BERKElIy LIBRARY UNIVERSITY OF CALIFORNIA (/--^r^-^^X^ ^ Digitized by the Internet Archive in 2007 with funding from IVIicrosoft Corporation http://wvyw.archive.org/details/advancedsuggestiOObrowrich ADVANCED SUGGESTION (NEUROINDUCTION) ADVANCED SUGGESTION (NEUROINDUCTION) BY HAYDN BROWN, L.R.C.P., Etc., Edin. Fellow or the Royal Society of Medicine NEW YORK WILLIAM WOOD AND COMPANY MDCCCCXIX VfU<<^ J PREFACE This book is small — suggesting that larger ones shall follow. It is rather in the nature of a guide which shall help others on the way than a text-book. Nor can it be considered perfect, for a vast amount of work on new lines, compressed into a few years, over a large field of investigation, will hardly permit this. Therefore, I hope for much patience. All I desire from readers, critics, and reviewers is that they shall scan these pages very seriously, and with an open mind, for I have earnestly endeavoured to put before them what I have confidence will be found helpful material in furtherance of medical science. HAYDN BROWN. 15, Cavendish Place, London, September 25, 1918. 2.^3 CONTENTS I. Provisional Psychology - - - i II. Some Object Lessons - - - 9 III. Neuroses - - - - • ^9 Insomnia, psychasthenia, hysteria, phobias, dysphagia, stammering, etc., speech- fright, epilepsy, chorea, somnambulism, night terrors, neuralgia, migraine, epilep- tiform attacks, vertigo, tics. IV. Disorders of Urination and of the Organs of Generation - - 97 Masturbation, perversion and inversion, im- potency, excess, urination. V, Psychoses - - - . . 106 Dementia praecox, borderline cases, melan- cholia, suicidal inclinations, depression, obsession, high blood-pressure (see also Heart). VI. Restoring Function in Special Senses 123 Smell, taste, hearing, sight, colour-blindness. VII. Disorders of the Alimentary Tract - 134 Dyspepsia, constipation, mucous colitis, diarrhoea, food distaste and craving, sea-sickness, vomiting of pregnancy. VIII. Heart and Circulation - - - 155 Flushing, tachycardia, sweating, irregular action, high blood-pressure. IX. Pulmonary - - - - - 161 Asthma, hay-asthma, phthisis, vii viii CONTENTS CHAl-TER PAGE X. Disorders of Gland Functioning - 176 Glycosuria, Graves* disease, myxcedema. XL Stimulant and Drug-taking to Excess 190 Dipsomania, medicine mania, morphine and cocaine taking, excessive smoking. XII. Surgical - - - - - 198 Haemorrhoids, varicose veins, prolapsus, painful joints, nasal thickenings, in- flammation, contractures. XIII, Skin Disorders - - - - 204 Pemphigus, urticaria, erythema, eczema, etc. XIV. Morbid Growths - - - 219 A study of effects in cancer, fibroids, warts. XV. Gyn/ecology . . - - 239 Menstrual, parturition, mastitis, milk secretion. XVI. Criminal Inclinations - - - 244 Kleptomania, homicide, personal assaults, suffragism. XVII. Early Moral and Educational - 257 XVIII. Cases Incidental to War - - 267 XIX. Notes on Psychology, Rationale and Technique .... 269 XX. Thought Analysis - - - 290 XXI. Some Golden Rules for the Practice OF Psychotherapy - - - 302 XXII. On Failures .... 315 XXIII. The Future - . - - 324 ADVANCED SUGGESTION CHAPTER I PROVISIONAL PSYCHOLOGY During the past two decades the science of Psycho- therapy has not advanced as far as it should have done in the direction of general acceptation. There may be several reasons for this, but I will refer to one in particular : the study was originally founded chiefly upon the phenomena of so-called hypnotism, which, while it was not sufficiently understood, was looked upon as something mysterious, occult, and in certain directions powerful, and therefore as a thing to be viewed by everybody with awe, and by many medical observers with a disposition to avoid it entirely. Like most new things, the hypnotism of the earlier writers was vigorously opposed as a therapeutic agency — and all the more so because it was almost wholly questionable, and in any case inexplicable. I first began to be interested in psychotherapy in 1887, when, in association with some fellow-students, I con- ducted a few experiments. In 1893 I felt obHged to try "suggestion" in a case of "stammering" bladder, which had defied all other treatments. It proved successful. Not only did this instance arouse Httle I 4 ADVANCED SUGGESTION interest among medical friends, but I was seriously advised not to continue such a study. In 1908, however, I exchanged scienti&c ideas with Dr. Lloyd Tuckey, which resulted in my studying " suggestion " in a more serious and determined mood, in the rooted belief that there was great work to be done in medicine by its aid. I resolved to continue the work of investigation where others had left off, realizing that it was necessary to find out more about the nature of the various phenomena of suggestion. I considered that it would not be sufficient merely to secure certain effects, but that I ought to delve as deeply as possible into the rationale of the matter, first because I was likely to go further the better I came to understand the scientific processes at work in studying cause and effect, and, secondly, because I might all the better be able to teach others such technique as I might happen upon, or work out, through a vast number of widely applied experi- ments — always directed towards diseases or disorders that presented extreme difficulties. I soon found that hypnotism was simply a kind of raw material, a pitch- blende, so to speak, not of much use in itself, but from the study of which it would be possible to make a very valuable alternative. I ultimately found neuro- induction, which is quite easy to understand and to employ ; it is also without disadvantages of any sort. I have studied under conditions which afforded me great privileges, in that I have had, during the past nine years, to encounter absolutely the most puzzling PROVISIONAL PSYCHOLOGY 3 problems to be found in the consulting-rooms of the specialists. Thus I have wasted no time in dealing with a glut of trivial ailments. Now, anything new or improved in therapeutics is likely to elicit the question, How is it done? This book sets out to teach and explain. Medical readers must naturally be just as eager to do, actually, as to learn what can be done. But conversations with friends have usually ended, of necessity, in my offer- ing the self-defensive explanation that one can only teach certain accomplishments up to a certain point. The best book in the world will not teach proficiency either in piano-playing, golf, black-and-white drawing, or surgery. In such matters a book may guide, but it is only practice that will bring proficiency. No teacher of golf can ever tell a pupil very much more than this, that he had better not "press"; the pupil must find out for himself what the teacher really means by this. Similarly, when I teach what full physio- logical relaxation should be, I expect readers to realise what is fully meant by the term by experimenta- tion upon themselves and upon others. Psychotherapy is easy, and difficult — ^just as is surgery. Lancing an abscess with a sharp-pointed bistoury is easy ; operating amidst a mass of abdominal adhesions will usually be difficult. In order to prove the bona fides of my offer to teach, as expressed in these pages, and to indicate the sincerity of my intentions and of my desire that as many as possible shall learn how to carry out my 4 ADVANCED SUGGESTION principles — for the benefit of the commonweal — and above all to prove how simple is the technique, essen- tially and primarily — as simple as a good knife operating in a capable hand — I hereby make the offer to give demonstrations before suitably organised meet- ings of medical men, and to afford the fullest explana- tions that I am capable of giving. I make this offer in every confidence that the work will thence make very rapid progress in the hands of a large number of the profession, and will thus not only enormously advance general therapy in its dealings with many kinds of disorders, but will eliminate, through pure force of scientific advancement, a very great deal of the existing lay-practice and charlatanry which is carried out by bone-setters, Christian scientists, and "clairvoyant healers" — the very existence of whom really constitutes a scathing criticism upon the short- comings of the profession in the study and applica- tion of treatment by suggestion. This book refers to advanced work ; but many will read it who are not initiated, and who wish to make a beginning. I strongly advise the latter to read some previous works on psychotherapy — such as Dr. Lloyd Tuckey's " Hypnotism " and Dr. Constance Long's translations of Jung's works — before begin- ning this book, and also to read Chapter XIX. of this book before the other chapters — that is to say, after reading this opening chapter. By neuroinduction I mean neurone induction, both of brain and body — central and peripheral — through- PROVISIONAL PSYCHOLOGY 5 out. It is impossible to neuroinduct locally, in any individual, without obtaining effects of a general nature, unless perchance one should wish for a particular purpose to induct towards dissociation. By the noun subconscious I mean the highest degree of consciousness, inherent capability, and receptivity to the ideas of others, which the psychic system of the patient is capable of manifesting. By the noun supraconscious I mean the highest degree of conscious- ness and receptivity to the ideas of others which the activities of the special senses can either demand, permit, elicit, or govern, according to natural in- fluences, necessities or requirements. The essential psychic capabilities of the subconscious are of a higher degree than those of the supraconscious, because the psychic processes of the former are free and unhindered, as compared with those of the latter, which are subject to the confusing and confining effects of the special senses engaged in their respective operations. I employ the term subconscious largely out of respect for former usage, in the hope that a much more definite and accurate meaning of the term will be found within the pages of this book; while supraconscious is pre- ferred to indicate all that consciousness which obtains when the special senses are in operation. The word " circling " is used to indicate the circular process familiar to those who have studied the theory of "vicious circles." But instead of "vicious circles" I write preferably of "negative" circles and their opposite, "positive," or favourable, circles. 6 ADVANCED SUGGESTION Suggestion should be considered as applicable, not only to brain conception, but to body perception. Under the methods which I employ a patient is not only instructed by words spoken, but his general system is at the same time inducted by manipulations which are designed to impress, both wholly and locally. In pointing out that I do not recommend what is known as hypnotic suggestion, it may be well if I make some comparison. I consider the state of hypnosis to be one in which certain neurones and synapses of the brain have, through induction, become temporarily inactive, but which are nevertheless dis- posed to accept the direction of another person for the time being. If there is a disposition to act in a contrary direction to the aim of induction, then there can be no hypnosis. The person hypnotised exercises volition in consenting to enter the state, after which he will carry out the orders of the operator; but he has the power to resist any suggestions should he take exception to what is suggested. For therapeutic purposes I require a patient merely to be willing to co-operate with me, so that he may receive the clear lessons I have to teach his mind and body. I do not wish for any state approaching sleep. I want just exactly the opposite ; and I get the opposite by specially eliciting the attention of the patient. In neuroinduction the confusing activities of the patient's eyes are inhibited by his closing them at my request. It will be obvious why I consider neuroinduction to b^ a more efficacious means of treatment than hy^pnotig PROVISIONAL PSYCHOLOGY 7 suggestion. In the former the patient is invited to think and act for reasons that are agreed upon in respect of reahsable advantages ; he is asked to exer- cise his unhindered reasoning powers to the best of his abihty. In hypnosis his initiatory power of thought is inhibited; he is led by the thoughts of another throughout. There is a further physiological effect of very great importance which is common to both neuroinduction and hypnotic suggestion — namely, an absolute relaxation of all voluntary and a reduction of abnormal involuntary muscular energy, the body being in a state of perfect rest. Neuroinduction involves limitation of both the physical and the mental energy of the patient down to a plain static receptivity on the part of the patient, and to an easy capability of comprehension of the remarks or sensations that are conveyed by the physician. It should, therefore, elicit no reply if consistently carried out, for this would entail effort at a time when absolute mental and physical relaxation was of prime necessity. If a patient moved in the slightest or uttered any word, then the relaxation requisite for fullest perception would not be present. Neuroinduction calls for no effort whatsoever on the part of the patient. When a patient is trained to relax absolutely he is ipso facto taught not to energise ; nor will he have the least desire either to speak or move, provided the technique is nearly as good as that required of one who is teaching another how to float in water effectually. I deem the subconscious to be .y^/^^rconscious, 8 ADVANCED SUGGESTION instead of unconscious — as so many erroneously imagine and allow it to be — simply because it proves itself to be superconscious in induction. When I induct toward the subconscious I make for super- consciousness by eliminating confusion and encourag- ing concentration, by bringing out the purest thoughts possible on particular lines. Amnesia does not mean unconsciousness of either the supraconscious or the subconscious; it merely means that some amount of dissociation exists for the time being. When lecturing on " War Shock " before the Royal Society of Medicine a distinguished psychiatrist said : " The . . . wish leading to the production of the neurosis is * repressed * and unconscious." This is a common error that is too flagrant to stand unchallenged. By neuroinduc- tion I enable "repressed" conscious ideas to become still more conscious, and I effect normal association to the level of the supraconscious if necessary. I should not expect to get any improved sense out of an un- conscious. What has so long been spoken of by authorities as the unconscious of the subconscious has therefore been a contradiction amounting to absurdity in the light of the later evidence of these present pages. CHAPTER II SOME OBJECT LESSONS This book is a digest of upwards of a thousand pages written on the subject of Suggestion. The war, and the scarcity of paper, have made it necessary to publish only such parts of the whole study as will serve to guide others who desire to work in the same field — as to methods of application, scope, usefulness, and possi- bilities for the future, having regard to the urgent and increasing demand for the best means of dealing with many disorders and diseases of a difficult nature, which are always more or less with us, but which the extra stress and strain of recent years have accentuated. Nothing could possibly be simpler than the methods I adopt. In all cases I explain to the patient the meaning of every procedure, in the simplest words, so far as in each instance he or she is capable of under- standing. Thus mystery is impossible; it is not allowed to enter. The great difficulty of certain disorders, and the failure to treat them successfully by any other means, has been the making of psychotherapy. " There is no other treatment left" has many times been remarked to me by physicians when discussing cases, ''It is 9 lo ADVANCED SUGGESTION the only treatment " has been a repeated comment, in reference to confirmed habits which have been based upon abnormal nerve-functioning. The instance of a distinguished physician becoming a sworn believer in suggestion within a couple of memorable hours is not without interest. He was attending a wealthy lady for supposed appendicitis, when he suspected stone in the kidney. Happening to mention his doubt to a member of the family, the latter proceeded to discuss the case in whispers, which were overheard by the patient, who thereupon became first hysterical and then seriously alarmed, until growing mental distress promised rapidly to develop into very serious disorder. The situation became acute when the physician was accused by the relatives of driving the patient insane through a careless remark. He hastened to his most intimate colleague for help; the latter was in a difficulty as to how he should reply, until he finally concluded : " The only thing to do is to get someone to treat her by suggestion." The ajarming position was thereby saved. At times, indeed, the employer of suggestion does distinctly "come out on top," and in these days with increasing frequency. Take the instance of a lady being seized with a sudden agony of mind on hearing of a tragedy. Acute dementia was diagnosed. She exhibited loss of mental capability to the extent of becoming incoherent of speech and violent, while there was a total lack of intelligent response to any ques- tioning. Certificates were written out and awaited SOME OBJECT LESSONS ii the husband's signature. He refused to sign, although one of the medical advisers was a specialist of stand- ing. He had heard of other ways of dealing with such cases. He discussed the situation with a reliable friend, who advised suggestion. To this there was opposition; indeed, it was only with great difficulty that the recommendation was pursued. Eventually the stronger conviction prevailed. After the second treatment the patient was able to converse sufficiently well to justify those around her in considering that a favourable prognosis was entertainable. She received only three treatments by suggestion in all, and required no further medical advice afterwards. I have been fortunate in my special study, in that I have from the first had to deal almost exclusively with complications : strange to say, for reasons which 1 will not explain, I never went through an elementary schooling. My first special case was given me to look after by a well-known psychotherapeutic prac- titioner of the earlier period ; the patient was a lady of position whom many specialists had given up as in- curable. My medical friend had long known that I was interested in psychotherapy; he asked me to attend, as a general practitioner, to the end. To his astonishment, I succeeded in curing the patient. He then tried me with a string of so-called incurables, from drug-takers to strange cases of mental derange- ment, and the results were such that I was able to divide my general practice between my erstwhile local Rivals, presenting each of them with a very welcome 12 ADVANCED SUGGESTION section of it as a Christmas present, to their astonish- ment and extreme gratification. Easy cases have not reached me for other and obvious reasons. Many times my opportunity has come when a patient has " seen all the best men," the last one having divined a possible means of checking an exasperating career by means of psychotherapy. To this day, the private watchword for some consul- tants is : " Never send a patient for treatment by suggestion so long as anything else can have a possible chance of effecting a cure ;" for they do not understand the treatment, and they therefore imagine that the best attitude to adopt is to say as little about it as possible. It is my object in these pages to induce them to understand, and, indeed, to adopt it them- selves. I am fair enough to acknowledge that there are a few consultants — very few — who "swear by" suggestion for certain cases ; and these are sufficiently strong frankly to say so. All honour to them. Their prosperity is largely the result of their all-round honesty, their fearless independence of judgment, and their deeper knowledge. No one can be blamed for not recommending psychotherapy when so little is known about it. Opposition, indeed, has been only natural. It has always been the attitude — and in general, perhaps, it is a wise one — of the mass of medical men toward anything new, until it has become obvious that its extensive adoption could only be advantageous and would involve no danger. SOME OBJECT LESSONS 13 In certain respects, I admit, the work is not always easy ; had it been so the possibilities of psychotherapy would be far more acceptable than they are. At times, indeed, the work is extremely difficult It is not so easy to follow a train of thought in the mind's eye as it is to observe anatomical and pathological structures by the naked eye. When hundreds of cases can be cited, all affording rich object lessons which cannot be gainsaid, and the illuminating effect of which no opposition can obscure, it is time for practitioners to open their hearts and minds to that which has proved to be to the advan- tage of the public, and must therefore be to their own interest also. I am citing in this chapter a few cases which have occurred among medical men and their families. I am offering such instances of set purpose, in order to show that in cases which have presented the utmost difficulty psychotherapy has intervened successfully, as nothing else could have done, eloquently teaching us the advisability of em- ploying this means of treatment, not merely as a last resource, but as an early remedy. A medical man had been for six weeks in a nursing home, suffering from heart failure, going from bad to worse. He was recommended to me by a consul- tant who felt that he could advise nothing more than had already been done, "unless it might be sugges- tion;" for this had been successful in the case of a near relative of the consultant, whose case had also been considered hopeless. The patient could hardly 14 ADVANCED SUGGESTION speak, through breathlessness. He handed me a, former speciahst's report as to valvular disease, which had followed upon rheumatic fever. I at once con- cluded that there was present a condition of general nervous chaos as an additional factor, and that it was precisely this which was aggravating both the organic condition of the heart and its functional distress, in spite of all therapeutic efforts. After one treatment, administered there and then, a marked improvement was to be recognised, both objectively and subjec- tively. He was well enough to resume work a few days later, being only too anxious to do so. Although on recommencing work he was feeling far from well in a general sense, he now no longer suffered any distress from his heart. He soon regained his normal strength under the exhilarating effect of employment, enjoying freedom of respiration, and being altogether in quite a happy frame of mind. I am not going to pretend that the patient grew new valves, whether immediately or later on. What I did was to diminish the nervous strain super- imposed, when the diseased valves were able to serve the heart quite sufficiently well. I do not suggest that all such cases could be similarly dealt with in a single treatment. In a further case, not nearly so severe, which was sent me by a leading heart specialist in London, the patient required three or four treatments. A sufferer from very severe tachycardia, the son of a medical man, required three treatments a week for a month before the trouble was entirely overcome, for SOME OBJECT LESSONS 15 the simple reason that in his case there were severe comphcations elsewhere localised, which also required treatment. I will just offer one more object lesson before I proceed to some very special data which the scientist should carefully ponder. The son of a doctor of medicine, being also the brother of another doctor, had for many years been suffering from "neurasthenia." He had consulted no less than twenty-four advisers, all specialists of different categories, from consulting physicians to oculists, from ear and throat experts to high-blood-pressure enthusiasts. Finally, being con- sidered quite incurable, a perfect nuisance to encounter, a positive bugbear to hear about, my colleagues got rid of him by sending him to me — partly, I am almost inclined to conclude, in order to punish me for my audacity, in that I habitually consented, by preference, to receive the most difficult cases. I secured evidence that in this case it was expected that I should miser- ably fail. The patient's age was thirty-four. His history included his never having been able to succeed in any employment; he had always been dependent upon allowances from relatives. He could hardly speak ; nor could he see sufficiently well to walk unaided or to read, having to wear an enormous shade over his eyes. He had been in bed for weeks. He went straight to bed on coming into my care. He was treated by suggestion for some months. To-day he has an almost world-wide reputation as a i6 ADVANCED SUGGESTION man of high professional attainments ; he is also quite above the average as a man of business. It was not to favour me that a Gold Medallist M.D. was recommended to me as a patient by another Gold Medallist M.D. ; it was because no other procedure seemed more hopeful in a position of desperate, urgent, and alarming difficulty. The decision that the patient had better be placed in my hands was arrived at because many instances were known of success in such cases when everything else had either proved, or promised to prove, a failure. If my readers, on perusing the " Contents " list, note the scope of the work described, and observe the head- ing " Surgical," they must not conclude that the author is suff"ering from over-enthusiasm. Let me tell them of the case of a child, two and a half years of age, which was suffering from prolapse of the rectum. When the case was recommended to me the trouble had existed for some months, and was gradually becoming worse. AU the usual and likely remedies had been adopted without avail; a surgeon was at length appealed to, who advised operation. This was objected to. One treatment by neuroinduction relieved the constipation ; a second confirmed the improvement; a third was g^ven by way of further security. The bowel never came down again after the first treatment. Nor need the heading "Pulmonary" astonish any who scan the index. I shall explain what can be done in desperately difficult cases. Surgeons must never again scorn psychotherapy SOME OBJECT LESSONS 17 after my now referring to a patient who was afflicted with lateral curvature of the spine, and had suffered years of agony from plaster and other barbarous fixtures, only to emerge worse than before. Neuro- induction served to restore confidence and to create such a keenness for exercise of the offending muscles that a very few months sufficed to restore shapeliness. In some antero-posterior cases of cure I am convinced that nothing but neuroinduction would ever have succeeded. The importance of a study of neuroinduction will be further seen from an analysis of such a case as this : A daughter complained of a dread of having anything to do with birds; she would neither eat chicken nor countenance feathers in hats. It was found that her mother had been terrified by a parrot becoming suddenly entangled in her hair while she was "carry- ing" the offspring in utero; thus I have found that certain "maternal impressions," of various kinds, are real. When we also bear in mind the example that bulldogs afford, which are now commonly born with distorted tails — the tails of their progenitors having been broken to keep the fashion — then one must con- clude that nothing but neurone process could determine transmission of acquired characters. If it be contended that a "nerve theory" has been advanced by former observers, I must point out that these have done no more than surmise, for no rationale has been forthcoming to sustain their idea. In these present pages a rationale does come into view, through 1 8 ADVANCED SUGGESTION the illumination which a study of neurones and synapses, glands, and sympathetic systems, provides. Professors Adami and Cunningham may therefore both be quite happy with the conclusions of this book, for if glandular secretions really do produce chemical stimulating effects, then I must maintain that this is primarily through the influence of neurones ; moreover, in the case of the lower organisms I would point out that we have every right to conclude that primitive neuronous elements were active before glandular, for, in studying the higher animals, when an idea has caused disturbance in bodily functioning it is the neurones which have primarily governed effect. CHAPTER III NEUROSES Insomnia Amongst the worst cases of this disorder are those in which the patient is obsessed with the idea of not sleeping, and has developed a mania for convincing all and sundry of the dreadful suffering which he undergoes. He thus feeds his disorder upon what successes he can obtain in the matter of finding others who can be wrought upon by his descriptions, until his own estimates as to the kind and the extent of his sufferings become so very much enlarged that they actually induce insomnia which otherwise would not exist. The fact is that insomnia is often an extremely useful complaint for the neurasthenic, for he can descant upon it to his heart's content, knowing that nobody is present to see whether he sleeps or no, and if his doctor should deliberately place someone beside him he would still have difiiculty in proving the truth. Most of the other forms of insomnia are very ordinary compared with this type, and can be successfully treated by various well-known means, according to the indications and etiological factors in each case. Not that ordinary cases ought to be treated by other 19 20 ADVANCED SUGGESTION means than psychotherapy, for — and here let there be no mistake — psychotherapy will readily prove itself to be the very best treatment for all kinds and all degrees of insomnia, even though organic disorder in the patient should require medicinal or hygienic adjuvants. When, in addition to the fundamental exigencies of the case, the patient further endeavours to torment himself, and to corner his doctor, with a phobia regard- ing the drugs he feels obliged to take, a veritable impasse may be reached, which will require strong measures, and perhaps even the resources of a scientific detective. The neurasthenic often becomes very in- genious in his cunning ; his success in baffling first one and then another doctor may create a yet more urgent desire on his part to prove the truth of his conten- tions; and in this way he may add other arcs to his negative circling. He may divine that he is being watched, and conclude that the most artful expedients are being adopted for catching him; his protesta- tions may at times become heated. Sooner than be found out, he will often do a desperate amount of thinking; he may also act desperately. Should it dawn upon him that he has been exaggerating in declaring that he ought not to be so cruelly accused, he may suffer a distress of mind that makes any road out of it preferable to facing the painful ordeal of exposure. He may finally quarrel with his doctor, and even with himself, and meditate suicide. Such a patient requires to be treated by a scheme KEUROSES 21 of psychotherapy which aims at such various symptoms of his neurasthenia as are acting in vicious encircle- ment. What will be the use of merely treating his dyspepsia by means of medicines and food, or of considering chiefly his loss of weight, or of heeding only his chief complaint that he gets no sleep, when all these features are caused by serious conflict in his subconscious mind, originating partly in some domes- tic circumstance, and being established still more deeply by worrying over his illness ? Having been a perfectly honest man when well, he now misrepre- sents the facts. There is discord in his constitution, and he feels downright unhappy. He may even be extremely ashamed of himself, while feeling helpless and unable to escape from it all. In employing psychotherapy nothing is so power- fully effective as logically cornering the patient, and bringing his misfeasances home to his subconscious- ness. The case of a lady who suffered from nervous breakdown through playing chess to excess may be referred to by way of illustration. She declared that she slept only two or three hours each night, and never before one o'clock in the morning. She was placed in a one-patient home; psychotherapy was applied for two weeks, with obviously favourable effects as to her general condition, but she adhered firmly to her story of insomnia. Accordingly a trap was laid for her: a book was lent her, which was just of a kind to induce her to read far into the night if nothing hindered. " Do not keep this long ; there is a run on 2^ ADVANCED SUGGESTION it, naturally. Several are asking for it," was the condi- tion of the loan. She read the book all the afternoon, and took it to bed with her. It was ten o'clock, and I thought I should like to read the book, for I had found a rare moment of leisure. I decided to go to the home, and to the patient's room, to ask for it. I knocked — and knocked gently ; no answer. Then I softly opened the door. Getting no response, I spoke : "Are you awake, Miss ?" No answer. Care- fully listening, I could hear the sounds which tell of delicious slumber. There was no mistake about it. I gave her a few minutes; then I called louder. She awoke with a start, in confusion, and immediately said : " I was not asleep — did you knock ?" " I only want my book," I replied; "I have just a chance to look at it, and I thought you would not mind my asking for it. It is not very late, and I thought you would not be disturbed." I took the book, and nothing more was said until the morning. Then the discrepancy was referred to during subconscious train- ing, with the result that ever afterwards none but accurate reference was made to anything and every- thing by the patient, the question of sleep never again being referred to in the supraconscious state.* The reader may conjecture that a patient may be similarly detected as guilty of incorrect representation without any special application of psychotherapy being necessary afterwards. My reply is that mere * Throughout this book all above the subconscious is termed the supraconscious, advisedly. NEUROSES 23 detection without psychotherapy may miserably fail; the patient may complain in anger that she is being disgracefully treated. Under the scientific and ex- perienced application of psychotherapy failure will be impossible, other things being equal. Of all the cases of insomnia I ever attended there was one I regarded as likely to be most hopeless. Lack of sleep was occasioned by the presence of an internal growth on which the surgeons would not operate, the patient being in mental as well as physical agony. She would not take drugs, so what further treatment could be applied other than psychotherapy ? Under the circumstances, I consented to treat her, and I was successful even beyond my own attenuated hopes. Assuagement of her fears, apprehensions, and misgivings by comfortable argument produced the most gratifying results. Psychotherapy has proved itself paramount over all other treatments that have been tried for insomnia. But why has it done so ? For three reasons : firstly, induction* has allayed mental excitement and reduced bodily tremors; secondly, induction has readily enabled analysis to detect any underlying mental tension; thirdly, induction has assisted the action of medicinal applications upon physical disorders, whether the latter have been consequent upon the in- * The word induction is employed to denote the education or re-education of the mental and physical systems, the patient being led from one clear understanding to another, the physician's plain and simple reasoning appealing to the inner conscience. A later chapter deals further with methods. 24 ADVANCED SUGGESTION somnia or have preceeded it, although such applica^ tions had formerly been of little use; this adjuvant action being due to the fillip administered to the process of metabolism, and to the feeling of well-being afforded thereby. Not that the use of chemical medicines is always recommended, for the effects of psychotherapy are so far-reaching and so prompt that in most instances medicines will be no longer required shortly after the commencement of the treatment, even though the sufferer may have become a drug maniac. Possibly none will be required from the outset; nevertheless, it is, of course, frankly admitted that some patients may be helped to more rapid improvement by the adminis- tration of stomachics, laxatives, tonics, and even sedatives, while psychotherapy is being applied. It is impossible in these days to study disorders which are difficult to diagnose fully, and when all treat- ments are difficult to apply, without having recourse to the lessons which an understanding of the process of "circling" offers. We owe much to the discovery of the " vicious circle " — if it deserve the label of dis- covery. The process must have been recognised to some extent and in various connections from time immemorial. It has taught us to make more correct esti- mates, and has drawn attention to the necessity for recognising the accurate sequence in identifying compli- cations. Now, having found its value, I venture to con- sider that the term should only be used with direct refer- ence to its opposite. At first (some years ago) I chose to refer to the opposite process as " favourable circling " ; NEUROSES i$ later on I came to adopt the terms positive and negative as being more suitable. In the matter of illustrations I conceived a dislike of drawn circles which contained reference words that were printed upside down and were not easy to read. I therefore adopted another form of circle, writing all descriptive words horizontally, so that they were easier to read. Now, in this book, I would ask permission to abandon the illustrative circle altogether, as too well under- stood to need actual representation. I find, indeed, that sequences may quite well be given in the printed lines of the context. This form of expression is readily understood by the reader, and it is much easier to print. I represent a case such as has been referred to in the last few pages in the following way, giving the arcs in the order in which they appear to have originated : Negative "Circling" (Corresponding) (i) Worry; (2) insomnia; (3) dyspepsia; (4) pain; (5) constipation ; (6) despair ; (7) drug mania ; (8) loss of weight. Positive "Circling" (i) Psychotherapy ; (2) psychotherapy ; (3) medicines and diet; (4) local applications; (5) laxatives or psychotherapy; (5) psychotherapy; (7) sedatives or psychotherapy, or both ; (8) diet. I have also found that diagnosis of a case is best expressed in terms of "circling" as above. For in- 26 ADVANCED SUGGESTION stance, it would be absurd to categorise the cases previously referred to as cases of insomnia. They are cases in which insomnia is merely a single feature, and not by any means the most important one. The following is an instance worth studying. A young man of twenty-six was sent to me by a consultant as a case of insomnia that " beat everything." He was an architect. He had been spoilt as a boy. He was very capable; almost too enthusiastic. Nothing had been successful in curing his insomnia. I found that he was chiefly afraid because nobody could help him. He felt that his was a hopeless case. Drugs had made him worse : in small doses they were useless ; in large doses they made him feel bad the next day. He was an obstinate patient to treat, and gave me the impression that he was afraid he would be compelled to sleep by " suggestion " — as he had heard the new treatment called. Mental analysis further showed that there was something more at the back of his mind. It was proved that he slept fairly well, although he continued to declare that he did not get more than a couple of hours* sleep each night. It turned out that six months previously he had been overworked, and had been offended by someone who had remarked upon an error in an architectural design. This fact he kept to himself, until he fell ill ; then followed insomnia, which itself was simple enough, and would have been curable by ordinary means, but for the fact that the patient, in his malaise, developed obsessions and phobias arising from the aspersions cast upon his work. At NEUROSES 17 length he felt that certain thoughts were accumulating which he must by all means conceal. Even convinc- ing him that he slept was of no avail until the nature of his strain had been explained, and until he had learned to recover a greater degree of self-confidence. This patient had made references in his diary to the various authorities whom he had formerly con- sulted, and to their treatments and observations. When he recovered he recognised quite clearly that he had been incontinently drifting into negatives which would finally have rendered him insane had they not been checked. He had become afraid of himself and of everybody else. One of his confessions was this : " One side of me said, * You do sleep * : the other, ' You don*t ; you must keep up the idea that you don't, or you will expose yourself.' I got into an awful fix, until I found that whatever initial insomnia there had been was kept up by the unsuccessful efforts doctors had made against it." He finally admitted that the whole chaotic position had been brought about through the early remarks made to him about his work. Quite a number of patients, who get well under psychotherapy, quietly discontinue further treatment, with very little comment, giving, when questioned, some simple answer such as this : " Getting right by degrees, thank you." Later one hears of their being quite well. The explanation is that they have corrected their obsessions as induction has continued, and have decided not to reveal the initial worry, what- 28 ADVANCED SUGGESTION ever it might have been, especially as no specifi.c in- quiries had been made in respect of its nature — as they need not be if a case should seem to the physician to be proceeding satisfactorily. Thus there is very often no need to grope amongst a person's private affairs if he shows early signs of responding to treatment. PSYCHASTHENIA (INCLUDING NEURASTHENIA) I have chosen to make a study of neurasthenia under the heading psychasthenia, after the manner of a psychotherapist who never sees the one disorder with- out the other ; who cannot, indeed, see the one without the other, for the very reason that there is no such thing as neurasthenia without some degree of psychas- thenia. Neurasthenia means — if it means anything — weakness of the neurones and their connections, which is bound to include a diminished power of thought. I allow the greater to contain the less. It is my conten- tion that psychasthenia is the most important factor in the causation of functional derangements. By means of a treatment called suggestion (which means educa- tion) both the psychasthenia and the neurasthenia belonging to it may be cured. This is clearly seen in practice : we hardly seem to need the word neuras- thenia any longer. The neurasthenia of former writers is shorn of all its difficulties when its protean mani- festations are viewed under the lenses and by the light which a study of psychasthenia and its treatment affords us. A great authority has published a book NEUROSES 29 on neurasthenia; in it he frankly admits that "the weariness complained of by neurasthenics is a central phenomenon." We thank him for these words. Notwithstanding the fact that large and valuable volumes have been written on neurasthenia by very clever men, I propose to peel off a good deal of thick encrustation which many years of very serious thought have deposited over the kernel of this disorder, together with much of the dust and cobwebs of time-honoured theory surrounding the whole. I am sorry if I offend the susceptibilities of lovers of the old order of things ; but experience compels me. I feel that psychasthenia gives us all the elucidation we want ; in our study neuras- thenia will melt into a matter hardly worth any special consideration as a great disorder in itself. It seems impossible to think otherwise ; the teaching of psycho- therapy is so clear that there can be no other alter- native. I will allow at once that a toxaemia of dyspepsia plus intestinal stasis may be the cause of a so-called neurasthenia; but I shall show in later chapters that the former conditions are caused chiefly by mental stress, which is best treated by "suggestion." Psychasthenia may be regarded as anything between general depression and inertia such as follow influenza, nerve shock, or mental strain, on the one hand, and utter exhaustion of power of thought, such as we see in dementia (or complete chaos, as in mania), on the other. It follows that this chapter will be a very short one. 30 ADVANCED SUGGESTION Psychasthenia will be considered broadly as it may occur in different forms and various headings. I shall make but a brief reference to cases not having- an organic or toxic origin, in which nothing but inertia, a disinclination to do anything, and an incapacity to feel interest, are the chief features, there being neither any particular phobias nor anything definitely hysteri- cal, illusional, or delusional to characterise. All such featureless instances of psychasthenia require analysis.* This should not only serve to reveal traumata, but should begin by making a careful etiological inquiry, the physician remembering that far from being a weary and thankless task, when properly conducted the very process of inquiry creates an immediately curative effect, whether anything definite be found or no. In some instances a commonplace fear or an inherited timidity may be at the root of very great disorder. After several attempts to find a cause in one such case, it was remembered that the patient — suffering from severe phobias — had declared that nothing whatever would be discovered excepting " constitutional cowar- dice." Here, in two words, was all the analysis one wanted, as time went to prove. Treated by the method of analysis which I recommend, the patient soon becomes the physician's most valuable assistant. Many patients keep their complaints going just * In my system, to be explained in a later chapter, I have no use whatever for what are known as Freud's or Jung's systems. My method is rapid, and it produces dependable results without possessing any disadvantages of its own. NEUROSES 31 because of the treatment which has been laid down for them, designed to meet their disorder — so often does a routine happen to be wholly satisfactory to them from every point of view. Should this frame of mind be sufficiently obvious to the physician, his best plan is to inculcate an energy, an active disposition, by an induction which brings in full play of emotion. Self -analysis should also be brought to bear, making apparent the meanness, unfairness, and unwisdom of any resignation to a slothful life. Yet even this must be done with discretion on the part of the physician, and with due regard for further depression or melancholia which may be ready to develop. Stimulation of emotion should always be applied indirectly, or by innuendo, and should be leavened by a bright cheering mood which is quite sincerely applied. In analysing for negative circles we should endeavour to estimate the proportional effect of the different arcs, ascertaining how far dys- pepsia may be contributing to the whole, or how much insomnia ; also, having found an early psychic trauma- tism, whether there did not exist dyspepsia or some other negative arc before this had occurred. Inherited difficulties are very often found to be at the back of all. It will be well to bear in mind that psychasthenics are always so much on the defensive, that disputation, and even antagonism, often becomes the dominant trait manifested in ordinary discussions of their cases with them. This naturally follows from fearj^ 32 ADVANCED SUGGESTION which begins as an instinct and goes on accumulating, in subconscious calculation, according to the power and the kind of negative arcs encircling the patient. I feel bound to express a conviction begotten of much observation, that the usual idea that one should urge employment when treating such cases is one that requires very considerable modification. Take the case of a man in whom there were many arcs of negative "circling," one of the deepest being the fact that his relatives despised him because he would do nothing, describing him as lazy, " fat enough to work," and heaping upon him expressions of reproof which nearly drove him to suicide. The very first " positive arc" which I felt obliged to implant in his mind was the correction of this mass of negative injunctions in- flicted on him by his relatives, by telling him (a) to take no notice of what other people had been saying ; (d) that he would work all right when he felt well enough. In twenty-four hours these points of view helped to make two other "positive arcs"; he slept better, and he had less indigestion after food. Employment should be suggested to patients only after they have been made well enough to consider it. It is true that advisers who never suffer from sea- sickness are those most given to urging sufferers to " go down to every meal and eat, whether they wish or no ;" while there are people who declare that epileptic confu- sion is "downright naughtiness," and that it ought to be punished. But the physician who has studied psycho- therapy knows better. NEUROSES 33 "If I had to work I should not be where I am," a wealthy lady in an asylum told me. She was right, and she was wrong. She had intelligence enough to know that work was healthy, but she could not engage in work, as she was then suffering. When I had got her well enough, it was not at all necessary to tell her to work ; she became industrious quite of her own accord. Psychasthenics may he obstinate, for the reasons given : the very mention of work will often produce further incapacity for action. But continue to treat a case properly, and just as surely as the patient will presently arrive at self-analysis, so she will presently work when she can work, thanks to auto-suggestion and natural inclination. Precisely the same observations are applicable to the question of work in the case of sufferers from phthisis, in which disease there is a psychasthenic arc, as we shall see in a later chapter. To prove the possibility of work when suggesting employment is very important in inductive treatment ; and the physician often finds this rather difficult. A lady came into my hands who was suffering from very severe psychasthenia, after having been in a home for observation for twelve months. There were only three "arcs" which seemed to me to count in "negative circling"; there were several others, but they were quite inconsiderable. The three were : (a) worry about her husband ; {b) the feeling that she could do nothing; {c) the idea which she had gleaned, from conversations which she could not help overhearmgj 3 34 ADVANCED SUGGESTION that she was Hkely to go out of her mind. I treated (a) and (<:) quite easily, while the patient clung to (Jb) with the tightest of grips. She declared that she could not read, because she could not follow the words, either by sight or understanding. I therefore found it neces- sary to set traps for her, having roughly tested her eye- sight. I asked her to look on a page of a book in order to distinguish certain words. I found she could differ- entiate between large and small words. I therefore remarked : " But you told me you could not read a single word ! Ah, well ; I want you to be quite accurate. You therefore can see words." Induction afterwards enabled her to take an interest in seeing more words, until one day she announced the marriage of a great friend. I asked her who had written to her about it, in order to see if I could secure her admission of having read a letter — a nurse being accustomed to read all her letters to her, as I had understood. She replied that she had caught sight of it in the paper. " What were you doing looking at the paper ?" I asked. " I was holding it in my hand, trying to make out the headlines, for practice," she replied. Further induc- tion made use of this incident. Not that the patient was really dishonest; she had thought she could not read a word, in fearing that her case would not be considered sufficiently serious, until at length she had become obsessed with the idea. Induction on lines which developed a capacity that was at first quite infinitesimal, but was frankly accepted, enabled her in four weeks to read all the chief news of the day, Had NEUROSES 35 she been told that she could read, and that she was lazy and untruthful, she would at this moment be languishing in another home, instead of being in per- fect health and exercising uncommon ability in ordinary life. Sometimes a patient will elect to take no notice of questions asked, making an interview seem of little apparent use, as though not understanding anything said to her; in such a case induction should be com- menced by means of studied conversations with a nurse or friends in the patient* s presence^ the physician knowing perfectly well that the patient will take in every word. If tactfully done the patient will possibly speak quite freely on the next occasion. I give the following three cases by way of illustra- tion : A young lady of twenty-eight years of age had for years been the puzzle of consultants in two con- tinents. In England every remedy was tried, from high-frequency currents to the Weir-Mitchell treat- ment, without favourable effect. As she was suffering from dyspepsia, constipation, and emaciation, mas- sage, strict confinement to her bed, and a course of feeding-up, were prescribed by yet another consultant. After three weeks of this treatment the patient had lost weight alarmingly, to the amazement and dis- appointment of all. Her insomnia was greatly aggravated. When the patient came into my hands induction toward the subconscious was fortunately allowed in the second interview, after which analysis detected the folie. The patient described her tendency 36 ADVANCED SUGGESTION to think and to act in direct opposition to all persua- sion. In despair, and afraid of everybody and of all recommendations, she evolved a mood of universal perverseness. She further explained that three years previously she had been quite certain that one of her doctors had been entirely wrong in thinking that her womb was at fault ; she believed that he was merely guessing. This patient made a fairly rapid recovery, to the immense satisfaction of the consultant who had recommended psychotherapy after so many other treatments had failed. A man, aged forty-seven, had been treated for some eighteen years for various attacks of psychasthenia — by travelling, electricity, massage, lymph and culture injections, rest-cures in bed, and so on, until he got out of patience and became very irritable and despairing. At length petulant opposition grew into active resist- ance; he first refused medicine, then food, and after- wards declined to take any notice of anyone. He was consequently restrained and subjected to force. On being sent to me, I reversed the tactics, the great contrast in itself being such a relief to the patient as to cause him to attend to the very different recommenda- tions addressed to him in respect of his case, the result being that for two weeks he consented to take food. He would only take medicine, however, upon my offer- ing to taste a dose myself out of his bottle in his presence. I treated him largely by observations made to a third party present, after getting him to close his eyes for a few moments at a time by tiring him out NEUROSES 37 with platitudes. Each day or two some ground was gained, and he continued to make progress until he completely recovered. He then declared that he had concluded, when ill, that no efforts would ever be of any avail to save him. As an example of partial benefit the following case is worth studying. A lady forty-six years of age had been for some years psychasthenic, for no reason what- ever that could be discovered; she gradually became worse, developing symptoms of melancholia. She would do nothing but very slowly dress and take a little garden exercise ; eating just enough to keep alive, refusing to see anyone, and crying a great many times each day. She said she did not want anything, not even doctors. She would listen to nobody's arguments or persuasions, declaring that she was past all help, and ridiculing any suggestion for her benefit. She altogether declined to see one doctor who called repeatedly. Her distinguished consultant sent her to me for psychotherapy. She declined to see me for a week. I sent a lady to call upon her daily; she received her kindly but deprecatingly ; at length she took the advice given that she should see me. For two weeks she would only submit to my very simple conversations, after which she very reluctantly con- sented to start a course of induction. I told her that she need only close her eyes, and that if she did not understand what I said she was to say so and I would explain. She ridiculed the idea that this could do any good. After three treatments of twenty minutes 38 ADVANCED SUGGESTION each she seemed to divine subconsciously that favour- able effects would follow, for she became more cheerful and went out and bought a new hat. Unfortunately the nurse noticed this, and mentioned it to the patient as a favourable sign. She now began to dislike the idea of any further treatments, yet consented to take another. Analysis following this treatment revealed an unhappy relationship with a very near relative; whereupon she would consent to no further treatment, for it became clear to her that recovery must mean a return to this same relationship. All the former obstinacy and resistance then returned. I have explained to many medical men and anxious relatives that psychotherapy will not do everything, nor will it always do anything. It will not find new husbands or wives; it will not restore lost property; it will not make brain power when the brain convolu- tions are too few in number. There are bound to be incurable cases, incurable owing to outside conditions which cannot be altered satisfactorily. Amongst the most difficult patients to deal with are those in whom genuine physical disorder is compli- cated by crafty purposive design or hysterical artifice. Difficult cases indeed provide all conceivable blends and shades of reality and falsity. When dis- appointment, covetousness, or jealousy are at the root of the crying evil, one may really expect anything, according to the bias of inherited temperament or the urgings of emotional sensitiveness. I am thinking of a case in which genuine disorder prompted the deliberate NEUROSES i^ 'design to deceive and baffle, because it paid so well, until the lady overreached herself by embezzling some of the funds which had been given in aid of poor people suffering in the same way. Her behaviour upon accusation revealed the fact to the least acute beholder that she had for the most part been shamming. Her hurried volitional departure for fresh fields completed her cure, indignant protestations of innocency ap- peared to help enormously in dissipating most of her symptoms. More difficult still are cases in which stigmata of degeneration are to be found, such as badly shaped heads, marked asymmetry in facial features or in the organs of special sense. One might imagine that such cases should really be classed as quite imsuitable for induction of the subconscious ; but the fact is that many of them improve greatly under its training. I have frequently seen decided asymmetry of features be- come absolutely regular. No notes might be considered complete in these days unless some reference were made to the types of psychasthenia incidental to active warfare. But the fact is that such cases need little special consideration, for they fall naturally into the various categories of nerve and mind disorders which are occasionally observable in times of peace; their treatment will require little more additional study, once the principles of treatment by psychotherapy are appreciated as applying to strains and stresses of neurone function whatever the nature of the causation may be. 46 ' ADVANCED SUGGESTIOKf Hysteria Everyone must allow that a patient whose symptoms exhibit in a few hours trains of thought which range from exhibitions of the clearest and most capable intelligence to moods of pugnacious recalcitrancy that will brook no reasonable correction, which present features distracting to anxious relatives and puzzling to doctors, and offer an infinite variety of simulated pains, incoherent arguments, illusions, anaesthesias and paralyses, while the patient laughs, swears, or cries by turns, in the face of tender maternal admonition, being altogether unaffected by the family adviser's old-fashioned bromides and valerian, likely to give much trouble to everybody concerned. But how easy all becomes when tackled by an experienced psychotherapy ! In hysteria there is a history of an emotional crisis ; dissociation has been effected by some strain or shock sustained. Ideas of dissimulation, creating purposive dissociation, arise in the mind of the patient, as a means of self-defence. Should there be anything to be ashamed of, and should painful difficulties find no outlet in ordinary ways of communication because of the prevailing inco-ordination and chaos, the patient will make excuses, and in her fear will adroitly clutch at opportunities for adding to her means of self- defence. She will accept any hint which may fall from careless observers, for this may help her in one NEUROSES 41 direction, but it may succeed in adding to her troubles in another; thus she may become violent in her mania for making further difficulties. She will almost seem to enjoy deluding and defeating all efforts made on her behalf. Hysteria is a wholesale camouflage for concealing mental difficulties. Urgent repression and conflict give rise to frantic internal stress and external demonstrations. Psychotherapy of the right kind will facilitate re- association and easy communication with the exterior ; it will restore co-ordination, firstly in the internal pro- cesses of reasoning, and secondly in ordinary conversa- tional intercourse with others. In such cases the weakness of Freud's analysis — the analysis of other days and dreams — is self-evident. The conditions above recited mock the efforts of " word association" and similar failures; and if absolutely useless in hysteria, what proportionate value are such methods likely to possess in any disorder whatever ? The first steps to be taken in hysteria are those of induction towards the subconscious. The rest will be easy. The patient will very quickly learn to analyse herself if subjected to a suitable technique. A very fair example of self-analysis subsequent to induction is the following, taken from notes not a week old at the time of writing these pages. The patient, though a difficult one as commonly considered, was not asked a single question. At first it was difficult to obtain a quiet moment. At the outset exhaustion facilitated the initiatory induction of the physical 4^ ADVANCED SUGGESTION sensation of relaxation; mental relaxation followed ipso facto. After the second treatment on the follow- ing day she seemed quite glad of an opportunity to converse, and exhibited signs of returning ease and understanding. She now made a number of remarks, which included the following : " I have for years been trying to read other peoples' thoughts." " I feel now more inclined to examine my own." " What an awful fool I have been ! " "I seem to have been in a kind of horrid dream." " What should I have done without this help ?" " What a narrow escape I have had — they spoke of an asylum!" " I feel now quite different." "Last night I slept splendidly, and without any tablets." Patients may vary from day to day under treatment ; a drop in progress must not disconcert the physician in the very least. An exhibition of marked lucidity is almost sure to be followed, sooner or later, by a minor degree of recurrent obfuscation and riotous confusion. The following represents the oscillating progress made in a case of hysteria which had gradually developed over a period of five years, owing to various circum- stances which had imposed a series of shocks upon a condition of nerve strain — hte patient having inherited a tendency to the latter : NEUROSES 43 Twelve Treatments over Four Weeks • t 2 3 4 5 6 lO II 12 The number of weeks which must elapse before a case under treatment recovers and maintains normality will vary according to the symptoms and the duration of the illness. A study of environment should not be omitted during treatment, for much will naturally depend on this. A patient, when recommended treat- ment, may take shelter behind irresolute relatives, and refuse to do as she is told ; therefore all must be firmly instructed to assist, as may seem requisite, in " corner- ing" the patient and holding her to any admission in any manner reasonably indicated. Some patients are better entirely away from relatives ; but I cannot agree that all are. A very nice judgment must be exercised as to what environment is likely to be helpful. During the first week or two patients may possibly make strenuous efforts to get away from the treatment— though this is extremely rare. Instead of finding the methods quite pleasant, and something to look forward to (which is the rule), they may have reasons to suspect that an approach is being made toward something submerged, which they are afraid to have brought to light; accordingly they may make various excuses in order to get away — say to some especially attractive health resort. 