Thus for the psychologist the mental world is a system of mental objects. To be an object means of course to be object of some subject which is aware of it. What else could it mean to exist at all as object if not that it is given to some possible subject? But the world of objects is twofold; we have not only the mental objects of the psychologist but also the physical objects of the naturalist. Science must characterize the difference between those two and we pointed once before to the only fundamental difference. Physical objects are those which are possible objects of awareness for every subject; psychical objects are those which are possible objects of awareness for one subject only. The tree which I see is as physical tree object for every man, it is the same tree which you and I see; my psychical perception of the tree is object for one subject only. My perception can never be your perception. Our perceptions may agree but each has his own. As to the physical objects, we can entirely abstract from such reference to the subjects. We say simply: the tree exists or is part of nature; and only the philosopher is aware that we silently mean by it that it exists for every subject and that it is therefore not necessary to refer to any particular subject. But the perception of the tree which is either your idea or my idea evidently gets its existence only if it is referred and attached to a particular subject which is aware of it. Such subject of awareness is that which the psychologist calls consciousness and all the ideas and volitions and emotions and sensations and images which make up the mental life are then contents of the consciousness or objects of the consciousness. To have psychical existence at all means thus to be object of awareness for a consciousness. Something psychical which simply exists but is not object of consciousness is therefore an inner contradiction. Consciousness is the presupposition for the existence of the psychical objects. Psychical objects which enjoy their existence below consciousness are thus as impossible as a wooden piece of iron.
If consciousness is nothing but the subject of awareness for the individual objects, we see at once certain consequences which are too often forgotten in the popular, haphazard psychology. In the scientific system of psychology, consciousness has for instance nothing whatever to perform, that is, consciousness itself is in no way active. The active personality of real life has been left behind and has itself been transformed into that self which is merely content of consciousness. The person who acts and performs the deeds of our life is then only a central content of our consciousness which is crystallized about the idea of our organism. It has thus become one of the contents of which consciousness itself is passively aware. Consciousness is an inactive spectator for the procession of the contents. Thus consciousness itself cannot change anything in the content nor can it connect the contents. No other function is left to consciousness but merely that of awareness. Every change and every fusion and every process must be explained through the relations of the various contents to one another. Consciousness has, therefore, not the power to prefer the one idea or to reject the other, to reënforce the one sensation and to inhibit the other. From a psychological point of view, we have seen before that even attention does not mean an activity of consciousness but a change in the content of consciousness. Certain sensations become more impressive, more clear, and more vivid, and others fade away, become indistinct and disappear, but all that goes on in the content of consciousness and the spectator, consciousness itself, simply becomes aware of those changes. Consciousness has also in itself no special span, ideas appear or disappear not because consciousness expands or narrows itself but because the causal conditions awaken or suppress the various contents.
Consciousness has in itself no limit; all organization belongs to the content. Whatever psychical states are attributed to one organism belong thus to its consciousness but all the connections are entirely connections of the content. We, therefore, have not even the right to say that consciousness, as such, has unity. Unity too belongs to the organization of the content. One part of the content hangs together with the other parts but consciousness is only the constant condition for their existence. Where there is no unity, there it cannot have any meaning to speak of the double or triple existence. There may be a disconnection in the various parts of the content and a dissociation by which the normal ties between the various contents may be broken but consciousness itself cannot fall asunder. Thus consciousness cannot have any different degrees. The same consciousness experiences the distinct clear content and the vague fading confused content. Thus also consciousness can never be aware of itself and the word self-consciousness is easily misleading. In psychology, it can never mean that the consciousness which is a subject of all experience is at the same time object of any experience. Its whole meaning lies in its being the passive spectator. That of which consciousness becomes aware in self-consciousness is the idea of the personality, which is certainly a content. The personality, the actor of our actions, is thus never anything but an object in psychology, and consciousness never anything but a subject. Consciousness itself is thus in no way altered when the idea of the personality is changing. Only if all this is carelessly confused, if consciousness is sometimes treated as meaning subject of consciousness, and at another time as meaning the content of consciousness, and again at another time the unified organization of the content, and at still another time the connection of the content with the personality, and if finally all that is confused with the purposive reality of the immediate personal life—only then, do we find the way open to those tempting theories of the subconscious personality.
If, instead, we stick to the scientific view, we find the following facts. First, we have everywhere with us the fact that the earlier experiences may again enter into consciousness as memory images or as imaginative ideas, that is, in the order in which they are experienced a long time before or in a new order, either with a feeling of acquaintance or without it. Certainly at no time is the millionth part of what we may be able to reproduce present in our consciousness. Where are those words of the language, those faces of our friends, those landscapes, and those thoughts; where have they lingered in the time of their seclusion? Scientific psychology has no right to propose any other theory as explanation but that no mental states at all remain and that all which remained was the disposition of physiological centers. When I coupled the impression of a man with the sound of his name, a certain excitement of my visual centers occurred together with the excitement of my acoustical centers; the connecting paths became paths of least resistance, and any subsequent excitement of the one cell group now flows over into the other. It is the duty of physiology to elaborate such a clumsy scheme and to make us understand in detail how those processes in the neurons can occur and it is not the duty of psychology to develop detailed physiological hypotheses. Psychology has to be satisfied with the fact that all the requirements of the case can be furnished by principle through physiological explanation. Least of all ought we to be discouraged by the mere complexity of the process. If a simple sound and a simple color sensation, or a simple taste and simple smell sensation, can associate themselves through mere nervous conditions of the brain, then there is nothing changed by going over to more and more complex contents of consciousness. We may substitute a whole landscape for a color patch or the memory of a book for a word, but we do not reach by that a point where the physiological principle of explanation, once admitted, begins to lose its value. Complexity is certainly in good harmony with the bewildering manifoldness of those thousands of millions of possible connections between the brain cells.
Every experience leaves the brain altered. The nerve fibers and the cells have gone into new stages of disposition for certain excitements. This disposition may be slowly lost. In that case the earlier experience cannot be reproduced; we have forgotten it. But as long as the disposition lasts—it is quite indifferent whether we conceive it more in terms of chemical changes or physical variations, as processes in the nerve cells or between the nerve cells—the physiological change alone is responsible for the awakening of the memory idea under favoring associative conditions. Of course, someone might reply: can we not fancy that there remains on the psychical side also a disposition? Each idea which we have experienced may have left a psychical trace which alone may make it possible that the idea may come back to us again. But what is really meant and what is gained by such a hypothesis?
