Those engaged in such work were not long in finding out that the mere emotional inspiration is often no sufficient remedy, and the development went along the same lines in which it has gone everywhere for some thousands of years. Not to disappoint the sufferers, the religion had to become in very many cases simply an inactive side issue and the real cure was performed by the same methods with which any worldly neuropathologist would go to work. If the woman who cannot sleep is cured from her insomnia by being made to listen to the beats of a metronome, it may sometimes be effective, however crude, but it is certainly no longer religion, even though the metronome stands in a minister's room. The more the movement spreads to those who have no psychological training and knowledge, the more it must be necessary for them to import the whole claptrap of the quack hypnotist and soon the minister may discover that in certain cases physical means and drugs help still better. Thus he simply enters into competition with the regular physician, only with the difference that he has never studied medicine. The chances are great that in his hands even such remedies and drugs may do harm and finally, even if they were effective, is not the question justified: will not religion suffer?

Indeed we have so far considered the question from one side only. We have confined ourselves to the question of how far such a movement is sound for the interests of the patient; but can we be blind to the other side and overlook the not less important problem of whether it lies in the interests of religion and of the church to amalgamate its spiritual work with a medical one? We are not thinking of those widespread, unfair arguments to the effect that this whole movement is undignified because it is instituted by the desire to fill the empty pews or to make competition with the success of Christian Science. That is utterly unjust. But there are intrinsic factors in the movement which interfere with the true aims of religion. First of all it cheapens religion by putting the accent in the meaning of life on personal comfort and absence of pain. The originators of the Emmanuel Movement stand well above such error, but their national congregations do not. Certainly the longing for pleasure and a well feeling and the abhorrence of pain and illness pervades our practical life and keeps in motion all our utilitarian efforts. But if there is one power in our life which ought to develop in us a conviction that pleasure is not the highest goal and that pain is not the worst evil, then it ought to be philosophy and religion. It is only the surface appearance if it seems as if the religious therapeutics minimizes the importance of pain; in truth it does the opposite. It tries to abolish pain, but not because it thinks little of pain; on the contrary, because it thinks so much of pain that it is willing even to put the whole of religion into the service of this strife for bodily comfort. The longing for freedom from pain becomes the one aim for which we are to be religious. In a time which denies all absolute ideals, which seeks the meaning of truth only in a pragmatic usefulness, it may be quite consistent to seek the meaning of religion in its service for removal of pain, and personal enjoyment. But in that case the ideal of both religion and truth is lost. It is finally not less undignified for religion to seek support for the religious belief in effects which it shares and knows that it shares with any superstitious belief on earth. Granted that the church can cure: the shaman of Siberia can cure too, and the amulets of Thibet not less. The psychologizing church knows, therefore, that it is not the value of the religion which restores the unbalanced nervous system; and yet it wants to provide for the spreading of true belief by the miraculous cures which it exhibits.

This situation naturally produces the desire of the church to substitute a religious explanation for a psychological one. It is claimed that after all it is not the mental effect of the prayer, but the prayer itself, not the psychophysical emotion of religion, but the value of religion which determines the cure. Yet in that moment the whole movement in its modern shape comes into a still more precarious position. If the cure results from the inner value of the religion how can we confine it to the so-called functional diseases and abstain from any hope in organic diseases? Luther, from his religious point of view, still had the right to separate the two groups because only those functional diseases were effects of the devil, obsessions which could be banished by the minister and by prayer, while the other diseases did not result from the devil, but merely from natural causes. Such a definition does not fit into the modern system. To-day from a really religious point of view, both groups of diseases must be acknowledged to be natural or with Mrs. Eddy, as the work of the unholy spirit. Christian Science is indeed by far more consistent. If the cure results through the meaning and value of religion, there is no reason whatever why cancer and diphtheria and paralysis should not be cured as well as psychasthenia. And if, on the other hand, organic diseases cannot be cured because the psychophysical process of the religious emotion has no influence over diphtheria bacilli, then the whole process is removed to the causal sphere and it is acknowledged that the purposive meaning of religion is not in question at all. The whole system of such religious psychotherapeutics is therefore in its inner structure contradictory. It contains causal and purposive elements without any possibility of unifying them. They are loosely mixed, and the power of prayer means on one page something entirely different from what it means on another. In these respects Christian Science is by far more unified and in harmony with itself; its therapeutics is really anchored in a system.

