Popular Science Monthly/Volume 15/May 1879/Bodily Conditions as Related to Mental States
WHATEVER that thing, fact, function, or idea which we call mind may be, or whether the brain, as is generally believed, is or is not its sole organ of manifestation, it is universally admitted that varying bodily conditions are accompanied by related variations of mental states. Aphasia, insanity, imbecility, are so often found accompanied by certain definite pathological alterations in the brain-substance that they are generally held to be symptomatic of such local changes. So, also, though in a more general way, melancholia and depression, as well as exaltations and excitements of the mind, are known to depend largely on corresponding general bodily conditions of retarded or accelerated physiological processes.
It is also held, though in a less definite manner, that the health of the body may be affected, beneficially or injuriously, by certain states of the mind, as of hope or despondency. Or, more in detail, medical men have observed that certain mental states affect certain functions in certain definite ways. As, for instance, sudden anxiety, as of the non-arrival of a friend when expected, may cause an increase of the peristaltic action, while prolonged anxiety is apt to cause the contrary effect. Joy over good news or at the return of long-absent friends diminishes gastric secretion and causes loss of appetite. The feeble hold on life of the suicidal, and the surprising recoveries from serious diseases and after apparently fatal injuries, in persons whose mental characteristics are hopefulness and determination, are often-recurring facts, familiar to all.
The nature of what we call mind and its relation to the functions of the body is a very wide field of inquiry — too wide, indeed, for our present consideration. But having had unusually favorable opportunities for observing certain phases of psycho-biological relations, I ask your attention while I present some studies which may help us, possibly, to arrive at more practical results, through more satisfactory explanations of certain phenomena, than we have hitherto possessed. So, without further preface, I will introduce my subject by giving a striking example of the influence of a simple mental impression as distinguished from and as independent of thought, will, or consciousness in controlling the manifestation of function.
In September, 1876, I received a letter from a prominent physician living in a Western city, saying that he, in connection with two other medical men, had been treating, unsuccessfully, a case of ununited fracture of the left thigh-bone; and he inquired if I thought I could do or suggest anything which would lead to its union. The result of some correspondence was that, a few weeks afterward, in October, the patient presented himself with his father at my office.
The case was briefly as follows:
Two years before the young man had met with an accident, and had broken his thigh-bone just above the middle. The family doctor proceeded to set it and apply the proper dressings. In due course of time the fracture united, and the patient got about with some shortening of the limb, and walked with perfect facility for one year, when, in crossing the street, he fell and broke the same bone again about four inches, so they told me, below the seat of the former fracture. Neither of the physicians who had attended him on the previous occasion being in the city, a third medical man, a surgeon of national reputation, was called, who proceeded to apply the proper bandages for fracture. After that the three attended the case conjointly, but no union of the fracture could be obtained, they said, though every usual means had been exhausted to secure it. Such, in brief, was the case as it was presented to me. A careful examination revealed two facts. The first was that there was no ununited fracture, and the second was that the bone had not been broken at the second accident. He was a well-grown, finely formed, intellectual young man of about sixteen, and he came in on a single crutch, with the left or affected limb swinging limp and wholly useless, and when I laid him on his back, and took hold of the leg to examine it, I found it utterly resistless to every motion. The muscles were wasted, soft, and without tonicity, and, there being a large outward bending in the middle of the bone with lapping of more than two inches, it would roll about, when touched, like a crooked stick on the floor, and it was almost impossible to keep it still long enough to make a diagram. The attenuation of the soft parts was so great that the bone was easily examined, and no line of union or the slightest evidence of callus being felt at the seat of the alleged second fracture, and being assured that one of the remarkable things in the case was that there had never been any callus, I concluded that the bone had not been fractured at the last injury. There was no doubt that an unfractured bone had been hastily put in splints, and for a year, and up to that time, three eminent men had been devising and using various splints for securing apposition of a fracture which did not exist. That it did not exist is proved by the fact that three days after his arrival he was walking on that leg.
