Chapter XIV: Part III: The Place of Psychotherapy (2)

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

Both the physician and the patient find their place in the community the life interests of which are superior to the interests of the individual. It is an unavoidable question how far from the higher point of view of the social mind the psychotherapeutic efforts should be encouraged or suppressed. Are there any conditions which suggest suspicion of or direct opposition to such curative work?

Of course society has to be sure that no possible misuse and damage are to result from such practice. Fears in that direction have been uttered repeatedly, but from very different standpoints. One which is perhaps most often heard in popular circles results from an entire misunderstanding and deserves hardly any discussion after our detailed study of the processes involved. It is claimed that suggestive power, especially in the form of hypnotization, may be secretly misused to make anyone without his knowledge and against his will a passive instrument of the hypnotist's intent. Often this is coupled with telepathic fancies. The hypnotist is believed to have mystic power to bring any person in a distant region under his mental control and thus to be able to carry out any sinister plans by the help of his innocent victim. All hypnotizing therefore ought to be interdicted by the state. The presuppositions of such a view are, as we know now, entirely absurd. We know that hypnotism is not based on any special power of the hypnotizer; there is no magnetic fluid in the sense of the old mesmerism. The imagination of the hypnotized person is the only hypnotizing agency. Thus no one can be hypnotized without his knowledge or against his will. The story of telepathic mysteries which is often brought before the public is probably always the outcome of a diseased brain. It is indeed a frequent symptom in paranoia and other insanities that the patient who feels abnormal organic sensations and abnormal unaccountable impulses interprets them as influences of a distant enemy. Whole pamphlets have been written with elaboration of such insane misinterpretations and requests to legislatures have been made in that spirit, but the physician recognizes easily throughout the whole argumentation the well-known phenomena of the mental disease.

To be sure, while no one can be hypnotized against his will, many a person is liable to accept suggestions from others and thus to carry out the wishes of others almost without knowing and certainly without willing that the other mind interfere with the interplay of the own motives. But if we were to strike out all suggestive influences from social life, we should give up social life itself. Suggestion is given wherever men come in contact; in itself it is neither good nor bad. The good resolution and the bad one can be suggested, the good example and the bad can be effective; both encouragement of the noble and imitation of the evil may work with the same mental technique. Certainly there are some persons who have a stronger influence than others on the imagination of those with whom they come in contact; their expression awakens confidence, their voice and their words reach deeper layers of the mind, their calmness and firmness overwhelm more easily the antagonistic ideas. But the chief difference lies after all in the different degrees of suggestibility among those who receive such impressions. The easily suggestible person cannot be protected by any interdict; he may catch suggestions everywhere, any advertisement in the newspaper and any display in the shop-window may overrun his own intentions. What he needs is training in firmness. The application of reenforced suggestion or even of hypnotism in the doctor's office is even for him no possible source of danger.

On a higher level are objections which come from serious quarters and which are not without sympathy with true science. In recent times this opposition has repeatedly found eloquent expression. It is an objection from the standpoint of morality, belonging therefore entirely to the purposive view of the mind, but we have now reached a point where it is our duty to do justice to this purposive view too. As long as we discussed the problem entirely from the standpoint of the physician, no other view of mental life except the causal one could be in question. As soon as we look at it from the standpoint of the community, it becomes our duty to bring the causal and the purposive view into harmony, and it would be narrow and short-sighted simply to draw the practical consequences of a naturalistic view of the mind without inquiring whether or not serious interests in the purposive sphere are injured. If there is moral criticism against suggestive therapy, it is the duty of the community to consider it. This opposition argues as follows: Hypnotic influence brings the patient under the will control of the hypnotizer and thus destroys his own freedom. Whatever the patient may reach in the altered states is reached without his own effort, while he is the passive receiver of the other man's will. His achievement has therefore no moral value, and if he is really cured of his drunkenness or of his perverse habits, of his misuse of cocaine or of his criminal tendencies, he has lost the right to be counted a moral agent. It would be better if there were more suffering in the world than that the existence of the moral will should be undermined.

