Boris Sidis Archives Menu Table of Contents Chapter IX
A Symposium by Frederic H. Gerrish... James J.
Putnam... E.W. Taylor... Boris Sidis... George A. Waterman... John E.
Donley... Ernest Jones... Tom A. Williams...
Boston: Badger, 1908
PSYCHOPROPHYLAXIS IN CHILDHOOD
TOM A. WILLIAMS, M.B., C.M. (EDIN.)
Lecturer on Nervous and Mental Diseases, Howard Univ., and Neurologist to Freedman's Hospital
DEFINITION. Just as psychotherapy denotes not treatment of the mind, but treatment by psychic means (1), so I shall use the word psychoprophylaxis, not to signify the prevention of psychic disorders, but to mean the preservation of health by psychic means.
The limited amount of space at my disposal will, however, restrict the consideration of the subject to the psychic means to 1 be employed for the restriction of psychic disorders, leaving aside the fascinating psychoprophylactic procedures, which are one of the main elements used by the physician to persuade patients whose symptoms have been long absent, to regulate their life so as, for instance, to prevent failure of cardiac compensation and asystole, or to continue a mercurial course; or, again, in order to cure an incipient tuberculosis, to persuade them to continue to visit him, to avoid foul air, take regular meals, and avoid excesses of work and pleasure. Still more largely is psychoprophylaxis employed by the sanatarian, who persuades first his colleagues, later public opinion, and lastly legislatures and municipalities to adopt the means for the prevention of the disease. For instance, the greatest obstacle to the employment of efficient means to combat yellow fever lay in the psychological attitude of the people of the South. Their horror of “Yellow jack” was so great that they could not even discuss the subject. It was only when some hope was inspired that the dreaded disease might be prevented that the phobia could be controlled sufficiently to permit of action.
In short, the means of overcoming public and personal apathy and mental inertia are the most difficult problems of preventive medicine. Were this done, the tuberculosis dispensary would really perform the functions it is supposed to perform, and which I am assured it does not do from a lack of this psychic motive power of persuasion. The disgraceful typhoid situation in Pennsylvania will terminate only when the people’s feelings are aroused by conviction to the pitch of real will that the abuse shall cease.
Only those ignorant of psychology, and especially laymen, and more particularly ecclesiastics, who are always dualists, will expect too much from psychoprophylaxis. The physician is not likely to forget the state of physical nerve insufficiency (10), which is at the root of so many psychic perturbations, which are often mere exaggerations of the tendencies of the character, normal and morbid; nor will the physician forget the role of intoxication in inducing mental confusion, melancholy, acute psychasthenic symptoms, twilight states, often miscalled hysterical. The physician will take care that the exhortation, advice, and instruction he brings to bear are not obstructed by the intellectual handicap of exhausted or intoxicated neurones (11), nor by the affective distress caused by insufficient oxidation, intestinal irritation, and so on.
In other words, he will adopt a monistic interpretation of his patient, contrary to the view of Déjérine (12), who has said that to be a good psychotherapeutist one must not be a determinist. He has not taken into consideration the fact that the therapeutist himself, in becoming part of the patient's environment, determines a new sequence of ideas. On the contrary, as monists we shall protect our patient from such dualistic vagaries as Christian Science, for with the monistic attitude we are much more apt to constantly relate mind and brain to one another.
But one must be careful to avoid the pitfall into which many psychiatrists at one time fell, but which we now know how to avoid, thanks to the efforts of the French school and of men like Adolph Meyer and Morton Prince in America. I refer to the premature attempt to refer every psychic perturbation to a vice of structure, as, for example, is done by Swift (13) when he relates the difference of mental capacity between the adult and a child of seven to corresponding neural changes. As a matter of fact, such difference is one merely of orderliness of mental reactions, as is shown by the superiority of the child in acquiring unrelated facts, as, for instance, words and the use of language. A man deprived of education would show no greater capacity and have perhaps less potentiality than a child of seven. Of course, ultimately, any acquired skill must depend upon neuronic dispositions of molecular kind; but we are not even in a position to perceive the nature of these, though that they depend upon the functional capacity of the neurones is evident from the disappearance of skill and other forms of memory during intoxication, as well as after destruction of nerve matter.
