The power of mind over body for the relief of symptoms has been recognized, not only by physicians, but by the generality of men at all times. Every one has had experiences of aches, or actual pains, or discomfort quite annoying while one is alone, but that disappear while in pleasant company or occupied in some absorbing occupation. Many a headache that was painful enough to disturb us seriously while we tried to apply ourselves to something of little interest, and became almost unbearable if we tried to do something disagreeable, and actually intolerable if the occupation of the moment was a drudgery, disappeared, at least for the time, when we turned to a pleasant game of cards or indulged in some other favorite pastime. Our relief was not, however, from an imaginary ill, for the symptoms usually reasserted themselves when we got through with the pleasant occupation, showing that they have been there all the time and that we have only turned our mind away from them, and hence have ceased to feel them. This is so familiar it seems almost too commonplace to repeat, yet it constitutes the special phenomenon that lies at the base of psychotherapeutics, or the mental healing of physical ills.
It is not alone the slighter, more or less negligible aches or pains, nor the vague discomforts that thus disappear when our attention is occupied, but even quite severe and otherwise unbearable pain may be modified to a great extent. A toothache that is bearable, though it nags at us constantly and never lets us forget its presence while we are occupied with many other things during the evening, may become a positive torture when we get to bed. This is not only because of physical conditions modifying the pain, for there seems no doubt that the warmth induced by the preliminaries for sleep and the bed-covering have a tendency to increase congestion, but it is mainly because as we doze off we are able, less and less, to inhibit our attention, or divert it from the pain that is present, and so this is emphasized until we have to do something for it or lose hours of sleep. This lack of inhibition, which characterizes the dozing hours, represents the state of mind in which people are who have no interest in their occupations, and who have ceased to find recreation in the ordinary pleasures of life, when pain of any kind comes to them.
Cabanis, at the beginning of the nineteenth century, under the title of {85} "The Influence of the Moral on the Physical," discusses what we would now call mental influence on the body. He says:
The great influence of what one may call the moral or mental on what
may be called the physical is an incontestible fact. Examples
without end confirm it every day. Every man capable of making
observations finds proofs of it thousands of times in himself. Many
physiologists and psychologists as well as moralists, have collected
the evidence that brings out clearly this power of the intellectual
operations and emotions on the different organs and the diverse
functions of the living body. All of us could add new illustrations
to these collections. Men who are rude and credulous talk of the
effect of the imagination, and if they are not themselves its
playthings and its victims, at least they know how to observe its
effects In others.
As a matter of fact, the action of our organs can be in turn
excited, suspended, or totally inhibited, according to the state of
mind, the change of ideas, the affections and the emotions.
A vigorous, healthy man has just made a good meal. In the midst of
the feeling of satisfaction which diffuses itself over all his body,
his food is digested with energy and without any bother. The
digestive juices perform their work steadily and without causing any
annoyance. But let such a man receive some bad news; let some sudden
emotion come to excite him, and especially to shock him into
profound sadness, and at once his stomach and intestines cease to
act upon the food which they inclose, or they at best perform their
functions badly. The digestive juices, by which the food materials
were gradually being dissolved, are suddenly stricken with
inactivity. What might seem to be a stupor comes over the digestive
tract, and while the nervous influence which determines digestion
ceases entirely, that which tends to bring about the expulsion of
material from the digestive tract may become more active and all the
material contained in the digestive viscera may, in a short time, be
expelled.
Relief in Severe Injuries.—Even extremely severe injuries, which inflict serious organic lesions that ordinarily would produce shock and collapse, quite apart from the pain induced, may at moments of excitement pass unnoticed. A soldier often does not know that he is wounded until the flow of blood calls his attention to it, or perhaps a friend points it out to him, or loss of blood causes him to faint. The prostrating effects of even fatal wounds may thus be overcome for a considerable time in the excitement of battle, or because of a supreme occupation by a surpassing sense of duty. There is the well-known story of the young corporal detailed to make a report to Napoleon at a very important crisis of one of his great battles, who made the report with such minute accuracy that it called forth a compliment from Bonaparte, for it involved a very special exercise of memory for details, yet who was actually on the verge of death when he delivered the message. As his duty was accomplished the Emperor, noticing his extreme pallor, said: "But you are wounded, my lad." The young soldier replied, as if, now that duty was done, the consciousness of his wound had just come to him, "No, Sire, I am killed," dropping dead at the Emperor's feet as he uttered the words.
