Psychotherapy

PSYCHOTHERAPY.

The term psychotherapy (Gk. Psychē, "soul," and therapeuein, "to heal"), taken largely, denotes the treatment of disease through the influence of mental, moral, and spiritual states upon the body. An exhaustive discussion of the subject would involve an examination of many crude and fantastic theories, partly theological, partly metaphysical or psychological, with which the fundamental ideas of psychotherapy have been connected. The purpose of this article is to sketch briefly the history of psychotherapy, and to state the main principles which underlie it in the scientific form that it has assumed to-day.

1. Early Magic and Incubation.

In one fashion or another, psychotherapy has been practised, consciously or unconsciously, not only by all medical men, but also by those who in premedical times played the part both of priest and of physician. It rests upon what has become the fundamental dogma of modern physiological psychology-the idea that mind and body constitute a unity, that for every thought and feeling, however alight, there is a corresponding nervous event, and that the smallest physical process awakens an echo in the psychical realm. The charms and incantations both of savage and of civilized man are simply forms of self-suggestion, which has, in certain types of disease, curative power. The earliest historical notices of healing, through mental influence are to be found in the magical texts of ancient Egypt (cf. G. Ebers, Papyros Ebers, das hermetische Buch über die Arzneimittel der alten Aegyptern, 2 vols., Leipsic, 1875). As early as about 1600 B.C. It was the custom in Egypt to heal 352diseases by touching the person diseased, while various incantations were being uttered; it is known also that certain formulas pronounced over the images of divinities were believed to impart to these images the power of dispelling the poison of serpents. Among the most ancient of Egyptian myths are those of the healing of Ra by the goddess Isis, and of the healing of Horus, the son of Isis, by Thoth, in virtue of certain words supposed to have magical power (E. Naville, The Old Egyptian Faith, p. 5, London, 1909). In virtue of the same principle, kings and priests and reformers, under all religions and with every variety of metaphysical and theological creed, have wrought what seemed to their contemporaries to be nothing less than deeds of miraculous healing. In Alexandria, on the testimony of Suetonius, Tacitus, and Dion Cassius, the Roman Emperor Vespasian healed a blind man by touching his eyes with spittle. In the Old Testament the great prophetic figures Elijah, Elisha, and Isaiah were psychotherapeutists. David was able to charm away the melancholia of Saul by the strains of a music the echo of which may be heard in some modern hospitals for the insane.

The inscriptions dug up in our own time at Epidauros, the site of the famous shrine of Æsculapius, the patron divinity of the healing art, show what a great part the mind played in the cures effected. For example, a sufferer from dyspepsia, one Marcus Julius Apellas, who had been cured in the temple, set up an inscription in gratitude to the god. After mentioning some physical remedies which the god prescribed, Apellas continues:

"When I called upon the god to cure me more quickly I thought it was as if I had anointed my whole body with mustard and salt and had come out of the secret hall and gone in the direction of the bath-house, while a small child was going before, holding a smoking censer. The priest said to me, 'Now you are cured; but you must pay up the fees for your treatment.' I acted according to the vision, and when I rubbed myself with salt and mustard I felt the pains still, but when I had bathed I suffered no longer. These events took place in the first nine days after I had come to the temple. The god also touched my right hand and my breast" (Mary Hamilton, Incubation, p. 41, London, 1906; [Epidauros and its cures are treated in pp. 8–43 of Miss Hamilton's work]). This inscription probably belongs to the second century of our era. Speaking of the same period S. Dill remarks (Roman Society from Nero to Marcus Aurelius, p. 459, London, 1904): "The temples of Æsculapius arose in every land where Greek or Roman culture prevailed. Patients came from all parts of the Greco-Roman world. The temples had dormitories; retreats often contained beds for 200 or 300 persons."