First, do not let us forget that such a proposition could only have one possible end in view, namely, the explanation of the reappearance of memories. But when we discussed the basis of physiological psychology, we convinced ourselves that mental facts as such are not causally connected anyhow. Our real inner life has its internal connections, connections of will and purpose, but as soon as we have taken that great psychological step and look on inner life as merely psychological objects, then the material is connected only through the underlying physiological processes and we can never explain causally the appearance of an idea through the preceding existence of another idea. We may expect one after the other, but we have no insight into the mechanism which makes the second follow after the first. Such insight into necessary connection we find only on the physical side, and we saw that just here lies the starting point for the modern view of physiological psychology. If that holds true for the connections between idea and idea, of course it holds true in the same way for the connection between mental disposition and the corresponding memory. We can understand causally that a chemical disposition in the nerve fibers brings about a chemical excitement in those neurons, but how a mental disposition is to create mental experience we could not understand; and to explain it casually, we should need again a reference to the underlying physiological processes. The hypothesis of mental dispositions would thus be an entirely superfluous addition by which we transcend the real experience without gaining anything for the explanation.
Secondly, if we really needed a mental disposition for each memory picture, in addition to the physiological disposition of the brain cells, can we overlook that exactly the same thing would then be necessary for every perception also? The outer impression produces, perhaps through eye or ear or skin, an excitement of the brain cell and this excitement is accompanied by a sensation; and no one fancies that the appearance of this sensation is dependent upon a special disposition for it on the mental side. No one fancies it, because it is evident that such a hypothesis again would be entirely useless. If every new perception needed such a special mental disposition, we should have to presuppose dispositions for everything which possibly can come into our surroundings. Every smell, every word, every face which comes anew to us would need its special ready-made disposition. In other words, our mind would contain the disposition for every possible idea and that would mean that these dispositions would be in no way helps for explanation. If the disposition exists for everything, no one particular thing can be explained by the existence of that disposition. Again we should have to rely entirely upon the physiological brain excitement for explaining that this word or that word is perceived by our mind. But if the brain excitement alone is sufficient to explain the new perception in the mind, then no reason can be found why the renewed brain excitement would not be sufficient to renew the mental experience. Thus there is nowhere room for mental dispositions below the level of consciousness.
Thirdly, what could we really mean by such mental dispositions? A physiological disposition for a physiological action is certainly not the action itself. The finger movement in piano playing finds only a disposition in my brain centers, in case I am trained; the movement itself does not last. But the disposition is at least itself a change in the physical world. The molecules are somehow differently placed, the disposition has thus as much objective existence as the resulting movement. Nothing at all similar can be imagined in the sphere of psychical contents. Such mental dispositions would have to exist entirely outside the world of concrete mental experiences and, if we scrutinize carefully, we soon discover that such theories are only lingering reminiscences of the purposive view of life, and do not fit at all into the causal one. If we take the purposive attitude, then every idea and every will contains indeed all that its meaning involves and everything which we can logically develop out of it is by intention contained in it. All mathematical calculations are then contained in the thought of figures and forms, but they are contained there only by intention, they are logically inclosed; psychologically the consciousness of the figures and forms does not contain any disposition for the development of mathematical systems. We indeed have no right to throw into a psychological subconsciousness all that which is not present but involved by intention in the ideas and volitions of our purposive life.
If thus the memory idea is linked with the past experience entirely by the lasting physiological change in the brain, we have no reason to alter the principle, when we meet the memory processes of the hypnotized person or the hysteric. It is true their memory may bring to light earlier experiences which are entirely forgotten by the conscious personality, but that ought to mean, of course, only that nerve paths have become accessible in which the propagation of the excitement was blocked up before. That does not bring us nearer to the demand for a subconscious mental memory. The threshold of excitability changes under most various conditions. Cells which respond easily in certain states may need the strongest stimulation in others. The brain cells which are too easily excited perhaps in maniacal exultation would respond too slowly in a melancholic depression. Hypnotism, too, by closing the opposite channels and opening wide the channels for the suggested discharge, may stir up excitements for which the disposition may have lingered since the days of childhood and yet which would not have been excited by the normal play of the neurons. Quite secondary remains the question of how these reproduced images finally appear in consciousness, that is, whether they appear with reference to earlier happenings and are thus felt as remembrances, or whether they enter as independent imaginations, or whether they finally, under special conditions, take the character of real, new perceptions. The latter case is well-known in crystal-gazing, where long-forgotten memory ideas project themselves into the visual field like hallucinations. But for the theory of the subconscious, even these uncanny crystal visions do not mean more than the simplest awakening of the experience of a landscape image of yesterday.
We turn to a second group of facts and again we have no fault to find with the observation of the facts, even of the most surprising and exceptional ones. Our objection refers to the interpretation of them. This second group contains the active results of such physiological nervous dispositions. In the first group, the dispositions come in question only as conditions for a new excitement which was accompanied by mental experience. In this second group, the dispositions are causes for other physiological processes which either lead to actions or to influences on other mental processes. The dispositions are here working like the setting of switches which turn the nervous process into special tracks. In the simple cases, of course no one doubts that a purely physiological basis is involved. The decapitated frog rubs its skin where it is touched with a drop of muriatic acid in a way which is ordinarily referred to the trained apparatus of his spinal cord, as no brain is left, and the usefulness of the action and its adjustment is very well understood as the result of the connecting paths in the nervous system.
From such simple adjustment of reactions of the spinal cord, we come step by step to the more complex activities of the subcortical brain centers, and finally to those which are evidently only short-cuts of the higher brain processes. That we react at every change of position with the right movements to keep our bodily balance, that we walk without thinking of our steps, that we speak without giving conscious impulse for the various speech movements, that we write without being aware of the motor activity which we had to learn slowly, that we play the piano without thinking of the special impulses of the hands, that we select the words of a hasty speech, if we have its aim in mind, without consciously selecting the appropriate words—all that is by continuous transitions connected with those simplest automatic reactions. And from here again, we are led over gradually perhaps to the automatic writings of the hysteric who writes complex messages without having any idea of their content in consciousness. It is in such cases certainly a symptom of disease that the activity of these lower brain centers can go over into the motor impulse of writing without producing secondary effects in the highest conscious brain centers; it is hysterical. But that the message of the pencil can be brought about by such operation of lower brain centers, or at least with imperfect coöperation of the higher brain centers, is certainly entirely within the limits of the same physiological explanation.
On the other hand, nothing is changed in the theoretic principles of the case if the effect of these automatic processes in the nervous system is not an external muscle action at first, but an influence on other brain centers which may furnish the consciousness with new contents. We try to remember a name, that is, a large number of neuron processes are setting in which normally lead to the excitement of that particular process which furnishes us the memory image of the name. But those brain cells may not respond, the channels may be blocked somehow or the excitability of those cells may be lowered. Now new excitements engage our psychophysical system. We are thinking of other problems. In the meantime, by the new equilibrium in the brain the blockade in these first paths may slowly disappear or the threshold of excitability may be changed. The physiological excitement may now be carried effectively into those tracts. The cell response sets in and suddenly the name comes to our mind. This purely physiological operation in our brain paths must thus have exactly the same result which it would have had, if more parts of the process had been accompanied by conscious experience. And again from mere remembering a forgotten name, we come by slow steps to the solution of a problem, to the invention, and finally to the creation of the genius.
