Freud - Complete Works (280 page)

Psychical (Or Mental) Treatment

1591

   Just as pains are produced or
increased by having attention paid to them, so, too, they disappear
if attention is diverted from them. This experience can always be
employed as a means of soothing children; adult soldiers do not
feel the pain of a wound in the feverish heat of battle; martyrs
are probably quite impervious to the pain of their tortures in the
over-excitement of their religious feeling and in the concentration
of all their thoughts upon the heavenly reward that awaits them. It
is not so easy to produce evidence of the influence of
volition
on pathological somatic processes; but it is quite
possible that a determination to recover or a will to die may have
an effect on the outcome even of severe and precarious
illnesses.

   Our interest is most particularly
engaged by the mental state of
expectation
, which puts in
motion a number of mental forces that have the greatest influence
on the onset and cure of physical diseases.
Fearful
expectation is certainly not without its effect on the result. It
would be of importance to know with certainty whether it has as
great a bearing as is supposed on falling ill; for instance,
whether it is true that during an epidemic those who are afraid of
contracting the illness are in the greatest danger. The contrary
state of mind, in which expectation is coloured by hope and faith,
is an effective force with which we have to reckon, strictly
speaking, in
all
our attempts at treatment and cure. We
could not otherwise account for the peculiar results which we find
produced by medicaments and therapeutic procedures.

   The most noticeable effects of
this kind of expectation coloured by faith are to be found in the
‘miraculous’ cures which are brought about even to-day
under our own eyes without the help of any medical skill.
Miraculous cures properly so-called take place in the case of
believers under the influence of adjuncts calculated to intensify
religious feelings - that is to say, in places where a
miracle-working image is worshipped, or where a holy or divine
personage has revealed himself to men and has promised them relief
from their sufferings in return for their worship, or where the
relics of a saint are preserved as a treasure. Religious faith
alone does not seem to find it easy to suppress illness by means of
expectation; for as a rule other contrivances as well are brought
into play in the case of miraculous cures. The times and seasons at
which divine mercy is sought must be specially indicated; the
patient must submit to physical toil, to the trials and sacrifices
of a pilgrimage, before he can become worthy of this divine
mercy.

Psychical (Or Mental) Treatment

1592

   It would be convenient, but quite
wrong, simply to refuse all credence to these miraculous cures and
to seek to explain the accounts of them as a combination of pious
fraud and inaccurate observation. Though an explanation of this
kind may often be justified, it is not enough to enable us to
dismiss entirely the fact of miraculous cures. They do really occur
and have occurred at every period of history. And they concern not
merely illnesses of mental origin - those, that is, which are based
on ‘imagination’ and are therefore likely to be
especially affected by the circumstances of a pilgrimage - but also
illnesses with an ‘organic’ basis which had previously
resisted all the efforts of physicians.

   There is no need, however, to
bring forward anything other than mental forces in order to explain
miraculous cures. Even under conditions such as these, nothing
happens that can be considered as beyond our understanding.
Everything proceeds naturally. Indeed, the power of religious faith
is reinforced in these cases by a number of eminently human motive
forces. The individual’s pious belief is intensified by the
enthusiasm of the crowd of people in whose midst he makes his way
as a rule to the sacred locality. All the mental impulses of an
individual can be enormously magnified by group influence such as
this. In cases in which someone proceeds to the holy place by
himself, the reputation of the place and the respect in which it is
held act as substitutes for the influence of the group, so that in
fact the power of a group is once more in operation. And there is
yet another way in which this influence makes itself felt. Since it
is well known that divine mercy is always shown only to a few of
the many who seek it, each of these is eager to be among the chosen
few; the ambition that lies hidden in everyone comes to the help of
pious faith. Where so many powerful forces converge, we need feel
no surprise if the goal is sometimes really reached.