2. The Middle Ages and Later.

During the Middle Ages the science of therapeutics was in bondage to superstition. The church was Supposed to have a monopoly of the healing power. Fragments of the cross, the team of the Virgin Mary and of St. Peter, the hair of martyrs, iron filings from the chains that had bound Peter and Paul, were regarded as miraculously efficacious in the cure of disease. Great personalities, such as the founders of cloisters, or persons of great sanctity, such as Francis of Assisi, Catherine of Siena, and Bernard of Clairvaux (qq.v.), it was claimed, healed multitudes by the power of their touch. In France from medieval times down to the age of Charles X. the kings claimed the gift of "touching for the evil" (scrofula). In the Anglican prayer-book there was printed down to the year 1719, "The Office for Touching." The actual ceremony is described by Evelyn in his Diary (ed. W. Bray, in Memoirs, London, 1818–19; by Upcott, 1827; by H. B. Wheatley, 4 vols., 1879) under date July 6, 1660. Among the famous persons touched for the evil was Samuel Johnson, in the reign of Queen Anne.

The short and easy way of dealing with these stories was to reject them as superstitious legends. Modern investigation, however, has shown that this method is quite too drastic, and that thus to deal with human testimony is to make the search for historical truth almost futile. The generally received view to-day is that the principle by which these phenomena were brought about is what is called "Suggestion," or expectant attention; and it may be said that in all modern mental healing systems these psychological influences play a dominating rôle. It was only in the eighteenth century that the foundations for a scientific understanding of the subject were laid. Just as chemistry arose out of alchemy, and astronomy out of astrology, and the science of internal medicine out of the tentative therapeutic efforts of the medicine man, so modern scientific psychotherapy takes its origin in mesmerism.

3. Mesmer.

Friedrich (or Franz) Anton Mesmer (b. at Iznang, 11 m. n.w. of Constants, May 23, 1733; graduated at Vienna in medicine, taking for his thesis, "On the Influence of the Planets on the Human Body," published in 1766; d. at Meersburg, 5 m. e. of Constants, Mar. 5, 1815) first came into notice in 1773 by his novel method of curing disease through the application of magnetized plates to the human body. He was an ardent student of the medieval mystics, Paracelsus and the Rosicrucians (q.v.), from whom he obtained the idea that there existed in nature a mysterious and subtle force which he called "animal magnetism." This he conceived to bean invisible fluid, which by a skilled hand could be so manipulated as to heal all manner of diseases. Some of the methods by which he applied his theory he owed probably to Father Gassner, a German priest who cured sufferers by means of exorcism, his theory being that the given disease was due to demon possession. In short, it may be said that Mesmer found all the elements of mesmerism already in existence. He simply deprived them of their mystical setting, reduced them to terms of matter and force, and thus commended them to the age of reason. Mesmer appeared in Paris in 1778, and in a short time created a sensation by his wonderful cures in all classes of society. He believed that magnetism could be imparted to wood glass, iron, and other physical objects, and that these in turn could communicate the magnetism to the sick person. Hence he constructed his famous baquet, an 353elaborate apparatus consisting of an oak tub with a lid made in two pieces, and itself enclosed in another tub. Inside the tub were bottles filled with magnetized water and tightly corked. The magnetic influence was conducted to the bodies of the patients by means of rods and ropes. Mesmer was overwhelmed with the crowds that came for treatment, but was condemned by the medical profession as a quack. He challenged the faculty of medicine at Paris to select twenty-four patients, twelve to be treated by orthodox methods, twelve to be treated by animal magnetism, and compare results. The doctors treated his challenge with contempt, but in 1784 the government appointed two commissions to inquire into the claims of mesmerism. One was chosen from the faculty of medicine and one from the Royal Society. A few months after their . appointment, both commissions reported. Bailly drew up the report of the faculty of medicine. The commission rejected Mesmer's doctrine of a healing fluid, on the ground that no adequate proof of the existence of such a fluid was given. The physiological effects of the treatment were ascribed to the power of imagination. With this finding the report of the Royal Society was in agreement. The reports of the commissions were marred by professional prejudice and lack of scientific insight. To attribute changes for the better in the health of sick persons to the power of imagination, and then to dismiss this agency, as though it were an unreality beneath the regard of scientific investigators, was to make a reality the effect of an unreality. They forgot that a psychological factor able to produce permanent functional changes demanded, searching scrutiny. Nor did the commissioners note the strange problem which emerged -that Mesmer the quack had been able to work cures which were impossible to his scientific contemporaries. As for Mesmer, the reports of the commissions were his death-blow. He retired from Paris and returned to Germany.

