Popular Science Monthly/Volume 82/January 1913/Canst Thou Not Minister to a Mind Diseased?

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WITH respect to this most pathetic question of the sick-room, the good Doctor in "Macbeth" seems to have exhausted the medical possibilities of his time, in his answer, "Therein the patient must minister to himself." Moreover, had he tried, though never so devotedly, to remove from Lady Macbeth's mind the "thick-coming fancies that kept her from her rest," he would have almost ignominiously failed, not only to "cure her of that," but equally to

Pluck from memory a rooted sorrow,

Raze out the written troubles of the brain,
And with some sweet oblivious antidote
Cleanse the stuff'd bosom of that perilous stuff

Which weighs upon the heart;

and all this, in spite of the dangerous gravity of the case, and his royal employer's urgent need.

Indeed, not only then but always, even until now, has the skill requisite "to purge to sound and pristine health" the mind thus seriously troubled been so generally wanting, that it does not now seem amiss to point out once more some of the difficulties which lie in the way, and likewise to indicate wherein, to some extent at least, surer and more permanent means of success than those heretofore used may be looked for, if not just now, then in the near future.

In this worthy undertaking, even Macbeth himself, by his remarkable diagnosis, may help us to make a more promising beginning than his contemporary physician could possibly make, at that time, and without necessarily becoming involved in so many of the mistakes which otherwise might seriously obstruct vision and paralyze action as well. To the king, stunned, remorseful, apprehensive as he was, the case presented, notwithstanding, certain very definite characteristics, which, in his rather picturesque classification, may be noted as "thick-coming fancies," "rooted sorrow," "written troubles," and the "stuff'd bosom" that "weighs upon the heart." Looked at in the light of modern knowledge, this list of insistent ideation, deep grief, visual hallucinations, morbid apprehensions and fears, guilty conscience and depressed emotions, are seen to make up still a very large percentage indeed of the sufferings of those who are looked upon as having either potentially or actually a "mind diseased," and who have imperative need to be cured, if possible.

Yet, frequent as this kind of disease is, great as is the suffering, so often prolonged indefinitely, and so often full of hindrance and atrophy and danger, it yet remains a matter of very common observation, that anything like a full understanding and appreciation of its real significance, or a desirable possession of efficient skill in its management and relief, is almost as unusual now as it was when Lady Macbeth's "amazed" physician so fumbled in his answer to Macbeth's demand, "Well, well, well. . . . This disease is beyond my practise. . . . More needs she the divine than the physician," but consoled himself so complacently by adding, with by no means unfamiliar unction, "God, God forgive us all!" and thus justified Macbeth's, "Throw physic to the dogs; I'll none of it," with an unsuspected completeness!

Nevertheless, no matter how incompetent Macbeth's physician felt himself seriously to be, one now feels, especially in the presence of actual cases, that the acknowledged darkness respecting the more common conceptions of a "mind diseased," or more definitely, "mental pain," and all its invaliding consequences should not continue indefinitely to prevail; and also, with equal warmth, that with more accurate knowledge there ought to come a better and still better practical skill in dealing with it, both by way of cure and prevention. Much promise of this there certainly now is, especially in the rapidly accumulating reports of those who have recently devoted themselves to careful investigations of the varied substrata of consciousness, through certain ingenious yet well-considered processes known as "psycho-analysis"; through careful study of the effects of fright, whether experienced during waking hours or in natural dreams, and as recited by those who remember and are competent to give them form; through studies of autohypnosis, and various induced "hypnoidal" conditions and the records of what is thus revealed; to which may be added a like study of the contents of certain waking trance-like or semi-hypnotic dreamy states; the coming and going of "tunes in the head," and all the other distressing trains of "imperative" ideas and impulses ("obsessions"); as well as, possibly, an entirely new series of results to be obtained through photographic records of changes in facial expression—i. e., through accurate observation and interpretation of the "physiognomical (phiz) reflex" through all these, together with much other probable investigation along lines yet to be uncovered—all of which must before very long certainly add almost beyond calculation to our present knowledge of a "mind diseased" in itself, as well as of our means for its successful alleviation.