No one ought to take such arguments lightly. The spirit which directs them is needed more than anything else in our time of reaching out for superficial goods. No one can insist too earnestly that life is worth living only if it serves moral duties and moral freedom and is not determined by pleasures and absence of pain only. Those who set forth this argument are entirely willing to acknowledge the profound effect which suggestive therapeutics may create. More than this, they have to acknowledge it to gain a basis for their attack. Just because the hypnotizer can entirely change the desires and passions, the habits and perversities of the suffering victim, he seems to them a moral wrongdoer who negates the principle of human freedom. A forcible book of recent days calls the suggestive power of the psychotherapist "The Great Psychological Crime." It says to the hypnotist: "By your own testimony, you stand convicted of applying a process which deprives your subjects of the inalienable right and power of individual self-control. In proportion as you deprive him of the power of self-control, you deprive him of that upon which his individual responsibility and moral status depend. In proportion as you deprive him of the free control and exercise of those powers of the soul upon which his individual responsibility and moral status depend, you thereby rob him of those powers upon which he must depend for the achievement of individual immortality."

But this censure too is entirely mistaken, not because it urges the purposive views against the causal but because it is in error as to the facts. Such critics are fully under the influence of the startling results which are reached; they do not take the trouble to examine the long and difficult way which has had to be traversed with patience and energy. It is quite true that if I hypnotize a man and suggest to him to take up after awaking the book which lies on my table, he follows my suggestion without conflict and in a certain sense without freedom. He feels a simple impulse to go to the table and lift the book and, as no stronger natural desire and no moral objection stand in the way, he carries out that meaningless impulse and perhaps even invents a foolish motive to explain to himself why he wanted to look at that book. But after a long experience, I have my doubts as to whether a man was ever cured in such a way by hypnotism of serious disturbances and of those anomalous actions which the critics want to see overcome by the patient's own moral efforts. On the contrary, every suggestion has to rely on the efforts and struggles of the patient himself and all that the psychotherapists can give him is help in his own moral fight. His own will is presupposition for being hypnotized and for realizing the suggestion. If again and again I hesitate to undertake new cases, it is just because I have to see during the treatment too much of this daily and hourly striving against overpowering impulses. The joy of removing some obstacles from the way of the patients is too much overshadowed by the deep pity and sympathy with their suffering and craving during the whole period of successive treatments. To make a man fight where despair is inevitable, and where the enemy is necessarily stronger than his own powers, can certainly not be the moral demand. Morality postulates that everyone find conditions in which he can be victorious if he puts his strongest efforts to the task.

In our discussion of the mental symptoms I reported as an illustration of the suggestive treatment of the drug passion the case of a morphinist. To make clear this purposive side of the case as against the causal one which alone interested the physician, I may add a few features to the short report as a typical example. When that man left my laboratory for the last time to go out to work and happiness, you might well have believed from his joyful face that it had been an easy and pleasant time in which hypnotic influence smoothly removed from him the dangerous desire for morphine. In truth it was the result of four months of the most noble and courageous suffering and struggling. He had been for years a slave to his passion. To quote from his little autobiography: "When I realized that I was addicted to morphine, I was at first not at all worried as I did not then understand the real horror of the thing, and did not then realize all the future suffering and misery that is coming to anyone who is the user of opium or any of its alkaloids. For the first few months, I found great relief after every injection of morphine, but soon I could not get the same easy feeling and could eat but very little and what sleep I got was in the daytime. I finally went to the sanitarium of a doctor but it was simply a money-making business for him; if he ever cured anyone, I never heard of it. I then tried another one; it was the same kind of a place as the former. When I first went to see the professor in the Harvard Psychological Laboratory, I was using between thirty-two and thirty-eight grains of morphine daily. He put me under his treatment October 6th and that day cut me down by hypnotic treatment to nine grains a day or three doses of three grains a day. I took my hypodermic as directed, but on the following day I lay on the bed too exhausted to get up even to get around the room, and I could not eat and only drank a very little water. The desire for the drug was something terrible. But in about four days I got used to the loss of so much morphine and stayed on this amount for a week, seeing the professor every other day for hypnotic treatment and then returning to my room where I spent twenty-two hours of the twenty-four on the bed, but did not sleep more than two or three hours a day. At the end of the week I was cut off by hypnotic suggestion half a grain and this put me to fighting the desire again. This lasted two or three days and then I began to feel better and began to sleep a little more. But at the end of the week I was cut off another half grain, and the whole fight would have to be begun over. These reductions of the dose were made a week apart and sometimes only two days. The worst time of all was a cut from four injections of a fourth of a grain each to four of one eighth of a grain each, which was about January 10th. At this time I had the worst two days of my life. I tried whiskey, but it gave relief only for about half an hour and then the desire was worse than ever."

