Psychic Element In The Practise Of Medicine

PERHAPS the most potent means of giving healthful suggestion is the personality of the physician himself. How often one hears a patient remark of his beloved physician : ” It does me good to see him come in.”

Learning and medical skill are certainly desirable qualities, but unless optimism and geniality are part of his equipment one had better confine himself to laboratory and didactic medicine.

Brilliant scholarship never made a successful practitioner. Genuine good nature, a hopeful manner, and an honest desire to relieve suffering humanity should be cultivated to their fullest degree. If the study of mental physiology does nothing more than to inculcate this principle into the very fiber of one’s being, it will have served no mean purpose.

The selection of a certain physician presupposes a special confidence in his skill. Whether the means employed be drugs, surgery, or orthopedics, a lack of this confidence seriously cripples his efforts.

On the wall of a sanitarium near Boston is the following stanza :

” Talk Health, the dreary, never ending tale Of mortal maladies is worn and stale, You cannot charm or interest or please By harping on the minor chord disease. Say you are well, or all is well with you, And God shall hear the words and make them true to you.”

The author has changed the last two lines as follows :

When asked if well, if not too ill, say “yes,” And haply, e’en this slight untruth may bless.

The stanza is printed on a small card which is frequently given to a patient inclined to hypochondria, with the suggestion that he take it home. It sometimes occasions a smile, but I firmly believe that great good is accomplished.

Hudson, in ” Law of Mental Medicine,” shows how nearly all our articles of diet, one after another, have come to be regarded as unhealthful. The physician is prone to assume that the particular food which causes indigestion in himself must there-fore be harmful to others, and warns all his patients and friends against eating it. There is a widespread failure to realize that ” one man’s meat is another’s poison.” When two or three happen to agree upon the indigestibleness of anything, and repeat their fears to one who indulges it, the suggestion is apt to be accepted by the subliminal consciousness, and the normal secretion of the digestive ferments may be inhibited, and another witness against the innocent offender is gained.

Conning over the symptoms of disease often leads to a morbid introspection, which is a veritable looking for trouble. The quack advertiser is keen enough to use this method of malevolent suggestion, and thus lures his victim, at least, into the symptomatology of a chronic disease.

Interwoven with all forms of physical therapeutics are the threads of suggestions. These are obtained from the direct statements of the physician, from his manner whether hopeful or discouraged, and also from the preconceived ideas of the patient.

The recovery from morbid symptoms which frequently follows a simple anesthetizing with pre-tended surgical interference, or simply exploratory incision, is so well recognized that we are apt to lose sight of its significance. In mechanical therapeutics the suggestive element is less conspicuous, but frequent examples have occurred in the practise of the writer.

A patient came with well-marked symptoms of eye-strain, glasses were prescribed, and the symptoms entirely disappeared. Leaving off the glasses would cause a return of symptoms, again wearing them the pain ceased. The case was one of astigmia, and the lenses for the two eyes were quite different. At a subsequent visit, there having been no return of the symptoms, it was discovered that, in repairing the frames, the optician had carelessly transposed the lenses, and yet the patient felt sure that she could not get along without her glasses. They were a positive detriment to vision when in the wrong positions.

Probably no physician who has used electricity has failed to note the suggestive element. Undoubtedly the buzzing of the faradic current and the sparking of the high frequency make these forms especially potent.

Massage calls the patient’s attention to the part rubbed. Is it unreasonable, in the light of Doctor Anderson’s experiments, previously mentioned, to assume that the subliminal can be thus roused to greater therapeutic power?

When we come to the realm of materia medica we find such a confusion of ” post hoc ” and ” propter hoc ” that there is the greatest diversity of opinion among the profession concerning the value of drugs as a whole, and what drugs are indicated in certain conditions or diseases, and by what rule this shall be determined, instead of depending on the empiricism which has led so many into sloughs of despair in the past.

Of the various sects, homeopathy has grown to be a respectable minority of the body medical. Here too, as with the other school, is a recognition of this misleading principle. Dr. William C. Goodno, professor of medicine in Hahnemann Medical College, Philadelphia, is quoted as saying : ” There is a serious weakness of many of our workers in materia medica in the way of credulity. The greed for provings leads many able men to accept too readily symptoms having a most doubtful relationship to the drug supposed to cause them.”

This does not mean that drugs are not curative, but it does imply that, in this department, medicine is still more of an art than a science.

We have a few specifics, and a growing list of drugs scientifically adapted to cure certain morbid conditions. A very commendable effort has been made to put the homeopathic materia medica on the same basis.

Under the auspices of the American Homeopathic Ophthalmological, Otological, and Laryngological Society, with the cooperation of the national and several State societies, the effect of belladonna on the human system and on animals has been exhaustively studied by a method originated by Prof. H. P. Bellows of Boston.’

In order that the suggestive element might be entirely eliminated, only one person in each of the eleven cities where the experiments were made knew what drug was being administered. The subjects experimented upon were examined by specialists in each department before, during, and after the tests. The most approved scientific methods were used to determine the objective symptoms, and only such subjective symptoms were accepted as trust-worthy as were experienced by a majority of the provers.

The chapter on ” The Effects of Belladonna upon Animal Tissues ” is contributed by Dr. Solomon C. Fuller, pathologist of the Westboro (Mass.) Insane Hospital.

The experiments were carried out in a thoroly scientific manner, and the work is a valuable contribution to toxicology. In this department suggestion was certainly eliminated.

THE HIDDEN SUGGESTION

Since the days of Galen the race has been more and more imbued with the idea of the efficacy of drugs, till today a little sugar pill is loaded with the suggested efficacy of generations. This it is which gives the successes of the quack ” cure-alls.” Given sufficient advertisement, and a pungent taste or smell, and the testimonials are soon forthcoming.

