MIND AND MEDICINE

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MIND AND MEDICINE
A LECTURE
DELIVERED IN THE JOHN RYLANDS LIBRARY ON THE
9TH APRIL, 1919

BY

W. H. R. RIVERS, M.D., D.Sc, F.R.C.P., F.R.S.
FELLOW AND PRAELECTOR IN NATURAL SCIENCES, S T . JOHN'S COLLEGE, CAMBRIDGE

Reprinted from

"The

Bulletin of the John Rylands

Library"

Vol. 5, Nos. 3 and 4, April-October, 1919

SECOND

MANCHESTER:

EDITION

AT T H E UNIVERSITY PRESS

LONGMANS, GREEN & COMPANY
LONDON, NEW YORK, CHICAGO, BOMBAY, CALCUTTA, MADRAS
1920

132
R52m2

MIND AND MEDICINE.1
BY W. H. R. RIVERS, M.D., D.Sc, F.R.C.P., F.R.S.,
FELLOW AND PRELECTOR IN NATURAL SCIENCES, ST. JOHN'S COLLEGE, CAMBRIDGE.

T

H E early relationships between mind and medicine are intimately bound up with the process by which medicine grew
out of magic and religion. The history of medicine reveals
a long and chequered progress, still far from complete, in which Man's
attitude towards disease slowly became different from that he held
towards the many other mysteries by which he was surrounded. His
endeavours to cope with disease took at first two directions. In one
he ascribed disease to the action of beings different from himself, but
capable of being reached by rites of prayer and propitiation. Since
these rites, wherever we study them, reveal an attitude of respect and
appeal, and imply powers which man does not himself possess, it seems
legitimate to regard the beings to whom they are addressed as higher
arid more powerful than himself. The general body of rites and beliefs forming the means of intercourse between Man and these higher
powers make up the aspect of life we call religion. One of Man's
early modes of behaviour towards disease may thus be regarded as
forming part of religion and the religious attitude.
In the other direction disease was ascribed to the action of other
human beings, or of beings of a non-human kind believed to be amenable to processes of a compulsive nature, and therefore less powerful
than Man himself, so that the attitude adopted towards them implied
neither respect nor appeal. When his efforts to deal with disease took
this direction, Man compelled or induced the being to whom disease
was ascribed to withdraw the agencies by which the illness was being
produced, or himself employed measures designed to negative their
effects. Beliefs and measures of this kind make up the aspect of
1

A Lecture delivered in the John Rylands Library, the 9th of April,

1919.
5

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life known as magic, but this aspect is less capable of definition than
religion and needs analysis into several distinct elements. One of
these is certainly degenerate religion, beliefs and rites no longer implying any reference to higher powers which at one time formed their
motive and sanction.
The great majority of the measures by which existing savage peoples
attempt to cope with disease fall into one or other of the two categories of religion and magic. All that we know of the history of
mankind suggests that it was only after long ages, and in some few
parts of the earth, that Man reached a conception of disease according to which it is ascribed to processes similar to those underlying
modern systems of medicine. The emergence of medicine from its
intimate associations with religion and magic is closely connected with
the gradual substitution of the concept of physical causation for the
spiritualistic agencies of the animism which formed the early attitude
towards nature. The growth of medicine is closely bound up with
the development of the concept of a natural world as opposed to a
world we now regard as supernatural.
All the evidence at our command goes to show that as Man relinquished his early animistic interpretation of the universe, this was
replaced by explanations of a materialistic kind. In so far as events
were not ascribed to spiritual beings or to direct human agency, they
were believed to depend on the action of material agents. The agents
thus supposed to be effective in the production of disease during the
history of medicine have been of two chief kinds. Among peoples
who have been especially influenced by beliefs concerning animals,
this branch of creation has been prominent in their theories concerning
the production of disease. Elsewhere the evident connection of the
blood with life has led to the belief that disease is predominantly due
to an altered character of this fluid, and this belief formed the startingpoint of the humoral pathology which for so many centuries formed
the basis of medicine. The two great developments of our own time
in medicine have followed these two main lines of early belief. For
the worms and snakesx of savage medicine h^ve been substituted the
microscopic and ultra-microscopic organisms of the germ theory of dis1

When these early beliefs are regarded as previsions of the germ-theory
it should be remembered how naturally they follow from the general beliefs
concerning animals characteristic of certain forms of human culture.

