What we have said of hypnotism, and particularly of suggestion, may lead the reader to understand the virtue of medicine for the imagination, of which the importance has already been intimated by earlier writers. Deslon asked why, if medicine for the imagination was the most effective, it should not be employed.
We must be permitted to dwell for a moment on this medicine for the imagination, which is entitled to the name of suggestive therapeutics. The process is as follows. Influenced by a persistent idea, suggested by external circumstances, a paralysis is developed. The physician makes use of his authority to suggest the idea of an inevitable, incontestable cure, and the paralysis is cured accordingly. This cure, as well as the development of functional disturbance, was directly effected by an idea. An idea may, therefore, be, according to circumstances, a pathogenic and a therapeutic agent. This notion is not new, but since it was misinterpreted, it has remained unfruitful.*
Diseases have been termed imaginary, or diseases caused by the imagination, and this confusion of terms has confirmed, the confusion of ideas. We have, however, just shown, especially by means of the facts which relate to paralysis by suggestion, that diseases caused by the imagination — that is, produced by a fixed idea — are real diseases, and, at any rate in some cases, display undisputed objective symptoms.
Since the existence of real diseases, produced by means of the imagination, is proved, it is thereby proved that imaginary diseases do not and cannot exist; by this we mean purely fictitious diseases, since as soon as the subject has accepted the fixed idea that he is affected by any functional disturbance, such a disturbance is in some degree developed. It should be added that these diseases, produced by means of the imagination, are not merely influenced by a local disturbance; the subject who allows himself to be dominated by this idea of disease must be peculiarly excitable and open to suggestion; he must be endowed with a condition of congenital psychical weakness which is frequently found in conjunction with more or less strongly marked neuropathic manifestations, or with physical malformations. As Laségue observed, not every one who pleases can be hypochondriac.
This distinction throws light on the therapeutics of diseases produced by means of the imagination, or suggested diseases.
When one of these victims to hypochondria, anaemic and emaciated, who are usually called malades imaginaires, has recourse to medicine, on the plea of suffering pain or some other subjective disturbance, he is usually told that it is of no importance, that he is rather
fanciful and should think less about his health, and some anodyne is carelessly prescribed. The patient, who is really suffering from the pain he has suggested to himself, feels convinced that his malady is not known, and that nothing can be done for him. The idea that his complaint is incurable becomes intense in proportion to his high opinion of his physician's skill, and thus the patient, who was suffering from the chronic affection suggested by his imagination, often goes away incurable.
Those who undertake miraculous cures act very differently. They do not deny the existence of the disease, but they assert that it may be cured by supernatural power. They act by means of suggestion, and by gradually inculcating the idea that the disease is curable, until the subject accepts it. The cure is sometimes effected by the suggestion, and when it is said to be by saving faith, the expression used is rigorously scientific. These miracles should no longer be denied, but we should understand their genesis and learn to imitate them.
There are, therefore, no imaginary diseases, but there are diseases due to the imagination, and accompanied by real functional disturbances. Such disturbances may be developed under the influence of spontaneous, accidental, or deliberate suggestion, and they may be cured under the influence of another suggestion of equal intensity working in an inverse direction. The moral treatment ought not, therefore, to consist in denying the existence of the disease, but in asserting that it is susceptible of cure, that the cure has actually begun, and will soon be completed.
When a believer associates the Deity with his idea
of cure, he is accustomed to expect it to be sudden and complete, as the result of a definite religious manifestation; and this, in fact, often occurs. We had a well-known instance at the Salpêtrière, when a woman of the name of Etcheverry was, after her devotions in the month of May, suddenly cured of an hemiplegia and contracture, by which she had been affected for seven years. Only a slight weakness of the side remained, which disappeared in a few days, and which could be explained by the prolonged inaction of the muscles. This may be termed an experimental miracle, since the physicians had prepared for it beforehand, having for a long time previously suggested to the subject that she would be cured when a certain religious ceremony took place, and it is a miracle which explains the numerous cures by the laying-on of hands which are recorded in the Bible. If we do not go further back than the last century, suggestion explains the cures by Greatrakes, the exorcisms by Gassner, Mesmer's successes, and the miracles performed at the tomb of the deacon Paris in the cemetery of Saint Medard; and in our day, in the famous caves on the slopes of the Pyrenees.
The resources of the physician, who does not profess to be a thaumaturgist, are more scanty. When he is consulted by a patient whose disease has a psychical origin, he is unable, unless in some exceptional circumstances, to inspire confidence in remedies which are not more or less gradual, but whatever they are, he must prescribe with firmness and authority. It is a well-known fact that the hydropathic treatment of some forms of hysteria has afforded more speedy results than other modes of treatment, merely from the fact that suggestion
has been employed at the same time. This remark also applies to massage, etc., under analogous circumstances.
In many cases suggestion may become a valuable therapeutic agent. In addition to the paralysis and spasms which are of psychical origin, it has a great influence on nervous or hysterical anorexia, and on the anaemic disturbance which is generally developed on an hysterical soil (A. Voisin, Seglas, Lombroso, Dufour, etc.). Some weight must be given to several facts of this nature, reported by Braid, Charpignon, Liebault, Bernheim, Beaunis, etc.* It is, therefore, useful in such cases to inquire into the most favourable conditions of suggestion, to ascertain whether the subject is susceptible to hypnotism, or peculiarly sensitive to any mode of suggestion which is employed with confidence and authority.