In this way every few days I gave the poor fellow under hypnotic influence the suggestion to reduce the dose of morphine in a prescribed way, and with enormous effort he withstood his craving for more, in spite of the fact that he had during all this winter a bottle with a thousand tablets of morphine, prescribed by an unscrupulous physician, in his writing desk. He was thus at every moment during the day and night in full possession of the deadly poison with which he could have fully satisfied his craving. It was a moral victory when he finally reached the point at which he went for several weeks without any desire for morphine and finally presented the remaining tablets to a hospital. And yet there would not have been the least chance for his winning this ethical victory without the outer help of the hypnotist. We do not eliminate the moral will but we remove some unfair obstacles from its path. We have no mystic power by which our will simply takes hold of the other man's will, but we inhibit and suppress by influence on the imagination those abnormal impulses which resist the sound desires. If that were immoral, we should have to make up our minds that all education and training were perverted with such immoral elements. Every sound respect for authority which makes a child willing to accept the advice and maxims of his elders is just such an influence. If it were really a moral demand that the will be left to its own resources and that no outside influence come to strengthen its power or remove its hindrances or smooth its path, then we ought to let the children grow up as nature created them and ought not to try to suppress from without by discipline and training, by love and encouragement, the willful impulses and the ugly habits. Even every good model for imitation is such a suggestive influence from without and every solemn appeal to loyalty and friendship, to patriotism and religion, increases the degree of suggestibility. That is the glory of life that the suggestive power may belong to moral values instead of mere pleasures, but it is not the aim of life to remain untouched by suggestion. And he who by suggestion helps the weak mind to overcome obstacles which the strong mind can overthrow from its inborn resources works for the good of the individual and of the community in the spirit of truest morality.

Much more justified than such ethical objections are the fears which move entirely in the causal sphere. It must be acknowledged that a method which has such powerful influence over the mind that it can secure ideas and emotions and impulses which the own will of the patient cannot produce, ought to be allowed only to those who are prepared for its skillful use. To hypnotize or to perform any persistent psychotherapeutic treatment may thus be dangerous, if it is done by the unfit. We have discussed before the injuries which might result from the administration of such powerful psychotherapeutic effects through the best meaning minister, but we can extend this fear to anyone who has not systematically studied medicine and to a certain degree normal and abnormal psychology. The possibilities of overlooking symptoms which ought to suggest an entirely different treatment, or of adjusting the treatment badly to the special physical conditions, or of ignoring the desirable physical supplement by drugs, or of creating unintentionally by suggestion injurious effects, are always open when medical amateurs undertake such work. Certainly there is no physician who is not liable to make mistakes, and a physician who has never given any attention to psychology and psychiatry would also be a rather poor agent of psychotherapeutic methods, but the probability is that such a physician would simply abstain by principle from all psychotherapeutic methods; his mistake only begins if from his lack of acquaintance with the subject he draws the conclusion that the method itself is undesirable. That his real preparation ought to include psychological studies we have pointed out before, and the time seems ripe for the community to urge such a reform of the studies.

All that involves the conviction that even the experimental psychologist as such is not prepared to enter into medical treatment; and a "Psychological Clinic," managed by a psychologist who is not a doctor of medicine, is certainly not better than a church clinic. I cannot even acknowledge the right of psychologists to make hypnotic experiments merely for the psychological experiment's sake. Nobody ought to be brought into a hypnotic or otherwise abnormal state of mind if it is not suggested by the interests of the subject himself. Science has the right to make hypnotic experiments, or experiments with abnormal mental states, only under the one condition that a physician has hypnotized the subject in the interests of his health and that the patient has agreed beforehand to allow in the presence of witnesses certain psychological studies. Needless to say that any hypnotization for mere amusement and as a parlor trick ought to be considered as criminal.