44 ADVANCED SUGGESTION The most difficult cases of all are those in which an old love affair has caused deep disappointment, illness having in time spoiled the health and appearance, making it hopeless for the patient ever to expect a fair chance again. You may at first get the thoughts to run on nearly normal lines, only to go astray again through an insufficient desire on the part of the patient to get completely well. An induction must therefore assist in the creation of trends of thought which make for separation from the ties of former emotions and a more independent mood; sometimes it will be useful to suggest an entirely different kind of future, as also the pleasure to be derived from many other things in life, and the real delight which is bound to arise from her feeling that it is possible for her to render some assist- ance to others. Emotional impulses may be roused in order to stimulate the healthy employment of mind and body, so that the old story may be left behind in favour of new possibilities. A simple and perfectly truthful account of other cases may well be given by way of example, in order to throw a cheerful light upon the outlook. In one case a patient felt much happier when she had decided that there was more to live for than mere marriage; she also learned that the best way to get married was to endeavour to think of every other pleasant pursuit in addition to this particular one, for this procedure would greatly increase her attractiveness. Having agreed (at the suggestion of the physician) to abandon altogether, for a period of twelve months, the idea of becoming engaged, she NEUROSES 45 was delighted beyond all expression to receive an offer six months after the date of this temporary renuncia- tion, and from quite an unexpected quarter — from a man who was even more handsome and lovable than the previous one who had fallen in love with her, for now she was so pretty and yet seemed to think so little of the fact. In hysteria the doctor should constantly bear in mind (even during those fits which seem to be accom- panied by utter unconsciousness) that the patient may not only perfectly well understand every observation made by those present in connection with her case, but may be gathering information which will enable her to devise a great deal of further trouble. Apparent stupidity and lethargy must not on any account be presumed upon at any time ; on the contrary, everything spoken should be of the nature of corrective suggestion, and the more indirect this is the more favourable will be the effect, as a rule. I am bound to admit that in many cases of hysteria treatment of the nervous system by ordinary hygienic means and medicines will so far improve certain arcs of "negative circling" that the patient will gradually recover. Adventitious strokes of good fortime will sometimes succeed in converting a negative into a positive arc, when nothing else had previously proved of use. The death of a relative, or the inheritance of an estate, for instance, may open up possibilities that will serve to loosen the bonds of thought and liberate the mind from certain hampering physiological in- 46 ADVANCED SUGGESTION fluences in a manner which might well appear magical. But in cases which are at all difficult psychotherapy must henceforth rank as the first specific. We must judge these with due regard to etiological sequence, pathological significance, and clear psychological re- quirements. We shall be justified in reminding ourselves that psychasthenia and hysteria are very frequently associ- ated in the same case; long-standing hysteria can hardly exist without causing psychasthenia. Let me mention a case of hysteria of twenty years* standing, begotten of neurone strain and shock. A lady, fifty-four years of age, was sent to me as having suffered from pains, anaesthesias, contractures, and spasms of various limbs and regions of the body. She had been under many distinguished specialists in France, Germany, America, and England. Her case had baffled all, from Charcot, quite early, onwards. After three weeks' treatment she wrote me a note expressing her pleasure, saying she had at length obtained com- mand over her spasms and contractures, and that she now could easily prevent their occurrence, mentioning other points of improvement in her health. In a month she gave, without being asked, a lucid history of her troubles, plainly and intelligently, her face and de- meanour now being bright and her spirits quite buoyant. She suggested to me the probable cause of her limb spasms, which was this : After being up night and day for a week, nursing her mother, " twenty -one years ago," she went to bed, and placed a hot-water bottle, which NEUROSES 47 had no cover on, to her feet. She took a sedative given her by the doctor, but some time later awoke in a fright, with a stinging pain in her left foot. She had dreamed that a reptile had seized hold of her toe. The hot- water bottle, which she had touched by chance in her movements, had probably caused this nightmare. She declared that she had never really got over the fright of this incident. Her cure tended to confirm the significance of the story. In my experience there is no royal road to the detection of original mind traumata in neurasthenia, nor need analysis, and the searchings for such, be always considered a sine qua non procedure in our efforts for success. I had practically cured the patient just referred to before she brought out her history in detail. To learn of traumata, shocks, and strains may be very valuable and interesting at times; and if discovered they had better be dealt with en route, but there has been an inclination shown by neurologists and psychiatrists in the past to attribute too great an importance to just one particular incident in a patient's history, as accounting for a whole train of troubles. It is true that if a single nerve shock is effectually dealt with all others may, in some instances, take them- selves out of the field of disorder. Searching for a very rare shell on the beach, and finding it, will not necessarily make a seaside place pleasant, nor will a bucket and spade make it sunshiny and sanitary. I have known patients to find and declare traumata in order to conceal others; treatment has eventually 48 ADVANCED SUGGESTION enabled them to deal with the latter in entirely their own way, and to complete their cure. Hysterical oedema makes an interesting study. The most interesting case I have to record is that of a lady, twenty-two years of age, who developed oedema of the left leg, which had apparently originated from a few inches of varicose vein below the knee. Under the circumstances, her surgical adviser hesitated before operating. She was sent to a nursing home and ordered to bed, etc., to prepare for operation; but so far from any favourable effects following this pro- cedure, the swelling began to extend. Every conceiv- able superficial application and internal remedy was now tried, in reason, but the leg increased in size until, after a week or two, swelling appeared in the abdomen. The surgeon would not operate, and the parents were anxious. After twelve weeks' rest in bed the patient went home. Subconscious induction not only served to reduce the leg, but the distension of the varicose veins was very soon greatly diminished. Successful operation was in due course performed. In all such cases vaso-motor control can be readily and certainly demonstrated by suitable technique. Hysterical contractures appear to be sustained reflex posturings consequent upon some initiatory idea which has entered the mind; they exist even during the apparent unconsciousness of natural sleep, but dis- appear under the true unconsciousness produced by deep anaesthetic inhalation, which inhibits any sensori- motor reflexes by its toxic and paralysing effects. It NEUROSES 49 is a well-known fact that many cases of hysterical contracture are cured by the inhalation of chloroform. This method of cure is greatly facilitated if it be pointed out to the patient, by way of simple sugges- tion, under a small dose, that the contracture has dis- appeared, just as he is returning to consciousness. The pain perceived upon forcible manipulation of an hysterical contracture is to be explained by the reflex opposition aroused, the patient tending to make abnormal efforts of a subconscious character, while not precisely intending to do so on the volitional or supra- conscious plane; so that a determined resistance has become automatic. The hysterical patient is more resigned to, more comfortably satisfied with, her con- tractures than a normally minded person would be, although she may always declare that she is greatly troubled about them. Vaso-motor spasm and paresis have been suggested by Bastian and Savill as accounting for certain symp- toms. Savill found that hysteria "consists of an instability or undue irritability of all the nervous and reflex centres throughout the body, ajid particularly those of the vaso-motor and sympathetic systems, while hysterical paralysis or tremor, and many other hysteri- cal phenomena hitherto unexplained are produced by vascular changes in the nervous system and elsewhere." He further admitted that emotion, as a determining factor, may set in action the irritable vaso-motor machinery. Robinski, on the other hand, believes that symptoms of hysteria are implanted wholsesale by 4 50 ADVANCED SUGGESTION physicians and by the patient's friends. Ormerod objects "to making suggestibility the sole canon of hysteria." He is undoubtedly right when he also reminds his readers in these words : " That we all know people who are gullible enough who are not at all hysterical ; and, on the other hand, many hysterical patients are not particularly open to persuasion, at any rate when you try to remove their symptoms that way, whether in hypnosis or out of it." As a matter of fact, all these authorities are right ; but none so right as Janet, when he attributes hysterical defects to " feebleness of mental synthesis," which Ormerod says " has to be inferred and cannot be directly observed." My reply to the latter is that it can be observed very decisively and clearly by the physician during treat- ment by induction of the subconscious. Phobias It might safely be stated that whenever you have to deal with any degree of psychasthenia you will find phobias of one kind or another ; and if psychasthenia gives rise to phobias, so also do phobias give rise to psychasthenia. On the one hand, there is a weakened nervous system favourable for developing phobias ; on the other hand, shocks and frights so affect the nervous system as to render it inordinately sensitive towards anything which might have the effect of a neuron trauma, so much so that the person becomes possessed and obsessed to an extent which finally makes him psychasthenic. NEUROSES 5t Conceiving the possibility that injury may be inflicted by an act or circumstance has an effect upon the sympathetic nervous system. In order to create an instant defence, even non-reasoning animals when in fear of injury will exhibit exemplifications of almost synchronous connection between sensory stimulation and reflex power of movement in limb and skin. Human beings are far more susceptible than animals, being able to think rapidly and intensely upon the sudden perception of sensations; hence their reflex sensations, movements, and thoughts are magnified, according to the acuteness of their intelligence. There- fore we are prepared to find reasons for such classic phobias as agoraphobia (fear of open spaces), claus- trophobia (fear of closed spaces), amaxophobia (fear of carriages), batophobia (fear of heights), zoophobia (fear of animals and insects), and others. These phobias manifest themselves chiefly through the emo- tions, as they aff'ect the viscera, skin, and glands. Just as in cases of hysteria, we shall find a history of nerve strains, shocks, and traumatisms, which may have been lost to memory amid the innumerable con- fusing streams of thought during the subsequent years while the victim has been concerned in the ordinary affairs of life. Whether the patient is able to recollect them will depend largely upon their nature. There may, moreover, be a particular reason for their being forgotten. As a rule, sufferers from phobias can give no cause for them; induction and analysis will, how- ever, almost invariably bring the original shocks to mind. 52 ADVANCED SUGGESTION Agoraphobia. A common idea underlying this phobia is that of insecurity, giving rise to an impulse to catch hold of something, or to obtain help of some sort. Some patients conceive a notion of falling down through space, or of being hurt, while there is nothing and no one to help them. This arises from some instance which has usually occurred in childhood ; for example, a child in the fields or on the highway, absorbed and interested in something, may suddenly have found itself alone — may perhaps have been left picking daisies in a meadow, to realise that its companions have gone home. Patients who suffer from phobias of any kind have, as a rule, been nervously sensitive from birth. It may be possible for a terrifying experience to generate a phobia in a subject who has always been quite robust, but this must be very rare. As an example of such a case, I may mention that of a man, twenty-nine years of age, who was sent to me suffering from agoraphobia, which had become so aggravated that he could not walk across a small market-place; he had even some difficulty in getting across a street. He had previously had no nervous troubles whatever, and his family history was clear mentally and physically. His phobia had gradually become worse over a period of three years. It had arisen from a vertigo, which was caused by astigmatism, and, although this defect had been treated by suitable glasses, which had cured the NEUROSES 53 vertigo two years previously, the fear of going into open spaces had continued to grow upon him. He had forgotten the vertigo; treatment and analysis enabled him to remember it. A variety which is contradistinctive, but sufficiently of the same nature as to justify its consideration under the heading of agoraphobia, is fear of crowds. Cases of this kind can readily be analysed; they usually result from being lost in a crowd during early childhood. The case of an auctioneer may be men- tioned, who broke down in health and found himself getting into panics whenever he had occasion to enter an excited assembly of men. I found his earliest dread had been experienced when, as a child, he had been with his mother to a circus. The mother, on leaving, having several children with her, missed him in the crowd; he was found some minutes afterwards in a screaming panic, some strangers having taken charge of him. It had better be clearly borne in mind that trau- matisms, or painful experiences, tend to develop others, and this is particularly the case with phobias; thus we have an additional reason why original shocks are so often lost sight of. The fear often undergoes an extension, until from referring to crowds it embraces the particular conduct of the patient when in a crowd : many patients as they grow older will retain the fear of crowds, but will develop additional anxious notions as to what precisely they will do when in difficulties. " It is not so much the crowd," a patient 54 ADVANCED SUGGESTION will explain, " as the idea that I shall make a fool of myself." In the case just referred to, the patient became excited when in a crowd, and felt that he must scream aloud. Repressing the latter impulse caused him to fall down "in a swoon," making a scene, and having to be carried out. He further developed a feel- ing of armoyance, and became distressed because he had a growing inclination to lash out and hit some- body. Consequently he dared not continue to risk encounter with crowds. Re-education of his nervous system gradually restored his confidence and com- posure, and he was able to resume business with greater success than ever before, for at the best, in the past, he had been working under some indescrib- able difficulty. I have found a number of phobias to be originally caused by practical joking in childhood. Nursemaids will purposely desert their charges, hiding behind trees to enjoy their panic. Children are sometimes dangled over heights or forced to lean over parapets, etc., in order to frighten them, by spiteful and almost crimin- ally disposed persons, apparently just for the fun of the thing. I can recall the case of a boy who would have been an incurable invalid for life, perhaps to the extent of insanity in time, had he not been properly treated ; his condition was caused by a servant slam- ming the door of a lavatory and bolting it upon him, in order to annoy him. Some cases of agoraphobia have originated in exf)eriences which have resulted in feelings of shame NEUROSES 55 or dislike on being looked at. For example, a man, thirty years of age, was sent to me suffering from the fear both of crowds and of open spaces. He got into a panic if he could not readily get behind something. I found the cause of his trouble to be that he had vomited in a crowd when a small child, on which occa- sion he was stared at, and could not hide from view, fearing every moment that he would surely make another hideous exhibition of himself. Another case illustrates how the same sensation had finally created reclusive tendencies. In this patient dyspepsia was very pronounced ; unaccountable and unexpected vomiting was daily anticipated, making him entirely unfit for any occupation. He only felt fairly happy while wandering in country lanes. A curious point about his case was that he had never actually vomited after the original painful experience, from any cause what- ever, not even in a bad sea when crossing the Channel. Indeed, he never remembered having vomited in his life until treatment and analysis revealed the single instance of childhood. He always took good care to go nowhere unless certain that there would be a place to which he could retire at need. Treatment should correct erroneous ideas in the subconscious, abnormal impulses being negatived by positive assurance, various kinds of indirect encourage- ment being given in order to stimulate energy in the right direction through emotional conception. Simple, plain, correct thinking should be learned by the patient from instances of such given by the physician. 56 ADVANCED SUGGESTION while open-hearted composure, confidence, and steadi- ness under all conditions, should be inculcated as a constant virtue. Tests should be imposed from time to time, with exercises in post-inductional fulfilment — such as the injimction, for example, that when next requiring to post a letter the patient himself will deliberately choose the difficult way, and will be proud that his will-power has so prompted him. The injunc- tion should be so often administered that if not forth- with fulfilled it will weigh upon the mind of the patient for future fulfilment, each failure under appropriate encouragement only serving to make him more firmly desirous of success. A very good plan to adopt in very obstinate cases is this : Ask a patient to state just exactly what he thinks will happen to him under difficult circumstances ; get him to describe the worst fear he can conjure up in his hyper-imaginative mind. Then surprise him (after a few treatments) by offering to go with him into a crowd or across a market-place, in order to observe the dreadful result. Nothing, of course, will happen as he anticipated. Then implant in his sub- conscious collection of experiences, through emotional appreciation, this proof that he was wrong, as a new conquest, to which others will soon be added. While it may be conceivable that an attack of some sort might possibly occur if the patient were alone, I have never known ont to occur during a test if he were accompanied by the physician who was teaching him. Under such circumstances he may complain of illness, and may NEUROSES 57 endeavour to appear afraid, but an experienced observer will know how to detect the semblance from the full reality, and will deal with it accordingly in future treatments. The absurdity of occurrence while the patient is alone may then be emphasised to the sub- conscious. I have many times seen pallor in the faces of patients during a first test, but never on a second occasion. Recollect that there are no royal figures of speech which will cure any of the phobia cases. They are certainly not to be won by any kind of specious artifice. On the contrary, any deception will be likely to make them worse. Most phobias are bad habits of thought and perception, of many years* standing, and only weeks of re-education will eradicate them. All the supraconscious appeals which the cleverest debaters could devise and express in chorus would not only fail to produce any favourable result whatever, but would probably have the very opposite effect, making the patient more uncomfortable than ever, and inclined to cease to converse with any stranger. Some patients are afflicted by the fear that they might die in public; and they will not go into open spaces or among crowds lest their sudden illness should " make a scene." Others are afraid of crowds lest they should be attacked by some terrible and indescrib- able seizure, the originating cause being some occasion in childhood on which they witnessed an epileptic fit. In one case for twenty years the word Fit was seen in the coal-flames of the fireplace; this was found, 58 ADVANCED SUGGESTION upon analysis, to be an explanatory word which had been spelt out by a nursemaid who had accompanied the child when the latter had seen a man struggling and making horrible faces in a fit. Claustrophobia. Though in many cases the seeds of this disorder have been sown in childhood, after the fashion ex- plained when considering agoraphobia, quite a number of cases have originated in heart panic, which makes the person anxious to find someone who can give assistance, often feeling absolutely beside himself with fear. Having once experienced such a shock, a person sensitively constituted will avoid a railway carriage as though it were a death-trap. It is the sympathetic nervous system which is mainly affected in this as in every kind of phobia. Once the system has received a shock of some severity in childhood, it seems ready in future to respond to the slightest suggestion or sensation that the experience might be repeated. In most of the severer forms of phobia, patients almost invariably complain either of cramping, painful, sicken- ing sensations in the region of the stomach, or of heart distress and palpitation. They not uncommonly turn pale at the very mention or thought of a recurrence of the dread experience, showing how deeply the original thrill has penetrated. It follows that any sufferer from claustrophobia is relieved when he knows that opportunities for escape exist should he, more or NEUROSES 59 less of necessity, be temporarily shut in anywhere. When going into a room it is likely that the first thing looked for will be the doors and windows, while the fastenings of the doors also may be observed. In amaxophobia the patient is comparatively happy in a corridor compartment, where he can get to other people if afraid. In many of these cases the originating dread has been complicated by an awkward and sudden desire to visit the lavatory of the compartment, at an early age. A good plan to adopt in the training of this class of case is to induct the patient to remain in sub- conscious rest in a room by himself. Usually he will at once declare this to be impossible. In one instance a man assured me that he would run out of the door immediately if I left him alone, and, with a rapid con- jecture, he followed this up by saying : " And if you lock the door I shall be out of the window, though I know quite well there is a deep drop into an area." He had divined the existence of an area from the formation of the upper portion of the building outside, which he had rapidly scanned as he looked out of the window on entering the room. He was, however, quite cured of all this urgency in one sitting. I told him, after induction towards the subconscious, that I should remain with him on this occasion, but that he would be quite content to be alone on the next. Many patients who suffer from phobias are quite content to continue disordered, notwithstanding the advice of friends that they should seek c^ gure. 6o ADVANCED SUGGESTION They have become so accustomed to arousing interest by narrating their peculiar experiences that they will reluctantly part with these individual attributes. When diagnosis reveals the fact that they are only luke- warmly anxious to become normal, induction is so applied as considerably to augment their desire to be cured, by creating emotional shame or by pointing out, for subconscious realisation, the greater advantage of being like other people. A patient was sent to me suffering from phobias in whom analysis revealed a history of nervous shock at a time when he was overwrought in connection with some Stock Exchange transactions. I found that he would rather continue to put up with the phobias than get well enough to return to city life. There are patients who become so accustomed to looking for sympathy that they would rather put up with the phobias than become less interesting. There are more advanced instances still in which the patient will so hanker after " negative circlings " that, failing to get enough out of his usual phobias, he will argue that his worst fear is that he is in danger of becoming insane. A patient of this class remarked : " The biggest trouble I have is the knowledge that I have phobias. I should not mind the phobias themselves ; I have got used to them." In another case, the patient actually declined to leave off troubling about them, advancing the argument that though she no longer had the dreads for which she originally consulted me, she was even more distressed that she should still continue to imagine that she had NEUROSES 6i them. All such patients should be finally treated by insisting that there shall be a ruling out of all reference to the subject either to the physician or to anyone else; they should be told that it will be more and more difficult to speak of them. They will first cease to speak of their "negatives" to the physician; this re- ticence should then be extended to all and sundry, but it will usually be necessary to find out whether reference to the subject to other persons has really ceased before concluding that a cure has been effected. If there is any leakage the third party must be brought forward so that the falsehood may be exposed, to the discomfiture of the patient. If a clear instance of disobedience, with the ensuing discomfiture, be emotionally realised by the patient after a very serious accusation, this will usually dispel all tendencies of the kind in future. Sympathetic emotional traumata require to be treated by an induction which re-educates the sensa- tions, causing them to regress along the paths by which they came into being. But I strongly advise that no antipanic should ever be devised to correct the original ; this procedure would probably result in setting up yet further nerve-strains. Calm, strong and deliberate measures should in all cases be adopted, indirectly as well as directly, all such measures being designed to relax any constraint or difficulty of thought which may exist in any connection, as well as all distresses of retro-reflection. 62 ADVANCED SUGGESTION Fear of Heights. Great heights arouse unpleasant feelings in most normal people. They cause thoughts as to what would happen should a fall occur. A " shiver " of fear sent through the sympathetic nervous system of a child, if severe, may implant negative sensations of a per- manent character, especially if undue sensitiveness has existed from birth. Later in life a temporary loss of tone provides a favourable soil. Those who are not permanently affected are more robust as to their nervous constitutions, being able to break away from any spell to a normal sense of security, once they have had time to reason things out. Normally a person may feel a momentary shock, but he will very soon correct this by the thought that such and such is really safe. The steeplejack is a man who is so intent upon his work, and the payment he will receive for it, that he is able to concentrate his mind on what real security exists, as he has good reason to see and to know it, feeling it all the time under his foot. In time he becomes quite accustomed to relying upon it in prac- tice ; he is thus in no mood for being afraid at any time. In treating this phobia it is useful to get the victim to perform an act which is of such a nature as will divert his thoughts, while it is at the same time opposed to his prevailing dread. A patient sent to me by a distin- guished consultant had been suffering from nervous breakdown. Among various other dreads he was incapable of going down ordinary flights of stairs; NEUROSES 65 this had gradually developed from a fear of great heights, until any steps at all were distasteful to him. He would only sleep on the ground floor of a house ; he would not attempt to patronise hotels which had no ground-floor bedrooms. " Negatives" had encircled him until his life was hardly worth living. In treat- ment his condition of general nervous shakiness was first of all steadied by induction, so that his insomnia and dyspepsia should become less aggravating, while some sort of general hopes were engendered. Then variations were suggested in his walking exercise, until a bigger test seemed indicated. He was instructed in the presence of his wife to assume for the occasion that she was ill, weak, and afraid of steps. I expressed my wish that he should take her to the top of " Jacob's Ladder " (a well-known steep flight of steps) and help her firmly all the way down. She was to pretend that she was helplessly afraid throughout, making the fiction appear as real as she could. After all this had been clearly explained, the man's interest having been trained by induction, the two went forth and accom- plished the task with the greatest success. Going alone down the same steps the next day, he gradually gained his confidence, and in a few weeks was perfectly well in every way. Various other Phobias. A very curious phobia came under my observation among the complaints of a patient who was sent me for analysis. He could not carry anything in his 64 ADVANCED SUGGESTION hands. He felt obliged to drop whatever he tried to hold for more than a moment. This affliction became serious, because it hindered his progress in employ- ment. At length he became entitled to a junior partnership by reason of seniority, being very capable in other respects. In his growing distress he there- upon grew afraid of his disability, thinking it would develop into "mind weakness," and so put a full-stop to any further progress in his career. His phobia extended to a constant fear lest he should be asked by anybody to carry anything. Analysis proved the trouble to have originated from an occasion in early boyhood when he was obliged to put down a box he was carrying because he felt his nose was running ; he was afraid lest others should notice the fact. He explained that for a long time he had been able to carry certain things in one handy so long as he could get the other up merely to touch his nose with his fingers, even though there was no nose-running to attend to. He had later gone to the length of refusing to carry anything in either hand, in order to prevent his ever being asked to carry things in two hands. He hated being asked for explanations. He could offer none. Five years after the initiating instance he would consent to carry for his mother only, knowing he could easily put his hand to his nose en route without having to explain anything. For years he had never known any real necessity for a handkerchief when required to carry anything. Had he been supraconsciously com- pelled to conquer the disability, he would doubtless have NEUROSES 65 developed other "negatives," probably far more serious. Inordinate dread of insects and certain animals seems easy enough to understand. Analysis finds each instance to have originated from a shock or scare while the general health v^^as below par, or when the nervous system happened to be suffering from a sustained strain. The idea that patients may be so susceptible that they can tell when certain things are in the room, such as a cat or a spider, while ordinary people cannot, has been greatly exaggerated. It is true that some people may possess an unusually acute sense of smell, as well as other highly cultivated powers of discern- ing signs and symptoms of the presence of things they dread, but there is nothing in the way of occult faculty, divination, or clairvoyance about these cases. I cordially agree with Sir Ray Lankester, who writes that all this " cat and spider sense " is utter nonsense. I have this explanation to offer : The victim having been at some time below par, perhaps long ago in childhood, has been scared, or has been deeply in- fluenced in some way, beyond the normal, by a scent, sight, or sudden noise which indicated the presence of something; this has created an emotional shock be- cause of its momentary objectionableness, which in turn has caused a particular alertness in the special senses. The result is that things dreaded are in future really subconsciously detected, while the supraconscious mind will not be able to explain how they are detected. Subsequently, questions regarding this strange power 66 ADVANCED SUGGESTION produce an increased subconscious tendency to look for the objectionable thing", so that the capacity for dis- covering it is more definitely than ever dissociated from the power of explaining to others why the patient is able to distinguish its presence. Such dissociation may even give rise to untruthfulness in the individual, who may have actually and supraconsciously seen that an object was present, yet will declare that it was impossible for him to have done so. Fear of animals and insects may also be associated with sexual sensations. For instance, a man loathed dogs and cats ; he fell ill when he saw them. He was sent to me as a case of psychasthenia. Analysis dis- covered the sexual factor quite close to the surface. It was found that the dread of these animals was associ- ated with sexual sensations. The latter he hated because he thought they were injurious to him. Hav- ing once felt a sensation of sexual excitement when stroking the fur of a cat, and having been informed later on that seminal emissions caused " brain-sapping," he had developed such an increasing fear of cats and other small animals that he began to avoid going out of doors. Later still he gradually came to imagining that animals were monsters and devils. Suicide then came into the range of his thoughts, coupled with the inverted idea that he must actually go and look for the very things which he had formerly conceived to be so terrible, as though to take a last look at them and die. This was a very interesting case ; it was found that NEUROSES 67 there was dual and conflicting thinking going on, governed largely by sexual incontinence. He reached the stage at which he hated and yet desired, reminding one of the moth and the candle. Fear of certain kinds of food is not an uncommon phobia, caused by some sort of illness; it is often established in childhood, after eating something which has disagreed. The worst case I have seen was a man forty-eight years of age who had burnt his mouth when six years of age by inadvertently drinking from a bottle containing acid which he had reached from a shelf. The presence of food caused pain in the mouth for some days afterwards, and, being nervous, he grew permanently to dislike those things he had attempted to eat while in pain, until he gradually brought other kinds of food into the same category. At length he reached a stage of great emaciation and weakness. Neuroinduction gradually restored him to normality after a period of several months' training. There are many other phobias and varieties of cases. I cannot deal with all. I can only afford space to give certain illustrations, in order to substantiate the theo- retical aspect of the problems, and to introduce a few points in connection with such afflictions, a knowledge of which would seem to be useful and important. The reader will remember that in cases of constipa- tion, enuresis, and many other nervous disorders, the more pronounced the degree of the disorder, the more easily is the cure effected as a general rule, and the more rapid is the result. One of the worst cases of 68 ADVANCED SUGGESTION phobia I have ever treated made the most marked recovery. The patient was a young man who could not be left for a moment, night or day. He would not walk a yard out of doors without a companion. After cure he asked me to recommend him for the army : I replied that I did not feel able to do so. The next I heard of him (a few weeks later) was that he had obtained a commission in the army. Later he joined a more combatant corps, and finally he applied for a position in the flying corps. Epilepsy. Where there are nerve storms of any kind neuro- induction will serve to alleviate them, either wholly or in part, provided any intelligent attention on the part of the patient is at all possible during the periods of calm. This has been, and can be, demonstrated, in respect of all grades and shades of "nerve storm," from bad temper to haut-mal. It is true that if the induction be inexperienced and inadequate the very opposite of favourable results may be obtained. Again, if the epilepsy be organic one may get no result ; this may lead some authorities erroneously to conclude that in all cases of epilepsy the very best kind of psycho- therapy will be unavailing. Also, if a neurosis belong to one of the hopeless insanities, psychotherapy may, of course, fail. The benefit conferred by psychotherapy in epilepti- form conditions (as, indeed, in cases of bad temper also) is quite sufficient to compel the expectation that we NEUROSES 69 should obtain some degree of positive result in cases of haut-mal. And instances go to confirm the supposi- tion. A lady was sent to me suffering from an average of 150 fits a year. She was in every way extremely difficult to treat, her temperament varying from mere morose obstinacy and irritability to maniacal attacks of such violence that only very large doses of bromide could appreciably assuage them. Loss of memory and considerable dementia also existed. Psycho- therapy soon worked wonders : the patient's bad temper rapidly diminished, and she gradually altered for the better in every respect. Nor was this altogether to be wondered at, inasmuch as induction enabled her to feed without swallowing her food whole, as she had been in the habit of doing, and to accept reason- able guidance in many ways. From being so de- mented and incapable that she was not able to do anything by way of employment, nor to converse excepting in monosyllables, after three weeks' treat- ment she was able to read and to conduct a conversation quite satisfactorily. In six months the fits had diminished to one a month. No medicines of any kind had been administered. There can no longer be any doubt whatever that epilepsy is a disorder which tends to make itself, and to do so all the more rapidly once there has been a fit of haut-mal. In many nervous disorders the patient's knowledge that certain attacks occur is apt to make them occur, in the weakening of natural resistance which is thereby entailed. Psychotherapy 70 ADVANCED SUGGESTION has proved in my hands that even diminishing the fear of fits will render them less liable to occur. All this one would naturally expect. But let me give the instance of a patient whom I taught how to prevent her own fits; and this method I strongly recommend as one likely to prove of the utmost value in the treat- ment of epilepsy in future. The patient was one who could never distinguish any warning whatsoever that a fit was impending. In subconscious training I clarified her thinking and co-ordinating powers, and made her happily observant of herself, in a mood of hope, begotten of the benefit so far derived from the treatment she was undergoing. I educated her not to look out for any abnormality, but to distinguish calmly any sensation which might occur that seemed unusual ; when such did occur she was immediately to go and lie down. The result was that on one occasion she even entered the garden of a private house, in order to lie down on the lawn, having " felt queer " when out on a shopping expedition; in this way she prevented a fit from developing. In course of time the patient told me she was much less afraid of fits, because she now felt able to stop them. The consequence was that apart from the feel- ing of being able to stop them, the prodromal sensa- tions themselves occurred far less often, until only very unusual worry would produce them. Later on nothing would produce them. But the reader will meet with the very counterpart of this rationale in the treatment of other nervous disorders as expounded in these NEUROSES 71 pages, so that there need not be the least surprise at the attainment of such results in epilepsy. In our studies we must not overlook cases in which the brain is so constituted from birth that the fitful functioning of certain organs will necessarily be mani- fest ; as, for instance, the heart. Now, while even this organ can to some extent be favourably affected by psychotherapy, as will be seen in a later chapter, it may rvappen that it is sufficiently influenced by the cen- tral abaormality to produce a rapid toxaemia ; this may come iito play as an arc of "negative cirling" which cannot be influenced sufficiently in a positive direction by psychotherapy, constituting such an advanced de- velopment as is incurable. In one of my cases every- thing codd be dealt with favourably excepting the heart, whi:h could itself be somewhat better regulated, but not entirely governed. It is fair to add that in this case there were pronounced stigmata of degenera- tion, inducing cranial as well as facial asymmetry. Many caes of epilepsy exhibit a tendency to eat voraciously :>n occasions. Now, nothing can alter the vagaries of astes and impulses of various kinds so readily and sirely as neuroinduction. In one instance I completely and permanently cured an epileptic patient by dieting and regulating the appetite alone, under subconscious direction, having found that the fits always followed occasional impulses to eat quickly and largely, the patient having been found by previous observers to be absolutely impossible to control in this respect. 72 ADVANCED SUGGESTION I do not hesitate to warn the reader that if the technique throughout is not a sufficiently wise one unfavourable results may possibly follow. The first occasion of an interview or of treatment may be an exciting one for an epileptic : a fit may follow — nay, I can conceive that it might occur during the very first interview with the physician. But this woiild not indicate that psychotherapy must prove of IJttle value in this particular case. Lhave never kndvn a fit to take place during treatment by subcoi^cious induction, or even shortly after it. From tl^e first moment of commencing the relaxation the ccndition of ease induced cannot but be likely to pre^nt any sort of " nerve-storm." Now I ask the best of all physicians wl^t is his rationale and method of treating epilepsy, leayng out of account plain commonsense measures direct/d against "negative arcs"; he will probably reply "Bromides; nothing to beat them, in one form or anotier. They just diminish the number of fits; that is /ll that can be said." At the same time he will le prepared honestly to own that they have great diadvantages in serious cases. They are like narcoticsjn insomnia ; they must to some extent poison the ^tient to do him any good. Epileptiform Seizures, VertAo, etc. Vertigo will benefit from psychotheipy whether it be of the cardiac, epileptic, gastric, jaryngeal, psy- chasthenic, aural, or ocular variety /the treatment NEUROSES 75 will act both directly and indirectly, chiefly the latter. Here is an interesting case to study ; one which not only presents instructive features of its own, but which will enable the reader to draw useful conclusions when considering the varieties of vertigo. A clever city business manager, twenty-six years of age, was sent to me complaining of vertigo and other sensations, which had been diagnosed as incipient epilepsy by three medical men and as dyspepsia by another. All three had failed to cure him. He had received medicines, and had also been advised to take a holiday; these measures resulted only in a slight alleviation of the symptoms. He had also con- sulted an oculist, who found astigmatism. The wear- ing of glasses made things a little better for a time, but the trouble recurred, until it had become as bad as ever, and its frequency was now greater. The dis- order had commenced twelve months previously, when the patient felt his head and body turning to one side. Cold weather increased the vertigo. His sleep was not good. Occasionally he felt inclined to faint. On beginning to walk anywhere he felt unsteady. Worry about his condition was fast making his whole state worse. The patient had no bad attacks for a week after the first treatment by suggestion. A slight "sensa- tion" was perceived before attending for the second treatment. On the third day he was clear of all abnormal sensations, and this went on until the 74 ADVANCED SUGGESTION seventh day, when he was again troubled by a shght sensation. An analysis was now undertaken, which revealed several intentions to commit suicide on learning that the disorder was epileptic. The patient had told others to take his razors away, and had bought a safety razor. After the third treatment he bought ordinary razors again, liking them better than the safety pattern. Analysis became quite easy as the mind cleared. In two weeks I dismissed him as being quite well and likely to remain so. After ten weeks' absolute cessation of trouble the attacks began again, for no reason that he knew of. Again he felt his head turning to the right, and he was also conscious of an inclination to walk towards the right. On walking with others he felt unsteady, but he did not think they were aware of this. He always chose the right side; later on he preferred to walk alone rather than explain his difficulties. Later still he feared collapse ; he had to " make " himself go any- where. Though he now believed that psychotherapy was not a lasting treatment, he nevertheless called again upon me in order to explain matters — fortu- nately for him. This time he complained that he felt as though he must " roll " when walking. The return of any patient treated successfully by psychotherapy being so very rare, I viewed the case at this stage with all the greater interest. I asked the name of the oculist he had consulted. I sent the patient back to him. Alteration was made in his glasses. He then went to watch a football match with NEUROSES 75 the new glasses, after having obtained firm assur- ance that they were correct, but he collapsed on the ground. I therefore reapplied psychotherapy. He had no more trouble after two more treatments, and is still well after a couple of years. This was probably a case in which epilepsy was threatening to develop, owing to (a) astigmatism, and {b) an abnormally sensitive nervous disposition. Psychotherapy cured the man for a time, notwith- standing an astigmatism which was not properly corrected by glasses. We have thus an instance of recurrence of trouble due to the persistence of a " nega- tive arc" of a provoking nature. Correct glasses did not of themselves cure the condition, but in conjunc- tion with psychotherapy they did so. Some might say that the glasses alone would in time have effected a cure; yet, again, they might not have done so, for the patient had lost faith in everything. Worry would probably have fostered sensations of insecurity, to be followed by other "negative arcs." The case well illustrates the rule that when once a patient has been cured, even temporarily, by psychotherapy, the treat- ment is far more prompt in its effects if it should be again required. I am inclined to believe that this patient would have become very seriously disordered had it not been for the application of psychotherapy. He was on the point of losing his post as manager of a large business concern when he saw me first. He feared this result even more immanently upon the second occasion. 76 ADVANCED SUGGESTION Somnambulism and Night Terrors Such disorders are occasioned by the adventitious discharge of neurone energies during ordinary sleep. They belong to the region of the subconscious; their connection with the supraconscious is usually but not always completely severed. A neurone instability has been produced at some period or another by nervous stresses or shocks which have affected the subconscious and the reflex processes; ideas are generated which break through the ordinary state of sleep. These con- ditions may well be postulated from the following details of an interesting case : A girl, twenty-five years of age, was sent to me on the advice of the late Sir Francis Cruise, after he had conferred with Dr. Lloyd Tuckey in order to ascer- tain what should be done with her ; her case had defied all efforts over a period of ten years. She suffered from somnambulism to such a degree and of such a nature that nobody was safe with her, in that she would dangerously attack even her mother if the latter interfered with her when she wandered out of bed; on these occasions she would scream and fight any- one near her with a power that seemed superhuman. Her health had always been good. "She never was a day sick from anything," her mother declared. A strong, powerful, tall young woman, she was very amiable during the daytime. She had given no trouble until twelve years of age, when menstruation commenced ; this was scanty and caused headaches. NEUROSES 77 Almost every night, about twenty minutes after going to sleep, she would spring up and scream ; then, on someone coming to her, she would attack them dangerously and fight until exhausted, afterwards gradually quieting down and going to sleep, awaking in the morning astonished, and crying because she felt sorry, being quite innocent of having hurt anyone, the victim being usually her mother. After a bad night she would feel dull and out of sorts during the day, looking, at times, worried and overwrought ; after a more favourable night she would appear in robust and happy health again. Sometimes successive nights were unusually bad. Most of her nights had been bad for some months before she came into my care. Such was the history given. Her health had suffered severely at intervals while under certain treatments and restraints which had been deemed necessary under the stressful and extremely difficult circumstances. It had been found necessary to tie her in bed every night for months on end. Gradually, over a period of a decade, the compli- cations had become worse, having developed from plain sleep-walking. This itself Sir Francis Cruise cured by hypnotic " suggestion," which he had applied three times a week for nine months; synchronous with the gradual waning of the somnambulism the screaming and fighting developed by degrees. I imagined from this that the hypnotic suggestion had been of a direct nature, and that the disordered impulses changed in character because only the sleep-walking 78 ADVANCED SUGGESTION had been stopped. The results of the indirect treat- ment which I adopted in this case also suggested as much. I merely offer this hypothetical explanation: in a broadly defensive attitude, in case any reader should at this stage argue that treatment by sugges- tion was apparently of little use in this case. I had no evidence as to how Sir Francis had applied his treatment, beyond the fact that he employed hypnotic suggestion. I placed the patient in a cottage under day and night nurses, for though able to walk about alone and enjoy life in the daytime, she dared not go out in the dark unaccompanied. I found that even towards sun- set she had slight hallucinations of seeing people under trees and of being clutched at the back of the neck from behind. I decided that I myself would sit up in a room adjoining the patient's — at any rate on the first night — not only in order that I might render immedi- ate assistance in the event of any disturbance, but because the case was a somewhat terrifying one for any nurses, yet chiefly because I wished to study and treat what seemed a unique case. As a precautionary measure I fastened the patient's wrists in a particular manner that was not uncomfortable, she being only too amiably willing, knowing how violent she was reported to be. I decided to commence treatment before she went to sleep, though I much wished to see just what would happen without treatment. She proved an easy patient to treat, and quickly went into an ordinary NEUROSES 79 sleep from quite a superficially neuroinducted relaxa- tion. I did not aim at perfect undisturbed sleep, for I had the pardonable desire to see just what would happen at this stage, feeling sure that the patient would now be controlled with comparative ease in any case. Thirty-five minutes after leaving her, while I was sitting in the adjoining room, there was a hasty momentary muttering, which subsided; five minutes afterwards there was more muttering. I was begin- ning to think that there would probably be no more than this, as a result of the steadying effect which even slight induction toward the subconscious usually produces, when I heard a great thump, which sounded as though a prodigious weight was being hurled about the room, and a hideous scream rent the quiet of the night, followed by sounds of the most desperate strug- gling. I shot into the room, and found the nurse under the clothes, in an adjoining bed, petrified with fear. The patient had in an instant leaped out of bed, and in one effort had dragged a large double bed across the floor of the room toward the window, by means of the webbing secured round her wrists and fastened to the bedside. I caught her just at the end of the main struggle, when she could get the bed no further than the window, and, while she was still tense and trying to do more, I put my hand on her forehead. The association between my touch and the words previously spoken to her in neuroinduction served immediately to relax all muscular and mental strain. I then helped the nurse to pull back the bed; the 8o ADVANCED SUGGESTION patient was then unfastened and led to the side of the bed, into which she rolled. She fell asleep again in a few seconds, after I had told her she need not worry about anything, that all her thoughts would be as easy as they were at the moment, and that she had nothing to fear. She continued to sleep through the night without any further disturbance. She was under my care for a month, and from the first night never had more than a sudden rising up in bed to a sitting posture, lying down again at once, probably on account of an auto-correction which entered her mind, immediately following whatever disturbing thought had occurred to it. The nurse reported that she sat up in the same manner on two further occasions during the first week. She also twice called out "Mother" in the third week, but at once fell asleep again. During the whole of the fourth week she was perfectly well in every way. She married and became a mother. Chorea It is generally accepted that a uric-acid diathesis somehow provides a fruitful soil for chorea. What- ever truth there may be in this theory, I am bound to study chorea in the light of an amended psychology, and as one who has profited by the teachings of psychotherapy. Take the case of a girl, eleven years of age, who was brought to me as having suffered from chorea for six years, during which time she had been ordered various treatments by medical advisers. She NEUROSES 8 1 was thin, pale, irritable in disposition, and had hardly received any education on account of her weakness. In two sittings I not only stopped all choreic move- ments, but there followed such a general improvement in health as made it almost appear as though there had been some magical influence at work. Her dyspepsia and insomnia cleared up, her appetite became normal, and in a week or two she gained weight and exhibited a good colour in the face. It is perfectly obvious that in this case the disorder was merely functional. Doubtless uric acid had been a factor in its causation; but might there not have been some neurotic sensitiveness which had conduced both to the rheumatism and the chorea, which psycho- therapy reduced to normality? We shall answer this question more fully in a later chapter, especially as regards the uric acid, which might at one time have been a factor, and which had been eliminated by previous medicinal and hygienic treatment, leaving the nervous factor to continue its fostering of a " bad habit." We may now consider the lessons to be learned from a case of a different variety. A man suffering from psychasthenia moved all his limbs jerkily and spas- modically, dropping cups, and making movements which were indistinguishable from ordinary choreic movements; at all events, his family attendant and a consultant noted irregular, spasmodic, and, as they described them, "choreic** movements. Two or three treatments which steadied the subconscious mind 6 82 ADVANCED SUGGESTION entirely cured these movements, the patient being able to lie comfortably in bed, using his hands, arms, and legs in quite a normal manner, if somewhat feebly. Although the movements had for months been strongly marked, this patient never suffered from them again ; but also in the other respects his case proceeded to complete cure. The most advanced forms of tremor, including instances in which certain articles cannot be held in the hand, the tremor increasing the longer the attempt is made, are easily cured by one or two treatments of subconscious induction, provided the complications are not too severe, as may well be imagined from the study of cases of phobia already considered. Cases are not uncommon in which people will avoid drink- ing at meals because they cannot lift a glass or cup without trembling and letting some spill over. Some will not accept invitations to dine out on account of discomforts of this nature. It is interesting to observe the astonishment with which they are able to hold a glass brimful after one treatment, hardly believing their own eyes as they note their own steadiness. I remember a male patient of twenty-eight who kept on staring at his hand, expecting the usual tremor to occur, almost as though he was trying to make it shake after such a sensational negativing of his symptoms, but nevertheless failing. I require no further substantiation of my conten- tions in this chapter than the words of a great authority on chorea and its treatment. He believes it '*to be NEUROSES 83 always rheumatic," ahd he always administers sodium salicylate. He writes (British Medical Journal, June 14, 191 3): "The child who becomes the subject of chorea is usually nervous, excitable, and imaginative. She is easily frightened. At school, though by no means a dunce, she lacks concentration of thought and perseve- rance. Her attention wanders from the work to the creations of her active mind. It is easily diverted by all manner of extraneous and trivial circumstances. " As evidence of the ill-balanced and hyper-excitable mental state is the frequent occurrence in the history of the same child of such functional errors as night terrors or day terrors, somnambulism, eneuresis, nervous diarrhoea, and tic. " The mental state when the chorea is readily recognizable is usually ill-balanced and the emotions are beyond control. It has been aptly likened to April weather, sunshine and shower alternating in quick succession. Tears flow as part of real distress, for which there is no adequate reason or perhaps no reason at all. " A very astute physician, so I have been told, once said that one of the most dangerous attributes of chorea is its treatment. While it is active, rest both to body and mind is essential. All occasion for excite- ment or fear should be carefully avoided." I cannot but consider that all these data constitute ideal material for the psychotherapist; and I do not think I am too enthusiastic. It is true that I should also find pleasure in introducing suitable chemical medicaments and dietaries which might help to con- trol the uric acid factor, such as any other rational therapeutist might agree to : enthusiasm is not going 84 ADVANCED SUGGESTION to drive me to unwarrantable extremes, either in one direction or the other ; but neither do I intend to allow myself to