PSYCHOTHERAPY. 
 
 . 33. 
 
 ICAN MEDICO-PeVCHOLOQICAL AS6OCI 
 INaTON, D. O., MAY, limn.
 
 Y
 
 KM 
 
 PSYCHOTHERAPY. * 
 
 By Ralph Lyman Parsons, M. D., 
 
 Private Hospital for Mental Diseases, Greenmont-on- Hudson, 
 Ossining Postoffice, N. Y. 
 
 The fact that the mind has an important influence on bodily 
 conditions is very well understood. The subject has been dis- 
 cussed by many able writers, yet it is of so great importance 
 that it is always worthy of consideration and of re-considera- 
 tion. It may be that this is especially true at the present time, 
 when the knowledge of the physical means for the prevention 
 and for the cure of disease has become so great as to divert the 
 attention, in no small degree, from the potency of those mental 
 influences which are, sometimes, still more important. 
 
 A distinguished philosopher has said, "In nature there 'is 
 
 nothing great but man; in man there is nothing great but 
 
 mind." It might be added that the mind constitutes the man; 
 
 v^ it makes him what he is; considered in its broadest sense, it 
 
 ^comprises whatever in his being is not material; it builds up, 
 
 "^controls and governs the body. Even when the physical man 
 
 ^ is asleep, or in a state of unconsciousness, the sub-conscious 
 
 i mind is always active; it keeps those functions, the integrity of 
 
 ^ which is essential to the continuance of life, in a state of activ- 
 ~^-~. .... ... 
 
 ity; it continues, in some degree, to receive impressions from 
 
 ^ without; and these impressions may and often do become the 
 i subjects of cerebral activity. 
 
 How the mind may affect the body, in a state of health, the 
 ' excretions, the sweat, the saliva, the appetite, the digestion, 
 ^ the catamenia, the capillary circulation as in blushing, or in 
 e pallor caused by fear is too well known and of too fre- 
 quent occurrence to call for more than a passing notice. In 
 woman, parturition is often delayed by her anxiety for seclu- 
 
 *Read at the Annual Meeting of the American Medico-Psychological 
 Association held at Washington, D. C., May, 1903.
 
 2 PSYCHOTHERAPY. 
 
 sion and quietude during the great crisis; or her milk is sup- 
 pressed, or is rendered poisonous by an accession of fear or of 
 anger. The action of the heart is habitually more or less 
 influenced by the emotions of fear, of joy, or of anger; and the 
 effect on a heart that is weak or diseased may be such as to 
 stop its action altogether, as in the case of the late Dr. John 
 Hunter. The sudden blanching of the hair, through mental 
 shock, is not of infrequent occurrence. The case of Louise 
 Lateau is of especial interest, as an illustration of the influence 
 of fixed attention on a particular part of the body. She was a 
 devotee and had contemplated the tragedy of the crucifixion 
 with profound attention and emotion. On Fridays she would 
 lie on her back, with her arms extended, as in the crucifixion. 
 Each afternoon, while she was thus lying in a state of deep 
 religious absorption, the stigmata of the five wounds made 
 their appearance. While this girl was, undoubtedly, a pro- 
 nounced neurasthenic and of a hysterical temperament, there 
 was nothing in her physical condition, nor in the general state 
 of her health that would at all account for the occurrence of 
 the stigmata. Their cause was mental and mental only. She 
 was so closely watched by physicians, undoubtedly both capable 
 and honest, that physical means of producing the stigmata could 
 not have been employed without detection. Many similar 
 cases have been reported. Sympathetic pain is not uncommon; 
 as when a person experiences severe pain in some part of the 
 body on seeing another person who seems to be suffering from 
 an injury in the same location. 
 
 The influence of the mind on the body may be so profound 
 and so persistent as to be a cause of actual physical disease. 
 Fear often renders the subject especially susceptible to epi- 
 demic influences. Fright is not an infrequent cause of epilepsy. 
 Fear of hydrophobia may cause the symptoms of the disease, 
 although the subject has not been inoculated with the virus. 
 