Thus, as of all prophylaxis, an essential preliminary is diagnosis, by which only an intelligent prophylaxis can be guided.
The essence of psychoprophylaxis, as of psychotherapy and education, is to associate useful activities with agreeable feeling-tones, and to disassociate from useless or injurious acts the agreeable feeling-tones that may have been acquired. For instance, the kind of social obsession which eventuated in the crusades does not differ psychologically from that which leads to empire building; but the former was a pernicious activity, while the latter may have its uses. A fixed idea may often prove an incentive to useful work in individuals as well as in societies.
Fundamentally none of the processes we employ differs from those used by Pawlow (2) in “conditioning” the reflexes of his experimental dogs, when he caused an expectant wagging of the tail and a flow of saliva and gastric juice upon ringing a bell.
Similarly, when the petted child ceases his crying upon seeing his father, it is because he reflexly has associated a greater discomfort with the persistency of his tears than with their cessation. The effect, fear, aroused by association, banishes that of fretfulness.
Gradually the emotional element of the reflex fades (3), and sight-of-father connotes cessation-of-weeping. This leads to a respect-reflex. On the contrary, the intellectual content of the phenomenon may be submerged below the threshold of consciousness, only the effect persisting; in which case occur painful or pleasurable emotions, the origin of which is not manifest in the subject. Recollect that functional derangement may continue just because it began.
The interest sentiment is an essential of all psychotherapy, as of effective pedagogy; as when a young child about to cry is quickly diverted to a passing scene or made to perform an act. The doing so quickly substitutes the new interest sentiment for the disagreeable former one, the feelings are changed, and we have performed psychotherapy by distraction and substitution.
This simple principle, then, of finding or creating the interest-effect, associating it with the desired conduct, and training it into habit, as simply illustrated above, may be found at the bottom of even the complicated ratiocinations required in the therapy of the psychasthenic, and is also the outstanding indication in all paranoid psychoses.
On the other hand, in the hysteric, if the tour de force cannot be employed or fails, the method of repetition is requisite. Those who do not depend upon reason must grow into feeling by accustomedness, if the first blow fails. Who does not know of communities where a doctor’s prestige is measured by the years he has spent there, of the reverence derived from seniority? The mentality which accedes to such a criterion is, of course, irrational, and it is at bottom that of the hysteric. Hence, the clinical procedure of isolation to increase the speed of accustomedness, and of reiteration to force into the unreasoning affectivity a realization of the notions to which the patient is refractory. This is not persuasion: it is the method of pertinacity.
Hypnosis, hypnoidization, etc., are merely means of increasing impressionability to suggestions. In principle there is no difference between these and such means as were empirically used in ancient times through ceremonies, religious observances, ritual, etc., for the same purpose. (Such methods can perform nothing more wonderful than Judge Lindsay's feat of persuading the incorrigible truant boy to himself purchase a ticket and travel many hours to a reform school.)
As set forth elsewhere, the distinction between suggestion and persuasion is one of awareness by the percipient (4), the acceptee. Hence, to be unaware of why one accepts an opinion that so and so is the most skillful, and to do so on length of acquaintance is to do so by suggestion; and an idea received by suggestion is a hysterical one, as shown by Babinski in his definition, “A hysterical symptom is one susceptible of induction by suggestion and of removal by suggesti-on-persuasion. (5)”
In all of these procedures the preliminary sentiment of respect, reverence, awe, is engendered among the people by the devices of expectation, unfamiliarity, and sacredness or mystery. This sentiment in modern democratic days is less the actuating factor than that of the pseudo-intellectual shibboleth, which seems to be a strongly determining factor in the popularity of modern movements of all kinds. The social tropisms of the unthinking may be graded in three categories of decreasing strength, beginning in ritual and passing via shibboleth to snobbery, its modern attenuated form. In all these modes of conveying influence, distraction is obtained by engaging the sight by the rhythm of the ceremony and by engaging the hearing by the rhythm of music, to which are often added the dynamic rhythms of movements directed conformably with the desires of the priest or other operator.