be blindfolded by empirical usage in the study of any disorder whatsoever. I have enjoyed too many years in general practice for that. Again, I have a perfect right to take up a firm position with regard to any disorder, and to advance theories and recommend practices which elucidate cause and effect, if only because they will help in the exposition of the general argument. Tics These psychoneuroses are so well known to be amenable to favourable treatment by psychotherapy that very little more need be written about them. The worst case which I have to record is that of a lady who had mental troubles impossible to alleviate. I obtained an improvement which sufficed to enable me to realize that a cure was possible provided that certain family difficulties and dissensions could be removed — which they could not be. A new husband cannot easily be found exactly to suit a difficult wife, even when the health may make urgent demands. Difficult cases should be classed under the heading of psychasthenia. Some are as incurable as the worst cases of stammering and dipsomania, in which neither sufficient strength of mind can be brought about by any training whatsoever to enable the patient to appreciate the idea of normality, nor emotional tone enough to sustain the desire to get well. It is the NEUROSES 85 mental factor which is the most important in neuroses, rendering many more fit to be labelled psychoses, as we have seen in cases of neurasthenia. Treatment by psychotherapy would prove the latter statement to be true enough, even if nothing else could be found to substantiate. Stammering and other Defects of Speech Stammering commonly denotes conflict in dual cerebration; it is usually initiated at an early age by emotional distress and difficulty. There is first hesita- tion of thought. Later on the consciousness of the defect in action introduces another arc of "negative circling," and so on — for example: (i) Weak nerves, inherited : (2) emotional difficulty ; (3) repeated hesita- tion of thought; (4) established disability; (5) worry and shyness; (6) worry caused by the prompting of others ; (7) failure to reach a cure. Many cases exhibit dual thinking to the extent of absolute and repeated falsehood ; such will not be cured until there is better co-ordination in the subconscious plane. Exercises in enunciation and fluency, as commonly employed, will sometimes cure simple super- ficial cases ; but if a fundamental error persists of the nature of a conflict due to auto-contraception in a state of emotional sensitiveness, there is likely to be re- currence and continuance of the defect, unless the case be treated by psychotherapy. I cured one patient of stammering by pointing out, plainly and kindly, that 86 ADVANCED SUGGESTION both in his letters and in his conversation I had found contradictions (falsehood). It is always true, throughout the whole scope of the direct and indirect effects of any treatment, that if you cure one arc of negative circling, this will be of the greatest assistance in the direction of alleviating others. A youth who is suffering from stammering, and is trained by simple exercises in deliberateness and accuracy of utterance, may have these positive arcs so well developed that other defects will be induced to move in the right direction. Thus he may readily be cured by teaching of quite an ordinary kind. But in certain long-established cases the trouble will be too deeply rooted for suprainduction to hold out any hopes whatever. In one of my cases the patient seemed likely to make a rapid cure until fundamental timidity and perversity betrayed themselves. Then the difficulty was revealed. He was afraid to get well because of what would be expected of him. He had got accustomed to such sympathy on the part of his mother as enabled him to enjoy a very pleasant and easy life under his affliction. Neuroinduction resulted in his becoming ashamed of his condition, and was instrumental in his wishing to get well in every way. There are some patients, however, who will not under any inducement allow themselves to become cured ; their conviction cannot be shaken that they are very happy as they are. They come into the category of those who subconsciously do not want anything else but what they possess, and are not going to assist NEUROSES 87 in altering their state or estate. We shall meet this class of case again, among the sexual disorders. They may supraconsciously agree that their condition is unfortunate, and they may express themselves as duly sorry, but subconsciously they are adamant, in which demeanour they correspond to a person who will not receive suggestions offered in induction which are offensive or obviously harmful to him. A cure would be objectionable from their own particular inner point of view. It is extremely important that medical men — and patients themselves — should realize the existence of this class of very real difficulty, for it is one that may be observed in connection with several other kinds of nervous disability, notably in many cases of hysteria. Let me draw a clearer distinction between the supra- and the subconscious flow of thought in many difficult cases of stammering. I induct toward the subcon- scious, and the patient now exhibits the power to speak at once and without hesitation. This I have never yet failed to observe in any patient who can speak at all. From this fact we learn that there may be three trends of thought in a patient under treatment : {a) That he can speak quite normally while undergoing neuroinduction ; {b) that he does not want to speak otherwise than abnormally, notwithstanding {c) that the affliction is truly in certain respects a great trouble to him and others. In other words, a patient may not possess sufficient emotional desire to get well ; there is conflict, therefore, in the subconscious, and thq patient's reasoning may win. 88 ADVANCED SUGGESTION Most stammerers can sing their words quite fluently, because the act of singing serves to link the words together for them. Again, if one directs the patient to speak while he taps the hand on some object at each word, one usually finds that no stammering will take place, because the tapping serves to link the words. Again, most stammering patients can whisper fluently; this is explained partly by the fact that nearly all neurotics will feel quite easy in the per- formance of anything that is less than the major difficulty; they may even display a certain pride in calling attention to the contrast. The ability to whisper is also due to the fact that another order of musculature is brought into play. Many sufferers will cease to stammer when greatly angered for any reason, while an equal number will manifest the very opposite tendency, showing that when all main causative hesita- tion is set aside the normal power enters, It is equally interesting to note that a patient may not stammer at all when reciting or reading with another. Getting out of breath usually leads to an increase of stammering; a large number of cases display a defect in the rhythmical action of the respiratory musculature. Public speaking will sometimes cure stammering, the enforced publicity, the directness, the singleness of purpose and accuracy required by the speaker, all serving to reduce shyness to the vanishing-point. Treatment should be in the direction of mental as well as physical training ; and the latter should involve NEUROSES 89 the subconscious correction of the offending muscles, vocal, oral, and respiratory, not forgetting that the greatest offender is often the diaphragm. Exercises in smoothness and fluency of utterance will, of course, assist the enunciation, by correcting spasms and con- tractures of muscles, as they will help muscles in any part of the body. Patients should first be trained to thinky slowly and in the right order, and should have examples given them in neuroinduction of single, simple, accurate sequences of ideas. It may be realized how comparatively use- less is mere exercise in supraconscious utterance alone, when it is appreciated that no amount of physical exercise in utterance can possibly control the in- accuracy and hesitation of thought which is the origin of all bad cases. Only in the subconscious can we deal with emotions and impulses rapidly and effectually. Cultivating a different tone of voice, as commonly recommended, is a very unwise procedure. A case once sent to me had been made decidedly worse by an unscientific voice-trainer who spent months in getting the sufferer to speak in a very low pitch ; this failing, he tried an unusually high pitch, with even less success. One must be equally emphatic against cultivating a singsong manner of speaking, for this may add just the very self-conscious factor which we wish to eliminate. Precisely the same remarks apply to stuttering, which is a spasmodic repetition of g, syllable. It is tq go ADVANCED SUGGESllON be noted that in these disorders muscles in distant parts of the body may have been brought into " nega- tive cirding " ; some patients become so bad that they will eventually decline to converse at all; kicking, stamping, and choreiform contortions may thus mani- fest themselves. Cases of speech paralysis of the kind so ably explained by Dr. William Russell {Lancet, Novem- ber 1 6, 191 2) as due to cerebral angiospasm can be most successfully treated by psychotherapy. This should, perhaps, at this stage of our study, go without saying, even before we come to the chapter on the Heart and Circulation, which will help to convince the reader. Missing out words, and repeating the same sentence over and over again, are characteristic of psychoneu- roses which readily yield to subconscious induction. Here is the " circling " of a patient who was a public speaker : (i) Neurotic history ; (2) overwork; (3) miss- ing words; (4) worry; (5) loss of employment; (6) financial worry ; (7) dyspepsia ; (8) insomnia ; (9) bad temper. Everything had been tried in this case before psychotherapy made it possible to overcome every difficulty ; in a few months the patient became normal, and secured more lucrative employment than ever before, because the opportunity was taken to tone up his whole system. I found the bad temper to be more difficult to deal with than any other "arc" in this case. NEUROSES 91 Collapse on the stage or in the pulpit is sometimes due to "blood rushes," angiospasms, or heart panic. The first thing noticed by some patients is an inability to go on with their work, which causes a feeling of alarm ; this serves to start a " negative circle " through the tendency to gather in further " arcs." Laryngeal, (Esophageal, and Pharyngeal Disabilities A clergyman, fifty-seven years of age, was sent to me, suffering from a difficulty in swallowing, which had lately become so much worse that he began to refuse to eat, and later also to drink. Great mental distress began to develop. It was obvious that he had a slight stammer. The latter defect he thought little of, as it was a trouble of long standing. Here was clearly a case of stammering which had brought in other serious negative " arcs." The patient had for some time been worried in connection with his parish duties, complaints having been made by parishioners respecting his waning ability to conduct the services; this was long before any difficulty in swallowing had appeared. He ex- plained that the muscles of his throat seemed to go into spasms on his attempting to swallow anything. I at once considered this to be just the sort of case in which a practised psychotherapist could immediately demonstrate a method of curing the chief disorder com- plained of — in one sitting even. I asked him to take off 92 ADVANCED SUGGESTION his collar, so that I could see his neck muscles. I then told him I wished actually to see the spasm as it occurred. He replied that this could only be pro- duced if he there and then tried to swallow something. I therefore got him a glass of water. He protested that the water would go all over the floor — that this was just the effect that drinking produced at home. I told him I would get a large hand-basin and plenty of cloths to lay down ; I further explained that he was not to bother about the floor. I gave him the glass of water, and, standing in front of him at a distance of about a yard and a half, I watched very closely for the spasm, saying abruptly : " Now, drink 1 " The water went quietly down the throat. He seemed astonished, and said, " I will try again," as though this time he would certainly satisfy my curiosity as regards the precise muscles which were affected. I told him that it was of no use to try again ; the muscles would not go into spasms any more. Nor did they; he was delighted, and enjoyed free and repeated draughts of water — drinking, as he remarked, while he had the chance. The case affords a very good example of successful treatment by supraconscious induction. The pro- cedure may appear very simple to the reader, who might himself succeed in producing the same effect on every occasion. But another reader might fail ; in- deed the slightest variation of sequence in treatment by induction might even make matters worse, causing the patient to return home with his disorder more NEUROSES 03 advanced than ever. If the slightest hesitation or dubiety were betrayed, or any sort of mystery con- ceived as to the psychotherapist's particular purpose, this might be sufficient to produce spasms more violent than any previously experienced. Just as the right sequence will cure as by magic, so may the wrong one make the patient promptly and alarmingly worse. But here we have a great difference between induction in the supraconscious and in the subconscious : the latter could never do any harm. The speech difficulty in the particular case just cited afterwards required much longer treatment, even by subconscious induction, fulfilling the truism that in all nervous functional dis- orders the length of time required for cure will usually be in proportion to the number of months or years which the particular trouble has existed — roughly speaking, as many weeks being required for a cure as the trouble has lasted years. We may now consider a different variety of case : A man, forty years of age, was sent to me at my suburban residence very late at night, in the greatest possible distress, suffering from oesophageal spasm; he felt every moment as though he would choke. A throat specialist had already employed a probang, the patient having swallowed a fish-bone some hours previously. Though no bone was present after this operation, the spasm increased, and the patient thought his end was at hand. I sat him in a chair and inducted toward the subconscious, steadying his neck muscles the while by palpation; after five 94 ADVANCED SUGGESTION minutes' rest, I asked him how he felt. He would iiot be comforted. " It is better, but it will come on again, I know," he replied. He did not wish to leave my house. I told him he could, and must. "What should I do if it came on again ?" " It will not 'come on again," I answered. " But if it did, there are no more trains out here," he continued. I told him to go by the last train, and to phone me in the morning if no better. With difficulty I induced him to return; I was not in a mood to treat him for folie de doute, giving up my time near midnight when I knew he would be quite safe. He telephoned in the morning that he had had a splendid night's sleep, apologizing for having been such a nuisance. I ought to give a few brief particulars of the most extraordinary case I ever saw, or ever heard of, in this class. A man thirty-two years of age was sent to me ; he was pale and emaciated, having suffered from spasms in his neck muscles for fourteen months, and he was gradually getting worse. Several doctors had tried many treatments, but all to no purpose. At length he became unable to go to bed ; he was afraid to sleep for fear of choking. Feeding, even on fluids, had become impossible. Under observation the degree of spasm was, in its excess, beyond all belief. Every few moments his larynx leaped up toward the chin in a manner which amazed myself and another medical man brought to witness the example, the muscles having become hugely developed by the pro- longed automatic urgency of the disorder. The range of NEUROSES 95 movement seemed beyond all physiological possibility ; yet the condition was there, before our very eyes, com- pelling us to account for it in some way. To-day I should value a cinematograph film of the extreme movements in this unique case. As it was, the man's terrible distress prompted the application of every possible expedient for immediate alleviation. I never in my whole experience saw a case more readily relieved; complete correction was effected in one sitting. Immediately upon induction towards the subconscious the muscles ceased their abnormal exertions. The patient, perceiving this, now seemed exhausted; he appeared about to collapse. I had to allow him to lie down for a time. The fact that the general tension which the disorder had produced had been so rapidly relieved, and that the throat sensations were becoming so comfortable and easy, now produced an immediate tendency to "sink" from sheer relief. After freely taking some liquid food the patient there and then fell fast asleep, and had to be driven from the house in care of his friends, in a somnolent condi- tion, which was due to his having had very little sleep for some weeks past. He attended for treatment the next day, complaining only of occasional little spasms. In a few weeks he grew quite strong in every way. I afterwards discovered some epileptiform manifesta- tions, which had existed on and off since boyhood. These also were cleared away. As medical men are well aware, hiccough may defy all ordinary means, and has even been known to be g6 ADVANCED SUGGESTION fatal. However bad, the disorder yields at once to subconscious induction, provided there is no organic disease. I make this reservation, for I have not treated a case in which organic disease accounted for the spasm; but I am of opinion that, even then, subcon- scious induction would be more likely to succeed than to fail. I may as well refer to an easy means of stopping simple hiccough supraconsciously^ which I have found more efficacious than anything else in the ordinary way. It derives its value from a certain control which is imposed upon the diaphragm; but it also has the effect of diverting the mind. Tell the patient to stand up erect, and now to bend the head and neck as far back as possible, and to look along an imaginary line running backwards on the ceiling. The spasms will go as he curves himself backwards. I have not as yet seen this fail to afford an immediate cure, provided there have been no particular complications. CHAPTER IV DISORDERS OF URINATION AND OF THE ORGANS OF GENERATION As regards technique, rationale, and progress in the apphcation of psychotherapy to this class of disorder, the cases cited may well speak for themselves, after what has been written in other connections. A man suffering from incontinence at one time, and inability to pass water at another, was cured in one sitting by induction. Other physicians, adopting various kinds of treatment by " suggestion," have obtained good results in similar cases. This is one of the easiest of all classes of functional disorder to deal with. A youth, twenty years of age, was sent to me suffer- ing from a dribbling away of urine, continuing all day and all night, which followed a feverish influenza con- tracted some months previously. In this case I should imagine that acid urine had first caused pain, and that this had created fear or worry, which served to per- petuate the trouble by the formation of "negative circling" — especially as his parents had scolded and punished him. The urine was running at the time he consulted me, and the patient had to stand on a piece 97 7 98 ADVANCED SUGGESTION of oilcloth. He was asked to lie down on a couch upon some waterproof sheeting. Ten minutes' rest follow- ing one minute's induction was sufficient to stop the flow before he rose. He had no further trouble. Every kind of medicine, and various other means, had previously been tried in this case by his medical advisers, including chloroform and the administration of large doses of narcotics. A boy of thirteen was sent to me with a history of nocturnal enuresis of some years' duration; this had at length become diurnal as well. He was thin, pale, and looked greatly worried. Water was dribbling at the time. When he arrived I was dressed in my over- coat and about to catch a train, for which I was due to leave the house in ten minutes' time; I therefore declined at first to treat the case. But the appearance and temperament of the boy appeared to me to be favourable; I therefore told the father I would treat his son (as he had come a long distance), but that he must remain in the room with him a few minutes after I had gone, after which he could take him home. The boy was very easily dealt with, as it happened. I told him to lie still for ten minutes, that the water would stop, and that there would be no further trouble. I left, after instructing the father that if there should be any further dribbling the boy should attend again. A message was sent to me next day to say that all had been well. Later I received information to the effect that the boy was developing physically at an astonish- ing rate, daily exhibiting a better colour, and rapidly DISORDERS OF URINATION 99 increasing in weight. Such instances serve to indicate the prompt and easily obtainable effects of treatment in this class of disorder. I wish every case of nocturnal diuresis were also diurnal, for the object-lesson of the correction of the diurnal diuresis is of the greatest help in the matter of inducting towards correction of the nocturnal trouble ; it is, indeed, far more effectual than any kind of treatment for the nocturnal trouble. There are reasons why this should be so, which need not detain us here. Some cases of nocturnal enuresis will be found very easy to deal with, and others extremely difficult. They are difficult when the mentality is of an abnormal character, apart from any reduction of the general health which might well be inculpated ; indeed, some of the most difficult patients are physically robust. When one is obliged to make a patient's mental power sufficiently vigorous for him to be interested in his cure, a certain amount of time will be required. Parents will not always admit the mental weakness, having very good reasons for concealing it. In obstinate cases, however, careful inquiry will usually contrive to elicit complications in the shape of some sort of nervous or mental deficiency. Bad temper also hin- ders treatment. Petted boys are far more difficult than those who are not so spoilt; it is sometimes far more difficult to correct home habits than mere func- tional disorders. An epileptic diathesis may cause a great deal of difficulty. But even with such predis- loo ADVANCED SUGGESTION posing and complicating conditions psychotherapy holds out by far the best hopes of cure. A lady, married, thirty-five years of age, suffered from occasional inconvenient dribblings, as well as impulsively sudden desires to urinate. This made her nervous in many respects, and led to the formation of other "negative arcs" over a period of several months. Induction corrected the entire disorder in two treatments. I am aware that such cases can be most effectually treated by life in the South of France, by high-frequency currents, building up the constitu- tion, massage, patent foods, various medicines, and so on ; and I cannot consider such measures anything but very rational; but I beg permission to place psycho- therapeutic induction among the measures deserving of very serious consideration — at all events, for such cases as have been found difficult to treat by any other means. Masturbation. In treating masturbation, very little good will be done by being angry with the patient. Indeed, this will usually make matters worse. Difficult and disorderly thinking is present in all bad cases ; usually some kind of concomitant physical disorder may readily be found — apart from phimosis. Many bad cases are not troubled with the latter defect at all. Tying the hands and all measures that are harsh, scolding, or of a puni- tive nature usually have a most unfavourable influ- ence; they are apt to provoke a still more cunning DISORDERS OF URINATION loi determination to thwart all preventive measures. The subconscious mind must be got at if real success is to be attained in the quickest possible time : it would seem superfluous to emphasise, even to the veriest tyro in practice, that in most sexual disorders psycho- therapy will surpass all other treatments, so long as the technique is — well, good enough. Tendency to sexual excess, functional impotency, and spermatorrhea are equally amenable. Primarily these conditions result from local and general nerve disorder, in which some amount of psychasthenia is usually present ; introspection and self-irritation do the rest. If masturbation be the result of morbidly sensitive moods, it reacts in turn, forming "negative circling," which gives rise to further moods. Authorities should therefore be very careful, on finding masturbation, not to blame this for a whole train of psychasthenic symp- toms such as may exist in a bad case, for any kind of treatment may then be quite unsuccessful. Let us study the following bad case : (i) Nervously sensitive ; (2) morbidly unhappy and lonely ; (3) imitating others in disorder; (4) masturbating; (5) more lonely and secretive ; (6) more unhappy ; (7) feeling generally out ■ of sorts; (8) bad temper; (9) psychasthenia; (10) inclined to suicide. In treatment (i), (2), (3), (4), (5), (6)» (7)» (8), (9), (io)j arc all open to suggestions which inculcate positive — that is, favourable — thoughts. After masturbation has been practised for a time the generative organs become unstable; they are more I02 ADVANCED SUGGESTION ready to burst forth into irregular action on slight excitation than they would be normally, both in the daytime and at night. Emissions in the psychas- thenic are as often as not of the nature of obsessions ; the patient has not only a tendency to find worry in anything he can, but he is further harassed by psychical conflict, by the failure to stop either the emissions or the masturbation, having learned that the latter is the cause of the former. I should like at this stage to offer my reply to the question — as yet not definitely answered by anyone, as far as I can find — as to whether a slight amount of masturbation is harmful to anyone or no. My firm opinion is that the practice should be viewed as on a par with morphia-taking — in this respect, that little is constantly inviting to more; but it is further harmful under a law which I feel justified in stating, as being helpful in a study of psychology, that negatives tend to beget negatives, once there is the least disequili- brium. Normally a balance obtains between positive and negative mental tendencies; any addition to the mass of the negative tendencies is likely to diminish the mass of positive tendencies. We shall therefore find in every case that masturbation is an " arc " which tends to drag in other " arcs " ; indeed, it begins to do so at its initiation, all the more because of the sense of wrong-doing and the secrecy under which it is carried out. I have hardly ever seen a case in which this sort of confession has not been made during analysis : " I have always felt that it was wrong." The reason for DISORDERS OF URINATION 103 the latter conception is, in my opinion, to be found in the fact that a normal sexual act is only fully and truly enjoyable in co-operation with another of the opposite sex, as a law in Nature's scheme ; and that should there be any evasion of this law some form of penalty will surely be exacted. This will all the more be apparent to those who have studied natural processes exten^ sively and broadly. Show me a masturbator and I will in a trice find in him other "arcs" of "negative circling," however he (or she) may be inclined to appease the soul of self with exculpatory arguments, and even though there may be declarations that "only a very little" is indulged in. Dr. Gordon Holmes has written, and others have agreed, that "the habit may be, and usually is, persisted in for a considerable time without any evident effect on the individual " ; but this only serves to remind me of an instance of a man who murdered a lady in a railway carriage, and who was reported as having previously been of perfectly normal mind because " people had seen nothing wrong about him." I have seen many individuals — and so have others, for that matter, including Dr. Holmes — in whom mental disorder has been obvious in the midst of what has appeared in the estimation of others to be perfect normality. Indeed, who knows who is normal, until thought analysis reveals the truth ? I have analysed certain geniuses, only to think how much more brilliant they might have been had masturbation not come into their life. Here it might be possible to find a defend- I04 ADVANCED SUGGESTION ing counsel to argue that genius might be partly due to masturbation : at least one distinguished man has actually argued thus with me. I cannot admit the contention, however, for various and very important reasons which lack of space will not allow me to give, although I have studied cases in which masturbation has led to reclusive habits which have appeared to favour very close and persistent application to duties. I have carefully traced back to earliest sensa- tions and impressions in a number of cases of sexual perversion (including inversion), and I am bound to come to three outstanding conclusions. The first is, that definite anatomical structure will always tend to favour its own natural physiological processes, certain " other things being equal " : there is no such thing as a sexual invert being unalterably born such, notwith- standing that his family history may favour various abnormal tendencies. The second is, that in the vast majority of all kinds of sexual perversion instances are generated not so much through inheritance as by means of earliest sensuous elicitations. Simple over-sensitiveness is the fundamental predisposing factor in very many cases. If a child has not been normally brought up ; if it has been subject to laxity on the part of parents, servants, or acquaintances, then any inherited over-sensitiveness, or tendency to effeminacy in general behaviour, is likely to encounter early opportunity sufficient to establish an abnormal sexual life. An effeminate- minded boy, entirely unacquainted sexually, will be- DISORDERS OF URINATION 105 come sexually masculine provided his first sexual sensations and emotions (let these be ever so little to be enough, or ever so much) are aroused by sufficient communion with females. The third is, that when sexual perversions are definitely established they can be trained away, or neutralised, by neuroinduction, given an environment that is sufficiently favourable, just as kleptomania can be cured : cases found incurable are such as are mentally and emotionally unalterable. Hermaphrodites will lean towards that sex which first arouses sexual emotion in childhood. Sexual perversions — according to degree — are amongst the most powerful of all arcs for dragging in other negative arcs in circling : this explains why general physical and mental disorder is so very common in inverts — invariably including falsehood. Full inversion is determined by general-emotional contact rather than by local ; effects of the latter alone are comparatively easily corrected, either by auto- or hetero-suggestion. CHAPTER V PSYCHOSES It must not be imagined for a moment that I should consider it an easy matter to deal with the majority of persons of unsound mind by my methods, particularly those in hopelessly advanced stages; a more perfect form of open-air treatment than is commonly known could not in a few weeks empty our consumption sana- toria. All medical men would allow that the best treat- ment should be applied in both the conditions referred to at as early a stage as possible. We may well believe that the number of people certified as insane and requiring asylum care might be greatly reduced if my views as expressed in these pages be correct. In the past very little has been done for people who have developed early signs of mental dis- order, beyond watching and waiting — beyond recom- mending change of environment, and possibly of em- ployment, which, of course, will often do a good deal indirectly towards the improvement of difficult cases. No direct means have been adopted, no system of cor- recting particular tendencies of thought or inclinations, no scheme of training has been designed to neutralise or negative abnormalities in the insane. The careful classification of cases, and herding these together 100 PSYCHOSES 107 humanely, have been the main consideration, while the best medicinal and hygienic means that science could suggest have undoubtedly been employed. Insanity plainly spells disorder of thought; but there is no system in vogue in our asylums dealing specially with such disorder, or likely to help individuals to recover order. Not that I could possfbly attempt to run down asylum treatment ; indeed, I am on the whole inclined to praise it greatly. I have been able to offer special reasons why asylums can hardly be improved upon as institutions for the care of the majority of people of unsound mind. My plea is still more on behalf of those who are threatened with asylum life. At the same time, I must express my opinion that many who are now in asylums would be better treated by the appli- cation of principles such as are recommended in these pages : they would recover sooner and would not be so likely to relapse into mental disorder after recovery. I shall be candid enough to admit that I have known cases of insanity in which suggestion has failed to effect a cure by itself; but when the discipline of asylum life has been added the patients have been cured. This admission, I trust, will help to indicate the sincerity of my criticisms and recommendations. In such cases some compulsion has been requisite, plain induction not having been sufficient. I have been told by patients that their stay in an asylum had undoubt- edly put a stop to the wildness of their career, and that the (^uiet life enforced had enabled them to recall th? io8 ADVANCED SUGGESTION teachings which had been given them before they entered. They have frankly confessed that asylum life has played a very effectual part in their salvation. It must be clear to all on reading the pages of this book that those who suffer from early symptoms of mental derangement should be treated by a method which analyses and synthesises, whether the patient is to be treated in cottage, palace, private home, or asylum. It follows, also, that this method should con- stitute the very warp and woof of treatment at any stage of the disorder. We want more men with the broad spirit and understanding displayed, for exam- ple, by Dr. Bedford Pierce, who knows what is wanted, and who leaves no stone unturned to get it so far as his position will allow. He writes : " I fear that the amount of research work undertaken bears no relation to the excellence of the accommodation pro- vided for our patients." There is a plain candid truth for the consideration of his confreres. Very little need be added as to the value of subcon- scious induction in insanity, after so much has been said under the heading of Psychasthenia, and in other chapters, excepting that there could not be a greater mistake than to suppose that insanity is not amenable to treatment by psychotherapy — a common supposi- tion, and one even held by some psychiatrists of stand- ing. That the mentally afflicted are amenable to subconscious induction, so long as any potentiality of association remains in the patient upon commencing treatment, is the teaching of these pages. Provided the PSYCHOSES 109 induction be of the right kind, it will prove an instru- ment second to none, and I shall be greatly mistaken if the method does not soon become the sine qud non of treatment, to be employed by all psychiatrists, for such patients as are not too obstinate and too far advanced in disorder, and in whom no organic obstacle exists which would make improved functioning im- possible. The success with which certain cases of dementia praecox and melancholia can be treated by subcon- scious induction causes me to reflect how important it is that cases of these disorders should be diagnosed and treated by psychotherapy at an early stage. All cases of early mental disorder call for easy and rapid analysis, which means a really accurate diagnosis. I recall the case of a man who was obviously dying, in a nursing home, from exhaustion, in advanced melancholia, having been sent there by a specialist of considerable repute. On his relatives becoming alarmed by the report that he was gradually approach- ing his end, a general consent was given to my being called in. He was then, of course, bed-ridden. A few weeks later he was walking about comparatively well, thanks to treatment by suggestion ; and he would have become absolutely normal had he been a little younger. I have no hesitation in declaring that such a man ought to have been treated by an efficient psychotherapy some ten years previously, as soon as the early signs of the disorder had become sufficiently manifest to threaten development into anything more serious. 110 ADVANCED SUGGESTION Cases of paranoiawhichhavebeen successfully treated also serve to indicate the great advisability of dealing with such disorders by suitable induction years before the more difficult features permanently develop. I have made analysis of a sufficient number of cases to show that in a large percentage of them very early strains and shocks have made a deep impression, from which vicious "arcs" have gradually developed. I have attended a number of mild cases — in members of families which were well known to be extremely prone to derangements of a grave type, which had proved incurable — and I have checked the progress of such cases. The firm feeling, that these early cases were bound to go the way of the rest had existed in the minds of relatives and physicians alike; but the patients are now living to prove that subconscious induction served to check any advance of the disorder. The alienist critic might choose to argue impatiently that such cases count for nothing. But I have been fairly satisfied in my own mind that most of these patients would soon have followed their relatives. I hope that my professional confreres will not take umbrage at these firm and deliberate contentions, for they may live to see many proofs of them ere long. I tnay give just one example out of many. A specialist in mental disorders brought a patient to see me on the advice of another specialist, the case being a troublesome and difficult one. The opinion of two experts had been given me that the patient would not recover, and attempts were made to persuade me that PSYCHOSES 111 it would be useless to try psychotherapy. In my own mind, however, I was confident that it would prove successful. The patient is now an officer of high rank in the British Army, having received rapid promotion since his complete recovery. Whenever suicide is spoken of, contemplated, or attempted, the disorder being of purely functional origin, I always conclude that the patient feels cornered in some way, and for some particular reason, or that he fears that he may be cornered, and that if a way out can be found for him the desperate idea will then disappear. This may seem a commonplace observation; but I distinctly recommend common- places as factors of the very first importance through- out this book. I have found them of value in treating patients of standing, of great intellect, and even of scientific acumen and training. I have cured very distinguished people by means of commonplaces when I have known that I could not pretend to possess a fraction of their particular intellectual equipment when they were well. It has been my experience that if a way of getting over a difficulty can be reasoned out, so that conflict in the subconscious mind of a patient can be appreciably reduced, no suicide will follow. I say reasoned advisedly. Therefore analysis should first be directed towards finding out, reliably, what is in the mind; then the best ways out of tight corners should be discussed, in a tone of strong conviction and adopting a mood of common-sense composure. Suf- ferers often conceal difficulties ; they may become most 112 ADVANCED SUGGESTION subtle in their very real determination to do so, setting the psychotherapist one of the most difficult problems conceivable. The person who carelessly refers to committing suicide rarely kills himself, unless ridicule should seem to challenge him too fcir, or provoke too great annoy- ance; then a fit of temper, or spite, may prompt him to carry out his threat, in order to get the best — or worst — of the argument. Many speak of suicide with a view to eliciting sympathy, or fear, from others ; often for the purpose of obtaining something, it may be for purely selfish motives or on account of real poverty. Ideas of being persecuted, and of being asked or told to commit suicide are, of course, common; sometimes extreme jealousy will provide a motive. Very great differ- ences may be observed in the manner of either referring to or threatening suicide. Careful study of the patient's remarks and answers will often reveal second- ary currents of thought ; moods may be detected, per- haps in the eyes, the facial expressions, or the move- ments of the body, indicating profound trains of thought in those who apparently are speaking care- lessly. In those who really mean what they say there may also be discerned physical signs of secondary trains of thought designed to put any inquirer " off the scent." I do not hesitate to admit that such patients are very difficult to deal with; but induction toward the sub- conscious helps to clear up mental conflicts and to PSYCHOSES 113 reveal genuine or supposed troubles as no other treatment can. S6metimes a patient will be angry chiefly with him- self, thinking he is far better away from others — even from himself — having grown tired of conflicts. There are others who dislike forcing their troubles upon any- one. An instance is recalled of a man who thought he gave everybody he met a disease. There are many others who develop some habit or failing which they cannot master, becoming despondent in estimating their prospects for the future. I do not advise anyone to do as one husband did, to my knowledge : he placed a weapon in his wife's hands, after she had threatened to commit suicide, saying, " Do it, then ! " He explained afterwards that he knew she would not. It was not want of pluck on her part; the idea crossed her mind that he really would be glad to be free to marry another woman. This, as analysis indicated, caused her to wish to thwart him. But she nearly did pull the trigger when he followed up by calling her a coward. However, she refrained after instantly divining that he was angry principally because he could not easily get his own way. Under stress of occasion thoughts may change very rapidly, according to the exigencies of the moment or to any new factor entering into the argument. Thus a patient may begin a dispute by threatening, having no definite intention; then she may pass rapidly to absolute intention; finally, after she has used the 8 114 ADVANCED SUGGESTION weapon, she may immediately display profound regret. Vanity, of course, is at the bottom of many incidents. A girl of twenty-two described to her sister how she would spite her parents, and make them sorry for the way they had treated her, by " walking into the sea," until psychotherapy caused her to think calmly of such a procedure, as not only being a very unwise one to adopt, but very wickedly conceived. In analysis I sought the reason why this particular method was selected, and found that she had not forgotten to think of the sensation whi,ch her suicide would make among her friends when they read the account in the papers ; how pathetic it would seem to them for a lightly clad body to be found "floating with beautiful hair all loose." I further elicited that much study of her appearance had passed on to a consideration in her melancholic moments as to how she would look when actually dead. All this had been brought about by a disappointment in a love affair. A young University graduate in honours had made an attempt to cut his throat, after being received in a nursing home for neurasthenia. Particulars included the information that in his efforts he had seized a razor and had struggled on the floor with a nurse. Two male nurses were placed in attendance upon him in the home. This seemed to have greatly aggravated his mental condition. On his being sent to me, I found him taciturn, evasive, morose, contemptuous, and obstinate. I had no fear that he would do himself any PSYCHOSES 115 injury after the first treatment, which was only designed to impress upon him the fact that I should help him to fight a way out of his troubles. Careful induction further caused him to feel that he ought also to help me. He now felt easier, and quietly told me that it had seemed impossible that anyone could help him. I found unmistakable indications of an obstin- ate melancholia, and that he was on the verge of refus- ing to allow me to help him further, which induced me to search for some "skeleton." It took me a week to wear down his decision to thwart me if he could, and to "go out" by some means before the "skeleton" could be revealed. At length the prior idea that I might possibly help him mastered the sustained resolu- tion to resist and to practise concealment. Another week was occupied in dealing with an evident conflict, made up of efforts to find reasons for thwarting me and means of ending his life, on the one hand, and of strong incentives to accept my points of view on the other hand. Treatment was all the time directed to- wards enabling the latter to win, while finding less and less occasion for the former to keep its hold upon him. Finally, he gradually but fully disclosed the " skele- ton," which when looked at in full light of day caused me to express great surprise that such a thing should ever have caused any particular worry. From this moment he never looked back into the darkness again. He not only got well, but in a few weeks felt better than he could ever remember, showing that he had been a victim of " nerves " practically all his life, and ii6 ADVANCED SUGGESTION that analysis and treatment had gone to the very root of his disorder. Threats of suicide may mean anything; they may be the vulgarest "bluff" designed to call attention to a grievance in a court of law, by a person afflicted by a hankering for public sympathy ; while instances are common in which the patient quickly blurts out the hint, in a momentary wrestling of dual conception, feeling on the one hand impelled to carry out his threat, and on the other that it ought not really to be carried out. Undoubtedly we find the most firmly determined cases among those who never display any sign or utter any word of foreboding. Patients who take pains to conceal their intention may display the utmost cunning from the outset ; they will sometimes pride themselves on the thought of being far too clever for anyone to detect or thwart. In one case which was successfully analysed and treated the patient wanted to die, but she did not want any odious aspersion, arising from the fact of her suicide, to be cast upon her after death. She was pretty, and knew it. She was a victim whose mind was torn by con- flict, and by the stress of epileptic storms and exacerba- tions. She was subconsciously intellectual. She studied the matter carefully and exposed her bare body from the pelvis upwards before an open bedroom window " for some hours," in order to get a fatal chill. I believe her account of the exposure to have been absolutely true, from the carefulness of the analysis; though she seemed hazy in her account as to the exact PSYCHOSES ti; length of time she was exposed, I am quite satisfied as to what she intended. Indeed, the time may have been even longer than she admitted, for when asked whether it was for three hours she carelessly replied : "Two or three." To her own amazement nothing hap- pened, excepting very great discomfort. She was pale, thin, badly nourished, and suffered from dyspepsia and insomnia, being, of course, deeply worried at the time. Before coming into my hands the same patient had opened the window of a nursing home many times with a view to casting herself out, but had been checked by revolting ideas as to the nature of the injuries she would sustain, and the ghastly appearance which her body would present, as well as by the state of distress which the circumstance would produce in her parents. Many sufferers have a strong desire to contract all sorts of dangerous illnesses, not caring in the least whether the issue might be fatal or no. Some will work themselves up into ecstasies over the beautiful clean water, " sweet and inviting," and will visit a river or pond with a view to jumping in. Vanity very often corrects such impulses. Any sort of tentative behaviour may, as often as not, lead ultimately to the act being finally committed, unless some factor should enter to modify developments. The case of a man who had thought for months of placing himself on the railway line is interesting, because, by analysis, no reason could be found for this obsession. Supraconsciously he was greatly distressed that the idea should visit him — unusually so — and he n8 ADVANCED SUGGESTION could not in the least account for it. Here was a decidedly uncommon case, in which I felt obliged for the nonce to acknowledge the failure of analysis. Careful inquiry eliminated every likely factor, the patient being abstemious to the point of drinking "only tea"; it seemed as if I was fated to be non- plussed and defeated. Tea? I asked myself, as my recollection ran back to another case of interest which suggested a possibility. I made inquiry, and found that his wife had rewarded his careful virtues by making a great fuss over his tea. Because he never took anything " in the way of strong stimulant," every day she sent to his office tea of her own making in thermos flasks. He took this three times a day, and had more on returning home. He was stout, and usually rather thirsty, through frequent visits to hot engine-rooms. On stopping this large allowance, only permitting himself four small cups a day, according to the direc- tions I now gave him, and taking other even less harmful beverages in the intervals, such as a few drops of lemon- juice to the half-pint of water, or thin barley- water, he got perfectly well, and has remained so until now (three years later). Thus the case was hardly one for psychotherapy : it was a plain one of tea- poisoning. I have had cases of nervous disorder which have been quite incurable, into which ideas of suicide have entered; subconscious induction has removed the latter tendency permanently, while the organic obstruction has remained uninfluenced. t^SYCHOSES 110 That induction toward the subconscious is the treatment par excellence for the high blood-pressure so often found amongst the mentally distressed would seem to go without saying after a perusal of the fore- going chapters, even before we come to that on the Heart and Circulatory Disorders. But meanwhile let me cite the words of Haviland Hall to support my con- tention in this connection. They were uttered before the members of the Hunterian Society. He said : "Great stress is laid on the toxaemia of gastro- intestinal origin due to overeating, as a very important cause of increased blood-pressure." Now, if a later chapter on gastro-intestinal disorders be carefully read, it will be quite clear that psychotherapy should be resorted to for one reason at least, if not for others. He also averred : " Finally, mental strain and worry, especially if combined with deficient exercise and too rich living, are stated to be potent causes of high blood-pressure." My plea should need no further substantiation after these words. Dr. Langdon Brown entered into the discussion on the same occasion, and called attention to the difficulty of getting a correct record of the blood-pressure in nervous subjects, in whom the mere attempt to make the observation raised it temporarily. Now, all authorities are agreed that rest must assume a promin- ent position in the treatment of this condition of the circulation. And what imaginable rest could there be, I ask, which could equal that of fully inducted mus- cular and mental relaxation — a rest which need not 120 ADVANCED SUGGESTION be taken in bed, a rest which will favourably affect the whole functioning, mental and physical ? Further, Dr. O. K. Williamson agreed with Dr. Hall and Dr. Langdon Brown in the following words, as reported : "It is undesirable to make a routine practice of reducing the pressure; still, it seems advisable to try, cautiously, the effect of reducing the pressure, inasmuch as the continuance of the condition is, other things being equal, in itself harmful. Great caution is, however, necessary in such cases, and the effect of such treatment on the patient's general health and symptoms should be noted, as many of these patients will not bear reduction of their blood-pressure. Treat- ment is also called for in cases in which high blood- pressure is associated with marked local spasm of arteries, and consequent interference with function in areas which these supply ; it then becomes, especially in the case of the heart or brain, an urgent matter." But there can be no risk, no need of extreme caution, in the methods I am advocating, or, at all events, com- paratively none. There can be absolutely no risk, provided the operator has as much sense as the average medical man — enough to avoid exciting the patient. I admit that complicating disease, and forms of worry v/hich the patient cannot get rid of, may be dangerous factors — but so they will be under any treatment. PSYCHOSES 121 Dementia Precox. 1 have found in many cases diagnosed by alienists as dementia praecox that analysis is not at all difficult ; one may find such a history as the following, picked from my case-notes as an example : "As a child every time I broke my promise to mother that I would not pick my nose I felt troubled and drawn towards doing it again. Later on I read some pages of a book about a prince making a sentry bite off the head of a mouse, and this kept coming into my thoughts; and the idea grew into that of biting all sorts of nasty things. I used to hate to see pictures of the nude, but I seemed drawn to them." It is better to get such details written down by the patient; much more correct analysis will be made by this means than by vivd voce, for patients are often more capable of ready and lucid analysis when think- ing the matter out for the purpose of writing it down. In treatment all old ideas that have had the effect of dissociation should be swept clean out of the way — by observations designed to evoke healthy emotional activity in the subconscious realm — by words such as these : " You will really wish to leave behind — and will find you are leaving behind — such useless notions. You ought no more to have allowed them to stick to you than you would allow an irritating parasite to do so. You will now naturally think of things that are beautiful, easy, and orderly, instead of wasting time over what is horrid." i22 ADVANCED SUGGESTION I need urge no more in this chapter beyond quoting from Dr. L. A. Weatherly's letter in the Lancet of September 8, 1917 : " One great fact which has never been cleared up is the standing reproach that with our palatial institu- tions for the insane, and with our great increase in pathological research, the recovery rate of insanity is no higher to-day in these institutions than it was in the decade of 1865 to 1875." Dr. Weatherly considers that this is due, amongst other things, to " the want of individual study of the character, temperament, and causes which have led to the mental breakdown." CHAPTER VI RESTORING FUNCTION IN SPECIAL SENSES Entire loss of smell, taste, hearing, power of speech, and sight is not infrequently corrected to the normal by accident, by some very simple chance occurrence. Such cases as the following have been recorded : A boy who was dumb for ten years found he could speak after experiencing great excitement at a cricket match. He had incontinently tried to shout, and then " he thought he heard his own voice." A young man recovered his lost hearing and power of speech on hearing of the death of his sister. A man lost his speech in one epileptic fit and recovered it in another six weeks afterwards. A man who had been dumb for seven years recovered his speech on being startled by the explosion of a syphon. A girl recovered her long-lost sight at a funeral, while weeping over the grave. The war has been responsible for revealing scores of such cases among soldiers. The simple explanation is this : Something has caused neurone dissociation; accident, sudden emo- 123 124 ADVANCED SUGGESTION tion, or extreme tension, has had the effect of rectifying this. A visit to Lourdes, a sermon, a "laying on of hands," may possibly have the desired effect in some cases ; even the strange performances of a quack may work wonders. They all point the moral to the scientist, that if such things can come to pass in the "green tree," how much more may be done in the "dry"! I have very little more to write about these disorders beyond pointing out, firstly, that they are amongst the easiest in psychotherapy, one sitting only being required in quite a large proportion of cases, once the correct diagnosis has been made. Analysis will help immensely in the more difficult cases. In colour-blindness all authorities should grasp the truism that in many cases the disability has resulted either from actual ignorance regarding colour or through strain and shock producing dissociation. Men sometimes know surprisingly little about colour. Women, on the other hand, usually practise dis- tinguishing shades from childhood, and continue to do so through life, so long as they retain their interest in new dresses and ribbons. After investigating certain cases of men rejected as candidates for various positions, who have displayed examination-fright, I have found that they have felt infinitely worse on being subjected to colour tests. A worried and overworked signalman is liable to be seized by a subconscious fear that he will not be able to distinguish a signal ; as in cases of loss of memory, temporary dissociation may RESTORING FUNCTION 125 result, which may become permanent unless reassocia- tion can be effected in some way. A very slight emotion may lead to some temporary confusion of thought in a man who is called up to undergo a colour test ; dissociation may then take place on the spot, the colours being found far more difficult to distinguish than before (" negative circling "). In most instances which are not grossly complicated, it is only necessary to induct towards the subconscious, and to tell the patient that he will smell, hear, see, or taste, as the case may be, when a test will immediately yield a positive result. It should nevertheless be clearly understood that there are very difficult cases in this class, and sometimes impossible cases; and these fall chiefly into three divisions : (i) Those of such long standing that re- association seems impossible after trial. (2) Those too old for reassociation to be possible, there being evidence of some senile disconnectedness of thought or mental dulness, to be detected in ordinary conversa- tion. (3) Those who have some very definite motive for remaining afflicted. In most cases of complete loss of memory the treat- ment is easy and the cure rapid. Mere induction toward the subconscious may be sufficient. If not, then simple carefully uttered suggestions made in induction will readily restore mental association, first on the subconscious plane, and afterwards as between the subconscious and the supraconscious planes. My own observations tend to establish the fact that 126 ADVANCED SUGGESTION in functional loss of sight, memory, or hearing there is often a clear history of purposive repression, which later has become automatic; this is at first begotten of emotional excitement, such as the fear of seeing, remembering, or hearing something or other. In one of my cases of functional deafness, a case of twenty- five years' standing, the patient had, since her school- days, always felt nervous lest she should receive some troublesome information. When she came into my hands, quite late in life, she was able to recollect, after two treatments by induction, having retired to her room, being afraid to come out lest she should hear bad news about her son. In another case of loss of memory I only had to tell the patient in the subconscious rest that he was afraid to remember, and that he really need not be so, to bring back his recollection of every- thing. There was no volitional repression in the supra- conscious mind, but rather an auto-inhibition in the subconscious mind. The rack would not restore loss of functional power so quickly as hetero- leading to auto-subconscious enlightenment; in one case, my notes indicate that a patient had suffered terribly from his loss of memory. I found ample reason for believ- ing that no threat or penalty whatsoever would pro- duce the desired effect; on the contrary, such would merely make him worse, and probably drive him mad. In another case the patient was supposed to be sham- ming, and was treated roughly accordingly; he ex- plained to me, on recovering, how he had felt that there was no other chance for him but to be driven RESTORING FUNCTION 127 out of his mind, and that he had no power whatever of preventing this eventuality. Increased lacrymation is very prone to occur as a feature of many neuroses and psychoses, on account of a central disturbance which acts both on the vaso- motor system and on the glandular secretions, directly and through the emotions. It is the vaso-motor effect which will concern us for the moment. I have treated psychasthenic patients who have developed such an exaggerated sensitiveness that an extreme photo- phobia has provoked ophthalmitis, making it neces- sary for the patient to occupy a darkened room. Normal activity, local and general, has been restored by suggestion, no local hygienic or chemical applica- tions whatever having been required — indeed, these had previously been employed with little or no success. As to asthenopia and eyestrain from various causes, I have little to remark, beyond the fact that psycho- therapy may in some instances produce such a steadi- ness of action in the whole functioning as will either render it unnecessary for the oculist to prescribe any artificial adjustment, or will help him materially in effecting the latter, as the case may be. In many instances, after treatment by psychotherapy, errors have revealed themselves for treatment by the oculist which could not have been investigated previously, on account of the difficulties which the psychasthenia presented. In some instances the patient will refuse to consult an oculist until treatment of the general nervous. 