   Even those who are without
religious faith need not forgo miraculous cures. In their case
reputation and group-influence act as a complete substitute for
faith. There are always fashionable treatments and fashionable
physicians, and these play an especially dominant part in high
society, where the most powerful psychological motive forces are
the endeavour to excel and to do what the ‘best’ people
do. Fashionable treatments of this kind produce therapeutic results
which are outside the scope of their actual power, and the same
procedures effect far more in the hands of a fashionable doctor
(who, for instance, may have become well-known as an attendant upon
some prominent personality) than in those of another physician.
Thus there are human as well as divine miracle-workers. Such men,
however, who have reached eminence owing to the favour of fashion
and of imitation, soon lose their power, as is to be expected from
the nature of the forces which give it to them.

Psychical (Or Mental) Treatment

1593

   An intelligible dissatisfaction
with the frequent inadequacy of the help afforded by medical skill,
and perhaps, too, an internal rebellion against the duress of
scientific thought, which reflects the remorselessness of nature,
have in all periods (and in our own once more) imposed a strange
condition on the therapeutic powers alike of persons and of
procedures. The necessary faith only emerges if the practitioner is
not a doctor, if he can boast of having no knowledge of the
scientific basis of therapeutics, if the procedure has not been
subjected to accurate testing but is recommended by some popular
prejudice. Hence it is that we find a swarm of ‘nature
cures’ and ‘nature healers’, who compete with
physicians in the exercise of their profession and of whom we can
at least say with some degree of certainty that they do far more
harm than good. If this gives us grounds for blaming the
patients’ faith, we must yet not be so ungrateful as to
forget that the same force is constantly at work in support of our
own medical efforts. The results of every procedure laid down by
the physician and of every treatment that he undertakes are
probably composed of two portions. And one of these, which is
sometimes greater and sometimes less, but can never be completely
disregarded, is determined by the patient’s mental attitude.
The faith with which he meets the immediate effect of a medical
procedure depends on the one hand on the amount of his own desire
to be cured, and on the other hand on his confidence that he has
taken the right steps in that direction - of his general respect,
that is, for medical skill - and, further, on the power which he
attributes to his doctor’s personality, and even on the
purely human liking aroused in him by the doctor. There are some
physicians who have a greater capacity than others for winning
their patients’ confidence; a patient will often feel better
the very moment the doctor enters his room.

Psychical (Or Mental) Treatment

1594

   Physicians have practised mental
treatment from the beginning of time, and in early days to a far
greater extent even than to-day. If by mental treatment we mean an
endeavour to produce such mental states and conditions in the
patient as will be the most propitious for his recovery, this kind
of medical treatment is historically the oldest. Psychical
treatment was almost the only sort at the disposal of the peoples
of antiquity, and they invariably reinforced the effects of
therapeutic potions and other therapeutic measures by intensive
mental treatment. Such familiar procedures as the use of magical
formulas and purificatory baths, or the elicitation of oracular
dreams by sleeping in the temple precincts, can only have had a
curative effect by psychical means. The physician’s
personality acquired a reputation derived directly from divine
power, since in its beginnings the art of healing lay in the hands
of priests. So that then as now the physician’s personality
was one of the chief instruments for bringing the patient into a
state of mind favourable for his recovery.

   Now, too, we begin to understand
the ‘magic’ of words. Words are the most important
media by which one man seeks to bring his influence to bear on
another; words are a good method of producing mental changes in the
person to whom they are addressed. So that there is no longer
anything puzzling in the assertion that the magic of words can
remove the symptoms of illness, and especially such as are
themselves founded on mental states.

   All the mental influences which
have proved effective in curing illnesses have something
incalculable about them. Affects, concentration of the will,
distracting the attention, expectation coloured by faith - all of
these forces, which occasionally remove an illness, sometimes fail
to do so without there being anything in the character of the
illness to account for the different result. What stands in the way
of regularity in the therapeutic results achieved is evidently the
autocratic nature of the personalities of the subjects, with their
variety of mental differences. Since physicians came to realize
clearly the important part played in recovery by the
patient’s state of mind, the idea naturally occurred to them
of no longer leaving it to the patient to decide how much mental
compliance he should show but of deliberately imposing a propitious
state of mind by suitable methods. It is from this attempt that
modern mental treatment has taken its start.