 On the other hand, the agency of psychic causes in the cure 
 of ordinary physical disease is very great; but at this point 
 there should be a definite understanding of what is meant by 
 the term psychotherapy. 
 
 Psychotherapy, then, as the term is used in this paper, is in- 
 tended to include all the curative agencies in action which are 
 not material in character; and also all immaterial extraneous
 
 RALPH LYMAN PARSONS. 3 
 
 influences in so far as they act favorably on the mind of the 
 subject. 
 
 In many, if not in most instances, psychic influences are in- 
 timately associated with material agencies; as with drugs, stim- 
 ulants, diet, bodily exercise, occupation, condition of the air, 
 altitude, climate, etc. But the associated material agencies are 
 here so obvious, so obtrusive even, that they oftentimes re- 
 ceive the credit of being the real, the efficient agencies in the 
 cure of the patient, when in fact their influence has been quite 
 subordinate, if not entirely negative, or even prejudicial in 
 character. 
 
 And so, in the treatment of patients who suffer from any dis- 
 ease whatever, it should be borne in mind that however well 
 adapted the material remedies employed may be, the aid of the 
 psychic forces should also be brought into use by every avail- 
 able means. To this end, the persons associated with the in- 
 valid should be congenial and of a cheerful temperament. The 
 physician in attendance should be of a hopeful temperament 
 and should be able to inspire his patient with hopefulness. His 
 pains-taking care in making his examinations, the confident 
 manner in which he states his conclusions and the minuteness 
 with which he gives his directions may exert an important in- 
 fluence on the mind of the invalid and in no small degree pro- 
 mote his chances of recovery. Ignorant charlatans who have 
 the ability to inspire their patients with hopefulness and con- 
 fidence sometimes succeed in effecting a cure w r hen learned and 
 skilled physicians who lack this ability have failed. 
 
 All remedies that are really efficient in themselves may have 
 and usually do have an added curative effect when administered 
 to persons of intelligence and whose mental faculties are unim- 
 paired. The expectation of a definite, favorable result adds 
 greatly in bringing about this result. The strictness and par- 
 ticularity with which directions for treatment are given and 
 carried out serves to stimulate the expectant attention; and this, 
 in turn, stimulates the psychic forces to a state of activity. The 
 hopefulness engendered by the fact that something is being 
 done, whether by the administration of medicines, baths, elec- 
 tricity, massage, or any other suitable curative means aids in 
 bringing about the desired result. While material agents may 
 destroy organized, living, physical structures, they can never
 
 4: PSYCHOTHERAPY. 
 
 repair nor build them up without the aid of the psychic forces 
 as the builders. 
 
 Not only do the psychic forces aid material remedies in the 
 cure of diseased conditions, but they are often efficient agents 
 in themselves. As the expectation of a fatal result, on 
 the part of the patient, may lead to that result; so encouraging 
 assurances of recovery are often efficient in promoting recovery. 
 An exercise of the will, on the part of the patient, may even 
 overcome the adverse influence of the disease and an unfavor- 
 able prognosis combined. Skilled physicians sometimes depend 
 upon the psychic forces alone in the treatment of their patients, 
 stimulating hopeful expectation by the administration of sub- 
 stances that are entirely inert, as, for instance, in giving place- 
 bos for the relief of constipation. It has been found that 
 motherless babies thrive better in the care of indigent women 
 at their destitute homes than at hospitals where their food, sur- 
 roundings and attendance are of a much higher order. The 
 mental influence of the foster-mother on the baby, the mother- 
 ing the baby gets, in the former case, more than counterbal- 
 ances the advantages afforded by the hospital. 
 / Cures are undoubtedly effected through the agency of what 
 are called the Faith Cure, Mental Healing, Christian Science, 
 and other agencies that act, in the first instance on the mind 
 alone, and through the mental forces on the body. From time 
 to time, healers make their appearance under whose mental 
 influence sufferers from physical ailments seem to be cured; and 
 some of them, undoubtedly, are cured. They leave their canes 
 and crutches with the healer; they think that they are cured; 
 they can now do what they could not do before, and this cer- 
 tainly constitutes a cure. And so, there can be no doubt that 
 many of the pilgrims to Lourdes and to other religious shrines 
 are really cured of their physical disabilities, and that these 
 cures are effected mostly, if not altogether, through the in- 
 fluence of the mind. Their faith has healed them. If this 
 faith, if this mental influence, can be brought into action with- 
 out the intervention of the healer, without the pilgrimage to 
 the shrine, the result will be the same. If the mental forces of 
 the absent patient can be brought into favorable action, what is 
 called absent treatment may be effective without the presence
 