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7

ease, while the place of the old humours has been taken by the alteration in the proper proportion of internal secretions which is now
coming to be recognised as the immediate cause of so many morbid
states.
During the long period in which medicine was occupied in substituting these material agents for the spiritual beings to which all
disease was once ascribed, little if any room was left for agencies which
come within the modern connotation of mind.
When Man thought of the production of disease by other than
material agents, his concept of the activity involved was very different
from that of " m i n d " as held by ourselves, or at any rate by the
psychologist. The agency to which he ascribed disease was spiritual
rather than mental, and was conceived as having form and capacity
for independent existence. It might be a spirit which had never been
human or had human associations, or one which had once had a human
habitation but had come through the death of its host to acquire an
independent existence, or lastly, it might be a soul which still had its
customary seat within a human body, but could leave it in sleep or
trance to act as the producer of disease.
Though at this stage of human culture there is no trace of the
modern concept of mind as distinguished from spirit, we can see clearly
that most of the processes by which disease was thought to be produced,
and was treated, are such as would act through the mind. The manifold lines of treatment by which human or spiritual agents were induced
to cure disease acted, if they were successful, through the agency of
faith and suggestion. The curative measures which are still being
employed by many peoples, act through the same processes and owe
their success to the faith they inspire or to the more mysterious property
we call suggestion.
It is jaecessary, hoWever, to distinguish the production and treatment of disease by agencies actiiig through the mind from the knowledge that the measures used act in this manner. Though remedies
acting through the mind were probably the earliest to be employed by
Man, the knowledge that the remedies act in this way is one of the
most recent acquirements of medicine. It is said that the Japanese of
the sixteenth century understood the action of remedies through the
mind,1 while the great importance attached by the Hindus to the
1

M. Neuburger, History of Medicine, London, 1910, vol. i., p. 78.

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mental, as opposed to the material, makes it probable that they also
had more than an inkling pf the role* of mental factors in the treatment,
if not in the production, of disease. How far this may be so must be
left to special students who will examine the original authorities with
an eye to the possibility that the agencies in which these peoples believed wdre spiritual rather than mental in nature. If we confine our
attention to our own culture, it is only within the last fifty or sixty
years that there has been any clear recognition of the vast importance
of the mental factor in the production and treatment of disease, and
even now this knowledge is far from i being fully recognised either by
the medical profession or the laity.
For the first definite movement in this direction we have, as so
often happens in the history of human culture, to thank external influence, in this case that of India. The first great stimulus to the study
of the mental factor in disease came from the need to understand the
mysterious action of hypnotism. Though this agency had long been
known in Europe as in all other parts of the world and had been
brought prominently to notice at the end of the eighteenth century by
the activity of Mesmer, the knowledge which the Abbe Faria brought
to Europe from India acted as a great stimulus to its scientific study,
in which Braid of Manchester holds a foremost place, while the later
experience of Esdaile in India did much to help the practical utilisation
of hypnotism in this country.
About this time there was setting in the wave of materialism which
was to dominate European thought for many years. Under this influence the new agent was regarded as a form of magnetism or other
physical force. It was only slowly that there came into being the now
generally accepted view that the agency through which hypnotism
produces its effects is suggestion. This is a process comparable with
volition, imagination, or other similar concepts which, wholly devoid of
any implication of the independent action of a spiritual being, had been
reached by the new and slowly developing science of psychology.
The study of hypnotism and allied, processes led students to distinguish
clearly the important influence of suggestion in the production and
treatment pf disease.
The phenomena of hypnotism having led students to the definite
recognition of the mental factor in medicine, it was natural that attention should be directed to the influence of other mental conditions.

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This development followed many directions. The general public, less
under the influence of the prevailing materialism of science than the
medical profession, and more ready to accept any new doctrine which
could be made to harmonise with the old spiritualistic view of disease,
adopted with enthusiasm many new systems of healing*. In most of
these the vast power of religious faith was explicitly recognised. In
some, such as Christian Science and the " New Thought," etc., the
cardinal element of faith was made the starting-point of intellectual
constructions which gave, or seemed to the believers to give, a rational
basis for the success that these new movements so often obtained. At
the same time, within the medical profession, especially among French*
speaking peoples, there came into existence a definite system of psychotherapeutics in which suggestion and other agencies were assigned their
roles, and principles were laid down to indicate the scope of these
agencies and the means of turning them to best advantage. In
Switzerland P. Dubois x laid stress on the helpfulness of explaining
what he called the philosophy of disease, while in France J. Dejerine
and E. Gauckler2 in more scientific fashion, compiled a most valuable
text-book of the principles and methods of psycho-therapy.
Independently, growing out of dissatisfaction with the practical
use of hypnotism, a third line of approach was taken by the Viennese
physician, Sigmund Freud. It had been found by earlier workers that
hypnotism was often the means of reaching experience which had been
so completely forgotten that by no effort of the will could it be recalled.
Working in conjunction with Breuer,3 Freud found the process of
bringing these buried memories to the surface led to the disappearance of
hysterical symptoms of long duration, and the two authors founded
upon this experience a theory of hysteria according to which its symptoms
are the indirect expression of old mental injuries (traujnata), especially
those of early childhood.
Later, Freud found that the buried memories which manifested
1