128 ADVANCED SUGGESTION system corrects the folie de resistance. That eye- strain is of great importance in various neuroses and psychoses has been emphasised by such observers as Ernest Clarke, Sydney Stephenson, and Gould, though the latter has appeared at times, in his extreme enthu- siasm, to have exceeded the bounds of safe and reason- able contention. From the psychotherapist's point of view eyestrain must be viewed as being usually just one "arc" of negative encirclement, as in this analysis : (i) Nervous sensitiveness; (2) hard work; (3) worry; (4) much, reading; (5) insomnia and dyspepsia; (6) eyestrain; (7) more worry; (8) psychasthenia. This is an example subject to an infinite number of variations which include all degrees of astigmatism. Of course, it is possible for eyestrain to be the actual fons et origo of the trouble. This is conceivable ; but it can rarely be the prime origin. Here is an ang^lysis which shows its very early appearance : (i) Nervous sensitiveness; (2) facial asymmetry and stigmata of degeneration -plus astigmatism; (3) worry; (4) psych- asthenia, insomnia, and dyspepsia; (5) phobias; (6) threats of suicide. Ophthalmologists are perfectly right to point out the importance of eyestrain as a factor in the causation of all sorts of troubles, even if they go so far as to con- sider that it may cause insanity. Yet bias, excitement, and enthusiasm may lead them beyond the bounds of the legitimate. Let me give an example : Mrs. had suffered for three years from so-called " neurasthenia," RESTORING FUNCTION 129 having become so ill that she was bed-ridden for months. She finally recovered perfectly after a few weeks' treatment by psychotherapy, when I recom- mended that she should engage in painting. She had never previously done anything of the kind in her luxurious life. She had made such a complete recovery from her "neurasthenia" that there was no longer any question as to whether there might be some remaining defect of vision. On commencing to paint, however, eyestrain began to trouble her, though it was not severe enough to bring back any of the old psychasthenic symptoms. I sent her to the family ophthalmologist, who duly corrected the defect by glasses. He questioned her as to her history, telling her he had heard of her case. He endeavoured to convince her that her troubles had really begun in her teens, and that they owed their origin entirely to the eyes. The patient was so far from being impressed by his remarks that I had great difficulty in getting her to wear the glasses at all, so little faith had she in what he said. The fact is that she knew better; analysis had distinctly indicated that there had been early nerve shocks, while everything pointed to the fact that the astigmatism had originated, together with asthenopia, while she was going through three years of Weir-Mitchell and other depressing treatments. It may be difficult to decide how far this or that negative factor has been of effect in any particular case ; all I wish to do is to warn the ophthalmologist against becoming biassed or astigmatic in the judg- 9 I30 ADVANCED SUGGESTION ment of his own mind's eye, and to remind him that one of the most striking effects of psychotherapy is the recovery from facial asymmetry, as exhibited by many cases. Mucous membrane secretions can be easily regu- lated by neuroinduction in most cases of nasal trouble, including hay asthma, as will be seen in another chapter. Indeed, we seem to require no further argu- ment than that sneezing and hyperaemia of the mucous membrane may be readily produced — as also suffused eyes — by common suggestion. We must at once con- clude that suitable induction will remove these dis- orders. In practice we find it does so. The follow- ing cases will illustrate this : A man, thirty-four years of age, was sent to me suffering from "borderline" psychasthenia. Among many other complaints, he mentioned having had four operations on the nose for polypus and " thickenings." He had sought the advice of a specialist "at least once a year." He asked me whether he should have "another piece taken out" before commencing treat- ment with me, or whether he should wait until after treatment. I told him to wait. On commencing treatment, I found that reclining on a couch was extremely difficult for him, both on account of his inability to breathe through his nose and because some discharge ran down into his throat from the back of the nose. Attempts at reclining were every few minutes disturbed ; he could not at first feel sufficiently comfortable even when leaning back in a chair. RESTORING FUNCTION 131 Accordingly neuroinduction was at first found almost impossible. Howevei*, I sought by efforts momentarily made, by induction with outward palpation, to diminish the swelling and discharge, with the result that in a few days he was delighted by the compara- tive freedom with which he was able both to breathe through the nose and to lie down. He has not been troubled since he was last treated two years ago. Miss , twenty-eight years of age, had suffered from childhood from very severe hysterical psychas- thenia. For a period of twelve months, during one of the more difficult phases, she had been certificated. She had had " some sort of operation " for pain in the nose, without obtaining any relief. Her throat also had been operated upon ; dilatation of the cervix uteri had also been performed. Many other propositions had been mooted in her case. When sent to me she was bedridden, for her eyes had become secondarily affected ; photophobia was intense, insomnia bad ; and there were also phobias in respect of swallowing and speaking, which had latterly developed to " fill up the cup." Neuroinduction first restored the sense of smell, which she never remembered having possessed in her life; this resulted from one treatment. In three weeks she was walking in the open, with no shade and no distress from either nose or eyes. In six weeks she was perfectly well, and for three years, up to this time of writing, she has remained so. As indicating what suggestion will accomplish after errors of refraction, astigmatism, and accommodation 132 ADVANCED SUGGESTION have been fully met by the artificial aid of " glasses," I will cite the case of a secretary whom an oculist could barely save from " going blind," so ineffectual was the functioning. Every few weeks, for many months, a cloudiness would occur, which the oculist deemed to be caused by haemorrhages. General nervous distress, with much pain and redness about the eyes, brought the patient into my hands. Within a few days from the first treatment by neuroinduction not only was a return towards the patient's normal obvious to every- one, but she could engage in her duties — which in- cluded reading and writing a great deal — better than she had done for many months past. The eyes are extremely sensitive to suggestion. I have known more than one case in which the remark of an oculist that he did not think the patient would " go blind " was sufficient to cause the eyes and the patient's general condition to become worse : the very mention of blindness had upset the whole nervous system, which neuroinduction restored by way of general confidence, a local feeling of comfort through actual inflammatory regression. The worst case in my experience of general nervous and mental stress through eyestrain is that of a girl whom many physicians and surgeons failed to help. She complained of a feeling that her " eyes were being pulled back into her head." She had sense enough to declare that nothing could prevent her " going into an asylum," the strain was so great. During several years her mental condition gradually became harder RESTORING FUNCTION 133 for everyone to bear. Neuroinduction restored all to normality, and she has been doing duty for several years in high Government office. She had worn "glasses" for years before coming to me, and these were neither changed at any period of the treatment nor afterwards. CHAPTER VII DISORDERS OF THE ALIMENTARY TRACT It is noteworthy how often we find a neurotic factor in the causation of gastric and duodenal ulcer. Such a factor should always be studied as an arc of a negative circle. We know, also, that malignant disease of the stomach sometimes follows chronic dyspepsia, which is itself so very often neurotic. Again, many cases of appendicitis may be regarded as plainly related to neurotic dyspepsia. Accordingly psychotherapy will make a very powerful appeal in this connection, especi- ally when we realise how greatly the glandular secre- tions may be influenced by neuroinduction. The effects of simple suggestion on the flow of the saliva are enough to arrest the most sceptical, and to recommend a serious study of the various glandular secretions, even if Pawlow's experiments were not sufficient to make the most obtuse believe that "there is something in it." In writing of dyspepsia Dr. Drummond was surely on the right track when he asked, " What is the cause of the condition ?" and went on to observe that, " to discover the cause . . . is . . . often a very difficult 1,34 THE ALIMENTARY TRACT 135 matter. ... If we are to treat indigestion with success, we must learn the art of getting our patient's secrets out of him." I do not mind whether the cause of dyspepsia be put down to diet, overeating, bolting food, insomnia, irregularity of meals, constipation, alcohol, tobacco, chronic debilitating disease, or worry — and of all these I should be inclined to give the last as the most con- stant and important " arc " of " negative circling " in all functional cases — in any case, any treatment what- soever must take a second place to psychotherapy, unless perchance removal of the cause can be effected by one simple action, as by a gift of income relieving penury. Moreover, if this conclusion be arrived at after treating a large number of the most difficult cases, one must admit the argument as applying to all degrees of the disorder. Even the toothless are curable. Among my cases have been many so-called incur- ables, such as one who had developed toxaemic neuras- thenia, and who would not hear of artificial teeth, all natural ones having been cleared out some years previously by a mouth-hygiene enthusiast ; also bolters of food with epileptic histories ; City neurotics who had for years done their best business at meal-times, and would " listen to no doctors," as their attendants and relatives have declared — even such have been cured. I will refer to one, by way of illustration : A man, forty-five, a City merchant, was sent to me by a distinguished neurologist suffering from dilated and ptotic stomach; he was thin, haggard, and dis- 136 ADVANCED SUGGESTION tressed-looking, and gave a history of years of stomach trouble. He had been treated by " stomach-tube and washing" every day for two years (for six months twice a day), on the advice of a leading consultant, and had finally been reduced to peptonised milk and certain special liquid foods. After three weeks' treatment by neuroinduction he was sent out to a restaurant in order to take a test-meal. He was told to take just what he fancied, regardless of consequences. He ordered steak-and-kidney pudding. His only answer to inquiry on the following day was : " I had a second helping." He explained afterwards that on making the frontal attack his ideas were half begotten of confident joy and half of a developing threat : " If I am ill again, then I know whom to blame, and I have done with ' suggestion.' " There is nothing so easy to treat by neuroinduction as a difficulty in digesting certain kinds of food, which has followed some feeling of sickness that has occurred years previously — after eating, for instance. I have had many cases of inability to eat cheese, and all sorts of indigestible things, "since childhood," in which normality has been restored quite readily, after due consideration of the physiological possibilities. Nor will this be so much wondered at when I declare that the therapeutist will hardly ever fail to restore taste or smell when lost by dissociation, and usually in one treatment. One of the chief reasons why psychotherapy is so eminently successful in nervous disorders is that the THE ALIMENTARY TRACT 137 treatment begins to correct errors of digestion from the very first, just as it commences to relieve general tension and abnormality of glandular secretion. I ought to explain that in some cases of dyspepsia treated by neuroinduction there is a return toward the normal anatomical arrangement and physiological disposition, even when visceroptosis obtains. This will not be in the least surprising to careful readers of medical literature — probably least of all to Dr. Percy Mitchell, who found that a mere touch of the skin near the left costal arch causes contraction of the stomach, which gives me reason to think that he will be interested in this paper. Of course, if the patient has suffered severely for too many years, recovery may not take place, although I have known men over fifty recover, in whom visceroptosis had been previously diagnosed. I prefer to study this class of case by a "circling" analysis which may be represented in the following sequence: (i) Born sensitive; (2) business and family troubles ; (3) dyspepsia ; (4) constipation ; (5) anorexia ; (6) loss of weight ; (7) worry about illness ; (8) depres- sion and neurasthenia. Another example : ( i ) Alcohol ; (2) tobacco ; (3) dyspepsia ; (4) insomnia ; (5) neuras- thenia. A medical man had suffered for ten years from insomnia, dyspepsia, gastroptosis, and psychasthenia. He was sent to me as suffering from psychasthenia. I could not view his case as psychasthenia following gastroptosis, dyspepsia, and insomnia, though respect- 138 ADVANCED SUGGESTION ing the opinions of various great authorities as to the " real trouble." I found that the seeds of gradually de- veloping insomnia and dyspepsia had been sown ten years previously by an injury to his leg, which had worried him greatly and laid him up for weeks. I was, therefore, obliged to go straight for his nervous system, which had been a sensitive one from birth, likely to beget dyspepsia and psychasthenia should any particular worry come upon him. Thus it is immaterial to me whether a dyspepsia has been diagnosed by anyone as flatulent, hyper- chlorhydriatic, atonic, or mental (Drummond), or whether this tonic or that holiday has improved it; psychotherapy of the right kind will, above all, prove equal to it. Pawlow did a great deal for psycho- therapy when he dealt with non-conscious animals, and inquirers of to-day are not slow to take advantage of it. If dogs can exhibit an increased flow of gastric juice due to the stimulus of sight or sound, how much more, therefore, might we expect human beings to be influenced by induction, which has much finer mechanism as material — mechanism which is in all respects comparatively ideal. Professor Cannon's investigations on cats may use- fully be referred to. He found that disturbances in the higher cerebral mechanism associated with psychical activity caused movements in the alimentary canal and favoured digestion, which movements were inhibited by anything that irritated the animal and created fear or anger. How frivolous seem some THE ALIMENTARY TRACT 139 injunctions in the way of treatment ! One may read, at the close of heavy, dignified articles in medical journals on dyspepsia, recommendations of "rest," "exercise," "fresh air and exercise," "forced feeding and rest," " Weir-Mitchell and forced feeding," and so forth; and as to drugs, what a difficulty there seems to be to find something new, authorities finally falling back in sheer beggary on the conclusion that " nothing is so good as the old things," and resorting to bismuth, soda, antiseptics, pepsiri, patent foods, and even lactic acid bacilli — oh, what a museumful of remedies ! How behind the times, when one knows that favourable effects in human beings had been produced by psycho- therapy years before Cannon and Pawlow started experimenting ! Psychotherapy would have long ago made the way it is making to-day had it not been for misunderstandings and prejudices. Advancement, however, is often all the more swift and compelling the longer one is obliged to wait for its culmination. We now know not only that the supply of gastric juice, but a large number of other processes can be regulated, by a means operating both locally and centrally — directly and indirectly — with an ease of application, fineness of adjustment, and efficacy in respect of functional disorder, which combine to characterise the neuroinduction stage of therapeutic development as " destined to be epoch-making," to use the expression of an unbiassed and open-minded scientist who has a sufficient acquaintance with th? fact§, HO ADVANCED SUGGESTION Constipation Is it necessary to write a word more under the heading " Gastro-Intestinal " ? Does it not follow from what has already been said that there cannot be any treatment for disorders of intestinal functioning which can hope to equal neuroinduction ? Mrs. , of , fifty-six years of age, had for some years been a bad sleeper. Frequently she would '* lie awake all night." She had suffered from constipa- tion, indigestion, and disturbed sleep since childhood. For the last seven or eight years before treatment by neuroinduction she had taken every form of medicine she could procure, in considerable doses. She had not had any movement of the bowels without medicine for some three years, and never recollected being a whole week without medicine in her life. Among her distressing symptoms were almost constant headache, dizziness (sometimes so bad as to cause her to feel that her mind was becoming disordered — she could not be left alone), want of energy, disinclination for action of any kind, loss of appetite, nervousness regarding sounds, etc., sensations of fulness and indigestion, with nasty risings and tastes in the mouth. One treat- ment by neuroinduction, lasting thirty minutes, pro- duced a daily regularity of the bowels; a second confirmed the new condition ; since which all symptoms have rapidly disappeared, and the patient is compara- tively " a new being." Mr. , of , twenty-seven years of ag^. THE ALIMENTARY TRACT 141 complained of feeling generally ill. His chief symp- toms were weakness, want of sleep, and constipation. He had been advised by his " chief " that if his health remained as it was he could not retain his position; he felt that he could not continue his daily duties any longer. He took pills four to six nights a week, and had reached a stage when nine were proving insufficient. He had not had a natural movement for five years. His headaches had been distracting, and the sleep- lessness so severe that he could only obtain " snatches " of half an hour to an hour, being thus disturbed all night. One treatment of neuroinduction of thirty minutes' duration produced a natural movement of the bowels next morning; a second confirmed the altered state, and all symptoms cleared up, no medicines of any kind being afterwards required. The change in the man's appearance and in his cheer- fulness, in the week following and since then, have been most striking, as may be imagined. In a fort- night he declared himself as feeling better than he had been since his marriage, twelve years previously, and more capable of performing his duties. Miss , of , eighteen years of age, first sought advice for painful, haemorrhagic piles. Her mother had been advised that only a surgical operation would cure her, such was the severity of the case. She suffered from constipation, of course, which necessi- tated dosing with purgatives of all kinds, without which she never had a natural movement of the bowels. There was also loss of appetite, sleeplessness, and 142 ADVANCED SUGGESTION nervousness. She had become thin and ill-looking. The distressing pain of the piles and her " feeling fit for nothing" led the mother to take further advice before consenting to operation. I treated her twice, with the same results as in the above cases — that is to say, all symptoms disappeared, no medicines were required for the bowels, and the piles vanished, causing no more trouble. Nurse , of , thirty-seven years of age, com- plained of constipation a week before each monthly period. When this set in she was sick and faint for some three hours, retching frequently, having to lie down, and feeling fit for nothing, while the pain was always great. Neuroinduction corrected the constipa- tion the next day, and this cure became permanent, while the periods became absolutely normal, without pain or distress of any kind — and, of course, without sickness. Miss , of , eighteen years of age, was brought to me by her distressed mother, suffering from headache and mental confusion. I found her morose and irritable, and she complained of sleeplessness. She had no appetite, constipation was bad, and she had not for years had a movement without large doses of medicine. Her monthly periods had ceased five months previously, after having been irregular for some time. Neuroinduction cleared up all symptoms, and she gained over a stone in weight in six weeks. This patient was somewhat limited in her mental powers, owing to her general condition; she was, in THE ALIMENTARY TRACT 143 consequence, at first rather difficult to treat, but a gradual improvement all round soon made it easy to obtain permanent effects. (The more intellectual a patient, the quicker and easier is the permanent cure.) Referring to certain observations made by Sir Arbuthnot Lane, Dr. Distaso has written : "All these observations confirm the assertion that constipation is due to the intestinal flora which cause the retention of the faeces in the large bowel for a long time. These undergo putrefaction. Hence, the pro- duction of the soluble poisons on the one hand, and the extraction of the poisons retained by the dead microbes on the other, give rise to auto-intoxication. All these phenomena are removed by the removal of the large intestine. Therefore there is no doubt that the seat of constipation is in the large bowel, and that the intoxication occurring in a constipated person is the result of the activity of the microbes of the intestine." A well-known surgeon has contributed a very good article to the Clinical Journal on large bowel disorders needing the surgeon. He writes : "Another common cause of these disorders is con- stipation. Of course, I cannot go into that, but I should like to say that if anyone can tell me of a cure for constipation I shall be very glad." In this chapter he has his answer, not for a time, not such as will satisfy a passing fashion, but one for all time. Nor can it possibly be urged that the science and the technique of the treatment are difficult : the whole thing is quite easy for any medical man to 144 ADVANCED SUGGESTION employ — at least, as regards most cases of constipa- tion — as I am prepared any day to demonstrate. Hertz and Newton have made it abundantly clear " that the ileum possesses the terminal sphincter which was claimed by Professor Keith, as an anatomist, more than ten years ago; and further, that this sphincter governs (as Keith suggested) the flow of contents from ileum to caecum. It is now demonstrated that this sphincter is regulated by impulses connected with the passage of food into the stomach — the gastro-iliac reflex. Normal iliac stasis is therefore to be regarded as the outcome of this regulating mechan- ism; abnormal iliac stasis seems clearly due to some defect of this mechanism. Again, after the caecum and colon have become filled by the passage of intestinal contents through the ileo-caecal valve, movements of the large intestine are apparently produced by the stimulus of the entry of food into the stomach — the gastro-colic reflex — which in most in- individuals results in defaecation after breakfast, although the desire to defaecate may also be manifested after other meals." Professor Cannon has made it equally obvious that under certain circumstances the sphincters of the alimentary tract should relax. I simply offer the asseverations of these authorities en passant, as being interesting contributions to our argument. There are others worth notice in this connection, such as Caird's remark at a meeting of the Edinburgh Medico- Chirurgical Society, January, 191 4, that he " had in his experience of abdominal operations found kinks and bends but rarely, while in the post-mortem room he had seen cases of very extensive and serious THE ALIMENTARY TRACT 145 peritoneal adhesion associated with good digestion and normal evacuation." Torrance Thomson gave his opinion on the same occasion "that in addition to the local condition in the bowel there was also a constitutional fault, and that nervous debility and some psychic factor were present." All these little indications help us. I must respectfully remind Sir Arbuthnot Lane that constipation is the initial factor which brings in train all the effects of stasis, the wrinkled skin, the offensive axillae, the enfeebled circulation, occasionally cancer, and even certain cases of tuberculosis. To the writer of these pages the cause of constipation is equally clear. Personally, I view all this fuss about chronic intestinal stasis, and the theory that the "only thing for it is to cut out the large intestine," as a revelation of painfully ineffectual therapy, and I am not going to hesitate to say so. I might agree that it is a counsel of perfection that many large intestines should be sacrificed to-day as they exist, in a hopeless degree of disorder; but I am more than satisfied that were the principle of treatment which I advocate adopted early and extensively there would very soon be a mere frac- tion of the present number of cases which would require this extreme surgical measure. I feel confident that Sir Arbuthnot Lane would admit this if he knew the facts. In bad cases of intestinal stasis I recom- 10 146 ADVANCED SUGGESTION mend treatment by high enemata over the period during which neuroinduction is employed. Cases too bad for even this procedure to effect a cure I should, of course, refer to the surgeon. As regards technique, I declare frankly that I can- not give the proportional value of manipulation and mental induction; nor can I express an opinion as to whether it is of any use to attempt to deal separ- ately* with contractile and expansile power, when dealing with the intestines. Sometimes it seems that word of mouth gives the best results, quite independ- ently of any manipulation whatsoever. I have tried this in a case of constipation with mucous colitis which had defied all other methods, and which was made worse by massage — this having the effect of increasing hysterical ideas. I decided to use no local manipula- tions at all, and to depend upon general training and the spoken word; the result was eminently satis- factory. I am not going to be dogmatic in any way ; I feel sure that a much finer technique will be forth- coming at some future day, in the hands of those who will take up the work from the stage it has now reached, and will greatly improve upon it. As an example of analysis of "negative circling" in intestinal stasis I offer this: (i) Depression; (2) impaired peristalsis ; (3) dyspepsia and auto-intoxica- tion; (4) central inefficiency; (5) enteroptosis and stasis ; (6) loss of weight ; (7) worry (illness and finan- cial) ; (8) insomnia. I must here give myself the pleasure of referring to THE ALIMENTARY TRACT 147 the work of Dr. Brock of Edinburgh, who seems to me most dehghtfully to understand the sequence of factors in the etiology of gastro-intestinal disorders. I would counsel students of psychotherapy to read every word whenever Dr. Brock writes the smallest fragment under this particular heading. Let such be searched for in the indices of the medical journals; they make downright good reading. I should also like to give myself the pleasure of commending the work of Dr. Betts-Taplin of Liverpool in this and in many other connections. I will conclude a section which might well be enlarged into a whole volume by referring to a mental case. A man of forty-five had suffered from severe constipation for years, and since being under restraint had resisted all efforts made by others to compel evacuation by means of medicines; very large doses of drastic purgatives had been employed, until it was advisable to lessen the risk of poisoning by giving enemata, which required three and sometimes four strong men to administer, until something led to my being called in — as much the hopelessness and despair of everybody concerned as anything else. I secured some "snap" chances to employ neuro- induction, by means of very slight manipulations of the abdomen, while making careful and suitable remarks to others in the presence of the patient. Natural normal movements were the result. I feel confident that no treatment on earth but that which I employed — or one just similar, exercisable by any 148 ADVANCED SUGGESTION who might learn the simple technique — could have accomplished as good results. DiARRHCEA In this disorder favourable results from the employ- ment of neuroinduction might be taken almost for granted by readers of the foregoing. But some readers might, perhaps, be disappointed if I did not give a case : A lady of title had suffered some years from diarrhoea, which had become so bad that at times she dared not leave her bed; she had been judged, by consultants of standing, to be incurable by any means short of such as would have been risky at her advanced age. Everything had been tried in the way of diet, antiseptics, and astringents. Very simple induction was sufficient to effect a complete cure, without employing any medicines whatsoever. Where "intestinal flora" are at work in "negative circling " they might well, as a rule, be ignored in treat- ment by psychotherapy, for this would, other things being equal, soon restore equilibrium, and leave no chance for any flora to thrive; but in some cases certain well-known medicines will undoubtedly help, the point being that the latter might be found of little use by themselves. It is true that neuroinduc- tion often brings about changes very rapidly, but for the first few days I should not, in bad cases, hesitate to give medicines in addition, believing that as adju- THE Alimentary tract 149 vants to psychotherapy they will be of more use than alone — they will get their best chance, so to speak, for whatever they might be worth. Similarly, in some cases of constipation I may occasionally give some simple remedy for a day or two, until neuroinduction has proceeded far enough — especially when there is severe stasis or any degree of impaction. Mucous Colitis Inasmuch as many present-day physicians — among whom may be mentioned Professor Osier and Dr. Goodhart in this country, and Professor Van Noorden abroad — have regarded true mucous colitis as " a motor-sensory and secretory neurosis of the bowel, which is in its turn a manifestation of general nervous irritability or neurasthenia," the present writer's remarks regarding the effects of neuroinduction need neither be very emphatic nor lengthy. The deduction I have to make is already in the reader's mind. Another authority on intestinal disorders may well write: "From this point of view the name mucous colitis is ill-chosen." Surmont and Detrou in France, and others, have conducted interesting experiments which demonstrate the fact that mechanical irritation determines a state of spasmodic constipation with hypersecretion of mucus, while faradisation of the vagus produces all the symptoms of myxorrhoea. Bacterial infection has also been proved capable of causing the latter dis- 150 ADVANCED SUGGESTION order. All this is quite useful for our present argu- ment. One is moreover quite thankful when Good- hart writes : " Mucous colitis is more of the nature of an abdominal neurosis than of any real disorder of the mucous membrane of the bowel." Psychotherapy confirms all this up to the hilt; indeed, it lets in still further light. Miss , twenty-six, had suffered from psychas- thenia for fourteen years, the complicating features of which ranged from dyspepsia, vomiting, and constipa- tion, to insomnia, hysteria, and paralysis of the limbs. She had been operated on for a possible kink, for stric- ture of oesophagus, and also for appendicitis, with no more favourable results than could easily be put down to good nursing and a pleasant environment. At length mucous colitis was diagnosed by a London physician, when everybody concerned was conscious of great relief that something had been found to account for everything; if not accounting for every- thing in the past, it could at least be depended upon as constituting a diagnosis of the present condition. But the usual treatments for mucous colitis, varied and classical, proved ineffectual. The case then came into the hands of a distinguished neurologist, who recommended psychotherapy. In a few weeks the psychasthenia was reduced, the constipation was relieved, and the mucous colitis simply disappeared. Thus the patient was gradually restored to a comfort- able position in the world. After being so far cured she required a little further treatment by suggestion, THE ALIMENTARY TRACT 151 being apparently ready to shrink back into some sort of neurosis due to the excitement of her new Hfe of free- dom and activity, after years of comparative imprison- ment in hopeless exile from society. Finally she grew accustomed to normal life. No healthier or happier human countenance could be seen to-day : she presents no sign or symptom which could be discerned in the ordinary observation even of experts — nothing but the marks of old operations. As an object-lesson, which teaches various scientific truths regarding the functioning of the alimentary tract, whether associated with psychasthenia or no, the following notes of a case will be found worthy of study. I give first the "negative circling" of the patient, a man aged fifty-five, who had been energetic, clever, and prominent in the business world : ( i ) " Nervy," highly strung ; (2) successful in business ; (3) constipation and mucous colitis; (4) dyspepsia; (5) insomnia; (6) phobias; (7) highly obsessional; (8) losing flesh. He was sent to me by his general practitioner after he had conferred with two consultants. I picked out (5), (6), and (7) as the chief " arcs," requiring immedi- ate psychotherapeutic attention, and in dealing with these I knew I should also benefit the dyspepsia. I then found a distinct food phobia amongst others, the patient being afraid lest he should not be getting proper nourishment all the time. Though I had early formed the opinion that overfeeding had been con- tributory to arc (4), I considered that I ought to be iS2 ADVANCED SUGGESTION careful not to cause any negative addition to arcs (5), (6), and (7) ; I therefore postponed dieting for arc (4) until (5), (6), and (7) were less negative. I told the patient I was going to diet him later on, which pleased him greatly, until I explained that I should be obliged to reduce the amount of food. Now, even though I had inducted in the direction of easy resignation in view of the change, this did not operate far enough to prevent a measure of alarm. Letters were at once sent to relatives and doctors, to the effect that he thought he had better return home; he told them he was afraid he should become thinner, because I was going to reduce his food. My answer was a typewritten page of dietary for him, and a copy for his nurse-com- panion, with injunctions to the latter that she should help the patient to adhere to it, for it was severe; it brought the patient down to about half the amount of food he had been taking for at least a couple of years. I believe the patient would have gone his own way and sought other advice, under the obsession of an added phobia, had I not established some amount of confidence in dealing with (5), (6), and (7). I man- aged to steady him over the added phobia. A few weeks went by, during which time I saw that he was making quite good progress all the time, and in every direction. One day I saw that a tight collar round his neck was likely to hinder circulation; I therefore instructed the patient to get new shirt neck-bands and collars. I now gave instructions that he should be weighed, and found that he had gained one and a THE ALIMENTARY TRACT 153 half stone in six weeks, to his own amazement. This marked the completion of his perfect cure. It is characteristic of such cases that this patient had for three weeks turned a blind eye to his improve- ment, owing to a remaining trace of fear that it might not be real, or that it was only quite ephemeral, and would be followed, perhaps, by a relapse. The literature which favours and confirms my con- clusions is enormous ; or perhaps I had better put it the other way, and observe that my conclusions, which are based on obvious restoration of vital processes by induction, serve to substantiate the innumerable con- clusions which have been arrived at by great authori- ties. I may refer the reader to Professor Keith's theories as to the causation of enterostasis {Lancet^ August 21, 191 5), a most valuable and learned article; also to the contribution of MacNiven, of New York, on the emotional influences in gastro-intestinal diseases, as reported in the Medical Press of October 31, 191/. On gastro-intestinal secretions and functions, Beau- mont, Ridder, Schiff, Richet, Rogen, Le Coute, Bickel, Auer, Mantegazza, and Kast have done magnificent work. MacNiven has drawn from various conclusions the following facts : (i) The initial flow of gastric juice is psychic. It is brought about through the sight, odour, taste, or chewing or swallowing of food under normal condi- tions, whether the food enters the stomach or is side- tracked, as in sham feeding. (2) The flow of saliva 154 ADVANCED SUGGESTION and pancreatic secretions, and, to some extent, of the bile, is more or less subject to the same influences that govern the gastric secretion. (3) The flow of the digestive secretions may be modified or inhibited as a result of great disappointment, disgust, fright, anxiety, rage, or pain. (4) Fatigue or systematic infections may cause a temporary or prolonged cessa- tion of gastro-intestinal motility. (5) In the absence of appetite or relish for food, there is a diminished activity of the secretory glands of the mouth, stomach, etc. (6) The factors influencing the digestive secre- tions may also modify or temporarily inhibit the motility of the stomach and intestines. Dr. Guthrie Rankin is very helpful in his article entitled "The Highly Strung Nervous System," in the British Medical Journal of October 21, 191 6, in which he concludes that " Mucous colitis is yet another intestinal derangement which seems to be more truly symptomatic of a leakage of nerve energy than of any established change in the colon itself." CHAPTER VIII HEART AND CIRCULATION In considering Raynaud's disease, "local asphyxia," symmetrical gangrene, acroparesthesia, angioneurotic oedema — diseases which Kinnier Wilson and others agree are so obviously associated with disturbances of the sympathetic innervation of the vascular system — the reader must at this stage of our study see that there is a vast field of usefulness for psychotherapy, not as something to turn to when everything else has failed, but as a therapy which easily wins its own title to the front rank wherever it is clear that the nervous system is sympathetically involved. My technique begins by making the functioning of the whole system easier, through lessening strain and abnormal activity. In any case of disorder of the heart's action the physician will induct towards the subconscious with extra care, just as an anaesthetist will tend to be more circumspect. Psychotherapy need be no more risky when applied to any disorder whatsoever than a simple discussion between two people, one of whom is " ill." In neuro- induction the mind and body of the patient are brought to a better and easier level of action, just as 155 156 ADVANCED SUGGESTION a printing machine may be prepared, by certain adjust- ments which ease it, to run much better than it did before it received experienced attention. In treating cases with a view to reducing blood- pressure, even if the physician begin by first endeav- ouring to allay supraconscious excitement he can only benefit the patient at the outset. He may well leave alone the heart itself. There will be no occasion to rush at this organ ; it will be relieved by indirect influence, provided the excitement incidental to the preliminary interview be allayed by suitable demeanour and words that make for easy understanding and acquaint- ance. Take the case of a retired general officer, aged seventy-two, who was sent to me by his family medical practitioner, who had conferred with a neurologist of rank. He suffered from outbursts of anger on little provocation, on which occasions he developed clonic and tonic contractions of the limbs, cind other nervous manifestations, which caused alarm. He suffered not only from a high-tension pulse, but from extreme irregularity of the heart's action. It was feared that he might drop dead any day, and all walking had been stopped by urgent order. His pulse was uncountable. He made rapid progress towards recovery from the first induction; and in three weeks he enjoyed walking up-hill, the heart being perfectly regular, arterial tension having gone down to as near normal as a good deal of atheroma of the arterial walls would allow. HEART AND CIRCULATION 157 Respecting auricular fibrillation, Dr. Charles H. Miller has written a very interesting article {Lancet). I should like to quote a few words from this, as follows : " In the particular functional disorder we are deal- ing with the cause is only conjectural. Auricular hyperexcitability is provisionally suggested as the direct incentive to fibrillation of its musculature. Neither is the causa causans known, though it has been noted that both gross and microscopical exa.mination have shown in the auricular inflammatory and struc- tural change. In a few cases it is possible that nervous influences have been an important factor. So far, no drug has been discovered that has any effect in either preventing or checking fibrillation. Not even digitalis, which has so potent an effect in lessen- ing the severity of the associated symptoms, has any effect in this direction. Complete cessation of fibril- lation may occur independently of any known cause, and the same may be said of its onset." I will refer to an actual example, as severe a case as could ever be observed, in my opinion. A man, twenty-seven years of age, had been suffering for some years from "failure of the heart's action," which had gradually become worse; he suffered from syncope, and had fallen down occasionally. He had been treated by many doctors, including a specialist, and was sent to me because report had reached the latter of another case which had been treated with success by neuroinduction. His condition was approaching emaciation ; his eyes were sunken, and he walked with great difficulty even with assistance. He could only 158 ADVANCED SUGGESTION take very small quantities of soft food, dyspepsia being very severe, while insomnia had set in to hasten on the end. He sighed during his first interview, telling me that he felt every moment that he would " go down." I steadied him ; he then reclined upon a couch. Momentary palpation indicated that his pulse was quite impossible to count. Naturally, he began to improve from the first treatment. There were so many "negative arcs," however, that treatments once a day for ten days were required before he could begin to smile. In three weeks he had gained a stone in weight, and in six he was practically normal all round. He now tried some light gardening, then heavier exercise of this nature, with interested pleasure. As the weeks went by he made no complaint whatever worth speaking of. He is at the moment of writing engaged in heavy artillery work. I have treated cases which have clearly indicated the value of psychotherapy in actual valvular disease. This should go without saying. Not that drugs and other hygienic adjuvants should be considered of little value; but it naturally follows that if function- ing is cured by neuroinduction when there is no actual disease this treatment is at least likely to confer some benefit when there is disease. An example has already been given in the chapter on "Object Lessons." Three cases will close this chapter, and will serve to teach their own particular lessons : A retired officer of the Indian Army, aged seventy- HEART AND CIRCULATION 159 two, had become "tottery" and feeble. The doctor warned his wife that he might fall dead at any time, and that he should always be attended when walking out, for his heart had become enfeebled. Having developed shakiness of the hands, dyspepsia, and irritability of temper, he was sent to me for treatment by neuroinduction. I found a very irregular and intermittent pulse. After three weeks' treatment by neuroinduction he was taking walks up stiff inclines alone. A few months later all " nerviness " had gone, and he became an enthusiastic motorist ; even a severe accident did not upset him more than it would any average person. A schoolmaster was sent to me by a neurologist, whose advice had been sought by a leading heart specialist on account of irregular cardiac action, with dyspepsia and insomnia, the heart being mentioned as the chief offender. Everything had been tried in the ordinary way, including some weeks' rest in a nursing home. Three treatments re-established perfect action of the heart, and, incidentally, removed other difficul- ties, so that the patient was able to declare that "he had not felt so well for many years." Mrs. , forty-five years of age, had suffered from psychasthenia, with weak circulation, for two years, having had nurses in constant attendance, day and night, for half this time. She was advised to come to me in the month of September, but she declared that my services would be of no use, because she could not possibly live through another winter, as the cold i6o ADVANCED SUGGESTION affected her so much. " Could I not go as far south as possible, and come to you early next year ?" was her anxious enquiry. I decided that she had better be treated at once. In a month the nurse was sent away. In two months she was almost normal. The first frosts of the season she enjoyed, whether in bed or out walking. She has since enjoyed perfectly normal health, having gone through yet another severe* winter. CHAPTER IX PULMONARY CONDITIONS Phthisis Nervous coughs are common, more so than is gener- ally imagined. Beginning with a slight real cough, due to the presence of micro-organisms, or to trivial local inflammatory sensitiveness, the neurotic habit may easily be superimposed — all the more so when there is any fear of becoming worse, or of particular conse- quences arising, which may so contribute to " negative circling" as to make the latter powerful. To give an example : (i) Nervously sensitive constitution; (2) slightly run down; (3) bronchial catarrh; (4) cough; (5) worry ; (6) additional nervous cough; (7) dyspeptic malaise; (8) tubercular invasion. Such a study of consequences will persuade us that phthisis may often be of nervous origin. Indeed, the more we study this disease the more established will our conviction become that it deserves to be described etiologically as founded, at least as often as not, primarily on a neurosis. Twelve years ago I made a special study of phthisis in a well-known sanatorium, for a period of eighteen months, during which time I founded an adjoining establishment for nervous con- 161 n i62 ADVANCED SUGGESTION editions, so firmly convinced had I become that what helped the one order of disease would surely be of great value in the other. The nervous character of the majority of cases of phthisis was further borne in upon me by fuller study. I found the sort of "circling" indicated above to be very common, and I have not the slightest doubt but what the same conclusions would be reached were one to analyse the patients of any sanatorium. I will pick another case out of a number: (i) Nervous family; (2) worry; (3) cough; (4) dyspepsia (loss of weight) ; (5) loss of employment ; (6) worried by relations ; (7) fear of phthisis ; (8) more cough and malaise (tubercle diagnosed). The reader himself may easily find variations of vicious encircle- ment in recalling cases he has known. Instead of worry through loss of employment as a factor, we may have a wife who is disappointed in her husband ; or the latter may be depressed about his future. In many instances a number of "worry factors" enter into action. Authorities who have command of funds, powerful benevolent societies founded for the purpose of deal- ing with the " great white scourge," would do well to begin with a study of the psychology of the con- sumptive. The open-air treatment has been found efficacious in certain instances, as when sanatorium life has tended to correct " negative arcs." I now offer an example of " positive circling " in a case of cure : (i) Brighter hope away from causes of worry; (2) the via medicatrix naturce given the best chance; PULMONARY CONDITIONS 163 (3) gland action and metabolism improved ; (4) sleep- ing better; (5) feeling stronger and gaining weight; (6) good appetite. There has recently been a discussion on tuberculosis at a meeting of the Medical Society of London. Under the heading "Expert Opinion on the Sanatorium Treatment of Tuberculosis," the British Medical Journal referred to the occasion in these words : "The recent discussion at the Medical Society of London has served to indicate the considered opinions of a large number of physicians and others who have had long practical experience in dealing with tuberculosis. That sanatorium treatment has not as yet fulfilled the expectations entertained when it was instituted has long since been obvious to everyone. " Neither the general cure incidence nor the death- rate have been materially affected. As a general out- come of the discussion, it would seem that sanatorium treatment from the public point of view has proved to be a failure, although it has rendered very material service to individuals." This might possibly serve to shake some people's faith in Dr. Bodington's simple teachings many decades ago, and, indeed, in every expert's opinions since. But let us consider carefully why sanatorium treatment has failed. Open-air methods have been right to some extent — Bodington's ideas will never be anything else but right — but the fact is that sana- torium life has not fulfilled them ; it has too often over- done them, and in addition has defeated its own goocj ends in other respects, having created an artificial i64 ADVANCED SUGGESTION environment for patients in the mass in which they could not lead the naturally happy lives which Boding- ton meant them to lead. As in the case of nervous or mental disorders, for phthisical people to herd together, to see each other's plight, to hear each other's distressing sighs and coughs, and to exchange hopeless stories, is bad for all; not to speak of infection, which in my opinion should be quite a secondary matter, notwithstanding authorities who have made it of prime, almost of sole moment. All but the obstinately blind and foolish will to-day realise that in order to cure consumption it is not so much the bacillus that should be aimed at as the soil. When the latter is healthy it is ipso facto unfavourable to the bacillL I therefore come to the conclusion that the follow- ing represents a more correct etiologic study of con- sumption : 1. Depressed Spirits. — Practically always an initi- ating factor; absolutely always identifiable as an " arc " in " vicious circling." 2. Dyspepsia. — This is chiefly the result of depressed spirits. 3. Unhygienic Surroundings and Habits. — Some- times apparently an initiating factor, but nearly always a secondary one. If apparently coincident with (i), I have usually found it to be plain that (i) had entered first : it is to be noted that in many cases (such as those of athletes, sailors, etc.) the surroundings had been hygienically excellent. PULMONARY CONDITIONS 165 4. Inherited Tendency. — This might be bracketed with (i), for in very many cases the tendency to despondency and to " take things to heart " is clearly inherited. In a family with a bad history of consump- tion I found that it was the cheerful-spirited who had survived, and who had got well soonest when attacked. The above etiology will help authorities to realise why sanatorium treatment has only to an extremely small extent been successful. Patients who have been happy in sanatoria (more particularly those of the poorer classes) have done well; those of the better classes have not progressed nearly so favourably, because the environment has not been so conducive to good spirits. Cases of phthisis arising in unexpected quarters are an interesting subject of study. The disease is found among sailors, soldiers, and athletes often enough to make scientists ponder deeply. Many have found this problem insoluble, even to the present day. Instances have been referred to family history, or to some specially unfortunate chance acquaintance with a more virulent type of bacillus; but usually such cases have been absolutely inexplicable. It is through a study of the neuroses, however, that we are able to approach the right solution. The successful athlete is often a highly-strung individual, who thinks hard, and applies himself to his work or hobby most enthusi- astically, diligently, and successfully, but who is very prone to worry subconsciously and in secret. He may be a good sportsman^ ^^.y'xn^^ very little abput his feats^ i66 ADVANCED SUGGESTION but his thinking hard affects his digestive powers ; he may become overwrought, physically and nervously, and very rapidly develop "negative arcs." It is true that hard training may help to create " positive arcs," but it will also contribute " negatives " in certain con- stitutions. Any disappointment after making special efforts is apt to create a very powerful " negative arc." The British Medical Journal of May 21, 19 10, con- tributes the following in a leading article : " Dr. Maurice Fishberg has discussed the psy- chology of the consumptive. He holds that, exclud- ing nervous disorders, there is no chronic organic disease in which the psychical control of the patient is a more essential condition of successful treatment. He says he has seen many cases of tuberculosis on the down grade in which improvement — indicated by gain of weight, recovery of appetite, and mitigation of cough — followed examination by a new physician, who insisted on going through the whole ritual of physical examination in its minutest details, using the X rays, the ophthalmis or cutaneous tuberculin test, and exam- ining the sputum and urine in the presence of the patient, but making no change in the treatment. The same directions that had already been given without benefit were repeated, but in different words. Dr. Fishberg adds that many consumptives had undoubt- edly been benefited by the different kinds of *mind cures.' ... But few writers on tuberculosis have taken into consideration the mental state of the patient, though many mention the importance of per- fect discipline and the influence exerted by the physi- cian. . . . The attention of medical practitioners has been called to the relation of the nervous system to tuberculosis by the large number of consumptive lunatics, especially in asylums. Clouston has stated PULMONARY CONDITIONS 167 that the death-rate from tuberculosis among the insane is three times that among the sane of the same ages. . . . Another proof of the influence of the nervous factor in pulmonary tuberculosis is the prevalence among consumptives of neurasthenia and hysteria in their various manifestations." A consulting physician to a leading hospital for con- sumption replied to an eminent counsel in a court of law : " I attribute recovery to a variety of circum- stances. I have even known a very bad case recover because he had been very successful in writing a book." Asthma We had better begin our study of this disorder by accepting the definition of Sir Samuel West : "Asthma is a widespread spasm of many groups of the respiratory muscles." Here we have a direct avenue to the solution of the problem of treatment clearly opened up for us, for we know that muscular spasms of all kinds can be promptly and successfully dealt with by neuroinduction. Let us again accept the assistance of this distinguished physician, and quote from an address which he gave before the Medical Society of London in 191 2 : " The extraordinary fact about asthma is the variety and multiplicity of causes which evoke an attack. Yet the individual must be asthmatic — that is, predisposed — for the same irritation which excites an attack in such an individual will have no such effect in a normal person. It is this underlying predis- posing condition which is the essential factor in asthma. This cannot be seated in the respiratory i68 ADVANCED SUGGESTION centre in the medulla, but must be looked for in centres above this, possibly in the brain itself, though we do not know where." After comparing asthma with epilepsy and pointing out how often both are hereditary, while the one often alternates with the other, he went on to observe : " These and similar considerations lead, necessarily it would seem, to the conclusion that the asthmatic condition must be of central localisation, and that asthma must therefore be regarded not as a respiratory disease, but as a central respiratory neurosis." In fact, had psychotherapy never been tried in asthma, one could almost visualise an earnestly inquir- ing physician, moving towards the small end of the network of evidence by the sheer process of plain exclusion and deduction, the meshes closing in behind and around him, until out of the hopelessness of his heart he frankly invited the psychotherapist to see what he could do in a case of difficulty. Now, just what he can do is fairly well illustrated in the follow- ing case : Mrs. had been a martyr for some years to asthma. She had been in an attack for three days and nights when she sent for the present writer. Her hus- band declared she had "never closed her eyes, and had eaten nothing." She looked a pitiable object. I asked the husband to remain in the bedroom, for I wanted his wife to rest awhile. I put the patient's head back as far as the necessarily strained sitting posture would allow, resting it on heap^d-up pillgws. PULMONARY CONDITIONS 169 I then inducted to relaxation, telling her that she would notice her breathing becoming slower and easier, and that she would fall into a comfortable sleep. I then left her, after observing that the breathing was already becoming easier. I afterwards learned that the breathing had gradually become ordinary as she slipped fari -passu further into the recumbent posture, and that she had slept for twelve hours — only being disturbed now and again by a "phlegmy cough" — having awakened just once, when she asked for a drink of milk, after which she relapsed into a comfort- able sleep immediately. She had only one threat of uneasy breathing at any time afterwards, over a period of eighteen months during which her case was under observation. This cleared up in a few minutes. I have helped to establish the fact that bronchiolar muscular contraction is the chief factor in the causa- tion of asthma attacks : psychotherapy has tended to confirm this, for I have obtained favourable response to muscular induction without making any appeal to the central or local vaso-motor mechanism. But I am bound to add that it is not at all unlikely that in the latter technique muscular relaxation has caused vaso- motor relaxation by autoinduction, or through some reflex neurone association, for there is a distinct con- nection between the respiratory, vaso-motor, and cardio-inhibitory bulbar centres. Now I just want the reader to understand that the above is not a solitary case treated as if by magic. Thousands of people can be treated successfully in I/O ADVANCED SUGGESTION just the same way, not by me, who could not take them, but by others who could easily learn what to do. Just as Sir Samuel West's words, which I have cited above, are true, so it is equally true that there is an instant remedy in neuroinduction when carried out efficiently. I do not care what may cause the " spasm of many groups of respiratory muscles"; psycho- therapy will relieve it, if the mind of the patient is sufficiently clear, to an extent which is variable accord- ing to the precise nature of the causation, sometimes at once and permanently, at other times after a few treatments directed against various "arcs" of "nega- tive circling." In an article contributed to the Practitioner^ Dr. Arthur Latham has written : " I do not propose to deal with a classification of the different forms of the disease, or to discuss the different forms separately. I wish once again to call attention to the form of asthma — in my belief the form most frequently seen — in which the disease depends largely upon the interaction of an abnormally sensitive nasal mucous membrane, and in this respect an abnormally excitable condition of a portion of the nervous system. Many other authors have discussed this question. I have nothing new to add, but I direct attention to it once more, as I do not think its practical importance has as yet been sufficiently grasped." It follows that some cases, though they may be at once relieved in an acute attack of asthma, may require further treatment for dyspepsia or worry — dyspepsia caused by worry. Cauterisation of the pose is undoubtedly in very many cases effectual as PULMONARY CONDITIONS 171 a treatment by suggestion. I do not think that even surgeons who deal specially with the nose will dispute this entirely. Psychotherapy will sometimes affect a cure in cases of asthma caused by nasal polypus; nor is this at all to be wondered at. Francis himself found that " asthma has been relieved, more or less permanently, by cauterising the nose without touching the polypi." That neuroinduction will reduce local sensitiveness is now a commonplace; we are prepared to agree with Dixon, Brodie, and Dundas Grant that in certain cases of asthma " a most important reflex is from the nasal mucous membrane." Not that one would allow for a moment that any polypus should remain where it is — far from it; the argument is merely advanced in order to prove the feasibility of the main contention. We may also read the further words of West with much profit : "Inasmuch as the cure of chronic nasal disease involves prolonged, tedious, and often somewhat dis- tressing treatment, hesitation may be felt before advis- ing patients to submit to it, until ordinary methods have failed — unless the indications pointing to the nose as the source of irritation are much more evident than in most cases they really are." Dr. Bellingham Smith, in an article contributed to the Practitioner^ mentions an interesting point in respect of asthma in children, in these words : "There appears to be little doubt that, when the attacks are allowed to persist, the 'habit of them,' if I may use the expression, tends to become stronger. 