In all of the great theater fires examples of this kind are recorded. A woman who barely escaped with her life from a theater fire some years ago had an ear torn off, very probably by some one grasping it in the crowd. She knew nothing of this until it was called to her attention after she got out of the theater, and then she promptly fainted from the pain and shock. Under such circumstances men walk with broken legs or limp even with dislocations, utterly unconscious that anything serious has happened to them. Men have been known to be unaware of a broken bone or even more serious conditions, {86} ordinarily quite painful and disabling, while laboring to help others in an accident.
Suppression of Reaction.—This side of the influence of the mind on the body is so interesting that its effects have often been noted and studied. While we do not quite understand the mechanism by which it accomplishes its marvels of anesthesia and even of motility under apparently impossible conditions, there is no doubt that severe pain may utterly fail to reach the consciousness, though the nervous system is uninterruptedly carrying the messages just as it did before. The lack of attention suppresses the ordinary effect upon the personality. Evidently the messages originate and are carried to the nerve centers, but find no attention available for them, and so pass unnoticed. The study of phases of this phenomenon of suppression of reaction forms a good basis for the use of mental influence, and shows its marvelous power to overcome disturbing physical factors.
Amputation Stump Aches.—An interesting example of the influence of mind over body, when circumstances favor its exercise or emphasize it, and at the same time a striking illustration of the potency of suggestion in the cure of discomfort, is found in the stories that are so common of cases of pains in amputation stumps. Any number of weird tales are told of men who complain of feeling cramps in the toes of an amputated limb after this portion of their body had been buried. The discomfort is common enough. In the special stories, however, the limbs have been dug up, the toes straightened out—according to the story, they were always found cramped in some way—and then the patient is at once restored to ease. In the good old times they probably believed in some direct connection between the straightening out of the toes of the amputated member and subsequent relief of pain. For us it is but an example of the power of suggestion. It is not the sort of suggestion that one likes to think of employing, though it has a certain dramatic quality which adds efficiency to suggestion.
The Mind and Motility.—We have spoken thus far almost exclusively of painful conditions as relieved by suggestion or mental influence, but disturbance of motor function may also be favorably affected. There are any number of cases on record in which patients who had been utterly unable to walk were restored to motility by a shock. Many such patients have, in the midst of the excitement of a fire, or the scare caused by the presence of a burglar, got up and walked quite as well as ever, though sometimes they have been for years previously confined to bed. The San Francisco earthquake is said to have exerted such an effect on a number of patients, and, while such unusual disturbances cannot often be provided for the cure of these ailments, there can be no doubt at all of the power of a shock to the mind to overcome functional incapacity that has resisted every possible form of treatment.
Ailments of this kind, which involve inability of the will to control, or rather to initiate, movements of the body, receive their best explanation on the neuron or neuroglia theory. (See the chapter on the Mechanism of Suggestion.) The central neurons become either quite separated from certain of the peripheral neurons, or at least the connections are not made with that nice adjustment necessary for the proper passage of nerve impulses. The shock communicated to the nervous system by fright is sufficient, however, to restore these connections, and consequently to enable the patient once more to exercise motor functions that have been in abeyance for some time.
Astasia-abasia.—Any one who has had to deal with the cases for which the French have invented the rather impressive Greek name of astasia-abasia—how much better it would be to call the condition simply what we know it to be, nervous inability to stand or walk!—appreciates how almost a miracle is needed to improve them. The incapacity for station or movement to which the disease owes its name is so complete in many cases, and the patients' lack of confidence in self so absolute, that no ordinary remedial measure is capable of doing any good. These cases are usually a severe trial to the patients' friends. Indeed, the patients themselves maintain their nutrition so well and, as a rule, enjoy such good health, or, as has been said, enjoy their bad health so well, that it is for their attendants the physician feels most commiseration. Yet generally he is quite unable to do anything. It is certain, however, that with care and authoritative suggestion there would not need to be an earthquake, or a fire, or even a burglary, as a therapeutic measure in these cases. As a matter of fact, their cure when it occurs is always brought about by some strong mental influence.
Mental Influence on Organs.—The Heart.—The influence of mind can be noted on practically every organ of the body in a concrete way. It might be thought that the heart, the first living thing in the animal being, the pulsations of which begin before there is any sign of the nervous system, might be free from this influence. On the contrary, the heart is so readily affected by mental states that, taking effect for cause, the old popular, and even scientific idea with regard to it, was that it was the organ of the emotions. The heart is stimulated more by favoring circumstances, and suffers more from depression, than almost any other organ. In the melancholic states it usually beats less frequently and is sluggish. When individuals are tired out and the heart has become weakened in its action, new courage will first be noted as having its effect upon the heart action. As the whole muscular system is much influenced by the mental state and, as the control of the arterial system depends on the muscles in the arteries, it is easy to understand how much the general bodily condition may by mental influence be modified for good and ill.