Les Psychonevroses et leur traitement moral, Paris, 1908 ; translated
by S. E. Jelliffe and W. A. White as " The Psychic Treatment of Nervous
Diseases," New York and London, 1906.
2
Les Manifestations fonctionelles des Psychonevroses, Paris, 1911 ;
translated by S. E: Jelliffe as " The Psychoneuroses and their Treatment by
Psychotherapy," Philadelphia and London, 1913.
3
S. Freud, Selected Papers on Hysteria and other Psychoneuroses
(Nervous and Mental Disease Monograph Series, No. 4), New York, 1912.

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themselves in this morbid manner could be brought to the surface more
securely and with greater therapeutic efficacy, though less expeditiously,
without the aid of hypnotism. By means of his method of free association, starting as a rule from clues provided by dreams, Freud was
led to formulate a theory of the unconscious and an elaborate scheme
of the mechanism by which it is related to and acts upon the conscious.
In the course of this work Freud was led to the conclusion that the
mental experience which had been cut off from the general body of
consciousness was nearly always connected with sex. His work, and
still more that of his disciples, came to deal so exclusively with sexual
factors that the general body both of the medical profession and the
laity refused to give this movement the attention it deserved. They
failed to recognise the immense importance of the mental mechanisms
laid bare by Freud's method of analysis, and the body of evidence
which was thereby provided to. illustrate the influence of the unconscious.
One of the most important aspects of Freud's work was that the
role he assigned to the unconscious enabled him to adopt in the most
complete manner the principle of determinism within the mental sphere
which had been of such value in the progress of physical science. It
is essential to this progress that the student shall believe implicitly, or
at the least, act as if he so believe, that every physical event has its
physical antecedent, without the presence of which it would not itself
have come into existence. The progress of physical science depends
largely on the robustness of the faith in this law of causation which
allows no residue or anomaly, however insignificant it may seem, to be
put on one side as due to chance or accident. The successful worker
in science makes such residue or anomaly the subject of patient investigation until its occurrence has been traced to its antecedents, antecedents which may open new paths to the understanding of experience
which till then had had no adequate explanation.
So long as the attention of students of mind was confined to the
sphere of the definitely conscious, there was no opening for the application of a similar doctrine of determinism within the sphere of the
mental; Recognising that the principle of psychical determinism must
hold good if psychology is to become a science, some students had put
forward hypothetical mental dispositions where no antecedents could
be detected in consciousness, but these were too vague to be of any

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11

assistance in research. It is of no service to postulate a disposition of
which one knows nothing, which stands in no known relation to any
other part of a construction. Other students definitely threw over any
attempt to apply the principle of determinism within the sphere of
mind, and were content to seek for physical causes in the form of
physiological processes or dispositions whenever the study of conscious
process failed to provide an adequate explanation.
The special value of Freud's work is due to the fact that he was
not content merely to put forward unconscious dispositions as the
antecedents of changes in consciousness, but was enabled by the knowledge derived from his analyses to formulate a definite scheme of the
unconscious region of the mind and of its relation tp the conscious.
This scheme is of necessity to a large extent hypothetical, and as with
all hypotheses of such complexity, it will certainly require modification,
but growing experience is pointing more and more surely to the truth
of its main assumptions.
Five years ago, before the outbreak of the war, many were coming
to acknowledge the great importance of mental factors in the production and cure, not only of diseases obviously mental in nature, but also
of many which had been held to be wholly physical. There was,
however, no general agreement concerning the principles which should
underlie a system of psychological medicine. There was even no
geijeral belief in the possibility of principles which could act as the
basis and inspiration of research. From the one system which could
have provided such basis and inspiration the majority of workers were
estranged, partly owing to the undue weight laid upon sex by its ad*
herents, partly owing to the unsatisfactory form in which the new
doctrines had been put before the public.
The effect of their recent experience upon the opinions of the
medical profession has been profound. Perhaps the most striking
feature of the war from the medical point of view has been the enormous scale upon which its conditions have produced functional nervous
disorders, a scale far surpassing any previous war, although the RussoJapanese campaign gave indications of the mental and nervous havoc
which the conditions of modern warfare are able to produce. While
certain of these disorders are the result in part of physical causes, such
as cerebral concussion or illnesses specially affecting the nervous system,
it has gradually become clear, even to the firmest believer in the