Superficiality of thought is easily inclined to object to such a physiological interpretation and perhaps to denounce it pathetically as a crude materialism which lowers the dignity of mental work. Nothing shows more clearly the confusion between a purposive and causal view of the mind. In the purposive view of our real life, only our will and our personality have a meaning and can be related to the ideas and higher aims. Nature is there nothing but the dead material which is the tool of our will and which has to be mastered by the personality. In that world alone lie our duty and our morality. But as soon as we have gone over to the causal aspect of our life and have taken the point of view of the psychologist, making our inner life a series of contents of consciousness, of psychical phenomena, we have transformed our inner experience in such a way that it has become itself nothing but nature.
It is mental nature, nature of psychical stuff, but each part of it is nothing but a mental element, a mental atom without any meaning and without any value; nothing but a link in the chain, nothing but a factor in the explanation of the whole, nothing to which any ethical or æsthetic or logical or religious significance can any longer be attached. The psychical sensations and the physical atoms are equally material for naturalistic explanation. To understand causally a certain effect, for instance the creation of a work of art, of a discovery or a thought or a deed as the product of psychical processes, is thus in no way more dignified or more valuable than to understand it as the product of physiological brain processes. The one is not more dignified than the other because both alike have nothing whatever to do with dignity. Both alike are the necessary results of the foregoing processes, and to attach a kind of sentimental preference to the explanation through conscious factors is nothing but a confused reminiscence again of the entirely different purposive view of life. And surely nothing is gained for the higher values of life if this confusion sets in, because if the popular mind becomes unable to discriminate between the secondary, causal, artificial aspect of science and the primary, purposive aspect of life, the opposite effect lies still nearer: the values of the real life suffer and are crowded out by the knowledge of the scientific facts. Man's moral freedom is then wrongly brought in question, as soon as it is learned that every action is the product of brain processes. Life and science alike will gain the more, the more clearly the purposive and the causal point of view are separated and the more it is understood that this causal aspect itself is demanded by certain purposes of life. The oratory of those who denounce the physiological theories as lacking idealism in reality undermines true moral philosophy. There is no idealism which can really flourish merely by ignoring the progress of science and confusing the issues. The true values of the higher life cannot be safely protected by that thoughtless idealism which draws its life from vagueness and which therefore has to be afraid of every new discovery in scientific psychology. Our real ideals do not lie at all in the sphere in which the problem of causally explaining the psychological phenomena arises.
Our conscious experiences are thus indeed not only here and there, but usually the products of chains of processes which go on entirely on the physiological side. We have no reason at all to seek for those preceding actions any mental accompaniment outside of consciousness, that means, any subconscious mental states. Then, of course, this physiological explanation also covers entirely those after-effects of earlier experiences, especially emotional experiences, which the physician nowadays likes to call subconscious "complexes." We shall see what an important rôle belongs to these facts, especially in the treatment of hysteria and psychasthenia, but the interpretation again ought to avoid all playing with the conception of the subconscious. Emotional experiences may produce there some strong stable dispositions in the brain system which become mischievous in reënforcing or inhibiting certain thoughts and actions without awakening directly conscious experiences. The whole psychological switch system may have been brought into disorder by such abnormal setting of certain parts, but the connection of each resulting accident with the primary emotional disturbances does not contradict the fact that all the causes lie entirely in disturbances of the central paths. It is a change in the neurons and their connections. To discover it we may have to go back to early conscious experiences, but in the process itself there is no mental factor, and therefore no subconscious emotion is responsible for the mischief carried out.
Both groups of facts which we have studied so far, have dealt with processes which were indeed not conscious but which we had no right to call subconscious inasmuch as they contained no mental process at all but only physiological dispositions and actions. We turn finally to the other smaller and more abnormal group of so-called subconscious facts in which the facts are mental indeed and not only physiological, but not at all outside of consciousness and thus again not subconscious. A conscious fact may easily suggest the appeal to subconscious theories to those who have accepted such theories for other reasons. There are, for instance, plenty of mental experiences which we do not notice or which we do not recognize. Yet if we find later that they must have influenced our mind, we are easily inclined to refer them to subconscious activity. But it is evident that to be content of consciousness means not at all necessarily to be object of attention or object of recognition. Awareness does not involve interest. If I hear a musical sound, I may not recognize at all the overtones which are contained in it. As soon as I take resonators and by them reënforce the loudness of those overtones, they become vivid for me and I can now notice them well even when the resonators are removed. I surely was aware of them, that is, had them in consciousness all the time but there were no contrast feelings and no associations in consciousness which gave them sufficient clearness to attract attention.
In this way I may be again led by gradual stages to more and more complex experiences. I may overlook and yet include within my content of consciousness most various parts of my surroundings; and yet the neglected is not less in consciousness itself than the attended. Much that figures in literature as subconscious means indeed nothing else but the unattended. But it belongs to the elements of psychological analysis to recognize that the full content of consciousness is always larger than the narrow field of attention. This narrow field on the other hand has certainly no sharp demarcation line. There is a steady shading off from the most vivid to the least vivid. We cannot grasp those least vivid contents of consciousness, we cannot fixate them as such, because as soon as we try to hold them, they move from the periphery of the content into its center and become themselves vivid and clear. But as we are surely aware of different degrees of clearness and vividness in our central mass of contents, we have no difficulty in acknowledging the existence of still lower degrees of vividness in those elements which are blending and fusing into a general background of conscious experiences. Nothing stands out there, nothing can be discriminated in its detail. That background is not even made up of whole ideas and whole memories and whole emotions and feelings and judgments and volitions, but of loose fragments; half ideas and quarter ideas, atoms of feelings and incipient impulses and bits of memory images are always mixed in that half-dark background. And yet it is by principle not less in consciousness, and consciousness itself is not different for these contents. It is not half-clear consciousness, not a lower degree of awareness, only the objects of awareness are crumbled and fading.