The explanation of this case is exceedingly simple: he thought he had refractured his femur at the second accident. This impression caused him instinctively and quite unconsciously to withhold muscular action in that limb — that is, he did what he ought to have done if the limb had been fractured. It was the completeness of the control over the muscles, the utter restraint of all muscular action, causing the totally relaxed and powerless condition, which was mistaken for a broken bone. Of course, the trouble was purely mental. But it was not a condition of mind of which he was in the slightest degree conscious. He was not aware of the fact that he was restraining the muscles from acting during this long time; so effectually restraining them that all spontaneity was destroyed by a direct and positive effort of the will. He held his limb in a mental vise of such force and persistency that its nutrition was interfered with, and it was wasted to the last degree. And yet he did not know it. There was no shamming. His condition was a great distress to him. He was also at an age when male persons are the least liable to morbid sentiments. At any rate, I could find none in his case. A mere explanation of his condition was not sufficient to enable him to relax his mental hold on the limb. The mental impression subordinated his will and the ordinary desire. His treatment consisted in providing situations which would assist him to let go of his leg. I caused him to take certain violent exercises with his upper extremities. The intention was to make them so violent that his whole attention would be required for the upper, and there would be none left for the lower extremity. The plan succeeded. Within three days he gave up restraining the limb — let go of it; in fact, spontaneity was restored, and he began to walk; began involuntarily, and without being conscious of it, as he was not conscious of restraining it at and after the second injury.
In this, as in all such cases, accepting by the patient of the opinion that the power exists, is not sufficient to restore the member to use. It is very important to secure the intelligent coöperation of the patient, and instructing him by careful explanations goes far in assisting to arrange the circumstances which tend to restore the normal condition. But simply to know and understand the mental nature of the case is not enough to establish control, because it is not the intelligence principally which is at fault, but there is a modification of what may be called mental timbre, coloring the thoughts and all mental operations, which, in my estimation, is the quality with which we have to deal in this class of phenomena. Dr. Elsberg has used the word timbre to indicate the quality of a compound sound, and I use the word in an analogous manner to indicate a certain quality of the mind as a whole, as distinguished from separate mental attributes. Further illustrations will make this quality of the mind perfectly clear, as well as show that it is through this timbre that the mind makes its potent impressions on the organism.
A young lady was brought to me six years ago for what was supposed to be paralysis of the left lower extremity. She had lost the use of that limb eighteen months before, and, since that time, she had got about entirely on crutches. I immediately recognized the mental character of the affection, and adopted the following plan in order to differentiate between the conscious and the unconscious volitions: After a preliminary examination the day before, I called at her room while she was lying on the bed. Requesting her to remain lying, I engaged her in conversation with the intention of absorbing her entire interest. In this I so far succeeded that when I put my hand below her right foot and began to force it upward, she only remarked that that was the wrong limb, and immediately returned her attention to the story I was telling. When I had pressed it upward enough to bend the knee, I asked her to stretch it down again, which she did, repeating the movement several times without paying any particular attention to what I was doing. After making several pretty vigorous efforts to straighten the limb against some resistance from my hand below the foot, I quietly seized the foot of the affected side, and thus both feet were carried upward together, coming down together also. After several such movements, I began to feel distinct muscular action in the affected member, and, after it had become somewhat vigorous, I quietly let go my hold on the well foot, after which she continued to draw up and push down the affected limb as vigorously as she had just before done with the well one. I was successful in holding her attention to my story, so that she had at most but a dim consciousness, if any at all, of what I was doing. I then recalled her attention to her lower extremities, and requested her to push the left foot down, after I had pushed it up, but she could not make the slightest motion with it.
I say she could not, because, though there was power in the muscles, there was no consciousness of power, and thus there could be no volition.
The plan of securing an unconscious volition is often very useful and sometimes indispensable in determining questions of diagnosis growing^ out of mental influence over function. The following incident occurred within the last few weeks: A young lady nineteen years old was sent to me from Albany for what was supposed to be partial paralysis of the left foot and ankle. She had been affected during the past three years, and was so far disabled that she could not walk more than a block or two without danger of falling, and she actually did fall very frequently.
The exciting cause, or that which called her attention to her foot, was the alleged slipping of the tendon of the peroneus longus muscle where it passes under the outer ankle-bone. She had no theory, fancy, or any other sentiment regarding her lameness whatever. She simply dropped her toes when walking, and was obliged to lift that limb very high to advance the foot and prevent stumbling. When, in examining her, I asked her to raise the foot, she was unable to do so. The muscles moving the ankle-joint were powerless. She was very simple-minded, and would try to do whatever I asked of her. So, making an excuse to get off her shoes and stockings, and keeping her attention while gradually working myself across the room, I suddenly asked her to come toward me, being careful to keep her eyes on me instead of her feet. The floor is of hard wood, and without covering, except a bearskin rug in front of where she sat. The hair tickled* her feet, and she came to me with toes elevated and walking on her heels. I then called her attention to the fact that she had bent her ankles to keep her bare feet from contact with the floor, and asked her to bend them again while looking at them. But she could not do it. I found means, however, to relieve the mental impression which interfered so effectually with the autonomy of locomotion, consciousness of power in the affected foot was restored, and, after having been lame for three years, she went home, within ten days, in a natural state.
