George W 1856-1940 Jacoby.

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from a species of psychic seasickness. Feeling
well, the patient scoffed at that idea of the mental
origin of his trouble. The episode had been for-
gotten, when, six years later, a trip abroad again



PRACTICAL EXAMPLES 321

was planned and cabins secured. A week before
the time set for that saiHng, the same symptoms of
nausea and vomiting recurred. This time the
tickets were given up after two days of illness, and
again with the same result, cessation of the symp-
toms. Since that time, as a result of many inter-
views and much explanation through which the
patient was made to realize the cause and to under-
stand the development of his attacks, he has been
abroad without more than the actual mal de mer
which a stormy voyage entitled him to have.

I could report another such case, which, however,
did not have the same successful issue because the
patient would not persist in the endeavor to over-
come his trouble. He was not obliged to go abroad;
the trip was merely for pleasure, so battling was
not worth while to him. Similar examples could
be quoted endlessly from the experience of every
busy physician and they are being given now not
as curiosities, but as samples of ordinary occur-
rences.

A frequent symptom of functional nerve disorder
is anorexia, loss of appetite, or aversion to certain
or all kinds of food. Notwithstanding the organs
of digestion are apparently in the best of condition



322 PSYCHOTHERAPY

and chemical examination of the stomach contents
reveals no disorder, patients believe themselves to
be suffering from serious gastric disease, appre-
hensively abstain from all food which they consider
indigestible, show a repugnance to a food or a
beverage which at one time or another has, in their
opinion, caused distress, and thus, through their
constant fear of possible ill effects from food, lead
lives of anxiety and self-observation. Physicians
constantly are hearing patients say they cannot
take this or that food, that it is poison to them;
that they cannot take one medicine or another, or
can take it only in a certain form, as in a capsule,
but not in powder or solution. Occasionally these
complaints are due to an actual idiosyncrasy of
constitution, but in the majority of instances they
are pure products of the imagination. How easily
such an idea may take root and thrive, if not recog-
nized and combated, is demonstrated by the fol-
lowing case.

A physician of broad general culture and large
professional experience, accustomed to taking
claret with his dinner, was dining at a hotel, and,
immediately after drinking a glassful of that wine,
was taken with nausea and vomiting. He ascribed



PRACTICAL EXAMPLES 323

his illness to the claret, which to him seemed adult-
erated. At dinner the following day the first
mouthful of claret, which came from another source
than that of the preceding day, caused nausea, and
from then on the doctor no longer was able even to
taste red wine without the recurrence of nausea.
Other wines did not affect him in the same manner.
He abstained from claret for several years and then,
realizing the cause of his inability to drink it to
be purely psychic, the doctor rebelled at his weak-
ness and, by energetic counteraction, succeeded in
permanendy overcoming it.

The development and growth of such an erron-
eous idea in a person of neurotic constitution is
well illustrated in the case of a girl twenty-three
years of age whose trouble originated in an en-
deavor to reduce her weight. Thinking she was
too stout she began dietary restriction by dispensing
with potatoes and bread. Not losing weight rapidly
enough to suit her, she discontinued eating starchy
food of any kind and sweets. Finally, when she
had lost about twenty pounds, she was apparendy
satisfied and made up her mind to return to a
normal diet. For some reason or other the starchy
foods now disagreed with her; after partaking of



324 PSYCHOTHERAPY

them she suffered much from flatulence and belch-
ing. She sought relief by eliminating one thing
after another from her diet, and soon began to
run down owing to insufficient nourishment.
When her attention was called to her anaemic ap-
pearance she answered, "I never felt better in my
life." Little by little more and more food was cut
out, until she was taking but a bowl of soup, a
cup of milk, and one egg in twenty-four hours.
Following an appeal for her to eat, she consented,
took a full meal and promptly vomited; and that
was the first of a series of vomiting spells. Her
reasoning then was, "Why eat at all, since every-
thing I take is vomited?" When I saw her, she
was thin, pale, exhausted, and almost bloodless,
with a weak and rapid pulse. She appeared like
a person dying from starvation. Separation from
her family, isolation and psychotherapy in the form
of re-education gradually led to her recovery.