 RALPH LTMAN PARSONS. 5 
 
 of the healer, although in most cases the presence of an object- 
 ive stimulant, as the healer or the shrine, is essential. 
 
 It is by no means to be inferred that all mental healers and 
 Christian Scientists are dishonest, or are knowingly practicing 
 a fraud upon the public. On the contrary > some of them have 
 the most sublime faith in the efficacy of their methods; and it 
 is largely because of this sublime faith on their part that their 
 cures are brought about. They inspire their patients with 
 something of their own hopeful enthusiasm and thus stimulate 
 the activity of the real agents in the cure, the psychic forces of 
 the patient. 
 
 The ameliorations and cures which are, undoubtedly, effected 
 through hypnotism depend upon the same principle. In 
 neither case is there any emanation from the agent to the sub- 
 ject. The agent simply stimulates the psychic forces of the 
 subject to a state of activity. These forces alone effect all the 
 physical changes that are brought about. 
 
 Perhaps the most striking illustration of faith in the efficacy 
 of inert substances, as medicines, is to be found in the use of 
 the higher attenuations of homeopathic drugs. A single 
 minim of the tincture of any drug when carried to the thirtieth 
 centesimal attenuation would suffice to medicate an amount of 
 vehicle so enormous as to be quite beyond the power of con- 
 ception. A globe one hundred million miles in diameter would 
 suffice to contain only a small fraction of the supposed medi- 
 cine that might theoretically be made from one minim of the 
 mother tincture. The amount of the drug in each dose is of 
 course correspondingly diminished. The material effect of a 
 dose of this supposed medicine must be utterly inappreciable 
 and without physical effect. And yet recoveries follow its ad- 
 ministration; and physicians of a high degree of culture and of 
 intelligence have faith in its curative power. If such medicine 
 does have curative power, it must certainly be through pyscho- 
 therapy. 
 
 If it be objected that such cures as are claimed to be effected 
 by such means are not real cures, but either that the disease 
 never existed or that the cures are imaginary, it may be replied 
 that the variety of both disease and cure is quite the same as in 
 analogous cases which are diagnosed by competent physicians 
 and cured by means of material remedies.
 
 6 PSYCHOTHERAPY. 
 
 And if it be objected that the psychic forces are too myste- 
 rious in their nature to entitle them to consideration, it may be 
 replied that material remedies are no less mysterious in their 
 mode of action. We know nothing of the fundamental grounds 
 of their activity in either case. 
 
 Thus far no mention has been made of the psychic forces 
 with reference to what more especially concerns the members 
 of this Association the treatment of diseases involving the in- 
 tegrity of the mental faculties. While in the treatment of 
 mental diseases the favorable influence of certain agencies 
 which act directly and immediately on the mind is understood 
 and appreciated, it is very doubtful whether the full measure 
 of their importance is always kept in view and the principles 
 involved are put into practice. Nor is the reason for this far 
 to seek. In former times insanity was thought to be a disease 
 of the mind itself, a sort of demoniacal possession which needed 
 to be exorcised rather than cured. 
 