But unconscious mental interference with the muscles is to be seen not only in loss of muscular power. Increased muscular action, simulating muscular spasm, may have a mental cause. This may be illustrated by a case. In the spring of 1864 a lady, about thirty-eight years old, unmarried, presented herself with a lame shoulder. Three weeks before, as she raised her right arm to turn the slats of the shutters, she felt a sharp pain in the shoulder. It may have been due to a somewhat energetic contraction of certain muscular fibers, such as most of us occasionally experience without any impression being left on the mind, but which in her case left a lasting effect.
I did not understand the true mental character of the difficulty, and the consequence was, that I got into a great deal of trouble before I got through with the case. But it was all the more instructive on account of my ignorance, as will be seen in its relation; so I give the case more in detail than is necessary in most of these illustrations.
I found her with the right shoulder drawn forcibly upward, firmly fixed in that position, and very sensitive to handling. Supposing that it might be a sprain, and not wishing to treat such cases, 1 recommended her to apply to the late Dr. E. R. Peaslee, which she did. One year from the first visit she reappeared in a very sad plight indeed. I found the shoulder drawn up still higher than before, and so firmly fixed that the elbow could not be removed from the side of the body more than three or four inches. She looked haggard and worn out, and she reported her sufferings as having been and being very intense. The history intervening between the two visits was, that Dr. Peaslee had given her some liniments, and, after a while, seeing that she did not regain the use of her arm, he sent her to a professional "rubber," who had used a great deal of disagreeable, violent, and painful manipulation. Finding herself becoming steadily worse, at the end of a year she had returned to me. I immediately sought Dr. Peaslee, and together we made a new examination. We found the large pectoral muscle shortened and enlarged to twice its natural size, and the arm so firmly bound down that it was with difficulty that she got her clothing on. After several consultations, we resolved to etherize her and endeavor to stretch the shortened muscles. The plan was, to make an apparatus which should hold the muscles we were to stretch, under ether, in an extended position, for a certain length of time, and thus relax them. The operation was accordingly performed, and all the force consistent with safety to the bone was used, but without appreciable effect in relaxing the great pectoral muscle. The operation was therefore abandoned as a failure. We then considered the propriety of dividing the tendon of the great pectoral; but, as that was a novel suggestion, a consultation was called, Dr. A. C. Post, of this city, and the late Dr. Alden March, of Albany, being the surgeons selected.
The lady had come under the influence of ether with difficulty, and was very much prostrated by it; so that it was over one month after the attempted stretching of the muscle before the consultation was held at the lady's house in Brooklyn. The lady was still in bed, but, after explaining the case, she was got up, when, to our utter astonishment, we found the muscles completely relaxed and the arm perfectly free to move in every direction. Exactly three years after these events, this lady's brother called on me one evening, saying that he had just made an appointment with Dr. Peaslee — who was on the eve of starting for Europe — to meet me at his sister's house the next evening for the purpose of operating on her other arm, which had in the mean time, he said, become affected precisely as the right arm had previously been. It had been affected for a year, but his sister had kept the fact to herself, and it had only come out when she could conceal it no longer, the arm having become useless. Supposing that, somehow, the first operation had been the cause of the cure, we repaired to the house as requested, and, after Dr. Peaslee had etherized her, I operated by stretching: the contracted muscles. I found the shoulder in much the same plight as the other had been three years before, though the muscles were not quite so rigid, and I could overcome them without much difficulty. But the shoulder-joint had been held in an immovable position so long that the articulating surfaces had become united by bands of fibrous adhesions in various places, and the snapping of these adhesions, as they were torn asunder when the arm was moved about in different directions, made reports which could be heard at a considerable distance. But the muscles were completely relaxed by the operation, motion was restored to the joint, and we congratulated ourselves on having made no mistake and having had a successful case this time. Thus she was left — Peaslee going to Europe, and I about my business. Just one month afterward I was requested to visit the lady. I found that she had been prostrated by the anæsthetic as before, but that her arm and shoulder were in exactly the same situation as before the operation. Not the slightest benefit had been experienced from it. The shoulder was drawn up and immovable, the arm was held firmly to the side, and that extremity was entirely helpless and useless.
It was evident that the mystery of the case had not been fathomed, and I requested her to come to my house so that I might study it. To this suggestion she readily assented, and for the next few weeks I was vainly striving to find remedies for a state of things which I could not comprehend, and to locate a disease which had no existence. At the end of a month, and after calling a well-known surgeon to my assistance without avail, I resolved to try another operation by force brisée. Laughing-gas was being used in minor operations at that time, and, as ether made her so very sick, I resolved to use the nitrous oxide. This was administered twice with an interval of four days, when the muscles relaxed, motion was restored to the shoulder-joint, and there has been no recurrence of the condition described during the intervening thirteen years. A case precisely similar to the foregoing was brought to me two years later.
