James Walsh - Psychotherapy

This great physician, Sydenham, having long attended a gentleman of fortune with little or no advantage, frankly avowed his inability to render him any further service, at the same time adding, that there was a physician of the name of Robertson, at Inverness, who had distinguished himself by the performance of many remarkable cures of the same complaint as that under which his patient labored, and expressing a conviction that, if he applied to him, he would come back cured. This was too encouraging a proposal to be rejected; the gentleman received from Sydenham a statement of his case, with the necessary letter of introduction, and proceeded without delay to the place in question. On arriving at Inverness, and anxiously inquiring for the residence of Dr. Robertson, he found, to his utter dismay and disappointment, that there was no physician of that name, nor ever had been in the memory of any person there. The gentleman returned, vowing eternal hostility to the peace of Sydenham, and on his arrival, at home indignantly expressed his indignation at having been sent on a Journey of so many hundred miles for no purpose. "Well," replied Sydenham, "are you better in health?" "Yes, I am now quite well; but no thanks to you." "No," says Sydenham, "but you may thank Dr. Robertson for curing you. I wished to send you on a journey with some object of interest in view; I knew it would be of service to you: in going, you had Dr. Robertson and his wonderful cures in contemplation; and in returning, you were equally engaged in thinking of scolding me."

Morgagni.—In the century following Sydenham we have a number of examples cited by Morgagni, the father of pathology, in which his recognition of the value of the mind as a curative agent and of the harm that may be done by over-occupation of the mind is set forth at its proper value. Benjamin Ward Richardson in his "Disciples of AEsculapius" 2 2 London, 1901. tells of two incidents in which this phase of Morgagni's very practical application of knowledge to medical practice is exemplified:

In other examples, where the symptoms are due to mental oppression, he pursued a course of treatment that was of soothing nature. A distinguished professor of physic at Bologna happened to discover that his pulse was intermittent, and being extremely anxious about it was incessantly feeling his pulse, to discover that the evil was daily increasing. Morgagni's advice to his patient was to take his finger off his wrist and not to inquire too anxiously about his condition. The advice was followed, and the result was a complete removal of the disturbance.

It is a very singular truth that in describing the action of the nervous system on the circulation Morgagni shows that he was cognizant of the fact that the circulation may be disturbed by two sets of nervous irritations, one inflicted through the pneumogastrics, the other "through those nerves which are subservient to the arteries"—the vaso-motor system which is readily disturbed by the mind. In one patient he observed great perturbations of the pulse in both wrists as the result of mental anxiety. But a day or two later the pulse derangement was confined to the left side altogether. The pulse of the right arm was quite regular, while that of the left arm still showed the inequality. When the mental distress was relieved, this pulse also became equal.

Morgagni cites Sydenham's contemporary, Lancisi, the great Italian physician, as recognizing the influence of the emotions on the heart. Examples of similar convictions as to mental influence in medicine are also found in the works of Morgagni's great contemporaries, Boerhaave and Van Swieten, and the great physicians of the seventeenth and eighteenth centuries were closely imitated in their recognition of the value of the influence of mind over body in medicine by their successors in the profession.

John Hunter.—Wise old John Hunter recognized the influence of the mind on the body very clearly. He said, for instance, "There is not a natural action in the body, whether voluntary or involuntary, that may not be influenced by the peculiar state of mind at the time." He lays it down as a law that "every part of the body sympathizes with the mind, for whatever affects the mind, the body is affected in proportion." He said further, "as a state of the mind is capable of producing a disease, another state of it may affect a cure." He called attention to the fact that the touch of a corpse produced wonderful effects upon the minds of patients. He said, "Even tumors have yielded to the stroke of a dead man's hand." He observes that "while we should naturally expect that diseases connected with the nerves—and those in which their alteration is in the action of parts not in their structure—would be most affected by the imagination, we find that there are other diseases in which they appear to have little connection that are much affected by the state of mind."

German Mind Healing.—In his monograph on "Psychotherapy in Its Scientific Aspects" 3 3 "Die Psychische Krankenbehandlung im Ihren Wissenschaftlichen Grundlagen." Berlin 1910. Dr. Berthold Kern calls attention to a forgotten book of the German physician Scheidemantel, published in 1787. Its title was "The Emotions as Remedies." It seems to be very rare since even our Surgeon General's Library has no copy of it. The author treated psychotherapy systematically. He insisted that man was a unit in which body and soul mutually influenced each other. Scheidemantel blamed the moralists for considering the soul exclusively and the physicians for thinking only of the body. He thought that this was a serious mistake for both sides and he seems to have anticipated much of our recent discussion on the influence of the body and of things physical generally in what is called crime and various divagations from law. On the other hand, he thought that the influence of the mind on the body was one of the most important elements in therapeutics.

Reil, after whom the Island of Reil is named, and who taught us much with regard to brain anatomy, was also interested in the influence of mind on body. He was the professor of anatomy at Berlin in the early part of the nineteenth century and had great influence over the medical science of the time. He insisted on the recognition and development of psychotherapy and hoped to give it a place beside the medical and surgical treatment of human ills. He did much to create a current of thought in German medicine which culminated in Johann Müller's very definite expressions with regard to the power of the mind over the body.

Very probably the most striking expression of the influence of mind upon body is in that wonderful old book, Johann Müller's text-book of physiology, issued in an English edition (London, 1842) under the title "Elements of Physiology." The subject, a favorite study, is set forth very clearly, and evidently from personal knowledge. He recognized that the mind might influence every organ and function of the body. The influence of expectancy he emphasized particularly:

The influence of ideas upon the body gives rise to a very great variety of phenomena which border on the marvelous. It may be stated as a general fact that any state of the body, which is conceived to be approaching and which is expected with perfect confidence and certainty of its occurrence, will be very prone to ensue as the mere result of that idea, if it do not lie without the bounds of possibility. The case mentioned by Pictet, in his observations on nitrous oxide, may be adduced as an illustration of such phenomena. A young lady, Miss B., wished to inspire this intoxicating gas; but in order to test the power of the imagination, common atmospheric air was given to her, instead of the nitrous oxide. She had scarcely taken two or three inspirations of it, when she fell into a state of syncope, which she had never suffered previously; she soon recovered. The influence of the ideas, when they are combined with a state of emotion, generally extends in all directions, affecting the senses, motions and secretions. But even simple ideas, unattended with a disturbed state of the passions, produce most marked organic effects in the body.