 In opposition to this view, alienists have laid so much stress 
 on the doctrine that insanity is simply an expression of disease 
 of the brain that they have, to some extent, left out of consid- 
 eration the psychic forces upon which the functions of the ma- 
 terial body depend for their activity and their integrity. More- 
 over, the alienist has under his special care patients whose 
 mental faculties are in a state of disorder; and who are conse- 
 quently less amenable to psychic influences than those who are 
 not insane. It naturally follows that physicians who are en- 
 gaged in the treatment of diseases affecting the mind are, per- 
 haps, more likely to neglect the psychic forces, as a means of 
 cure, than are those physicians who are especially engaged in 
 the treatment of physical ailments. 
 
 However, alienists do fully recognize the importance of 
 psychic influences on the insane in certain particulars. Thus 
 all are agreed that such patients should be removed, as far as 
 possible, from disturbing mental influences; and that their sur- 
 roundings, their associations, their occupations and their amuse 
 ments should be carefully and intelligently adapted. 
 
 But much more than this is needful in all cases in which the 
 mind is still responsive to mental influences. In order to at- 
 tain the best results, as careful, individualized mental treat- 
 ment should be prescribed and carried into practice as in the
 
 RALPH LYMAN PARSONS. 7 
 
 case of material remedies. Just what this psychic treatment 
 should be must, of necessity, depend not only upon the condi- 
 tion and requirements of the patient, in each case, but also 
 upon the temperament, personal experience, aptitude and abil- 
 ity of the physician who prescribes and of the agent who car- 
 ries the prescription into practice. In a general way, the fol- 
 lowing suggestions may be made, by way of illustration: A 
 patient whose intellectual faculties are susceptible of improve- 
 ment should be constantly in companionship with and under the 
 influence of persons of sound mind; and these associates should 
 systematically exert that influence by conversation within the 
 sphere of the patient's intelligence, and by calling his attention 
 to objectivities in connection with any occupations or amuse- 
 ments in which he may be engaged. It is not to be inferred 
 that all insane patients should always be kept from companion- 
 ship with other insane patients. On the contrary, such com- 
 panionship may be so arranged as to make it a beneficial object 
 lesson. Insane patients often perceive and understand that the 
 ideas and acts of other insane patients are irrational; and, 
 whether they acknowledge it or not, are led to suspect that 
 some of their own ideas and acts may also be irrational. On 
 the other hand, the intimate association of large numbers of 
 the insane is without advantage and may be detrimental. This 
 is especially the case when those who are associated are uncon- 
 genial, or when many sufferers from mental depression are 
 kept in close companionship. 
 
 Schools and lectures such as are sometimes employed as sub- 
 stitutes for or as adjuncts to individualized methods of psychic 
 treatment are of advantage, especially in the larger hospitals 
 where individualized psychic treatment is difficult of attain- 
 ment. 
 
 In the carrying out of a plan of individualized psychic treat- 
 ment, the due exercise and stimulation of the moral faculties 
 should not be forgotten. To this end, the patient may be inter- 
 ested and occupied in the care of animals, or in doing some- 
 thing for the pleasure or the benefit of others. 
 
 The highest and at the same time the most difficult sphere 
 for psychotherapy is in the management of those cases of in- 
 cipient or of convalescent insanity which are characterized by 
 unfounded suspicions, hallucinations, or delusive ideas. And
 
 PSYCHOTHERAPY. 
 
 here it is well to ignore, for the time being, at least, the doc- 
 trine that insanity is always and only a symptom of disease of 
 the brain. It will be helpful, rather, to keep the facts clearly 
 in mind that many cases of insanity have their beginnings in a 
 brain activity which is due to mental causes; which, in the first 
 instance, is entirely compatible with a condition of sanity; and 
 that the continuance of this abnormal activity often results in a 
 brain habit which it is beyond the power of the subject to con- 
 trol; that is, the psychic cause has brought about a condition 
 of insanity; but that no change in the organic substance of the 
 brain has taken place may be inferred from the fact that some 
 of these patients seem to recover with great suddenness; almost 
 instantly, indeed; and from the fact that they recover under 
 the influence of psychic remedies alone. 
 
 The following history may serve to illustrate the causative 
 influences and the psychic treatment adopted in a case of hallu- 
 cinatory insanity. 
 