Still under the impression that the force used in the former case had, in some mysterious manner, been the means of cure, and concluding that nitrous oxide was the most favorable anæsthetic, I set to work to cure this case according to such views. After seven entirely successful operations there was not the least improvement in my patient, and I concluded that I had again mistaken the case. I kept her under observation several months, attempting various means, experimentally, which were of no avail, when, on a careful review of this and many other similar cases, I at last came to the conclusion that the whole difficulty was mental and only mental. Having settled the question of diagnosis, I sought an interview with this lady and explained my views to her. In plain language I told her that she was holding the arm down by direct though unconscious volition, and that all she had to do was to let go her mental hold on the muscles controlling the movements of the affected shoulder. At first she was a little startled, but I told her to think of it overnight and tell me in the morning if, with the aid of my explanations and the facts of her own and other cases which I related to her, she would not arrive at the same conclusion. She returned the next day, saying that she was convinced that I was right; that she was sure that, through dread of the pain which she anticipated, if she allowed the shoulder-joint to move, she was holding it by main force. She knew and believed all this, but still she had not the power to relax her mental hold on the muscles of the shoulder. To assist her in this I adopted the following plan: I caused her to recline in an easy position, while I stood behind her and took both her hands, the arms bending at the elbows. I made not the least traction on the hands, but simply held them for the purpose of directing and controlling her attention. My requirement was to raise both arms into the upright position, that is, to extend the arms over the head, but not to raise the right, which was free, any faster than she did the left, which she was holding down in close contact with the body. The object was to cause her to give her attention to and absorb her thoughts and interest in the right and unaffected arm, so as to enable her to relax her hold on the left and affected shoulder. The expedient was successful. She did let go her arm, and within a week she had entirely relaxed the muscles about the left shoulder, and regained complete use and control of the previously rigid joint.
I have seen every joint in the body relaxed or stiffened by mental influence, often disastrously so when no aid came to them — sometimes relaxed and stiffened by turns; but I introduce illustrations from cases where these peculiar manifestations have happened at the shoulder, first because they are typical cases, and secondly because I fancy they might be more likely to escape the possible suggestion that, after all, there might have been some organic lesion involved in the cases. We certainly do have the same mental influences complicating organic diseases of the joints. But my object, at this time, is to exclude such cases as can justly be subject to such an imputation. Of course, after once understanding the true condition of things, it is easy to see that the only influence of the respective operations of force brisée, in these cases, was on the patient's mind. In the first case, while she was lying weak and prostrate from the effects of the anæsthetic, she forgot her shoulder and simply let go of it. That was all. In the next operation, three years afterward, on the other shoulder, there was less novelty calculated to engage and keep her attention, and the rupturing of the adhesions which had sprung up in consequence of prolonged loss of motion was sufficient to maintain her interest in the joint, so that her attention failed to be diverted. But the circumstances attending the operations with the laughing gas were again calculated to absorb the attention in other directions and thus divert it from the shoulder. The result was the immediate relaxation of the muscles involved in maintaining the shoulder in a fixed position. In the absence of any local disease which could cause local irritation and reflex muscular contraction, this must have been kept up by direct volition. An important evidence of its voluntary character, besides that which is afforded by the prompt relaxation through opposite mental influence, was the immediate and very great improvement in the patient's general health. She was, in fact, completely exhausted by a labor which she was not conscious of doing, but when she ceased this continuous effort she at once improved in strength. The same improvement in the general health, but in an even more marked degree, was manifested in the second case above related.
Adult life is not alone liable to the class of mental influences which we are now discussing. Young persons and even quite small children are frequent subjects for psycho-biological study.
But mental influence over bodily function is exhibited not alone in connection with the muscles in determining their relaxation or rigidity, in certain cases; but what are called bodily sensations are even more dominated by the mental timbre of the individual. We have local and general hyperæsthesias and anæthesias both as transient and as permanent conditions from this cause. I feel obliged to employ phrases as they are employed in common use, but, strictly speaking, there are no bodily sensations, for all sensation is mental — there is and can be no other. The most that we can strictly say is that we feel in the mind, but refer the cause of such feeling to certain locations in the body. Stick a pin in my flesh, and whether I feel it or not, and how much I may feel it, will depend wholly on the state of my mind. If obscured by an anæsthetic or if asleep, provided the impinging on the nerves is not sufficient to waken me, or even if my attention be very much absorbed, I shall not be conscious of the pricking. On the other hand, if I have been pricked before so that my fears are aroused, or if I am worried or weary or ill, then the pain is many hundred times greater than under the opposite circumstances. We go to a dentist one day when we are in a hurry, and with the mind troubled about some matter. The drilling of his little instrument is agony. We leave and return the next day with plenty of time, and our business settled. The dentist drills still deeper into the same cavity while we sit in comparative comfort.