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dependence of mind on body, that in the great majority of cases the
conditions upon which the disorder depends are purely mental. All
are coming to see the profound effect of mental shock and strain in
weakening the powers of control by which instinctive processes are
normally held in check, if not completely suppressed. Moreover, it
has become clear that in the vast majority of cases the morbid processes
which have been set up by shock or strain are not connected with the
sexual instinct, But depend on the awakening of suppressed tendencies
connected with the still more fundamental instinct of self-preservation.
While the nature of the war-neuroses is satisfactorily explained by the
Freudian mechanisms of suppression, conversion, defence-reaction,
compromise-formation, etc., they lend no support to the exclusively
sexual origin :of neurosis which had been the chief obstacle to the
general acceptance of Freud's doctrines. It cannot yet be said that
the essential features of these doctrines have met with general acceptance, but the state of the matter is now very different frorh the widespread neglect, or even reprobation, which existed before the war.
The great majority of students of the neuroses are now prepared to
consider Freud's position, to accept such parts of his doctrine as seem
to them supported by the facts, and to suspend judgment concerning
those, parts for the truth of which they do not deem the existing evidence sufficient.
I have dealt at length with the controversial topic of Freud's views
concerning the neuroses because he, more than any other worker, has
emphasised the mental factor in disease, and more thoroughly than
any one else has based his work on a determinism which is as essential to the progress of psychology and psycho-pathology as determinism within the physical sphere is essential to the progress of the
sciences which deal with the material world.
In the foregoing sketch of the history of the relations between
mind and medicine I have considered at some length one of the most
important principles of psychological medicine, viz., the principle of
psychical determinism. This principle is of especial importance in
connection with the art of diagnosis, for only those who believe firmly
that every mental symptom has its mental antecedent will have the
patience and courage to probe deeply enough into the history of a
patient. They will not rest content until they have discovered, not
only the events which acted as the immediate conditions of the disease,

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but also those factors producing the special qualities of the patient's
mental constitution which made it possible for these conditions to produce so great and so disastrous an effect. A firm belief in the principle of psychical determinism is the most important condition of
success in the diagnosis and treatment of functional nervous disorders.
I propose now to consider some other of the more important
principles which underlie success in the treatment of these disorders.
One such principle may be regarded as a consequence of psychical
determinism. It is a general rule of medicine that the physician must
not be content to treat symptoms, but having traced these symptoms
to their source, should by suitable remedies attack this source and treat
the symptoms through the conditions by which they have been produced. This principle holds good for psychological medicine. If it
is believed that the symptoms have been produced by psychical factors,
it will follow that the remedies must also be psychical in nature. I do
not suppose that even the crudest materialist, having once acknowledged
that the symptoms depend upon a fright in childhood, a reproach concerning a misdemeanour in youth, or an anxiety in adult life, would
expect to produce any permanent improvement by the administration
of a drug or the performance of a surgical operation. It must be
pointed out, however, that such measures may be successful in some
cases, not merely through their psychical effect, but because, by removing secondary disturbances, they may break a vicious circle and
thereby give an opening for the action of intrinsic mental forces working towards recovery. The vis medicatrix naturce applies in the
mental as well as in the material sphere.
Another principle which is now meeting with general acceptance
in psychological medicine isr that functional nervous and mental disorders depend essentially on disturbance of the instinctive and emotional
or affective aspects of the mind. It is now widely acknowledged that
in the-attempt to get back to the roots of these disorders it is necessary
to look for experience which had a strong emotional tone. This principle has long been more or less explicitly recognised, and underlies
such general beliefs as are expressed in the adage that it is worry and
not work which kills. But it is only recently that we have learnt to
appreciate the extent of its application and to use it in treatment as a
guide of the first importance. It has long been known that in the more
explicitly mental disorders of insanity, no good is done by reasoning