172 ADVANCED SUGGESTION This suggests that each recurrent attack acts as an incentive for another, by leaving behind a more easily excitable or more unstable nervous centre. Every effort, therefore, should be made to check the re- currence, or to lengthen the period between attacks." This is in complete accordance with my own views with regard to epilepsy, where I have found the same developmental tendency. As regards cardiac asthma, concerning which so much has been contributed in debate, I agree whole- heartedly with my distinguished clinical tutor, the late G. A. Gibson, who maintained that there was but one true asthma, which was neurotic in origin, and must be distinguished from the dyspnoea due to toxic causes or to the cyanosis of cardiac disease, and who wrote that — "Asthma is a spasm of the smaller and smallest bronchial tubes, brought about primarily as a result of neurosis. . . . Cases of heart disease in which paroxysmal dyspnoea occurs naturally fall into two great classes. To the first belong patients with a tendency to cyanosis, who, from the increased cardiac weakness attendant upon sleep, or in consequence of some peripheral disturbance — for example, a distended stomach — suffer from paroxysms of breathlessness." I have found that psychotherapy acts both directly and indirectly, and I agree absolutely with Mackenzie, who has written : "I have elsewhere shown that the most instructive clinical phenomena are reflex in their origin, due to the fact that there is a nervous relationship between different organs and tissues, so that the affections of PULMONARY CONDITIONS 173 one organ can be manifested by phenomena in another organ or tissues remote from the offending organ. It is usually admitted that asthma can be provoked by remote organs stimulating a region in the central nervous system. This region can be played upon by any organ that is capable of giving rise to an adequate stimulus, and there is no reason for assuming that what many organs can do in this respect the heart cannot also do." Yet those who support the vaso-motor theory in considering the causation of asthma are equally favouring the psychotherapist, who does not much care what theory may be final so long as he can get results which nothing else can surpass. When Dr. Francis suggests that nasal cauterisation for asthma reduces blood-pressure, and thus causes an improvement, he employs the best possible argu- ment in favour of psychotherapy. Gibson not only believed that " all true asthma was neurotic," but that suggestion might be helpful in neurotic patients. He frankly stated this in an address. He would have spoken in no uncertain tones had he understood the methods of suggestion as they are explainable to-day by his former pupil. Dr. M. Saenger of Magdeburg has also assisted me in my contention, for which I have to thank him. His opinions are reported as follows : " Narrowing bronchioles by reflex action, when once it has occurred, is prone to occur again, and so to lead to irregular recrudescence of the trouble. But the psychical element has also to be reckoned with, and the author recognises that there may be a morbid 174 ADVANCED SUGGESTION direction of the attention of the patient to the associa- tion of symptoms, which may lead him to the constant fear that the symptoms which ushered in a previous attack are sure to lead to another. This fear is not controlled by the will, and the object of a part of the method of treatment which Dr. Saenger advocates is to overcome this want of will, and to enable the patient to realise that his will power is not lost, and that he can to some extent control the onset of the malady by its exercise." The worst case of asthma I have seen in my profes- sional life was that of a lady of title. She had suffered for twenty-fi.ve years, and had tried every- thing, from the leading consultants' recommendations to a well-known American remedy for inhalation which contained cocaine. She had reached the vicinity of sixty years of age. Her trouble had become gradually worse; she finally became afraid to eat anything but small amounts of certain well-known invalid foods. She was reduced almost to skin and bone, and became so weak that it was not safe to allow her to walk without assistance. Neuroinduction helped breathing, digestion, and insomnia, and the patient felt so safe after a dozen treatments that she became quite independent of the cocaine inhalations. She has remained quite well for the past two years. Practically nothing remains to be written on the subject of hay asthma, after so many direct and in- direct indications in the foregoing pages. I may mention a simple case which may interest the reader. A youth, twenty-four years of age, had been a sufferer PUEMONARY CONDITIONS 175 for several years. He mentioned this fact to me one winter, when quite well. I told him to see me if an attack should be either threatening or actually commencing the following season. He came to me. I found one of the chief exciting causes in his case to be the effect of morning sunlight coming through his office window, although he did not know that it had exercised any unfavourable influence over him. I first tested this by advising a change from this office window, which had a favourable effect to the extent of reducing the local sensitiveness to normal proportions ; and he was not troubled again. He had read every bit of literature he could obtain on the subject, and had never been able to get satisfactory relief before. The worst case of hay asthma I ever had to treat was a man who had had seven operations on the nose, and who had never been capable of engaging in any employment, for his general health had always been below par. He presented no less than eleven compli- cations. He was treated by me in 191 5. He has never had another attack since, and has since become an officer in the army. Nor was it military life that cured him; he was definitely well before he offered himself for service. CHAPTER X DISORDERS OF GLAND FUNCTIONING It will be found that the quality and the amount of glandular secretions can be regulated by a properly applied neuroinduction. This is the plain teach- ing of to-day. It is true that both quality and amount are controlled by autonomous mechanisms, but these are so associated with central processes that under certain circumstances a very considerable amount of control by suggestion can be exercised. Neuroinduction will, on the one hand, help normal secretion to take place, by eliminating or modifying such checks as have come into play, in the form of mental stresses and strains, and on the other hand by enabling emotional stimulus to produce its special effects. We all know of Pawlow's experiments, and are thankful for them, but the reader has yet to learn how readily most of the human glands can be made to respond to the experienced efforts of the psycho- therapist. Physicians working on the lines of sugges- tion have long ago concluded that as the secretion of the salivary fluid is increased by the mere supracon- scious appreciation of food, it should require very little 176 DISORDERS OF GLAND FUNCTIONING 17; influence to make the glands energetic at will ; and they found that certain suggestions yet further in- creased the secretion of the fluid. Now, not content with this very familiar object lesson, I felt convinced that other glands would similarly exhibit increased activity under certain circumstances. After working under this belief for some years, I have now plenty of evidence that practically all the glands will respond to suitable induction. Kinnier Wilson has made splendid contributions to the physiology of chromaphil tissue and its secre- tions. Those interested will do well to follow the writings of such authorities, for they provide the psychotherapist with the bricks and mortar for his work; they serve to elucidate physiological action, and help to make the subject of exaltation of central influences as a stimulus to the glandular secretions a most fascinating study — one which is destined seriously to occupy the minds of scientists in the future. I should not think of attempting to belittle such preparations as adrenalin, which are interesting and valuable remedies of the more artificial therapy, but I am bound to conclude that before many years have elapsed it will be generally admitted that neuroinduc- tion in the direction of full natural functioning is an even better means of accomplishing the end to be desired. I claim, and am prepared to prove, that neuroinduc- tion is to-day the best of all treatments for constipation. Should the reader doubt this, he will not do so many 12 178 ADVANCED SUGGESTION years longer. I am of opinion that the favourable effect of suggestion is due to a correction of tenseness or sluggishness, not only in local automatic action, but originating in some central "negative" influence. I am also of opinion that improvement in dyspepsias treated by psychotherapy may be similarly explained. Nor is it necessary to make any direct verbal reference to sluggishness in applying neuroinduction ; merely by securing an absolute physiological relaxation of the general system, psychotherapy will sufficiently relieve abnormal nervous tension to cifford obvious relief in many cases. But the technique must be adequate. I do not refer to a simple relaxation, such as may be enjoyed by a person sitting limply in a chair or lying easily in bed. Several psychotherapists have obtained favourable results in the treatment of diabetes, but rather by way of experimenting than by the systematic practice of a special technique. Moreover, they have not applied a reasoned method. Their cures, complete or partial, have to them been simply adventitious. In such instances I am of opinion that mere induction toward the subconscious — however crude or old-fashioned may have been the method employed — has permitted restoration to a better state of equilibrium, through relaxation of both mental and physical strain. Diabetes I am bound to regard as essentially belong- ing to the category of nervous disorders. It is a functional disease commonly occurring after or during nervous strain, usually in those who have a family DISORDERS OF GLAND FUNCTIONING 179 history of diseases and disorders begotten of over- sensitiveness. Modern life seems justly incriminated for the production of conditions favourable to its development, particularly among the well-to-do. Jews are especially liable to the disease; after years of increasing prosperity, should luxurious living cause a permanent strain upon the internal organs, and should anything then occur to produce a season of great mental depression, their physiological system is liable to serious functional disorder. The disease sometimes occurs as a complication of other abnormal conditions, such as mental disorders, Graves* disease, climacteric disturbances, etc. But here again psychology and psychotherapy help us. We may be certain that the disease is usually a func- tional one because it has been found that psycho- therapy is curative — or, at any rate, is so sufficiently often to convince us. A study of instances of spon- taneous cure gave me some idea as to the 'results I might expect from treatment by psychotherapy. To give an example : A lady had five bad attacks in ten years, it being clear that each was precipitated by worry ; she recovered each time completely as soon as the worry lifted, it having been obvious to all who had closely observed her case that medicines and diet had availed but little in comparison. I have come to look upon diabetes as presenting etiological similarities to mucous colitis and dys- pepsia, in certain respects, all three being usually due to some sort of strain which has upset the sympathetic i8o ADVANCED SUGGESTION balance. I am compelled to look upon neuroinduc- tion as the treatment par excellence for these three dis- orders. I am quite confident in my own mind that although diet may be found to be of very great value in diabetes, as in mucous colitis and dyspepsia, never- theless psychotherapy will in time to come prove to be the first specific. A considerable number of successes amply prove my contention. That Professor Macleod of Cleveland should have found evidence which " led particularly to the elucida- tion of the control by the splanchnic nerves of the glycogenic function of the liver" is good hearing for the psychotherapist, who knows how the sympathetic system lends itself to ameliorative induction. Hale White also helps us thus : "It has been known for a long while that various disorders of the nervous system will cause glycosuria ; indeed, rather over thirty years ago it was urged by some that diabetes was a disease of the nervous system. Instances in which it has followed shock and mental emotion are on record, and it has been known by Cannon and others that glycosuria appears in cats if they are frightened by a dog. Glycosuria has been found in association with meningitis, cerebral tumours, and other organic nervous diseases. It may, if care- fully sought, often be found after severe concussion. But most of these nervous varieties of glycosuria are clinically unimportant, for either the nervous lesion soon kills or the glycosuria is slight and transient. We know nothing for certain as to its mode of production in men, but, because the secretion of adrenalin is under the control of the splanchnics, it has naturally been suggested that nervous glycosuria is really adrenalin glycosuria, and for this there is strong experimental DISORDERS OF GLAND FUNCTIONING i8i evidence; or that, as the cervical sympathetic sends fibres to the pituitary and excision of the superior cervical ganglion leads to glycosuria, all nervous glycosuria is really pituitary glycosuria ; or it has been thought to be due to influences reaching the liver through the nervous system and leading into a rapid transformation of glycogen into sugar. . . . Turning now to the treatment of glycosuria. The influence of the nervous system is well exemplified in the benefit that follows a tranquil life. A moderate amount of work without anxieties, excitements, or worries suits best. I know a busy medical man who suffers from glycosuria which always disappears when he takes a restful holiday, though he does not alter his diet. The bad influence of excitement is seen not only in its effect on the sugar, but it is well known that it will induce coma." Lecorche held the opinion that diabetes is due to an " exaggeration " of the hepatic functions. Seegen, Pavy, and Schiff have all admitted the existence of hepatogenous diabetes. Gilbert was of opinion that there were two types of diabetes caused by functional hepatic disorders : one due to hyperhepaty, the other to hypohepaty. Opium derivatives have long been found advantageous in this disease ; I believe that this has been due not only to their having produced feel- ings of well-being in the minds of patients, but to their having created a better functional balance in strained states of the nervous system, through the general relaxation induced. Abrams, of San Francisco, has put forward a vaso- motor theory of diabetes; he considers that we have to deal with a vaso-motor paralysis, which results in iS2 AiDVANCED SUGGESTION an increased supply of blood to the liver; he ha^ referred to good results having been obtained from vibrotherapy. Doubtless the latter served to ease tenseness of various kinds, but possibly largely through suggestion : I have found that no system lends itself to favourable treatment by neuroinduction with more obviously satisfactory results, both locally and generally, than the vaso-motor system. Some authorities have demonstrated the existence of functional incapacity of the " islands of Langerhans of the pancreas" in diabetes. Leonard Hill has published his belief " that the cause of the non-utilisa- tion of dextrose is the absence from the organism of some internal secretion of the pancreas." MacCuUum and Weichselbaum have pointed out the great part played by the internal secretion of the pancreas in carbohydrate metabolism. All these conclusions I cannot but regard as affording arguments in favour of treatment by neuroinduction. I will now turn to Graves* disease. Mrs. , thirty-five years of age, married, had suffered for several years from enlarged thyroid, chiefly on the right side, together with tachycardia, insomnia, exophthalmos, headaches — also chiefly on the right side — and laryngeal cough. She was thin and dyspeptic. Treatment by ordinary means had given " very slight improvement at times." As phthisis was said to be threatening — there was an obstinate bron- chial catarrh — ^her condition began to appear desperate to those concerned. As a last resource she was sent DISORDERS OF GLAND FUNCTIONING 183 for treatment by suggestion. This cleared up all symptoms in a few weeks, excepting occasional bouts of coughing due to slight remaining dyspepsia and bronchial catarrh. Later the patient rapidly gained weight and became, as her husband described her, "a new woman." Simple analysis revealed an injury which she had once sustained on the right side of the neck and face ; this possibly determined the one-sided character of the case. The thyroid was not quite reduced to normal dimensions, but had become very nearly normal, when the patient felt so well that further treatment was deemed unnecessary. As to the technique to be applied in exophthalmic goitre, I do not advise great attention being paid at first to the particular gland affected. Not that I need particularly warn the practitioner against paying attention to one part only, for I have never seen any evil result from so doing. I recommend general treat- ment for a few days^ — that is, treatment directed toward reducing the heart-beats, making the patient comfortable all round, restoring sleep, helping the digestion, steadying the breathing, and allaying any tendency to cough. After this a little attention may be paid to the gland in the way of gentle palpation. In myxoedema I have obtained favourable results in cases of many years* standing ; after general treatment I have stimulated the gland by gentle rubbing. / do not yet know whether the local palpation of the gland is of any advantage or not. I have not yet treated a case without giving some local attention, for, i84 ADVANCED SUGGESTION in natural interest, I have in every instance been anxious to apply all likely neuroinductive means, so that favourable results might be quickly obtained, and I have not cared to delay these results by any undue experimenting. But I shall not be surprised if it is found in future that mere suggestion generally applied so levels the balance of polyglandular action that thyroid activity is reduced or increased, as the case may be, although no particular attention has been given to the gland itself. Turning to some of the literature dealing with exophthalmic goitre, it has been pointed out by Dr. Leonard Guthrie and by Dr. Hector Mackenzie that fear has been known to cause acute enlargement of the thyroid. There is also a case recorded by Dr. Brand, in which he sought to stimulate the vagus centre in the medulla by applying linimentum iodi behind snd below the angle of the lower jaw. He writes : " As soon as blistering occurred the nausea rapidly subsided and disappeared in a few days, to reappear, though to a less extent, when the blistered parts had healed. Fresh blisters were induced just below the previous ones, when the nausea once more disappeared and never returned. The patient was then able to take and retain food, and gradually put on flesh. Not only was the nausea removed, but the pulse-rate also fell in a week or two from 120-140 per minute to 80, soon afterwards becoming normal. This result may have been due to the afferent stimulation of the vagus centre causing afferent influences . . .to the stomach and heart." iDiSORDERS OP GLAND FUNCTIONING 185 Gibson wrote on the subject of emotional causation and recorded a case as follows : "A washerwoman, while standing at her tub, received a great fright owing to the roof of her house falling in upon her, and she entered a ward two or three days later with pronounced features of Graves* disease. . . . Irritations of mucous membrane of the digestive, respiratory, renal, and reproductive systems are undoubtedly causes; when these conditions are relieved the affection is greatly ameliorated. Even the ardent supporter of the nervous origin of the disease admits that, although the structural lesion of the functional disturbance of the thyroid gland is not the cause of all the symptoms, it must be recognised that it plays an important part in the genesis of a great many of them. On the other hand, the keen adherent of a purely glandular cause for the disease is forced to admit that many of the symptoms of the disease, while primarily due to thyroid activity, must be brought about by the intervention of the sympathetic system." The very best of help that the psychotherapist could wish for is to be found in conclusions such as Kinnier Wilson's, that "in Graves' disease vaso-motor irrita- bility is a cardinal feature;" and Dr. Bodley Scott's, that "we must look on Graves* disease as a pluri- glandular disturbance, in the common knowledge that fright causes great exhaustion of the suprarenal glands ;" and Dr. Stoney's, that " the thyroid is excited by mental stress and danger." I have very good reason for believing that many successes obtained by the employment of the X rays have been largely due to the suggestions involved. 1 86 ADVANCED SUGGESTION When Dr. Hernaman- Johnson writes, "Some of the most alarming cases yield to X rays, whereas now and then one of the more ordinary type fails to respond," I cannot help surmising that something more than the X rays has operated in all these cases ; in a bad case the best of hopes may have brightened the patient's thoughts, while in a mild one his mind may have been gloomy, the difference being due to environment or the varying temperaments of the patients. Exophthalmic goitre and rheumatoid arthritis have been found side by side, both having been deemed by some authorities to be the result of intoxication from the alimentary canal. The psychotherapist would seem to be equally justified in thinking that both conditions may be primarily due to want of balance in the sympathetic system, begotten of some strain. The most striking instance of a cure of rheu- matoid arthritis that I ever heard of resulted from indirect autosuggestion, the patient being a military man who became well enough to go on active service in the present war. I was discussing possibilities with a distinguished physiologist some fourteen months ago, when he remarked : " I do not think you will be able to make any impression upon the pituitary gland by sugges- tion." I replied that I saw no reason why this gland should not be included, for it seemed that functioning of the whole physical and mental system could be favourably assisted by neuroinduction. Shortly after this interview a case of early dwarfism was sent to DISORDERS OF GLAND FUNCTIONING 187 me, a girl of nine years of age. A consulting physician Had given his diagnosis as hypoplasia, and had ex- pressed his opinion that "nothing more could be done to correct the abnormality." It had been found difficult to educate her because "the attention wandered." She could not learn any arithmetic. At school she was pronounced "abnormal in mind." I found her very excitable, and unable to concentrate readily; at first she seemed eccentric, but underneath all this her answers to questions indicated every promise of a perfectly normal intellect. She possessed a larger head and shorter legs than the normal, and waddled somewhat in her walking. After three weeks* treatment by neuroinduction she was able to learn her lessons like other children; her excitability was gone. Her parents also noticed that her skin, which had previously been rough and harsh, was now soft and her complexion had quite changed to a good healthy colour. I gave instructions for her to be measured and weighed while undergoing treatment, and every three weeks afterwards. Altogether she had sixteen treatments, since which it is reported that she has been normal in every way — indeed, unusually capable. In four months she increased in height more than she had gained in three and a half previous years. In eight months she gained 5^ inches. I am enthusiastic in my recognition of the magnifi- cent work that is being done in serotherapy, vaccine therapy, and opotherapy. I am bound to add to the proofs of the efficacy of the last of these — at least, in 188 ADVANCED SUGGESTION certain disorders. But I am equally alive to the short- comings of these treatments; testimony is plainly eloquent of instances of failure. I have succeeded by neuroinduction in cases where organotherapy has previously failed. Moreover, my results appear to promise that neuroinduction will be found the more permanent in its effects, particularly in many cases in which the initiating psychotic and neurotic factors tend to remain, either preventing complete cure or acting as " negative arcs," which constantly invite other "negative arcs," and which are therefore like smouldering embers that may cause a fresh con- flagration. Then, again, I have employed organo- therapy and neuroinduction simultaneously, with most satisfactory results, in certain extremely difficult cases, and I shall not hesitate to do so again if I think I may obtain the desired results more rapidly by employing both. An interesting instance of glandular action is that of an infant fourteen days old which was cured of indiges- tion by the alteration of its mother's milk. The father had been sent to me suffering from phobias and nervous debility. His wife and infant moved from their home to be near him after the birth of the latter. He asked me what should be done. His wife was greatly distressed about his illness, and there was now very much trouble about the infant, which was suffering from pain and frequent vomiting. The father, who was an intelligent man, apologising for troubling me, asked me whether I thought that his DISORDERS OF GLAND FUNCTIONING 189 wife's worries were unfavourably affecting her milk. I replied that this was likely to be the case. I offered to call and see the mother. I felt justified, under all the circumstances, in treating her then and there by suggestion, for worry and nervousness. I was in- formed that the infant had exhibited no discomfort, and had ceased vomiting and crying after the very next occasion of suckling, soon after I had treated the mother. I may mention that I have found that the amount of milk secreted by a nursing mother may not only be increased by suggestion while she is nursing, but that if there has been insufficient milk during one or more previous nursings, and the mother is treated by suggestion before the next confinement, there will on this occasion be a better supply. I am not prepared to say, however, that this will occur in all patients so treated. I have pleasure in closing this chapter by quoting from a Lancet summary of Professor Pende's opinions, as expressed in his book " Endocrinologia," the eloquent words : " The endocrine apparatus is physio- logically inseparable from the sympathetic nervous system." The careful reader of these present pages will draw his own conclusions as to the feasibility of neuroinduction in glandular disorders. CHAPTER XI STIMULANT AND DRUG-TAKING TO EXCESS The psychotherapist will do well to bear in mind the neurotic factor both in simple alcoholism and in dip- somania. An excitable person belonging to an epileptic family may either be given to regular daily excess or he may be a victim of dipsomania, according to the way in which his disposition is governed by one or another particular form of nerve disorder. A craving for alcohol may act as an " arc " in neuras- thenia, insomnia, or even phthisis, for that matter. On the one hand, persons fond of good company and not easily able to find it are liable to develop drinking habits when no nervous disorder worth speaking of exists in either patient or relatives, while on the other hand a dipsomaniac of the most hopeless type may be found in an extremely quiet and orderly family in which epilepsy has occurred in the family history. Some of the worst cases may be found among persons suffering from mental disorder, of a degree and a type which is clearly distinguishable. I mention these variations and conditions chiefly in order to point out the certainty of obtaining a percentage of disappoint- ing results, no matter what the treatment may be. 190 STIMULANT AND DRUG-TAKING 191 Simple analysis should always be carefully con- ducted from the commencement of treatment in these cases, so that hidden "skeletons" shall not hinder rapid progress. In one very obstinate case I found the patient was kept in a state of tension by chronic differences with his wife, which on principle were never discussed with any third party. A lady inebriate I found to be suffering from a lump in the breast which she feared was a cancer; she was afraid to be examined and to learn the worst. Another was deformed in the sexual organs. Jealousy because a sister had married was the fons et origo of the evil habit in another patient. Excessive drug-taking helps the psychotherapist to understand alcoholism, and how to deal with it. One finds the greater containing the less; having to battle with the more difficult makes it much easier to deal with the more ordinary. Morphia and cocaine- takers are undoubtedly the most difficult patients to deal with, for the simple reason that once they begin taking these things they immediately proceed to make an "arc" of greater evil than any which already existed in their previous "vicious circling," which had demanded solace, namely, a weaker will-power to resist. Hence the malignant effect of these drugs in absorbing the victim, as the nimble spider enmeshes the fly in its controlling coils of web, eventually to poison it; their toxic power making the reaction of functional stress a matter of regular oscillation, always just a little more powerful in negative return than in 192 ADVANCED SUGGESTION the gratification of positive effect, until physical in- efficiency adds another " arc." Hence the necessity felt for increasing the dose. Nor are these cases at all pleasant to treat; so much firmness of resolve is re- quired, and such harsh injunctions to the effect that suffering must be endured, such as sometimes calls for extremely severe and sustained contest. I number among my successes some of the very worst cases ever known to the physician, and with all my heart I pity even psychotherapists who have many cases to deal with. Let me give an example. A man's illness was diagnosed over a period of ten years by many physi- cians as neurasthenia, mania, dementia, and so on, according to judgment or necessity. He at length took 8 grains of morphia a day, until he became a physical and mental wreck, having reduced his family of sons, daughters, and wife more or less to illness all round ; he certainly spoiled the best chances in life of most of them for years on end. It was reported that he had " killed " one doctor, had driven another out of practice through the worry of his case, and was severely harassing a third when he was finally brought to me. The letter of particulars which preceded him mentioned three forms of insanity, from which I was welcome to make my own diagnostic choice. The harassed third doctor himself brought the patient, and on bidding me good-bye, wished me luck, with the expletive : " He's the devil !" I found the patient suffering from toxaemia and STIMULANT AND DRUG-TAKING 193 insomnia, complicated by a most obstinate and deter- mined temper. He appeared to be an almost hopeless case, even for my methods. For six months I allowed him morphia, for I realised that I must first devote all my efforts towards correcting the other various " nega- tive arcs," some of which has led to his morphia- taking. After getting these sufficiently corrected, I took off the morphia, gradually reducing it over a period of three weeks. Two years have elapsed since I treated him, and he remains in perfect health. Another most difficult case which passed through my hands was that of a medical man of uncommon ability — so capable, indeed, that his absorbing work led him to take "stuff" which he had unfortunately tried as a student, in order that he might get through a harassing period. He began with morphia, after- wards adding cocaine. He was intellectual enough to realise what a prisoner he had made of himself, and finding no chance of release open to him, he contem- plated suicide. Ceasing work, he just had enough sense remaining to ask his wife to keep constantly with him. She persuaded him to consult me, as the result of a suggestion of his own, which he had made some months previously but had not then acted upon owing to his hesitation and obstinacy. This patient was reading a paper before one of the leading medical societies a very few months afterwards, in perfect health. Of all patients medical men are by far the worst to 13 194 ADVANCED SUGGESTION treat for any disorders whatsoever; this for obvious reasons, the chief perhaps being their subconscious objection to being helped in any self-governance. Medical men sometimes take morphia as a result of simple experiment during student days. They imagine that they will readily be able to avoid any enticements in future ; but they too often find that they are not. Pain is responsible for the habit in many cases. However strong I may possibly be in will- power, I would rather suffer agonies than have morphia given me, having learnt its " hellish " nature in the case of others ; nor will I ever take any m future unless I should have reason to believe that I must necessarily die shortly, and that I must suffer very great agonies before this event — then I might take it. A man had better be without a limb, or two limbs, than be taken prisoner by a drug for a term of years, or for life. I therefore strongly advise all lecturers in medical schools to warn students against taking such drugs for any reason whatsoever. An uncommon case deserves mentioning for the various lessons it offers. I was asked by a leading neurologist to see a married woman who was suffering from drug-taking, and I received the information that she had taken morphia for some years and chloroform for some weeks. I called upon her and found her intoxicated by both these drugs. She was suffering also from toxaemia, not produced by drug-taking ; she was restless, violent, and demented. I ordered her to a nursing home, and found removal all the easier upon STIMULANT AND DRUG-TAKING 195 pleasantly allowing her favourite nurse to go there also. I found it necessary to treat the nurse first, for duplicity and cunning ; I discovered that she had for some time been bribed by the patient, and sworn to secrecy, having apparently been a kind, confidential friend for some few years. The patient possessed con- siderable means, and the nurse had exercised complete command over the husband and everybody else in the household. In due course I further discovered that the patient had either been inhaling or otherwise using daily 8 ounces of chloroform for days together. The nurse could not say exactly how much had been inhaled or swallowed, for the patient had always put her head under the bedclothing while taking it. The nurse had been able to get the chloroform from chemists by asking for a mixture of chloroform and oil — half and half in an 8-ounce bottle, "to rub on painful joints." Whether this was the idea of the patient or nurse did not transpire. Before she came into my hands all ordinary meals for the patient had been found impossible ; strong beef- tea was the chief food, the husband declaring that the patient had not been able to take anything else but a little of this every two hours for some weeks. Morphia by injection had also been given by the nurse. The patient had been in the habit of giving away valuable jewellery to any who pleased her ; she offered some to a new nurse the first day she entered the home. After commencing treatment she was able to take solid food 196 ADVANCED SUGGESTION within a week, and she soon made a perfect recovery as far as drugs were concerned. It turned out that she had had Bright's disease, as an early " arc " ; this had resulted in her craving for drugs, while concen- trated beef-tea had fed the general disorder in two ways. The psychotherapist must make careful analysis in case a patient should be deceitful as regards the desire to be cured, for it happens that just as loss of will- power is a result of drug-taking, so is incapacity to tell the truth. Moreover, the patient must be given clearly to understand that his word cannot be taken, neuroin- duction must, if possible, be carried to the length of extracting the truth by means of the moral and emotional stimuli of suggestion. Tonics, sedatives, and various appropriate kinds of medicines may be given at any stage of cure, if it should seem that they are at all likely to help towards correcting such " negative arcs " as may be complicat- ing the case ; but these are not so likely to be required if the offending drug be reduced by degrees, which procedure I strongly recommend in all difficult cases, in preference to rapid or instant withdrawal. However powerful an argument may appear in favour of curing a morphia or cocaine habit by this or that medicinal means, nothing can diminish the posi- tion which neuroinduction occupies in order of pre- cedence, provided it is properly carried out. As an instrument, it ranks with the saw in surgery as compared with blisters and other superficial applica- STIMULANT AND DRUG-TAKING 19; tions, even though the latter might be both stimulative and analgesic. I offer the following analysis of negatives for study, taken from a set of cases : (i) Highly strung ; (2) diffi- cult thinking; (3) falsehood; (4) drug-taking; (5) more falsehood; (6) epileptic sexual impulses; (7) suicidal attempts; (8) dementia. Such patients are very difficult to treat by any means; obstinacy, suspicion, and mental duplicity will militate against the most careful and experienced psychotherapy. They sometimes resent control bitterly ; watchful companionship may only succeed in arousing further exercise of wit, directed on the patient's part towards thwarting the efforts of all advisers. Some of the very worst cases of excessive abuse of stimulants and drugs are to be found in families where there is a clear epileptic history, or where this may be strongly suspected either from a tendency to bad temper, voracious appetite, unusual variations in moods, or determination to masturbate. The following negative circling in which epilepsy came into the family history may be given by way of example: (i) Epileptic temper; (2) occasional vora- cious appetite; (3) dipsomania; (4) masturbation; (5) psychasthenia ; (6) loss of weight ; (7) worry, obstinacy, impatience; (8) drug-taking. CHAPTER XII SURGICAL HAEMORRHOIDS In daring to approach the surgical domain I am quite aware that I shall incur all sorts of satirical com- ments on the part of certain surgeons, who will allow themselves no further licence than to take a desultory interest in certain parts of this book, from a natural inclination to increase their general information. Some may read the title of this chapter and at first turn away impatiently. My study is in any case primarily offered for the consideration of psychologists and psychotherapists. But the surgical scientist pure and simple — leaving aside the obsessed operator, who might feel that he owed a special duty to his particular cause — will find food for reflection which he cannot fail to find of value, in this chapter as also in several others. Whatever their attitude, I expect all to be good-natured towards my endeavour to contribute to the etiology, pathology, and therapy of some very common surgical conditions. As regards haemorrhoids, very few surgeons would have the patience to consider any remedies to be possible beyond a few well-known ointments, as 198 SURGICAL too temporary expedients; nearly all expect these to be followed, sooner or later, through sheer necessity, by consent for a radical operation. Inasmuch as neuroinduction may be employed, not only in order to produce very considerable alteration in the circulation, both local and general, but as the very first treatment of all for correcting habitual con- stipation, we have in this method a means of prevent- ing and curing haemorrhoids which nothing can excel. A large number of cases serve to illustrate this, not only in my experience, but in that of several other practitioners employing psychotherapy in one form or another. It is true that others have published their experiences in respect of constipation rather than haemorrhoids; but I have no doubt whatever that where they have cured the former they have also bene- fited and usually cured the latter when these have been present. Let us now turn to a case of prolapsus ani, in a child two and a half years of age, whose mother had tried everything that medical advisers could suggest, including a diet of fruit and vegetables only, for some weeks in succession, in order to relieve the constipa- tion, but without success ; until at length a surgeon pro- posed to take away a portion of the bowel. A friend of the mother urged that other advice should be sought, for she had heard of some " wonderful cures " of constipation. After the mother had communicated with the surgeon the child was brought to me. As it lay in its mother's arms I elicited its attention first by 200 ADVANCED SUGGESTION means of toys, after which I had no difficulty in employing- neuroinduction. I established a sense of freedom of the abdomen by means of palpation, while at the same time I spoke a few words, which I specially selected as being suitable to a child. The result was that an easy natural movement occurred within a few hours, with no prolapse; nor has any trouble been experienced since. Previous to this the distress on each attempt at evacuation had been so great that the mother began to experience great difficulty in getting the child to entertain the idea of making any effort at all, or even to go near any " convenience." In the case of a man, forty-four years of age, haemor- rhoids had become so severe that there was prolapse of an enormous collection of haemorrhoids each time the bowels were moved, making it necessary for the patient to go to bed so that hot applications and pressure might be applied in order to allow the parts to recover as far as they could. His brother having unfortun- ately died from an operation, the patient had declined to undergo this ordeal himself; had it not been for this, I should probably not have seen the case. Treat- ment by subconscious induction completely cured both constipation and haemorrhoids. Varicose Veins The results of treatment by neuroinduction of many cases of nervous disorder, in which varicose veins have been a complication, have been quite sufficient to indi- SURGICAL 201 Cate that in this method we have a valuable means of preparing some of the worst cases for operation, to say the least of it. An instance of oedema of a whole limb and the lower abdomen has been referred to in another connection. Where the veins have been so long distended that any involution of a vis naturce order is impossible, there being no power of resiliency left, making surgical operation the only possible remaining procedure, a limb which has become vascularly weak generally may be treated by neuroinduction with the very great- est benefit. Neuroinduction will also render vari- cosity less prone to occur in other places. I hope the reader will not consider that I am advo- cating a measure in an overenthusiastic spirit; it would matter very little to me if I never saw another case of varicose veins. There is a field for my work which is much too big for me as it is, without going anything like so far afield as this. I feel bound, however, to make use of extensive experience and deep convictions which serve to give support to my main contentions. "Why cannot he leave surgery alone ? He wants everything !" I can hear the biassed critic remark, with an impatience which naturally dis- likes things that savour of universality, when it is perhaps difficult enough to find promising cases for the exhibition of surgical skill. I am very sorry if I offend anyone, but I must run risks as well as other people who have struck a successful scientific vein. However, I am really hopeful for the best. I venture 202 ADVANCED SUGGESTION to think that good-hearted surgeons will not too witheringly taboo me. Inflammations and GEdemas A clergyman, fifty-five years of age, fell and hurt his knee. A surgeon was called to attend him on account of pain, swelling, and inflammation. Local applica- tions and confinement to bed were ordered, the patient remaining in bed for six weeks. As nothing but the ecchymosis had gone during this period, in spite of the constitutional treatment which had been employed during three of these weeks, under the impression that a rheumatic or gouty diathesis was at the bottom of the obstinacy, the patient was ordered out of bed. But he could not walk. He was then sent to me. The swelling so subsided the day following the first treat- ment by neuroinduction that he could walk quite freely, and in a few days he was perfectly well. Cases of angioneurotic oedema do well under neuro- induction, of course, but so also do all swellings which are not due to organic disease of the limbs or organs, especially those which are merely the result of local vascular sensitiveness, lymphatic or sanguineous. Even local inflammation from injury can be reduced as quickly by neuroinduction as by any other means — and sometimes more quickly. SURGICAL 203 Surgical Operations in Contractures And OTHER Neurotic Cases I do not think that even surgeons would deny that many hysterical contractures have been surgically operated on, especially in cases of long standing. I have known such cases. I have been obliged to agree that such operations have been justifiable when a sufficiently advanced psychotherapy has not been available^ in days gone by. I am thinking at the moment of a patient who was operated on by one of the most distinguished surgeons of the day. A 5 -inch incision was made just through the skin over the abdomen — and no more. The wound was sewn up. This completely cured the patient. She was hysterical, and would not believe that there was nothing seriously wrong in the region where she complained of pain. The surgeon operated to prove his diagnosis as well as to cure the patient. Such instances are too well known to be worth more than passing reference. I am of opinion that nine-tenths of all the successes which bone-setters obtain are due to suggestion. Dr. Mott and others have found that suggestion by words spoken is more efficacious, when dealing with nerve- shock cases, if the patient is partially anaesthetised. One of the most successful bone-setters has long made a similar practice (see Medical Press and Circular, 1917, "Bone-setters and their Work," by the present writer). CHAPTER XIII SKIN DISORDERS Inflammation has been defined by a great authority as — "The reaction of irritated and damaged tissues which still retain vitality, or a series of vital changes which occur in the tissues in response to irritation. The irritants are either non-infective or infective ; the former comprising mechanical, electrical, chemical, and thermal agents, and such things as X rays, etc. ; the latter including the micro-organisms." Erythema is defined as "A morbid redness of the skin due to congestion of the capillaries, of many varieties." Now, as the vaso-motor effect of neuro- induction is practically the same, no matter what may be the variety of superficial congestion, we need waste no further time in discussing any pathological defini- tions; it is enough merely to mention some of them. Let us study a few interesting cases, the lessons from them being extremely important, from every point of view : Miss , twenty-five years of age, had been suffer- ing for some years from dementia praecox. The diag- nosis was sent to me with the patient, and I had no 204 SKIN DISORDERS 205 reason whatever to question it. She exhibited stigmata of degeneration, with facial asymmetry. Among her negative arcs was Hability to severe herpes of the lips whenever she was more than commonly worried about anything; this had troubled her for three years. I have a secondary purpose in giving just a few words of her history ; this explains how I came to study her skin disorder. The fact that eruption followed unusual worry interested me. On its reappearance upon the lower lip, I gently manipulated the eruption under general neuroinduction. It began to retrogress at once. By at once, I mean that in an hour the patient felt less pain. The following morning there was less swelling, and an obvious appearance of retro- gression, which continued until the cure was completed a few days later. A few weeks afterwards further worry, caused by letters from home, brought out a crop upon the upper lip. This was treated in the same way, and with the same effect. Then an unusually long time elapsed before any other attack occurred, though sufficient worries had been undergone, which made me think that the tendency had gone. Now there occurred what seemed to me a remarkable thing; a day of extra worry was followed by two patches of herpes, one on either side of the mouth, just below and rather outside the angles, which had apparently been unable to form in situations which had previously been favourable. The treatment for these resulted in total clearance and non-recurrence, since when the herpes made no further appearance, observation 2o6 ADVANCED SUGGESTION having been kept up for eighteen months personally, while for another twelve months information Was given me to the effect that there had been no recurrence. I have had so many cases of urticaria of a severe character and of long standing which have been readily and completely cured by neuroinduction, that I have no hesitation in declaring the treatment to be specific par excellence. As to whether the check to the urticaria be always independent of any alterations for the better in gastro-intestinal functioning, I am not prepared at the moment to give conclusive evidence, for general subconscious induction will always be likely to influence the latter appreciably, although especially directed toward correcting the former. Again, both direct and indirect results may be to some extent due to vaso-motor effects. If I am to judge from the case of herpes referred to, it would seem likely that there need not be any effect upon metabolism or toxaemia for favourable results to be obtained, although in three patients treated in whom urticaria had been a prominent trouble, among other signs and symptoms of a neurotic nature, and in which I had urgent occa- sion to deal with psychasthenia first, I found the tendency to urticaria getting less as I proceeded, until it vanished altogether, without requiring any refer- ence to it or any attention whatsoever. F. B. Jefferies, F.R.C.S., has written : " The causation and etiology of herpes being some- what obscure and theoretical, the following case may be of interest. I was asked to see a woman, aged fifty- SKIN DISORDERS 207 three, who was complaining of a rash on the arm. On examination she had a typical eruption of herpes on the left arm extending from the wrist upwards along the inner side of the forearm, arm, and extending on to the chest and back. The eruption on the arm follows the line of the internal cutaneous nerve ; on the left side of the chest it is scattered but profuse, and also on the scapular region. The patient is a very ' nervous ' subject, and the interesting point in the case is this : three days before she felt the pain which pre- ceded the appearance of the eruption a mouse ran up her left sleeve into her axilla, and was only liberated by her daughter unfastening her blouse at the back. The patient was always terrified of a mouse. I know her statement about the mouse is correct, for her daughter and her husband witnessed the occurrence." Herpes and urticaria are both, without a doubt, vaso-motor neuroses — at least, in many instances this is clear. G astro-intestinal treatment may or may not help. By getting favourable effects from any ordinary gastro-intestinal therapy we should only obtain evi-^ dence that under certain circumstances the soil had been favourable for vaso-motor neuroses — that is all.. Moreover, local micro-organisms may be discounted, in these as in many other skin diseases, provided the vaso-motor factor in etiology is dealt with effectively.. That certain skin eruptions may suddenly spring up for apparently no reason whatever, while others may disappear with still more astonishing promptitude, is a fact which every experienced doctor has either observed or heard of since medicine became a serious professional calling. Such examples impress upon us, the importance of forming a proper estimate qi th^; 2o8 ADVANCED SUGGESTION neurotic factor, whatever amount of respect organisms and soils may claim. In such disorders as chicken-pox, herpes, and urticaria, it would seem that there is a soil which favours a local outburst at certain points where the vaso-motor control happens, for some reason or another, to be weakest. When the vaso-motor tone is raised by subconscious induction retrogression takes place. We may see these things take place in the case of other pathological puzzles, and in various neurotic systems. Just why certain small places in the skin should be weakest may not be clear. I have proved the favourable effect of psychotherapy in certain eczemas, having had instances of outbreaks which have for years been recurrent, but which have promptly yielded to neuroinduction, just as the herpes did in the case cited above, with this exception, that in some cases I have not effected any local palpation whatever, having merely depended upon the general relaxation of induction by words spoken. But cases of the spontaneous cure of many skin diseases consti- tute a more eloquent plea for my theory than could anything else. W. B. writes to the British Medical Journal: " I think my experience may be helpful. A patient was sent to me for CO 3 snow treatment. There were patches on each wrist, about the size of a sixpence, that he wanted particularly removed, as they were so unsightly. One application for thirty seconds of COg effected a perfect cure in three weeks, leaving a faint blush on the new skin ; but, to the surprise and delight SKIN DISORDERS 209 of the patient, in about another fortnight his whole body, which was really covered with psoriasis when I first saw him, was quite free from any trace of the disease. The patient's explanation was that I fright- ened it away ; and that may be true, in this way : he was greatly run down, depressed, and disappointed at the failure in the prolonged and drastic attempt of several specialists. Everything had been tried out- side and inside, including thyroid extract (which nearly killed him), and a prolonged change at Bourne- mouth. He complained very much of pain, both in the freezing and thawing stages of the COg treatment, which is very unusual, and he anxiously inquired if I intended applying this all over his body, as he would not be able to stand it. I said I might do it piecemeal later. This evidently so frightened him that the psoriasis of over twelve months' duration completely disappeared in these few weeks. This I consider a splendid example of the influence of his mind over the body, and I think over such an intractable case as *Senex' describes. Suggestive treatment, with or without CO2 snow, for the lupus erythematosus on the face would be attended with the happiest results." Skin diseases are not by any means always easy to treat by neuroinduction. This may well be imagined. Now and again there is a submerged trauma that requires thought analysis, as the following unique case will serve to illustrate : A maji, aged forty-three, had suffered from pemphigus for some twenty years, his case having been diagnosed and treated by many specialists, including "the very highest in the land.'* His condition gradually grew so bad that walking was extremely difficult. Sometimes the extent of the erup- tion necessitated his confinement to bed. He was 14 210 ADVANCED SUGGESTION even unable to touch anything with his hands without raising large blisters — he could not even touch the handles of doors. At times the blisters occurred quite acutely "all over the body." A worse case could surely never be seen, to be living at all. He was sent to me, this time by a layman, by the way, a solicitor who had once been in my hands professionally, and who had become acquainted with the patient in his professional dealings — a prominent man in medico- legal cases. But, indeed, any layman might be excused for such a recommendation, for could you picture a skin specialist of rank and title sending such a case to any psychotherapist ! The suggestion would have sounded too ridiculous for words in the days before this book was published. The patient was a downcast wreck, suffering unspeakably, only just able to walk in specially made large list boots, in which were very thickly padded socks, and so weak that he required steadying. His face and hands were blebbed and scaly, hardly two square inches of his whole body being free from signs of old and new eruptions, his forehead and neck being* rather less attacked than other regions. His mouth and throat were raw in large patches, the lips being so covered that he could not speak distinctly. His latest difficulty for many weeks had been in swallowing; he had been reduced to eating soft farinaceous things, making here and there a slight departure. Sometimes for a whole day he could swallow nothing whatever. One of his eyes was blinded and badly inflamed, there SKIN DISORDERS ^n being even corneal and sclerotic blebs. He held his hands away from him lest they should come in contact with anything. Helpless as a child, he pointed to evidences of accidental touchings. Insomnia had entered the vicious circle, while constipation with very severe haemorrhoids had become so bad that he dreaded movements of the bowels as one would a repetition of the rack. Surgeons had refused to operate on him. It had long been agreed by consulting physicians that there might be something neurotic about this case. On commencing treatment, I proceeded at the same time to analyse for suppressed traumata. Inquiry went right back to five years of age. He now recol- lected that at this age he had accidentally swallowed some strong acid. This caused ulceration in his throat and mouth, making it extremely painful for him to swallow. I felt entitled to conclude that the shock from this occurrence had acted as a trauma, making the patient susceptible to everything likely to injure the skin, for he remembered that soon afterwards bullae began to appear about the face; later they became wider in their distribution and of more frequent occur- rence. The patient explained that he had never been nervous in the ordinary sense; others who knew him agreed. Indeed, on first seeing me he really did not seem afraid of his condition ; he was merely depressed and dejected. He was anxious not to get worse, much as a phthisical patient is sometimes afraid of catching cold ; there seemed in him a sort of sfes when I made 212 ADVANCED SUGGESTION any remark of a cheerful nature, which I could see would enable him to smile if his sore face and mouth would have allowed him. Two days after the first neuroinduction his hands showed signs of very slight improvement. In a week he said the pain from the haemorrhoids had very much lessened, the stools being easier. In ten days' time his taste was restored, after many years' abeyance, and he began to swallow food much more readily. I knew from these indications that, unless some unfortunate adventitious "arc" should enter the "negative circling," as from financial worry or from any regional exacerbation following some departure in diet — which might very well occur with such an extreme state of affairs all round — he would get completely well. Manipulation was for the first few days deemed in- advisable, for fear of adding to " negative circling " at the very beginning of treatment. I blew upon his hands instead, suggesting coolness. In a few days palpation was quite safe. He became so well that further treatment was unnecessary. I would warn the reader against running any risks of making a big "positive arc" too early in a very grave case. That way failure may lie ; for should an additional " negative " be obtained, or a slight advance occur in the disease, quite irrespective of any treatment whatsoever, which is conceivable, then retrogression might never take place, on account of the powerful auto- suggestion which might be engendered while the SKIN DISORDERS 213 patient was so much hoping for and expecting improvement. General and local hyperhidrosis has always caused dermatologists infinite trouble, as is so eloquently indicated by measures they have advocated by way of treatment. X rays have lately been favoured by Howard Pirie, who found drugs useless; while Koli- pinski has been drastic enough to use the thermo- cautery in the axillae, even producing "burns of the second and third degree." Major Porter has gone even further, having recommended dissecting away the skin of the axillae. Sufferers from hyperhidrosis are always nervous people. The disorder is like blushing, in this respect, that a patient's consciousness of the liability to it makes the trouble all the worse. I have probably seen some of the worst cases ever known, such as a girl who developed patches of eczema from the axillae down to the hips on each side, 7 to 8 inches wide for the upper half of the area. She had to go to bed, and was there treated locally and generally for many months before she was sent to me. Another patient treated successfully by psychotherapy had also been confined to bed, the arms having to be kept away from the sides, so that the cool air might help to prevent sweating. Neither of these patients was over the normal weight. Many patients have found it necessary to change their clothing several times a day, through hyperhidrosis of the axillary regions. The success with X rays in the hands of Dr. Howard Pirie has been so great that I 214 ADVANCED SUGGESTION really cannot find myself able to beat his records by psychotherapy, unless I might mention that in my cures I have also had to contend with serious condi- tions in which skin disorder has been a secondary feature. I have had no simple cases in which other more serious complications have not been present. As to pruritus, I must again bring a friend to my assistance. I am fond of getting others to support my contentions; this may be pardonable under the cir- cumstances, considering the risks and dangers of travelling in scientific regions where so few have ven- tured, and where the reputations of some have met with an untimely end. I find Dr. Bunch particularly interesting in his Lancet article concerning "Itching Diseases of the Skin," as follows : "Primary pruritus is a functional affection of the skin, the sole symptom of which is the subjective sensation of itching. The skin appears healthy and shows no pathological changes to which we can point as a cause for the irritation. Such pruritus occurs in neurasthenia, chorea, and excessive emotion, and may perhaps be ascribed to an over-excitability of the special end organs in the skin, if not to an ill-defined auto-intoxication." It is interesting to cogitate quietly over the path- ology of such disorders as eczema, psoriasis, herpes, pemphigus, and for that matter several other skin diseases, in the light of the effects of various forms of treatment. I would gently and apologetically ask : Is there any "suggestion" operating when X ray SKIN DISORDERS 215 applications are successful ? I also ask this question in another connection in a later chapter. I have experimented on a case of local " poisoning " from handling primulas, just before the patient was arranging to go to a skin specialist, and I obtained quite a marked improvement both as regards pruritus, erythema, and swelling ; but not wishing to deprive the patient of the benefit of well-tried and proved remedies, I encouraged her to visit the specialist. The dermatologist told the patient that the eczematous condition would certainly have spread ; indeed, it had spread up the arm before the dermatologist or I had seen it, as the patient had already observed. Now, primula poisoning is not likely to increase in area on the patient's abstaining from further handling the parts. Was the spread, therefore, neurotic in char- acter ? Do eczema and psoriasis ever spread in a similar fashion ? In the case of pemphigus just pre- sented, the sensitiveness was undoubtedly neurotic. I would therefore hazard the hypothesis that in many skin diseases there is a neurosis affecting the secretory apparatus of the skin, which displays variety of type according to the soil and the particular part of the skin involved — such involvement being sometimes determined by central selection, the very nature of the disorder as seen by the sufferer establishing itself more or less as part of an auto-induced " negative circling." Dr. George Fernet has "no doubt that the nervous system does play a part in psoriasis" (lecture on Psoriasis at the West London Post-Graduate College). 