Digestive Tract.—The stomach and intestines, though their functions might be presumed to be dependent entirely on physical conditions, are almost completely under the control of the mental state. At moments of depression, just after bad news has been received, the appetite is absent, or is very slight and digestion itself proceeds slowly and unsatisfactorily. On the other hand, when there is mental good feeling appetite is vigorous and digestion is usually quite capable of disposing of all that is eaten. If after a period of rejoicing in the midst of which food is taken abundantly bad news is brought, the mental influence on digestion can be seen very well. It is not alone that depression interferes with digestive processes, but apparently some favorable factors for digestion consequent upon the previous state of mind are withdrawn, and now what would have been a proper amount of food proves to be an excess and the digestive organs find it difficult to deal with it.
Nervous Inhibition.—The mind can actually inhibit certain of the involuntary processes of the body by thinking about them, and, above all, by dwelling on the thought that they are going wrong. This becomes easier to understand when we recall how, in the same way, we may disturb many habitual and more or less unconscious actions that we have grown accustomed to. There {88} are any number of actions requiring careful attention to details which become so habitual that we do not have to think of them at all. Not infrequently it happens when we try to explain to others how we do them, we disturb the facility of performance and have to repeat the acts several times before we succeed in performing successfully what a moment before we did without any thought. The story of the centipede who was asked how he walked with all his hundred legs, and who tried to describe how easy it was and got so mixed up that he was unable to move at all, is a whimsical symbol of conscious attention disturbing actions which go on quite well of themselves if only we do not allow ourselves to think consciously of each and every phase of them.
How much the mind may influence the body under certain conditions when trance-like states either assert themselves or are brought on, has often been noted. Lombroso in his book "After Death What?" [Footnote 11] says of Eusapia Paladino the "medium," that "when she is about to enter the trance state the frequency of the respiratory movements is lessened just as is the case with the Indian fakirs. Before the trance she will have been breathing eighteen to twenty times a minute; as the trance begins the number of respirations is gradually reduced to fifteen; when the trance is fully developed she breathes twelve times a minute or less. On the other hand, at the same time the heart beats increase. Normally her pulse is about seventy, but during the early trance stage it rises to ninety, while during the course of a deep trance, it may go as high even as one hundred and twenty. The passing from a more or less rigid state to that of active somnambulism is marked by yawns and sobs and spontaneous perspiration on the forehead." The observation of these phenomena is, of course, entirely apart from any theory one may hold with regard to mediumistic manifestations, and it provides evidence of mental influence that is very striking.
[Footnote 11: Small, Maynard & Co.. Boston, 1909.]
Imaginary Drug Effects.—Drug effects may be produced through the imagination. Physicians know that when patients are persuaded that certain effects are to be expected from a particular medicine, the effects may follow all the same in sensitive, imaginative people, if that medicine is replaced by some inert compound. Many a physician who has used bread pills or other placebos to replace a drug that he did not want the patient to acquire a habit for, has thus been able to allow good effects to go on without interruption, where the stoppage of medicine had previously interfered with the continuance of the good habit that had been formed. Very few physicians have not seen the effect of a hypodermic of pure water when a hypodermic of morphine is demanded, and when the patient would not sleep without having the hypodermic injection. Sleeping powders of various kinds can sometimes with distinct advantage be replaced by inert materials, because the patient's mind is fixed upon the idea of sleep coming after a certain time and they, in consequence, compose themselves to rest.
The Nerves and Tissues.—Cases occur where disturbances of vitality are noted as a consequence of nervous affections, though no gross lesion of the nervous system is demonstrated. Certain nervous people suffer from ulcerative conditions of their hands, and it is evident that in some the nervous impulses {89} that would ordinarily keep the skin surface in good, healthy condition are insufficient. Some people who use a typewriter have no difficulty at all with the ends of their fingers, while others are subject even to loss of skin or ulcerative conditions that make it almost impossible for them to go on with their work. In some this is true in the winter, in others in the summer. There are a number of skin conditions which are due to nervous factors and these evidently point to the influence of the central nervous system in keeping the forces of our body in such health, and resistive vitality, as will enable us to carry on whatever work we may wish to. This is, of course, a very individual matter. Some people chap very easily, some suffer from chilblains, or are frost-bitten even on slight exposure, and these peculiarities are evidently dependent on the intensity of the nervous impulses as well as the tone of the circulation, which itself depends on the nerves to a great extent.