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with the patient as a means of countering his delusions. It seems even
that such reasoning may only intensify and fix the delusions by driving
the patient to adoptjhe part of an advocate. We now see that this
is a necessary consequence of the emotional basis of the disorder. The
delusions are the product of a process of rationalisation by means of
which the patient has tried to account for his abnormal emotional state.
Treatment directed to these secondary products wholly fails to touch
the deeper and essential factors.
The modern theory of emotion connects it closely with instinct.
There is reason to believe that the emotional factor in neurosis is the
expression of some instinctive tendency which has been suppressed on
account of its incompatibility with social standards. Neurosis occurs
when,- through some shock or strain, the agencies which keep the
tendency in check are weakened, allowing it again to come into conflict with social standards. The form which the neurosis takes depends
on the process by which Nature attempts to solve this conflict.1
I must be content with this brief description of some of the more
important principles upon which rests our modern system of psychotherapy, and pass on to consider some of the main agencies which are
utilised by the practitioners of this branch of medicine. I shall lay
stress especially on the three agencies of self-knowledge, self-reliance,
and suggestion.
The agency of self-knowledge, which, following Dr. W. Brown, I
have elsewhere2 called autognosis, covers a wide field in which two
main sections can be distinguished. Where the morbid state depends
on some experience or tendency which lies within the region of the
unconscious, self-knowledge as a therapeutic agency will consist in
bringing the buried and unconscious experience to the surface. The
unconscious experience has to be brought into relation with the general
body of experience which is readily accessible to consciousness and so
made part of it that it ceases to act as a separate force in conflict with
the general body of conscious experience.
The other main form of the agency of self-knowledge comprises
1

See British Journ. Psych., 1918, vol. ix., p. 236, and Mental
Hygiene, 1918, vol. ii„ p. 513.
2
Art. "Psycho-therapeutics," Hastings', Encyclopedia of Comparative
Religion and Ethics, vol. x., p. 433. This article may be consulted for
information concerning other therapeutic agencies which I do not consider in
this lecture.

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the processes by which a sufferer is brought to understand elements of
conscious experience which are beiiig misinterpreted, and through this
misunderstanding are helping to maintain, even if they did not help to
produce, the morbid state.
Between these two forms lie a large variety of processes in which
there is a mingling of the unconscious and conscious elements brought
into relation with one another, thus doing away with the conflicts upon
which the disorder depends and restoring harmony within the personality.
It may seem that the r61e here assigned to the process of selfknowledge is in contradiction with what has been said earlier concerning the failure of appeal to the intellectual and the necessity of attacking
ing the instinctive and emotional basis of the disorder. The intellectual element, however, though secondary, is present and must not
be neglected. Experience shows that, while the direct attack upon
the intellectual aspect of a neurosis or psychosis will fail, a line of
treatment in which the intelligence of the patient is brought to bear on
the part taken by instinctive and emotional factors in the production of
his illness may be of the utmost value. Indeed, success in treatment
depends largely on the possibility of diverting the intellectual activity
from a channel which is forcing it into an asocial or antisocial direction
and leading it into one which will again enable the patient to live in
harmony with the society to which he belongs.
Where the sufferer from neurosis is intelligent, the mere exposure
of the faulty trend and the demonstration of the process in which this
trend took its origin may be sufficient. The patient only needs to be
started on the right path and his own intelligence will lead him back
to health and happiness. In other cases the faulty trend has been so
long in action that a lengthy process of re-education may be necessary
to put the morbid process in the proper light, and reduce the power
which through habit has been acquired by the secondary products
of the morbid process. In other cases, again, the intelligence of the
patient may not be sufficient to enable him to solve the conflict unaided,
and the process of re-education has to assist the patient to understand
the nature of his disorder and the processes by which he can again
place his steps upon the path of health.
,
The next agency I have to consider is one which may be summed
up under the term self-reliance. There is a pronounced tendency for

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sufferers from neurosis to avoid the unpleasant at all costs. Since all
social duties, even those in which the nearest relatives are involved,
are liable to become irksome or positively distressing, the patient seeks
quiet and solitude, and if left alone these antisocial tendencies may become a habit, converting one who before his illness was a social favourite
into a recluse or misanthrope. Aches and bodily discomforts which
in" health are disregarded, and when so treated soon cease to annoy,
are liable in neurosis to grow in intensity and insistence. They may
so absorb the attention that the sufferer's efforts are exclusively devoted
to the avoidance of all conditions, such as noise and excitement, which
aggravate, or seem to him to aggravate, his troubles. He is apt to
resort to drugs, either at his own or his physician's instance, and since
these are merely palliative and do not touch the roots of his malady,
they only serve to accentuate his pains and worries, even if he escapes
the greater evil of a definite drug-habit. He strives to banish from
his mind all distressing thoughts and memories, including experience so
arresting that, if his efforts were not exclusively turned towards the
avoidance of immediate pain, he would at once recognise the futility
of his attempt.
One of the first steps in the treatment of such cases is to persuade
the patient to forego any adventitious aids, such as drugs or electricity,
upon which hq has come tom rely. Assisted by a process of re-education designed/to show their subjective nature, he must be encouraged
to fighrhis pains and discomforts by his own strength. He must be
convinced of the futility of his attempts to escape from the thoughts
and memories which distress him and shown by trial that when these
painful experiences are faced they are far less terrible than they seem
to be when kept at a distance. He must be encouraged to mix with
his fellows in spite of the immediate discomfort which this produces,
and here again he must learn by experience that the pains of the reality
do not equal those of anticipation.
The policy of facing his troubles instead of running away from
^thern has certain effects of a far-reaching kind which are due to a
special mode of reaction of the mind when in the presence of the painful. By repressing unpleasant thoughts and memories the patient is
assisting a process by which we tend to suppress painful experience
and dissociate it from the general body of consciousness. When thus
suppressed and dissociated, however, such experience does not cease