Whether these background objects really exist can only be made out by studying carefully the changes which result under different conditions, the influences which those loose parts have on the structure of the whole, and the effect of their complete disappearance. I may never really notice a little thing in my room and yet may be aware that it has been taken away. The visual image of it was an element of my mental background, when I was sitting at my desk, but it never before moved to the center of my conscious content. But this center itself is also constantly changing. Sometimes the one, sometimes the other idea may enter into it, but in this alternation that which is not in the focus either remains in consciousness unattended or when it disappears from it it loses its mental character altogether. If I attend a tiresome lecture while my mind is engaged with a practical problem of my own life, there may be a steady rivalry between the words which come with the force of outer stimulus to my brain and make me listen and my inner difficulties which claim my attention. I listen for a while, and then suddenly, without noticing it, my own thoughts may have taken the center of the stage and again without sudden interruption a word may catch my attention. While I was thinking of my own problem the sounds of the lecturer were really outside of my field of attention, yet some remark now pushes itself again into the center. That does not mean that a subconscious mind is listening while my lucid mind was thinking, but it does mean that those words were unattended and remained in the periphery of the field of consciousness. But when some of the sentences stirred up in that peripheral field some important associations, they were strong enough to produce a new motor reaction by which the mental equilibrium became changed again and by which the lecturer overwhelmed my private thoughts. Yet even this state of mind, without any break, can go over into an absolutely physiological process. I may for a while really inhibit the lecturer's voice completely and remain in the thoughts of my own imagination. After a minute or two, the resistance against the acoustical stimulus will certainly be broken and the sound will again enter into my consciousness, but in that interval there was no subconscious and not even any unattended mental function; there was no mental process at all. The sound reached my brain but as the motor setting was adverse, the sounds did not bring about that highest act of physiological transmission which is accompanied by mental contents. Thus it became entirely physiological. Yet of course every word reached my brain and left traces there. If I were hypnotized after the lecture and thus the threshold for the real awakening of brain excitements lowered, it might not be impossible that some of the thoughts of the lecturer which did not enter my consciousness at all, are now afterwards in the hypnotic state stirred up in me. Yet even that would not indicate that they had become mental and thus subconscious at the time of the lecture.
The so-called subconscious, which in reality is fully in consciousness but only unnoticed, easily shades over into that unconscious which is also in consciousness but dissociated from the idea of the own personality and thus somewhat split off from the interconnected mass of conscious contents. Wherever we meet such phenomena, we are in the field of the abnormal. The normal mental life is characterized by the connectedness of the contents. Yet even that holds true, of course, only if we think of those mental states which exist at one and the same instant in consciousness. As soon as we consider the succession of mental events, we cannot doubt that even normal experience shows breaks, lapses, and complete annihilation of that which a moment before was a real content in our consciousness. We may have looked at our watch and certainly had in glancing at the dial a conscious impression, but in the next moment we no longer know how late it is. The impression did not connect itself with our continuous personal experience, that is, with that chief group of our conscious contents which we associate with the perception of our personality. Under abnormal conditions of the brain, larger and larger parts of the completely conscious experience may thus be cut off from the continuity of conscious life. But to be in consciousness, and therefore to be not-subconscious, does not mean to be through memory ties connected with the idea of our own personality.
The somnanbulist, for instance, may get up at night time and write a letter, then go to bed again and not know anything of the event when he awakes in the morning. We have no reason to claim that he had no knowledge of the letter in his consciousness when he wrote it. It is exactly the same consciousness from a psychological standpoint as the one with which he wakes up. Only that special content has in an abnormal way entirely disappeared, has not left a possibility of awakening a memory image, and the action of the personality in writing has thus become separated and cut off from the connected experiences of the man. But while the nocturnal episode may be entirely forgotten, it was not less in consciousness for the time being, than if a normal man should leave his bed hastily to write a letter. Moreover under abnormal conditions, as for instance in severe hysteric cases, those dissociated contents may form large clusters of mental experiences in the midst of which a new idea of the own personality may develop. Considering that through such disconnection many channels of discharge are blocked, while others are abnormally opened, it seems only natural that the idea of the own acting personality becomes greatly changed. Thus we have in such an episode a new second personality which may be strikingly different in its behavior and in its power, in its memories and in its desires, from the continuous normal one, and this secondary personality may now develop its own continuity and may arise under special conditions in attacks which are connected among one another by their own memory bonds.
The two personalities may even alternate from day to day and the normal one may itself become pathologically altered. In that case the two alternating personalities would both be different from the original one. But again we have even in such most complex and exceptional cases only an alternation in the contents, not an alternation in the consciousness itself. Different ideas of the own personality with different associations and impulses follow each other in consciousness and the abnormality of the situation lies in the lack of memory connections and of mutual influences, but consciousness remains the same throughout. It remains the same, just as we do not change consciousness if we feel ourselves in one hour as members of our family, in the next hour as professional workers in our office, again later as social personalities at a party or as citizens at a political meeting or as æsthetic subjects at the theater. Each time we are to a high degree a different personality, the idea of our self is each time determined by different groups of associations, memories, emotions, and impulses. The differentiation is to be considered as normal only because broad memory bridges lead over from one to the other. The connection of the various contents with the various ideas of the own personality constitutes thus in no way a break of consciousness itself and relegates no one content into a subconscious sphere.
Finally the same holds true, if the idea of the personality as content of consciousness in the patient is split into two simultaneous groups, of which each one is furnished with its own associations. Yet the interpretation here becomes extremely difficult and arbitrary. Take the case that a patient in severe hysteria at our request writes down the history of her life. We should not hesitate to say that she is doing it consciously but now we begin to talk with her and slowly the conversation takes her attention while her pencil is continuing to write down the connected story of her youth. Again the conversation by itself gives the impression of completely conscious behavior. As both functions go on at the same time, the person who converses does not know what the person who writes is writing, and the writer is uninfluenced by the conversation. Various interpretations are possible. Indeed we might think that by such double setting in the pathological brain two independent groups in the content of consciousness are formed, each one fully in consciousness and yet both without any mutual influence and thus without mutual knowledge. In the light of such interpretation, it has been correctly proposed to speak of coconscious processes, rather than subconscious. Or we may interpret it more in harmony with the ordinary automatic writing or with other merely physiological reactions. Then we should suppose that as soon as the conversation sets in, the brain centers which control the writing movement work through channels in which no mental factors are involved. One of the two characteristic reaction systems would then be merely physiological. We saw before that the complexity of the process is no argument against the strictly physiological character of the event. That various activities can coexist in such a way that one of them may at any time slide down from the conscious centers to the merely physical ones, we all know by daily experience. We may go home through the streets of the busy town engaged with our thoughts. For a while the idea of our way and of the sidewalk is in our consciousness, when suddenly we reach our house and notice that for a long while we have no longer had any thought at all of the way. We were absorbed by our problems, and the motor activity of walking towards our goal was going on entirely in the physiological sphere. But whether we prefer the physiological account or insist on the coconscious phenomena, in either case is there any chance for the subconscious to slip in? That a content of consciousness is to a high degree dissociated or that the idea of the personality is split off is certainly a symptom of pathological disturbance, but it has nothing to do with the constituting of two different kinds of consciousness or with breaking the continuous sameness of consciousness itself. The most exceptional and most uncanny occurrences of the hospital teach after all the same which our daily experience ought to teach us: there is no subconsciousness.