It is evident that some of these disturbances are not enduring, but are only temporary and therefore are due to functional disturbances of the nervous system. Physicians often see hysterical patients suffering from intense pain that requires an injection of morphine, yet after a series of such incidents, the physician is able to give an injection of plain water and produce just as good an anodyne effect. In these cases some influence of the will is enough to correct the painful disturbances. Occasionally a single member loses sensation, or motion, or both, yet the fact that its nutrition does not suffer shows that there is only disturbance in the motor connections between it and the central nervous system and not in the sensory nor trophic tracts, and that this functional defect may be restored by some favorable influence.
Nerve Supply and Health.—We know now that when a part of the body is cut off from its connections with the central nervous system, it begins at once to be lowered in vitality and gradually tends to dissolution. This will be true in spite of the fact that the circulation continues as actively as before. It is not necessary, indeed, that the nerve trunk to a part should be cut, if it is sufficiently compressed its function is stopped and various disturbances begin to appear in the vitality of the part which it supplies. A typical example is to be seen in certain fractures of the clavicle, where a fragment presses on one of the nerves leading to the arm. After a time pains develop in the arm, a burning feeling is noticed in the skin, which becomes shiny and cold and of distinctly lowered vitality. Even a slight injury to the arm will now produce a serious ulcerative condition. There are evidently important influences for life that flow down through the nerves from the central nervous system, quite as important in their way as the nutritional elements which flow through the blood.
How these influences of the mind on the body are accomplished is a portion of that larger mystery of the influence of mind, or soul, or principle of life, on the material elements of which our body is composed. Why a man receives a shock of lightning or a charge of electricity at high voltage, and without a mark on his body or a change in any cell that we can make out, be dead, though he was living an instant before, is another of these mysteries too familiar for discussion. There is no change in the weight of the body, nothing physical has happened, but what was living matter with the power to accomplish the functions of living things is now simply dead material, unable to resist the invasion of saprophytic micro-organisms which will at once, {90} unhampered, proceed to tear it down, though the preceding moment resistive vitality was completely victorious. The mystery remains, but the mechanism of the influence can now at least be studied with much more satisfaction than was the case a few years ago.
Death and the Mind.—The extent to which the mind can be made to influence the body is apparently without limit. While the doctor is frequently disturbed by the fact that death occurs when there is no adequate physical reason for it, just because the patient has looked forward to it with complete preoccupation of mind, there is no doubt that occasionally death may be put off in the same way. We talk about people living on their wills. This is a literal expression of what actually occurs in certain cases. On the other hand, without the will to live, it is sometimes extremely difficult to keep alive patients who are in a run down condition. If one of an old married couple dies when the other is ill, we conceal the sad news very carefully from the survivor. This is done not alone to put off the shock and sorrow for a time, but because often, under such circumstances, there will be no will to live.
When the vital forces have run down to such a degree that it seems impossible, so far as ordinary medical reason goes, to look for anything but dissolution, patients still cling to life if there is some reason why they want to live until a definite time. It does not happen so much with the acute diseases but is quite common in chronic cases. Patients will live on expectant of seeing a friend who is known to be hurrying to them, or for some other purpose on which they very strongly set their minds. In the life of Professor William Stokes, the Irish physician, to whom we owe the introduction of the stethoscope to the English medical world, and many other important contributions to medicine, there is a striking story that illustrates this power of the will to maintain life until a definite moment.
An old pensioner, a patient of Stokes' in the Meath Hospital whose life was despaired of, and whose death was hourly expected, was one morning distressed and disappointed at observing that Stokes, who believing that the man was unconscious at the time, and that it was useless to attempt anything further as his condition was hopeless, was passing by his bed. The patient cried out: "Don't pass me by, your honor, you must keep me alive for four days." "We will keep you as long as we can, my poor fellow," answered Stokes; "but why for four days particularly?" "Because," said the other, "my pension will be due then, and I want the money for my wife and children; don't give me anything to sleep for if I sleep I'll die." On the third day after this, to the amazement of Stokes and all the class, the patient was still breathing. On the morning of the fourth day he was found still breathing and quite conscious, and on Stokes' coming into the ward, he saw the patient holding the certificate which required the physician's signature in his hand. On Stokes approaching him, the dying man gasped out. "Sign, sign!" This was done, the man sank back exhausted, and in a few minutes after crossed both hands over his breast and said, "The Lord have mercy on my soul," and then passed quietly away.