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17

to exist, but by its activity produces many of the most painful features
of the illness, distressing dreams and nightmares being the symptoms
which form the most direct consequence of the repression and suppression. By facing his troubles in place of striving to banish them,
the dreams or other troubles due to repression may disappear or so
alter their character as not to interfere with comfort and health.1
Owing to the malign power of repressed experience, the policy of
facing the painful may have effects reaching far more widely than might
be expected from the normal experience of health that a trouble faced
loses half its terror.
The third agency I have to consider is suggestion. Though this
term is freely and confidently used in psychological medicine, there is
little agreement concerning its exact meaning, and much is included
among its activities which has little to do with it in nature.2 I use the
term for a process which belongs essentially to the instinctive side of
mind. It is the representative in Man of one aspect of the gregarious
instinct, the instinct which makes it possible for all the members of a
group to act in unison so that they seem to be actuated by a common
purpose. According to this view it is a process which differs essentially in nature from those mental processes which produce uniformity
of behaviour by endowing the members of a grpup with a common
idea or a common sentiment. Its activities lie definitely within the
unconscious sphere so that when the physician employs suggestion
consciously, he is using in an artificial manner an agency which belongs
properly to the region of the unconscious.
The most striking form in which Man has come to use suggestion
consciously and wittingly is hypnotism. All gradations are met in
practice between this definitely conscious use and cases in which the
physician acts upon his patient and moulds him to his will by the unconscious process of suggestion, without recognising the true nature of
the process which is taking place. As a rule the more unwitting the
use of suggestion, the greater is its power and efficacy. On this foundation rests the success of quacks, for they advocate and use their
1

For examples of the beneficial effects of this kind see The Repression
of War Experience, Proc. Roy. Soc. of Med., 1918 (Section of Psychiatry),
vol. xi., p. 1.
2
For its distinction from faith as a therapeutic agency, see Art. "Psychotherapeutics" in Hastings' Encyclopaedia.

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nostrums in blissful ignorance of the process upon which their efficacy
really depends. The physician who knows enough to distinguish between the influence of suggestion and other modes of action a remedy
possesses, may signally fail to attain the success of the quack, because
the instinctive process of suggestion is not being employed in the
manner natural to it.
One of the greatest difficulties of psychological medicine arises out
of the opposition, if it be not definite incompatibility, between suggestion and the group of agencies which rest upon the principle of selfreliance. The action of suggestion can never be excluded in any form
of medical treatment, whether it be explicitly designed to act upon the
mind or whether ostensibly it is purely physical in character. It is
when suggestion is used wittingly, and especially when it is directed
to produce a definite hypnotic or hypnoidal state, that the conflict with
the principle of self-reliance becomes most definite. In these cases the
patient is definitely led to rely on a power, in this case that of the
physician, other than his own. Even when, as in the most recent
developments of hypnotic treatment, suggestions are given in the hypnotic state designed to strengthen the self-reliance and volitional control of the patient, he cannot have the confidence, and especially the
confidence in the future, which is given by a recovery which he can
clearly trace to his own efforts. The whole process differs essentially
from that in which the action of the physician has been limited to
helping the agency of self-knowledge and placing the steps of the
patient on the right path. Even if the hypnotic suggestion should
succeed in strengthening the will and assisting the patient to face his
troubles, his satisfaction and confidence must in some degree be tarnished by the knowledge that this result is due to the action of another
person and not to his own activity.
There is also a certain amouiit of conflict between hypnotic treatment and remedies which rest on the principle of self-knowledge. We
do not yet understand the nature of hypnotism. Even to the physician
this remedy partakes of that mysterious character which belongs to
aspects of nature \yhich have not yet been brought into relation with
the rest of our scientific knowledge. To the patient, this mystic character must be far greater. In a fully satisfactory system of mental
medicine the treatment should follow logically from the pathology.
The remedies shoukl stand in a definite and intelligible relation to the