It should be observed that a neuropathic state does not occur suddenly, and is not created by the person affected by it. It is generally the result of a progressive and accumulated hereditary degeneration. The subject under treatment does not essentially differ from the rest of his family, who usually suffer to some extent from the same evil; the nervous patient lives in a nervous environment. If suggestion has taken part in the development of the affection in question, the moral treatment may be ineffectual because the pathogenic idea continues to be cultivated in this morbid environment. Such treatment will only have a chance of success when, as a measure of moral hygiene, we isolate the
patient, and this is still more necessary in the so-called epidemic phenomena of suggestion.
We are particularly anxious to call attention to the effect of moral treatment, and to the part taken in it by suggestion. This is no new thing; when the so-called fulminating pills are administered, suggestion is employed in the pilular form, and when pure water is injected under the skin, suggestion takes a hypodermic form. This medicine for the imagination is particularly to be recommended in that category of diseases which are of definite psychical origin.
This is not the place for insisting on the special indications of suggestion in therapeutics. The study just made is enough to "show to what extent it may act on motor, sensory or psychical phenomena, and consequently how it may be usefully employed in the treatment of the dynamic disturbances which are due to the influence of a psychical action, of a moral shock, or even of a peripheral excitement. Its effect cannot any longer be disputed. It is, however, still difficult to give a rigorously scientific account of the results obtained, since few observations have as yet been published, and in some of these it is impossible to find an objective characteristic of hypnosis. Others, again, are incomplete, or published by incompetent persons, whose descriptions do not carry with them a conviction of the reality of the morbid state in question. Finally, precisely on account of the nature of its action, which is exclusively exerted on diseases in which there is no definite material lesion, and which are, therefore, purely dynamic, suggestion only cures affections which are capable of spontaneous modification, or which are influenced by various external agents. At present, there-
fore, it is difficult to establish the real value of this mode of treatment, although less difficult than in the case of many remedies in general use. It can only be said that it is founded on accurate notions of mental physiology, and consequently on a rational basis.
Medicine for the imagination is distinct from hypnotic therapeutics, in which .the artificial sleep is itself the curative agent, in whatever way it may have been produced. These two therapeutical processes, artificial sleep and suggestion, have sometimes been erroneously confounded.* They are far from being of equal value.
The hypnotic sleep often exerts a merely suspensive and momentary action on functional disturbances, such as neuralgia, contractures, etc.; but, taken by itself, it rarely effects the complete disappearance of these phenomena, unless they are of an essentially fugitive nature. It should also be noted that in many cases hypnotic sleep, like other forms of artificial sleep produced by chloroform, morphia, etc., may cause neuropathic affections which the subject has not experienced before. Many hysterical patients were attacked by convulsions, when assembled round Mesmer's baquet, and magnetizers have often produced contractures of a cataleptic character. This fact must not be ignored, and it shows that the employment of hypnotism as a therapeutic agent should not be undertaken rashly.
When, however, we have to do with "strongly marked cases of hysteria, in which the convulsive attacks are intense, so that the artificial sleep can only produce affections which existed previously, it has been ascer-
tained that the number and intensity of these attacks may be greatly diminished by hypnotic treatment. Many of the hysterical patients of the Salpêtrière, who have been admitted on account of their attacks, enjoy a respite from them whenever they are thrown into the hypnotic sleep, even when it is not accompanied by suggestion. It should also be observed that the nervous sleep is something more than a simple hypnotic action. The subject is aware, when hypnotized by a magnetizer, that the object of his treatment is therapeutical, and the artificial sleep may in some cases be regarded as pertaining to the medicine of the imagination. Suggestion is present, whether it be the work of the patient or of his physician,
The employment of suggestion in education is probably as ancient as the art of teaching, and interesting remarks on the subject may be found in many educational works. Fechtersleben, in his Hygiene de l'ame, insists on the benefit of convincing children that they have a gift for some branch of study, in order to develop their capacity. Gratiolet remarks that certain gestures and attitudes will develop correlative tendencies in children.* But it would be a serious mistake to subject children of normal constitution to the regular practice of suggestion; there would be a great risk of making them into auto - mata, which is by no means the end of education. It is more easy to defend the application of hypnotic suggestion to vicious children. It is probable that it might succeed,
but it would be difficult to prove this by indisputable facts, for it is certain that some of the vicious children who escape from premature insanity or from a progress in vice, pass by spontaneous evolution into a psychical state which is almost normal. On the other hand, some of the vagrant children who have been confined in asylums are found under the same conditions as those whose penal sentence confirms the motives for avoiding vice. In these cases hypnotic suggestion only plays the part of penitentiary suggestion, and its utility is doubtful. The efficacy of suggestion by teachers may, as we believe, be shown by the possibility of modifying certain instincts by suggestion in the case of animals. One of the present writers has repeatedly witnessed a curious practice employed by a farmer's wife in the district of Caux. When a hen has laid a certain number of eggs in a nest of her own selection, and has begun to sit, if there is any reason for transferring her to some other nest, the hen's head is put under her wing, and she is swung to and fro until she is put to sleep. This is soon done, and she is then placed in the nest designed for her; when she awakes, she has no recollection of her own nest, and readily adopts the strange eggs. By means of this process, hens may sometimes be made to sit which had shown a previous disinclination to do so. This modification of instinct by suggestion seems to show that the educational use of suggestion is not so absurd as some authors assert it to be.