But not only the same person has different degrees of sensation at different times, according to his mental timbre at the time, but different individuals and different classes of persons feel both pleasures and pains more or less according to their individual or class elevation in the intellectual scale. If a knife were thrust into the flesh, in corresponding locations and to the same depth, in twenty people, no two would feel the incision to the same degree, and the difference in sensations would be simply the difference of mental constitutions, that is, it would be wholly mental. So of classes. The child of the widow, Bridget Murphy, who lives in a back alley and goes out to work by the day, leaving her children at home with nothing to stimulate the mind, does not feel the same amount of pain from the pressure of an instrument which is applied for disease of the hip-joint, which he has got in falling down stairs, as the child reared among the excitements of a cultivated home, with pictures and toys, the circus and menagerie, dogs and horses, and the society of cultivated adults to stimulate mental activity. While the widow's son can hardly talk at five years old, the other, by aid of French and German nurses, speaks three languages at the same age. But when he falls on the ice and gets hip-disease, his sufferings correspond to his mental rather than to his bodily condition, and his pains, like his pleasures, are as much greater than those of the first-mentioned child as his mind is more active and thus more susceptible. To continue the illustration, the instrument worn by the child intellectually low down may, by the mother's ignorance and neglect, become buried in the flesh, with slight murmur, compared to the distress caused by a crumb of bread or a wrinkle in the linen under the points of pressure in the mentally active child. Mental susceptibility corresponds closely with mental activity, so that so-called bodily sensibility must correspond closely again with mental activity. And we find this to be the case. What is said to be Indian fortitude, when they tear their flesh in some of their rites, is simply brutishness. They do not feel in the same degree that we should under the same circumstances. And, on the other hand, the cultured and aesthetic should comprehend, more than they do, that an increased capacity for painful sensations is the direct result and the constant accompaniment of the refinements of civilization, and that to suffer is inevitable along with the pleasurable emotions, which constitute at once the compensation and the charm of the higher civilized existence.
An illustration or two of the mental production of hyperæsthesia — and it is the same with anæsthesia — will suffice for this part of our subject.
It should be remembered that each case represents a class of cases, and is not simply an isolated and phenomenal instance of a curious manifestation. Many cases of lameness of the ankle-joint are produced by, or, strictly speaking, exist only in, the mind, as, for instance, the following among many others:
An unmarried lady of thirty called on me for advice with reference to a foot and ankle which she had not been able to use during the three and a half years preceding. There was a history of some slight injury, with periods of improvement during the first six months of her lameness, but with a final loss of ability to use it on account of its exceeding painfulness at every attempt to bear her weight upon it, and she had been for that length of time on crutches. The foot and ankle were very thin, cold, and clammy, and even very gentle manipulation caused considerable pain. I could not make out, from all the history which I could gather from the lady herself, with the help of her sister, who accompanied her, that the so-called injury had been at all serious, and I concluded that what had been supposed a serious injury to the ankle had simply been a circumstance which had established a condition of apprehension in regard to that locality.
A careful examination satisfied me that the lameness was in the mind, referring to the foot and ankle, but without any sufficient injury of the parts referred to to cause lameness. It was therefore the mind rather than the foot and ankle which ought to be treated, and it was the mind which I did treat, with success. There was no excessive fear here, as there is in many cases, but simply pain on using the foot. Of course there was the misapprehension with regard to the nature of the case, and correcting this misapprehension was one important element in treatment. But such correction only put her en rapport with her treatment, but did not alter the fact that it did hurt to bear weight on the foot. In such cases it is important to give some time for the emotions to adjust themselves to what the intelligence accepts on the subject. In the mean time something was given her to do, some uses of the foot which would fall far short of attaining the point of pressure or motion which her experience had shown would or might be painful; that is, she was required to never approach the point where she had been accustomed to expect to be hurt. Thus the element of expectancy was gradually lessened, and finally eliminated entirely, so that in a few weeks she could walk as well as ever. This was twelve years ago. She has never had a relapse, and is perfectly well to-day. This is one of the classes of cases out of which the so-called "bone-setters" make so much capital.