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causes by which the illness has been produced and the processes by
which these causes have produced their effects. The intrusion of a
mysterious agency interrupts the continuity of blended diagnosis and
treatment. It disturbs the process by which the patient is led towards
recovery by knowledge of the conditions through which he was led
astray.
In spite of these difficulties arising out of conflicts with the main
principles of psycho-therapy, there are certain cases in which the use
of hypnotism is justified. A faulty trend of thought or conduct may
by habit have become so fixed that it requires a process more drastic
than mere persuasion to break it, or the unaided strength of the patient
may be insufficient to enable him to stand up against the pains or
horrors of his malady. In such cases the experience which has produced or helped to produce his illness may by this treatment be buried
still more deeply than before ; no lasting and complete success can be
expected unless the treatment is continued sooner or later in accordance
with the leading principles of self-knowledge and self-reliance. If
however, the patient can be protected from undue stress, hypnotic or
other form of suggestive treatment may enable him to pass through life
without manifest nervous or mental disorder.
Another and perhaps more legitimate mode of using hypnosis is in
the interest of diagnosis. Dissociated or forgotten experience may be
recovered more speedily by means of hypnosis than by the process of
free association, the analysis of dreams, or other means of gaining access
to the unconscious. Such use of hypnotism as an instrument of selfknowledge need interfere very little with the principle of self-reliance,
the hypnotic process merely giving the knowledge from which the
therapeutic process starts and upon which it is based.
Though hypnotic treatment can thus be justified in certain cases, it
is rarely necessary. It is generally used, firstly, as a short cut to immediate results without regard to the future, and secondly, because the
striking and theatrical character of these results greatly impresses a
public accustomed to consider the needs of the moment as more important than a complete and lasting cure.
I must be content with this brief account of a few of the more
important principles of mental therapy and of the agencies which are
available in putting these principles into practice. I shall conclude
this lecture by pointing out that these basic principles of mental

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medicine are also those of all sound systems of education and underlie
success in social life, in health as well as in disease.
In the case of one process, the attainment of self-knowledge as a
means of treatment, the resemblance with a social process of normal
health is so obvious that the physician has come to use a term derived
therefrom. The process by which a faulty trend of feeling, thought,
or conduct is diverted into a more healthy channel is generally known
as re-education. This only differs from the ordinary process of education in the nature of the knowledge and attitude to be acquired. The
agency of self-reliance, which I have made of such fundamental importance in psycho-therapy, is of equally great importance in education,
though this importance is inadequately recognised in modern educational practice. This failure is due to the fact that it is far easier to
pour facts into a pupil than to develop an attitude of mind, just as it
is far easier to pour medicine into a patient than to instil hope, patience,
and self-reliance.
The influence of suggestion in education resembles in many respects that which I have assigned to it in medicine, and is of especial
importance owing to the great suggestibility of children. The importance lies in the power of suggestion in relation to that function of
education by which it develops an attitude of interest in the intellectual,
the beautiful, or the noble. Nothing assists the development of such
an attitude more than the mental atmosphere which the teacher has
produced, just as no factor is of greater importance in therapeutics than
the atmosphere of hope and trust produced, whether in home or
hospital, by a skilful physician. In each case this atmosphere is produced in the main by suggestion, and in education as in medicine this
success is the greater the more unwittingly this agency is used. The
success of a great teacher, or that which so often comes to new movements in education even when based on wrong principles, is due to
the infective enthusiasm and personality of the teacher acting through
an agency quite distinct from the matter he teaches. As in medicine,
the danger to which such a teacher is open is that he may rely too
greatly on this influence and fail to recognise its conflict with the principles of self-knowledge and self-reliance.
The principles which I have here put forward as suited for the
treatment of mental disorders of the individual are equally appropriate
to the treatment of the faulty trends and disorders of society as a whole.

