Part 20 (2/2)
Psychotherapy and narcotics are, and ever have been, the sheet-anchors of the charlatan and the miracle-worker.
The att.i.tude of the medical profession toward mental influence in the treatment of disease is neither friendly nor hostile. It simply regards it as it would any other remedial agency, a given drug, for instance, a bath, or a form of electricity or light. It is opposed to it, if at all, only in so far as it has tested it and found it inferior to other remedies. Its distrust of it, so far as this exists, is simply the feeling that it has toward half a hundred ancient drugs and remedial agencies which it has dropped from its list of working remedies as obsolete, many of which still survive in household and folk medicine. My purpose is neither to champion it nor to discredit it, and least of all to antagonize or throw doubt upon any of the systems of philosophy or of religion with which it has been frequently a.s.sociated, but merely to attempt to present a brief outline of its advantages, its character, and its limitations, exactly as one might of, say, calomel, quinine, or belladonna.
As in the study of a drug, the chief points to be considered are: What are its actual powers? What effects can be produced with it, both in health and sickness? What are the diseases in which such effects may be useful, and how frequent are they? In what way does it produce its effects, directly or indirectly?
The first and most striking claim that is made for mental influence in disease is based upon the allegation that it has the power of producing disease and even death; the presumption, of course, being that, if able to produce these conditions, it would certainly have some influence in removing or preventing them. Upon this point the average man is surprisingly positive and confident in his convictions. Popular literature and legend are full of historic instances where individuals have not merely been made seriously ill but have even been killed by powerful impressions upon their imaginations. Most men are ready to relate to you instances that have been directly reported to them of persons who were literally frightened to death. But the moment that we come to investigate these widely quoted and universally accepted instances, we find ourselves in a curious position. On the one hand, merely a series of vague tales and stories, without date, locality, name, or any earmark by which they can be identified or tested. On the other, a collection of rare and extraordinary instances of sudden death which have happened to be preceded by a powerful mental impression, many of which bear clearly upon their face the imprint of death by rupture of a blood-vessel, heart failure, or paralysis, in the course of some well-marked and clearly defined chronic disease, like valvular heart-mischief, diabetes, or Bright's disease.
Upon investigation most of these cases which have been seen by a physician previous to death have been recognized as subject to a disease likely to terminate in sudden death; and practically all in which a post-mortem examination has been made have shown a definite physical cause of death. The fright, anger, or other mental impression, was merely the last straw, which, throwing a sudden strain upon already weakened vessels, heart, or brain, precipitated the final catastrophe.
In some cases, even the sense of fright and the premonition of approaching death were merely the first symptoms of impending dissolution.
The stories of death from purely imaginative impressions, such as the victims being told that they were seriously ill, that they would die on or about such and such a date, fall into two great cla.s.ses. The first of these--involving death at a definite date, after it had been prophesied either by the victim or some physician or priest--may be dismissed in a few words, as they lead at once into the realm of prophecy, witchcraft, and voodoo. Most of them are little better than after-echoes of the ethnic stories of the ”evil eye,” and of bewitched individuals fading away and dying after their wax image has been stuck full of pins or otherwise mutilated. There have occurred instances of individuals dying upon the date at which some one in whose powers of prophecy they had confidence declared they would, or even upon a date on which they had settled in their own minds, and announced accordingly; but these are so rare as readily to come within the percentage probabilities of pure coincidence. Most such prophecies fail utterly; but the failures are not recorded, only the chance successes.
The second group of these alleged instances of death by mental impression is in most singular case. Practically every one with whom you converse, every popular volume of curiosities which you pick up, is ready to relate one or more instances of such an event. But the more you listen to these relations, the more familiar do they become, until finally they practically simmer down to two stock legends, which we have all heard related in some form.
First, and most famous, is the story of a vigorous, healthy man accosted by a series of doctors at successive corners of the street down which he is walking, with the greeting:--
”Why, my dear Mr. So-and-So, what is the matter? How ill you look!”
He becomes alarmed, takes to his bed, falls into a state of collapse, and dies within a few days.
The other story is even more familiar and dramatic. Again it is a group of morbidly curious and spiteful doctors who desire to see whether a human being can be killed by the power of his imagination. A condemned criminal is accordingly turned over to them. He is first allowed to see a dog bled to death, one of the physicians holding a watch and timing the process with, ”Now he is growing weaker! Now his heart is failing!
Now he dies!” Then, after having been informed that he is to be bled to death instead of guillotined, his eyes are bandaged and a small, insignificant vein in his arm is opened. A basin is held beneath his arm, into which is allowed to drip and gurgle water from a tube so as to imitate the sounds made by the departing life-blood. Again the death-watch is set and the stages of his decline are called off: ”Now he weakens! Now his heart is failing!” until finally, with the solemn p.r.o.nouncement, ”Now he dies!” he falls over, gasps a few times and is dead, though the total amount of blood lost by him does not exceed a few teaspoonfuls.
A variant of the story is that the trick was played for pure mischief in the initiation ceremonies of some lodge or college fraternity, with the horrifying result that death promptly resulted.
The stories seem to be little more than pure creatures of the same force whose power they are supposed to ill.u.s.trate, amusing and dramatic fairy-tales, handed down from generation to generation from Heaven knows what antiquity. Death under such circ.u.mstances as these _may_ have occurred, but the proofs are totally lacking. One of our leading neurologists, who had extensively experimented in hypnotism and suggestion, declared a short time ago: ”I don't believe that death was ever caused solely by the imagination.”