We have discussed the psychological tools with which the psychotherapist has to work but we have not spoken as yet of psychotherapy itself. All that we have studied has been by way of preparation; and yet the right preparation is almost the most important factor for the right kind of work. To rush into psychotherapy with hastily gathered conceptions of mental life may be sometimes successful for the moment, but must always be ultimately dangerous. It is often most surprising what a haphazard kind of psychology is accepted as a basis for psychotherapy even by scientifically schooled physicians who would never believe that common sense would be sufficient to settle the problems of anatomy and physiology; as soon as the mind is in question, no serious study seems needed. Can we be surprised then that in the amateur medicine of the country within and without the church any fanciful idea of mental life may flourish? If we are to recognize the rights and wrongs of psychotherapy in a scientific spirit, a sober analysis of the mental facts involved was indeed at the very first most essential. Now we can easily draw the conclusions from our findings.
We recognized from the start the fundamental difference between two different attitudes which we can take towards the inner life of any personality, the purposive view and the causal. We recognized the sphere to which each belongs and we saw that all medical treatment demands the causal view, thus dealing with inner life as part of the causal chain of events. Each inner experience became therefore a series of so-called contents of consciousness. These contents can be described and must be analyzed into their elements. The basis of psychotherapy is therefore an analytic psychology which conceives the inner experience as a combination of psychical elements.
But the final aim was the causal connection. The appearance and disappearance of those millions of elements and their connection had to be explained. We recognized that such an explanation of the contents of consciousness was possible only through the connections between the accompanying brain processes. Every psychical change had to be conceived as parallel to a physiological change. The psychology which is to be the basis of psychotherapy had to be therefore a physiological psychology.
We recognized that these psychophysiological processes were processes of transmission between impressions and expressions, that is, between incoming nervous currents and outgoing nervous currents, between stimuli and reactions. Thus we have no central process which is not influenced by the surroundings and which is not at the same time the starting point of an action. We have normal health of the personality as long as there is a complete equilibrium in the functions of the organism which adjusts the activities to the surroundings. Every abnormality is a disturbance of this equilibrium. A psychology which is the basis of psychotherapy thus conceives every mental process in relation to both the ideas and the actions; it avoids all one-sidedness by which the mind is cut off either from its resources or from its effects. The relations to the impressions are usually the less neglected: and we must the more emphasize the fact that the psychology needed for psychotherapy knows no mental fact which does not start an action and that every change in the system of actions involves a change in the central experience. Wherever this equilibrium of adjusted functions is disturbed, some therapy of the physician has to set in: whether psychotherapy is in order depends upon the special conditions.
We have recognized that there are no mental facts outside of those which are in consciousness and that from a psychological point of view consciousness itself does not have different degrees and different levels, that all varieties of experience refer thus only to the special content and its organization. There is thus no subconscious. On the other hand, we saw that there is no conscious experience which is not based on a bodily brain process. By these two fundamental facts of scientific psychology, every possible psychotherapy gets from the start its clear middle way between two extreme views which are popular today. The one school nowadays lives from the contrast between consciousness and subconsciousness and makes all psychotherapy work with and through and in the subconscious. The other school creates a complete antithesis between mind and body and makes psychotherapy a kind of triumph of the mind over the body. Practically every popular treatise on psychotherapeutic subjects in recent years belongs to the one or the other group; and yet both are fundamentally wrong. And while, of course, this mistake is one of theoretical interpretation, it evidently has its practical consequences. The fantastic position allowed to a subconscious mind easily gives to the doctrine a religious or even a mystical turn and the artificial separation between the energies of the mind and those of the body leads easily to a moral sermon. Whether this amalgamation of medicine with religion or with morality may not be finally dangerous to true morality and true religion is a question which will interest us much later. Here we only have to ask whether it is not harmful to the interests of the patient and thus to the rights of medicine, and indeed that must be evident here at the very threshold. Both schools must have the tendency to extend psychotherapy at the expense of bodily therapy and to narrow down psychotherapy itself to a therapy by appeals which in the one case are suggestions to the subconscious and in the other case persuasions and encouragements to the conscious will. As soon as we have overcome the prejudices of those two rival schools and have recognized that both are wrong, that there is no subconscious and that there is no psychological fact which is not at the same time a physiological one, we see at once that this common procedure of both schools is unjustified and dangerous. Mental therapy and physical therapy ought to be most intimately connected parts of the same therapeutic effort and mental therapy includes by far more than mere suggestions and appeals. All that involves of course that its systematic application belongs in the hands of the well-trained physician and of nobody else, but on the other hand, it involves that every physician ought to be well schooled in psychology.
As soon as a disturbance to be cured is considered as a lack of equilibrium in psychophysical functions, every mental influence, every suggestion and appeal becomes itself an excitement or an inhibition of nerve cells. The sharp demarcation line between a psychical agency and a physical one disappears altogether; the spoken word is then considered as physical airwaves which stimulate certain brain centers and in the given paths this stimulation is carried to hundreds of thousands of neurons. The protracted warm bath or the cold douche influences, too, large brain parts by changing the blood circulation which controls the activity of those neurons; or the bromides absorbed in the digestive apparatus, or the morphine injected, also reach the neurons and again have a different kind of influence on them, and the electric current may stimulate the nervous system in still a different way. It may be, and under many conditions certainly is, essential to influence the brain cells just in that particular way which results from the spoken word, but there too the causal influence remains a function of the physical effect and thus by principle there is no sharp separation from other physical means. Thus to believe in psychotherapy ought never to mean that we have a right to make light of the other means which, as experience shows, may help towards the treatment of disturbances in the central equilibrium. Suggestions and bromides together may secure an effect which neither of them alone will bring about. It is most unfortunate that not without some guilt on the part of the physicians themselves, the large public has begun to believe that orthodox psychotherapy has to mean a rejection of drugs and a contempt for the doctors who prescribe them.
Of course a discussion of psychotherapy cannot enter into the study of these physical agencies of treatment, but at the threshold, we have to insist that there exists no opposition between psychophysiological and physiological means of influencing the brain. It may be true that drugs and baths and electricity have no influence on the subconscious, but the trouble is not that the drugs are inefficient but that they cannot influence what does not exist. In the same way disappears now that new boundary line for psychotherapy which wants to limit it to mere suggestion and appeal. If psychotherapy employs all the means by which we can influence mental states in the interest of the health of the personality, we have no reason to confine it either to a persuasion of the subconscious through suggestion and hypnotism or a persuasion of the conscious, in which it works as a moral appeal. Suggestion and hypnotism certainly must play a large part in psychotherapy and that part does not become smaller by the fact that we reject the subconscious interpretation of them and consider them entirely as psychophysical processes. And in the same way undoubtedly we have to acknowledge the psychophysiological effect of persuasion and of the appeals to the conscious intellect and will. But for us as psychotherapists all those factors have no moral value but only a therapeutic one, and thus stand in line with any other influence that may help, even though from a purposive point of view it stands on a much lower level. A mere mental distraction by enjoyment and play and sport, an æsthetic influence through art, a mere stimulus to automatic imitation, an enforced mental rest, an involuntary discharge of suppressed ideas, and many similar schemes and even tricks of the mental physician belong with the same right to psychotherapy.