The distraction thereby obtained, almost tantamount in some cases to a dreamy state, favors what we nowadays variously call passivity, psychological automatism, mental dissociation, suggestibility.
In this state, plasticity of the desires is much facilitated, the operations of the will are in abeyance; for the critical judgment of the intelligence is no longer in action. The subject does not attain to the phantasmagoria of the complete dream state; for susceptibility to extraneous stimuli is much stronger than in sleep, or even than in somnambulism. The state resembles that in the day-dream, in which, however, the meditations are less- systematically determined.
The moral control, the psychoprophylaxis, secured by these means has in the past been incalculable; but as the sanction of these procedures has been crumbled by the trenchancy of modern analysis, and we now live in a scientific age, it is necessary to employ psychoprophylactic means which accord with the intellectual development of civilized man. Thus the further we depart from the methods of mental distraction, mystical appeal, and pseudo-scientific shibboleths (6), the more soundly and permanently shall we succeed in preventing the vagaries of the neurotic, and the less shall we be a party to the justification of the occult manner in which many of the public, and even some doctors conceive such psychological interpretations as hypnosis, sub-consciousness, divided personality, subliminal phenomena, mental dissociations, etc. The more we appeal to the method of common sense, plain matter of fact every day conduct (which is obviously the method so clearly explained and outlined by Dr. Taylor) (7), the less chance shall we give for the delusional interpretations of clairvoyants, medium spiritualists, and others whose sentiment of psychic imperfection leads them to seek in the occult the satisfaction they cannot find in current explanations of their mental life.
It is to be hoped that our labors along with other symposia like this may eventuate in a working doctrine held, in common by the whole medical profession, which will enable us to forestall and prevent the development of misinformation concerning psychic states which have been responsible for the birth and evolution of such modern movements as Christian Science, Emmanuelism, neo-yogiism, and other harmful misapplications of psychotherapeutics.
A concrete illustration of what psychoprophylaxis can do is afforded by a recent communication of G. Guidi (8), who has shown that fifteen per cent of attacks of migrain are preceded even for days by psychic symptoms either of excitable or depressant type, e.g., the need to move about, to talk, to tell funny or obscene stories, to look out for ridiculous situations, to laugh at them, or by a desire to go alone, irritability, sadness, anxiety, even tears. I have myself noticed a feeling of unusual mental clarity, of power, in certain cases. (Every one’s disposition is modified (9) by exercise, oxygen, food, etc.; we all have defective times. Want of exercise and elimination leaves toxins which cause restlessness, irritability and prevent quiet intellectual work.) Now if the migrainous attack can be prevented as a result of diagnosing this modified psychic state, it is evident that by prescribing mental and physical, including digestive, rest, we shall have performed psychoprophylaxis.
We must recollect that during the period while the functions of the neurones are perverted by physical maladies, especially the intoxicative ones which we call fevers, bad habits of action may be initiated and be reinforced through convalescence and become characteristics of the individual. As a matter of fact more careful psychic discipline is needed while neurotic activity is perverted (14) than when it is healthy, and it is the family physician’s task to guide the psychic management of his patients as well as the physical.
The principle of mental prepossession and inertia shows the power of an idea, which may originate as the result of slight physical disorder. Binet (15) has illustrated this experimentally by showing how children will go on increasing the length of a line when drawing from memory a series of lines shown them, though only the first few of them were actually increased. Another example (16) is the remarkable experience of the enumerators of the last census in endeavoring to adapt themselves to the supposed difficulties of a new dactylograph. Their work was rendered so disappointing by the “pressing” under difficulties that new clerks had to be employed: these quickly surpassed their more experienced colleagues. To be “on edge” is not the best state for showing high skill: as divided attention.
The state of keyed-up prepossessedness is induced by an excessive interference (19) with the activities of the child; when every act has been regulated and controlled he will constantly be referring for approval instead of confining himself to the task in hand. This principle; may be illustrated by the boy who instead of looking at a ball he is expected to catch looks at the thrower for the approval or blame he anticipates. Over-conscientiousness is quickly developed by such procedure; but, again, psycho-diagnosis will eliminate the danger, for it would be a mistake, for fear of risking over-conscientiousness, to have upset the entire sense of fitness of a boy of three who came to his father to be thrashed, declaring he had thrown a knife at the cook, an act which had been specifically forbidden.