From a scientific point of view, its dangerousness is of course much greater inasmuch as it extends its methods over every organic disease and thus applies merely psychical treatment where from a standpoint of scientific medicine, physical treatment would be absolutely necessary. Moreover its philosophy is after all only a pseudophilosophy; its tempting equations of disease and error and sin and unreality are ultimately a mere playing with conceptions. If we were to point to the root of the misunderstanding in Christian Science, we should say that everything depends on the philosophical commonplace that the objects with which we deal in our life are ideas and that our whole experience is mind. "Christian Science reveals incontrovertibly that Mind is All-in-All, that the only realities are the divine mind and idea." But now silently this mental character of the real world is identified with the mental experience which stands in contrast to the physical experience. There results the impression that physical experience therefore, does not belong to the world of reality. It is evident, however, that mental in contrast to physical means something entirely different from mental in the philosophical sense. In the latter meaning of the word, we all agree that the world is mental; the word mental indicates there that the world has reality not in itself but only as experience of subjects. In the second sense, mental or psychical means that it is experience for one particular subject only and not for every possible subject. The physical thing, for instance this table, is indeed different from my mental memory idea of a table, inasmuch as every possible subject can experience this table while my mental memory image belongs to me alone. The physical table and the mental memory image of it are both equally mental in the philosophical sense, inasmuch as the physical which is object for every possible subject and in this sense not mental is therefore not less given to subjects. Every physical body with its disease is thus in one sense taken as something not mental while in another sense as mental; if we use the same word in two entirely different meanings, it indeed cannot be difficult to demonstrate any metaphysical consequences.

But we do not have to deal here with the metaphysics of "Science and Health." If it is brought down to the concrete application, we stand before the same confusion which characterizes all compromises. Causal effects are sought in a sphere which belongs to purposive values. The psychological effects of the emotion of faith are sought and are misinterpreted as the emanations of religious powers. Religious psychotherapeutics in all its forms seeks to demonstrate to us the triumph of the soul over the body, while in reality it deals only with the mental mechanism which as such belongs to the chain of causal events in the same natural way as the organism. The soul, as spiritual agency in its sphere of purposes and ideals, does not enter the machinery of psychotherapy, and the psychological material on which psychotherapy is applied is not freer and not better and does not stand higher than the material of the bodily cells and tissues. The Emmanuel Movement deserves the highest credit for bringing about a systematic contact between religious faith cure and scientific medicine, but the time in which the minister himself undertook the medical treatment had to be a time of transition. It had to lead to a new relation in which the ministerial function is confined to the spiritual task of upbuilding a mind while the therapeutic function remains entirely in the hands of the physician. Where the physician believes that the psychomedical treatment demands a new equilibrium of the patient to be secured by religion, there the minister should be called for assistance. Psychotherapeutic hospitals would offer the most favorable conditions for such cooeperation. But the minister ought to enter even such a hospital with a strictly spiritual aim, and he should never forget that the task of the church stands much higher than the utilitarian task of removing pain from the sick room. But if those psychotherapeutic hospitals will flourish and the physicians will at last make use of psychical factors in their regular practice, they ought not to forget on their part that the important step forward was taken under the pressure of popular religious movements. The ministers first saw what the physicians ought to have seen before, but the physicians will see it more fully and more correctly.