4. Bertrand and Elliotson.

About ten years later, Alexandre Jacques François Bertrand gave a really scientific explanation of the mesmeric phenomena (Du magnetisme animal en France, Paris, 1826). He did not deny the genuineness of the alleged cures, but he maintained that the patients were and healed not by virtue of a magnetic fluid, but because of their own suggestibility, their capacity for being influenced by the imposing procedures of Mesmer. This explanation, which is accepted to-day, was regarded with incredulity by the medical profession at that time. The truth is, that Mesmer's success had brought into the field a regiment of mysterious, spectacular showmen, who traveled all over Europe and brought discredit upon the whole subject by their fantastic tricks and absurd pretensions. Up till 1837 this state of matters continued. In that year Dr. John Elliotson (b. in London is 1791; studied at the University of Edinburgh, and at Jesus College, Cambridge; d. in London July 29, 1868) began original researches at University College, London. He soon achieved wonderful therapeutic results, though so much to the scandal of his colleagues that the authorities of the college hospital in 1838 forbade him to practise animal magnetism. Elliotson immediately resigned, much mortified at the insult. In 1846 he chose mesmerism for his subject as the Harveian orator. In the course of his address he showed how magnetism could prevent pain during surgical operations, produce sleep and ease in sickness, and cure many diseases which were not relieved by the ordinary methods (Numerous Cases of Surgical Operations in the Mesmeric State Without Pain, London, 1843). Although he shared some of the erroneous ideas of his time, there can be no doubt that he was devoted to truth and to the interests of humanity, and that he suffered persecution at the hands of prejudice and bigotry.

5. Braid, Liébault, Berheim, and Tuke.

But the most important figure in the history of the subject is James Braid (b. at Rylaw House, Fifeshire, Scotland, c. 1795; was educated at the University of Edinburgh; d. at Manchester Mar. 25, 1860), who, in 1841, began his investigations into the nature of mesmeric phenomena. Until his time it is to be noted that the theories usually accepted in explanation of these phenomena were either that they were owing to a mysterious force or fluid, or to self-deception, or to wilful trickery. Braid attended his first mesmeric exhibitions under the influence of the last of these theories: he was anxious to discover how the trick was done. But he became convinced that the phenomena were real, and he determined to find out their physiological cause. In 1841 he gave to the public his view that mesmeric phenomena were purely subjective in character. He found that he could induce the mesmeric state by causing his patients to gaze steadily at some object and at the same time think of the object upon which they gazed. Thus he discovered that expectant attention was a necessary factor in mesmerism, or, as he now called it, hypnotism (Neurypnology; or, the Rationale of Nervous Sleep, London, 1843). He was, however, before his time. He was violently assailed by the old-school mesmerists and was regarded with suspicion by his medical brethren. Hugh MacNeile, an Evangelical divine of Liverpool and later dean of Ripon, charged him with producing his hypnotic effects through Satanic agency, and thereby much theological prejudice was excited against his work. After Braid's death in 1860, the subject, as far as Great Britain was concerned, fell into neglect. But in France a struggling physician, A. A. Liébault, published a book (Du sommeil et des états analogues, Nancy, 1866) in which he showed that hypnotism was a powerful curative agent, and once more demonstrated that the essence of it was suggestion. It is said that only a single copy of his book was sold. In 1882 Hippolyte Bemheim, a distinguished physician of Nancy, became interested in Liébault's work, and published his famous work on suggestive therapeutics (Hypnotisme, suggestion et psychotherapie, France, 1890). Meantime, at Paris, at the Salpétrière, Dr. Jean Martin Charcot experimented in hypnotism, and founded a school of which Janet, Binet, and Féré are brilliant representatives. Down to this time in England and in America, the movement which attracted so much 354attention on the continent of Europe was seriously hurt by the rise of spiritualism. Both the scientist and the man on the street confused hypnotism with spiritualism; but with the fame of Nancy and Paris, English and American physicians began to take an interest in the subject. Worthy of mention is Dr. Daniel Hack Tuke's work (Illustrations of the Influence of the Mind upon the Body, London, 1872). This was the first comprehensive and scientific treatment of the subject in English. His aim was to induce the medical profession to utilize in their practise the influence of mental states, and, as he says, to rescue psychotherapy from "the eccentric orbits of quackery and force it to tread with measured step the ordinary paths of legitimate medicine." Dr. William Benjamin Carpenter's Principles of Mental Physiology (London, 1874) marked an epoch in the study of psychological medicine. It had great influence upon professional students of mental diseases, but neither this book nor Dr. Tuke's made any great impression on the general practitioner. The attention of American physicians was drawn to the subject mainly through the fame of Nancy and Paris. Boston, especially, became the center of the new study, and indeed is now the seat of a psychological school of physicians. Morton Prince, Boris Sidis, and James Jackson Putnam (who has been called "the Charcot of America") are among the leaders of this group. Its strength lies in its grasp of the psychic factors in psychological states. Its weakness is its failure to recognize the curative influence of an idealistic conception of life or of a more satisfactory religious experience.