 Miss A. , a young woman of neurotic heredity, but of good 
 physique, good social position, and of good education, suffered 
 a severe mental shock through social disappointments and infe- 
 licities. Her appetite became impaired, her sleep disturbed, 
 and her power of self-control greatly diminished. A state of 
 hysterical excitement with great mental depression supervened. 
 After a little hallucinations of hearing were experienced. She 
 heard voices by day and by night, talking about her, making 
 vile accusations against her, and addressing her with oppro- 
 brious epithets. She insisted that the voices were real, that 
 they came from different locations, especially from a room over 
 her own, and demanded that her persecutors be removed. An 
 examination of the places from which the voices seemed to pro- 
 ceed did not remove her belief in their reality. The irritation 
 caused by the voices was so great as at times to throw her into 
 a state of ungovernable rage, during which she would scream, 
 slam the doors, throw articles of furniture about and make use 
 of violent and profane language acts which were entirely for- 
 eign to her normal habits. Although her appetite was not 
 especially impaired, she had lost in weight and become decid- 
 edly neurasthenic. In addition to the usual psychotherapeutic 
 treatment, removal from the original causes of mental disturb- 
 ances with suitable occupations and amusements, such tonic
 
 RALPH LTMAN PARSONS. 9 
 
 remedies were prescribed as seemed to be indicated. After this 
 line of treatment had been followed for a period of time, with- 
 out a favorable result, the following additional psychothera- 
 peutic measures were adopted: She was informed that in 
 many instances persons were annoyed by voices which had no 
 existence; that if they were able to convince themselves, or 
 could be convinced that the voices had no real existence the 
 annoyance they caused would be greatly diminished, if not 
 quite abolished. She was told of persons who have habitually 
 heard such voices, but who suffered little annoyance from them 
 because they fully understood the cause. She was also shown 
 the printed history of such hallucinated persons, in corrobora- 
 tion of the oral statements that had been made. She was also 
 told that she ought to give credit to the testimony of reliable 
 persons who assured her of the non- reality of the voices; that 
 the greater part of all she knew was not of her own knowledge, 
 but was founded upon the testimony of others. In addition, 
 the mechanism of hearing was explained to her, somewhat as 
 follows, to- wit, "You see that lam now talking with you. 
 You hear my voice, but only in this way. The words 1 am 
 speaking to you are simply a vibration of my vocal organs. 
 But it is not this vibration that you hear. This vibration of 
 the vocal organs in turn causes the vibration of the air; of the 
 drum of the ear; of the little bones of the ear; of the struct- 
 ures within the ear; of the nerves that lead from the ear to a 
 certain part of the brain and finally of the cells themselves. If 
 any of these had not been made to vibrate there would have 
 been no hearing. But now that the cells of this part of the 
 brain have been made to vibrate, you hear my voice. Now, if 
 these cells, through habit or through any other cause, should 
 vibrate in the same way when I am not speaking, you would 
 seem to hear my voice just as you do at present. I cannot give 
 you medicine, nor do anything that will stop these false voices. 
 But if you will accept the explanation and the assurance I have 
 given you I have no doubt that they will cease to annoy you; 
 and, then, they may stop altogether. This was repeated, on 
 occasion, when the patient was in a quiescent, receptive mood, 
 and in a restful, recumbent posture; but no attempt was made 
 to induce hypnosis. As was hoped, the voices soon ceased to 
 annoy and after a little ceased to be heard altogether. With
 
 10 PSYCHOTHERAPY. 
 
 the stopping of the voices, the other manifestations of mental 
 disturbance passed away. The patient had recovered. 
 ' No mention has been made of hypnosis as a means of placing 
 insane patients in a receptive state of mind, when an attempt is 
 being made to influence their mental faculties; in part, because 
 the result would be very uncertain and might be unfavorable; 
 and in part because such individuals can rarely be hypno- 
 tized. They are usually so suspicious or are so much absorbed 
 in their own ideas that they do not readily yield themselves to 
 the required conditions. In lieu of this, a favorable mental in- 
 fluence may sometimes be exerted by advice given and sugges- 
 tions made when the patient has fallen into a natural sleep, or 
 is in the somnolent state between sleeping and waking.. 
 