Dread and Death.—Dr. Laurent in his little book, "La Médecine des Âmes," [Footnote 12] has a story of similar kind but from a very different motive:
[Footnote 12: Paris, Maloine, 1804.]
They brought to the prison infirmary one day an old burglar, an
incorrigible offender, who was undergoing a long sentence. He was
suffering from cancer of the stomach, and was already in a very
advanced stage of the affection. The poor devil seemed to realize
his condition very well, and felt that it was only a question of a
short time until he should die. He had made up his mind to that with
the {91} resignation which so often characterizes
people of this kind. Only one thing put him out very much, and that
was the fear of dying in prison.
"I know well that I have to pass in my checks," he said over and
over again; "but I do not want to die here. I do not want to be cut
up after I am dead."
He still had two months of his sentence to undergo. Every day the
disease made notable progress. His cachexia became more profound.
Life was passing from him drop by drop. At the end of five weeks he
was scarcely more than a living skeleton. Every morning we expected
to find him dead, or at least in his last agony. Nevertheless, every
morning, by an effort, he was able to recognize me and a little life
shone out of his sharp, small eyes that seemed like those of a bird
of prey.
One morning he said to me: "Oh! you need not watch me. You shall not
have my carcass. I do not want to die in prison. I shall not die
here." He lived on till the end of his sentence. The morning of his
freedom he said to me, "I told you that I did not want to die here,
and that I would not die here."
By an effort of his will he aroused himself enough so that his
friends were able to take him out of the prison. It was the last bit
of energy he had, however. His will power was at an end. A few hours
after his arrival in the house of his son he went off into a
profound depression, and would not talk even to his own. Then his
death agony came on, and he died that same evening. The strange and
surprising struggle of this man against death, the marvelous force
of physiological resistance which the fear of autopsy, if he died,
gave him, struck me vividly at the time. What intimate and
mysterious bond connects mind and matter that the one is able to
react in so much energy upon the other. How wonderful to think that
the fear, lest his abandoned body should be cut up, should actually
keep body and mind together until after the danger of that dreaded
event was passed.
Suggestion and Death.—On the other hand, there are many stories that show us how the giving up of hope of life seems to even hasten death. We have many stories of the death on the same day of husband and wife, or of brothers and sisters who thought very much of each other. Some of these are mere coincidences, but there are too many to be all explained on the score of coincidence. It seems clear that the living one, on hearing of the death of the other, feels that now there is nothing more to live for, and gives up the struggle. Hence the important rule in medical practice that a seriously ill patient should not be told of an accident, and, above all, of the death of a near relative.
On the other hand, strong expectation of death at a definite time, especially if accompanied by suggestions with some physical signs, may bring about actual dissolution. We have a number of well authenticated stories to illustrate this.
Renewal of Hope.—How much energy even the slightest hope may furnish, when apparently all power of effort is exhausted, is well illustrated by what happens to men who are lost at sea or in a desert. After the lapse of a certain length of time human nature seems utterly incapable of further effort and they sink down exhausted. The appearance of a light at a distance, a hail, any communication that gives them even the slightest hope will renew their energy and enable them to draw on unsuspected stores of vitality after the end seemed inevitable. It may be said that the exhaustion in these cases is more apparent than real, that discouragement prevents the release of even the energy that is present, and might be used under more favorable circumstances, but that is exactly the argument which favors the deliberate employment of psychotherapeutic motives to enable patients to use the energies which they possess. In the midst of disease, or the struggle for life, when vitality is {92} being sapped, hope is lost or obscured, just as it is when a man is alone in the desert or struggling far from help on the ocean. If we can prevent this discouragement from sapping his powers there will always be a prolongation of life, and often this will be sufficient to enable vital resistance to overcome exhausting disease.
Law of Reserve Energy.—Prof. William James [Footnote 13] called particular attention to the law of reserve energy which recent studies in psychology have emphasized. This law of reserve energy is a conclusion from certain facts which are very familiar to men and have been observed as long as the memory of man runs, yet the full significance of which has never been read quite aright. Applied to a very limited range of actions, it has been applied only half-heartedly in ordinary life, and to its full extent only under the pressure of absolute necessity. This law holds out the best promise to psychotherapy. It shows that there are reservoirs of surplus energy in man which, if they can be successfully tapped, present possibilities of resistance to fatigue—and fatigue in many more ways than we used to think resembles disease. Besides, this law represents a very wonderful capacity for withstanding pains and aches and conquering disinclination that would otherwise seem impossible. If it can be made to apply to ordinary life as well as it does to extraordinary events, then the conscious deliberate use of psychotherapy or mental suggestion should prove to have wonderful remedial power. Prof. James said:
[Footnote 13: American Magazine, Sept., 1908.]