Such cases are not unusual. Not infrequently
a severe anorexia of purely psychic origin, when not
opportunely treated, has led to death. On the
other hand, the most marvellous results obtained in
this and analogous states by psychic treatment
form part of the experience of every neurologist.



PRACTICAL EXAMPLES 325

The suggestions of cure are so promptly accepted
that patients who hitherto have refused food of any
kind, and who, on account of their state of inan-
ition, have to be fed with a stomach tube, experi-
ence a return of appetite after brief psychic treat-
ment and take food with avidity.

A case reported by Dubois is that of a man
fifty-eight years of age, suffering from chronic
diarrhoea, which had been treated by a speciahst
according to all rules of science, but without suc-
cess. Dubois again tried the various remedies and
dietetic prescriptions given by the physician who
had preceded him, but without avail. A full gen-
eral diet, through which he had attained good re-
sults in similar cases, also failed; in fact, the
diarrhoea increased from day to day. Discour- >
aged by his failure, the Bernese professor did not
know "to which saint to appeal." In the begin-
ning of the treatment Dubois had sought in vain
for nervous symptoms, but these gradually made
their appearance until he became convinced that,
as a result of hypochondriacal depression, the pa-
tient was constantly thinking of his condition, and
in this manner himself was the cause of the long
duration of his trouble. The patient then also ad-



326 PSYCHOTHERAPY

mitted he talked frequently to members of his
family about his diarrhoea and always prophesied
its recurrence before sitting down to a meal. The
patient gained control of himself and his ailment
disappeared after Dubois had explained to him
that, notwithstanding the absence of any discover-
able inflammation, the bowel trouble had increased,
that this was due essentially to constant apprehen-
sive expectation, and that the patient had done
wrong in annoying and unnecessarily tyrannizing
himself and the people about him by his hypochon-
driacal ideas.

This case, it might be said, well exemplifies
Dubois's statement that " the nervous patient is on
the path to recovery as soon as he has the convic-
tion that he is going to be cured; he is cured on the
day when he believes himself to be cured." We,
however, believe this criterion, the self-feeling of a
patient after the application of a remedy, to be one
of but little logical force. It would be better to
say the patient is cured when the conditions which
have caused his sickness, and which tend to main-
tain it, have been removed.

A case that may be compared with Dubois's is
one recounted by Hirsch. To a young girl suffer-



PRACTICAL EXMIPLES 327

ing from torpor of the bowels Hirsch suggested
during hypnosis that a daily movement should take
place at three o'clock in the afternoon. The result
was the desired one. The patient then arranged
to go on a journey, and, in order that she might
not be inconvenienced at that inopportune time of
the day, Hirsch suggested in another hypnosis that
no movement would take place on the day of her
trip until eight o'clock in the evening, after she
arrived at her destination. After awaking from the
hypnosis the girl retained no recollection of the
suggestion which had been made. Its efficiency
may be seen, however, from a letter which she
wrote to a friend, saying: "Please tell the Doctor
his suggestion did not act punctually this time, for
yesterday, for the first time, my bowels did not move
at three in the afternoon, but at eight in the evening."

Breuer recounts the case of a man who witnessed
an operation performed on his brother. It was a
matter of forcible extension of a stiff knee. TOio
felt the pain? Not the deeply narcotized patient,
but the brother who was looking on, and he suffered
for an entire year from this pain caused entirely
by his imagination.

An analogous case, reported by Moll, is that of



328 PSYCHOTHERAPY

an opera-singer without organic heart or lung dis-
ease who maintained that whenever she was in a
closed room she suffered from shortness of breath
and an attack of suffocation, which disappeared at
once when a window was opened and fresh air
came into the room. Medical treatment had failed
to relieve her of this evidently functional trouble.
One evening after a performance she came home
ill and went to bed at once. After a few hours she
awoke with all manifestations of severe respiratory
oppression. The only means of relief, she thought,
would be the opening of a window, but she felt too
weak to get up. In her fear the oppression would
increase, she took up a candle-stick standing near
her bedside and threw it, as she believed, at the
window. The noise of broken glass falling to the
floor indicated the accomplishment of her purpose.
At once she felt very much relieved by the "inflow"
of fresh air and quickly went to sleep. The next
morning, awaking well and refreshed, she saw to
her great surprise that it was not the window which
had been broken, but a looking-glass hanging be-
side it; that, therefore, there had been no inrush of
fresh air, and that the relief from her oppression,
as well as its origin, had been due entirely to her



PRACTICAL EXAMPLES 329

imagination. From that time she really was cured
and the attacks of oppression no longer recurred.