2i6 ADVANCED SUGGESTION Before going to press I treated an interesting case — an officer who had suffered from psoriasis for eight years. This had been kept under by ointments ordered by a leading specialist, but was never cured by any of the best local and general treatments he could think of. When war broke out the patient was afraid his brother officers might observe his spots and suspect him of suffering from syphilis. As this idea took hold of him the psoriasis extended, until he became desperately afraid of having to leave the army. When he came to me he had decided to obtain his discharge unless I could cure him. After two treatments the edges ceased to spread, regression being obvious after four days. After two weeks he was well enough to discontinue treatment. I have since received a report to the effect that he is no longer troubled with the complaint, and has con- tinued on active service as a pilot in the Flying Corps. It seems worth noting that one of the commonest and most readily observed effects of neuroinduction is a softness and healthfulness of the skin of patients. Relatives of patients often remark this. At the same time those whose hair has fallen out during their illness almost invariably find the growth returning. The hair soon shows a natural moisture and lustre : I have never seen better instances of restored crops — in some cases after entire baldness of the top of the head. In a case of psychasthenia, in which the falling-off of hair was the chief factor in causation, all difficulties in mind and body ceased from the day upon which SKIN DISORDERS 21; new hair was found to be developing, as a result of general neuroinduction, without any reference being made to the local condition, and without any palpa- tion. In case there should be any specialists in the treat- ment of skin disorders who are inclined to be sceptical, or possibly scornful, or over-sensitively antagonistic, I will close this chapter by referring to the case of a medical man's son. I pick this out because it will be taken for granted as being at least probable that before the very near relative of a medical man was pronounced incurable all the best advice procurable would have been sought — particularly as the patient happened to be an only son. He was finally sent to me, after years of psychas- thenia, which followed a very advanced and successful course of education. Among other troubles was acne vulgaris, which was so extensive that he was not fit to be seen in public. On the face and neck it seemed impossible to place a finger-tip upon a sound piece of skin, the spots varying between a number which were absolutely fresh, and inflammatory, and others in the scaliness of recovery from the acute stages. The patient was also bald on the top of the head, the remainder of the hair having the appearance of being dry and badly nourished. A few months after treatment by neuroinduction — without any dieting or medicinal treatment whatever — in addition to the whole skin becoming clear, a thick healthy crop of hair grew where the baldness had been. 2i8 ADVANCED SUGGESTION I am of opinion that gastro-enteritic toxaemia, through dyspepsia — itself caused by worry — was the circle diagnosis of the skin disorder in this case, and that it was cured by normal functioning, which was brought about by neuroinduction acting both physic- ally and mentally. Lloyd W. Ketron and John H. King of America have studied the condition of the gastro-intestinal tract in this disorder. They found disorder in the region in 60 per cent, of the cases ; they considered that toxaemic absorption had taken place, which was the cause of the acne vulgaris. Albert Strickler has pointed out that — "It is a well-established fact that puberty is an important predisposing factor in the development of acne. It is unusual to see acne before the eleventh or twelfth year, although we have recently observed a case in a girl, aged nine years. It can be stated that acne vulgaris is most common between the fifteenth and thirtieth years, although cases are observed until the age of forty years. . . . That female patients will often remark that their acne gets worse at the menstrual period can be attested by most dermatologists." CHAPTER XIV A STUDY IN MORBID GROWTHS I WANT the help of friends in this chapter as much as in any. For here I may possibly get into serious trouble with critics. I go into the ring and shake hands, admitting the possibility of terrible blows awaiting me if I seriously slip. But I do not ask for a decision from any referee; I merely ask all readers to think very carefully. I shall not be disappointed if I get nothing from the crowd. If I am hissed for my impudence, I shall still have had my fling. I shall make some points without a doubt, and give my opponents some exercise; more I can hardly expect at this conjuncture. Professor Rutherford Morison has defined inflam- mation as — " The reaction of irritated and damaged tissues which still retain vitality, or a series of vital changes which occur in the tissues in response to irritation. The irritants are either non-infective or infective; the former comprising mechanical, electrical, chemical, and thermal agents, and such things as X rays, etc. ; the latter including the micro-organisms." Charles F. M. Saint, F.R.C.S., has given "some examples of tumours certainly or probably depending 219 220 ADVANCED SUGGESTION on irritation of some kind for their production," such asHpomata, fibromata, fibromyomata, and papillomata, and ha^ pointed out how prone some of the latter are to become epitheliomatous. Sir James Goodhart may also be quoted : "Are we wrong to expect that, if a complex body is possessed of energy or many centres of energy for orderly growth and development, this disposition or force will not now and then slip its leash and run off on its own account ? An analogy of this kind seems to me to convey a workable conception of a scheme of malignancy, where ordered growth diverges by successive steps of variation, of indulgence in func- tion, until cancer appears, until malignancy becomes the insanity, shall I say, of function." Dr. J. Thomson Shirlaw writes to the British Medical Journal: "I hold that the force for orderly growth and development is the chemical action of the secretions of the ductless glands." Mansell Moullin writes, April 27, 1914 : " There are certain clinical facts which seem to me to point with no uncertain finger. The secret of the origin of tumours (including cancer) lies not in trying to find influences or agents that will stimulate growth and reproduction, but in isolating and investigating the action of substances that possess the power of checking development and interfering with functional activity. Development controls growth and reproduc- tion. If development is arrested (as, for example, the development of epithelial cells is arrested under certain conditions by arsenic and soot) the functional activity of the tissues is arrested ; the power of growth and A STUDY IN MORBID GROWTHS 221 reproduction, or so much of it as the cells still retain, is freed from control, and if there is the least provoca- tion, such as may be caused by continued irritation, cells and tissues at once begin to increase and multiply at their own free will. The result is a shapeless, form- less mass of cells, resembling more or less closely the parent that gave them birth, never advancing beyond it in development, never doing any useful work, but growing without ceasing, so long as there are supplies of food — in other words, a tumour." Dr. H. G. Adamson writes as follows in the Lancet for March 21, 1914: " A striking feature in the etiology of squamous-cell epithelioma, in contrast to that of rodent ulcer, is that it arises always upon skin or mucous membrane which has been previously damaged by injury or which has been the seat of long continued local irritation. Among these 'precancerous' conditions are scars from bums, old syphilitic scars or the scars of lupus, chronic irrita- tion of the lower lip from pipe-smoking, leucoplakia of the tongue or vulva, the scars of X ray burns, and perhaps most common of all, the results of chronic dermatitis produced by frequent exposure to sunlight and known as keratosis senilis, sailor's skin or tropical skin. The same may be said of carcinoma, which occurs at the pylorus, in the gall duct or gall bladder, at the cervix uteri, and in the lower part of the bowel. All these parts are liable to chronic inflammation or ulcerations, and carcinoma in these spots is probably consecutive to these conditions. The theory of dormant embryonic masses cannot explain these facts. The formation of carcinoma can be more reasonably attributed to an irregular proliferation of the epithelial cells, as a result of the loss of normal relations between the epidermis and the subjacent tissue. The anatomi- cal balance between different tissues which normally prevents the epithelium from invading the connective 222 ADVANCED SUGGESTION tissue is disturbed by damage and partial repair. Disturbance of the anatomical balance is assisted possibly by an upset of the biochemical balance, owing to alterations in the nutrition and metabolism of the cells due to age or to the harmful action of agents such as light or X rays. " In sections of keratosis senilis and of X ray scars one may study this gradual disturbance of the balance of growth, beginning with irregular restoration of the epidermis, through warty growths, to the final stage, in which the irregular growths of the epidermis advance completely out of line and invade the spaces between the connective-tissue cells. The study of these affections of the skin would seem to suggest that true carcinoma, in whichever situation, is the result of a disturbance of the normal balance of growth between epithelial and adjacent tissues as the result of previous damage, and there seems to be no need to invoke the aid of embryonic cell-rests or of microbic invasion." All the above passages are far more eloquent than anything which I could write, and I leave them to speak for themselves, being only too thankful for their help, so that we may pass on to another consideration. It has been long known amongst psychotherapists that quite localised stigmata such as petechias or minute aneurysmal varix could be produced on the skin by "suggestion." Dr. Gilbert Scott and others have obtained photographs of instances from experiments made by himself. He moreover found that these stigmata would develop without the skin being touched. I quote from an article written by him : "Whilst in the somnambulistic state, the patient's eyes were opened, and she was shown the half of a A STUDY IN MORBID GROWTHS 223 four-pointed, star-shaped piece of paper, and was ordered to reproduce the pattern on her arm in points of stigmatisation. Her arm was not touched in any way. March 14, a figure, more or less similar to the pattern, was produced in a faint manner on her arm." I offer this experiment made by Dr. Gilbert Scott in absolute confidence of its having been bona fide ; it is an indubitable proof of a scientific fact. Not only have he and others produced stigmata, but such may be produced by anyone employing a similar technique, which is one not at all difficult for the uninitiated to learn. Such experiments prove some central control over the vaso-motor mechanism of the skin. Let us now consider some cases of my own which carry the subject further', and which are instances of precisely the opposite kind to those of Dr. Gilbert Scott. Take one of pustule on a patient's neck. By means of neuroinduction I elicited the sense of shrink- ing of this pustule, and of the reddened area around it, with the result that in the course of twelve hours it showed definite signs of retrogression, until in a day or two it entirely disappeared, save for a slight mark. I do not say or know that all pustules would do so, but this did. I have not wasted valuable time in trying experiments upon other patients suffering from pus- tules, for I have been very busy treating many disorders for the past few years. But, after some three weeks' interval, a pustule again developed in the very same spot, the mark of the first not having entirely gone. 224 ADVANCED SUGGESTION Again I treated it, and it disappeared in a similar manner, leaving for a week or two just a very small scar to mark the place. It is now five years since then, and the patient has had no recurrence. Amongst my nervous patients, eight years ago, was one having a wart on the knuckle of a finger, so large and inconvenient | inch in diameter at the base) that I recommended her to a local surgeon, for it seemed that any of the superficial applications would take far too long a time. The surgeon cut it off. But to my amazement the patient came to me a few days after healing was complete, and showed me the back of her hand, with twenty-five to thirty other warts developing. I concluded that these must be neuro- pathic, and decided that this would be conclusively proved if neuroinduction, designed to effect retrogres- sion, were successful. I treated about half the number at the first sitting; and each of these showed signs of shrinkage within twenty-four hours; while the remainder were unaffected, and I dealt with these at a second sitting. In a week the whole skin had a level surface. Analysis revealed the fact that a scare had entered the patient's mind; she thought that "it would be awful if many warts came, and if they all had to be cut away under chloroform." In my opinion this idea constituted the central initiating factor which produced the crop. I must apologise for referring so much to the writings of others ; I am, however, doing all I can to convey my A STUDY IN MORBID GROWTHS 225 message in as little space as possible, although the subject might easily be found worthy of a large volume all to itself. Rubens Duval has pointed out that — "Many of the malignant tumours removed by the surgeon contain abundant microscopic evidence that the organism has been reacting to the irritation they cause, and has done what it can to cause their spon- taneous regression. The sclerosis of the fibrous tissue round a cancer often leads to the death of masses of the cancer cells, as Sampson Handley and others have pointed out, and this may be regarded as a * defensive reaction' of these connective tissues by theologists. The bloodvessels join in the defence by obliterative processes, which still further cut off the supply of nutri- tion to the cancer cells." The British Medical Journal has commented : "As regards the modifications exhibited by the carcinomatous cells themselves, loss of vitality may be indicated in several ways. This is well shown by the results of treatment with radium. Radium causes the rapid necrosis and dissolution of some of the cancerous cells, others are similarly destroyed but more slowly, while others exhibit a phase of monstrous hypertrophy as a preliminary to rapid disintegration; and, as a final condition, some of them appear to be converted into normal cells (epithelial cells in the case of an epithelioma), and to ripen and run the natural course of evolution characteristic of the cells from which the malignant neoplasm originally arose." I wrote the following 8^ pages some time before finishing this book, and I offered it to two of the leading medical journals. It was declined — for 15 226 ADVANCED SUGGESTION what reason I shall probably never know; but I can only think, in all charitableness of heart, that the time was not ripe for it. Cancer and some Cogent Arguments At a moment when the treatment of cancer and other conditions by radium is receiving much deserved attention on the part of the public and medical profes- sion, and while enthusiasm is running high, I desire to put on record some conclusions which I have arrived at during the past five years. I am aware of instances of spontaneous reduction and disappearance of abnormal growths. I have also heard of some few favourable results having been claimed by certain experimenters in treatment by suggestion, who have not known how the effects were produced, even if they really obtained any at all, and who have not been able by applying definite technique in manipulation or speech to obtain repeated results. I have sought to obtain results beyond these, which could be explained. I must humbly enter my claim to be the first medical man who has succeeded in obtain- ing definite results of a curative nature in cases of organic disease and new growths by means of psycho- therapy, while being able to explain the technique and rationale employed in a manner which could be readily understood and adopted by other scientists. Having for many years been interested in psycho- therapy, and having made a special study of its A StUDY IN MORBID GROWTHS 2^; beneficial effects in nervous and mental disorders, I found, incidentally, that some remarkable effects were to be obtained upon the heart and the circulation. In 1908 I began to study the effects of suggestion upon the sympathetic nervous system — upon the vaso-motor mechanism and the blood circulation, both general and local. In the case of various organic conditions and new growths I succeeded in reducing size and in altering consistency in a hopelessly advanced case of cancer. At the same time, in cases of benignant new growths, I caused a decrease of the blood-supply, a reduction of the swelling, and in a short time the disappearance of the abnormality. In 1909 I obtained still more encouraging results, and was successful not only in preventing further obvious development in a recurrent case of cancer of the breast, but in causing nodules actually developed to regress and disappear. In 191 o I was further successful. I did not have the nodules microscopically examined : it is immaterial to me at the moment whether they were cancerous or no. In 191 1 I sent a letter to the British Medical Journal referring to my work and results, for which this journal could not find space, though I wrote again expressing astonishment that such an important communication should be crowded out. I am of opinion that the editor did not regard my observations with any confi- dence. I thus realised that the time was not ripe for such advanced work to be seriously regarded. Humble representations to certain other authorities, :^28 ADVANCED SUGGESTION and the dilatory responses elicited, did not encourage me to press my claims any further at the time. By no means the least difficulty I had to contend with at this period was the lack of material in respect of which I could extend my inquiries and experiments. Prompt surgical operation being the best form of treat- ment then known, having been fully tried and proved, every patient had a right to be allowed the benefit of it. The nature of my experiments was so little under- stood by others, and so sceptically regarded, that it was naturally not easy for me to fi.nd help anywhere. I had no other alternative but to accept this state of affairs with patience and forbearance, but with quite a healthy confidence that time would show. In 191 2 I made inquiry into the effects of Roentgen rays and radium ; I visited the Radium Institute for the purpose. I sent a case there for treatment, a woman suffering from advanced uterine cancer. As a result my conception was strengthened of the great likelihood that radium and Roentgen rays acted to an appreciable extent by suggestion. It will therefore be noted that my work in respect of new growths and cancer has necessarily proceeded very slowly; in fact, since 191 1 it has not been con- tinued, partly for the reasons explained, but also because I have been deeply engaged in other work — which I can hardly count of less importance, looking over the results. I have all the time been quite content with the belief that while organic conditions had better wait awhile, the work I continued to pursue in other A STUDY IN MORBID GROWTHS 229 directions would ultimately serve to help me to prove my contentions whenever I might return again to the question of abnormal growths. Meanwhile I have to note : — 1. In the absence of any better explanation we have a right to view' some cases of spontaneous cure as being possibly brought about by autosuggestion. One of the greatest surgeons and authorities on cancer (Butlin) spoke and wrote as follows (British Medical Journaly June 18, 191 o) : "Internal tumours disappear in persons who have been condemned to death by the most capable sur- geons ... as if by magic, ... as we occasionally know to our chagrin. ... I would ask whether it is not possible that a power of resistance may, once in many thousand cases, be acquired under the influence of a mental condition. And in referring to cases of spontaneous cure he declared : ' We are obliged to accept them as facts, but we are unable to explain them.'" 2. I have observed that the more genuinely cheerful a cancer patient is the longer will he live, other things being equal. In one case which was the object of particular observation, recurrence ceased when the person developed the disposition to worry less. It seems that idea of growth (including gloomy appre- hension) tends to further growth. Indifference towards growth tends to the maintenance of the status quo, other things being equal. Indifference towards abnormal growth plus a sense of healthy well- being and easy thinking tends to diminution and dis- 230 ADVANCED SUGGESTION appearance, other things being equal. The idea of a cure — a smihng inkhng of betterment — has a curative tendency, not only as regards morbid growths, but in the case of any disorder which is curable, other things being equal. 3. Many new remedies have created a favourable impression on the patient ; they have appeared to give benefit for a time. In some instances this has been on account of great concentration of the thoughts upon the idea of a cure which has resulted from their, use. 4. In the method of treatment by radium there are conditions which are highly favourable to the entry of the curative power of suggestion — {a) Lying very still for some time in a quiet room, thinking hopefully of a wonderful treatment so very highly spoken of, and so impressively and cleverly applied. {b) Mental concentration upon the diseased spot in a happier plane of thought, which is more marked when remedial applications are employed, also tangible and visible instruments, there being obvious sensation and perception. 5. I have myself, at will — knowing how to act and what to expect — obtained unquestionable results by psychotherapy in dealing with examples of organic disease and abnormal growth, which could not be exceeded by radium in similar cases. 6. The blood-supply can be very powerfully influ- enced, generally and locally, by neuroinductign^ A STUDY IN MORBID GROWTHS 231 visibly so, in fact. Now, the influence of radium on the bloodvessels and in checking haemorrhage has been found to be very prompt and definite. 7. It was reported that the bottles of radium emanations sent forth to patients in large numbers were producing "very encouraging effects." This report is to me extremely suggestive of the fact that suggestion may have been at work under this method of application. 8. I have indisputable proof of organic disorder and the development of new growth having been originated by suggestion. In one such case I have reversed the causative impression, and the new growth has regressed and disappeared. 9. In all inflammatory conditions, and in cases of functionally uncontrollable arterial dilation or con- traction, suggestion, when applied in certain ways, will act most powerfully either to increase or to diminish. 10. I have watched a case of inflammatory swelling which appeared and disappeared, afterwards becom- ing definitely periodic, and, later on, permanent ; and I have little doubt that operation would have been found necessary had not the patient been treated by suggestion, which first caused regression to the point of disappearance and then prevented recurrence. 11. I know how suggestion acts upon the blood- supply, and can demonstrate that it does so act. Now, nobody knows as yet absolutely and finally how radium acts. There are many who are not satisfied 232 ADVANCED SUGGESTION that radium possesses all the virtues it is credited with. Not a scientist could be found to dispute the effect and the explanation of my application of psychotherapy, for obvious effects can be produced, in some instances immediately. 12. Psychotherapy, as I am able to demonstrate, acts in three ways : Firstly, locally, influencing the vaso-motor mechanism; secondly, generally influ- encing the vaso-motor mechanism; thirdly, "sympa- thetically," producing remarkable improvements in the functioning of the glands. Psychotherapy read- justs, permits, and encourages the vis medicatrix natures. 13. The effects of psychotherapy on the organic con- ditions and new growths referred to have not only been studied directly, they have been observed in con- nection with a profound study of the nervous system ; hence a rationale of the treatment has been the more readily forthcoming. Many equally striking and con- vincing conclusions may be recorded respecting the effects of psychotherapy in certain mental and nervous disorders, and, indeed, in other specific organic con- ditions. 14. In opening a discussion on radium and cancer at the annual meeting of the British Medical Associa- tion in July, 191 3, Sir Alfred Pearce Gould said: " I shall never say otherwise than that any case of cancer which seems to have been cured by surgical operation has really been cured as a result of the com- bined work of the surgeon and of the great power of natural tissue resistance." A STUDY IN MORBID GROWTHS 233 On the same occasion Dr. Frank Fowler, in referring to results, concluded : " The relief that assurance gives to the patient helps to prevent the downward course that often follows the diagnosis of cancer. I do not attempt to discriminate the good that is done by the X rays, and that done by my confidence in their beneficial effect." 15. In referring to the action of X rays in certain skin diseases, Dr. Ernest Dore has mentioned {British Medical Journal October 18, 191 3) more than one case in which certain patches had been treated with success, while other patches, not treated, in the same patients, and at the same time, had also been cleared up. 16. Different authorities have written as follows : " Depression, grief, mental shock, worry or fear, appear to be predisposing causes of cancer." ... " Perverted or weakened nerve influence and impaired resistance are probably the determining factors." "A cancer growth is sick protoplasm worried by abnormal innervation." 17. Authorities have found that adrenin applied to cancerous growths has resulted in "unquestionable cure in some cases." We have thus two distinct and important claims — {a) that the X rays influence the blood-supply, and possibly also local nerve-supply; and (J)) that adrenin influences the blood-supply. I do not hesitate to advance the possibility that the X rays or adrenin, plus psychotherapy — specially modified and administered — might be found to agl; 234 ADVANCED SUGGESTION even more favourably than any one of these agencies employed alone. 1 8. It can hardly be doubted that cancer is a disease arising from both a local and a general cause. It would further seem that cures have been effected by agencies which have attacked both. When the X rays have been successful the local application has probably co-operated with an unintended mental suggestion which has happened to be of a sufficient character. Similarly in the case of adrenin. When spontaneous cure has taken place, are we not entitled to consider that some unknown influence has been at work both generally and locally ? When psychotherapy has acted favourably, are we not justified in concluding that both local and general effects have been produced ? Having long ago established the fact that cancer and new growths can be readily affected by sugges- tion, all I humbly ask at this juncture is that the reality of psychotherapeutic effects should be borne in the mind while considering other treatments. In the recurrent cancer case referred to in the above article, it may be that the disease only appeared to be recurrent. I have no desire to make any undue claim. It might be that I merely reduced the swelling. I am satisfied for the time being that very soon after the publication of these particulars the truth will be forth- coming. Meanwhile I can only say that the case seemed to me to be one of the recurrent type. I should like to add a few further contributions to A STUDY IN MORBID GROWTHS 235 the argument. Barling wrote (July 30, 1910, in the British Medical Journal) : "We can recognise one striking feature in the dis- tinction of cancer (epithelial) common to the experi- mental production of immunity, to the disappearance of the growths under radium, to spontaneous recessive processes in the human body. This is the active part played by the connective tissues; we have an irri- tative overgrowth and subsequent contraction which appears to determine the death of the epithelial cell." The following is also worth quoting from a leader in the British Medical Journal : "Just as the functional diseases underlie certain mental states, so disturbances of the mind or spirit may cause or aggravate certain bodily ailments. This is especially the case in the region of nervous diseases, but depression, grief and mental shock, worry or fear, appear to be predisposing causes of cancer and other organic affections." We may well ask : Does a local strain, injury, or irritation exhaust the local tone of the nervous or vascular supply, and so induce cell proliferation ? Dr. Aspinall Marsden writes (British Medical Journal) : "I believe that in cases of malignant growth per- verted or weakened nerve influence and impaired resistance on the part of the tissues are probably the determining factors. "In my view the changed nerve influence brings about a resuscitation of the ancestral reproductive faculty," 236 ADVANCED SUGGESTION Dr. Thompson Shirlaw writes {British Medical Journal) : " I fear that I do not see eye to eye with Dr. Brock where he considers that cancer is *a dissociation of personahty ' somewhat similar to that found in hysteria and alhed neuroses. In the latter I agree that 'the psychic condition of the patient is one of anarchy.' In cancer, on the other hand, there is no psychic condition to be considered, but a material pathological state, which can only be explained in a material way. ... I believe that the 'controller' or * governor ' is of the nature of a secretion, and that it is a combination of the secretion of the thyroid, the adrenals, and the pituitary body. The President of the Royal College of Surgeons in Ireland has pub- lished a case of glandular recurrence after extirpation of a carcinoma of the larynx, in which the growths disappeared on treatment with thyroid extract, and asked some important and interesting questions : " I. What is the nature of the influence of the thyroid extract and by what process did the tumour melt? (My answer is that the thyroid furnishes a large part of the governing secretion; the mutinous cells are checked and are brought into line with the loyalists whose good example softens their hearts.) " 2. How far does the existence of such cases go to prove that one of the conditions necessary for the occurrence of cancer in an individual is some defective or abnormal internal secretion ? (In my opinion it goes a long way in verifying such a hypothesis.) "3. Why does thyroid extract cure a few cases and leave others unaffected ? (For the simple reason that the thyroid furnishes only one of the necessary secretions.)" Our consideration of the problem is no less assisted by those who have, recorded their experiences A STUDY IN MORBID GROWTHS 23; of X rays and radium in the treatment of new growths. Dr. Dawson Turner, in a recently published volume, has enumerated certain conditions in which radium emanation treatment has been found beneficial, such as "gout, chronic articular rheumatism, gonorrhoeal rheumatism, rheumatoid arthritis, neuralgias of all kinds, certain diseases of women, high blood-pressure, premature old age." Now, we know to-day how much the nervous factor contributes to causation in all these, particularly in cases of gout, rheumatism, rheu- matoid arthritis, and high blood-pressure. As to premature old age, this is so often the result of untoward circumstances of living that it may well be described as a big " arc " of " vicious circling." Dr. Fernaud de Verteuil writes : "A third theory, propounded by Deane Butcher, is that radium possibly acts as a vaccine, its rays exciting the leucocytes to the production of antibodies. In support of this it might be stated that the opsonic index has been found raised after applications both of X rays and radium. " I have been using radium in my practice during the last two years, and the chief thing that has struck me about it is its wonderful influence on bloodvessels and lymphatics. The remarkable power that radium has in arresting haemorrhage was referred to by several speakers at the last annual meeting of the British Medical Association. It may, in fact, be stated that its chief utility in therapeutics is its power of obliterat- ing bloodvessels or spaces, as witness the way in which it removes various forms of naevi and angiomata. Now it seems to me that this action of radium on ^38 ADVANCED SUGGESTION vascular tissues will equally explain to a large extent its beneficial influence in new growths. The oblitera- tion of the blood channels which ramify in and supply the growth would in great measure tend to cut off its source of nutriment, which must eventually result in the death and disappearance of the growth." Just what determines the character of the local sign in pemphigus, eczema, psoriasis, and herpes, it may be very difficult at the moment to decide, but that the vaso-motor mechanism can be influenced in these diseases by neuroinduction cannot be questioned. I know that neuroinduction produces vaso-motor contractile effects, on local blood and lymph vessels and on secretory apparatus; it is proved also that a normal disposition of parts can be induced under the influence of a central impression. The reason I offer is that the central aid is of the nature of a correction of association; negative conceptions become positive, and produce sympathetic reflex effects accordingly. The reader may ask for some description of the particular technique employed. The physician having inducted towards the perfect physiological relaxation of every system, the diseased part should then be slightly palpated while words are spoken which convey the idea of a shrinking, shrivelling, con- tracting, and healthful feeling, in place of the very opposite conception that has existed in the patient's mind. CHAPTER XV GYNAECOLOGY Disorders of Menstruation In no department of medicine or surgery is psycho- therapy more strikingly effectual than in disorders of menstruation. I feel almost tempted to write no more than this under the heading, for the evidence is so abundant ; a whole book could be written on the sub- ject, and cases cited without end. I hesitate to continue. I feel I would rather avoid the recital of so many instances of operations being performed, curettings and dilatations galore, which have been ineffectual, while psychotherapy has easily corrected the difficulty. But I am not quite so absurdly obsessed as to declare there are no menstrual disorders requiring the surgeon's operation. There are many. My message is, that the majority of menstrual disorders are better treated by psycho- therapy than by anything else in this world. I shall have no difficulty in proving this if any medical society will offer me a platform. And I will promise not to reveal the names of surgeons, great and small, who have preceded me in the cases cited. Whether menstruation Be profuse, painful, scanty, 239 240 ADVANCED SUGGESTION or abnormally suppressed, seems to matter very little ; the patient can be inducted to the normal state, pro- vided no gross organic condition is at the foundation of the trouble, and provided the mental power of the patient is sufficient to allow of development, if not already quite adequate. But need we be astonished at this, after what we have seen respecting other disorders ? Should we not rather expect very favourable results in this connec- tion? Have we not already glimpsed the substance of this chapter through the lines of the foregoing pages on constipation? I will cite one or two cases — selected because they offer points of interest : A dancer, twenty years of age, was sent to me by a leading gynaecologist, suffering from irregular men- struation and floodings. Being a consultant of advanced ideas, after having prescribed everything else he could think of, he did not recommend an operation. Nothing abnormal took place as to men- struation after commencing treatment. Analysis (again not Freud's) showed that not only had the patient two years previously suffered from a rather increased amount of discharge at a few periods, but that this had since established hysterical exaggera- tions and misrepresentations. Extreme menstrual irregularity was complained of by a singer whose profession demanded her appearance before the public. Analysis showed that she had once been notified to appear before royalty ; the excitement GYNECOLOGY 241 of this caused delay, the worry of which estabhshed a permanent tendency. A married woman suffered from a menstrual flow which was unaccountably prolonged over two weeks. A general practitioner was called in by telephone, the nature of the case being explained. He arrived at the bedside and put down a bag on the floor, which the patient declared was an instrument bag — she said she had seen them before and knew them only too well. She declined operation or even examination. He prescribed ergot, and told the husband that if that was ineffective he should decline to attend again. The patient continued to suffer. Thereupon a specialist was called in. He recommended neuroinduction, and there was no more trouble. In treating disorders of menstruation one often has the satisfaction of finding that the more severe the symptoms the more rapid is the cure under psycho- therapy ; one finds the same thing in cases of skin disease, incontinence of urine, throat spasm, etc. Little attacks of many different disorders are some- times more difficult to cure than more pronounced ones. This is not astonishing when one analyses the "negative arcs." For should a slight complaint be taken to a specialist, while others of a more serious nature exist, although not deemed so important by the patient, then the smaller " arc " is almost certain to be kept going by the larger ones; on the other hand, if the "arc" complained of be the largest of several, it will receive particular treatment, the smaller ones 16 242 ADVANCED SUGGESTION being ignored : concentration on the big " arc " cures all the troubles promptly; concentration on the small one produces little effect. Hence the importance of detecting all "arcs," and of dealing indirectly with them when occasion indicates. Obstetrics r must ask the reader to excuse a passing reference to obstetrics under gynaecology; I can find no better place for the subject in any other chapter. I will merely give a case — well knowing that other psycho- therapists have obtained almost similar results — because I consider that it is interesting in the general consideration of the subject : When in general practice, some two years before I became engaged solely in special work, a pianist had been treated by me for hysteria, by psychotherapy. On becoming pregnant she dreaded the event of par- turition and asked if I would attend her. During the early pains she sent for me, the time of day being seven o'clock in the evening. By neuroinduction I enabled her to obtain natural sleep at bedtime, not- withstanding the fact that progress toward the birth of the child was being made all the time. At four in the morning I was telephoned for by the nurse, who excitedly declared that she had just found the baby in bed on being awakened by the patient. The latter had known nothing until she felt the child between her legs; she then called the nurse, who was herself fast asleep in an armchair. GYNECOLOGY 243 Cases of alteration of the amount and quality of mothers' milk have been referred to in a previous chapter. I have obtained many most satisfactory results from treating "expectant" mothers during the war years, and while there were air-raid possibilities, who have feared unfavourable eventualities of various kinds. One or two applications of neuroinduction have served to steady the whole nervous system and given oppor- tunities (incidentally) for improving the potentialities of the patients for their ensuing "confinement" — invariably reducing both the general and local dis- tress of " labour." CHAPTER XVI CRIMINAL INCLINATIONS Kleptomania I HAVE found some cases of kleptomania to have had their origin in mental traumata which have occurred in very early life. Analysis has revealed mixed emotional elevation due to the fact that an article of value has been taken, and has been missed by its owner, the success having involved sensations of pride at outwit- ting the latter, as well as delight in possessing the article, alternating with general fear, to which may be added dread of punishment and anticipation of accumulating anger and distrust. In other cases accu- sation has been "rubbed in," perhaps for weeks, the patient having been in the position of a prisoner incar- cerated for a first offence, who has decided that he was the sort of person known as a criminal, and felt he could not be otherwise, being afterwards attracted by opportunities for repetition of the act (just'' as a moth is attracted by any light that may be visible), there being little chance for the introduction of positive correction of a sufficiently emotional nature. I have found cases easy to treat by a neuroinduction which will permit positive emotion to exercise its 244 CRIMINAL INCLINATIONS - 245 neutralising force. The following instance may be studied. A young woman of gentle birth and breed- ing, aged twenty, was sent to me by a neurologist of high standing, suffering from kleptomania, falsehood, and general bad behaviour, with a history of having been for some time entirely uncontrollable by her parents. In the advanced stages she had given false names and addresses upon ordering valuable clothing, while nothing left lying about anywhere near her was safe. She had even learned all the procedure of pawning, as a secondary development, having discovered that to take things of great value meant further possibilities and delights quite beyond the mere satisfaction of a craving. She now enjoyed the sensation of defeating others and the idea that they were powerless to prevent her depredations. She was a most amiable girl and showed signs of being well-informed and clever. She had no supraconscious answer to the question as to "why she did these things." She simply replied with an artful smile : " I don't know." Treatment by neuroinduction stopped her telling falsehoods within a week, when she also exhibited the sincerest wish to do everything that was right, making me cautiously suspicious of the real genuineness of her remorse in one so capable in cunning. She never took anything belonging to another from the first treatment, and seemed very happy to learn how to win the trust of those about her. It is now three years since she was treated, and during this time she has been so happy and safe that I would, with the utmost confi- 246 ADVANCED SUGGESTION dence, recommend her as a teacher of others who should exhibit disorderly tendencies. She is now as industriously capable in right conduct as she was formerly studious in wrong-doing. Her appearance altered greatly; from looking furtive, miserable, and older than her age, because somewhat drawn in the face, she became brighter, more open-eyed, more intelli- gent and younger looking. She only required a few easy lessons before she altered negative trends of thought to positive, during which time analysis dis- covered a very early instance of stealing, on which occasion she had experienced a feeling of intense anger on being reproved, which had made her feel defiant, and inclined to "do it again." Later on she found that she could "make it pay," and that there was no reason why she should not continue to steal, "having got the name for it." She further explained that the knowledge that her mother was so ashamed of her and so anxious to keep her wickedness from the knowledge of others made her bolder still. Kleptomania is very often associated with some sexual strain. Women who have some growth or disease of the sexual organs are especially prone to kleptomania of a selfish or spiteful order. The thoughts running in the mind of one patient were these : " I have troubles which others do not seem to have. I wish they had something of the kind. I cannot give them any very well, but I can take some- thing belonging to them, and I will do so." Such sufferers appear as though they wish to vent their spite CRIMINAL INCLINATIONS 24; in one way or another, and the secret satisfaction is found to be more gratifying to self and more successful than anything open could be. I have known patients to be pained by the disadvantages of some illness, who have felt "hateful" towards others who are well. "Get out of my sight," I once heard a wife remark, with tense anger, to her husband, who stood sympa- thising at her bedside. " You are not suffering from cancer; you are well. You don't know what I feel." Toxaemia is sometimes an "arc" in the "vicious circling " of this class of case. Strivings and yearnings after a lover will some- times bring on kleptomania. Anxiety lest there shall be failure to attract, or a great desire to possess some- thing in order to help on a closer relationship, may be exhibited, together with a certain amount of jealousy because others are seen to be so happy and so much better off. There is another form of kleptomania in which early trauma may be found, in adult males more commonly, when self-flattery seems to have been the dominant error of emotion. A boy, having once prided himself on his cleverness in being able to take things without being "found out," will very quickly develop cunning and untruthfulness, and may go to great lengths to satisfy his vanity. I have had occasion to analyse such cases, from which I will select one, that of a man thirty-seven years of age. He owned a lucrative business; by means of a police trap, he was caught stealing from a house which he was surveying for 248 ADVANCED SUGGESTION repairs. He had gone so far as to believe, after years of practice, that a man in his position would never be suspected ; all the time he fed his conceited notions by instances showing how clever he was as compared with others. He had felt obliged to run many risks since his school-days, until there came a time when he was overworked; then the very strongest inclinations developed, with a newly added spirit of contempt for people whom he knew were not so clever as he. He had impulses to take something to prove his "smart- ness," recalling instances of what he used to do so often years ago. Anxiety to obtain material advan- tage while suffering from overstrain in business had also made him abnormally jealous. When arrested by the police he coolly displayed the most earnest diligence in defending himself, exhibit- ing almost an insane self-persuasion that he was really too good a man to do anything wrong. Such was the cleavage in his personality that he did not appear to be in the least ashamed ; he seemed to feel the incon- venience which his arrest was to his wife and himself, and the loss it meant to him in his business, more than anything else. He answered his friends* questions, and my own, with an air of injured guilt, as though everybody had better be careful what they said or did with him, all the time appearing to carry in his mind the idea that he was really very clever and cap- able and meant to show it, whatever happened — as, indeed, he was well known to be, both in respect of his business and in his public appointments. CRIMINAL INCLINATIONS m Success had brought his ultimate downfall, for it had prompted overwork. In the strain of his position, worry and ill-health repeatedly admitted some of the negative tendencies and reminiscences of his boyhood. He was not punished, though the offences with which he was charged had been continuing for two years, and they were very many; on the contrary, in a few weeks' time he was appointed to a very high position, the case having being considered by influential friends to be one of temporary mental aberration. People of artistic ability who are very ambitious and yet unsuccessful will sometimes develop kleptomania, the underlying aberration being of a desperately jealous nature; victims of this disorder usually suffer from dyspepsia, with loss of weight, due to worry. I am of opinion that not only should all cases of theft which are committed by those who are not habitual criminals be sifted by a medical expert, but that all criminals should be to some extent scientific- ally analysed, no matter what may be the nature of their crimes. Every prison or remand establishment should be in a position to call in a medical analyst who has had some experience of nervous and mental dis- orders, so that each prisoner may have the nature and causation of his offence gauged before sentence is pro- nounced. This may seem to be a counsel of too great perfection, but we shall move in this direction before many years pass. That eminent doctors should appear in defence, when crime is committed by the classes, while the masses must take their chance with- 250 ADVANCED SUGGESTION out such sound advice, cannot make for the best of all possible worlds. Homicide The recommendations of the last paragraph may be advanced with still greater insistence in respect of homicide or outrageous assaults of any kind, for very many of these cases are the result of mental aberration. Every doctor knows how often a person suffering from masked or suppressed epilepsy may develop insane tendencies to attack man or beast. Early signs of lust for blood should be promptly dealt with by the doctor, when detected, if serious tragedy is to be avoided later on ; the love of killing even birds or small animals in childhood or youth may develop very dangerously in after-life. The instance has come to my notice of a boy of aristocratic and wealthy parentage who became so fascinated by the sight of death being inflicted on animals — having once seen sheep killed in a slaughter-house — that he subse- quently sought to have a slaughter-house built adjoin- ing his amateur carpenter^s shop, so that he could himself superintend the killing of animals. The following case may be found interesting and instructive : I was asked by a humanitarian friend to see the pet dog of a lady which had had its tongue cut out, for not only did she wish to know what should be done to the dog, but she desired to have the case investigated, so that the miscreant might be brought CRIMINAL INCLINATIONS 251 to justice, there being no clue as to who had done such a cruel thing, or what the real motive might have been. On close examination I found that the tongue had been cut to the extent of two-thirds of its breadth, while the remaining third had been pulled and torn through. The chances of the dog living happily were so very poor that I ordered it to be shot. In the presence of three specially chosen inspectors of different authori- tative bodies I then conducted an autopsy. I found that in addition to the cutting and pulling of the nature described there were two small cuts on the lower lip near the angle of the jaw. I concluded from the one-third of torn tissue that the dog had strenu- ously resisted, and had frantically pulled away from the person cutting the tongue. I considered that the two cuts in the lower lip were made in the desperate efforts of the person to hold the dog in order to complete his criminal work. I therefore thought it extremely likely that some part of the guilty person had also been cut — probably the outer side of the left hand. Upon this conclusion the police inspector went to work, to search for a person having a cut hand. A man was found within twenty -four hours, with a white bandage upon his left forefinger. The person hap- pened to occupy such a prominent position that it was at first deemed impossible that he should be the mis- creant. But more inquiries were made, and further confirmations accumulated. Yet there was not suffi- cient evidence to charge him; not only did it seem almost impossible to establish proof, but there was also ^2 ADVANCED SUGGESTION the risk of a charge of libel and slander being made against the police. I made further inquiries myself, and found evidence of lust for blood and a tendency to seek revenge in the history of the suspected man; he was also known to be greatly addicted to speaking to children in a suspicious manner. Steps were taken; he promptly left the neighbourhood. I had no hesitation in warning the authorities that such a person would be likely to commit still more serious offences. Some very strange cases of homicidal tendencies have come before my notice from time to time. I will give short notes of some of the more instructive : A distinguished girl student at one of the leading schools of learning alarmed her sister in the midst of important examination work by telling her that she was developing ideas of killing her father and brother. She was sent to me by a neurologist as being a suitable case for "suggestion." On being questioned, she cried, and explained that her ideas were extending even beyond those already referred to, and added : " The worst of it is they are the people I am most fond of." Neuroinduction and analysis proved the earliest indications of disorder to have been of a sexual nature. Amid the enthusiasm aroused by lectures and studies she had felt curious about her sexual organs, and when a male lecturer appeared before the students she had been frequently troubled with thoughts about the anatomical formation of both sexes. She was found to be vain, ambitious, and proud of being above the CRIMINAL INCLINATIONS 253 average in her work; very shortly after her abnormal ideas had developed she became far more inclined to enjoy the curiosity which others displayed about her homicidal thoughts than to be at all serious about them. As is common in many nervous and mental dis- orders, she became extremely obstinate while neuro- induction was proceeding. I frequently observed her tightened lips and defiantly-clenched fists when con- versing with her, the interviews having the effect of arousing a vigorous contest between healthier trains of thought and the impulses of disordered ideas. There came a period when she broke away entirely, and refused to be treated any more. It seemed as though she wished to retain the capacity for arousing interest in her abnormal ideas. After forty-eight hours truancy she returned, as I expected, having been clearly convinced by her sister that she was in some respects much better already. It is extremely fortunate for such people that, though they may for some time be drawn by "negatives" during treatment, they are actuated even more power- fully by "positives," if only these can be inculcated sufficiently before any "kicking" commences. After resuming treatment this patient proceeded without a hitch to perfect recovery, and in due course renewed her studies. She passed her examinations with honours, and has since been engaged most successfully in teaching, never having displayed any abnormal traits whatever. 254 ADVANCED SUGGESTION Here is another case : A girl had married. But there was such a history of nervous disorder in her case as made it very questionable whether she should have done so. The more serious indications had been kept from her husband's knowledge. She herself doubted whether she was mentally sound, and while going through the months of gestation (it being her first pregnancy) she developed emotional ideas as to the serious responsibility of bringing a child into the world; she also began to worry more particularly because she thought the child might be like herself — or even worse. When born the child possessed a slightly abnormally shaped head. From the birth of the child onwards the mother gradually developed the notion that she ought to kill it in some way : she later proceeded to worry over the precise way in which she had better do this. She also frequently thought of suicide. That the baby happened to be physically a fine specimen helped me considerably in my treatment of the patient, as did also the fact that it gave clear signs of unusual intelligence. The mother, now realis- ing these advantages, became all the more satisfied to keep it. She made a very good recovery, and became a good mother and mistress of her house. Analysis revealed sexual perversions from the age of six, while she had always been given to cunning and mealy-mouthed dissimulation. Vanity seems to arouse retaliatory and spiteful ideas on the part of some expectant mothers ; such may develop puerperal mania, and impulses to kill the CRIMINAL INCLINATIONS 255 infant when it is born. Analysis has revealed in other cases the development of anger and hatred on account of the use of instruments at birth, and of disgust at what has to them seemed a mutilation which they have been forced to undergo, and which has made them feel, as they have looked at themselves afterwards in the mirror, "sick to see the wreckage," thinking that the chances of enjoying life in future would be hopelessly marred. I have given various analyses, readily recognising the fact that the psychiatrist may have other explana- tions which may perhaps be equally valid in the majority of cases of puerperal mania that come before him. I frankly admit that I have treated only a few of these cases ; and I write from the point of view of a psychotherapist who has been successful with these few. Of course I admit that the "negative arc" of toxaemia enters as a factor in some instances. I am also mindful of the fact that some of the more severe cases have a history of epilepsy in the family, and frequently of insanity, as Sir George Savage has so well set forth in his works. In considering crime in the adult, or bad behaviour in the young, the question has often arisen in the minds of criminologists, neurologists, judges, and governors of gaols, as to what is the best form of punishment. Before a remedy can be applied satisfactorily to a disease or disorder of body it is a commonplace that a correct diagnosis should be made : it would seem that it should be precisely the same with disorders of 256 ADVANCED SUGGESTION the mind. Whether we have to deal with cases of trifling misbehaviour, or have to judge homicide, the mind should be sufficiently analysed. The pages of this book offer ample evidence of the fact that under certain circumstances sufferers will reveal their own inner thoughts. I have endeavoured to establish the fact, in a later chapter on analysis, that under a train- ing which balances and levels the thinking processes, and which also gives a stimulus to healthy energy, patients will very largely analyse themselves, and will, in their own interests, find a reason for revealing themselves to their advisers. Thus confessions of guilt may be made, not under compulsion of the rack or an inquisition " of the third degree," but as a result of seeing things in a truer light and in a better mental perspective, not under threat compelled by the will of another, but on account of the restoration of the patient's own will power — confusions and subcon- scious chaos having been cleared away. The medical director of the psychiatric clinic of the American Sing Sing prison has reported in the Journal of Mental Hygiene of April, 191 8, "that no less than 59 per cent, of 608 cases, in addition to evincing various conduct disorders — the direct cause of their imprisonment — also exhibited some form of nervous or mental abnormality, which in one way or another had conditioned their behaviour." This report is eloquent enough for anything, and it emanates from a country that is far ahead of Great Britain in the study both of criminals and mental deficients. CHAPTER XVII EARLY MORAL AND EDUCATIONAL It goes without saying that the sooner abnormal ten- dencies are discerned and treated the better, for the reasons already given ; it is the rule that the younger the patients the more easily are they treated by neuro- induction when supraconscious guidance has been found insufficient. That the young are very open to receive information is a commonplace, but they are also prone to develop great confusion in the supraconscious, for reasons which it would be superfluous to mention. There is a higher degree of receptivity in the subcon- scious of the young than exists in older people; the natural desire to acquire understanding is great in the growing and developing body and mind. We have seen in a foregoing chapter how in the adult the memory depends upon subconscious fitness and balance, how it may be restored from complete abeyance, and improved when weak, by subconscious training, while greater powers of concentration and detachment may be developed. It follows, therefore, that nothing can be so beneficial as neuroinduction when defects of mind power or abnormalities of func- tioning show themselves in the days of education. 