The source of another danger proceeding from over-conscientiousness is that of shame of eating (18), as illustrated by the same boy, when conscious of wrong-doing, repeating “no bananas for boy” (a dish he loves). But it is very easy to prevent a perverted affect in this case, while at the same time furnishing a consistent and coherent system of conduct and morality.
In this connection one must avoid formation of bad affective habits during the temporary intoxication of poor oxydation due to a full stomach or too heavy a meal. In this state a child while playing hard may be carried away by excitement till he loses his temper and begins to cry, just because “things are too much for him.”
Again, constantly interrupting him in a train of thought by regulating his least little impulse promotes suggestibility, and the child becomes accustomed not to act until told. In not availing one's self of a moment of excitement to inculcate a difficult act, one loses a chance of cultivating presence of mind, even during emotional states. This may even be done during pain and tears by making the child do something else during them, thus gaining self-control. In speaking slightingly of what one wishes contemned, be sure it is not against human nature. To forbid healthy acts to a boy is detrimental to him, he derives a false notion of morals when he knows that innocent acts are forbidden. So provide ample outlet for spirit of adventure, without which a boy’s whole character suffers. It either is exercised illicitly, or is suppressed and forms intellectual dishonesty and emotional incompleteness, so fertile a source of psychasthenia.
But in early childhood, and in some matters even in adolescence, it is best to employ authoritative affirmation rather than suggestion. A child cannot see the reasons for the need for certain prohibitions; and it is a bad principle to be constantly side-stepping issues by the giving of suggestions. Besides, it prevents the child acquiring the power of immediate subordination of his own desire to what after all must be done sometime. For instance, a boy who cannot understand the rationale of bacterial infection is forbidden to take milk unless boiled. The mandate can be enforced by the suggestion that boiled milk is a delicacy, and that he is privileged in being permitted to have it; but this procedure is quite unnecessary when a mere affirmation should suffice, which, moreover, will prevent the danger of his foregoing the privilege, in order to drink raw milk. The advantage of assured obedience to authority is most manifest during such periods of emotional motor or intellectual hyper-excitability as precede exhaustion. They may be compared to the paralytic secretion of the physiologists. Hence the more simple the brake used the better, for complex means of arrest only increase the cerebral activity.
Another example of a misapplication of suggestion consists of saying to a child, “You are not afraid,” when he shows timidity in some unusual situation. The child knows quite well that the mere making of the remark indicates a reason for fear; and the real effect produced is the suggestion of fear, which might have been avoided by assuming a matter of fact manner as soon as indications of hesitancy or timidity were shown by the child, taking care at the same time to replace the unpleasant affective mode by another, through substitution and distraction. Of course, reliance on simple affirmation must be maintained by truthfulness, and later by reasonableness.
The habits of accuracy and orderliness may be inculcated without the danger of their becoming besetments, if it is done, so to speak, spontaneously as a pleasure, and not as a duty Calvinically, that is, if it is made kinetic rather than inhibitive. For example, a boy of two and a half is asked to bring in two balls with which he was playing in the garden, and later to pick out from some others those he brought. This exercise not only cultivates memory and accuracy, but the power of perception of difference as well as the notion of responsibility and the pleasure in having it recognized.
A boy’s whole world of fitness is upset when unusual acts are done. A boy of three will allow no one else to touch the letters placed on his father's plate. After playing with his father and wanting “more fun,” he would not desist from his demands when told it was too hard for his father, replying “not too hard,” but at once did so when told “Father tired.” He recognized this from his mother's and his own experience as a valid excuse for stopping.
These habits become morally imperative (19), and are very hard to eradicate in after life, for they do not depend upon clarity of conception, as is well shown by the fact that most of us do not act entirely in accord with our intellectual convictions, but persist in regulating our conduct by doctrines long outgrown. Hence, the importance of preventing the feeling of dependence by encouraging the child's desire for and pride in performing tasks about the house and garden. If, for instance, a child is encouraged to put on his own clothes under the belief that it is a clever act or to wash itself, these actions will become automatic, and he will not later have to go through the difficult acquisition of the clean hand instinct and that of self-helpfulness (20).