XIII

PSYCHOTHERAPY AND THE PHYSICIAN

Every thought of the physician moves in a world the structure of which is determined by the thought forms of cause and effect. He knows the effect which he wants to produce; it is the restitution of the organic equilibrium. He studies the causes which can secure that end. And again the disturbance of the equilibrium itself, the disease, is for him an effect which he seeks to understand by an analysis of the preceding causes. The means which he applies can therefore be valued only in reference to their efficiency; no other point of view belongs to his world. The religiously valuable may be indifferent or even undesirable in the interplay of causes, and the morally indifferent may be most important for the physician's interests. The religious emotion accordingly has to stand in line with any other mental excitement or with a hundred physical means which the laboratory and the drug store supply. The physician will welcome the methods of treatment without reference to metaphysical systems or to religious beliefs. To him it is an empirical fact that many disturbances of mind and body which interfere with the equilibrium of life can be repaired by influences on certain psychophysical organs. A part of these repairing influences he finds in the sense stimuli, for instance, of spoken or written words which reach the brain and awaken associative and reactive processes. He finds further that these influences can be reenforced in their effectiveness by certain general conditions of the nervous system and again finds that these can be secured partly by sense impressions, and once more especially by words.

It is a matter of course to the physician that application of any sense influence on the brain demands a most subtle analysis of the psychophysical situation. Therefore he gives no less attention to the disentangling of the whole history of the individual brain, to its stored-up energies and to its mental possibilities. If he knows the psychophysical status, and finally if he knows the means of influencing those psychophysical organs which stimulate or inhibit the disturbed central parts, he can foresee the psychophysical effects with a certain definiteness. Thus everything depends upon the sharpest possible, almost microscopic, mental analysis, together with a most thorough examination of the whole nervous system and the most careful calculation of the mental influences applied. The vagueness of the religious appeal transforms itself into an exact calculation and the unity of the soul which seeks spiritual uplift transforms itself into a mental mechanism of bewildering complexity, and yet not more complex than the physical organism, to which for instance, the chemical means of the physician administer. To-day medical science is certainly only in the beginning of this great movement. Especially the analysis of the psychophysical conditions still lacks a sufficient refinement of method. But at least the causal principle is now fully recognized and the scientific man of today no longer doubts that this whole play of psychotherapeutic processes goes on as a causal process in the psychophysical system of the individual without any mysteriousness, without any magnetic influences, without any miraculous interference, without any agencies except those which are working in our ordinary mental life in attention and reaction, in memory and sleep.

It is surprising how late this recognition appeared in the history of human knowledge. It occurred here as in so many places in the history of human civilization that the simple is the late outcome of the complex. Just as in technique the apparatus often began in a complex, cumbersome way and then became steadily simplified, so it is with explanations. The complex machinery of cosmic influences and obsessions by demons and magnetic mysteries was at first necessary until the simple explanation was found that all the results depend upon the working of the mind itself. Yet in technique and explanation alike, such progress to the simpler means always at the same time the making use of much richer knowledge. To explain an obsession or a sleep state by the agencies of evil spirits or magnetic fluids is certainly an unnecessary side conception. But to understand it from the working of the mind presupposes after all the whole modern physiological psychology, and thus had to be the latest step.

The effects themselves were certainly observed in all times. Even the phenomena of hypnotism date probably back some thousands of years, however difficult it may sometimes be to discriminate between the artificial hypnotic states and hysteric or hystero-epileptic occurrences in the past. Certainly it may be acknowledged that the Yogi in India cultivated in the most remote times the methods of autosuggestion which evidently led to hypnotic states, and everywhere around the Mediterranean, antiquity knew the hypnotizing effect of staring on polished metals and crystals. So in Egypt, so in Greece and Rome; and it has often been claimed that the priestesses of Delphi and the sibyls of the Romans were in states of hystero-hypnotic character. As to the therapeutic use, especially the Greek physicians applied hypnotic means. Excited patients were brought to repose by methods of stroking. The efforts to explain scientifically the mysterious powers which men can gain over the mind and will of another begin at the end of the Middle Age and were developed quite naturally from the prevailing astrological doctrines. Astrology worked on the theory that the human fate depends upon the stars. These stars have an effect on the human organism. That proves that an influence can exist between distant bodies. It is, therefore, not more surprising that one organism can also have an influence on another organism. Well known since antiquity were such influences from one object to another, as in the case of the magnet. Thus there may be a kind of magnetic power which creates relations between all objects in the universe.