In the course of time it has come to be recognized that hypnotism is only one weapon, and by no means the chief weapon, in the psychotherapeutist's armory. Indeed, except in a small group of deep-rooted perversions, hypnotism is falling more and more into the background.. The great psychotherapeutic classical methods to-day are ordinary or waking suggestion, explanation, encouragement, education and reeducation, psycho-analysis, rest, and work. We owe this development to such neurologists as Weir Mitchell; J. P. Möbius, Forel, Freud, and the layman, Grohmann.

6. Recent Movements in the United States.

At this point logically occurs consideration of mental healing or irregular and unscientific psychotherapy. The various forms of mind cure or faith cure in the United States may be traced back to Phineas Parkhurst Quimby (see Science, Christian), the son of a New England blacksmith. He was a self-educated man, with much natural shrewdness and power. When he, arrived at manhood he became interested in mesmerism and occult phenomena, which at that time were much discussed among the semi-educated classes of the country. Quimby was discontented with the current theology and the popular notions of mind and body. He determined to create a philosophy, a theology, and a medical science for himself. Gradually the conviction dawned on him that disease was not real, but only an ancient delusion handed down from generation to generation. In the strength of this conviction he set up as an unconventional practitioner in Portland, Me., and there treated such sufferers as came to him. He published no books, nor did he found a school, but he committed to paper his ideas, and ten volumes of his manuscripts are in existence. His memory, however, probably would have perished, had it not been for the visit paid to him in 1862 by one Mrs. Patterson, suffering from some nervous trouble. He was able to cure her. This Mrs. Patterson achieved world-wide fame as the founder of a new religion, the writer of a sacred book, and the creator of a growing church. The name by which she is known is Mrs. Mary Baker Eddy (q.v.; see also Science, Christian). Christian Science may not unjustly be described as an almost equally "grotesque mixture of crude pantheism, misunderstood psychological or philosophical truths, and truly Christian beliefs and conceptions" (G. T. Ladd, Philosophy of Religion, i. 167, 2 vols., New York, 1905). The fundamental idea of Christian Science is the unreality of sickness, of matter, of evil, and of the human mind, usually called by Christian Science writers "mortal mind." Its philosophic postulates, as stated by Mrs. Eddy, are as follows: (1) God is All; (2) God is Good; (3) God is Mind; (4) God is Spirit, being All. Nothing is Matter; (5) Life, God, Omnipotent good, deny death, evil, sin, disease. Christian Science is at once a philosophy, a theology, a religion, and a therapeutic system. Many of the therapeutic results set down to the credit of Christian Science may be accepted as undoubted facts; but unless a break is made with the main stream of right reason in the world and with the Christian religion, the metaphysics, the theology, the Biblical exegesis, and the psychology of Mrs. Eddy must be rejected.