The ineradicability of fear when inculcated in early childhood is clearly illustrated by the Southern lady, who even in advanced age dared not go alone into the dark, although she has long ceased to believe in the stories which first made her afraid to do so. She realized this so forcibly that she would not permit her three daughters to be told any of the alarming stories which most Southern children learn. Her psychoprophylaxis resulted in the girls never having known what it meant to be afraid in the dark. Indeed, it was the habit of their schoolfellows to send them into dark and eerie places to show off their powers. The tenacity of early affects is again illustrated by the immovable depression produced by the playing of gospel hymns on a reed organ in the case of a lady in whose childhood the Calvinical Sunday had almost caused fear. The psychoprophylaxis here is obvious (21). In another case the hearing of a brass band invariably produces weeping and terror. This is due to the fact that such playing occurred during the horrors of the civil war.
In some children (22) care is needed to avoid the “besoin d'être aimé,” the craving for sympathy. This may be induced by excessive petting and loving while a child is tired or after injury. It is better to send the child to bed when tired and to divert his attention when injured. But denial of sympathy is equally bad, and is the cause of the intense love hunger seen in many young people whose surroundings have suppressed their natural affection.
It must be remembered that the fundament of altruism lies in the affectivity (23), and this must not be suppressed, but must be controlled and used. For instance, during sympathy, interest may be aroused and turned into an unrelated channel, and thus used for moral and intellectual teaching instead of being roughly ignored. These may appear small matters, but they illustrate important principles, as will appear when they are applied to the matter of lying and the acquisition of the, sense of responsibility and right conduct.
The mythomanic (24) tendency, which is responsible for so many medico-legal difficulties, would be much diminished by a psychoprophylaxis addressed to the afore-mentioned habit of accuracy; for the conduct indicated is merely a mode of truth in act, which to a child precedes the significance of truth in speech. The latter is discouraged, I believe, by mystery tales, as well as by those of voodoo, though I am aware that much difference of opinion on this point exists among pedagogues. I cannot enlarge upon this theme, except to point out how often mythomanic manifestations are miscalled hysteria by medical men who have been unduly impressed by the doctrines of Charcot (25); whereas, the difference has been clearly pointed out by Dupré (26) and Babinski
(27). The newspapers of the day afford innumerable examples of the dishonest point of view which eventuates in mythomania. It is almost entirely preventable by a proper psychoprophylaxis, if not on the part of the parents, then later and with more difficulty on the part of the schoolmaster.
In this connection, I must express the belief of the need for men in the moral training of boys. The best elements of moral development are inculcated, not in the schoolroom, but at play, in which the masters must participate more or less: and as at present trained, very few women are capable of this. The revolution effected in the habits or character of the English school boy by the methods of Thomas Arnold of Rugby (28) afford a striking illustration of this.
To attempt to manage boys by religious sentimentalism and softness, the woman-and-slave morality of Neitzsche (29) is to encourage hypocrisy in the strong and exaggeration of weakness in the feeble. Of course sympathy must be used, but it must be a manly one, referring mainly to the forceful activities of the life of a normal boy. In this way a self-reliant character is built up by the encouragement of constant relation of itself to the welfare of a society in the responsibilities of which each boy has a separate niche to fill.
Than this there is no better prophylactic against despondency, suspiciousness, and other anti-social feelings of paranoid type. By this system of encouraging morality to become constantly kinetic and to be thought of and controlled by its relation to others while self-respect is maintained, the hyper-suggestibility is restricted and hysteria prevented.
Psychasthenic types too are environment where solitariness not apt to develop in an is impossible, and where the stresses are healthy and kinetic, and the emotional and intellectual appeals are of a positive and clear comprehensibility. Hence the rarity of psycho-neuroses in the men who have been trained in the public schools of Great Britain. And their influence has not ceased here; for the habits of conduct illustrated and brought into prominence by Arnold’s boys have permeated the whole national life, with the result that De Fleury (30) has been able to comment with admiration upon the freedom of the nation from the psycho-neuroses, the study of which has given such distinction to French neurologists.