Everyone knows what it is to start a piece of work, either
intellectual or muscular, feeling stale—or "cold," as an Adirondack
guide once put it to me. And everybody knows what it is to warm up
to his job. The process of warming up gets particularly striking in
the phenomena known as second wind. On usual occasions we make a
practice of stopping an occupation as soon as we meet the first
effective layer (so to call it) of fatigue. We have then walked,
played, or worked enough, so we desist. That amount of fatigue is an
efficacious obstruction on this side of which our usual life is
cast.
But if an unusual necessity forces us to press onward, a surprising
thing occurs. The fatigue gets worse up to a certain critical point,
when gradually it passes away, and we are fresher than before. We
have evidently tapped a level of new energy, masked until then by
the fatigue obstacle usually obeyed. There may be layer after layer
of this experience. A third and fourth wind may supervene. Mental
activity shows the phenomenon as well as physical, and in
exceptional cases we may find, beyond the very extremity of fatigue
distress, amounts of ease and power that we never dreamed ourselves
to own—sources of strength habitually not taxed at all, because
habitually we never push through the obstruction, never pass those
early critical points.
He then states what has come to be called the law of reserve energy.
It is evident that our organism has stored up reserves of energy that are ordinarily not called upon, but that may be called upon; deeper and deeper strata of combustion or explosible material, discontinuously arranged, but ready for use for any one who probes so deep, and repairing themselves by rest as well as do the superficial strata.
There is, then, a marvelous reserve power in men and women which can be used in emergencies and in times of severe strain, to enable men and women to accomplish what looks impossible and which has often contradicted the prognosis of the physician. History is full of applications of this law which, however, does not come into action, unless especially called. Men and women {93} may die simply because they give up the struggle. Men and women who will not give up seem able to overcome severe illness that would take away ordinary people. It has often been said that tuberculosis takes only the quitters and that men of character constitute the typically favorable patients for tuberculosis sanatoria. Psychology is now getting at the explanation of many events that were formerly quite inexplicable. The science has come to recognize the reservoir of reserve energy in human nature which may be tapped under special favoring circumstances. The physicians of the past have often succeeded in tapping it deliberately as well as unconsciously. There is large room, however, for the further development of medicine along this line, to the great advantage of therapeutics and probably the most promising field at the present time in view in therapy lies in this direction. Hence the necessity for more deliberate conscious use of it in every possible suitable form.
Much as may be accomplished by psychotherapeutics through favorable mental influence—the modifying of the mental attitude towards disease, diversions of mind from aches and pains, concentration of attention on subjects apart from ailments—much more may be done by removing any unfavorable mental influence. This of itself produces symptoms either by interfering with normal processes through surveillance of them, or by so exaggerating, through attention to them, slight symptoms that may be present that patients are made quite miserable, though there is no adequate physical cause for their condition. Perhaps the most striking example that we have of unfavorable mental influence as productive of the persuasion that disease is present, is familiar to every physician who is close to medical students when they are first introduced to the symptoms of disease. It is almost a rule that certain members of the class immediately conclude that they are suffering from one or more of the symptoms which they are studying, and that, therefore, they must have the diseases with which the symptoms are associated. If at this time they walk on the shady side of a street on an autumn day and have a little shivery feeling, or when they get into the sun they feel a glow, these two very normal feelings are exaggerated into chilliness and fever, and the student has to go to his professor to have his mental malaria or typhoid treated. To the student, his symptoms are for the moment very real, and unless someone in whom he has confidence reassures him, his discomfort will probably continue for some time.
Pathological Suggestion.—In a word, suggestions of disease are much easier to take than is usually imagined, and if people read or hear much about diseases they are likely to jump to the conclusion that they are sufferers. Under present conditions there are many more such sinister suggestions put before people than used to be the case. The newspapers are constantly reporting curious cases and rare diseases, and usually those of absolutely unfavorable prognosis and inevitably fatal termination are particularly dilated on. Pathology has become a source of many sensations, until the community {94} generally has come to eke out the thrills of the day's news by reading about fatal diseases and fatal injuries, whenever murder and suicide sensations fail. As a consequence, many become persuaded that they are suffering from forms of disease of which they have not a symptom, and, not infrequently, the wonderful cures that are reported in the newspapers consist of nothing more than recoveries from these imaginary ills into which people have suggested themselves as the result of reading about morbid states.