On some other objections which interest the community as such we had to touch before, and there is no need of returning to them with any fullness of argument. We spoke of the danger which the mental cures carry with them when they are based on any particular creed, and especially when they are tied up with a semi-religious arbitrary metaphysics. What is gained if some nervous disorders are helped by belief, if the belief itself devastates our intellectual culture and brings the masses down again to a view of the world which has all the earmarks of barbarism? That is indeed one of the central dangers of all non-medical suggestive cures, that while any belief may cure through the mere emotional power of the act of believing, the content of the belief gains an undeserved appearance of truth. Any absurd superstition can become accredited because its curative value may be equal to a truly valuable suggestion. The intellectual life of the community would have to suffer greatly if the way to be freed from bodily suffering had to be the belief in the metaphysical doctrines of Mrs. Eddy's "Science and Health." From a cultural viewpoint, too, suggestive therapeutics must stand the higher, the more sharply it is separated from special philosophical or religious doctrines. No theory of the world and of God ought to gain authority over the mind from such an external motive as a belief in its curative effects. Freest from such implications is certainly the hypnotic method of the physician who does not need the strong religious reenforcement of the suggestion because he reenforces instead the suggestibility of the patient by slight influences on his senses.

Even where sound religion without superstition and without pseudophilosophy stands behind the therapeutic work, the community will not give up the question whether the church does not necessarily neglect by it the interests which are superior. The community becomes more and more strongly aware that too many factors of our modern society urge the church to undertake non-religious work. Social aid and charity work ought to be filled with religious spirit, but to perform it is not itself religion. Still more that is true of the healing of the sick. Whether or not such expansion of church activity in different directions saps the vital strength of religion itself is indeed a problem for the whole community. The fear suggests itself that the spiritual achievement may become hampered, that in the competition of the church with the other agencies of social life the particular church task may be pushed to the background, and that thus the church in imitating that which others can do just as well or better loses the power to do that which the church alone can do. The final outcome is therefore practically in every way the same. From whatever starting point we may come, we are led to the conviction that the physician alone is called to administer psychotherapeutic work, but that he needs a thorough psychological training besides his medical one.

But the interest of the community is not only a negative one. Society does not only ask where psychical treatment can be dangerous, but asks with not less right whether the scheme and the method might not be fructified for other social ends besides the mere healing of the sick. If psychotherapy demonstrates that for instance hypnotism makes possible the reshaping of a pathological mind, it is a natural thought to use the same power for remodeling perhaps the lazy or the intemperate, the careless or the inattentive, the dishonest or the criminal mind. Both educators and criminologists have indeed often raised such questions, and social reformers have not seldom seen there wide perspectives for social movements in future times.

There can be no doubt that the possibility of such remodeling activity is given, but as far as education is concerned certainly grave misgivings ought to be felt. When we spoke of the treatment of the sick, we had always to emphasize that the suggestion cures symptoms but not diseases. In the same way hypnotic suggestion might reenforce a single trait but would not reform the personality of the child. Yes, the artificial reenforcement of such special features would deprive education of that which is the most essential, namely, the development of the power to overcome difficulties by own energy. Wherever a reasonable amount of own will force and attention can be expected to overcome the antagonistic influence, there artificial hypnotic influence ought to be avoided. Everything ought to be left in that case to suggestions within normal limits, in the form of good example and persuasions, authority and discipline, love and sympathy. That holds true even for very slight abnormalities which seem still within the limits where the own energies can bring about the cure. For instance, I have steadily refused requests of students and others to use hypnotism for the purpose of overcoming merely bad habits, such as the habit of biting the nails. A child who finds some difficulty in sticking seriously to his tasks might learn now this and now that under the influence of hypnotic suggestions but he would remain entirely untrained for mastering the next lesson. In the same way some naughty traits might be artificially removed but the child would not gain anything towards the much more important power of suppressing an ugly tendency by his own effort. All that finds its limits where the inhibitions or obstacles in the brain of the child are too strong possibly to be overcome by the own good will, but in that case we already stand in the field of abnormal mental life and then of course psychotherapy has its right. The feeble-minded and the retarded child, the perverse child and the emotionally unstable child, belong under the care of the physician, and in such a case he ought not to hesitate to use the whole supply of psychotherapeutic methods which are at his disposal.