Pomponnazi explained thus at the end of the fifteenth century the therapeutic effects of the human soul by the mutual influence which stars and men have on each other. This theory comes to much more important development in the writings of the physician Paracelsus. One individual by the power of his effort can influence the will of another individual, can fight with it, and suppress it; and all through energies which are analogous to the magnetic power which binds stars and men. In the middle of the seventeenth century, Helmont connects this power of magnetic attraction and repulsion with an ethereal element which penetrates all bodies and keeps them in motion. Through it man, too, can by his mere imagination work on other men. This will can also be effective on drugs which get through it a special therapeutic power. Somewhat different was the theory of a Scotch physician, Maxwell, in the second half of the seventeenth century. The ethereal spirit, which is identical with light, can be artificially cumulated in any organism and that secures its health. As one man can influence this vivifying ether in any other man, he can produce cures even from a great distance. All diseases are merely reductions of this ethereal spirit in the organism.

But the general stream of the explanation continued in the direction of the magnetic doctrine. It was especially Mesmer in the eighteenth century who, in a long life of fantastic mysticism and yet of universal serious study, surely contributed much to the development of the theory. He had started to use, like others, the magnet in his medical practice. But he discovered that the same therapeutic successes could be gained without applying the magnet itself, but by simply using his own hands. The patients became cured when he moved his hands slowly from their heads to their feet. The magnetic power was therefore evidently in man himself. It was an animal magnetism in opposition to the mineral one which belonged to the magnet and to the stars. He believed further that he was able to infuse this magnetic power into any lifeless thing, which would then have curative influence on the nerves. There can be no doubt that, whatever may have been the value of his theories, he cured a large number of patients, evidently producing a state which we would call today a hypnoid state and often simply appealing to the natural suggestibility of the impressionable minds. Among his pupils, usually called mesmerists, was Puyseyur, who discovered, in 1784, the state which was called artificial somnambulism, a kind of sleep in which the ideas and feelings of the magnetized can be guided by the magnetizer. Here evidently was the first recognition of the psychotherapeutic variation which we call today hypnotism. There followed a period in which the scientific interest of the physicians was somewhat sidetracked by an unsound connection of these studies with mystic speculations and with clairvoyance. But especially in Germany animal magnetism in Mesmer's form and in the form of artificial somnambulism grew in influence through the first decades of the nineteenth century and succeeded in entering the medical schools. The reaction came through popular misuse. At about the third decade of the century, interest ceased everywhere.

The Portuguese Faria insisted in 1819, practically as the first, that all those so-called magnetic influences, including the delusions, the amnesias after awaking, and the actions at a command, did not result from a magnetic power but from the imagination of the subject himself. He believed that the effect depended upon a disposition of the individual which resulted from a special thinness of blood. He abstained therefore from the magnetic manipulations and produced the somnambulic state by making the patients simply fixate his hands and by ordering them to sleep. Thus he is the first who understood these changes as results of mental suggestion. The next great step was due to the English surgeon, Braid, who in the forties studied the magnetic phenomena and like Faria insisted on the merely mental origin of the abnormal state. He proved that a person can bring himself into such an artificial state and that it is therefore entirely independent of energies from without. He examined especially the influence of staring at a shining object, a method which not seldom was called Braidism. He also introduced the word hypnotism. In America mesmerism was generally known under the name of electrobiology; and Grimes in particular came to results similar to those of Braid. Yet the influence of these movements on the medical world remained insignificant until a new great wave of psychotherapeutics by means of suggestion began in France in the sixties.

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.

