PSYCHOTHERAPY
552
PSYCHOTHERAPY
of anxieties, of exaggerations and sensations, and then
of habits and of lack of will power, that can only be
properly treated through the mind. The dreads, or
phobias, constitute a rather large class of nervous
affections; perhaps the most common is mysophobia,
or dread of dirt, sometimes under the form of bac-
teriophobia; acrophobia, the dread of heights, which
may become so poignant as to make it impossible for
a person to sit in the front row of a gallery or even
to say Mass on a high altar; alurophobia, or the dread
of cats, which may make life miserable. Then there
is dread of the dark, the dread of wide open places,
the dread of narrow spaces, the dread of walking be-
neath anything overhanging, and numbers of others.
There is always a certain mental element in these, yet
they occur in persons of intellect and character. Only
suggestion and training will cure them. Usually they
are worse when the patient is run down.
Tremors and Tics. — After the dreads come the tremors, the tics or habits, and then the conscious surveillance of actions usually automatic, such as talking, writing, even walking, which interfere with the accomplishment of them. Under emotional stress, as after a panic, men sometimes find themselves un- able to sign their names when anyone is watching them. Some men cannot drink a glass of water at a strange table without spilling it. These are psychic rather than nervous conditions, and must be treated as such. There are a number of tremors that occur as a consequence of fright which can only be bettered in the same way. JMany of the tics — as winking, head-nodding, slight con\'Tilsive movements of the arms, mo\'ements of the lips, and nose— must be looked on in this same way. Children must be watched and prevented from contracting them. They have a tendency to run in families by imitation. If noted early, they can be removed by the formation of a contrary habit. Some habits of children, espe- cially certain sucking habits and tongue movements, lead to ugly deformities of the mouth when the jaws are in the plastic stage. Thumb-sucking is a habit that must be taken seriously, or the results on the mouth will be very marked. Biting the nails in older people is a corresponding affection. Such habits de- velop, as a rule, only in those with some psychasthenic condition, but the individuals maj' be very useful members of society.
Alcoholism and Drug Habits. — The greatest use- fulness of psychotherapy is in alcoholism and in the drug habits. There is no remedy that will cure alco- holism. We have had, during the past half century, hundreds of advertised cures: we know now that all of them owed their success to influence on the patient's mind. When a new cure is first announced many are benefited by it. Afterwards it sinks to the ordinary level and comes to be recognized as only a helpful physical treatment with a strong mental factor at- tached. When the patients are in the midst of the attacks of alcoholism, their physical state makes them crave some stimulation. At this time they must be given other than alcoholic stimulants, and must be under such surveillance as shall help them to keep away from liquor. After a variable time — from a week to two or three weeks — they are quite capable of re- sisting the craving by themselves, if they really want to. The cure of alcoholism Ls easy, but relapses are easier still, because the patients think that they can take a glass and go no further. When they are tired or chilled, or fear that they are going to catch a cold, or when friends suggest it to them, they indulge in a glass and then in the second and third, and the old habit has to be broken again. We have any number of examples, however, of men who have not drawn a sober breath for ten, twenty, or thirty years who have resolved to drink no more and have kept their resolutions. If a man inclined to alcoholism is put in the way of temptation, he will almost surely fall;
he ia more susceptible than others; he must be kept
from contact with it in every waj', and then it is com-
paratively easy for him not to relapse into the habit.
Probably the most helpful factor in the treatment of alcoholism is for the patient to have some friend, phy- sician or clergj-man, whom he thoroughly respects, to whom he turns with confidence in moments of trial. There is no reason, except in case of distinct deteriora- tion, why he should not be completely cured; but not drugs, but mental influence and will power is the important remedy. The same is true of drug addic- tions, now grown so common in the United States. That country uses more than ten times as much opium and cocaine as is required in medicine. The special victims of the habits are those who can easily procure the drugs — druggists, physicians, and nurses. It is quite easy to cure a drug habit. It is even easier to resume it. Relapses take place because the patients persuade themselves that for this once they need a dose of their favourite remed}-. One dose leads to another, and so the habit is resumed. After a time a habit of relapse into the habit develops and is most difficult to break. It the patients themselves want to, however, it is not hard as a rule to correct these habits. Moral factors mean much more than physical. Patients must have someone whom they take into their confidence, they must live normal, regular lives, with long hours in the open air and good hours of sleep, and must not be subjected to emotional strains. It is almost impossible to break up the habit in an actor or a broker, or a gambler, because every now and then he feels the need of the stimulant to enable him to accomplish some sudden call in his work. The same thing is true of a doctor or a nurse with many emergency calls to answer. Often the change of life necessary may be difficult, but as the wages of the drug habit is premature death, it should not be diffi- cult to make patients understand the necessity.
Other habits — dietary, se.xual, and the like — must be met in just the same wa}-. The patient can be helped in the beginning by means of drugs. After that it depends on his will. His will may be helped very much, however, by having a confidant, a confessor, or a physician to whom he goes in relapses, and who advises him so that his surroundings may be made more favourable.
Faith Cures and Miracles. — It is often said that the cures at shrines and during pilgrimages are mainly due to psychotherapy — partly to confident trust in Providence, and partly to the strong expectancy of cure that comes over suggestible persons at these times and places. Undoubtedly many of the cures reported at shrines and during pilgrimages are of this character. An analysis of the records of cures carefull.y kept — as, for instance, at Lourdes — shows, however, that the majority of accejitcd cures have been in patients suffering not from mental persuasions of disease, nor from neurosis, nor from symptoms exaggerated by anxi- ety, but from such very concrete affections as tuber- culosis, diagnosed by one or more physicians of stand- ing, ulcers of various kinds, broken bones that have long failed to heal, and other readily demonstrable organic affections. When cures are worked in such cases, some force beyond that of nature as we know it must be at work. The physicians who have been mostclosely in touch with the patients at such shrines are those most confident in their expression that they have seen miracles take place. A visit to a shrine like Lourdes is sufficient to convince any physician that there is something more than psychotherapy, t hough he can see also abundant evidence of psycho- therapy at work.
Cycles of Psychotherapy. — Our time has seen a revival of psychotherapy in many forms. Interest in it runs in cycles. It is always most intense just after a period of such devotion to physical science as produces a general impression that at last the mys-