It is really doubtful whether the moral and religious appeals are always helpful and not sometimes or often even dangerous for the health of the individual; and it is not doubtful that morally and religiously indifferent mental influences are often of the highest curative value. The more we abstract from everything which suggests either the mysticism of the subconscious or the moral issues of a mind which is independent of the body, the more we shall be able to answer the question as to the means by which health can be restored. This question is neither a moral nor a philosophical one but strictly one of experience. In this connection, we must remember that we also have had to give up the artificial demarcation line between organic and functional diseases. We recognized that every so-called functional disease has its organic basis too, and that it is entirely secondary whether we are able to find visible traces of the organic disturbance. We had to acknowledge, to be sure, the difference between reparable and irreparable disturbances, but such grouping expresses only in another form the fact that experience alone can show whether the methods of treatment which we know so far will be successful or not. Not a few disturbances of the equilibrium which appeared irreparable to an earlier time yield to the treatment of to-day, and no one can determine whether much which appears irreparable today may not be accessible either to psychotherapeutic or to physical therapeutic means to-morrow. If we were carelessly to identify the reparable troubles with those which we cannot recognize visibly, we should be at a loss to understand why, for instance, many forms of insanity are entirely beyond our psychotherapeutic influences. On the other hand, every physician who uses psychotherapeutic means is surprised to see the effective bodily readjustment where serious disturbances perhaps of the circulatory system or the digestive system existed. What the methods can do and what they cannot do must simply be left to experience, but of course to an experience which is eager to expand itself by ever new experimental curative efforts.
From this point of view we can see clearly the general division of the whole field of possible psychotherapy. Psychotherapy influences psychophysical states in the interest of health. There are only two possibilities open: either the disturbance is in the psychophysical system itself or it is outside of it, that is in the other parts of the body which are somehow under the influence of the mind. In the first case when the disturbance occurs in the mind-brain system itself, we ought to separate two large groups, first those cases in which the system itself is normal and the disturbance comes from without, and second those in which the constitution of the system itself was abnormal and led to disturbances under conditions in which a normal system would not have suffered. We have to consider both groups somewhat more in detail, as each again allows a large variety of cases.
Thus we have before us, first the normal mind-brain system into which a disturbance breaks, injuring more or less severely and for a longer or shorter time the equilibrium of the psychophysical functions. Here belong any bodily processes which produce pain or any bodily defects which produce blanks in the content of consciousness; the pain of sciatica or of rheumatism, or the defect of the blind or of the deaf, certainly interferes in a disturbing way with the perfect harmony of psychophysical activities. But here also belongs the suffering which results from conditions in the surroundings, the loss of a friend, a disappointment in life, any source of worry and grief. Social and bodily conditions alike may thus work to break up the equilibrium. The pain sensation interferes with the normal flow of mental life and the grief may undermine the mental interests. The psychotherapeutic effort may be directed toward removing the source of the disturbance, bringing the patient under other conditions, curing the diseased organ, and where that is not possible, may work directly on the psychophysical state, inhibiting the pain, suppressing the emotion, substituting pleasant ideas, distracting the whole mind, filling it with agreeable feelings, until the normal equilibrium is restored.
The psychophysical system itself was not really harmed by such influences. In the following groups, such is no longer the case. We here think at first of those severe injuries which have their sources in abnormal processes outside of the brain. The anæmia of the patient or the low state of his nutrition or the fever heat of his blood impairs the harmony of the mental functions. Another and for the psychotherapist much more important group is that in which the impairment results from toxic influences. Alcohol, morphine, cocaine, tobacco, and many other drugs may have been misused and may have produced a most marked alteration in the mind-brain system. Desires may have developed which completely destroy the balance of the normal functions and yet the satisfaction of which increases the poisoning effect. But here belongs further the effect of poisons which the body itself produces: the toxic disturbance of uræmia or the coma in diabetes, or especially the grave disturbances resulting from the abnormal action of the thyroid gland, the source of cretinism. Many indications suggest that a near future will consider this group much larger than we are really justified in doing today, probably soon connecting a number of other mental diseases like dementia præcox with toxic effects of bodily origin. Experience shows that in this group not a few chances exist for successful psychotherapeutic influence. Yet the means may be various in character and their effect may be a direct or an indirect one. A psychical shock may remove directly the mental disturbance of the alcoholic state, but it is more important that mental suggestion can remove the alcoholic disturbance indirectly by suppressing the desire for alcoholic excesses. Even where cure by psychotherapeutic means is out of the question, as is the case with feverish delirium or uræmic excitements, no skilled physician ignores the aid which a well-adjusted mental influence can offer to the patient.
We come to a third group. Some outside cause has harmed the central nervous system directly, and has left it in a disabled state after the cause itself has disappeared. Such causes may have been at first purely functional: for instance, a neglect of training, or a wrong training, or an over-activity, but the ill-adjusted function which involved, of course, every time an ill-adjusted organic activity or lack of activity, has led to a lasting or at least relatively lasting disturbance in the system of paths. The neglect of training, for instance, in periods of development may have resulted in the retardation which yields the symptoms of a feeble-minded brain, or the wrong training may have created vicious habits, firmly established in the mind-brain system and gravely disturbing the equilibrium. Above all, the overstrain of function, especially of emotional functions, may lead to that exhaustion which produces the state of neurasthenia. It is true that not a few would doubt whether we have the right to class neurasthenia here where we speak of the harm done to the normal brain. Many neurologists are inclined to hold that neurasthenia demands a special predisposition and is therefore dependent upon a neurotic constitution of the brain itself. But if defenders of such a view, as for instance, Dubois, acknowledge that "we might say that everybody is more or less neurasthenic," we can no longer speak of any special predisposition. Certainly there exists a constitutional neurasthenia sometimes but we have hardly a right to deny that overstrain in the brain activity may produce a series of neurasthenic symptoms in any brain, and the special predisposition is responsible rather for the particular selection among the innumerable symptoms.