Similar methods may be applied with success even to boys perverted by faulty environment; for instance, Tomlins (37) developed a thieving jail boy into a useful citizen by reversing the mawkish treatment he had been receiving in the reformatory, and substituting a peremptory and rough method of making him responsible for certain duties and for other boys, and showing surprise that he did not do better work than he at first showed.
On the other hand, there is the case of a girl in whom intractable fits of temper were cured by one display of kindly sympathy after she had torn up her books in a fit of rage. The prophylaxis in each of these cases meant the saving of a whole life from the misery which would have arisen in a purely psychogenetic way.
The psychological insight which enabled the reflexes to be “conditioned” in these two cases is responsible for these two useful lives.
Many a phobia or angoisse can be prevented by psychic means. Similar in principle are the means to be employed against the self-distrust and diffidence of the psychasthenic form of insufficiency. The natural desire of a child to play with its fellows will soon disappear if he is too slow-witted to comprehend the game or too clumsy to take his due part, or is constantly humiliated by his failure or by the mockery of his fellows. Want of capacity in some study arising from the defect of some motor sensorial or associational process may produce a self-deprecatory or anxious attitude very unfavorable to healthy psychic development and most provocative of the scrupulosity of psychasthenia.
The method of conditioning the reflexes is illustrated most clearly by human beings in cases of sexual perversion where some artificially introduced element becomes the efficacious provoker of future sexual desire, or at least satisfaction. The genesis of the fetich constitutes the conditioning of the sexual reflex in that person.
The whole element of the sexual element in the causation of the psycho-neuroses is too long to discuss here. I must, however, deplore the difficulties thrown in the way of the study of these very important problems of psychoprophylaxis by the unwillingness of some observers to investigate the sexual life of their patients. To establish a solid psychoprophylactic doctrine we need accurate information, and the scientific search for such information must not allow itself to be hampered by national prudishness. It is this noli me tangere perversion of morality which arrogates to itself the exclusive title of morality which is responsible for much of the prurient attitude of the young towards sexual relationship.
What shall we think of a civilization which permitted a highly respected woman physician of twenty years’ standing to be placed in jail for having written a book instructing young women upon sexual hygiene? This actually happened less than five years ago in Chicago. Such an attitude fosters ashamedness in the young; and shame of the bodily functions as we know frequently dominates the field of consciousness of a psychasthenic. An adolescent who has been discouraged from discussing or understanding the phenomena even of his own sexual life and taught to regard them as different in kind from other facts of personal function and hygiene is sadly handicapped in the difficult process of somato-psychic or allo-psychic adjustment in that difficult period of his life.
Similar animadversion may be made against what is now less common—the state of apprehension and terror induced by religious teachings founded upon the doctrine of man’s inherent evil nature and damnableness. A research by Coe showed that less than ten years ago a very large percentage of college students had suffered severely from the spiritual agonies of the attempt to reconcile their dawning knowledge of the universe with the inadaptive and injurious doctrines they had been taught in the name of religion and morality.
Now it is very simple to forestall such morbid reaction by directing the activity of such children into channels for which they show aptitude. From the feeling of accomplishment and triumph thus engendered the child will gradually learn to adjust himself to difficulties which mental prepossessions and inertia would have rendered impossible to overcome. A delusion of persecution so often fertile in dangerous reactions has really its source in a mistrust and suspiciousness which might have been prevented or removed by the self-satisfaction coming from the fulfilled desire of productive activity. The delusion is essentially a defense reaction against the feeling of self-distrust. Such feeling is powerfully conduced to by cultivating in children a pride not consonant with their true relation to others; for the social activities of such children will be contaminated by an exaggerated self-respect which will necessarily be constantly wounded, whence an inevitable withdrawal from social activities which do not minister to their pride, and therefore an ever-increasing seclusion which is more and more dominated by suspicious inferences from innocent words and acts of others and brooding thereupon until this ideational-emotional complex dominates and becomes the character of the person and refractory to intervention; but the psychoprophylaxis would have been simple, and is obvious.