To cure ” speedily, gently, and permanently,” is the desideratum of the medicine. Having obtained this result, we are all of us prone to rest content, and have little interest in studying our cases critically to determine if the particular means employed were the effective agent. Most diseases are self-limited, and we all admit in the vis medicatrix nature a powerful ally. We are also thankful for any psychic element which may have contributed to the happy result.

So long as the average physician exhibits this frame of mind, can we wonder that Christian Science and mental healing are gathering adherents from the most intelligent class of the laity ?

It is this principle of post hoc ergo propter hoc which has established (?) so many misconceptions and false theories as truths. Most Christian Scientists whom I have met are sure of their science because they have been cured. The theory has been accepted because ” it cured me.”

Some one has facetiously remarked that there are ” three kinds of lies : white lies, black lies, and statistics,” and to a certain extent this is undoubtedly true. Statistics often fail to tell the ” whole -truth,” altho they may tell ” nothing but the truth.”

In order to add to the sum of human knowledge, the statistician must possess a judicial mind, and must never allow his preconceptions or his inclinations to influence him ” to make up a case.”

Dr. Austin Flint was one of the first to enunciate a principle which is truly scientific. He advocated a more careful study of the natural history of disease, the average duration of a large number of cases of a given malady when no medicine was given. Then he compared with this the average of an equal number of cases of the same disease, where medical treatment was had, contending that unless the duration or severity or mortality was less under treatment than without, one was not warranted in concluding that his interference had been beneficial.

Happily this inference is generally justifiable. Granting this to be true, -a second question is presented to the candid truth-seeker, viz.: What was the curative agent?

Dr. F. B. Percy, professor of materia medica, Boston University School of Medicine, says : ” Let us admit from the beginning that in the cure of the sick many influences must be considered.

” (a) Natural history of morbid processes.

” (b) The recuperative energies of the organism.

” (c) The favorable agencies of hygiene.

” (d) The power of personal magnetism in the practitioner.

” (e) Suggestion and auto-suggestion.

” (f) Faith.

” (g) Courage.

” (h) Drugs.

” Here then is the problem which faces every fair-minded man, to apportion to each of these influences its due weight.”

Four of the above list, namely : (d) The power of personal magnetism in the practitioner, (e) Suggestion and auto-suggestion, (f) Faith, (g) Courage, are evidently psychic influences.

While it is difficult to eliminate suggestion from practical therapeutics, and indeed undesirable so to do after having established therapeutic facts, it is easy by the placebo to eliminate the drug. The practical man takes things as he finds them and makes the best of them. The majority of one’s patients believe in the unlimited efficacy of drugs, so the practical disciple of suggestion will recognize in the placebo a preexistent vehicle for suggestion.

There should be as much care, and precise instructions given, as tho one were administering toxic medicine. The patient catches from one’s manner a suggestion as to the powerfulness of the drug.

The late Prof. J. Heber Smith was accustomed to advise : ” Until you have studied your case carefully, use a placebo.”

The late Prof. Conrad Wesselhoeft once remarked of a certain high dilutionist, who always said ” There ” as he flicked the powder on the patient’s tongue, ” There was more ‘medicine in the ` There’ than there was in the powder.”

Dr. Frederick C. Shattuck, professor of clinical medicine, Harvard Medical School, says : ” Let us use suggestion as far as is necessary to subserve the best interest of our patients ; but let us strive without ceasing to separate in our own minds mere suggestion from actual drug action. Few are capable of either imparting or receiving a suggestion strong enough to prevent a hypodermic of apomorphia from producing active emesis, or zinc sulphate given by the mouth for that matter. But we have all seen cases in which the patient was relieved by a hypodermic of plain water, which he or she believed to contain morphia.”

CONCLUSIONS

The psychic element is present in all therapeutics, even in surgery, refraction, electrotherapy, and massage.

It is the therapeutic element in Christian Science, mental healing, etc.

It and not the drug is probably the active agent in most cures by quack medicines.

It and not the drug is probably the active agent in many medicines prescribed by qualified physicians.

It is impossible to eliminate it from any form of therapeutics.

The majority of humanity is so constituted that the ” placebo ” is the most feasible form of administering suggestion.

There is another side, however, to the placebo question. Dr. Richard C. Cabot, instructor in medicine, Harvard Medical School, has stated the case very forcibly.

” Drug therapeutics in cases in which drugs do no good represent either mental fatigue or mental myopia on the part of the physician : sometimes mental fatigue, because the easiest thing one can do for a patient when tired is to write a prescription; sometimes mental myopia, which prevents the physician from seeing that the habit of giving placebos and of prescribing a medicine for every symptom leads straight to the ` patent medicine’ habit.

” Why do people take ` patent medicines’ and expect us to give them a drug for every symptom? They were not born with a desire for nauseous mixtures. They acquired it under instruction, ultimately our instruction. From the patient’s point of view the net result of the doctor’s expensive visits is too often a row of medicine bottles on the shelf. The thrifty patient thinks he sees a way to get the net result of the doctor’s efforts without so much expense. Why not save the middleman, he says to himself, and get the goods direct ? So arises the habit of going to the apothecaries or to the ` patent medicine ‘ vendors for a cure. When we stop giving placebos, cease acting as middlemen for drugmakers, and admit to their rightful place the non-medicinal branches of therapeutics, we shall deal a powerful blow at the ` patent medicine ‘ evil.”

Plato says : “Beauty we love best because we see her clearest. Wisdom with bodily eyes we cannot see or terrible had been the loves she had inspired.”