Neurasthenia certainly is the classical ground for the psychotherapist. The patient's insomnia and his headache, his feeling of tiredness and his disgust with himself, his capricious manias and his absurd phobias, his obsessions and his fixed ideas all may yield to the "appeal to the subconscious," and as a neurasthenic easily believes in the existence of various organic diseases in his body, Christian Science can perform here even "miracles." In the case of retardation, the psychical influence will have to be in the first place one of training. Yet it would be narrow to overlook that in neurasthenia, too, suggestion has to be only a part of the psychical treatment. Training and rest, distraction and sympathy and many other factors have to enter into the plan. Incomparably small, on the other hand, is the aid which psychotherapy can offer in cases of real destructions in the brain, as in the case of tumors, hemorrhage, paresis or the degeneration by senility. More effective may be its work in concussion of the brain and especially with traumatic neuroses, as in the case when a railroad accident has put the mind-brain system out of gear.
So far we presupposed that the central system itself was normal. No sharp separation line, however, lies between all these disturbances and the equally large group of psychophysical disabilities resulting from a defective constitution of the brain. The normal brain shades over by smallest differences into the abnormal one; yes, even the varieties of temperament and character and intellectual capacity and industry and energy represent, in the midst of our social surroundings, large deviations from the standard. That which might still pass as normal under certain conditions of life would be unadjusted and thus abnormal under other conditions. In the same way, we certainly cannot point out where the natural constitution of a brain ceases to be fit for its organic purposes and where the structural variations are ill-prepared for the struggle for existence. Just as we claimed that an entirely normal brain might be brought by an emotional overstrain to a state of exhaustion and disability, we may claim on the other side that a brain which nature has poorly provided may yet be protected against damage and injury. The inborn factor does not alone decide the fate. Psychophysical prophylaxis may secure steadiness of equilibrium to a system which inherited little resistance. Yet this large borderland region, where an ill-adjusted brain may be saved or lost in accordance with favorable or unfavorable circumstances, shades off again to the darker regions where the inner evolution leads by necessity to disaster even under favorable conditions.
We might begin this large group of the constitutional disturbances with that neurasthenia which develops on the basis of inherited disability. Lack of energy resulting from a feeling of tiredness, a quick exhaustion, a mood of depression, an easy irritation, even despair and self-accusation, sullenness and fits of anger, cranky inclinations and useless brooding over problems, headache and insomnia characterize the picture which everyone finds more or less developed in some of his acquaintances. If we classify symptoms, we may separate from it that which we nowadays are inclined to call psychasthenia. An abnormal suggestibility for autosuggestions stands in the foreground. Fixed ideas and fixed emotions, especially fears, trouble the patient. He may pick up his obsession by any chance experience and no good-will liberates him from the intrusion perhaps for years. The patient is perfectly well aware that his ideas and his emotions are unjustified, he himself does not believe in them, and yet they come with the strength of an outer perception and with the vividness of a real attitude, and his whole mental equilibrium may be upset by the continuous fight against these involuntary interferences. In the light cases, sometimes the one and sometimes the other autosuggestion may hold the stage; in the severe cases, mental life turns more and more around certain definite fears and yet it may all still be in the limits where the daily work can go on and the world may not know of the hidden tortures. Here belongs the fear of open places or the fear of touching certain objects, the fear of doing harm to others or the fear of deciding actions wrongly, the fear of destroying valuable things or the fear of being the center of public attention, the fear of crowds or of closed doors, of altitudes or of bridges. And in all cases emotional reaction may set in with anxieties, and bodily symptoms such as palpitation of the heart may result, whenever an effort is made to disregard the nervous fear. There is perhaps no group of patients which so much deserves the most careful efforts of the psychotherapist. Still more than the hysterics they suffer from the fate of seeing their ills counted as not real. For them everybody has the good advice that they ought to overcome their fancies; and yet they feel their life ruined with their endless fight against the overpowering enemy. And if anywhere, it is here that the psychotherapist is successful. Psychasthenic fear can be removed, while the developed melancholic depression, for instance, is entirely beyond the reach of psychical influence.
We have after all the same psychasthenic state before us when the obsession has impulsive character, from the mere abnormal impulse of lying, or making noise in a quiet place or crying in the dark, or touching certain places, to that of stealing, indecent speech, arson, and perhaps even murder. The symptoms might easily be mistaken for those of graver diseases. Yet the fact that the patient himself really does not will the effect at which he is aiming separates, mostly without difficulty, the diagnosis of psychasthenia from that of insanity. Quite nearly related to it are the manifold variations of abnormal and perverse sexual tendencies. The psychiatrists are perhaps too much inclined to bring all these pathological impulses and desires, fears and anxieties, into the nearest neighborhood to real insanity. The indisputable success of psychotherapy in these spheres ought to add a warning against these expansions of the strictly psychiatric domain. The psychologist will be more inclined to emphasize their relation to simple neurasthenia which itself imperceptibly shades over into our normal life.
All neurasthenic and psychasthenic disabilities show a certain emotional continuity and uniformity. It is the emotional instability and the quick alternation of symptoms which characterize hysteria or rather the hysterias. It seems as if science were near to the point of explaining the hysterical disease by one common principle, but certainly the symptoms are an inexhaustible manifold. The rapid changes of the intense moods of the patient usually stand in the center. Torturing obsessions, abnormal impulses, over-suggestibility, hypochondriac depressions, paralysis of arms or legs, anæsthesia and paræsthesia, a mental stupor and confusion, illusions and perceptions of physiological symptoms may work together in spite of his, or rather her clear intelligence. It is probably on a hysteric basis also that somnambulic states arise during the night, and from them a straight way leads to those mental attacks after which the memory is entirely lost, or for which fundamental associative connections are cut off. And from here we come to the exceptional cases of alternating personality. The more we recognize the myriad symptoms in the hysteric patient as products of the emotional instability, of autosuggestibility and of inhibition, the more we understand the almost miraculous result of psychotherapeutic treatment. Autosuggestions can be fought by countersuggestions, anæsthesia and paræsthesia can be removed often in an instant, dissociated personalities may be built up again through hypnotism, the most severe bodily symptoms may disappear by influences in a waking state. Hysteria alone would justify the demand that every physician in his student days pass with open eyes through the field of psychology. Quite near stand chorea and the epidemic impulses to imitative movements. And we might bring into this neighborhood also the disturbance in the equilibrium of the speech movements through all degrees of stammering and severe impairment. Up to a certain degree, though not often completely, they too yield easily to psychotherapeutic influence.