The foot, ankle, knee, and hip joints are all frequently referred to when there is no organic affection at the point indicated by the mental impression, and I might go on almost indefinitely relating instances, if time permitted. But it may be sufficient to indicate the frequency of disturbed psycho-biological relations to say that I estimate that not less than one half of all cases applying to me for relief from joint affections belong to the class under discussion.
Before leaving this aspect of the subject I think I ought to mention the case of a little girl living in Williamsburgh, who, when she was about three years old, saw a very lame child in the street one day, a patient of mine, and when she returned home her family were surprised to find her lame. The patient the child saw was affected by paralysis, but, curiously enough, the child's lameness simulated disease of the hip-joint. Paralysis could not be well imitated. I was consulted some two years after the first appearance of the lameness, and her attending physician, the late Dr. Brady, of Williamsburgh, gave me the history of her case and the treatment which he had pursued. I had pronounced the lameness mental before I knew of the circumstance which this physician related to me. A surgeon celebrated as a joint-doctor was consulted soon after the lameness was discovered, who pronounced it a case of hip-joint disease. She was treated by confinement and extension, the weight and pulley being used for the latter purpose. The limb, which had been drawn up very much, quickly came down to its natural position, and, after three months of this treatment, finding everything right, no pain on motion, the limb straight out, etc., the case was considered cured, and the doctor asked some of his friends, brother physicians, to see her put on to her feet and attest the remarkable cure. So, after they were assembled, the bandages were taken off and she was put on the floor and told to walk across the room. "You can imagine my surprise and disgust," said he, in telling me the story, "to see her go across the room with the leg drawn up precisely as it was before, and without any change whatever in the amount of deformity or her manner of walking." This child has been brought to me from time to time during the past twelve years, but I have always refused to accept the case as one of disease of the hip-joint. Just one year ago I examined her for the last time. She was then fourteen years old, and anxious to get her leg down. It had been drawn up since she was three years of age. The hip-joint was in perfect condition, and the only reason why she couldn't walk as other persons do was the shortening of the flexor muscles due to the persistent, drawn-up position. The growth had been retarded somewhat, because it had been used less forcibly. But no injury had been done to the hip-joint.
This child was so young when the affection first appeared that it was never made out what were the particular sensations which influenced the volition in the way they did.
It is necessarily more easy to get demonstrations and illustrations of the various influences of the mind over the sensations and the voluntary muscular actions than of the involuntary processes of life. But it must not be supposed that sensation and motion are alone influenced or dominated, as the case may be, by mental states, for it is possible that involuntary processes are even more under the same influence. To a certain and very positive extent they certainly are. To merely mention the phenomena of blushing, pallor, palpitation, shivering, sea-sickness, etc., suggests effects on the involuntary functions which are so common as to be almost overlooked in enumerations of kindred examples. But that the influence of certain sentiments on certain involuntary functions is very potent and positive is well illustrated in the following case:
A lady friend of mine had for some years been speaking to me, as I met her socially from time to time, with regard to the condition of one of her daughters. Otherwise a healthy young lady of about twenty-four years of age, she had had, all her adult life, the one trouble of inveterate constipation. The most powerful medicines in exceptionally large doses failed to produce more than the most meager effects, until at last her condition became alarming. At this juncture they put her under my direct professional care. But nothing that I could do seemed to have the slightest effect on her in ameliorating her condition. As she lived in my family, I had every opportunity to observe her, and after a while my attention was attracted to the fact that, in making my inquiries as to how she felt, she never seemed to know anything about it. In fact, she would deny having any sensations of any kind whatever. I would sometimes see her, while in the family circle, put her hand to her back or to some other part of her body, acting as if she had a sharp pain there. But, even when I made immediate inquiries, she would invariably deny that she had felt any pain whatever. At length circumstances supervened which made me positive that conditions existed which, in any ordinary person, would cause the sensation of pain. But she denied any such sensation. At last, after three months of fruitless effort to relieve her, I made up my mind that this was a case the reverse of the more common result of civilized existence. Her mind, instead of being too firmly centered on some organ or function, was too much withdrawn from the ordinary phenomena connected with existence. In a word, she was suffering from not perceiving, and thus not knowing and heeding, the natural monitions. Having come to a correct diagnosis of the case, I explained very carefully all the facts, and gave her minute directions calculated to assist her in fixing and keeping her attention upon her bodily functions till they should respond to the mental stimulus thus restored to them. The result was that, within two days, by the mere change of sentiment regarding a certain function, that function, which during not less than fifteen years had been wellnigh suspended, was immediately stimulated to full activity. I impressed her mind with the belief that certain results would happen by following the directions which I gave her for the purpose. This was eleven years ago, and this lady told me only a few months ago that she has remained in perfect health, so far as the function in question is concerned, during the whole time.