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The statesman whose duty it is to find remedies for such faulty trends
and disorders has, like the physician of the individual, to discover the
deeper conditions by which they have been produced and may do
much to amend the evil by remedies based upon this knowledge, H e
can hardly, however, expect a lasting cure unless he tell the people
what is wrong and where they have gone astray. Without such selfknowledge his work is liable to be upset by later conditions which
would be innocuous if the community had been led to see and understand the nature of their earlier misfortunes.
Moreover, the self-knowledge of the community is like that of the
individual in that the social group is even more subject than the individuals of which it is composed to the influence of conditions lying
deeply beneath the surface. It is generally recognised that the factors
upon which social disorders depend usually go far back in the history
of the people, factors, not only in conflict with later social standards,
but also in many cases with existing social conditions. To understand
the evil and find the right remedy, inquiries are needed which go so
far into the past that they lie altogether outside the memories of the
people and can only be reached by special processes of historical research and sociological reasoning. These factors belong just as much
to the unconscious of the folk-mind as the factors producing a neurosis
or psychosis belong to the unconscious region of the individual mind.
The importance of self-reliance in disorders of the body politic is
as great as that of self-knowledge. A nation which refuses to face the
facts and is content to swallow every placebo and nostrum of its politicians cannot expect to gain thereby the permanent improvement of
any disorders by which it is affected. Even if the remedies of its
rulers be wise, only a temporary effect can be expected if the people
rely too much on this wisdom and fail to make a united effort to remedy
the faults of their society.
It is less easy to compare the role of suggestion in the group with
that it takes in determining the fate of the individual. Suggestion is
essentially a process tending to produce unanimity in the social group,
and its action is even more inevitable when we are dealing with social
than with individual disorders. The physician who knows that suggestion cannot be excluded, but that its influence may be for good or
evil, will be forewarned and forearmed, and this is equally true of the
statesman. Suggestion is responsible for panic or collapse, just as it

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may be responsible for harmony to a more useful end, The wise
statesman who understands the pervasive and yet elusive nature of this
agency, may by such understanding do much to avert its more malign
aspects and turii it to a useful purpose, while a people who understand
may be-prevented from falling victims to the excesses of which this
agency is capable. In the society as with the individual the potency
of suggestion is the greater, the more unwittingly it is in action. And
as in medicine its greatest dangers may be averted through knowledge,
so may much be done to avert danger and make suggestion an instrument for good in social and political life if its nature and mode of
action are understood.
Closely connected both with education and statesmanship is the
subject of ethical training. Here the importance of self-knowledge
and self-reliance is so well recognised that it is not necessary to dwell
upon it at length. It must be enough to point out that the principles
so universally accepted as the means of treating faulty trends in those
aspects of behaviour which, though clearly abnormal, are yet usually
regarded as lying within the bounds of health, have been shown in this
lecture to hold good for the correction of morbid tendencies which lie
definitely within the region of disease. The modern theory of psychological medicine supports the close relation between mental disease
and crime to which all recent developments in sociology and jurisprudence are tending. Moreover, if the principles of psychological
medicine here put forward are accepted, they should remove, or go
far towards removing, the obstacle to the acceptance of this close relation which is presented by the problem of moral responsibility. It
will be seen that the recognition of crime as a manifestation of disease,
far from implying an absence of responsibility, would on the lines laid
down in this lecture lead us logically to treatment which does not
differ greatly from that implying such responsibility. The mode of
treating crime and moral disorder which is suggested by its relationship
to disease differs from the older method in that the erring person would
not be merely exhorted to exert his will, but would be shown how his
faulty trend has been produced and would thus be assisted in the application of his voluntary efforts.
It is a striking fact that the organisation which has by long experience acquired the most highly developed system of treating moral de--ct, the Catholic Church, lays great stress on the apparently minor

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faults which have led up to definitely immoral conduct, and directs the
attention and efforts of the penitent to these quite as much, as to the
conduct which is the immediate occasion for penance. This close resemblance of the traditional practice of the Catholic Church with that
of the most modern systems of psycho-therapy leads me to the place
of religion in psychological medicine. From one point of view the use
of religious motives in treating mental disorder is definitely in conflict
with the principle of self-reliance. For the essence of religion is that
it inculcates reliance upon a power other than that of the sufferer.
Some degree of such conflict there must always be, and in many of
the forms in which religion is adopted as a therapeutic agency, this
conflict is pronounced. But in the most recent developments of religious doctrine, in which it is recognised that the higher power acts
through normal mental process, the conflict becomes of no great account. The modern religious teacher does not tell the sufferer that he
will get rid of his troubles by the mere act of faith, but counsels selfexamination and self-help. To put his advice into simple language,
he says that God only helps those who help themselves, and thus
adopts a line which in essentials is that advocated in this lecture. In
thus treating religion as a therapeutic agency, I recognise that I am
dealing only with one aspect of the matter. I could not, however,
leave the subject wholly on one side. It is necessary that those who
employ religious. agencies in the treatment of disease, whether they be
physicians or priests, should realise that in so doing they are running
in some degree counter to one of the principles of psychological
medicine, for if this fact is recognised they will avoid the evils which
might accompany too crude an application of the religious agency.
Moreover, no treatment of the subject of mind and medicine would be
complete which ignores religion. One of the most striking results of
the modern developments of our knowledge concerning the influence
off mental factors in disease is that they are bringing back medicine in
some measure to that co-operation with religion which existed in the
early stages of human progress.

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