Other movements, notably the Mind Cure Movement, inaugurated by W. F. Evans (Primitive Mind Cure; Nature and Power of Faith, Boston, 1885; Mental Medicine; 15th thousand, ib. 1885; Esoteric Christianity and Mental Therapeutics, ib. 1886), and the New Thought movement (see New Thought), represented by such writers as Horatio W. Dresser, Ralph Waldo Trine, Charles Brodie Patterson, the Christian and. Missionary Alliance, under the leadership of the Rev. Albert B. Simpson, may be traced to the inspiration of Quimby's teaching. The influence of Swedenborg and Emerson on New Thought is especially marked. Up till recently the churches have looked with disfavor upon these movements, and have, for the most part, sought not so much to understand them as to criticize and to ridicule.

7. The Emmanuel Movement.

Recently, however, an effort has been made to utilize the genuine elements in these healing cults, to free them from the notions with which they have been bound up, and to make them available for the help and uplift of suffering humanity. This effort is popularly called "The Emmanuel Movement" from the name of the church in Boston where it originated under the leadership of Rev. Drs. Elwood Worcester and Samuel McComb. The fundamental aim of the work is to ally, in friendly cooperation, the physician, the clergyman, and the trained social worker in the alleviation and cure of a certain class of disorders which may be 355described as semi-moral and semi-nervous. Among the more familiar types of these disorders may be named neurasthenia, hysteria, hypochondria, psychasthenia, insomnia, alcoholism, and bad habits generally. The Emmanuel Movement is not to be confounded with Christian Science or with New Thought or with occultism in any shape or form. It is under strict medical control, and therefore accepts the conclusions and methods of medical science. It lays no claim to any new revelation or any mysterious doctrines of matter and mind. It is the first attempt of the liberal theological school to bring to bear in a practical way the forces of ethics and religion upon suffering and misery. The movement is distinguished from ordinary academic psychotherapy by including among curative methods the power of religion and morality. It seems, in aim, at least, to be the crown of a preceding development, for it tries to unite in practise whatever is sound in the various mental healing cults that have too often been the field of charlatanism, with the proved conclusions and the recognized methods of the medical profession.

Samuel McComb.

Bibliography: For early practise consult the literature on magic under Comparative Religion, and under Magic; the work of Miss Hamilton cited in the text is masterly. On Mesmer consult: J. Kerner, Franz Anton Mesmer, Frankfort, 1856; W. B. Carpenter, Mesmerism and Spiritualism Considered, London, 1877; M. Bersot, Le Magnétisme animal, 4th ed., Paris, 1879; C. Kiesewetter, F. A. Mesmers Leben and Lehre, Leipsic, 1893. On Christian Science consult the literature under Eddy, Mark Baker Glover; and under Science, Christian. On the general subject of psychotherapy read: A. Moll, Hypnotism, New York, 1890; P. Dubois, Psychic Treatment of Nervous Disorders, New York, 1905; idem, Influence of the Mind an the Body, ib. 1906; A. H. Forel, Hygiene of Nerves and Mind in Health and Disease, New York, 1907; P. Dearmer, Body and Soul. An Inquiry into the Effects of Religion upon Health, with a Description of Christian Works of Healing from the New Testament to the Present Day, London, 1909; M. Price and others, Psychotherapeutics: a Symposium, Boston, 1910; Mrs. E. G. H. White, The Ministry of Healing, Mountain View, California, 1910. On the Emmanuel Movement consult: E. Worcester, S. McComb, and I. H. Coriat, Religion and Medicine; the mental Control of Nervous Disorders, New York, 1908; E. Worcester and S. McComb, The Christian Religion as a Healing Power, ib. 1909; C. R.. Brown, Faith and Health, ib. 1910 (favorable to the Emmanuel Movement, antagonistic to Christian Science).