Psychical (Or Mental) Treatment

1595

   Quite a number of different
methods of treatment have thus arisen, some of them simple to
arrive at and others which could only be reached on the basis of
complex hypotheses. It is easy to see, for instance, that the
physician, who can no longer command respect as a priest or as the
possessor of secret knowledge, should use his personality in such a
way as to gain his patient’s confidence and, to some degree,
his affection. He himself may succeed in doing this with only a
limited number of patients, whereas other patients, according to
their inclinations and degree of education, will be attracted to
other physicians. Such a distribution will serve a useful purpose;
but
if the right of a patient to make a free choice of his
doctor were suspended, an important precondition for influencing
him mentally would be abolished
.

   There are many very effective
mental procedures which the physician is obliged to renounce. He
either has not the power or has not the right to invoke them. This
applies in particular to the provocation of strong affects - the
most powerful of all the means by which the mind affects the body.
The vicissitudes of life often cure illnesses through the
experience of great joy, through the satisfaction of needs or the
fulfilment of wishes. The physician, who is often impotent outside
his profession, cannot compete along these lines. It might be more
within his power to employ fear and fright for therapeutic ends;
but, except in the case of children, he must have the gravest
doubts about the use of such double-edged tools. On the other hand,
the physician must rule out any relations with his patient that are
bound up with tender feelings, owing to their implications in
practical life. Thus from the first his power to bring about mental
changes in his patients seems so restricted that mental treatment
conducted on a deliberate plan would seem to offer no advantages
over the earlier haphazard method.

   The physician can seek to direct
his patient’s volition and attention, and he has good grounds
for doing so in the case of various pathological conditions. He
may, for instance, persistently oblige a person who believes he is
paralysed to carry out the movements of which he professes himself
incapable; or he may refuse to fall in with the wishes of an
anxious patient who insists on being examined for an illness from
which he is quite certainly not suffering. In these instances the
physician will be taking the right course, but such isolated cases
would scarcely justify us in setting up mental treatment as a
special therapeutic procedure. There exists, nevertheless, a queer
and unforeseeable method which offers the physician a possibility
of exercising a profound, even though transitory, influence on the
mental life of his patients and of employing that influence for
therapeutic purposes.

Psychical (Or Mental) Treatment

1596

   It has long been known, though it
has only been established beyond all doubt during the last few
decades, that it is possible, by certain gentle means, to put
people into a quite peculiar mental state very similar to sleep and
on that account described as ‘hypnosis’. The various
means by which hypnosis can be brought about have at first sight
little in common. It is possible to hypnotize someone by getting
him to stare fixedly at a bright object for some minutes, or by
holding a watch to his ear for a similar length of time, or by
repeatedly passing the open hands, at a short distance away, over
his face and limbs. But the same result can be brought about by
describing the onset of the state of hypnosis and its
characteristics quietly and firmly to the subject - that is, by
‘talking him into’ hypnosis. The two procedures may
also be combined. We may make the subject sit down, hold a finger
in front of his eyes, tell him to gaze at it fixedly and then say
to him: ‘You’re feeling tired. Your eyes are closing;
you can’t hold them open. Your limbs are heavy; you
can’t move them any more. You’re falling asleep---'
and so on. It will be observed that all the procedures have in
common a fixing of the attention; in those first mentioned the
attention is fatigued by slight and monotonous sensory stimuli. It
is not yet satisfactorily explained, however, how it comes about
that mere talking produces exactly the same state as the other
procedures. Experienced hypnotists assert that by these means a
definite hypnotic change can be brought about in some eighty per
cent of subjects. There is no way of telling beforehand, however,
which subjects are hypnotizable and which are not. Illness is far
from being one of the necessary preconditions of hypnosis: normal
people are said to be particularly easy to hypnotize, while some
neurotics can only be hypnotized with great difficulty and the
insane are completely resistant. The hypnotic state exhibits a
great variety of gradations. In its lightest degree the hypnotic
subject is aware only of something like a slight insensibility,
while the most extreme degree, which is marked by special
peculiarities, is known as ‘somnambulism’, on account
of its resemblance to the natural phenomenon of sleep-walking. But
hypnosis is in no sense a sleep like our nocturnal sleep or like
the sleep produced by drugs. Changes occur in it and mental
functions are retained during it which are absent in normal
sleep.