A typical illustration of the power of the mind to influence the body unfavorably is recognized in many of the comic stories that have had a vogue in recent years. Their underlying thought is that if a man is only told often enough, and by a number of different people, that he does not look well, or if he is even asked a little solicitously as to whether he feels well or not, he will almost invariably begin to persuade himself that there must be something the matter with him. After a time, under the influence of this unfavorable suggestion, he begins to feel tired and is likely to think that he cannot go on with his work. When meal time comes his appetite fails him. A victim has been even known to go home and send for the doctor, persuaded that there is something the matter, simply because a series of friends, for a joke, or sometimes through a mistake, have insisted on asking him questions that called attention to his state of health. Few men are strong enough to stand the influence of unfavorable suggestion of this kind, if it is frequently repeated. More direct forms of suggestion of disease have, of course, even greater effects. Many a man goes to a quack only feeling a little out of sorts and wanting to reassure himself, but easily becomes persuaded that there is something serious the matter with him.
Unfavorable Suggestion in Ancient Times.—This unfavorable influence of the mind on the body, even to the extent of the production of disease by means of suggestion, was recognized by the ancients. They knew and wrote of hypochondriasis and, indeed, they invented the term. In many of these cases the seat of auto-suggestion is supposed to be the digestive organs and the localization of the discomfort is in the hypochondria, that is, in the upper abdominal region. The Grecian writers seemed to recognize clearly that the symptoms were the result of thinking over much about self and concentration of attention upon unfavorable suggestions.
Plato, in the "Republic," says:
In former days the guild of Asclepius did not practice our present system of medicine, which may be said, he declares, to educate diseases. He cites the example of Herodicus who, "being a trainer (of gymnasts) and himself of a sickly constitution, by a happy combination of training and doctoring, came to the invention of lingering death; for he had a mortal disease, which he perpetually tended, and, as recovery was out of question, he passed his entire life as a valetudinarian." Plato, finishing the description, makes us recognize the hypochondriac when he says: "He could do nothing but attend upon himself, and he was in constant torment whenever he departed in anything from his usual regimen, and so dying hard, by the help of science he struggled on to old age."
The picture of the neurasthenic, or hypochondriac, who has educated himself, as Plato says, into disease, is an interesting parallel to modern conditions in this matter.
Nowhere more than in this matter of knowledge of disease, can weight {95} be attached to Pope's dictum that a little knowledge is a dangerous thing, and that one must drink deep or touch not the Pierian Spring of medical information. The teaching of pathology under the guise of physiology, now so common in our schools, is likely to do more harm than good. Various pathological conditions, such as those produced by alcohol and tobacco, have been emphasized to such an extent as to produce unfavorable suggestions in the pupils' minds with regard to the untoward events that may happen in their insides, and the serious lasting pathological changes that may occur, though all unconsciously, to the sufferer as the result of indiscretions. The study of the morbid changes produced in the mucous membranes of the digestive tract by the use of stimulants, impresses ideas on the mind that are readily transferred to other abuses in eating or drinking. The rather vivid pictures and descriptions of the pathological conditions that may develop, become a portion of the acquired consciousness as to internal conditions, and this consciousness acts as an unfavorable suggestive factor whenever there are any digestive symptoms.
Bacteriphobia.—The development of bacteriology has had a similar effect, especially because periodicals and newspapers like to take up only the sensational side of biological discoveries. Most physicians who have had anything to do with nervous diseases have seen cases of misophobia, the fear of dirt, which in our day has taken on the special character of fear of microbes. Those who are sensitive to the possibility of contamination learn of the almost sacrificial precautions that surgeons take to avoid wound infection, and conclude that practically everything they handle must fairly reek with microbes. They hesitate about touching the door knob or latch, and invent all sorts of excuses to wait for a moment outside the door in order to have someone else open it. Especially are they timorous about touching the door knobs of a physician's residence, or the chairs in his waiting room, or even to shake hands with him. Hospital walls and doors become an abomination to them. These cases emphasize how much of unfavorable suggestion there has been in the present spread of popular knowledge with regard to microbes.