Whether pedagogy and criminology are to make use of the services of psychotherapy is thus certainly an open question. It would be short-sighted to overlook the serious obstacles which stand in the way. But while the social life outside of the circle of real disease may better go on without direct interference by psychotherapeutic influences, it is certainly the duty of the community to make the underlying principles of psychotherapy useful for the sound development of society. The artificial over-suggestions which are needed to overcome the pathological disturbances of mental equilibrium may be left for the cases of illness. But we saw that every mental symptom of disease was only an exaggeration of abnormal variations which occurred within the limit of health. To reduce these abnormalities means to secure a more stable equilibrium and thus to avoid social damages, and at the same time to prevent the growth of the abnormality to pathological dimensions. To counteract these slighter variations, these abnormalities which have not yet reached the degree of disease, will demand the same principles of treatment, only in a weaker form. It is in a way not psychical therapy but psychical hygiene. And this is no longer confined to the physician but must be intrusted to all organs of the community. And here more than in the case of disease, the causal point of view of the physician ought to be brought into harmony with the purposive view of the social reformer, of the educator and of the moralist.

The ideal of such mental hygiene is the complete equilibrium of all mental energies together with their fullest possible development. To work towards this end does not mean to aim towards the impossible and undesirable end of making all men alike, but to give to all, in spite of the differences which nature and society condition, the greatest possible inner completeness and outer usefulness. The efforts in that direction have to begin with the earliest infancy and are at no age to be considered as finished; the whole school work and to a high degree the professional work has to be subordinated to such endeavor. Society has further to take care that those spheres of life which stand less under systematic principles, such as the home life of the child and the social life of the man, his family life and his public life, are steadily under the pressure of influences which urge in the same direction.

Harmonious development without one-sidedness, and yet with full justice to the individual talents and equipments, should be secured. That means from the start an effort to secure balance between general education and particular development. The latter has to strengthen those powers by which the boy or girl by special natural fitness promises to be especially efficient and happy. It has to be supplemented later by a wise and deliberate choice of such a vocation as brings these particular abilities most strongly to a focus. Yet this alone would mean a one-sidedness in which the equilibrium would be lost. More important, it would leave undeveloped that power which the youth especially needs to acquire by serious education, the power to master what does not appeal to the personal likings and interests. An equilibrium is secured only if at the same time full emphasis is given to the learning and training in all which is the common ground of our social existence. From the multiplication table to the highest cultural studies in college, the youth is to be adjusted to the material of our civilization without any concession to the emasculating desire to adjust civilization simply to the particular youth. He has to learn learning and not only to play with knowledge, he has to learn to force his attention in adjustment to those factors of civilization which are foreign to his personal tendencies and perhaps unsympathetic. Free election of life's work and unyielding mental discipline in the service of the common demands should thus steadily cooeperate. The one without the other creates a lack of mental balance which is the most favorable condition for a pathological disturbance.

The mere learning is of course on both sides only a fraction of what the community has to develop in the youth. Mental hygiene begins with physiological hygiene. The nourishment of the child, the care for the child's sense organs, the recesses and the rest from fatigue, and especially the undisturbed sleep are essential conditions. The interferences with sufficient sleep are to a high degree responsible for the later disturbances of the mental life. It must not be forgotten that the decomposition of the brain molecules can never be restituted by anything but rest, and ultimately by sleep. Physical exercise is certainly not such restitution. In the best case it brings a certain rest to some brain centers by engaging other brain parts. The child needs sleep and fresh air and healthful food more than anything else, if his mind is active. The careful examination of the sense organs and of the unhindered breathing through the nose is most important. Even a slight defect in hearing may become the cause of an under-development of attention.

More important than mere physical hygiene is the demand that a sound character and a sound temperament are also to be built up, at the side of a sound interest. Here again everything depends upon a wise balance between the development of that which is given by nature to the particular individual and the reenforcement of that which society demands and which belongs therefore to the common equipment. The emotional stability and emotional enlargement of the mind is perhaps most neglected in our educational schemes. On the one side it demands a systematic discipline of the emotions, on the other a healthy stimulation of emotions. Here is the place where imagination in play and later in art come in. The biological value of play always lies in the training for the functions of later life, and especially for the emotional functions. The play of our children is too little adjusted to this task. For this reason it leaves too many unprepared for the world of art and for the emotional experiences of real life. Both lack of emotional discipline and narrow one-sidedness of emotions interfere with the harmonious development. Destructive emotions like terror ought to be kept away and not needlessly brought near by uncanny stories and mystic superstitions. It is the healthy love and sympathy of the home which contributes most strongly to the normal development of emotions. Again in the field of will, we want the strong, spontaneous, independent will which is not frightened by discomfort and not discouraged by obstacles, and yet we want the will which is not stubborn and selfish but which subordinates itself to the larger will of the social group and to the eternal will of the norm. There is no balance where independence and subordination do not supplement each other. A wide education not only trains for both but also secures habits which work as autosuggestions in both directions.

