Psychotherapy And Modern Medicine





Paracelsus.--Paracelsus, the great physician of the first half of the

sixteenth century, who may well be considered the father of modern

pharmaceutics, had no illusions with regard to the exclusive power of

drugs over disease. He recognized that mental influence was extremely

important, and often lent a power not otherwise possessed to many

remedies. He said:



Imagination and faith can cause and remove diseases. Confidence in

the virtue of amulets is the whole secret of their efficacy. It is

from faith that imagination draws its power. Anyone who believes in

the secret resources of Nature receives from Nature according to his

own faith; let the object of your faith be real or imaginary, you

will in an equal degree obtain the same results.



Personal magnetism, in the sense in which we now use it, a

transference of the idea from the science of magnetics as related to

the phenomena of the magnet, seems to have originated with Paracelsus.

He was sure that the influence exerted over certain patients by

certain physicians was due to a force very like that exerted by the

magnet over iron. He was even inclined to think that magnets

themselves might exert a strong potency over diseased conditions, and

he found them to be useful in epilepsy. Doubtless in many cases of

supposed epilepsy successfully treated the ailment was really of an

hysterical nature. In these cases the strong suggestion which the use

of the magnets gave for many centuries acted favorably.





Agrippa.--The writings of Cornelius Agrippa, a contemporary of

Paracelsus, and, like him, a student of alchemy and of the secrets of

nature, contain corresponding passages which serve to show how much of

interest there was in mental influence during the Renaissance. All of

these men were, of course, a little outside of the ordinary medical

tradition, intent on getting to realities, not being satisfied either

with words or assumptions, refusing to accept many thing that the

physicians of their time completely credited. Agrippa in a

characteristic passage said:



Our mind doth effect divers things by faith (which is a firm

adhesion, a fixed intention, and a vehement application of the

worker or receiver) in him that cooperates in anything, and gives

power to the work which we intend to do. So that there is made in

us, as it were, the image of the virtue to be received, and the

thing to be done in us, or by us. We must, therefore, in every work

and application of things, affect vehemently, imagine, hope and

believe strongly, for that will be a great help.





Van Helmont.--At the end of the sixteenth century Van Helmont, who

carried on the work in pharmaceutics begun by Paracelsus, and to whom

we owe the discovery of a number of substances commonly used, as well

as the invention of the word "gas," was a thorough believer in the

influence of mind over body and, indeed, in the existence in human

beings of storehouses of latent energy ordinarily unemployed, but

that might under special circumstances be tapped to produce wonderful

effects. Indeed, some passages remind us of Prof. James' expressions

in his discussion of the law of human energy. Van Helmont said:



All magical power lies dormant in man, and requires to be excited.

(Compare Prof. James's "Law of Mental Energy" in the chapter on

Mental Influence). This (need for excitation) is particularly the

case if the subject upon whom we wish to operate is not in the

most favorable disposition; if his internal imagination does not

abandon itself entirely to the impression we wish to make upon him;

or if he towards whom the action is directed possesses more energy

than he who operates. But when the patient is well disposed or

weak, he readily yields to the magnetic influence of him who

operates upon him through the medium of his imagination. In order to

operate powerfully, it is necessary to employ some medium; but this

medium is nothing unless accompanied by internal action.





Sydenham.--In the more modern period the deliberate use of the

influence of the mind on the body is quite as clear. Undoubtedly the

greatest of modern physicians, who well deserves the name of the

English Hippocrates, is Sydenham. How much Sydenham realized that many

of his patients' ailments could only be cured by occupying their minds

with other things is seen in his writings. There is a characteristic

story told by Dr. Paris in his "Pharmacologia" which illustrates this

well and is a striking anticipation of what we are prone to think of

as very modern views in these matters:



This great physician, Sydenham, having long attended a gentleman of

fortune with little or no advantage, frankly avowed his inability to

render him any further service, at the same time adding, that there

was a physician of the name of Robertson, at Inverness, who had

distinguished himself by the performance of many remarkable cures of

the same complaint as that under which his patient labored, and

expressing a conviction that, if he applied to him, he would come

back cured. This was too encouraging a proposal to be rejected; the

gentleman received from Sydenham a statement of his case, with the

necessary letter of introduction, and proceeded without delay to the

place in question. On arriving at Inverness, and anxiously inquiring

for the residence of Dr. Robertson, he found, to his utter dismay

and disappointment, that there was no physician of that name, nor

ever had been in the memory of any person there. The gentleman

returned, vowing eternal hostility to the peace of Sydenham, and on

his arrival, at home indignantly expressed his indignation at having

been sent on a journey of so many hundred miles for no purpose.

"Well," replied Sydenham, "are you better in health?" "Yes, I am now

quite well; but no thanks to you." "No," says Sydenham, "but you may

thank Dr. Robertson for curing you. I wished to send you on a

journey with some object of interest in view; I knew it would be of

service to you: in going, you had Dr. Robertson and his wonderful

cures in contemplation; and in returning, you were equally engaged

in thinking of scolding me."





Morgagni.--In the century following Sydenham we have a number of

examples cited by Morgagni, the father of pathology, in which his

recognition of the value of the mind as a curative agent and of the

harm that may be done by over-occupation of the mind is set forth at

its proper value. Benjamin Ward Richardson in his "Disciples of

AEsculapius" [Footnote 2] tells of two incidents in which this phase

of Morgagni's very practical application of knowledge to medical

practice is exemplified:



[Footnote 2: London, 1901]

In other examples, where the symptoms are due to mental oppression,

he pursued a course of treatment that was of soothing nature. A

distinguished professor of physic at Bologna happened to discover

that his pulse was intermittent, and being extremely anxious about

it was incessantly feeling his pulse, to discover that the evil was

daily increasing. Morgagni's advice to his patient was to take his

finger off his wrist and not to inquire too anxiously about his

condition. The advice was followed, and the result was a complete

removal of the disturbance.



It is a very singular truth that in describing the action of the

nervous system on the circulation Morgagni shows that he was

cognizant of the fact that the circulation may be disturbed by two

sets of nervous irritations, one inflicted through the

pneumogastrics, the other "through those nerves which are

subservient to the arteries"--the vaso-motor system which is readily

disturbed by the mind. In one patient he observed great

perturbations of the pulse in both wrists as the result of mental

anxiety. But a day or two later the pulse derangement was confined

to the left side altogether. The pulse of the right arm was quite

regular, while that of the left arm still showed the inequality.

When the mental distress was relieved, this pulse also became equal.



Morgagni cites Sydenham's contemporary, Lancisi, the great Italian

physician, as recognizing the influence of the emotions on the heart.

Examples of similar convictions as to mental influence in medicine are

also found in the works of Morgagni's great contemporaries, Boerhaave

and Van Swieten, and the great physicians of the seventeenth and

eighteenth centuries were closely imitated in their recognition of the

value of the influence of mind over body in medicine by their

successors in the profession.





John Hunter.--Wise old John Hunter recognized the influence of the

mind on the body very clearly. He said, for instance, "There is not a

natural action in the body, whether voluntary or involuntary, that may

not be influenced by the peculiar state of mind at the time." He lays

it down as a law that "every part of the body sympathizes with the

mind, for whatever affects the mind, the body is affected in

proportion." He said further, "as a state of the mind is capable of

producing a disease, another state of it may affect a cure." He called

attention to the fact that the touch of a corpse produced wonderful

effects upon the minds of patients. He said, "Even tumors have yielded

to the stroke of a dead man's hand." He observes that "while we should

naturally expect that diseases connected with the nerves--and those in

which their alteration is in the action of parts not in their

structure--would be most affected by the imagination, we find that

there are other diseases in which they appear to have little

connection that are much affected by the state of mind."