The gastric neuroses are a striking example of the non-use of psychoprophylactic power by medical men: for the great majority of these cases occur as the result of the suggestions of medical men while prescribing for patients suffering from temporary indigestion (33) or by the indirectly gained notions of medical origin with regard to eating and diet. Again, recent work has shown the difference between tic and true chorea, and also that the latter, now clearly shown to be an organic disease (37) may begin by intellectual and emotional perturbations long before the motor areas are affected.
The only practical way of detecting these early conditions is through medical inspection of school children by trained neurologists whose knowledge of physical and mental test signs will anticipate many a breakdown, besides removing from the other children the contagion which habit-spasm and chorciform movements are known to exercise on their plastic minds. As a matter of fact the co-operation which should be sought is much less that of the priest than that of the teacher of the young. We can hope to influence him to a scientific attitude toward the biological phenomena with which he deals; besides which the help in managing difficult and neurotic children which he gains from neurological advice makes him very ready to welcome it, as my experience shows.
And indeed pedagogues themselves have noticed the need of medical psychoprophylaxis. Thus Swift (loc. cit.) says, “Half an hour’s observation of pupils at their school work will convince one skilled in interpreting nerve signs that nervous disorders have become so common as to menace our national health, and the significance of this for education has been too generally ignored.” And again further, “It is unfortunate that instincts are so frequently the child’s only defense against the pedagogical enlightenment (sic) medical supervision cannot fully meet the need unless a nervous affection is detected in its incipiency; so the teacher must be taught about the early signs, so as to call in a physician to prevent aggravation by the continued irritation of test and examination.”
As desirable would be the teaching of the mothers to form healthy emotional habits in their children. The happy-go-lucky absolutism which so often asserts itself as capacity is sadly defective as such a guide for hesitating childhood. The management of the mind and the emotions into a morality constitutes the most difficult study and art. But it can hardly be expected that fortitude can be inculcated by a mother who has not herself shown it sufficiently to even attempt to understand the biological laws upon which depend the reactions of the nervous system which we call conduct, for the ethics taught to most children is a vestige of medievalism conspicuous for its poverty in such criteria of modern civilization as justice, liberty, courtesy, altruistic sympathy. The child’s natural good impulses are checked and twisted; when his reasoning from cause to effect is not neglected or obstructed, he is thus confused and finally often discouraged into sadness or indifference, becoming as a man either despondent or happy-go-lucky, with either no morality or one of words only, which has no efficacy in preventing maladjustment.
But a morality which is really active instead of being merely received on faith becomes a part of a boy’s character and is carried out in his conduct. It intertwines with his every thought often quite unconsciously. Suggestions contrary to this trend are then automatically repulsed, and we secure reliability of conduct; and socially speaking that power of prediction which gives security in man's relationship with man.
Now this may appear hardly a medical but more a sociological matter; but there is no difference of kind between a perversion of conduct which we call criminal, that is, anti-social, and an aberration proceeding from ideas which we call hysterical. The false belief that one’s limbs are incapable of locomotion or the comfortable and cherished feeling that one is an invalid and unable to support one's self are both anti-social attitudes, in whatever good faith they are assumed.
Now their prevention as well as their cure is the prerogative and duty of medical science, which is called upon to distinguish from the aberrations of conduct due to the change in the secretions, and the nervous system those due to aberrant notions. And, nowadays, as this symposium shows, we have to apply the remedy, not only to the former, but the latter in supplementing the activities of the pedagogue and priest with the special means the psychiatrist's training permits; that is to say, when a pathological type of reaction has been constituted by the hurtful suggestions of a faulty environment, it is the doctor’s province to eradicate the hurtful suggestions and to emplant a habit of mind tending for the good of society and refractory to suggestions contrary to that object. For a close analysis shows that the real cause of most so-called “nervous prostration” is failure of adjustment to environment, and is psychogenetic. A rest cure in itself is inefficacious, but gives the doctor the opportunity to re-educate the perverted trends of the patient’s disposition. Before reaching the neurologist, a patient has been “suggestioned” ad nauseam: and such empirical therapy has failed, as has the injudicious appeal to his will power already exhausted by the complexities, social and professional, which contributed to his failure of adjustment.