257 17 258 ADVANCED SUGGESTION Even absolutely normal people may be improved by neuroinduction, just as an average individual may develop more powerful muscles by training. In America subconscious training has been tried in the normal with wonderful results, enabling pupils to acquire accomplishments of a very high order. Nevertheless I distinctly and emphatically advise against any undue subconscious "cramming" of the young, as I certainly would in the case of ordinary education. I consider that those psychotherapists who have succeeded in producing exceedingly clever and capable children — almost phenomenally so — have exceeded the limits of the justifiable. I consider that all we have any right to aim at in any method of dealing with the young is reasonable excellence, not supernormal precocity. But although I think there may be danger in forcing the young too far, it is only fair to remark that I have yet to learn that any untoward effect has actually been produced. Can- didly, I do not like the idea of aiming at an abnormal development of intellectual power, even in a useful direction. But I may be too cautious in this matter. The fact is that I prefer to be cautious for the time being. I do not think one could possibly overstrain adults in subconscious education; but I do think it may be possible to overstrain those who, because they are not old enough, are not completely developed anatomically or physiologically. Difficult boys and girls, and spoilt children, will, of course, very greatly benefit by neuroinduction, especi- EARLY MORAL AND EDUCATIONAL 259 ally when their bad behaviour has prevented any suc- cessful progress which ought to have been made. Many badly behaved and " incorrigible " children are really very capable if they are put on the right road. It is well known that some do no good at school, yet distinguish themselves later on. History records plenty of such examples. In these cases the emotional power of some chance interest has produced an auto- matic eagerness to cultivate — on certain lines, in the midst of their drifting — some employment which has led to success. Perhaps a hobby has gripped and fascinated the growing mind, and has subsequently been turned to profitable account. Extreme intelligence may itself be a cause of confusion as well as chief con- tributor to the supraconscious delights of life in the young ; the mixture may make for over-indulgence, and so cause parental despair, leading finally to the buying of a single ticket to one of the Colonies. It may well be imagined, after one has made an extensive study of various mentalities, how many youths might have dis- tinguished themselves in the past had psychotherapy been brought to bear upon them in order to create a better balance between the emotional impulses and a reasonable calmness of the subconscious under- standing, the latter being then enabled to control the former. Then, again, many boys and girls have been known to win excellent reputations, and to receive the best of reports on leaving school, who have gone altogether wrong directly afterwards. One of my patients had 26o ADVANCED SUGGESTION been dux in both school work and games, and had taken to drink within a year after the completion of his education. He had been "good" under the pleasant stimulus of winning plaudits for successes in certain grooves, while being under a control which he strictly regarded and wholly respected. When away from this, the world was at once too fascinating and too exciting for him; like the horse at the corn bin, he wanted to take more than was good for him, so soon as he felt perfecdy free to help himself ad lib. Neuroinduction will enable a person to derive pleasure from hard, plain, ambitious thinking, who perhaps could never reach such under any other cir- cumstances. Many a boy has been packed off abroad to find his way in a pitiless unhelpful world, unhappy, yet knowing that he possessed capabilities, never to rise again, who, if he had been placed under a psycho- therapist of quite elementary powers, would have been saved to become a credit to his family. If there are instances of "spontaneous cure" — as I believe there are many of them — then all I can say is that there would be many more under scientific treatment. I have known several " bad boys " return home to family reconciliation, ten and even fifteen years after they were sent away for bad behaviour, who have finally been very successful. One, for instance, returned when his father died. Another worked his passage home and begged for reinstatement. He need not have been sent abroad at all had his father been better advised. Of all tendencies in childhood which make for the EARLY MORAL AND EDUCATIONAL 261 graver disorders, which foster and feed them after they have been generated, falsehood is probably the commonest and the most powerful. It is often the very first "arc" in a life of "negative circling," and there may be inheritance of a disposition to falsehood. Should the untruth happen to succeed, from the youngster's point of view, in its first manifestation, the results may be disastrous in their tendency to bring in other " negative arcs " in natural consequence. On the one hand, falsehood may lead to serious crime ; on the other hand, it may result in ultimate psychas- thenia and mental derangement. Therefore it is of cardinal importance that first instances of falsehood should be very wisely dealt with; not too harshly, but by reasoning, which will arouse sufficient shame to create a real desire for avoidance in the future. Suffi- cient fear should be produced to cause the child to choose the truth more carefully and decidedly; the sense of self-respect should be encouraged sufficiently to fashion positive " arcs " rather than negative ; and the sense of emulation should be ehcited by early lessons in proportion and true balance. "Honesty is the best policy " should be taught as a practicable and profitable rule of conduct, rather than as a copybook maxim or a vaguely religious injunction — at a time of life when everything is new, strange, and very often difficult. The reward which right conduct brings should be made obvious by interesting and emotional object-lessons. Those who exhibit a tendency to false- hood acquired by inheritance gan b^ changed for the 262 ADVANCED SUGGESTION better with very little difficulty by the psychotherapy of to-day. I have so often found sufferers from mental and nervous disorders to be saturated with a tendency to falsehood — analysis proving almost as frequently that it appeared as a very early trait — that I feel bound to lay very particular stress upon it in these pages. When it constitutes a later " arc " in a patient already afflicted with difficulty of thought, and possibly also hampered with phobias or abnormal cravings, it may not be so easy to deal with ; but whenever and wherever found, the correction of it by neuroinduction is most effectual in the treatment of all disorders of thought, for this involves an emotional straightening out of the processes of thought; thus the whole, mentality is eased. One of the most difficult cases of psych asthenia I ever treated successfully was conquered from the moment I found a deliberate and clearly distinguishable false- hood in conversation and dealt with it on the spot. The patient had found this "negative arc" valuable to her after many years of difficulty ; and so cleverly did she exercise it that nobody was able to bring any instance home to her. She was securely hedged and fenced against opposition by her environment and her influence over all the personnel of her household, and everybody in or out of the house, servants, mother, and doctors — all seemed powerless before the well- trained ingenuity of her ingrained evil habit. The result of any attempt to thwart her was usually an EARLY MORAL AND EDUCATIONAL 263 outburst of wrath, which caused yet greater disorder of thought ; her whole mentaHty had become a mass of contradictions; the particular tendency had reached such development that in the later stages she appeared to believe that many of her falsehoods were really true, so divided into definite sections did her thinking become. All this was clearly demonstrated during her treatment by trapping of instances of falsehood, and by analysis of her case. Each lie was, as gracefully as possible, almost pleasantly, pinned upon her night- dress, so to speak, for she was bed-ridden. The exposure was made as an " arc " of positive " circling," out of which other " arcs " were to be fashioned swiftly, one after another, until a perfectly normal condition was attained. She was greatly impressed by being clearly "found out." A sense of shame produced an ample flow of auto-suggestion. Subconscious auto- analysis and synthesis further enabled her to co-ordin- ate her ideas to the extent of effecting a clear self- exposure ; she began to take infinite care that nothing but the whole truth should be told for the future. Such a case serves to indicate very emphatically the power which a free debauch of falsehood can exer- cise in "vicious circling." No matter what variety of psychic disorder is considered, this particular "arc" will usually present the greatest difficulty to the doctor, for the simple reason that attempts at cor- rection may cause a hopeless rupture of the relation- ship unless all are very carefully prepared beforehand, 264 ADVANCED SUGGESTION A schoolmaster was sent to me suffering from in- somnia. I soon found the case to be one of scare with a considerable amount of misrepresentation. To make his anxiety and trouble still more convincing to me, after the first interview and treatment he added rheumatic pains as a "negative arc." It was his opinion that the insomnia was due to rheumatic pains, and that if the latter disappeared so would the former. I argued with him that if the rheumatism were genuine it would go under the medicine I should give him, for there obviously could not be much of it ; if not genuine then any tendency he might have to tell falsehoods would go. We should see ! The result was that the former did go ; his subconscious mind found the argu- ment too straight to resist. He attempted occasional opposition, but always found that he only succeeded in further exposing his tendency to exaggerate and mis- represent. I afterwards remarked to him that he surely must often teach his boys to be perfectly accurate in their answers, and to conduct themselves properly, which caused a slight increase of coloration in his neck, as he turned his head to look out of the window, making an uneasy movement of the mouth to one side. Analysis was required once more in his case; sexual perversion was discovered, having existed since boy- hood. The idea of rheumatism having been cured, carrying with it four-fifths of the insomnia, the balance afterwards disappeared on treatment of the sexual dis- order. The patient got the best lesson pf his life as EARLY MORAL AND EDUCATIONAL 265 regards perversion of the truth; the wrongfulness of it had been appreciated all along by one part of his personality, but a conflicting idea of the advis- ability of employing it in certain extremities had been persisted in quite studiously by another part. He explained afterwards that he knew I should cure him from the very first interview; he subconsciously realised that I was pursuing the right track. Literature for the young requires wise censorship. The question is comparatively immaterial as regards those over the age of youth. Mr. McKenna once replied to a deputation which waited upon him, asking him to urge legislation and more vigilant administra- tion in respect to demoralising literature, as follows : " The police know that a very large quantity of liter- ature of this kind was circulated, unfortunately in the most improper quarters possible, in schools amongst young boys and young girls. He was a supporter of freedom of trade, provided it was for the public good, but this trade could not be described as being for the public good. He was grateful to the deputation for strengthening the hands of the Home Office on this question, and he assured them that they would find the Home Office only too anxious to carry out the wishes that had been expressed." It may usefully be repeated that the young are par- ticularly amenable to direction by neuroinduction ; they respond to suggestion to a far higher degree than do adults ; their mental and physical mechanism is ripe for learning, they possess youthful respon- siveness and eager desire to "make good"; their 266 ADVANCED SUGGESTION mentality has not become encrusted and seasoned by many years of confusional experience and with buffetings incidental to a more responsible later life. They make the very best plastic material to work upon. Every child which is difficult to direct, whether of the poorer or richer classes, should be sent to a sufficiently experienced psychotherapist, who need not even be very highly experienced. I could train a hundred doctors in a couple of weeks, who had never studied the subject before, to treat cases very successfully. All I should require would be that they were men of average tact and common- sense, and preferably those who had had some years of good general professional experience. If medical men were to study on their own account they might become first-class psychotherapists, able successfully to treat various functional disorders, in from two to five years, by the aid of such a book as this. The work is no more difficult than painting, piano-playing, or golf. But on the other hand it can hardly be much easier than these, if all-round proficiency is to be arrived at. CHAPTER XVIII CASES INCIDENTAL TO WAR Cases of nerve-shock, shell-shock, insanity, the inhibi- tion of special senses, and so on, as observed in the Great War, have afforded no better material for study than has been found in times of peace — no particular features for which anyone employing treatment by suggestion has not been thoroughly prepared before the war. Treatment by neuroinduction and analysis will reveal the extent and the nature of the disorder as surely as X rays will detect metal in muscle, if not quite so quickly; and it will materially assist us to form conclusions as to how much organic injury of the brain there may be in particular cases. Very great use has been found for treatment by neuroinduction in cases where patients have not been able to make up their minds as to whether they ought to enter one of the war services or no. Auto-analysis, following upon altero-analysis, has in many cases revealed a real inclination to serve when a vigorous supraconscious opposition has been displayed. In one case a conscientious objector became a loyalist during induction; it had been previously explained to him thai no attempt would be made to alter his views — that he would alter them of his own free will ^^7 268 ADVANCED SUGGESTION if he saw reason to. This case shows clearly that the subconscious is the conscious — the superconscious. I may add that I entirely agree with those physi- cians who have recommended that military men suffer- ing from functional nervous disorders should not be treated in institutions where they see so much of other cases of the same order. Such are better placed where they may be helped towards employment, in order to forget their troubles as much as possible. Years before the war I adopted this method ; I placed certain patients under suitable supervision where they might live just an ordinary life amongst normal people, the latter being carefully instructed as to how they should help if need be. Several military cases have been referred to in various former chapters. I will, however, shortly refer to one en passant. A mental specialist brought to me a late lieutenant, invalided out of the army, for his friends wished me to see him. The specialist frankly declared to me his opinion (away from the patient's hearing) that the condition was quite a hopeless one — he having in his experience "known so many similar." Treatment by neuroinduction not only restored the patient to the normal, but he entered the army again; his work was now found to be of a higher order than before; so much so that his promotion was unusually rapid. He is undoubtedly more capable to-day than ever before in his life, as he happily declares. His is a very good example of a patient reaching a legitimate supernormal — as one might describe it— after a ppurse of neuroinduction, CHAPTER XIX NOTES ON PSYCHOLOGY, RATIONALE AND TECHNIQUE There are some very good works on psychology which are useful to the psychotherapist, such as McDougall's books and articles, than which there is nothing better for laying a reliable foundation. I shall refer shortly to matters already well known, but I shall deal particularly with very vexed questions, and I shall form conclusions from actual work done in -psycho- ikerapyy with a view to helping to elucidate certain problems. Thus I shall draw upon a hundred pages of material originally designed for a longer chapter, and compress the gist of these into less than one-tenth of the space. I object to the term " suggestion." I prefer " induc- tion." The dictionary gives us this meaning of sug- gestion : " Information or hints to the mind or thoughts." But the physician means more than this, and includes clear explanations, reasonings, impres- sive illustrations, cogent contentions, and at times even urgent adjurations. I therefore prefer "induction," which a dictionary describes as " an inference of some general truth from special facts." But inasmuch as I always include very definite effects upon sensation in 269 ijo ADVANCED SUGGESTION every application of the system of induction, I find the word " neuroinduction " still more apposite and expressive. At the commencement of every treatment by neuroinduction I make sure of general physiological relaxation as a sine qud non state throughout both the mental and the physical systems. I have found that full physical relaxation always conduces to relaxation of thought. I look upon it as a simple law that physi- cal relaxation is bound to involve an amount of mental relaxation, and vice versa. There can be no exception to this law, as extremely simple investigation and demonstration will be able to verify. Physical relaxa- tion, when properly inducted, should involve all sensorimotor arc mechanisms of the body ; any degree of reduction of tenseness anywhere in the system will affect the whole balance to some extent. In neuro- inducting a physician demonstrates both to the sensa- tions and to the understanding of a patient that which he considers is of value for the latter to experience. By altero-induction I mean induction conducted by a physician in treating a patient. By auto-induction I mean a patient inducting himself, he himself making and accepting physical relaxation and mental conclu- sions, either deducted, or divined, perhaps read about, or possibly given him in ordinary conversation by another. It follows that altero-induction carries with it some amount of auto-induction when the patient acquiesces. The term " auto-suggestion " has, in the past, been defined and employed somewhat carelessly by some authorities. Usually meaning NOTES ON PSYCHOLOGY ijx little more than acceptance, it is a term that is of very little use to us. The word "suggestion" has been understood by some to imply that false as well as true representation may legitimately be made as thought necessary. Now, I do not allow induction to involve anything but scien- tific deduction — in other words, the truth. I have never yet found any misrepresentation which could not be surpassed, as a power, by accuracy — other things being equal. The technique is faulty if a patient can only be led by a lie — even by a purely white one. One may avoid answering? Yes; but as to ever making an actual misrepresentation — no ! Many will disagree, but years of experience have proved and con- firmed the soundness of this advice. Once let a patient suspect that any word or action is false, and the work of curing him will be multiplied. In my use of the term, neuroinduction implies the accurate conveyance of reliable sensations and conclu- sions, and their correct interpretation ; it is a true sense demonstration and elucidation, both physically and mentally. In neuroinduction peripheral confusion of special- sense employment is minimised. Thus the area of brain activity is reduced, which enables a patient to concen- trate more effectually upon such matters as are put before him by the physician's words and manipula- tions. It follows that words and manipulations will concern the sympathetic system more nearly and impressively, by the power which suggested normality 172 ADVANCED SUGGESTION gives, in prompting, releasing, encouraging, or exalt- ing function, in any way acceptable to the sympathetic system under both central emotional excitation and local stimulus. Many erroneous arguments have been written and spoken both by medical men and the laity concerning the expression "will-power." "Will," according to the dictionary, is "the power of determining and choos- ing " — or " inclination," or " intention." Now, in ordinary education we have a means by which we increase knowledge; we elicit the power of exercis- ing further thought. But we do not consider that ordin- ary pupils have defective will-power ; nor do we speak of a teacher as exercising his will-power over his pupil. On the contrary, what really happens is that the pupil is taught in the belief that he possesses will-power of his own. It is true that the will-power of one may be exercised over another by way of compulsion if reason- able inducement does not elicit more right apprecia- tion than wrong ; the will-power exercised by systems of law and order must be employed against the mood of a criminal or a lunatic, whose will-power is deficient, and whose actions may be crudely instinctive and constantly abnormal — akin to those of animals. In hypnotic suggestion the will-power of the subject is not so much trained. In true and perfect definite hypnosis there is rather obedience, after the initial resignation. Neuroinduction instructs : The will- power of the patient is increased from the first, and it grows apace, to the point of automatic ease. NOTES ON PSYCHOLOGY 273 Instead of the rapport of the older writers, I prefer the term altero-association ; instead of the hypnotism of the older writers, I would describe the process as dX\.^rQ-conduction ; in place of suggestion, altero-induc- tion would seem preferable. The moment altero-induction becomes complete conduction, the condition should constitute the hyp- nosis of the older writers, with the capacity of exhibit- ing hallucinations, and incapability of remembering in the supraconscious what happened during the state of hypnosis. Hypnosis (so-called) or altero-conduction is not the best state for treatment by suggestion, for the simple reason that the most efficacious suggestion is only to be obtained by the most perfect co-operation possible on the part of the patient. In so-called hypnosis the patient is not asked to co-operate : he is bidden. He consents to enter into the state of absolute resignation, leaving all direction to the physician. He resigns his volition, but retains just enough potentiality to enable him to resist and oppose in case this should seem advisable. Let the reader avoid any misconception here : the hypnotised or altero-conducted patient can always exercise volition to the extent of refusing to obey an injunction if he has sufficient reason to do so. Because he does not act according to behest he must not be regarded as either unconscious or without volition; it is simply that he so far ceases to exercise his own volition. Inducted patients fully co-operate all the time. 18 274 ADVANCED SUGGESTION When a physician treats by suggestion he teaches, advises, inducts. What does this do physiologically ? It creates or facilitates association between neurones, through synapses, according to acceptance of reasoning. I would also prefer to speak of the process of con- vection from neurones to neurones, through synapses, as synapsis. Now in order to create or facilitate synapsis it has been found that it is better to deal first with any chaos of activities that exists, to limit con- fusion amid a multiplicity of energies. Hence we should begin by inducting towards limitation and concentration. We actually do so on commencing treatment, when we merely elicit a patient's attention. We help him to leave out of account certain considera- tions of his own for the time being, and to give heed to others. We limit his own disordered energies, and invite more profitable expenditure in certain particu- lar directions. The extent to which induction may facilitate neurone energy will be variable according to the powers of understanding possessed by the patient, which powers vary as do facial features and cerebral convolutions — nay, even as the quality of the neurones. The capacity for understanding varies more than any- thing functional that we can think of. When the trombones of an orchestra are going badly in the concerted playing of a symphony, the conductor, when practising, will stop the whole orchestra ; he will then tell the trombones to play alone. In like manner, if a patient has an obsessed or difficult-thinking mind, NOTES ON PSYCHOLOGY 275 the physician will induct towards the more desirable energies, while inhibiting all but those he wishes to improve. He will ask the patient to lie down, so that even the muscles shall not energise to hinder thought. He will tell the patient to close his eyes, so that he shall not look about and catch confusional ideas from what he might see in the room; he will ask the patient's attention, in order to encourage concentration of thought. He may achieve a high degree of co-opera- tion in this process ; the more perfect the co-operation, the more readily will the patient learn correct sensa- tions, ideas, and conclusions. The best technique does not require obedience so much as acquiescence ; it does not intend that a patient shall do as another advises him, but as the patient shall advise himself, as a corollary, of the clear and sensible issue discussed with him. Thus treatment by neuroinduction is nothing more and nothing less than a training of the activities and intuitions of neurones and their connections ; a teach- ing of that consciousness which has been called the subconsciousness by the older writers, but which one has every reason for calling the superconscious, for within it resides our greatest intellectual capacity. Treatment by neuroinduction is imparting informa- tion to the purest and finest consciousness the neurones are capable of displaying, in order to make it still more widely conscious. Everything goes to prove the greater value of neuro- induction over hypnosis. The fuller the awareness, 2;6 ADVANCED SUGGESTION the purer the consciousness : the greater the power of co-operation exhibited by the patient, the greater must necessarily be the results of induction. In times gone by hypnosis to an extreme degree was sought by some physicians, who were under the impression that it was the most desirable state to aim at, in their quite pardonable ignorance as to what this state really was. Yet good work has been done by hypnotism in the past, in spite of its drawbacks, just as surgeons did good work under very crude anaesthetics and tech- nique before better were discovered. What is the subconscious ? I shall not give any of the definitions of former writers, for I disagree with them all; I must ask permission to give my own. I consider the subconscious, which I would much prefer to term the superconscious, to be the clear and essen- tial consciousness which exists when the mind is busy with nothing but internal thought — when it is unaffected by any special sense activity. It often energises automatically upon first waking in the morn- ing, after all the muscles and special senses have been completely at rest for some time, and everything is still inclined to rest, excepting the power of thought. The same state is reached in variable degree when a patient is treated by neuroinduction, and is told to close his eyes, to do nothing — not even to listen, which would involve some effort. After his plain hearing is elicited he is expected to understand the words and to feel the manipulations of the physician because he will not avoid either ; at the same time he is taught to NOTES ON PSYCHOLOGY ^;; relax every muscle absolutely, in the fullest physio- logical meaning. According as he is inducted or taught to fulfil these conditions, so will the subcon- scious be reachable by suggestion in further in- duction. Opposition to induction will vary according to differences of opinion and purport which may exist between physician and patient. Therefore it behoves the former to be as absolute in order and accuracy as it is possible to be; also in philosophy, in religious beliefs — in fact, in any subject referred to by any patient who is suffering from distress of mind. Differences of opinion may have a neutral effect, or they may arouse opposition. The latter may either be exhibited on the instant, or after a treatment, lesson, or training — call it what you will. If a patient be obsessed, or under a chronic misapprehension, the physician will correct this, employing such illustrative arguments as he considers best. Nothing is more likely to fail than words spoken by the physician which are inapt and unconvincing; incorrect teaching will be hopeless. A Protestant physician remarking to a Roman Catholic patient that his beliefs are wrong, for instance, is not likely to cure a patient suffering from religious mania. Hypnotic suggestion has often failed to cure patients suffering from mental or nervous disorder, for reasons which the reader will clearly understand from the foregoing. Treatment by neuroinduction will hardly ever entirely fail, so long as the patient has any sound 2/8 ADVANCED SUGGESttON sense left in the subconscious plane. It is not even so likely to fail as well-taught lessons in natural history, say, imparted to the supraconscious mind of an ordinary pupil. The value of neuroinduction over hypnotism lies in the patient's self-assistance and his co-operative manner of learning. Moreover, the results of the neuroinductive form of co-operative sug- gestion are permanent — at least, as permanent as the most useful and valuable lessons learned in the process of ordinary education when this is at its best, and often much more so; for lessons which make for pleasure instead of pain, and health instead of ill-health, are likely to be better remembered than any other — much more, therefore, are they when conveyed directly to the subconscious. I am obliged to conclude that the hallucinations and delusions of the insane arise out of the conscious. Suitable and sufficient analysis will prove this. I will give a reason for coming to this conclusion. A paranoiac informed me that he was persecuted by people. I treated him by neuroinduction, and to a certain extent cleared his subconscious mind. He was then able to explain that years ago he had stolen money from a friend's desk. This had "got on his mind," and had given rise to ideas, later on, that he was being accused by people. He saw men pointing, at him in his imagination. Thus we have no right to say that delusions and hallucinations arise out of the unconscious mind. It is simply plainly erroneous to do so. The person is conscious of them, but it merely Notes on psychology ^;0 happens that he is not supraconscious ; hence he is supposed by the more superficial observers to be uncon- scious of them. It follows that I can only study insanity of e\nery kind, first through the truism that every thought or idea exists in the consciousness, or rather first in the subconsciousness, the purest potentially equipped con- sciousness of the individual, which in any instance of insanity is not sound ; if wholly unsound then we have a real unconscious. I proceed to study any case of insanity just as I would one of simple or complicated hysteria ; I set to work to find out what are the flaws in the sufer conscious mind. Nothing can be found in a really unconscious mind. The word " unconscious " has been far too laxly employed even by recent writers, in my opinion. Novelists may write of " unconscious humour," but psychologists should have such respect for the subconscious as to realise that a person may appear unconscious in the supraconscious realm while being eminently conscious at the moment in the sub- conscious realm, in respect of and concerning the same idea. It is the consciousness of the subconscious that primarily matters in any person. Only complete inertia of subconsciousness should be accounted uncon- sciousness. Jung and many English psychologists and neurologists write of the conscious as only belong- ing to the plane that is above the subconscious. The truth is that the chief conscious — the superconscious — is in the subconscious. It is there potentially, and it may be active under certain circumstances, whether ^8o ADVANCED SUGGESTION supraconsciously obvious and capable of communicat- ing with another or no. Neuroinduction as affecting the Physical System It has never been clearly explained by any psy- chologist or physician employing treatment by sug- gestion — whether this be simple, advanced, or the old so-called hypnotic suggestion — what happens physic- ally as a result of suggestion. Entirely erroneous descriptions of phenomena have frequently been given — descriptions of patients falling "asleep" or not, as the case might be, or of their appearing to be in this particular stage of suggestibility or that degree of hypnosis, but nothing more. Hypnoidal and other terms have also been employed in the effort to describe stages and degrees ; but nothing simple and sufficiently accurate has as yet been taught. In this chapter I hope to add still further to any light I may have been able to throw on the subject in previous chapters. We have touched upon rest in very simple terms in the foregoing pages; we have also seen that there is an approachable subconsciousness which may natur- ally and automatically find itself sometimes on going to bed, just before going to sleep, or oftener still on just waking in the morning; and we have recognised that this happens to be conditioned by perfect physical relaxation. Therefore the nature of our quest must be as follows : How can we secure this same state when NOTES ON PSYCHOLOGY 281 We require it for purposes of treatment ? How can we produce it when we want it ? Let me inform the initiate at once that it is quite insufficient for him to ask his patient to become relaxed— to relax himself; practically all the experi- enced physicians employing suggestion are guilty of employing this inefficient technique. It is too absurd to expect auto-relaxation in such as have not been able to find mental or physical ease perhaps for months or years ; we might as well tell patients that they should just treat themselves as ask them to " be easy and to think of nothing," when the mind is unsteady and the body trembling, or, if not unsteady and trembling, then at least to some degree tense, on account of troubles of one kind or other. Under such condi- tions how can they relax? A photographer does not offer his room and tell the customer to snap the shutter of the camera himself. It is therefore our duty to teach relaxation. We must teach what it is, and not only implant the knowledge of this in the patient's mind, but fix it in his sensations. This is one of the most important lessons of this book. It may be diffi- cult to do so at times, but it must be done if the tech- nique is to be effective — if the best results are to be obtained definitely and rapidly. When this point is properly understood we are then in a promising position to consider the treatment of mental disorder, of deranged functioning in the internal organs, and even of organic conditions. In this lies the great secret of efficacy when we are aiming 2^2 ADVANCED SUGGESTION at advanced results. In treating the heart, or certain local blood vessels, it is not sufficient that the patient shall be lying down, resting, so that certain words spoken may be heard readily ; this might or might not do a certain amount of good. He must be wholly relaxed. In the past many physicians have found that cases of a certain class have done well, while others of the same class have done unaccountably badly. The explanation of this I have usually found to lie in the faulty technique employed. And here again we are reminded of certain difficulties of treatment by sugges- tion ; we are obliged to bear in mind that while most patients may truly be said to be alike in anatomy and pathology, in both brain and body, when suff^ering from disease or disorder, no two patients can be found who are even approximately alike in the sum of their mental energies or capacities. Nor can the psychotherapist apply his treatment as easily as the physician can apply electricity or order chemical remedies. The former must necessarily employ a fine adjustment of thought to suit each indi- vidual case. Exposure of a body to cold is less likely to produce difficult complications than exposure to mental shock ; the latter may also confuse, or even destroy the power of the agency through which complications can be made manifest — the balance of thought necessary to explain them. Exposure to cold can be expressed in three words ; a bullet may be seen clearly by X rays ; NOTES ON PSYCHOLOGY 2^3 but a shock may not be declarable, having been repressed or suppressed for years ; and if revealable it may require great efforts to correct it, not only on the part of the physician, but on the part of the patient. Many neurasthenics have remarked : " I wish I had a bad limb instead, so that I might have it cut off, and have done with the trouble quickly." Another very important subject for study is emo- tional process — emotivity, as Dr. Mott terms it. This would need a whole book to itself, if justice were to be done to the subject. I have found that when a patient's perception, either of inducted sensation or of mental conclusion, is derived in emotional association, it is of much greater value than at other times, showing that emotional process assists the general neurone process in a most effectual manner. If a patient understands the subject of treatment by suggestion, as it is explained to him while it is being applied, he is all the more interested in it, and its effects are corre- spondingly greater. If a patient can see the force of taking exercise and of avoiding anger, he will put these recommendations into automatic practice much more readily than he would if he were merely ordered to carry them out. These propositions may seem so simple as to be hardly worth stating; nay, some physicians may say they have adopted these means. Such a demeanour is very common when anything is claimed as an advance. Very well then, all I can do is to impress and emphasise their importance, so that the principle may be still more extensively employed. I 2§4 ADVANCED SUGGESTION shall attempt to justify myself, however, in one state* ment : I have found that most physicians are too direct in their methods of applying recommendations. Indirect means are far more widely educative; they produce the desired effect much more strongly and permanently. Incidentally, again, in this paragraph, I have given reasons why neuroinduction is superior to neuroconduction (hypnotic suggestion). Sherington has remarked very truly that, " of points where physiology and psychology touch the place of one lies at emotion. . . . Built upon sense-feeling much as cognition is built on sense-perception, emotion may be regarded almost as a feeling. . . . That marked reactions of the nervous areas regulating the thoracic and abdominal organs (and the skin) con- tribute characteristically to the phenomena of emotion has been common knowledge from time immemorial." What better testimony could psychotherapists have than this, from the physiological side ? The importance of studying the effects of thought upon physiological systems may well be conceived when it is realised how worry or shock affects diges- tion. A hundred excellent examples might be given, but I am limited as to space. I must content myself with calling the reader's very serious attention to the large field which lies open to a serviceable technique which not only gives full cognisance , of its capacity for cor- recting disorders of the sympathetic system — dis- orders that are largely responsible for abnormal in- voluntary processes of all kinds, by means of direct NOTES ON PSYCHOLOGY 285 and indirect (mental) effects— but which also directly assists the functioning of the powers of thought. Inas- much as disorders of various kinds involve both the mental and the physical systems, through the sympa- thetic, in order that a technique may deal with etiologi- cal "circling" it must be such as deals with negative disorder by the adjustment of positive order. Indigestion causes worry ; worry causes more indiges- tion. We must therefore diminish worry by thought induction and strengthen the local sympathetic pro- cesses by sensation induction. It is quite true that thought induction may do everything in certain cases, as it is that medicine or electricity will cure some cases of dyspepsia; but difficult cases will require more, as we have seen, and the more difficult the more indirectly may it be found advisable to adopt a procedure. In order further to emphasise the importance of suggestion directed towards the physical sensations, I need only refer to two interesting facts that have come to light in extensive practice in difficult cases. A patient who can neither speak nor see (having the eyes shut) may be treated quite successfully by neuro- induction so long as manipulations designed to convey impressions are understood ; the supraconscious mind is at the time both on the alert and unusually capable of interpreting meanings — often extraordinarily so. The reader will again be reminded that when a patient appears to understand nothing when spoken to, he must not on this account be deemed to be demented, 286 ADVANCED SUGGESTION insane, comatose, or intoxicated. He may understand everything in the subconscious mind, while seeming stupid in his supraconscious behaviour. My collec- tion of remarks made by former doctors — opinions given by them during their treatments, as narrated to me by supposed " lunatics," after their cure by neuro- induction, who had been repeatedly pronounced in- curable — would make a whole book of eloquent proof of the shortcomings of physicians; and the same applies to matrons and nurses. Some of the very best results may follow mere auto- inference in the course of very simple induction. I have known many cases in which a serious disorder has cleared up soon after commencing treatment, the disorder never having been mentioned, and the patient having proceeded so rapidly to form clear judgments and accurate deductions that nothing more by way of help was wanted- — the full and true facts having been represented by the patients, sometimes months, and in more than one case years, after treatment. In these cases treatment has made it unnecessary to mention symp- toms which disappeared at the outset of the treatment ; later on a natural joy and interest in the permanent relief obtained has elicited the full and actual facts, in sheer enthusiasm and recognition of the advantages derived. For example, the early suggestion that " for a person to be in full command of self is a grand attribute" cured a man in one treatment of taking drugs. He applied this emotional lesson forthwith to NOTES ON PSYCHOLOGY 287 his particular failing, which he had been ashamed to declare when complaining merely of insomnia. It follows that manipulations should never be mean- ingless, for the patient m.ay perhaps realise them to be so, and respond to no further suggestion. Hence it will once again be seen why treatment by suggestion must in many cases be a difficult matter. Memory This depends upon the power to generate facile automatic association between neurones through their connections. In cases of entire loss of memory due to shock or nerve strain there has been complete inter- ruption of association, as often as not induced by excessive communication having gone on in other directions. Occasionally shock may auto-suggest an amnesia, as being the best expedient under awkward circumstances, which amnesia may thus be false at the start, but may become true later on. It may even be first hetero-suggested, someone remarking that the patient's memory seems deficient. This may lead to the auto-suggestion that amnesia might be the best thing to simulate in the meantime; later on the auto- suggestion may become first obsessional and then delusional, reaching finally a complete incapacity, the patient not being able to remember when — other things being equal — he really wants to do so. No class of case is easier to treat than these, pa^- 288 ADVANCED SUGGESTION ticularly when the disability is of comparatively recent origin — say of less than twelve months* standing. Sometimes the slightest suggestion will correct complete amnesia into perfectly full and free association, whatever the cause of the disorder may have been, so long as there is no toxaemia, injury, or gross disease of the brain. Complete loss of memory of merely a few days' standing may require only a single treatment. Slowness or "poorness" of memory is equally easy to treat if due to mental strain ; this trouble is like all disorders open to treatment by suggestion, in that the longer it has existed the greater the length of time will be required by suggestion to bring to the normal. Again, a good deal depends upon the nature of the causation. * "Poor" memory of five years* standing may possibly be trained to normal in a week; or it may take many months if due to psychasthenia — itself due to worry difficult to get rid of. If due to strain in developing a hopeless business it may require treat- ment so indirect as to include improvement of half a dozen faults of habit or temperament, which have led to failure in the business before any loss of memory had resulted. It will also be appreciated by the reader how necessary it is, when informed of what appears to the patient or others to be the only abnormality that requires curing, to analyse and search for others. While offering my congratulations to Dr. Mott and NOTES ON PSYCHOLOGY 289 others who have obtained favourable results through suggestion under anaesthesia, I am bound also to give my opinion that treatment under anaesthesia must have limitations which would not obtain in the case oi neuroinduction, for reasons which will be obvious. One could not so broadly or extensively re-educate in cases of nervous, mental, or physical disorder while the patient was in a state of real, even if partial, un- consciousness. In this chapter I have endeavoured to propound a sufficiently practicable psychology which will enable a psychotherapist to do his work to advantage. He may get lost amid the six theories of the subconscious that have been propounded by other authorities : in this chapter he will be safe. As showing the ridiculous chaos which the study of the sub- conscious has formerly reached, I need only quote a "fifth theory" as given by Isador Coriat (though not his own) in his book on " Abnormal Psychology " : " The physiological idea of the subconscious, the theory known as unconscious brain thinking," he writes. Until such contradictory nonsense is swept out of the way progress in psychotherapy is likely to be slow. Psychologists have no right to allow themselves more than one kind of unconsciousness, in their vocabulary, that of thought inhibition due to brain injury, toxins, or natural, perfectly undisturbed sleep. 19 CHAPTER XX THOUGHT ANALYSIS Fortunately for my readers and myself, this chapter will be very short. First let us consider psycho- analysis as it is regarded up to this day of writing, and for the purpose let us turn to Murphy's " Practi- tioners' Encyclopaedia of Medicine." Here we find Dr. Bedford Pierce writing with an amount of care and insight which is characteristic of that sincere writer and genuine authority on mental disorders : "The object of psycho-analysis is to investigate the trains of thought which, directly or indirectly, have produced a given morbid psychical disturbance. Everyone is reminded at times of experiences that are distasteful, and even repulsive, the memory of which we endeavour to ignore ; and the mental conflict which this repression involves varies in intensity according to the nature of the experience in question and the temperament and education of the individual. Such memories and emotions are called 'complexes,' and when they are forgotten and cannot be called into consciousness they are called * buried complexes.' They usually relate to some fundamental instinct or desire, and when circumstances prevent these desires from being gratified some compromise must be reached. Under normal conditions such repressed desires are directed into healthy channels ; they are * sublimated' 290 THOUGHT ANALYSIS igi and the energies find outlet in some form of active work, but in some cases no such outlet is found, and the buried complex becomes a centre of internal stress till a 'substitution' takes place and hysterical symp- toms appear. The patient is probably altogether unaware of what has happened, and sometimes the original desire cannot be remembered, so successful has been the repression. The end-product may appear to have no relation to the complex, and is so frequently confused and distorted that the task of tracing out its origin may be extremely difficult. In this way arise the many symptoms of hysteria and psychasthenia, palsies, phobias, obsessions, tic, morbid doubting; all of which are regarded by the psycho-analyst as sym- bolical representations of wish-fulfilments. They produce a certain amount of unconscious gratification, and in a perverted and incomplete manner they relieve the underlying mental conflict." He then goes on to explain the "free association" and "word association" methods of Jung. Experience has taught me that of all methods likely to confuse the issue, likely always to make as much trouble as ever could be cleared away in many instances — in some even far more trouble than already existed — these are the foremost : perhaps we might imagine worse intentions, such as filling a patient with more difficulty than he already suffered from, in the hope that a surfeit and nausea might be produced, which would either "kill or cure," according to chance, as a large dose of poison may occasionally cure by causing vomiting. Enough of destructive criticism, of bad methods which the future will break to atoms, as having been 292 ADVANCED SUGGEStlON so monstrously conceived as to remind one of the country whose watchword is "world dominion or downfall." Certain British scientists once upon a time developed the habit of taking all things emanating from Germany as " the last word " — as we now know only too painfully. The real truth has been that British scientists were all along capable of doing better; they have proved over and over again, during the Great War, that they can be more capable than German scientists. The whole British people have been hoodwinked by a plausible and industrious ambi- tion, that has persuaded them to accept too high an estimate of German scientific progress ; they admit this now, so little more need be said in the matter. I shall propose to abandon the term "psycho- analysis," as one that can only bring unhappy recollec- tions. May I suggest something plain and simple in its place — namely, " thought analysis " ? We want to know what is in the minds of patients troubled with " difficult thoughts." It is not absolutely necessary for us to know entirely what is in the sub- conscious mind. Still less necessary is it for anyone to attempt to grope in the unconscious^ about which so many have floundered, even in the very definition of it. All we need is an analysis of the conscious. We may speak of the subconscious if it may seem con- venient, but henceforth we are bound to consider that this is rather the superconscious. The best way of proceeding to do this is perhaps already to some extent suggested in the foregoing THOUGHT ANALYSIS 293 pages. If we get down to the best consciousness that potentially exists the rest will be easy, if our induction be wise and sufficiently experienced : neuroinduction from this position onwards will then enable all patients to analyse themselves. Let me take the case of a doctor's son, thirty years of age, who had suffered from oversensitiveness of the nervous system since childhood, and for fifteen years from phobias which made life a burden, preventing his engaging in any employment beyond the very simplest. He was sent to me by a consulting physician as the last resource, everything else having failed. After four treatments by neuroinduction he gave (without any leading questions being asked) the story of his having been lost in his native town, when about six years of age, and of his having been taken to the police, and kept at their station, until inquiries could be made. At the age of eight, also, he had been a witness to the injury of a woman. In relating this incident he could recollect the horrible face she had then made; from that day he subconsciously felt afraid lest anything of the kind should ever happen to him. When asked why he did not give these particulars to anyone else, or even to me when I first took his case, he replied that he had "never thought of them until now." Half an hour after relating the second incident he had an attack of dizziness and sickness. The next day his improvement was so great that I found it advisable to treat him specially for overexcitement, which could only be interpreted a§ 294 ADVANCED SUGGESTION an exhibition of joy begotten of a sense of release and relief. If some of the employers of psycho-analysis had obtained similar accounts and results from a patient, after labouring perhaps for six months on the lines of "word-association," they would probably have recorded this in a medical journal as something wonderful. Indeed, one may read in some of the special journals of recent years of cases at home and abroad in which one year and even two have been occupied in obtaining results by psycho-analysis which can nowadays be obtained sometimes in as m:iny weeks, or even hours, by neuroinduction. To give examples of one or two more severe and complicated cases, I will pick out the following from a very large number : A bedridden case of nervous breakdown was sent to me by an eminent neurologist. She had been sent from abroad to this country, as requiring higher advice, having already had the advantage of all that could be obtained in the country to which she belonged. She had been ill for fifteen years, having suffered from so many gastro-intestinal derangements, heart troubles, and nerve stresses that I cannot bother to recite them. By both surgeons and physicians she had been earnestly advised. I cannot enumerate the various treatments she had undergone before an up-to-date neurologist saw chances in psychotherapy, and sent her to me for analysis. I have taken this case as example because the patient seemed to the ordinary THOUGHT ANALYSIS 295 observer to have no mind for contemplation; it was difficult for her to follow ordinary conversation. She could not supraconsciously think ; she had neither the power nor the spirit. I must express my opinion that such a case would not be tackled with any honest expectation of favourable results ensuing by any lead- ing expert in Freud's or Jung's methods, for I have received similar cases which have been abandoned, patients who have not been in half so hopeless a condition, either mentally or physically, as the one under consideration. In five weeks this is what I obtained, cheerfully, happily, and easily delivered, without asking for it : " I remember an incident occurring in my childhood which may be interesting. I thought I had better tell you. I was living in India, and we were told by mother never to go down the garden. She went out, and I disobeyed. While wandering along a path I was seized by an Indian gardener, and he handled me improperly. I could not tell mother, and I felt the shock for weeks afterwards." Again an example. I inducted to the normal a girl of twenty-five years of age who had suffered from phobias and other mental derangements described by her family medical attendant as bringing her within the "borderline" category. I merely straightened out her thoughts, effected better associations, helped the memory, smartened up wholesome volition, and she soon returned to her work as a college tutor. Twelve months afterwards I wished to survey h^x 296 ADVANCED SUGGESTION mentality in order to see how she was shaping, and in a simple conversation she remarked : " I cannot tell you how thankful I am that you got me right. I often wondered whether I should tell you, but as I felt myself getting the idea under perfect command under your methods, I did not think it at all necessary to go into details of things long past; but I entirely got rid of a sexual idea that was at one time driving me mad, caused by a male tutor, who was not at all at fault, but circumstances seemed to make the thing a great shock to me. As soon as I was able to recall the whole incident quite clearly I felt myself getting stronger." Why did I not straightway analyse in this case? The reply is that it did not seem indicated ; the patient was so responsive to indirect suggestion, and did so well, that there was no occasion to trouble. This case, with many others like it, serves to show that indirect suggestion will, if of the right sort, enable the patient to conduct a private analysis and to apply her own arguments. The more one abides by simple accurate principles the easier does the whole thing become, which brings an aphorism to the mind : if there is work to be done, more than you can do yourself, teach others how to help themselves, in their own and everybody's interests ; in any case avoid making more work, for yourself and others. Should the reader be disinclined to take me at my word and demand further proof, I will give the case of a daughter who declared thg,t she had a certai^n THOUGHT ANALYSIS 297 story which could not and would not be told to a living soul beyond her father confessor, who had told her that God forbade her going beyond him. She informed me that she would go on contented with her fate if need be, but if I could help her nervous system otherwise she would be grateful. I merely treated the "awful thing" as an unknown quantity, more or less indirectly, and she got just as well as any more elabor- ate analysis could have made her; indeed, if an analysis had been insisted upon and had been ever so covertly attempted, it might have caused complica- tions of a nature difficult to conjecture, which would have aggravated her general condition. A frank consent to leave the particular subject alone really cleared the way peacefully for other quests and other alleviations. Analysis should be preceded by neuroinduction sufficient to steady and clear the thinking apparatus ; the patient should not only be asked by the physician to follow a quiet train of thought, easily and accurately, but any sign to the contrary should be at once dealt with. The slightest contradiction, either within the patient's self or as towards the physician, should be pointed out, simple examples being given, until ease and clearness of mental power is induced — which, of course, the patient always enjoys. In future — as it is, in my hands, to-day — analysis should always be made first by the patients. This recommendation will startle psychotherapists of the old school. Patients should be instructed never to 298 ADVANCED SUGGESTION force their thought, never to try to think, never to " make " themselves do anything. No memory is improved by being " made." Many readers may think to the contrary, but further study and experience will show them that memory is an automatic affair of neurones, that when the state of the mechanism is satisfactory memory asserts itself — it just comes. As to suppressed ideas, possible reasons for keeping them back or hiding them may be judged from the patient's replies or observations in conversation; deliberately designed conversations for this purpose, if seen through by the patient, are not so good as very easy chatter. When a simple reply from the patient appears important to the physician he may follow this up, if the occasion seems to make it advisable ; he may thus help the patient to understand himself. No patient's case requires analysing by the physician, as I am able to prove after many years' investigation and experience. If the patient cannot do the work himself, he must be treated and helped until he can. He should never be told to do so. A better remark would be : " There is something to account for that. One of these days it will occur to you. No hurry ; it will come. We might want it ; it may be very useful to us." After this no more, until it does come, and perhaps one or two other facts with it, equally, if not more, important. Is this method of conducting an analysis ever difficult ? Yes. I have found it extremely difficult to elicit causation when military service has been avoided. THOUGHT ANALYSIS 299 or when an offence is of such a nature as to be revealed most unwilhngly, because criminal There will be no difficulty, provided the patient is willing, but patients may sometimes realise whither they are going, and will avoid further revelations by ceasing to attend for treatment. Occasionally patients are sent for treat- ment against their wish, by doctors or parents; these may be difficult, but by no means impossible to treat. I could give many cases to illustrate all the principles stated in these pages, but I have given sufficient examples ; such as these have been valuable enough to me; they have taught me principles, and they go on teaching me. These principles I now hand on. In years gone by I have become weary of reading of cases of extraordinary results in the treatment of this or that disorder*, without any real explanation as to the why and how. Here I present principles, and I ask readers to go forth and practise them; they will then find examples enough at every turn to substan- tiate the teaching I humbly offer. If cases should in future be wanted for further proof — if ever I should be challenged — I can offer any number of them. A useful hint as to analysis is this : The sexual factor should never be deliberately sought for; it is not one-tenth so important as Freud and his friends have believed. Indeed, I have found it the very factor to avoid if possible. A highly educated man informed me that his difficulties had been multiplied fourfold through a "word-association" physician trying to discover something sexual about him, as being "the 300 ADVANCED SUGGESTION root of the whole thing." My difficulty in this case consisted in eliciting and eliminating the obsessions and delusions which psycho-analysis had been the means of creating. If the sexual factor is suspected, my recommendation is that every other factor should be attended to first. That the sexual factor is very often important, I freely admit — sometimes it is the most important of all — but on this account all the more caution should be exercised regarding it. The reader may be surprised that I have so few hints to give on analysis. My reply is of much the same nature as the advice