties and, if looked for, other causes will usually be found." He had said just before, "To talk of 'religious insanity' as if it were a definite and definable form is in my judgment a mistake."

On the contrary, there is now a growing conviction that a deep religious feeling, a sense of dependence on and trust in the Almighty, will do more than anything else to keep people from those neurotic manifestations which so often are seen in our day and are growing more and more frequent as life becomes more strenuous and more attention is paid to the material side of things, to the exclusion of the spiritual. How true this is may be judged from expressions that have been used in recent years by well-known specialists in nervous diseases and in psychology. These have included men who were often not believers in religion themselves but who recognized its influence for good for others. Such expressions are to be found in the writings of men of every nationality. Not infrequently, in spite of their own religious affiliation, they acknowledge what a profound influence certain forms of religion have over people. These testimonies have been multiplying in our medical literature in recent years, because apparently physicians have come to appreciate much better by contrast the influence for good of religion over some of their patients, since so many of the sufferers from nervous diseases they see have not this source of consolation to recur to.

In America we have a number of such testimonies. In his "Self Help for Nervous Women" Dr. John K. Mitchell of Philadelphia, who may be taken to represent in this matter the Philadelphia School of Neurologists, to which his father has lent such distinction, said:

It is certainly true that considering as examples two such widely separated forms of religious belief as the Orthodox Jews and the strict Roman Catholics, one does not see as many patients from them as from their numbers might be expected, especially when it is remembered that Jews as a whole are very nervous people and that the Roman Church includes in this country among its members numbers of the most emotional race in the world.

Of only one sect can I recall no example. It is not in my memory that a professing Quaker ever came into my hands to be treated for nervousness. If the opinion I have already stated so often is correct, namely that want of control of the emotions and the over-expression of the feelings are prime causes of nervousness, then the fact that discipline of the emotions is a lesson early and constantly taught by the Friends, would help to account for the infrequency of this disorder among them and adds emphasis to the belief in such a causation.

Prof. Münsterberg, who may be fairly taken to represent the German school, but whose long years of residence in America have made him a cosmopolitan, is quite as positive in his declaration of the place that religion may hold in making human suffering less. In his "Psychotherapy" he devotes considerable attention to the subject. The religious discipline, that is, the training of human beings from their earliest years to recognize that there is a higher law than their own feelings and that they must suppress many of their desires and take evil as it comes as a portion of human life, is of itself, he insists, an excellent preparation to enable the individual to bear up under the physical and mental trials of life and to make many symptoms that would otherwise be almost intolerable, quite bearable. It is from earliest years that this training must make itself felt, and Prof. Münsterberg insists that from early childhood the self-control has to be strong and the child has to learn from the beginning to know the limits to the gratification of his desires and to abstain from reckless self-indulgence. A good conscience, he says, a congenial home and a serious purpose, are, after all, the safest conditions for a healthy man, and the community does effective work in preventive psychotherapy whenever it facilitates the securing of these factors.

Self-denial has always been one of the main elements of religious training, and indeed was declared a chief source of merit for the hereafter. The modern psychotherapeutist, however, preaches self-denial almost as strenuously as the religious minister of the olden time, only now not for any religious merit or reward, but because it makes life more pleasant and by that much happier. When men and women have learned to deny themselves in their younger years, it is not hard to stand even pain when they grow older, and pain is inevitable in every human life and the training to stand it is therefore worth while. Pain borne with equanimity is lessened by one-half if not in its intensity then at least in its power to disturb, and since religion will do this it possesses an important remedial value. Here is where religion is particularly valuable and the passing of it from many minds has thrown them back on themselves and left them without profound interests, so that they occupy themselves overmuch with the trivial incidents of life within them and disturb the course of many of their functions by giving exaggerated thought to them. Religion adds a great purpose to life and such a purpose keeps men and women to a great extent from being disturbed about trifles.

Of course, it would be too bad if religion should do no more than this. This, however, is the only phase of it with which we are concerned here. We may think very strongly with Prof. Münsterberg, that it would be quite wrong to assign to it only this place in life. He says: "The meaning of religion in life is entirely too deep that it should be employed merely for the purpose of lessening the pains and aches of humanity and the dreads that are so often more imaginary than real." He insists that "It cheapens religion by putting the accent of its meaning in life on personal comfort and absence of pain." He adds, "If there is one power in 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." Present-day movements, however, tend to subordinate religion to this-worldliness rather than to other-worldliness, and by just that much they take out of religion its real significance. We are here on trial for another world is the thought that in the past strengthened men to bear all manner of ills, if not with equanimity, at least without exaggerated reaction. It has still the power to do so for all those who accept it simply and sincerely.

1

"AEquanimitas and Other Addresses."

2

London, 1901.

3

"Die Psychische Krankenbehandlung im Ihren Wissenschaftlichen Grundlagen." Berlin 1910.

4

Houghton, Mifflin Co., Boston.