To arrest a morbid train of thought and set a mind at rest is an art requiring knowledge and skill. Its attempt by untrained men has been even more disastrous than the work of the tyro in gynecology; for it is the direct cause of the rise of Christian Science, Emmanuelism, and such cults. Happily, a body of experts in psychopathology is now counteracting their injurious influence: for an affectation of knowledge will not supply the public’s demand for real psychic treatment. But we require greater facilities for instructing medical men in the principles of psychopathology and therapeutics; and proper wards and out-patient clinics under competent teachers should be provided, at least in every large city.
1. Grasset, Therapeutique des Maladies du Systeme Nerveux. Paris, 1907.
2. The Huxley Lecture, Brit. Med. Jour., 1906.
3. See Morton Prince: The Unconscious, Journal of Abnormal Psychology, 1909, Dec.; Friedmann and Gierlich, Studies in Paranoia. Trans. Nervous and Mental Series, N. Y., 1905.
4. Suggestion and Persuasion, Alienist and Neurologist, 1909, May.
5. Rev. Neurologique, 1907.
6. Camus et Pagniez, Isolement et Psychotherapie. Paris, 1904.
7. The Relation of the Med. Prof. to the Psychotherapeutic Movement, Boston Med. Jour., 1908.
8. Riv. Sper. di Phren. et Psy., 1908.
9. Janet, Les Oscillations du Niveaux Mentale Congrès de Rome, 1904.
10. Williams, The Differential Diagnosis between Neurasthenia and Some Affections of the Nervous System, for which it is often mistaken, Archives of Diagnosis, 1909, Jan.
11. Williams, Hints on Psychotherapy, Monthly Cyclopedia, 1908.
12. Lecons Cliniques, 1907. (Unpublished.)
13. Mind in the Making. New York, 1905.
14. Williams, Discussion on Responsibility of Hysteria, Contes rendues Congrès de Lille, 1906.
15. La Suggestibilité. Paris, 1897.
16. Jastrow, Fact and Fable in Psychology. N.Y. and London, 1907.
17. See O’Shea, The Dynamic Factor in Education, 1904. N.Y.; Archibald, The Power of Play, London, 1908.
18. Raymond et Janet, Les Obsessions et la Psychasthenic. Paris, 1903.
19. Leuba, The Nature of the Moral Imperative, Amer. Jour. Psy., 1897.
20. See Williams, The Psychological Bases of Inebriety, New York Med. Journ., 1909, April. Also Pedag. Seminary, 1909.
21. See White, Theory of Complex, 1908, April. Morton Prince, loc. cit. Chap. II.
22. Raymond et Janet, loc. cit.
23. Spencer, The Data of Ethics.
24. Dupré, La Mythomanie. Paris, 1906.
25. See such current text books as Saville, Church, and Petersen.
26. Loc. cit.
27. Ma Conception de l’Hysterie. Paris, 1906. La Démembrement de l’Hysterie, Semaine Médicale, 1909.
28. See Tom Brown’s School Days and Numerous Lives.
29. Mancken, The Philosophy of Neitzsche. New York, 1908.
30. La Figaro. Paris, 1906.
31. Communicated verbally.
32. See Williams. The Most Frequent Cause of Nervous Indigestion, Journal of Abnormal Psychology, 1909, Feb. Also Amer. Med., 1909, April. Old Dom. Jour., 1908, Nov. Dégérine Les Fausse Gastropaths, Presse Med., 1906.
33. Le Rôle du Medecin en créant ou en maintainant par ses Suggestions Maladroites les Maladies produites par l’Imagination. Congrès des Neurologists à Lille, 1906. Trans. Amer. Med., 1908, Aug.
34. Steherback, Arch. De Neur., 1709.
35. The Psychology of the Spiritual Life, Chicago & New York, 1904.
36. Meige et Feindehl, Les Tics et leurs Traitements, Paris, 1901. Williams, Differential Diagnosis of Tics & Spasms, Via Semi-Monthly, 1908.
37. Payne et Pynton, The Etiology of Chorea, Brit. Med. Jour., 1906.
38. Burr, President's Address, Jour. Nerv. Et Ment. Disease, 1908.
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