given that patients should be inducted to analyse themselves; it is to the effect that medical men can easily discover for themselves how they may proceed by simply practising what I have above recommended, and by abandoning every method likely to create difficulties instead of reducing them. Only a certain degree of instruction is possible on paper; no artist or golf -player could teach others to become skilful by means of a book. Pupils can only be helped to become skilful by such limited means; their skill will finally emerge from their own capaci- ties. If Braid writes " Do not urge too much at golf," I advise " Do not adopt ' word association ' in diagnos- ing or treating mental disorder." It is for players and practitioners to apply any useful hints they may receive if they wish to become more proficient. One might, to some extent, demonstrate what should be done, and give examples as to what should be said; but even then pupils would require to find out much THOUGHT ANALYSIS joi for themselves. I myself was never at any time told or shown anything by way of treatment by psychotherapy ; indeed, most of what I could read on the subject I found misleading. May I finally recommend physicians neither to be too ready to probe, nor to "cut down and see," nor to "work away until something turns up." One should always bear in mind that the patient is usually quite the best material if properly handled. Only when you cannot yet help your patient will you perhaps be justified in certain cases in making an a deep "exploratory" search into mental corners. Even then your patient will be the one to clear every- thing up for you. There may be nothing to be dis- covered by the patient. Many most difficult cases have had no particular traumata in their history, toxaemia states having alone produced strains and stresses of thought. CHAPTER XXI SOME GOLDEN RULES FOR THE PRACTICE OF PSYCHOTHERAPY (a) Never compel, force, or "make" a patient do anything. Psychotherapy is only possible when there is some intelligence left; it is this remainder that the physician must make use of. The amented and demented will sometimes require to be helped by the control of others, like non-conscious animals. It may, of course, be difficult to decide when dementia is sufficient to demand the exercise of force; the extent to which reason fails must naturally be left to the experienced understanding of the physician. I have pointed out to many clergy, teachers, leaders of movements, politicians, and others, how much greater is the power of appealing to the thought by reason than by any threatening or urging to action. It is a commonplace that you had better make people sober by reason rather than by act of Parliament. It is true that fear and sentiment, through emotion, may work wonders ; but these will derive their power largely through volition on the part of the recipient of the suggestion — which volition is begotten of intelligence. Any exercise of compulsion against a patient's volition 302 PRACTICE OF PSYCHOTHERAPY 303 should be considered as possibly an offence against in- telligence. To ignore the existence of any intelligence when a certain amount really assists is bad policy in psychotherapy. Multitudes of people may be won by reason who would instantly become obstinate and mutinous if kept in ignorance. . It follows that if people seem unreasonable in their obstinacy they may not have been properly informed — provided the subject- matter be capable of reasonable explanation. {b) Instruct patients never to force themselves to do anything. They should be mentally inducted to see the wisdom of allowing themselves -to think and act reasonably. On entering upon new ways of employ- ing the power of thought, patients under treatment may come to you, with pride, with an instance of their developing powers, in such a remark as : "I made myself go for a walk, as you told me." The physician's reply had better be : "I did not tell you to make any- thing, excepting such articles as you may like to fashion with your hands. Next time take my advice, just let yourself act, nicely and easily." Another will remark : " I try to think." " Then do not try " is the best answer, which to the patient will usually be surprising. "All you need to do is just quietly and easily to let yourself think ; it is so much easier." (<:) // a reasonable suggestion be not at once responded to^ it indicates that you are going too fast^ other things being equal. You may not make good progress if you try to get your patient to read a classic before you have taught him enough grammar. If a 304 ADVANCED SUGGESTION patient appears dull you must not conclude at once that he is incapable of learning. All normal minds are not by any means equally rapid in acquiring knowledge ; much more, therefore, shall we be likely to find variation in the abnormal. This is seen in both physical and mental results. (d) Always bear in mind that yon are dealing with a patient who^ in his disorder ^ may not be capable^ for the time, of being wholly single-minded. It is your business to help him to be so. He may tell you that he cannot play golf, but after treatment he may astonish you by going forth and playing. This means that his supraconscious idea has been out of harmony with his subconscious inclination, and that now he is actuated more by the latter, which has been in- ducted. If, again, he tells you that playing golf caused him pain, this may not be in accordance with his experience in the subconsciousness, which may be capable of admitting that he had no pain. A patient comes to be single-minded — and therefore ceases to be a patient — when his supraconsciousness at length admits that he can play golf and that it does not really cause him pain. (e) Never allow yourself to be angry with a patient under any circumstances whatsoever. You may be very strong, and as firm in argument, as unbending in urging your claim, or in insisting upon obedience, as ever you please ; but never more than this. In order to demonstrate the sincerity and integrity of this rule, I have even extended it in giving advice PRACTICE OF PSYCHOTHERAPY 305 to those who feel obhged to exercise force in cases of dementia or mania : attendants should never allow themselves to get angry. If they will cultivate this plan they will not only save themselves much un- necessary strain, mentally and physically, but they will exercise a stronger control over the patient. Up to the very day of the publication of this book I know of certain high-class attendants, employed even by leading mental experts of this country, who practically fight their patients every time they find it necessary to control them, using aggravating violence, accom- panied by threatening expressions and even by swear- ing. When the word of a patient is disbelieved it is of little use for him to report any conduct or language shown by the attendants, which has been displayed, it may be, behind closed doors. The disposition to get angry is very naturally aroused in those who know no better. It has not been for me to correct many instances which have been described to me; I could not interfere without being guilty of a breach of eti- quette; but there they have existed, and some still exist. Patients should be taught to regard rather than be afraid. "Serves them right," says an attendant who knows no better, and has never been taught better. When a patient sees that firmness and strength are applied with consideration this does not rouse his opposition nearly so much as a display of heated animus, which will arouse retaliation for a long time. The former will give the patient to understand that opposition will be of no use; the latter will provoke 30 3o6 ADVANCED SUGGESTION him and increase his determination to fight "the devils " more than ever. (/) Never allow a patient to be angry. It should be patiently and repeatedly explained that nothing is required or necessary but clear, simple, accurate think- ing, however vexatious anything may seem, (^) Never deceive a patient who has sufficient sense to accept straightforward reasoning. If there does not seem to be sufficient reasoning power some amount of tactful dissimulation may be necessary. If, for instance, a patient does not sleep at night, and refuses to take any sedative, being obsessed, you may find it advisable to give some sort of sedative in food which will conceal it. {h) Teach the difference between a white and a black falsehood; for otherwise you may be asked by a patient why, if she can giw& this excuse, she is rebuked for offering that. (i) Always carry in mind tJie very great value of the emotional in induction by words spoken, being care- ful, however, not to create too severe misgivings. (/') Always judge a patient by what he does rather than by what he says. When a certain amount of dissociation exists, the representations of the supra- conscious mind cannot be depended upon. A patient may declare that he cannot walk, but may afterwards be heard to walk to and from the window, having had the impulse to shut the latter; thus he may induct himself to falsehood, and declare he did not do so, wh?n challenged. Again, he may not know in PRACTICE OF PSYCHOTHERAPY 307 the supraconscious mind that he did shut the window. (k) Detecting falsehood is a powerful means of eifecting association. By this means the patient is persuaded to reconcile the contradictory tendency which exists between the subconsciousness and the supraconsciousness, and to bring the two into har- mony by emotional bonds and linkings. It is very interesting at times to observe how a patient can hardly believe that he has just told a lie when immediately after it has been told, a better association is effected ; but it must be remembered that his astonishment may be either real or assumed. (/) Is! ever let a patient study other patients excepting under your purposive direction. A good deal may be learned from other patients, for good or ill, accord- ing to circumstances which only the physician is able to take into proper account. {m) Take pains to employ the simplest teachings possible. Some of my best patients have been clever university professors, and in dealing with such I have found that the patent simplicity of everything I have uttered has had far more effect than similar words have had in the case of the more simple-minded. Simplicity has the greater effect the higher the intellectual capacity. This will surprise some of my uninitiated readers, but will be understood without my mentioning it by any experienced teacher. in) Never allow any remark of yours to be misunder- stood. Instruct p9,tients to ask the meaning of any- 3o8 ADVANCED SUGGESTION thing which does not seem clear. On no account should there be any mystery in connection with any- thing done or referred to. Anything mysterious should be deemed an insult where any intelligence exists. A scientific physician should be able to find methods which are neither derogatory to himself nor offensive to any of his patients. (o) Always take a patient's word without question- ings unless you have good reason to doubt; then give this reason. By this means patients are helped to believe in themselves. Even after detecting a lie, go on assuming the truth (after exposing the lie) until you find another. Thus you induct for the truth. Analysis (simple) is proceeding all the time, and will bring out contradictions and misrepresentations. {p) Never make a manipulation or a movement^ nor direct it or allow it^ as affecting the patienty without offering an explanation. There should be no palpa- tions whatever which are not understood — not even the simplest touching. {q) Choose the m,ore restful times of the day for treat- ment in difficult cases. After lunch or tea is a good time. But when a disorder requires a course of re-education, the patient being physically fit and steady all the time, any hour of the day that is con- venient will be suitable for the lessons. {f) Welcome difficulty and eiijoy dealing with it. Any appearance of disappointment or defeat will be looked for by difficult patients, and seized upon, if possible, for a perfect revelling in of " negatives." Show PRACTICE OF PSYCHOTHERAPY 309 your power in helping the patient to exhibit his own power. He will learn to imitate, and to be less afraid of anything. In this way a physician will develop his own power as he goes on. If he shows disappointment he will produce it in his patient; he will soon want a holiday himself. Even if an incident is unavoidably disappointing, it may well be treated in a spirit of armour-plate defiance, for this will develop emulation. (s) Direct your best mind towards making your fatient well. Once you have undertaken a case because you have reason to think you will succeed, put every other consideration aside save the determina- tion to win to the normal. There are men who do not believe in curing lunatics, who imagine that they need only be kept from doing harm, and argue that they are never worth curing. Such might be the opinions of ultra-eugenists, but the idea cannot be entertained by the present writer, and the majority agree. The spirit which obtains the best results will also profit better than any other in the end ; it reaches people who are cheerfully willing to pay fees. (/) When yo7i benefit another you benefit self. This is one of the best aphorisms to teach any patient who through illness has become selfish, self-centred, and self-fearful. The truth of it is as irrefutable as one might expect a fundamental philosophical truism to be, when it is begotten of the great purpose of the creator of all things. But the desire to benefit must be honest. It must not be a makebelieve, or it may be hurtful in its recoil, 3i0 ADVANCED SUGGESTION like the boomerang flung by careless hands. Thd intention of an act must be straight; it must not be performed in order to obtain cheap plaudits in respect of its apparent virtue. An overbalance of self-sacrifice should, of course, be guarded against, as possibly or actually unwise, and as likely to defeat its own purpose. Psychotherapy is therefore likely to be very whole- some work if properly understood and practised. (u) See your patient alone as a rule. A person's ill-health should primarily be his own concern; he ought to feel that when he is of value to himself it is time for him to be of value to others, and he should look forward to being so. A patient should therefore not want a third party present, unless at first he or she should be afraid; if so, the fear should straight- way be treated, until it ceases to exist. A physician to be of any account should require no one else to be present, having found that a new patient is neither a dangerous lunatic nor one of criminal potentiality. A psychotherapist's thinking and speaking powers ought to be his best weapons of defence, provided the patient can so far understand him; he will never be very successful if he does not act in an openly honest manner with his patient. Third parties often confuse the patient, who may be deeply considering his own private thoughts as well as the physician's. This does not seem to agree with the fact that in certain foreign clinics the assembling of many patients in the same room for treatment is favoured for various reasons. It is true that good PRACTICE Ot PSYCHOTHERAPV 311 results are to be obtained in the ensemble^ especially when patients are impressed with the thought that others are being similarly benefited. Individual treatment, however, is bound to produce the greatest percentage of successes, as is the case with instruction of any kind. Treating patients before others in a hospital ward will not give good results, for any staring curiosity is bound to be most disconcerting. On the contrary, if your patient is unreasonably disputatious or awkwardly untruthful, the presence of a third party may act like a charm. {v) If you do not succeed, try to find out why, and adopt other lines of induction. Never at once con- clude that the patient is a bad subject ; it may be more correct to decide that your method is not a suitable one for the particular personality or state you are dealing with. (w) Remember that effectual induction will depend upon certain sequences in acts and arguments designed to fit each case. If you miss the links in a chain of reasoning you may be obliged to begin again. If you too hastily contradict, this may break the course of the treatment and give you trouble. {x) Direct suggestion may be good at times, but indirect suggestion must always be far more effectual. Clearing a garden of weeds will always be better than spudding odd thistles. If a patient is afraid of a thing, and is told that he need not be, he may so far accept the idea and be cured. But the fact that he is afraid when he ought not to be is conclusive evidence that his 312 ADVANCED SUGGESTION nervous system is abnormally sensitive, for a normal person would not be thus afraid. Therefore his nervous system requires treatment, and then the particular fear may vanish without any direct reference to it what- ever. " You will now be less afraid of anything " will be of greater value than, "You will not be afraid of that particular thing." Direct reference, of course, may often be usefully included. A study of relapses under defective technique in cases treated by inexperienced physicians has conclu- sively indicated that the direct method employed has accounted for them. A single " negative arc " is prac- tically non-existent. It would be as difficult to find a thistle by itself in a field ; there are sure to be other weeds somewhere. If you take away only one nega- tive, you will have remaining negatives (however small) which make for more, and in course of time these will bring back the principal one which was originally complained of. The whole field should therefore be cleared, and the particular weed with it. (y) Always bear in mind that arguments with the supraconscious mind are worth nothing as compared with the force of arguments with the subconscious mind. The best plan to adopt is to gather together the patient's ideas in simple conversation, making roUgh notes of them as he speaks; then you should answer them when you have reached the subconscious mind. It is utter waste of time to attempt to treat diffi- cult cases by any form of supraconscious conversation. It follows that this degree of proportional value will t^RACTICE OF PSYCHOTHERAPY 313 obtain even in quite simple disorders. The concep- tion of what is right will first be entertained by the subconscious mind, which will ultimately correct the supraconscious mind. The method advocated by some mental specialists which they term "employing psychotherapeutic con- versations," may sound important, but it is com- paratively useless, and may even be worse than use- less. Most experts have found out how vain it is to attempt to conduct ordinary arguments with neuras- thenics and phobiacs, however cunningly and care- fully the debating points may be selected and applied. Nay, more, argument on the supraconscious plane usually serves to provoke the patient to search for more points to the contrary. If a patient could be successfully dealt with by ordinary conversation, then there would be hardly anything the matter with him. I should like to warn those neurologists who will persist in delivering the emphatic diagnosis : "Nothing the matter with her really — only she will not believe it " : there is usually so much the matter in these cases that it is not properly understood. Such cases may be aggravating when " they will not believe." The truth is that they require a treatment which to-day is very special, but which before very long will be comparatively ordinary, namely, efficient suggestion. (z) Avoid asking patients how they are. Find ozit how they are^ by observing, or by asking others what they have observed. This rule follows naturally from the 314 ADVANCED SUGGESTION truism that replies cannot be depended upon in an inco-ordinated mentality ; merely to elicit a misrepre- sentation or an incorrect conception will not help dis- order. The very neglect to ask about symptoms teaches the patient also to cease referring to them. Of course, here and there a question may be necessary, if informa- tion cannot be obtained in any more satisfactory way. CHAPTER XXII ON FAILURES Does one have failures? I have failed when there has not been enough mind in the patient to work upon. And here I should like to recommend beginners in psychotherapy to consider patients not so much with regard to their insanity, but rather in the regard to their sanity. What sense is there left in the patient ? This should be the query in taking a case. Relatives and even doctors will call one aside, and refer to such and such symptoms as " surely insane." I am obliged to refuse to converse in this mood. I prefer to say : "Please tell me what is sensible about the patient." I practise and advocate a development from what is sane into what is saner, until there is no room for anything but sanity. "It is the mind, I suppose, doctor ?" says a mother. " What do you mean by the mind ?" I ask. " Well, she is insane, is she not ? Her aunt, you know, was so." I decline to accept the idea either from the aunt's case or the patient's indications of eccentricity. " I cannot think ; I know I am going off my head," says a patient. My reply is that the patient is obviously able to think, or she would not be able to speak in so sensible a manner. Is there any 315 3i6 ADVANCED SUGGESTION wonder that such a patient often feels better after the first interview? On the other hand, some cryptic response, such as " Very dreadful," accompanied by a silent, superior side-look of impatience, or "We will consider what we shall do," may bring about more confusion and distress than ever, enough to necessitate an increase of the " sleeping stuff " resorted to. If one were to judge that the nature of earth were poor because of weeds growing instead of good corn, great mistakes might be made. I recollect a Scotsman of my acquaintance making a little fortune from his purchase of an estate which had crumbling buildings upon it, with grass-grown gardens all around. For years it had been mistaken for something in some way hopelessly blighted. " There is value in all this, if I pull down and build up," he ruminated. There was a fine position and good soil; that was enough for him. Incidentally he found some very valuable Italian marble mantelpieces among the debris. I have had failures because physical defects had been overlooked by others. A patient suffering from mania was restless and even violent ; she had run away from a medical home where she had been for some weeks. Her case was sent to me as "purely nervous." In deference to the well-known physician who sent the case to me, and counting upon the care with which her case had been dealt with at a well-known home, I concluded that all physical examinations had been made. I soon found that psychotherapy was not sufficient to improve her condition. She became so ON FAILURES 31/ violent that removal to further control was necessary. General measures, including high enemata, cured her very quickly. She was really not in a fit condition to be passed on to a psychotherapist at all. In another instance, the friends of a man had heard of a former case of cure, and were very anxious for the man to come into my care. His local attendant con- sented, and the patient came. I placeci confidence in the local attendant's judgment that the patient was a suitable case — one of nervous dyspepsia, as he had described it. When he arrived I found him not only more mentally deranged than had been represented, but in a physical condition that was hopeless. He had no mind to work upon, with a body that was so emaciated that it was not equal to keeping "a soul alive." I forgive the local attendant, for he had been previously informed that another patient sent to me had been cured as by a miracle ; he probably thought there was no limit at all as to the possibilities of the treatment. A case of concealment of real condition is not with- out interest. A lady had been ill for years. I had treated her for nervous dyspepsia for a few weeks some four years previously. She now sent for me complain- ing of insomnia and of feeling very ill. She had had so many doctors years ago that she would not send for any but the one who had cured her dyspepsia, as she explained. I told her she ought to have a local doctor. She declined ; I therefore treated her for insomnia, and recommended a certain dietary. No 3i8 ADVANCED SUGGESTION improvement. She seemed to worry over my ques- tions as to her general condition. I did not like her demeanour. She turned unaccountably irritable, and began to blame me for not curing her insomnia. I was not satisfied about her feeding, and, whether it might worry her or no, I determined to examine her stomach. I found advanced cancer of the left breast and growths in other places. She had known, before sending for me complaining of insomnia, that she was going to her doom suffering from a disease which she dare not think or speak about; she had hoped that I should only trouble about the insomnia and "the remaining old indigestion." She had concealed her real con- dition from her daughter and all her most intimate relatives. A failure in the case of a medical man is instructive. He suffered from such advanced neurasthenia and melancholia that he became bedridden for many months, and at length refused further advice, after having been attended by many medical men. He aggravated everybody by taking things of his own prescribing, making all attendance on the part of even nurses impossible. Insane obstinacy were the only words which could adequately describe his condi- tion. He simply disputed and resisted everything that could be devised to help him. When I declined to treat him any longer his relatives compelled his removal to a home. There his obstinacy went even further, and he refused all food. I wrestled most earnestly with the difficulties of his case for some ON FAILURES 3i9 weeks, and had implanted a great deal that was beneficial in his subconscious mind; but he declined to be persuaded. Ultimately he was taken from the home and placed under complete control. He was then fed by force. This provided just the one thing necessary to make cure possible. He was wholly compelled, even physically. This put an end to his opposition ; further subconscious training at my hands did the rest. Alienists perhaps might say that " sug- gestion" had nothing to do with his cure: it is for this reason that I give his case as a failure. A case of morphia-taking was once sent to me, the patient being a man who had been subject to nerve- strain for many months. The explanatory informa- tion was given to me by a medical consultant that the patient had had an accident some time previously^ and had suffered greatly from a wound cicatrix. Moreover, he had been greatly afraid of cancer, and I was asked if it were possible to get this idea out of his mind. When the patient arrived I was not at all pleased with his physical condition. I judged him to be in an advanced state of weakness. I examined the cicatrix and the abdomen, and formed the opinioa that he was dying from cancer which had spread internally. I succeeded in relieving him very con- siderably to the end, however, especially as to his state of mind. But what did the consultant really send him to me for ? Did everybody believe he had no cancer? Or was it the plain intention to land a difficult and desperate case upon somebody else?- 320 ADVANCED SUGGESTION The patient declared from the first that he felt greatly relieved at being away from home. When I have asked the reader to bear in mind that many cases of alcoholism really belong to the category of mental unsoundness, the latter being the primary condition, the likelihood of many failures in the employ- ment of any treatment whatsoever for this affliction will be easily understood. In some of my failures insanity of a hopeless type, and stigmata of degenera- tion, have been only too obvious. A study of one or two examples will help. A young man, an only child, had been more or less spoilt from infancy. He was good-natured but at times unreasonably irritable; he was very fond of cheerful company. At the age of twenty he used with others to visit drinking bars. He was too well off to do any serious work. His parents were naturally anxious, but they were very lenient towards him, being inclined to be gentle, and to excuse him readily after administering mild reproofs. I found him to be easy, smiling, and affable. He had sense of a kind, and in some directions he appeared even clever. But some- thing was wanting. He was shallow in his replies to questions as to his amusements. He misrepresented facts, and he could not clearly follow arguments about his case. He invented excuses very readily, not hesitating to tell very clumsy falsehoods. He said he never got into a real temper, but only felt very annoyed inwardly about things at times. I found that he often had these sensations of inward annoyance before bouts ON FAILURES 321 o£ drinking. He improved greatly for some weeks under treatment, but eventually became insane. Another very similar case of failure may be referred to — that of a man in the twenties. He displayed great ability in certain directions; was very conceited, and often laboured under suppressed excitement. He was given to telling falsehoods very freely, almost stupidly. He improved greatly, but broke down occasionally. He also admitted having a temper which did not display itself, but which tended to "boil inwardly." Affable, good-natured, and energetic, he revealed indications of permanent mental instability. I have found cases of incurable dipsomania in epileptic families frequently enough to be note- worthy. A failure of another kind may be mentioned : the case of a man who was always under the disordered impression that he was hardly dealt with by every- body, by his wife, by business people, by doctors, and by most people with whom he came into contact. He had a badly shaped head, and gave me the impression that his future, if he lived long enough, would be one of further mental derangement. He had actually attempted suicide. He got quite well when taken away from everybody he knew, but broke down at once on returning home or on mixing again with old acquaintances. A business worry, either real or imagined, would send him wrong at once. No man was more readily cured for months on end, so long as the surroundings were not the usual ones of his previous ^22 ADVANCED SUGGESTION life, and so long as he was under direction and under- going nerve training. The best psychotherapists will have failures amongst cases of sexual disorder, for here we have often to deal with the highly artistic and emotional, who exhibit uncontrollable flights of fancy, and lose themselves in outpourings of enthusiastic appreciation. We have only to make a study of pervert art to imagine the impossibility of curing the majority of its converts: they are subject to functional disorder. In an era of cubism in painting and cacophany in music we are likely to find many people hopelessly deranged in their sexual life. Among my failures in this class of case, I may refer to a good-looking youth of exalted parentage. He was inordinately vain, and one could not help observing in him signs of inherited mental disorder. When I refer to mental disorder in cases of sexual perversion and alcoholism, I mean something that is likely to be permanent and unalterable by any known means; so that in these cases the sexual and dipso- maniac features must also be incurable. This youth was openly proud of his disorderly sexual tendencies, and declared that he had only come to me because he had been asked to do so. He was quite pleased to admit perversions and inversions, and to abide by all possible consequences. He wanted neither help nor guidance, he said. I have failed in the case of a medical man who suffered from lifelong sexual inversion; he had ON FAILURES 323 developed such mental distress on realising the difficult position in which he was ultimately placed by his disorder, that inordinate fears and dreads developed, with which no form of treatment by sugges- tion would be likely to cope. The history of his case was extremely interesting to me: his earliest experi- ences appeared to have developed from an inherited oversensitiveness of the sexual organs, which I have found to have been the case with many patients afflicted with an inverted disposition ; their desire has received its first response from one of the same sex, and this occurring at an age when the system was ripe for learning things, has become so firmly established under feelings of hyperemotion that a reversal of the condition in most instances will be extremely difficult to effect, even by a long course of neuroinduction. One may fail to cure constipation if stasis or organic obstruction of too long duration stands in the way. This should go without saying. CHAPTER XXIIl THE P'UTURE Psychotherapy has now passed very far beyond the experimental stage. It is no longer necessary to wonder whether it is worthy of being considered as of serious and permanent value or no. Its future is assured. Whatever may have been its shortcomings while in the hands of the pioneers of the past, who so nobly struggled against heavy odds of prejudice and sheer ignorance, it is now recognised and countenanced as an established science. Former oppo- sition was mainly due to the mistaken and persistent conviction — very pardonable at one time, no doubt — that the treatment was most objectionably potent, in that it involved some personal control over another's will-power. It is easily seen to-day that neuroinduc- tion, far from being a treatment which essentially involves the power of alienating the will-power of another, is, by its very nature and method of applica- tion, a means of restoring the will-power not to be equalled in efficacy by any other known agency. This must be the verdict of scientists in this year of grace 191 8 — a verdict which no conceivable arguments of the future can upset ; its truth is as final as the law of gravity, or any other scientific truth. 324 THE FUTURE 525 Medical men must therefore not only cease to oppose psychotherapy; they must cheerfully and whole- heartedly come forward to accept its great scientific facts. There can now be no excuse for opposition. The subject may be found difficult — many compara- tively new procedures are: I have chosen to admit that, at first, and in certain respects, it is so, and for the best reasons. But what work has ever been initiated that has not become easier and easier as time and understanding have "cleared the air"? I have attempted to explain procedure with a desire to help, as a later pioneer; I have endeavoured to pass on my knowledge and experience for the benefit of others, so that, by their working on similar lines, a much greater progress may very soon be achieved than that to which I have attained. Fashions in therapy have existed at every stage of the history of medicine, but in this book we go beyond the possibility of incurring that insecurity of tenure which merely whimsical or fanciful work deserves. Every effort has been studiously made to steer clear of speculation, not so much in a spirit of self- commending virtue as with a comfortable feeling that one has had no occasion to do so. All may not be final that is here laid down. Doubtless all is not final. I have at most been desirous of soliciting interest and a following, by refraining from making unfair deduc- tions. Moreover, I shall be instantly prepared to bow to any corrector who can prove his case, and to applaud improvement — such as we shall surely get 326 ADVANCED SUGGESTION before long — the moment that I see other hands are effecting it. Many cases have been considered which serve to indicate very plainly that a valuable therapy has been employed with great success when everything else had failed. To-day it is obvious that this therapy should be recognised as a force to be employed at the outset of certain disorders, once these can be accurately diagnosed. Some of the cases cited have indi- cated a painful want of knowledge on the part of the doctor as to what was the best course to take, the patient refusing to die, or declining to go irrecoverably mad, while a hopeless prognosis was repeatedly offered in answer to pitiful appeals made in well-known consulting-rooms. Cases which have been successfully treated by psychotherapy are growing in number, and, in future, records of object lessons will necessarily find their way into print; so that psychotherapists of capacity and attainment may henceforth be easy in their minds. Medical men will be obliged to study the subject, and to conquer their obsessions begotten of misunder- standing, or they will remain at the mercy of those who know better. This is the plain issue for such as are recalcitrant and obstinate. Psychotherapy is to-day in a very strong position, and it is likely to become much stronger. It will in future find plenty of material if such movements as " futurism " continue to gain ground. There need be no anxiety on the part of medical men lest advanced methods of curing THE FUTURE 327 the sick should leave any the less to do for future practitioners. New cults which set out to advocate perversion and inversion in art, and in as many other things as they can extend disorder to, instead of the naturally beautiful, are almost certain to be prolific of material. Persons who degenerate so far as to devise monstrous contrivances called "noise-tuners" instead of ordinary musical instruments, and who write poetry which not only includes "Kafhr clicks," but indicates a predilection for " delirious onomatopoeics," are likely to beget a strange and perplexing offspring in abundance. I am of opinion that not many years will elapse before neuroinduction — as carried out properly by others — will have proved itself to be first in efficacy as a treatment for several disorders that have persist- ently baffled medical scientists heretofore, particularly diabetes, exophthalmic goitre, intestinal stasis, and insanity. An outstanding derivative of present-day conflicts of opinion regarding the formation of a Ministry of Health and a State Medical Service — all begotten of the pressing needs of a whole world's plight — is the writing on the wall, "Better preventive systems are wanted against disease." In neuroinduction we have a natural system which makes for natural process both in the prevention of certain diseases and their cure when established, whether bodily or mental INDEX I'AGES Abdominal bends and kinks, rarity of . . . . I44"5 Abnormal growths, see Cancer, Carcinoma, Morbid growthr^ Acne, gastro-intestinal disorders in . . . . . . . . 218 ,, neuroinduction, treated by .. .. .. 217-18 , , puberty, during Acquired characters, transmission of A damson, Dr. H., on tumours Adhesions, intestinal, not incompatible with health Adrenals, the, in cancer Adrenin , . in cancer Agoraphobia cases of, treated causes of Alcoholism . . . . . . . . . . . . 145 neurotic factor in, the Alimentary tract, disorders of the negative circles Altero-association Altero-conduction Altero-induction Amaxophobia . . Amnesia, simulated Anaesthesia, suggestion during Analysis in psychasthenia, (see Self-analysis, analysis) Anger, bad effects of . Angiospasm Appendicitis, supposed Arthritis, rheumatoid, in exophthalmic goitre auto-suggested case of Artifice, hysterical Asthenox)ia .... Asthma . . cardiac ,, cases treated by neuroinduction cauterisation, effect of, in . . children, in . . habit in ,, neuroinduction, power of, in 329 270, 218 17 221-2 144-5 236 177 233 51-8 52-5 52-3 190-7 1 90- 1 134-54 134-5 ■ 273 ■ 273 273 51 287 bought 30 • • 304- ' 91 10 .. 186 .. 186 ■• 38 127 167-75 172-3 168-9, 174 171. 173 171-2 .. 171 170 330 ADVANCED SUGGESTION I'AGES Asthma, neurotic character of .. .. ., 173-4 spasmodic nature of .. .. 167, 169, 170 Astigmatism, predisposing to epileptiform attacks . . 73-5 ,, ,, to phobias .. .. .. 52 ,, ,, to vertigo .. .. .. 73 Asymmetry, facial . . . . . . . . . . . . 205 Auricular fibrillation . . . . . . . . . . 157-8 Auto-induction . . . . . . . . . . . . . 270 Auto-inference . . . . . . . . . . . . . . 286 Auto-intoxication . . . . . . . . . . . . 143 Auto-suggestion . . . . . . . . . . 270-1 ,, ,, obsessional . . . . . . . . . . 287 " Bad boys " .. .. .. .. .. .. .. 260 Baldness cured by neuroinduction . . . . . , 216-18 Batophobia . . . . . . . . . . . . . . 51 Benignant growths treated by suggestion . . . . , . 227 Birds, uterine antipathy to .. .. .. .. .. 17 Blindness, functional .. .. .. .. .. 123, 126 Blood, lust for . . . . . . . . . . . . . . 250 Blood-pressure, high ,. .. .. .. .. ..119 cases treated by neuroinduction 119-20, 156 nervous^subjects, in .. .. .. 119 over-eating, due to .. .. .. 119 Bodington, Dr.. on phthisis . . , . . . . . 163-4 Bonesetters and suggestion . . . . . . . . . . 203 " Bonesetters and their Work," by the author . . . . 203 Brand. Dr., on a case of thyroid enlargement . . . . 184 British Medical Journal, on radium in treatment of cancer .. .. .. .. .. .. 225, 235 British Medical J our >ial refuses author's article on neuro- inductive treatment of cancer . . . . . . 227-8 Brock, Dr., on cancer . . , . . . . . . . . . 236 ,, on gastro-intestinal disorders . . . . . . 147 Brown, Dr. Langdon, on high blood-pressure . . . . 119 fi«nc/i, Dy., on pruritus .. .. .. .. .. 214 Butcher, Dr. Deane, on action of radium . . . . . . 237 Butlin, Dr., on spontaneous reduction of tumours . . 229 Cancer, author's work and theories in respect of . . 226-34 blood-supply in, controlled by neuroinduction 230-1 breast, of the, successfully treated. . . , . . 227 cause of . . . . . . . . . . . . 221 cheerfulness, effect of, in . . . . . . . . 229 ,, cheering effect of new remedies in . . . . , . 230 connective tissue, part played by, in . . . . 235 defensive reaction of . . .. .. .. .. 225 radium treatment of , suggestive factor in .. 230 ,, spontaneous reduction of .. .. .. 226, 229 ,, suggestion and .. .. .. .. 226-7 ,, technique of neuroinductive treatment of . . 238 INDEX 331 I'ACES Cannon, ProJ., on the digestive process in cats . . . . 138 on sphincters of the intestine .. .. 144 Carcinoma, causes of . . . . . . . . . . . . 221 radium treatment of .. .. .. .. 225 " Cat and spider sense " . . . . . . . . ^ . 65 Charlatanry and psychotherapy . . . . . . • • 4 Children, see Young, the Chloroform, abuse of . . . . . . . . . . 194-6 hysterical contracture, in cases of . . . . 49 Chorea . . . . . . . . . . . . . . • ■ 80-4 cases treated by neuroinduction . . . . . . 80-2 ,, children, in . . . . . . . . . . . . 83 ,, uric acid diathesis in . . . . . . . » 83 " Circling " 5. 24 Claustrop)iobia . . . . . . . . . . 51, 58-61 cases treated by neuroinduction . . . . 59 Cocaine, abuse of . . . . . . . . . . . . 191 severe case of .. .. .. .. 193 ,, ,, vicious circling in . . .. .. 191-2 Conflict, cerebral, a cause of neurasthenia . . . . . . 21 Constipation, cases treated by neuroinduction 140, 141, 142, 147. 177 cause of.. .. .. .. .. .. 143 Contagiousness, delusion of .. .. .. .. ..113 Contractures, due to traumatisms . . . . . . . . 46-7 ,, hysterical . . . . . . . . . . 49 ,, ,, operations upon . . . . . . 203 ,, manipulation of . . . . . . ^ . . 49 ,, neuroinductive treatment of . . . . . . 203 Co-operation of the patient .. .. .. .. 273, 277 " Cornering " patients . . . . . . . . . . 21-2 Criminal, mental aberration in the . . . . . . . . 256 Criminal inclinations, analysis of . . . . . . 249, 255-6 treatment of .. .. .. 244-56 Criticism a cause of neurosis . . . . . . . . 26, 32 Cruelty, early . . . . . . . . . . . . . . 250 Cruise, Sir Francis . . . . . . . . . . . . 76-7 Deafness, functional .. .. .. .. .. 123,126 Deceit, harmful effects of . . . . . . . . . . 306 Degeneration, stigmata of . . . . . . . . . . 39 Dementia, acute ,. .. .. .. .. .. lo-ii Dementia praecox . . . . . . . . . . . . 121 herpes in conjunction with .. 205-6 self -analysis in .. .. .. ..121 Diabetes, authorities, various, on . . . . . . 180-1 cases treated by neuroinduction .. .. .. 179 Jews liable to .. .. .. .. .. 179 psychotherapy and .. .. .. ..178-9 strain, due to . . . . . . . ^ 1 77-80 Diagnosis expressed io terms of " circling '\ . , , . 25 332 ADVANCED SUGGESTION Diarrhoea treated by neuroinduction Digestive secretions, emotions control flow of effect of shock on Dipsomania, the neurotic factor in . . Discord, cerebral, a cause of neurasthenia Distaro, Dr., on constipation . . Dove, Dr. Ernest, on cancer . . Dropping articles, dread of Drugs, abuse of . . . . . . . . ii, 24, epileptic history and negative arcs in moral effects of abuse of useless in case of insomnia Duodenal ulcer, the neurotic factor in Duval and Rubens on tumours ])war{ism, case treated by neuroinduction Dyspepsia, cause of . . infantile, cured bj'' treatment of mother neuroinduction,- treated by neurotic . . Early moral and educational effects and uses of induction . . . . . . Eczemas, neuroinductive treatment of Education, neuro-induction as an auxiliary in Embezzling, a case of . . Emotional process value of . . Employment of neurotic patients Enterostasis Epilepsy astigmatism predisposing to , , cases treated . . . . . . 69 fear of fits in medical treatment powerless Epileptiform seizures . . ,, astigmatism predisposing to Epithelioma Erythema . . . . . . . . . . ' Eye, sensitiveness of, to suggestion . . Eyestrain importance of, as predisposing -factor severe case of Exophthalmic goitre, arthritis, in conjunction with intoxication a suggested cause of treated by neuroinduction .. PAGES 148-9 154 284 190 21 143 233 63-4 190-7 197 197 196 26 134 225 187 135 188-9 136-7 134 Failures alcoholism, in cases of mental deficiency, due to physical defects overlooked, due to neuro- 257-66 208, 215 257.8 39 283-4 .. 306 ■ • 32-3 •• 153 68-72 •• 73-5 70. 71. 73-5 69-70 72 72-5 73-5 221 205 132 127 151-2 132-3 . 186 . 186 . 183 315-23 320-2 • 315 316-17 126-8, INDEX 333 . • 307 260-2 . . -245 262 263 173-4 166-7 57 36, 07 • • 305 233 299-300 41. 295 30 41 299-300 123-133 124-5 125 Falsehood, association effected by detection of children, in detection of . . . . . . kleptomania, in . . nervous sufferers, in vicious circling in Fear in asthma Fishberg, Dr. Maurice, on psychology of phthisis Fits, fear of Food, refusal of Force, use of . . Fowler, Dr. Frank, on cancer Freud, sexual factor exaggerated by Freud's analysis system.. ,, " word association " . harm done by Function, restoration of colour-blindness, treatment of ,, ,, difficult and impossible cases ,, ,, indviction, by .. .. .. 125 memory, loss of, treatment for . . 125 sudden recovery from deafness, dumbness, blindness . . . . 123 theory of . . . . . . . . 123-4 Future of psychotherapy, the . . . . . . .. 324-7 Futurism . . . . . . . . . . . . . . 326 Gastric juice, central control of . . . . . . . . 139 ,, ,, initial flow of, due to psychic factors .. 153 Gastric ulcer, neurotic factors in .. .. .. .. 134 Gastro-enteritis, neuroinductive treatment of . . . . 218 Gastro-intestinal disorders, emotional influence in. . . . 153 German science and scientists, over- valuation of . . . . 292 Gibson, G. A., on neurotic origin of asthma . . . . 172 ,, ,, on emotional causation of Graves' disease 185 Gland functioning, disorders of .. .. .. 176-89 Glands, the, induction, effects of, on . . . . . . 177 ,, opotherapy, effects of, on . . . . . . 177. ,, secretions of, affected by induction .. .. 177 influenced by neurones . . . . 18 suggestion, effects of, on .. .. .. 177 Glycosuria, authorities, various, on . . . . . . 180-2 ,, caused by shock, cured by rest. . . . 180-1 opium in .... .. .. .. .. 181 pancreas, effect of, in . . . . . . . . 182 Goitre, see Exophthalmic goitre. Graves' disease, Thyroid, Myxoedema Goodhart, Sir James, on mucous colitis . . . . . . 150 on tumours .. .. .. .. 220 Could, Sir Alfred Pearcc, on cancer . . . . . . . . 232 334 ADVANCED SUGGESTION HAGBS Graves* disease, treated by neuroinduction . . 182-3 Gynaecology . . . . . . . . . . . . 239-43 Haemorrhoids, caises treated by neuroinduction . . 198-200 prolapse of, severe case . . . . . . 200 Hall, Dr. Haviland, on high blood-pressure . . . . 119 Hallucinations .. .. .. .. .. .. ..278 Haut mal . . . . . . . . . . . . 68, 69 Hay asthma . . . . . . . , . . . . . . 130 severe cases treated by neuroinduction .. 175 Heart and circulation, disorders of the . . . . 155-60 treated by neuroinduc- tion . . . . 155-6 Heart, cardiac irregularity, cases of, treated . . 136 failure of the . . 158-60 13-M 91 62-3 62-3 207 panic Heights, fear of , , , , cases treated by neuroinduction . . Herpes, due to shock . . lips, of the .. .. .. .. .. 205-6 vaso-motor neurosis, a .. .. .. 207-8 Hiccough, treatment of . . . . . . . . . . 95-6 Hill, Dr. Leonard, on diabetes . . . . . . . . 182 Holmes, Dr. Gordon . . . . . . . . . . . . 103 Homicidal inclinations . . . . . . . . 250-4 ,, „ gestation, during . . . . . . 254 ,, „ girl student, in a . . . . 252-3 ,, ,, sexual factors of . . . . . . 252 ,, ,, vanity a factor of . . . . 254-5 Hyperhidrosis, neuroinductive treatment of . . 213-14 treatment of, by cautery and X rays . . 213 Hypnosis, true . . . . . . . . . . . . . . 272 not the best state for suggestion .. .. 273 Hypnotic suggestion . . . . . . . . . . . . 273 failure of . - . . . . . . 277 ,, ,, not recommended ., .. .. 6 Hypnotism, early prejudice against . . . . . . . . i Hysteria . . . . . . . . . . . . 40-50 cases treated by neuroinduction . . . . 41-2, 44-5 dissimulation in . . . . . . . . 40. 45 enjoyment of . . . . . . . . . . 41 environment in . . . . . . . . . . 43 fear of revelations in . . . . . . . . 43 Freud's analysis of . . . . . , . . . . 41 history of . . . . . . . . . . . . 40 hygienic treatment of . . . . . . . . 45 induction and self -analysis in . . . . . . 41-2 love affairs and . . . . . . . . . . 44 „ oscillating progress of . . . . . . . . 42-3 ,, relatives and . . . . . . . . • • 43 Hysterical artifice ■. . . . . 38, io-i INDEX Hysterical contracture oedema theories of Ileum, terminal sphincter of the Impotence, functional " Incorrigibies " and psychotherapy " Incurables " cured . . Induction, definition of effects of ,, suspicious patients, how applied Inflammation, definition of . . Insane, the, anger harmful in treatment of ,, asylum treatment of the hallucinations of ,, induction in treatment of ,, research, lack of, concerning , , suggestion in treatment of Insomnia cases treated by neuroinduction idea of inability to sleep in, the Intestinal flora . . Intestines, neuroinduction of the Intoxication in constipation . . to JejfeHes, Dr. F. B.. on herpes Jung \ . ,, analysis, his methods of ,, his system Keith, Prof., on the ileum Keratosis senilis Kleptomania ,, ambition, thwarted, a cause of ,, analysis of ,, cases treated by neuroinduction ,, sexual strain in „ toxaemia in „ trauma, early, responsible for Lacrymation, excessive Lane, Dr. Arbuthnot, on constipation Laryngeal disabilities . . Latham, Dr. Arthur, on asthma " Laying-on of hands " Literature, demoralising Lourdes . . Lunatics, confidences of supposedly unconscious 335 PAGES 48-9 49-50 .. 48 .. 144 . . lOI 259, 260 II 23, 269 •• 23-4 35 219 • . 305 107 .. 278 108-9 .. 108 107-8 19-28 26-7, 35. 264-5 19, 21-2 •• 143 146 •• 143 206-7 4 291, 295 30 . 144 221-2 244-50 . 249 • 244 245-9 246-7 . 247 247-8 . 127 • 143 . 91-6 170 124 • 265 . 124 . 286 Macleod, ProJ., on diabetes . . . . . . . . . . 180 S56 ADVANCED SUGGESTION PAGES Malingering . . . . . . . . . , . . . . 30-1 Manipulation . . . . . . . . 146, 276, 286-7, 3^8 Marsden, Dr. A^pinall, on nerve influence in cancer . . 235 Masturbation . . . . . . , . . . . , 100-4 negative circling in ,. .. .. . . loi tendency of .. .. .. .. 102-3 McKenna, My., on demoralising literature . . . . . . 265 McNevin, Dr., on emotional influence in gastro-intestinal disorders . . . . . . . . . . 153 Medical men, bad patients . . . . . . . . 193-4 drugs, liable to abuse of .. .. .. 194 Medical Society of London, discussion of phthisis by . . 163 Medicinal treatment, when advisable . , . . . . 24 Melancholia, cases treated by neuroindiiction . . 37-8, 109 Memory, loss of, treated by neuroinduction 125-6, 257, 287-8 Menstruation, success of psychotherapy in disorders of 239-40 ,, irregular cases, neuroinduction in . . 240-1 negative arcs in irregular . . . . . . 241 Milk, secretion of, affected by suggestion . . , . 189, 243 Miller, Dr. C. H., on auricular fibrillation . . . . . . 257 Moral effects of neuroinduction . . . . . . 257-66 Morbid growths . . . . . . . . . . 219-38 causation of .. .. .. 219-22 Morison, Prof. Rutherford, on inflammation . . . . 219 Morphia, abuse of . . . . . . . . . . 102, 91 severe cases, neuroinduction in 192-6 vicious " circling "in . . . . 191-2 Mothers, expectant . . . . . . . . . . . . 243 vanity in, leads to homicidal ideas . . 254-5 Moullin, Dr. Mansell, on tumours . . . . . . 220-1 Mucous colitis . . . . .... . . 146, 149-54 cases treated by neuroinduction .. 149, 150-2 nature of ' . , . . . . . . . . 1 49 negative " circling " in .. .. 151-2 Mucous secretions, control of the . . . . . . . . 130 Mutilation, savage, a case of . . . . . . . . 251-2 Myxoedema . . . • . . . . . . . . . . 183 Nasal troubles .. .. .. .. .. •• 130-1 Negative " circling " . . . . . . . . 5, -^5, 285, 31 -" drug-taking, in . . . . 190-1 examples of . . . . . . . . 25 hysteria, in .. .. .. .. 45 ,, ,, opposition of, by positive . . 25, 32 Neurasthenia, central origin of . . . . . . . . 29 cunning, in cases of . . . . . . 20, 38-9 elucidated by psychasthenia ^.. .. 29 ,, eyestrain a cause of . . . . 127-9 ,, severe cases of . . . . . . 15-16, 28 toxecmia in . . . . . . . . . . 29 INDEX 337 PAGES Neuroindtiction . . . . . . . . .... 2 cancer, in treatment of . . . . 226-38 constipation, the best cure for . . . . 177 ,, definition of . . . . . . 4-5, 270 ,, demands on patient made by . . . . 7 ,, hair, effects of, upon the . . . . . . 216 „ hypnosis, superiority over . . 6-7, 275 ,, physical system, effects of, on the . . 280 ,, preventive powers of . . . . . . 327 ,, skin, effects of, on the . . . . 216-17 ,, technique of, offer to teach . . 3-4, 269-89 „ treatment by, nature of . . . . . . 275 ,, vaso-motor effects of . . . . . . 238 ,, war, cases incidental to, treated by 267-8 Neurone strain due to psychic traumatism . . . . . . 46-7 Neuroses . . . . . . . , . . . . 19-96 Neurosis . . . . . . . . . . . . . . 8 Night terrors . . . . . . . . . . . . 76-80 Nurse treated for duplicity . . . . . . . . • • 195 Nursemaids often responsible for phobias and traumatisms 54 Obstetrics . . . . . . . . . . . . 242-3 dread of parturition removed . . . . 242-3 sleep obtained during childbirth ,. .. 242 CEdema, hysterical . . . , . . . . . . . , 48 lower limb, of .. .. .. .. .. 201 neuroinductive treatment of . . . . . . 202 (Esophageal disabilities . . , . . . . . . . 91-6 spasms, case treated .. .. .. .. 93-4 Organotherapy in conjunction with neuroinduction .. 188 Ormerod, Dr., on hysteria . . . . . . . . . . 50 Osier, Prof., on colitis . . .... . . . . . . 149 Over-eating a cause of high blood pressure . . . . 119 Pancreas, effect of, on diabetes .. 182 Paranoia .. .. .. .. .. .. no, 278 vicious arcs in .. .. .. .. ..no Paresis . . . . . . . . . . . . . . . . 49 Pavloff's researches concerning the digestive juices 134, 138-9 Patient, what is asked of the . . . . . . . . 6-7 Pemphigus, extraordinary case of . . . . . . 209-12 Pende, Prof., on the endocrine apparatus . . . . . . 189 Pernet, Dr. George, on psoriasis . . . . . . 215-16 Perverseness . . . . . . . . . . . . . . 36 Pharyngeal disabilities . . . . . . . . . . 91-6 Phobias 50-68 analysis of . . . . . . . . . . . . 51-2 cases of rapid cure . . . . 67-8, 293-4, 295-6 causes of . . . . . . . . . . . . 51-5 drugs, relating to . . . . . . . . . . 20 malingering of sufferers from . . . . 59-61 22 338 ADVANCED SUGGESTION PAGES Phobias, psychasthema, m . . . . . . . . 30, 50 sexual element ot . . . . . . . . 66, 296 treatment of.. .. .. .. .. .. 55.8 various . . . . . . . . . . . . 57-8 see Agoraphobia, Batophobia, Claustrophobia, Photophobia, etc. Photophobia 127,131 Phthisis 161-7 etiology of 164-5 inherited tendency to . . . . . . . . 165 ,, negative " circling "in . . . . 161, 162, 166 positive " circling " in .. .. .. 162-3,166 psychology of .. .. .. .. 166-7 ,, sanatorium treatment of . . . . . . 163-4 Pierce, Dr. Bedford, on psycho-analysis . . . . . . 290 Pituitary gland, effect of suggestion upon . . . . 186-7 „ ,, cancer in .. .. .. .. .. 236 „ ,, treated in case of dwarfism . . . . 187 Polyglandular action, effects of suggestion on . . . . 184 Polypus 130, 170 asthma a cause of . . . . . . . . . . 171 Positive " circling " 5. 25, 32 Precocity in education, dangers of . . . . . . . . 258 Premature old age 237 Primula poisoning 215 Prolapse of haemorrhoids 200 Prolapsus ani . . . . . • • . . . . . . . 16 in child, treatment of, by neuroinduction 199-200 Pruritus 214-15 X-ray treatment of .. .. .. 214-15 Psoriasis, CO2 snow treatment of . . . . . . 208-9 severe case of, treated by neuroinduction . . 216 Psychasthenia . . . . . • • . . . • . 28-39 analysis in, necessity of . . . . . . 30 ,, cases treated by neuroinduction, 30, 32, 33, 33-4. 35-6. 36-7> 37-8. 38-9, 46-7, 130, 131 defensive attitude in . . . . . . 31-2 definition of . . .. .. .. ..29-30 dyspepsia, with .. .. .. 137-8 eyestrain, caused by .. .. 127-9 hysteria and falsehood in . . . . . . 263 hysterical, with phobias .. .. .. 131 phobias in .. .. .. .. 3°' ^3^ warfare, cases of, special to . . . . 39 Psycho-analysis, see Thought analysis Psychology of neuroinduction, the . . . . . . 269-89 Psychoses . . . . . . . . . . • - 106-22 Psychotherapy, difficulty of .. .. .. .. .. 13 first experiment in, the author's .. .. r future of, the 324-7 ,, limitations of .. .. .. .. 38 INDEX 339 PAGES Psychotherapy, origin of, the . . . . . . . . i ,, prejudice against . . . , . . i, 12 rules for practice of . . .. 302-14 technique of, offer to teach .. .. 3-4 Puberty and acne .. .. .. .. .. .. 218 Puerperal mania . . . . . . . . . . . . 255 Pulmonary conditions .. .. .. .. 16, 161-75 Pustule, shrinking of, under neuroinduction . . 223-4 Radium, action of, on leucocjrtes and haemorrhage . , . . 237 bloodvessels, obliteration of, by .. .. 237-8 cancer and carcinoma, in treatment of, 225-6, 228, 230, ^^ . 235. 237-8 Rationale of neuroinduction . . . . . . . . 269-89 Read, conviction of inabiUty to . . . . . . . . 34-5 Receptivity . . . . . . . . . . . . . . 7 Relaxation, physiological and mental . . 270, 275-7, 281 Repressed ideas . . . . . . . . . . . . 8 Rheumatism and chorea . . . . . . . . . . 82-3 Rohinski on hjrsteria . . . . . . . . . . . . 49 Roentgen rays, see X rays Saenger, Dr. M., on fear in asthma . . . . . . 173-4 Saint, Dr. C. F. M.. on tumours . . . . . . 219-20 Saliva controlled by suggestion and emotion . . 134, 154 Savill, Dr., on hysteria . . . . . . . . . . 49 Scare, a case of, due to sexual perversion . . . . 264-5 Scott, Dr. Bodley, on Graves' disease . . . . . . 185 Scott, Dr. Gilbert, on stigmata produced by suggestion 222-3 Sea-sickness . . . . . . . . . . . . . . 32 Self -analysis, in hysteria .. .. .. .. .. 41-^ in malingering .. .. .. .. 31 in neurasthenia . . . . . . 295-6 in neuroinductive treatment .. 292-3 Sexual factor, the, in psychasthenia . . . . . . 299 inversion .. .. .. .. .. 104-5,322-3 perversion . . . . . . . . . . 264-5, 322-3 Shirlaw, Dr. J. T., on cancer 236 on ductless glands .. .. .. 220 Sing- Sing Prison, report of the director of the clinic in . . 256 Skin disorders . . . . . . . . • . • • 204-18 difficulty of treatment by neuroinduction 209 Smell, sense of, restored .. .. .. .. ..131 Smith, Dr.Bellingham, on asthma in children . . 171-2 Somnambulism . . . . . . . • . • 76-80 case treated by neuroinduction . . 76-80 hypnotism, treated by .. .. .. 77 Speech, defects of . . . . . . . . . . 85-91 paralysis of . . . . • . . • • • • • 9° Spinal curvature . . . . . . . . . . • • 17 Spoiled children . . . . . . . . • . 258-9 340 ADVANCEJD SUGGESTION rA(;Ks Stammering . . . . . . . . . . . . 85-91 cases treated by neuroinduction . . 86, 90 extreme cases in . . . . . . . . 90 falsehood and . . . . . . . . . . 85 malingering, in cases of . . . . S6-7 negative " circling " in . . .. .. 85, 90 public speaking as a cure for .. .. .. 88 singing and whispering words as a cure for . . 88 treatment of, by neuroinduction . . . . 87-9 Stasis, intestinal . . . . . . . . . . . . 29 Stoney, Dr., on thyroid hyperactivity . . . . . . 185 Subconscious, the, definition of . . . . 3, 22, 276, 2S9 ,, ,, the superconscious . , . . 7-8, 268 training, in America . . . . . . . . ..'58 Subconsciousness, prodviction of . . . . . . 280-1 Suggestion . . . . . . . . . . . . . . (> ,, anaesthesia, under . . . . . . . . 288 ,, cancer and . . . . . . . . 2.26-34 ,, conversion to use of . . . . . . . . 10 ,, direct and indirect .. .. .. 311-12 dread of . . . . . . . . . . . . 26 hypnosis and . . . . . . . . . . 6 not the best state for treatment by 273 ,, objection to use of term . . . . 269, 271 stigmata produced by .. .. .. 222-3 warts cured by . . . . . . . . ^23-4 Suicidal obsession due to abuse t-f tea . . . . 11 7-1.8 Suicide, attempted, by exposure .. .. .. 116-17 motives of . . . . . . . . . . 111-14 threats to commit .. .. .. .. 111-18 Superconscious, the . . . . . . . . . . . . 270 ,, in the insane . . . . . . . . 279 Supraconscious, the . . . . . . . . . . . . 285 ,, ,, definition of .. .. .. .. 5 „ ,, induction in the .. .. .. 92 Surgical conditions . . . . . . . . . . 198-203 Suspicion, bad effects of . . . . . . . . . . 271 Swallow, inability to . . . . . . . . . . . . 91-2 Sympathetic system, disorders of the . . . . 284-5 ,, influenced by neuroinduction 271-2 Synapsis . . . . . . • . . . . . . . 274 Tachycardia . . . . . . . . . . . . . . 14 Tea, obsession of suicide caused by .. .. .. 117-18 Technique of neuroinduction . . . . . . 269-89 faulty .. .. .. 312 ,, offer to teach ,. .. 3-4 Thought analysis . . . . • . . . . . 290-301 should be accomplished first by patient 297 self analysis .. .. .. 292-3 INDEX 341 Thyroid enlargement, caused by fear * . . . . . 184 reduced by lin. iodi .. .. .. 184 glaod, in cancer . . . . . . . . . . 236 neuroinduction of the .. .. 182-4 palpation of doubtful effect in treatment of 183-4 ,, X rays in treatment of .. .. 185-6 sec Exophthalmic goitre, Graves' disease, Myxoedema, etc. Timidity, inherited . . . . . . . . • . . . 30 Toxaemia, arc of negative " circling," an . . . . . . 71 cause of high blood-pressure, a . . . . . . 119 neurasthenia, in .. .. .. .. .. 29 Traumata, psychical . . . , . . . . . . . . 30 ,, neurasthenia, a cause of .. .. 46-7 ,, pemphigus, in a case of , . 209-12 ,, phobias, a cause of .. 50-5, 58, 61, 67 ,, ,, skin diseases, in .. .. .. 209 Tremor . . . . . . . . » . . . 82 Tuckey, Dr. Lloyd . . . . . . . . . . 2, 4, 76 Tumours, see Morbid growths Tttrner, Dr. Dawson, on cancer . . . . . . . . 237 Unconscious, the Uric acid in chorea Urination, disorders of 279 80-1 97-105 cases treated by neuroinduction 97, 98, 100 . 97-8 97 99 206 . 207 17 enuresis 111 induction and suggestion mental weakness in Urticaria vaso-motor neurosis, a Uterine impressions, transmission of Valvular disease of the heart Vanity, a motive of suicide . . Varicose veins . . Vaso-motor control ,, mechanism, controlled by induction 169 H 227, 158 114 200-2 4b 231-2, 238 49 237 spasm Verteuil, Dr. Fernand de, on cancer . . Vertigo . . . . . . . . . . . . . . . . 72-3 ,,