Heretofore I have adduced such cases only as were clearly uncomplicated with organic disease, and generally where there had been some exciting cause to determine the special location of the mental interference.
When I say "exciting cause," I mean, of course, some circumstance or event which is calculated to fix the attention and make a mental impression. But, in the majority of instances, no such "exciting cause" is traceable. It generally simply happens that the subject finds himself with certain abridgments or apparent exaltations of the led directly to the result as seen, but which have made no impression on the patient's memory. Still, it seems probable also that there may be mental influences excessively manifested over particular organs and functions, which are determined by purely subjective causes and without the intervention of external circumstance. Be that as it may, it seems to be necessary that there should be a certain preparation — a sort of condition precedent — in the mind which makes it liable to abnormal manifestations. Mental influence over bodily function is in itself a constant and therefore a normal condition of existence. But one of the products of civilization is to exalt the mental into a too preponderating influence. In that exaltation the mind easily becomes hyper-susceptible. It takes on, with abnormal facility, a timbre of which it is not itself conscious, but which tends to modify biological relations in the way, among others, which I have to a certain extent illustrated in the preceding pages.function, without being able to trace the event which determined the character and location of the mental influence. It is highly probable that in most cases there have been circumstances which have
Now, there are various circumstances which favor modifications of psycho-biological relations, but which do not themselves directly cause them. Among those most frequently coming under professional recognition, hysteria may be instanced as a potent influence; but, in the light of the facts in my experience, it is incorrect to speak of the hysterical foot or the hysterical stomach or knee. We have the phenomena exhibited in both sexes, in children of tender years and in men and women in advanced life. Hysteria, or, more properly, imperfect sexual hygiene in both male and female, by perturbing the system, does produce a condition favoring modifications of the mental states; but the phenomena under consideration are not themselves hysterical. Any thing or any influence — and they are many — which can increase the mental tension and impressionability beyond a certain normal standard, will produce a modification of the timbre such as we see exemplified in so many instances. Besides the peculiar cases given as illustrations, there is a large class of what are called "simulated diseases," persons with local sensations or pains which do not arise from or represent corresponding local diseases. These can not have even a passing allusion here. Time also prevents me from entering into a discussion of the important subject of mental influence on actual disease, even if that aspect of my subject did not more properly belong to the medical department of biology. Suffice it here to say that, as must be inferred from the facts and arguments already adduced, no system of therapeutics can be complete which does not embrace the design of controlling psycho-biological relations in general, and with reference to chronic disease especially.
From the foregoing presentation, several important and practical deductions may be drawn:
1. Mental culture, while it brings more physical pleasure, brings also increased bodily susceptibility.
2. Pain, at least that which we are now considering, is but an increased degree of sensation, which, in ordinary measure, is either not noticed or pleasurable.
3. Sensations called pains should not be mistaken for, confounded with, or be considered the measure of disease, even when accompanied by it.
4. All sensations, including unpleasant sensations or pains, represent mental qualities only, and these always correspond, no matter what the exciting cause, with the capacity of the mind to be impressed; that is, with its rapidity and force of action.
Lastly, the individual is generally incapable of correctly estimating the subjective value of his own sensations, whatever character they may assume.
Intimately connected with, and in fact growing out of, the subject of the influence of mental timbre over the functions of the body, are many interesting questions of mental ethics which, it seems to me, ought to be studied from a somewhat different point of view than that from which they are commonly regarded.
As we have seen that bodily functions may be profoundly modified under unconscious mental influence, so it will be found, when carefully analyzed, that the product of the mental operations themselves may be likewise modified, under peculiar subjective influences, without arousing the consciousness. In a word, the mind may be in a condition of what we may, illustratively, call mental allotropism, during which the laws ordinarily controlling mental operations seem to be reversed, with corresponding products of intellection.
