Even the deadliest and most serious of infectious diseases, consumption, has—as is well known—as one of its prominent symptoms an irrepressible hopefulness and confidence that they will get well, on the part of a considerable percentage of its victims. This has even been formally designated in the classical medical treatises as the "Spes Phthisica," or "Consumptive Hope." But these hopeful consumptives die just as surely as the depressed ones; in fact, if anything, in a little larger proportion. It well illustrates the other side of the shield of hope and confidence, the danger of unwavering expectancy, in that it is chiefly those who are early alarmed and turn vigorously to fight the disease under intelligent medical direction, who make the recoveries. Too serene a courage, too profound a confidence in occult forces, is only a form of fatalism and a very dangerous one.
Broadly speaking, mental states in the sick-room are a pretty fair index—I don't mind saying, product—of bodily states. Hopefulness and confidence are usually favorable signs, for the reason that they are most likely to be displayed by individuals who, although they may be seriously ill, are of good physique, have high resisting power, and will make a successful fight against the disease. So, roughly speaking, courage and hopefulness are good omens, on purely physical grounds.
But these are only rough indications of probabilities, not reliable signs; and as a rule we are but little affected by either the hopes or the fears of our patients in making up our estimate of their chances. The only mental symptom that weighs heavily with us is indifference. This puts us on the lookout at once. So long as our patients have a sufficiently vivid and lively fear of impending death, we feel pretty sure that they are not seriously ill; but when they assure us dreamily that they "feel first-rate," forget to ask us how they are getting along, or become drowsily indifferent to the outlook for the future, then we redouble our vigilance, for we fear that we recognize the gradual approach of the Great Restbringer, the merciful drowsiness which in nine cases out of ten precedes and heralds the coming of the Long Sleep.
Lastly, the cases in which the sufferings of the patient are due chiefly to a morbid action of his or her imagination, are a small percentage of the total of the ills which come before us for relief. But, even of this small percentage, only a very few are in perfect or even reasonably good physical health. A large majority of even these neurasthenics, psychasthenics, imaginary invalids, and bodily or mental neurotics, have some physical disturbance, organic or functional, which is the chief cause of their troubles. And the important point is that our success in relieving these sufferers will depend upon our skill in ferreting out this physical basis, and the extent to which we can succeed in correcting or relieving it. We no longer ridicule or laugh at these unfortunates. On the contrary we pity them from the bottom of our hearts, because we know that their sufferings, however polarly remote they may be from endangering their lives in any way, and however imaginary in a purely material sense, are to them real. Their happiness is destroyed and their efficiency is crippled just as genuinely and effectively as if they had a broken limb or a diseased heart.
We are now more and more firmly convinced that these patients, however ludicrously absurd their forebodings, are really sick, either bodily or mentally, and probably both. A perfectly healthy individual seldom imagines himself or herself to be ill. And as the list of so-called functional diseases—that is to say, those diseases in which no definite, objective mark of degeneration or decay in any tissue or organ can be discovered—are steadily and swiftly diminishing under the scrutiny of the microscope and the methods of the laboratory, so these purely imaginary diseases, these "depressed mental states," these "essential morbid tendencies," are also rapidly diminishing in number, as cases are more conscientiously and personally studied and worked out.
Even hysteria is no longer looked upon as sheer perversity on the part of the patient, but is patiently traced back, stage by stage, until if possible the primary "strangulated emotion" which caused it is discovered; and where this can be found the whole morbid tendency can often be relieved and reversed almost as if by magic.
To sum up: My contention is, that the direct influence of emotional states upon bodily organs and functions has been greatly exaggerated; that it is exceedingly doubtful whether, for instance, any individual in a reasonable condition of health was ever killed by an imaginary or even an emotional shock; that there is surprisingly little valid evidence that the hair of any human being turned white in a single night, or was completely shed within a few hours, under the influence of fright, terror, or grief; that the effects upon bodily functions and secretions, digestion, etc., produced by emotion, are due to secondary effects of the latter, diverting the energy of the body into other channels and disturbing the general balance of its forces and blood-supply; that the actual percentage of cases in which the imagination plays the chief, or even a dominant part, is small, probably not to exceed five or ten per cent; that a very considerable share of the influence of mental impressions in the cure of disease is due to the relief of mental panic, permitting the rallying of the recuperative powers of the body, and to the extent to which they produce the reform of bad physical habits or surroundings or conditions.
The most important element in the cure of disease by mental impression is time plus the vis medicatrix naturæ. The mental impression—suggestion, scolding, securing of confidence—diverts the attention of the patient until his own recuperative power and the intelligent correction of bad physical habits remedy his defect. Pure mental impression, however vivid, which is not followed up by improvement of the environment, or correction of bad physical habits, will be almost absolutely sterile. Faith without works is as dead in medicine as in religion. Mental influence is little more than an introduction committee to real treatment. Even the means used for producing mental impressions are physical,—impressions made upon some one of the five senses of the individual. In short, as Barker aptly puts it, "Every psychotherapy is also a physical therapy."
Furthermore, even mental worry, distress, or depression, in nine cases out of ten has a physical cause. To remedy conditions of mental stress by correcting the underpay, overwork, bad ventilation, or underfeeding on account of illness or death of the wage-earner of the family, is, of course, nothing but the most admirable common sense; but to call it the mental treatment of disease is a mere juggling with words. "Take care of the body and the mind will take care of itself," is a maxim which will prove valid in actual practice nine times out of ten.