We enter now that region of constitutional disturbances in which psychotherapy is of small help. It leads from epilepsy to the periodic diseases, especially the maniacal depressive insanity, the paranoia which develops late, and finally to states of idiocy which cover the whole life. We are far from claiming that psychical influences are entirely powerless, the more as we insisted that psychotherapy goes much beyond mere suggestions and appeals. No psychiatrist will work without psychological tools when he deals with the exultations of the maniac and the depressions of the melancholic, with the hallucinations of persecution or the erotic insanities of the paranoiac. Still more the whole register of psychology has to be used, when we are to educate the idiot and the imbecile. But the disappearance of the disease or of the chief symptoms through the mental agencies is in all these cases out of the question. Only in incipient cases, especially of melancholia and mania, the psychotherapeutic work seems not entirely hopeless; and for epilepsy some distinct successes cannot be denied.
We have reviewed the whole field of psychophysical disturbances, those produced through external conditions in the normal brain and those resulting from abnormal brain constitution. We have seen that the work of the psychotherapist is of very unequal value in different parts of the field; in some, as in neurasthenia, in psychasthenia, in hysteria and similar regions most effective, in others like paresis or paranoia reduced to an almost insignificant factor. Where it can help and where not we recognize as a mere question of experience. Certainly the severity of the symptoms alone does not decide it. As the treatment is entirely empirical, no one can foresee whether or not the situation may change to-morrow. We may find psychotherapeutic schemes by which epilepsy or maniacal depressive insanity or traumatic neuroses may become accessible. We simply do not know why we may remove stammering or synthesize a dissociated personality or overcome an inborn sexual perversity, while we are unable to remove the depression of the melancholic. Certainly the symptoms of the circulatory insanity disappear completely in the free intervals; there is no reason to give up hope that psychotherapy might find the way to hasten the appearance of such a normal period.
But we have emphasized from the start that the psychotherapeutic work has not only to set in when the disturbance itself lies in the psychophysical system. We may utilize the influence which the mind-brain system has for the whole body and thus may apply the psychical tool to work on the disturbances in the bodily apparatus. We may discriminate a direct and an indirect influence in the psychical treatment of bodily diseases. Transition from the foregoing group of psychical disturbances offers itself perhaps most easily through the state of insomnia.
The causes of sleeplessness may still lie in the psychophysical sphere; restless thoughts may inhibit the idea of sleep. The effect of sleep is again in the sphere of the mind, the annihilation of conscious contents. But the center which regulates and creates the sleep, probably by contracting the blood-vessels, lies outside of the psychophysical system in the lower centers of the brain. The real disturbance thus lies in the inactivity of this purely bodily apparatus and mental influence which is to create sleep has therefore to work downwards from the mind to a bodily organ. In the same way many other non-psychical centers of the brain may be brought to efficiency through psychophysical regulation.
But the therapeutic effect is certainly not confined to the central nervous system. Whithersoever the centrifugal nerves lead there the mind-brain system may have its curative influence. In the most startling way that is true for the digestive apparatus. The secretions of the stomach, the activity of the intestines can be influenced to a decree which it is difficult to explain. Important also is the relation to the circulatory system, especially the disturbances of the heart: innervation may be corrected, abnormal dilations and contractions of blood-vessels may be regulated. The bladder, uterus, even the pancreas and the liver seem to be influenced by the peripheral effects of the central excitement. And while no warning can be serious enough against the absurd belief that diseases like cancer or tuberculosis can be cured by faith, it must be admitted that psychical influences under special conditions may have a retarding influence on any pathological process in the organism. Much of that certainly is indirect influence but the physician would be reckless if he should ignore the aid which may result from such indirect assistance. Even if psychotherapy could not do more in the treatment of bodily diseases than to secure a joyful obedience to the strict demands of the physician, it would yet have to be accredited with an extremely important service.
In a parallel line comes the effective aid by the stimulation of hope and the suppression of fear, by suggestion of a feeling of encouragement and the inhibition of the emotions of worry. This is a field where even the average physician is most easily inclined to play the amateur psychotherapist. He knows how convalescence is disturbed by psychical depression and how much more quickly health returns, if it is confidently expected; he knows how many dangerous operations are disturbed by despondency and helped by bravery; he knows what a blessed change has come into the treatment of tuberculosis since a psychical factor of social interest has set in; he knows how many ills disappear when regular occupation and interesting work are established or the strain of distasteful work removed. Even the mere suppression of the pain works backwards on the bodily disease which produces it. The pain was a starting point for disturbing reactions; with its disappearance through psychotherapeutic influence, the reactions of the irritated brain come to rest, the diseased body can carry on its struggle without interference and may win the day. Often the psychical influence may not even change the symptoms at all but may remove other troublesome effects. The sufferer from locomotor ataxia may learn to walk again through mental education without any restitution of his spinal cord. In short, there are endless ways in which psychical influence may work towards the general health and towards the victory over bodily disease; and all that may be acknowledged without the slightest concession to the metaphysical creeds of mental healers and Christian Scientists. But to make use of those means and to harness such influences, it cannot be enough to rely on the common-sense of the physician any more than we should trust the common-sense of the surgeon to use his knife without condescending to the study of anatomy. The psychological study of the anatomy of the soul shows a not less complicated system of mental tissues and mental elements.
To enter into the full richness of this whole, large field of course lies entirely beyond the scope of our short discussion, which seeks as its only aim a clear recognition of the principles. Yet it seems essential to illustrate at least this sketch of the field by a more detailed account of actual developments. Various ways of procedure might appear in order and the most natural one would be, of course, to pass down from disease to disease and sketch special cases from diagnosis to cure. We might go through the various stages of neurasthenia and then through psychasthenia and then through hysteria and so on. And if we had to write a handbook for physicians, it would certainly be the desirable way, in spite of the too frequent repetitions which would become necessary. But as our aim is only a discussion of principles of psychotherapy, we have no right to use this method. Moreover, such a method would suggest the misleading view that the psychotherapist is called and is able to treat diseases. All that he treats are symptoms and he ought not to pretend that he can do more, as long as he abstracts from all other therapeutic agencies. Psychotherapeutic influence may remove the phobia of a psychasthenic or the obsession of a neurasthenic or the emotion of a hysteric, and thus may bring not only momentary relief but a change which may be favorable for general improvement, but certainly the neurasthenia and psychasthenia and hysteria are not really removed by it. Of course, even the treatment of symptoms demands a constant reference to the whole background of the disease. The depression of the neurasthenic must not be treated like the depression of the melancholic, the obsession of the psychasthenic must not be mixed with the fixed ideas of a paranoiac, the hysteric inability to walk must not be confused with an injury of the motor nerves; in short, each symptom has to be treated as part of a complete situation. The efforts of the psychotherapist will move over as large a part of the disease as possible and cover, perhaps, the causes of the disturbance as far as they are of psychical origin. Yet it would remain dilettanteism if we were to accept the popular view that the mere psychotherapeutic aid is a sufficient treatment of the whole disease. The physician has to be much more than a psychotherapist. Our discussion only seeks to point out that whatever else he may be, he must be also a psychotherapist.