A case in point is now attracting altogether more attention than it deserves, or would receive, if properly understood. It is stated in the newspapers that there is a young lady living in our neighboring city of Brooklyn who, among other surprising things which she does or omits to do, has not eaten any food or taken any nourishment during the past nine years. It is claimed, on the one hand, that this lady is a perfectly truthful person, with a highly endowed moral sense, intelligent, kind, benevolent, and shrinking from notoriety, and that her statements ought to be taken as conclusive in regard to the facts. The absence of any motive for propagating an unprofitable, ridiculous falsehood is held as confirmatory of her allegations. On the other hand, it is as stoutly maintained that she is an arrant impostor, whose sole purpose is to acquire a transient notoriety; and the non-acceptance of various tests, proposed to substantiate or disprove her statements, is adduced as evidence of the fraud attempted. Now I think we shall see that, in the light of inferences from what has preceded, neither party to this controversy is wholly right or altogether wrong. While it can not for a moment be admitted that a person can live nine years, or any number of years, without food, yet it would be contrary to related facts, and illogical, to assume that she intends to deceive. It is quite within the possibilities that this lady believes that she does not eat. And yet she must necessarily take food. There can be no doubt of that. Let us draw a few parallels, and see how easily such cases are explained by very ordinary and accepted facts. Every physician has had cases of persons who asserted that they did not sleep at all for long seasons at a time, while the fact was that such persons did actually sleep a good deal, as proved by being seen asleep, and by the fact that they did not suffer in health, as they must have done if sleep had been entirely absent. But these persons, while asserting that which was not true concerning an important matter, did not intend to falsify. They simply stated what they believed to be true. Their mental condition was such that they did not feel the impression which sleep ordinarily makes on the consciousness. They slept, but, having no impression of sleep, they asserted that they did not sleep. They could not, with the only evidence which they possessed, the absence of any mental impression of having slept, assert otherwise. There are other persons who, under certain states of mind, say that they eat almost nothing at all — "not enough to keep a bird alive" — while, as a matter of fact, they do eat very well, sometimes even heartily. We see them eat enough to maintain them well nourished, and yet they assert that they do not eat enough for the bodily requirements. Again, the difficulty lies, not in the fact of eating, nor in any desire to falsify, but in the fact that, in their peculiar mental condition, their eating, though seen by others and by themselves, makes no impression on their minds. They state, not what is true, but what they feel to be true. To recur to the more typical class:
A lady, who was at once the daughter of one physician and the sister of another, lost the use of one limb soon after a slight attack of sore-throat. She got about on crutches for nearly a year, and when summer came she went into the country, where she grew stout and was in perfect bodily health, joyfully anticipating a speedy return to her home in the city with restored powers. But suddenly the other limb gave out, and she was brought helpless back. After I had examined her I knew that she had all the power in her limbs which she had ever had, but that did not make me think that she was intending to deceive me when she asserted that she had no power to stand. Her statement was contrary to the fact, but she had to express that which she felt to be the fact. The parallel goes even further than this.
This person did use her limbs more or less in certain ways, and under certain circumstances. But that fact made no impression on her consciousness, as against the stronger impression of entire want of power in her limbs. And so it is in all of the cases of perverted and abnormal mental timbre, when this condition has passed a certain boundary. The words spoken and the things done are dominated by the paramount influence on, and take their quality and coloring from, the predominating mental state of the subjects of it.
Nevertheless, while the mental timbre is an independent condition, it does not prevent the introduction of moral qualities also. A person may lose the use of a member, for instance, through loss of consciousness of power in that member, and at the same time she may have so much pleasure in the sympathy which the disability excites in those around her as to prefer to be lame or bedridden. Confinement, from any cause, is more apt to be demoralizing than elevating, at the best, and it is not strange that a certain number of bedridden cases should, more through the ignorance and want of tact of those around them than original desire to deceive, form the habit of, first, making the most of their infirmities to increase sympathy, and, finally, come to exaggerate and to falsify; thus they pave the way to becoming the instruments of their own and others' craving to be considered phenomenal. And it may well be, and circumstances seem to establish, that the Brooklyn case alluded to has arrived at that point now. I only insist that it is not logically necessary, in similar cases, to assume intentional deception from the beginning, nor, in many cases, at any time can this be rightfully asserted.
It will be observed that I have not used the word "imagination" in connection with the phenomena under consideration. I have not used that term, because it does not apply to the facts. Imagination is an attribute of the mind, an important but wholly distinct mental faculty. But it is not the whole mind, neither does it represent a special condition of the mind. The imagination is often given full play in many of these cases, and undoubtedly assists in producing that mental state which ultimately ends in mental allotropism. But, however conspicuous the imagination may be in such a case, its only importance consists in being one of the many factors tending to produce a certain definite result, which, when reached, is not imagination nor the direct product of the imagination. I speak of this because I think a great deal of harm has been done by the use of this word. It is employed, generally, as if the use of it carried some explanation, and it is understood by the subjects as casting some imputation. Besides, abnormal mental timbre, productive of positive effects on the organism, is quite as apt to be manifested in certain wholly unimaginative persons as in the imaginative. The most marked cases which have come under my observation have been those of persons whose characteristics have been strong common sense and self-forgetfulness.
- Read before the New York Academy of Sciences, Section of Biology, January 27, 1879.