German Mind Healing.--In his monograph on "Psychotherapy in Its

Scientific Aspects" [Footnote 3] Dr. Berthold Kern calls attention to

a forgotten book of the German physician Scheidemantel, published in

1787. Its title was "The Emotions as Remedies." It seems to be very

rare since even our Surgeon General's Library has no copy of it. The

author treated psychotherapy systematically. He insisted that man was

a unit in which body and soul mutually influenced each other.

Scheidemantel blamed the moralists for considering the soul

exclusively and the physicians for thinking only of the body. He

thought that this was a serious mistake for both sides and he seems to

have anticipated much of our recent discussion on the influence of the

body and of things physical generally in what is called crime and

various divagations from law. On the other hand, he thought that the

influence of the mind on the body was one of the most important

elements in therapeutics.



[Footnote 3: "Die Psychische Krankenbehandlung im Ihren

Wissenschaftlichen Grundlagen." Berlin 1910.]



Reil, after whom the Island of Reil is named, and who taught us much

with regard to brain anatomy, was also interested in the influence of

mind on body. He was the professor of anatomy at Berlin in the early

part of the nineteenth century and had great influence over the

medical science of the time. He insisted on the recognition and

development of psychotherapy and hoped to give it a place beside the

medical and surgical treatment of human ills. He did much to create a

current of thought in German medicine which culminated in Johann

Mueller's very definite expressions with regard to the power of the

mind over the body.



Very probably the most striking expression of the influence of mind

upon body is in that wonderful old book, Johann Mueller's text-book of

physiology, issued in an English edition (London, 1842) under the

title "Elements of Physiology." The subject, a favorite study, is set

forth very clearly, and evidently from personal knowledge. He

recognized that the mind might influence every organ and function of

the body. The influence of expectancy he emphasized particularly:



The influence of ideas upon the body gives rise to a very great

variety of phenomena which border on the marvelous. It may be stated

as a general fact that any state of the body, which is conceived to

be approaching and which is expected with perfect confidence and

certainty of its occurrence, will be very prone to ensue as the mere

result of that idea, if it do not lie without the bounds of

possibility. The case mentioned by Pictet, in his observations on

nitrous oxide, may be adduced as an illustration of such phenomena.

A young lady, Miss B., wished to inspire this intoxicating gas; but

in order to test the power of the imagination, common atmospheric

air was given to her, instead of the nitrous oxide. She had scarcely

taken two or three inspirations of it, when she fell into a state of

syncope, which she had never suffered previously; she soon

recovered. The influence of the ideas, when they are combined with a

state of emotion, generally extends in all directions, affecting the

senses, motions and secretions. But even simple ideas, unattended

with a disturbed state of the passions, produce most marked organic

effects in the body.



With regard to the influence of the mind over the body in the matter

of fatigue Mueller is especially emphatic. He states just as clearly

two generations ago the Law of Reserve Energy as James stated it in

recent years. Of course, Mueller was far beyond his time in everything,

but then men who really think always are, and even Mueller's accurate

expression only represents what had been in the minds of thinking men

in many previous generations. He says:



The idea of our own strength gives added strength to our movements.

A person who is confident of effecting anything by muscular efforts,

will do it more easily than one not so confident in his own power.

The idea that a change is certainly about to take place in the

actions of the nervous system, may produce such a change in the

nervous energy, that exertions hitherto impossible become possible.

This is still more likely to be the case, if the individual is at

the time in a state of mental emotion.



Even this necessarily fragmentary and rather disjointed sketch of the

main features of psychotherapeutics, as we see them recognized by the

great physicians of the past, serve to show that mental influence

has always been appreciated as an important element in the care of the

individual patient.



The times when special attention has been paid to psychotherapy have

certain special characteristics. Usually the periods have come just

after a signal advance in medicine made through devotion to physical

science. Great attention is given to the advances and for a time the

individual patient is forgotten in the hope that at last physical

science is going to solve the problems of the physical man. With the

disappointment that always follows there is a reversion of feeling and

men realize once more how important is the mental state of the

patient, even in physical diseases. Then there comes an emphatic

expression of the value of psychotherapy. We are at present in the

midst of one of these periods, hence the widespread interest in the

subject.





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