 While there are few insane patients who cannot be favorably 
 influenced by psychotherapeutic methods, it must be admitted 
 that the great majority of those who are under hospital care are 
 not very susceptible to such influence; and yet, it is not un- 
 likely that many of these last have at some time been more 
 susceptible to the favorable influence of psychotherapy than at 
 present. Indeed there is reason to believe that there are few 
 incipient cases of insanity, of partial insanity, or of those in 
 the convalescent stage which may not be benefited by carefully 
 considered, tactfully applied, and thoroughly individualized 
 psychotherapeutic measures. 
 
 Assuming, then, that psychotherapeutics might advantage- 
 ously be employed with greater frequency and to a greater ex- 
 tent than has hitherto been done, it remains to be inquired 
 what obstacles are to be removed and what measures are to be 
 inaugurated to this end. It is obvious that the person who 
 undertakes the practice of psychotherapy in a given case, in 
 addition to being of a suitable temperament and to having 
 made a careful study of the principles involved, should gain 
 the entire confidence; and should be on terms of friendly, sym- 
 pathetic intimacy with the patient. After having become thor- 
 oughly conversant with the history and mental peculiarities of 
 the case, he should wait patiently for a favorable opportunity, 
 when the patient is in an agreeable and receptive mood, and 
 then exerci.se such special mental influences as may be within 
 his power; repeating his advice, his teachings, or his sugges- 
 tions as occasion may offer the opportunity. The time which
 
 RALPH LTMAN PARSONS. 11 
 
 may seem to be lost in waiting is not really lost, if the agent is 
 suited to the work in which he is engaged. His influence, 
 while placing himself on harmonious terms Avith the patient, 
 may be really no less helpful than his more systematic efforts. 
 The exact methods to be employed in psychotherapy must of 
 necessity be left entirely to the judgment of the practitioner. 
 On the one hand the varieties in disposition, circumstances, edu- 
 cation, mental capacity, and vagaries of the subject are almost 
 infinite, and can be learned only by personal study; and on the 
 other, the variety in the mental status and equipment of agents 
 who will be suited to the work are equally great. However, in 
 order to obtain the best results the agent should, at least, be 
 equal to the subject in mental capacity, education, culture, and 
 intelligence. 
 
 Naturally, the physician in charge would be the person best 
 suited to put the methods of psychotherapy in practice; but in 
 large hospitals for the insane the medical superintendent could 
 rarely undertake this duty, on account of the time that would 
 be required. The task might even be too great for the mem- 
 bers of the medical staff. In this case it might be advisable 
 either to increase the number of the medical staff, or to employ 
 non-medical assistants who are especially adapted to this sort of 
 work. Of course the duties of such assistants should be en- 
 tirely distinct from those of ordinary nurses, attendants, or 
 supervisors. While they should do their work under the gen- 
 eral direction of their medical superior they should be allowed 
 to choose their own methods and to carry them into practice 
 without interference. 
 
 In a paper entitled, "The Constructive Forces," which was 
 read before this Society a few years ago, u special reference 
 was made to the immaterial forces through which and by which 
 the body is built up and kept in a state of repair. It is the ob- 
 ject of this paper to suggest a consideration of the influence 
 which the immaterial, the psychic forces have or may have 
 upon bo tii body and mind in a state of disease. In pursuance 
 of this object, reference has been made to the influence of the 
 mind upon the body, in a state of health; to mental states as 
 causes of ordinary maladies, and to their influence in the cure 
 of these maladies; to mental influences, on the one hand as 
 causes, and on the other as aids in the treatment of insanity; 
 
 _, 
 
 J ''
 
 12 PSYCHOTHERAPY. 
 
 and, finally, to some of the conditions which are required for 
 the efficient practice of psychotherapy in the treatment of the 
 insane.
 
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