Now as to the scope of this remedy, the extent of the field in which it can reasonably be expected to prove useful. This discussion is, of course, from a purely physical point of view. But it is, I think, now generally admitted, even by most believers in mental healing, that it is only, at best, in rarest instances that mental influence can be relied upon to cure organic disease, namely, disease attended by actual destruction of tissue or loss of organs, limbs, or other portions of the body. This limits its field of probable usefulness to the so-called ”functional diseases,” in which--to put it crudely--the body-machine is in apparently perfect or nearly perfect condition, but will not work; and particularly that group of functional diseases which is believed to be due largely to the influence of the imagination.
Nowhere can the curious exaggeration and over-estimation of the real state of affairs in this field be better ill.u.s.trated than in the popular impression as to the frequency in actual practice of ”imaginary”
diseases. Take the incidental testimony of literature, for instance, which is supposed to hold the mirror up to nature, to be a transcript of life. The pages of the novel are full, the scenes of the drama are crowded with imaginary invalids. Not merely are they one of the most valuable stock properties for the humorist, but whole stories and comedies have been devoted to their exploitation, like Moliere's cla.s.sic ”Le Malade Imaginaire,” and ”Le Medecin Malgre Lui.” Generation after generation has shaken its sides until they ached over these pompous old hypochondriacs and fussy old dowagers, whose one amus.e.m.e.nt in life is to enjoy ill health and discuss their symptoms. They are as indispensable members of the _dramatis personae_ of the stock company of fiction as the wealthy uncle, the crusty old bachelor, and the unprotected orphan. Even where they are only referred to incidentally in the course of the story, you are given to understand that they and their kind furnish the princ.i.p.al source of income for the doctor; that if he hasn't the tact to humor or the skilled duplicity to plunder and humbug these self-made sufferers, he might as well retire from practice. In short, the entire atmosphere of the drama gives the strong impression that if people--particularly the wealthy cla.s.ses--would shake themselves and go about their business, two-thirds of the illness in the world would disappear at once.
Much of this may, of course, be accounted for by the delicious and irresistible attractiveness, for literary purposes, of this type of invalid. Genuine, serious illness, inseparable from suffering and ending in death, is neither a cheerful, an interesting, nor a dramatic episode, except in very small doses, like a well-staged death-bed or a stroke of apoplexy, and does not furnish much valuable material for the novelist or the play-writer. Battle, murder, and sudden death, while horrible and repulsive, can be contemplated with vivid, gruesome interest, and hence are perfectly available as interest producers. But much as we delight to talk about our symptoms, we are never particularly interested in listening to those of others, still less in seeing them portrayed upon the stage. On account of their slow course, utter absence of picturesqueness, and depressing character, the vast majority of diseases are quite unsuitable for artistic material. In fact, the literary worker is almost limited to a mere handful, at one extreme, which will produce sudden and dramatic effects, like heart failure, apoplexy, or the ghastly introduction of a ”slow decline” for a particularly pathetic effect; and at the other extreme, those imaginary diseases, migraines and vapors, which furnish amus.e.m.e.nt by their sheer absurdity.
Be that as it may, such dramatic and literary tendencies have produced their effect, and the popular impression of the doctor is that of a man who spends his time between rus.h.i.+ng at breakneck speed to save the lives of those who suddenly find themselves _in articulo mortis_ and will perish unless he gets there within fifteen minutes, and dancing attendance upon a swarm of old hypochondriacs, neurotics, and nervous dyspeptics, of both s.e.xes. As a matter of fact, these two supposed princ.i.p.al occupations of the doctor are the smallest and rarest elements in his experience.
A few years ago a writer of world-wide fame deliberately stated, in the course of a carefully considered and critical discussion of various forms of mental healing, that it was no wonder that these methods excited huge interest and wide attention in the community, because, if valid, they would have such an enormous field of usefulness, seeing that at least seven-tenths of all the suffering which presented itself for relief to the doctor was imaginary.
This, perhaps, is an extreme case, but is not far from representing the general impression. If a poll were to be taken of five hundred intelligent men and women selected at random, as to how much of the sufferings of all invalids, or sick people who are not actually obviously ”sick unto death” or ill of a fever, was real and how much imaginary, the estimate would come pretty close to an equal division.
But when one comes to try to get at the actual facts, an astonis.h.i.+ngly different state of affairs is revealed. I frankly confess that my own awakening was a matter of comparatively recent date.
A friend of mine was offered a position as consulting physician to a large and fas.h.i.+onable sanatorium. He hesitated because he was afraid that much of his time would be wasted in listening to the imaginary pains, and soothing the baseless terrors, of wealthy and fas.h.i.+onable invalids, who had nothing the matter with them except--in the language of the resort--”nervous prosperity.” His experience was a surprise. At the end of two years he told me that he had had under his care between six and seven hundred invalids, a large percentage of whom were drawn from the wealthier cla.s.ses; and out of this number there were _only five_ whose sufferings were chiefly attributable to their imagination.
Many of them, of course, had comparatively trivial ailments, and others exaggerated the degree or mistook the cause of their sufferings; but the vast majority of them were, as he navely expressed it, ”really sick enough to be interesting.”
This set me to thinking, and I began by making a list of all the ”imaginary invalids” I had personally known, and to my astonishment raked up, from over twenty years' medical experience, barely a baker's dozen. Inquiries among my colleagues resulted in a surprisingly similar state of affairs. While most of them were under the general impression that at least ten to twenty per cent of the illnesses presenting themselves were without substantial physical basis and largely imaginary in character, when they came actually to cudgel their memories for well-marked cases and to consult their records, they discovered that their memories had been playing the same sort of tricks with them that the dramatists and novelists had with popular impressions.
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