Let us also briefly consider here those neuroses
which so often follow injuries in accidents, and
which are of especial interest from a medico-legal
aspect on account of the prolonged earning in-
capacity which they often entail. In any railroad
accident, during routine factory work, injuries may
be suffered which permanently restrict or, perhaps,
entirely destroy a person's capability for self-sup-
port. Many similar cases are encountered, how-
ever, in which no organic disorder is discoverable
or in which the organic disturbance primarily
present passes away, but certain disorders of func-
tion, essentially dependent on auto-suggestion due
to fright and dread, remain. Very often the
sufferers from traumatic neuroses — those due to
accidents — are persons of neuropathic constitu-
tion, though even persons previously healthy are
not immune from such nervous manifestations.
Those manifestations arise days, weeks, or months
after the accident, often after symptoms of con-
cussion of the brain and the spinal cord have been
present and passed away, often without being pre-
ceded by any disorder immediately due to the ac-



330 PSYCHOTHERAPY

cident. The chief functional manifestations of the
later peroid are hypochondriacal or melancholic
depression, tearfulness, feelings of head pressure,
tremor, increased excitability of the sensory nerves,
motor insufficiency, disorders of the heart and res-
piratory action, with which also may be combined
symptoms due to organic changes consisting chiefly
in affection of the smaller blood-vessels of the brain
and the spinal cord.

The fact that these varied evidences of disease
are due to one and the same cause, accident, justi-
fies their combination into one group, even if the
view that traumatic functional nervous disorders
represent a certain well-defined picture of disease
be not generally endorsed. Some writers lean
toward the view that the neurosis which occurs
after a traumatism must be classed, according to
its predominating symptoms, as a hysteria, a neu-
rasthenia, or a hypochondriasis. While a definite
analysis is by no means always possible, it is cer-
tain that the most important factor in the produc-
tion of all traumatic neuroses is not the physical
injury but the psychic shock which accompanies it.
Therefore, in conformity with the psychic causa-
tion, the treatment must also be a psychic one.



PRACTICAL EXAMPLES 331

What materially adds to the difficulty of treatment
of these neuroses due to accident is the litigation
which usually follows a claim for damages made
by the victim and the fear that the award for
damages may be lessened through a rapid recovery.
This by no means signifies there is any conscious
simulation. Little knowledge of human nature is
necessary to understand that the promise of per-
manent support or a lump sum paid in compensa-
tion for injuries will exert a truly magical curative
influence on certain people, while the mere assur-
ance that they are cured and perfectly able to work,
when unaccompanied by material compensation,
will prove of little avail. Notwithstanding the diffi-
culties with which treatment of these cases is be-
set, good results are frequently obtained, especially
in those cases in which there is no question of
claims for damages, through psychotherapy alone,
with or without hypnosis.

The following case reported by Dubois shows
how the circle made up of suggestion, fear, emotions
of other kind, and bodily disorder is formed.

An intelligent literary man, twenty-four years of
age, accidentally struck his knee against the edge
of a table. He said the blow was insignificant and



332 PSYCHOTHERAPY

caused hardly any pain. He always had a notion,
however, that injuries to the knee were particularly
dangerous. Under the influence of fear, which, as
we all know, augments our sufferings, the disorder
grew and the apprehensive patient consulted a sur-
geon, who found nothing wrong, but advised rest
in a reclining-chair and cold applications. Under
those conditions the idea of illness gained more
and more ascendency over the patient's mind.
One day, as a result of self-observation, he felt
something was wrong with the other knee. He
communicated his fear to a physician, who con-
sidered the involvement of the other knee quite
possible because, he said, there existed a "sym-
metry of sensibility" between both legs. A few
days later the patient bumped his right elbow and,
in conformity with this law of "symmetry," which
he now understood, he soon had pain in the left
elbow, too. In consequence of inactivity his diges-
tion became sluggish, his appetite waned, and he
believed himself to be suffering from cancer of the
stomach, the symptoms of which he then studied
with the aid of popular writings. For months he
lived on a restricted diet, lost in weight, and became
more and more ill. The emotional state induced