A writer on popular science once said that every time we spread a piece of bread of the size of the hand with butter, we scatter over its surface as many microbes as there are inhabitants in the United States. The expression has gone the rounds, producing its effect on sensitive people, occasionally causing even a disgust for so important an article of diet as butter, more often giving rise to an extreme sensitiveness with regard to any special savor that butter may have, and it may have many according to the prevailing food of the cow. There has been much emphasis laid on the potentialities for harm of the microbes, and very little on the important part which they play in the production of many forms of food materials. Most people know and dread the fact that microbes produce disease. Very few seem to realize that while we know many thousands of different kinds of microbes, scarcely more than a score of them are known to be seriously pathogenic, while all the others are either indifferent or, as we know of very many, are actually benefactors of mankind.
People have heard much of the flora of the digestive tract, until they have come to think with anxiety of the almost infinite number and multitudinous variety of the minute plant life that finds a habitat in the human intestine. Most people think that all of these are, in tendency at least, {96} harmful, and are only kept from being positively dangerous by the overwhelming vital activity of the mucous membrane and the secretions which keep them from exerting their malign activity. Very few appreciate the fact that the intestinal flora, far from being a disturbing factor, are often an aid to digestion, and that the equilibrium established among them favors many biological and chemical processes which help in the preparation of food and in the breaking up of waste products that might be dangerous if reabsorbed during their stay in the intestinal tract. Microbes we have always with us and always will have, and men have lived to round old age, not only in spite of them, but very probably partially because of them. They are part of that beneficent mystery of nature of which as yet, in spite of scientific progress, we know comparatively little.
Opposing Favorable Suggestion,—A recent striking change of sentiment with regard to one form of food material furnishes a good example of how little we know about the real effect of bacterial life within the digestive tract. There was a time, not so long since, when sour milk was supposed to be especially harmful, or at least only likely to do good to those of particularly strong digestive vitality. Metchnikoff's work on the influence of sour milk on the digestive tract, however, has brought a complete reversal of opinion in this matter. Now most physicians are convinced that the bacillus of sour milk, acts in the intestinal tract to inhibit the reproduction and growth of other, and possibly more disturbing, bacterial agents. Sour milk is looked upon as one of the things that, by neutralizing certain unfortunate bacterial processes in the digestive tract, lead to longevity. There seems no doubt at all, that those who consume a great deal of it, live longer lives than the average, and many old men have taken to its use with a consequent amelioration of digestive annoyances.
The popularization of bacteriology, then, has been one of those moments of unfavorable suggestion that have affected a large number of people. Such influences do not mean much for people of phlegmatic temperament. For others, however, they have a weighty significance and make every symptom, or more properly every sensation, that is at all unusual in the digestive tract, seem of ominous import. Certain sensations inevitably accompany digestion. The peristaltic movements are usually said to be unfelt, but even a slight exaggeration brings them into the sphere of sensation. Where attention is given to the abdominal region and its contents, feelings that ordinarily are not noticed at all come to be perceived. With the unfavorable suggestion derived from the unfortunate diffusion of a superficial knowledge of pathology and of bacteriology instead of hygiene and the science of beneficent microbiology, these feelings produce a bad effect upon the individual.
Familiar Examples of Unfavorable Suggestion.—There are many familiar examples of the discomfort that may be produced by the mental persuasion that something will disagree with us, or that certain feelings have a significance quite beyond that which ought to be attributed to them. Everyone knows how qualmy may be the feeling produced by being told that something eaten with a relish contained some unusual material, or was cooked under unclean conditions. Food that agrees quite well with people, so long as they do not know too much about it, often fails to be beneficial after they see how it has been prepared. It is often said that people would not relish the food {97} placed before them if they were aware how lacking in cleanliness was the place of its preparation, and how negligent those who had charge of it. Occasionally a peep at the kitchen of a boarding house effectually takes away appetite, or disturbs the equanimity with which food must be taken, if there is to be that undisturbed digestion which makes for healthy nutrition.
It is, indeed, with regard to digestion that the influence of the mind on the body, favorable as well as unfavorable is, perhaps, most effectively exercised. Unfortunately the unfavorable influence is even more pronounced than its opposite. Some people are much more sensitive than others in this respect, and even the thought of certain defects in the preparation of their food seriously disturbs them. Everyone has had the experience of seeing sensitive persons leave the table because some one insisted on telling a nauseating tale. Anyone who has seen the effect of talking of blood sausage or fried brains with black butter sauce at a table on shipboard, when some practical joker was exercising his supposed wit, knows how much the imagination can disturb, not only appetite but digestion. The attitude of mind means much, and especially are such unfavorable suggestions likely to produce serious effects in inhibiting digestion.