But all this harmonious development of intellect and temperament and character has to go on when the school days are over and just here begins the duty of the community as a whole. The special functions of the teachers have to be taken up by the public institutions. The whole social life must shape itself in such a way that everyone finds the best possible chances to perfect this harmonious growth. In the field of the intellect, the community must take care that thoroughness of training and accuracy of information is rigidly demanded and not thrust out by an easy-going superficiality. The expert ought to replace the amateur in every field. Every society which allows successes to superficiality diminishes its chances for mental health. Yet while thoroughness demands concentration in one direction, society must with the same earnestness insist on well-rounded general education and continuity of general interests through life. Literature and the libraries, the newspapers and the magazines play there a foremost role, and again the mental health of the community has to pay the penalty if its newspapers work against general culture. In the emotional field art and music, fiction and the theater on the one side, the church on the other side, remain the great schools for a development of sound emotions. Where literature becomes trivial, where the stage becomes degraded, and where the church becomes utilitarian and uninspiring, great powers for possible good in emotional education are lost. But with this enrichment of feelings the disciplinary influence too has to go through the whole social life. Where art is sensational and the church hysterical,—in short, where the community stirs up overstrong feelings,—the wholesome balance is lost again. In a similar way the public demands should throughout stimulate the energy and ambitions and initiative of the man, and yet should keep his desires and impulses in control.

Few factors are more influential in all these directions than the administration of law. Sound sober lawmaking and fair judgment in court secure to the community a feeling of safety which gives stability to emotions and feelings. The disorganization which results from arbitrary laws, from habitual violation of laws, from corruption and injustice works like a poison on the psychophysical system. A similar unbalancing influence emanates from overstrong contrasts of poverty and comfort. A poverty which discourages and leaves no chances and a wealth which annihilates the energies and effaces the consciousness of moral equality, create alike pernicious conditions for mental balance.

Unlimited furthermore are the influences which depend upon the sexual ideas of the society. It is the sphere in which it may be most difficult to indicate the way towards a development without dangers. There is no doubt the arbitrary suppression of the sexual instinct must be acknowledged as the source of nervous injury while indulgence may lead to disease and misery. But in any case frivolous habits and easy divorce contribute much to the unbalanced life which ruins the unstable individual. Not less difficult and not less connected with the mental hygiene is the alcohol problem. For normal adult men mild doses have through their power to relieve the inhibitions undeniable value for the sound development of the community. Its intemperate use or its use by young people and by pathological persons is one of the gravest dangers. Whether intemperance ought to be fought by prohibition or rather by an education to temperance is a difficult question in which the enthusiastic women and ministers, backed by the well justified fears of psychiatrists, will hardly be on the same side as the sober judgment of scientists, unprejudiced physicians, and historians. In any case the saloon and its humiliating indecency must disappear and every temptation to intemperance should be removed. Above all, from early childhood the self-control has to be strengthened, the child has to learn from the beginning to know the limits to the gratification of his desires and to abstain from reckless over-indulgence. With such a training later on even the temptations of alcoholic beverages would lose their danger. Not less injurious than the strong drinks are the cards. All gambling from the child's play to the stock exchange is ruinous for the psychophysical equilibrium. The same is true of any overuse of coffee and tea and tobacco, and as a matter of course still more the habitual use of the drugs like the popular headache powders and sleeping medicines. The life at home and in public ought to be manifold and expansive but ought to avoid over-excitement and over-anxiety. A good conscience, a congenial home, and a serious purpose are after all the safest conditions for a healthy mind, and the community works in preventive psychotherapy wherever it facilitates the securing of these three factors.