PRACTICAL EXAMPLES 333

by his notion of having cancer in turn set up numer-
ous disturbances of function, such as palpitation of
the heart and shortness of breath, which still more
increased his fears. Thus he got into a vicious
circle in which his emotional processes produced
bodily disorders and those reciprocally aroused
new emotions. In this deplorable state the patient,
who in the beginning actually was not sick at all,
the entire fabric of his disease having been woven
essentially by his imagination and the resultant in-
correct mode of life, existed for eight years. Then
he went to Dubois, who cured him in a week through
psychotherapeutic influence.

The following case, which I observed myself,
also shows the influence of suggestion in a neuro-
pathic individual after an accident. The patient,
a girl of twenty-two, was thrown from a bicycle and
fell on her left side, striking on her shoulder and
the the left side of her head. Dazed, but not
unconscious, she arose and, thinking she had dis-
located her arm, walked to the office of a near-by
physician. He, believing her to have been seri-
ously injured, sent her to a hospital, where she was
placed in a surgical ward. Careful examination
in the hospital failed to reveal any symptoms of



334 PSYCHOTHERAPY

organic trouble, but she was allowed to remain so
she could recuperate from the emotional shock
caused by the accident. On the fifth day of her
stay, a woman suffering from a brain injury was
placed in the adjoining bed. During the night this
woman had a convulsion beginning in the left arm,
and that formed the topic of a conversation on the
following day between one of the internes and a
nurse. Our patient, the girl, heard this conversa-
tion, and the same evening began complaining of
renewed pains in her left arm. These pains grew
in intensity, the arm began to shake, and in an
hour she had a generalized convulsion. On sev-
eral subsequent days she had similar convulsions,
which bore all the characteristics of major hysteria.
Examination showed a loss of sensation of the skin
and of the mucous membrane of the entire left
side. The girl was removed from the ward, iso-
lated, and treated as a case of hysteria, special pains
being taken to explain to her the psychic genesis of
her trouble. In a fortnight she was discharged as
cured.

Neurasthenoid cases cured by psychotherapy
could be cited in large number. Typical of this
class is the case of a man with all symptoms of



PRACTICAL EXAMPLES 335

marked nervous exhaustion, fear and restlessness,
weakness and tremor of arms and legs, incapacity
for work, sensations of dizziness, sleeplessness, and
loss of appetite. A death in his family brought on
a depression which caused him to wish for nothing
but death. No symptoms of organic disease were
present. This patient was cured through sugges-
tion, one symptom after another being explained
to him to show him its origin, its development, and
its influence in the production of other symptoms.
First his sleep returned, then his appetite became
better, next his general nutrition improved, and
with that all his nervous troubles disappeared.

Medical literature is replete with cases of various
forms of sexual neurasthenia, masturbation, sexual
impotence due to fear and apprehension, and per-
versions in the same domain, all of which have
been cured or, at any rate, materially relieved by
psychic treatment. The same holds true of the
various obsessions and phobias which so often
thrive upon a neurasthenic or hysteric soil, the most
common of these being agoraphobia, the fear of
open spaces, claustrophobia, the fear of being alone
in a confined space, stage fright, and the fear of a
fear. Cases also could be quoted showing that the



336 PSYCHOTHERAPY

remarkable influence exerted by psychotherapy is
not confined to pure neuroses and psychoneuroses,
but extends also to diseases which are only partly
dependent on psychic causes, such as stuttering,
nocturnal bed-wetting of children, neuralgias of
various kinds, chronic alcoholism, and morphinism.
Even pronounced anaemias may be beneficially in-
fluenced through suggestion therapy in so far as an
improvement of appetite, digestion, and general
condition by psychic means gives an impetus to the
formation of haemoglobin and an increase in the
number of red blood-cells.

