PSYCHOTHERAPY
551
PSYCHOTHERAPY
worn in the front and back of the chest — these are
modern examples of superstitious practices.
Special Psychotherapeutics. — Ordinarily, it is presumed that psychotherapy is only efficient in affec- tions that are due to mental persuasions, so-called imag- inary diseases, and that it cannot benefit organic affec- tions. In recent years, however, abundant proof has been forthcoming that favourable influence upon the mind can modify even very serious physical conditions. It is not unusual for a cancer patient who has lost some twenty or thirty pounds in weight to regain this and more after an exploratory incision which has shown the condition to be inoperable. The patient, to save solicitude, is given to understand that now he ought to get better and he proceeds to do so. In one such case a gain of seventy pounds was recorded. The patient eventually died of cancer", but there had been months of strength and efficiency that would not otherwise have been secured. There are affections, too, in which unfavourable mental persuasion produces serious physical changes that may even prove fatal if any other cause intervenes. It is now very well known that a great many cases' of so-called dyspep- sia are really due to over-solicitude about food and the elimination from the diet of so many articles supposed to be indigestible that the patient's nutri- tion is seriously interfered with. Occupation of mind with the stomach is particularly likely to interfere with its activity. Certain thoughts bring a sense of nausea. DeUcate people may reject a meal if they are reminded of something nauseating, or if a particular smell or some untoward incident disturbs them. Food eaten with rehsh and in process of satisfactory digestion may be rejected if something deterrent is heard in reference to its origin or mode of preparation, and rejection occurs whether the disgusting statement be true or false. A conviction that certain articles of food will disagree with us is almost sure to make them difficult of digestion: a great many people are quite sure that they cannot digest milk or eggs, but prove thoroughly capable of digesting those articles of diet without difficulty when, as in tuberculosis sanatoria, they are required to take them regularly.
Heart and Mental Influence. — The heart might be presumed free from the influence of the mind, because of its great importance. It is probably through this organ, however, that most of the favourable and unfavourable influence of the mind on the body is exerted. The heart begins to beat in the embryo long before the nervous system is formed, but it very soon comes to have the most intimate relations with the nervous system. In excitement and joy the heart beats fast; in fright and depression it beats slowly; and any vehement emotion seriously affects its action. This is true in health, but is particularly true in disease of the heart itself. Sufferers from heart-disease die from joy as well as from fright. The state of mind may influence the heart favourably or unfavourably in the course of disease, and the physician must recog- nize this and use his understanding of it to good pur- pose. Many of our heart remedies are rather slow to act, taking twelve hours or more for theii- effect. An hour or two after the ^^sit of a physician, however, most heart patients will be ever so much better than they were before, and their improvement may be at- tributed to the physician's remedies, though it is only due to confidence aroused by his presence and the feeling of relief afforded by his careful examination and assurance that there is no danger. By the time this feeling would begin to lose its effect, his remedies take hold and the patient continues to improve.
Great physicians have at all times recognized the strong influence that the mind has over the heart. Lancisi [De subit. morte, I (Geneva, 1718), xix, §3] tells of cases in which over-solicitude about the heart was the cause of the symptoms. Morgagni, in "The Seats and Causes of Diseases", I (London, 1769), Let-
ter xxiv, tells of a physician who, from worrying about
his heart, caused it to miss beats. Sydenham and Boer-
haave both note the unfavourable effect which the mind
may have on the heart [Brown, "Academical Lectures",
VI (London, 1757)]. In our own times Oppenheim
("Letters to Nervous Patients", tr. Edinburgh, 1907)
tells one patient that whenever he feels the pulse, the
patient being conscious of it, beats are missed; when-
ever he feels it without advertence on the part of the
patient, it is quite regular in its actions. He insists
that the heart resents surveillance, "which not only
accelerates, but may even inhibit its action and render
it irregular". He adds: "And so it is with all the
organs of the body which act spontaneously; they get
out of order and become functionally defective, if,
as the result of the attention and self-observation
directed towards them, impulses flow to them from
the centres of consciousness and will in the same way
as they flow to the organs [e. g. the muscles) which
are normally under the control of the will." Prof.
Broadbent, whose experience with heart disease was
perhaps the greatest in our generation, frequently
dwells, in "The Action of the Heart" ("The Writings
of Sir Wm. Broadbent", Oxford, 1910), on the neces-
sity for setting the mind at rest. MacKenzie, whose
work on the mechanics of the heart was in a contrary
direction, has been quite as emphatic in recognizing
mental influence ("Diseases of the Heart", Oxford,
1910). Psychotherapy means more in heart disease
than anywhere else, and in other diseases its effect upon
the circulation through the heart is very important.
The absolutely automatic action of the lungs might seem to indicate that these were free from any emo- tional or mental influence. Most of the asthmatic conditions characterized by difficulty of breathing have large mental elements in them. Neurotic asthma is more dependent on the mental state than anything else. Most of the remecUes that affect it have a dis- tinct action on the mind as well as the lungs. Even tuberculosis is very largely influenced by the state of the patient's mind. A patient who gives up the struggle will succumb. "Consumption takes the quitters" is an axiom. Patients who bravely face the danger and the difficulties usually live on much longer and sometimes live their lives out, and in spite of serious invasion of the lungs die from other inter- current disease. In all the functional nervous dis- eases — that is, those nervous affections not dependent on some organic change in the nervous system, yet often accompanied by pains and palsies — the con- ditions known as hysterical — treatment through the mind is most essential. Even when other remedies are used it is only if they affect the patient's mind that they do good. The ill-smelUng remedies, the bread pills, the stronger cathartics and emetics for- merly used in these cases produced their effect through the mind.
Even in organic nervous disease, however, there is a distinct place for mental heahng. Patients become depressed when they learn that they are sufferers from some incurable nervous disease, the appetite ia disturbed, the digestion impaired, constipation sets in, they go out less in the air and take insufficient exer- cise, and then many adventitious symptoms develop. The patient attributes these to the underlying nervous disease, though they are really due to the mental state and to confinement. The promise of a cure lifts up the despondent mind, tempts the patient to go out; the appetite will be improved, many symptoms will disappear, and the patient thinks that the under- lying disease is being helped. Hence the many ad- vertised remedies for even such absolutely incurable diseases as locomotor ataxia, multiple sclerosis, epilepsy, and the like.
Dreads. — Psychotherapy is of course most impor- tant in the treatment of such affections as depend on mental influence. We have a whole series of dreads,