5

"See pointed metals, blest with power t' appeaseThe ruthless rage of merciless disease,O'er the frail part a subtle fluid pour,Drenched with the invisible galvanic shower,Till the arthritic staff and crutch foregoAnd leap exulting like the bounding roe!"

6

"Mesmer and Perkins's Tractors,"

International Clinics , Vol. III, Series 19. 1909.

7

Compare the first effects of the Leyden Jar, related in the chapter on Pseudo-Science.

8

Houghton Mifflin Co., Boston.

9

A king of Italy of the later nineteenth century used to send the parings of his toe-nails to friends to be worn in rings for luck and protection against disease.

10

Small, Maynard & Co.. Boston, 1909.

11

Paris, Maloine, 1804.

12

American Magazine , Sept., 1908.

13

McClurg, Chicago, 1903.

14

This article is a translation made by the author shortly after a visit to Ramon y Cajal in Madrid, in 1900. See International Clinics, Phila., Vol. II Series Eleventh.

15

International Clinics , Vol II, Series 11.

16

A number of poetic products of dreams are in our literature, some of them interesting for more than their curious origin. Dr. S. Weir Mitchell, in his latest volume of poems, "The Comfort of the Hills," made an interesting contribution to the psychology of dreams by publishing two poems which were composed by him while asleep. The little poem, "Which?" has all the curious alliterativeness and frequent rhyme that is so likely to be noted in expressions that come during sleep, or just as we awake. The other is more like a somnambulistic effort. What we might suggest here is that the habit of poetizing during sleep would surely be dangerous to any one less eminently sane than their author. We give them as curious examples that will interest patients who complain that their dreams are too vivid.

17

"Louis Agassiz, His Life and Correspondence," edited by Elizabeth Cary Agassiz, Houghton, Mifflin and Co., 1885.

18

The story of Hans, the calculating horse, shows that even animals usually thought rather dull-witted may catch muscle movements so slight as to be scarcely visible to any but one looking particularly for them.

19

"Hypnotism. Its History, Practice and Theory," by J. M. Bramwell, 2nd edn. London, The De la More Press, 1906.

20

Philadelphia, Lippincott, 1909.

21

"Curiosities of Lead Poisoning," International Clinics, Eighth Series, Vol. II.

22

British Medical Journal , January 18, 1896.

23

Lippincott & Co., Phila., Vol. IV, 8th series, 1899.

24

English translation by Dr. Smith Ely Jelliffe. New York, 1909.

25

"New Psychology," by J. P. Gordy, New York, 1898.

26

Those who are interested in fossil words will find many curious confirmations of the connection between weight and good health and good humor. A typical illustration is the word buxom, derived from the German biegsam, which means "ready to obey," from the original significance of being ready to bend, that is bendsome. In our day it has come to have quite a material rather than an ethical significance. A buxom woman is one who is round and full of form and while she usually also is cheerful and tractable, the two ideas are not necessarily connected. It is curious that what was originally the obedient wife should now have become the stout and healthy wife, as if stoutness and healthiness were somehow inseparably connected with the preceding idea so that gradually one portion of the meaning was lost sight of and now only the physical significance remains.

27

"Diseases of the Heart," by James MacKenzie, M. D., 1910, Oxford Medical Publications.

28

The Medical News , November 10, 1900.

29

Frowde, Oxford Univ. Press. 1908.

30

American Journal of Medical Sciences , 1886.

31

A case of this kind came under observation as this book was nearly ready for the press. The patient, a young woman in an office, had to refuse a vacation with a wealthy friend in Florida, because she knew that friend could not be separated from her pet cats, five in number, and the patient would have been intensely miserable were she near them, so that even the joys of Florida in the winter did not make up for the constant, intolerable discomfort they would have caused her.

32

The position here taken, that acute articular rheumatism never leaves a mark after it, is entirely due to the observation that whenever cases were seen in which sequelae were noted, there always seems to the writer to be question of something else besides simple acute articular rheumatism—a complication. Subsequent pathological investigation may show that occasionally acute articular rheumatism does to some extent disorganize joint tissues. Personally, however, I have the feeling that there are a number of different kinds of acute arthritis, probably three or four, and that most of them leave no pathological condition in the tissues. Perhaps we shall be able to differentiate the severer forms and recognize them from the beginning, as we have already done with regard to scarlatinal, gonorrheal, influenzal and other so-called rheumatisms. For practical purposes it certainly seems better to emphasize the fact that chronic rheumatism following an attack of simple acute arthritis is so rare as to be negligible.

33

On Suggestion and its Applications in Therapeutics.

34

How much deterioration of the tissues of the foot may be brought about by improper footwear and, above all, by sedentary life and the substitution of the trolley car for the exercise of walking, is well illustrated by the functions that are lost. The child can use its adductor and abductor muscles for the toes quite as well as for the fingers. Those who go barefooted retain those muscular powers. Some time we will be able to influence young folks' minds enough to keep them from sacrificing all the more delicate muscular powers of their feet to the fashion of small or curiously shaped shoes. Armless men learn to use their feet almost as hands, they write, pick up small articles, oven play musical instruments.