Finally, in so far as purely organic diseases are
concerned, psychotherapy can serve only to palli-
ate some of the distressing symptoms, while, of
course, it can have no influence on the organic
changes themselves and the process of disease will
take its own course, whether toward recovery or
toward death. But even when the changes which
disease has produced in the body can no longer be
remedied, and when the patient, in spite of surgery,
medicine, and all solicitous care, is doomed to lan-
guishing dissolution, the power of the mind to mas-
ter disordered feelings through exertion of the will
causes pains and distress to appear less intense and



PRACTICAL EXAMPLES 337

makes disease more endurable. Through foster-
ing and strengthening that power in his patients
who are hopelessly sick, the physician can best
demonstrate his powers for good. As Billroth said
in a speech delivered in 1891, "The patient comes
to the physician for advice, consolation, and hope;
if you give him nothing of this, you may be an ex-
cellent diagnostician and prognosticator, but you
are no doctor."



CONCLUSION

The road we have travelled has been long and
arduous, and we have now come to the end of our
excursion into the fields of suggestion and psycho-
therapy. Like the wanderer who has reached his
destination and looks backward to recall to mind
the chief stages of his journey, let us summarize and
take a brief retrospect of the chief results obtained
through our medico-psychologic study.

Above all we have learned that, without a knowl-
edge of the facts which govern suggestion, no com-
prehension of psychotherapy can be had. The
doctrine of suggestion, in turn, premises a knowl-
edge of physiologic psychology based on observa-
tion and experiment. Just as the entire art of
medicine was dependent on accident and chance,
so long as the cause and the nature of disease were
unknown, so psychotherapy, without the ground-
work mentioned, would be pure speculation, a
groping in the dark. Medicine during the last
century has been placed on an entirely new basis,

through which alone it has become possible for

338



CONCLUSION 339

psychotherapy to develop from a mystic hocus-
pocus into an exact science. As chemistry has
arisen from irrational alchemy, as astronomy has
developed from that pseudo-science, astrology, so
has modern psychotherapy grown from mediaeval
belief in miracles, from the cloudy conceptions of
animal magnetism and from the spiritistic trickeries
of a Cagliostro and a Slade.

This transformation cannot be better pictured
than by citing the words of Mephistopheles to the
student in Goethe's "Faust":

" To grasp the spirit of medicine is easy;
Learn of the great and little world your fill
To let it go at last, so please ye,
Just as God will." — Taylor's Translation.

Then it was not known that diseases were proc-
esses of nature governed in cause and course by
inalterable laws. Then disease was attributed to
astral influence or to some other incomprehensible
power. Then the pious believed, as some ot them
do to-day, that diseases are visitations of God,
punishment for sin, and that recovery can be ob-
tained only through God's pardon, all going at last
"just as God wills."

To-day we need no longer fold our hands in



340 PSYCHOTHERAPY

resignation and inactivity. To-day we know that
there is no intervention of supernatural power in
the laws of nature, and whether diseases will be-
come our undoing or whether we will be able to
deflect their course or to cure them depends essen-
tially upon our comprehension of the physical and
chemical forces which nature holds in store. The
ills which oppress us are the result of our own
ignorance or folly — hence can be combated only
by appreciation of their productive causes and by
systematic modification of the natural laws which
govern them. This applies with equal force to
those functional diseases for which psychotherapy
is to be the means of cure.

We hope we have succeeded in showing to what
extent a physician, by means of suggestion, can in-
fluence the brain activity and the imaginative power
of his patients in order to relieve them of suffering.
Is not the influence exerted by methodic commenda-
tory advertisements a matter of daily experience?
Do not the newspapers, through dissemination of
questionable, or even entirely untrue statements,
create and foster belief, sacrifice, and enthusiasm,
as well as the lowest passions? Why should not
the physician make use of this power of imagina-



CONCLUSION 341

tion in order to restore his patients to health and
contentment ? The determining and difficult meas-
ure for this purpose is the employment of thera-
peutic suggestion in accordance with a well-defined
method, a method based on the scientifically proven
fact that an effect which the human organism antic-
ipates tends to take place. There is nothing won-
derful in this. There is no need for looking far
afield, no need -for seeking supernatural causes.


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Online LibraryGeorge W 1856-1940 JacobySuggestion and psychotherapy → online text (page 17 of 18)