Still more complex is the criminological problem. It sounds like an easy remedy for the greatest social calamity, if it is proposed simply to hypnotize the criminal and to supplant his antisocial will by a moral one. And if the absurdity of such a proposal is recognized it seems to many justified to demand such an intrusion at least in the case of the born criminal, even if the occasional criminal cannot be reached. But the conception of the born criminal is also only a label which is superficially used for a great variety of minds. That men are born with a brain which necessarily produces criminal actions is not indicated by any facts. The varieties which nature really produces are brains which are more liable than others to produce antisocial actions. We recognized from the start that the abnormal mind never introduces any new elements but is characterized only by a change of proportions. There is too much or too little of a certain mental process and just for that reason there must be a steady and continuous transition from the normal to the entirely abnormal. Here again we have not a special class of brains which are criminal; but we have an endless variety of brains with a greater or smaller predisposition for antisocial outbreaks. The variations which produce this criminal effect may lie in most different directions.

The brain may be for instance inclined to overstrong impulses, so that any desire rushes to action before the inhibiting counter-idea gets to work. Or, on the other hand, the brain may have unusually weak counter-ideas so that even a normal impulse does not find its normal checking. The fact that selfish and thus antisocial desires awake in the mind is not abnormal at all; only if they are not normally inhibited, the disturbance sets in. Furthermore the associative apparatus of the brain may work especially slowly; it may thus bring it about that the counteracting ideas do not arise in time. Or the emotions of a person may be unusually strong. Or there may be strong suggestibility, by which a bad example or a strong temptation has especially easy access. Or there may be negative suggestibility, by which a moral admonition stirs up a vivid idea of the opposite. In short, there may be a large number of factors, sometimes even in combination, each one of which increases the chances that the individual may come in danger in the midst of developed society. Yet no one of those factors involves just the necessity of crime. The same kinds of brains might simply show stupidity or credulity or inconsiderateness or brutality or stubbornness or egotism, and might by each of those factors decrease their chances in the community without directly running into conflict with the law. The criminal is therefore never born as such. He is only born with a brain which is in some directions inefficient and which thus, under certain unfavorable conditions, will more easily come to criminal deeds than the normal brain.

With the idea of a stereotyped born criminal there disappears also the idea of a uniform treatment against criminal tendencies. That men are different in their power of resistance or in their power of efficiency or in their intellect or in their emotions, we have to accept as the fundamental condition with which every society starts. It would be absurd to remodel them artificially after a pattern. The result would be without value anyhow, inasmuch as our appreciation is relative. No character is perfect. The more the differences were reduced, the more we should become sensitive even for the smaller variations. All that society can do is, therefore, not to remodel the manifoldness of brains, but to shape the conditions of life in such a way that the weak and unstable brains also have a greater chance to live their lives without conflicts with the community.

The situation is different as soon as the particular surroundings have brought it about that such a brain with reduced powers has entered a criminal career. The thought of crime now becomes a sort of obsession or rather an autosuggestion. The way to this idea has become a path of least resistance, and as soon as such an unfortunate situation has settled itself, the chances are overwhelming that a criminal career has been started. If such cases should come early to suggestive treatment which really would close the channels of the antisocial autosuggestion, much harm might be averted. Yet again the liability of the brain to become antisocial would not have been removed, and thus not much would be secured unless such a person after the treatment could be kept under favorable conditions. With young boys who through unfortunate influence have caught a tendency, for instance, to steal, and where the fault does not yield to sympathetic reasoning and to punishment, an early hypnotic treatment might certainly be tried. I myself have seen promising results. But if the impulse has irresistible character in such a way that the good will is powerless, we are again in the field of disease and the point of view of the physician has to be substituted for that of the criminologist.