Moral Suasion is historically the oldest method, and was advanced to a high level of excellence by the Stoic Philosophers. Illness, whether mental or physical, involves, to an extent de- pending upon the circumstances of the case and the character of the patient, pain and discomfort, disability with the fear of its consequences upon economic and social position and the fear of death. It is principally in the relief of discomfort and pain that persuasion has its success. Many patients are seriously alarmed at any abnormal feeling in any of their organs, are apt to call such feelings painful and to colour their descriptions with such adjectives as " awful " and " terrible." Others will ascribe symptoms of a commonplace character to serious disease of some important organ, for example, when flatulence is mistaken for heart disease or turbid urine or pain in the back is regarded as indicative of kidney disease. Merely to induce such patients to be more precise in language and then in simple terms to offer some proximate explanation of their symptoms will often, without the association of any remedial agent, place their ideas in better proportion and mitigate or abolish their pains. Therapeutics have, very naturally, up till quite recent times been dominated by the endeavour to treat the symptom of which the patient complains rather than to attack the disease which is producing the symptom. For the most part treatment has been either by frankly miraculous methods or by those which have been in part empirical and in part miraculous, that is, by those in which some wonderful and unknown factor has seemed to cooperate with the supposed remedy. It has more recently become increasingly apparent that remedial agents not uncommonly owe their seeming success firstly to the fact that most disorders pass away whether treated or not, and secondly to the fact that the mental attitude of the patient can in itself assist at his cure and that this attitude may in many persons be modified for good or ill by the physician or other attendants of the sick man. Galen long since pointed out that " when the imagination of a sick man has been struck by the idea of a remedy, which of itself is without efficacy, it becomes endowed with beneficent power." The method of persuasion seeks to use this recuperative power which lies in the patient's mental field and to set it to work either without or with the assistance of physical agents. It seeks by reasonable explanation to impress upon the patient that his symptoms are transient and that his malady is curable, that it is important for him to aid in his own cure by taking a balanced view of the ills which afflict him and to face them with hope and courage. There is not, as in treatment by suggestion, an endeavour to impose an authoritative assertion to be blindly accepted as a matter of faith, but an endeavour to secure the penetration of an idea by the power of reason, to discuss the situation with the patient and to obtain his accept- ance of the case as put forward by the physician. The fear of the disabling effect of illness may also be dealt with by the physician, who may point out, where he is so justified, that on recovery the disability will pass away or that if any be left it will be of an entirely trifling character. In serious disable- ment and in cases of which the end is likely to be death, it be- comes the duty of the philosopher and the priest to fortify the courage and resignation of the patient. Not infrequently, how- ever, the physician, willing or not, has himself to assume their functions and to adapt his exhortations to the needs of men of various creeds and levels of culture.
That persuasion on these lines is of value as a therapeutic agent there can be but little doubt, but its chief disadvantage lies in its limited scope, in that its appeal is to highly developed and organized faculties, just those faculties with which the neuropathic are not for the most part particularly gifted and which are the first to be weakened in disease. In practice, per- suasion is apt to degenerate into partial explanations author- itatively enunciated, in which the physician has to make the best he can of the ignorance of the patient and of his own necessarily meagre scientific acquisitions, and in which pure ratiocination plays a small part. In short, persuasion merges into suggestion.
Suggestion, as a formal method of therapeutics, is but of recent origin (see 26.48). In large measure it has been, from the
earliest times, ancillary to miraculous, magical and professional modes of healing. Under other names it has often been the only curative agent and has been used uncombined with physical agents or ritual performances, but for the most part it has been practised in combination with these. Professional or scientific medicine, though seeing no way of escape, has often sought and still seeks to have as little to do as possible with so indeterminate and varying a mode of cure. It struggles after more exact and precise results, in the fond hope that at some distant date each disorder, psychic or somatic, shall either be prevented from occurring at all or if it occurs shall be met forthwith by some one rapidly acting and efficacious medicament.
The first great impetus to the use of suggestion as a formal method of therapeutics came from Mesmer during the latter part of the eighteenth century, and for well nigh a century suggestion, employed as such, was associated with hypnotism (see 14.201). The artificial induction, but not by drugs, of a state in some ways resembling sleep was first called by this name rather before the middle of the nineteenth century, and it was found that the hypnotized person was, in a great majority of cases, in a condition in which suggestions made to him were acted upon with astonishing accuracy either at once or at some subsequent time as determined by the hypnotizer, in short that his suggestibility or capacity for receiving and acting upon suggestion had been much increased. The word "suggestion" used in association with mental therapy has lost some of its preci- sion. Few are agreed as to its meaning: no one can do more than speculate as to the mode of action implied by it. It is common to hear detractors of some cure, whether it be miraculous, or of the character of those relied on by Christian Science, or emanat- ing directly from orthodox medicine, explain it as being " merely " due to suggestion. What is really meant by such an explanation is not always apparent, and it is desirable to restrict the meaning of the term " suggestion " as applied to therapeutics to the process in which it is sought authoritatively to instil an idea into the patient's mind with a view to the relief of some morbid process. From the catalogues of cases set forth by some practitioners it would appear that almost any affection is capable of ameliora- tion or cure by suggestion. A more modest and a more generally held estimate would limit the cases amenable to this treatment to those of functional disorder and of organic disease in which super-added functional symptoms are a prominent feature. The difference between persuasion and suggestion, as indicated above, is that in the former an appeal is made, at least in theory, to the highest levels of the patient's mind, whereas in sug- gestion (and particularly is this the case when it is combined with hypnosis) directions are delivered to levels of which the patient is only partially conscious, or which he is not aware of as being concerned in the production of his symptoms, or which he does not hold to be capable of activation in their amelioration, or of which, indeed, he is wholly unconscious. In the endeavour to make use of such levels it is plain that it may be necessary to endeavour to inhibit the operations of those that are higher, since these are occupied largely and sometimes almost wholly by the miseries of the patient.
Suggestion suffers from the essential vice of the older therapy in that it is directed rather to the treatment of the symptom than to the disorder of which the symptom is but part. Move- ment may, for example, be restored to a paralysed limb, but the mental processes of which the movement is the outcome may nevertheless remain unhealthy. A coordinated purposive action is not wholly explained in terms of the movement c; a limb, but involves preliminary sensual, perceptual, rational and volitional activities, one or several or all of which may be affected. Criti- cism has largely been directed against the method of suggestion in that it would seem to convert the patient into an automatic machine which responds to activation without knowing what it does or why it does it : there is obedience without reflection or judgment. Whether this be always so or not, the physician in any case is in ignorance as to which part of the whole psycho- logical system he is operating upon; indeed he is ignorant as to which part of it is in a morbid state. Hysteria is held by many