In connection with this, there undoubtedly appears something like an imperative duty on the part of all to help on these investigations and thus serviceably pave the way for practical application of what may thus be gleaned as rapidly and as fully as possible; while to any one who has personally reached the point where he can carefully differentiate the essential features of the more frequent cases of a mind diseased, as these appear in different communities or families, and especially to one who has come more or less to fully appreciate some or all of its discouraging perplexities, depressions, fears and apprehensions; or its disappointments, emotional perversions and interferences; or the accompanying loss of confidence and hope, inordinate sense of dependence, seemingly irrevocable detachment from human and divine fellowship; and perhaps something of the shame and degradation, the general unfitness for planning work, and the conscious inadequacy of power to do it, incident thereto;—who has in fact rightly comprehended what goes to make up dire mental pain, and the inevitable "sickness of soul" that centers in and clusters about the innermost selfhood in all these distressing cases—to such an one a prompting to further study and to more skilful practise, as well as to enthusiastic hope regarding it all, becomes so irresistible that any suggestion of apology for even intrusive interest and propaganda is not to be thought of.

With respect to the manner in which this kind of suffering comes to be, it may be said that almost every unusual experience has in it one or more elements of causation of subsequent mental pain and derangement. Most certainly, even such experiences as broken bones may lead to it; likewise, post-infections as well as certain endogenous poisonings are sources not to be neglected; also, too many children, too heavy financial burdens, too prolonged hours of arduous labor, physical or mental; too overweening or unrealized ambitions; or poorly cooked food and noxious air; disappointed love or social aspiration; financial reverses and other forms of "ill-luck"; as well as unsatisfied deeply implanted longings of every sort; weak will or over-emotionalism; gluttony and laziness; early impressive childish experiences, especially terrorizing dreams, frightful shocks, prolonged perversions of development; gloomy or inadequate education; unpropitious parenthood; vicious or disturbing neighborhood—all these may contribute, in incalculable proportion, yet never except by their due share, either to the genesis of a mind painfully diseased, or to its prolongation and deepening, or worse still, in many instances, to most serious interference with cure.

Thus, by way of particularizing in respect to our present purpose, let us consider an instance where the mental pain has developed in the course of recovery from some kind of not unusual physical injury, or of ordinary infection from without.

In a certain proportion of such cases, it is to be noted, especially in the more impressionable constitutions, that long before the physical trouble or infection can be recovered from, even though most prompt and efficient measures have been resorted to, the tendency to the development of mental pain has become so marked and the results so deeply registered, that it is with great difficulty and only after much time that it can in turn be recovered from, if ever at all. Could we ever have accurate data or skilled experience enough to enable us truly and properly to differentiate the readily impressionable and weakly resisting, from the less impressionable and fully resisting, constitution, the problem of what to expect and consequently what to do by way of prevention in these cases would be much simplified. But here as elsewhere our knowledge respecting inherited traits and tendencies is so vague that practically it is not to be relied upon, at any rate very absolutely or very generally. Hence, it follows, beyond question, that the universally better way is to secure complete recovery from every sort of physical trouble, no matter of what nature or how severe or otherwise, as quickly as possible, and likewise during all the time required for this to sedulously guard against the invasion of mental invalidism with as much determination and skill as against renewal of the injury, or against contagious diseases or other purely physical complication; and if, perchance, mental pain does appear, then promptly to apply such corrective measures as will prevent, so far as possible, its further development into a permanent after condition. Nipped thus at its inception mental disease as a concomitant and resultant of physical trauma or infection can often most surely be; and the outcome to the sufferer is of the nature of a benefit that is simply incalculable.

Important, however, as this theoretically must appear to every one, how frequently, notwithstanding, is exactly the opposite seen. During the process of recovery from physical injury, not only is there incredibly often little or no thought given to the possibility of an original simultaneous psychical "insult," or to subsequent consequences which may be owing to necessarily prolonged distress and confinement and weakening; on the contrary, how often likewise does it seem as if everything untoward was most unwittingly allowed, or made, day by day, to conspire to deepen the impressions of the original experience and whatever immediately follows, as well as to make doubly sure that what was at first but truly accidental and comparatively harmless, shall almost designedly be made to develop into something which in the end must prove to be as permanent and blasting as it was unexpected. Into this conspiracy, not only do the immediate friends and acquaintances of the sufferer often most thoughtlessly enter, but, and it is strange so frequently to note, do those higher in authority and responsibility likewise as unwittingly enter and remain, with a resulting summation of consequences to the sufferer, which in the given case simply defies anticipation or even estimation. Nor in this connection should the rather too frequent untoward outcome of ordinary operative procedures and post-operative care be thoughtlessly passed by. Sometimes, even on the operating table, or more frequently during the period of recovery from anesthesia, or, in fact, at any time later, the sensitive mind may thus receive impressions which may persist permanently and prove to be sources of painful invaliding beyond all expectation. In fact, it is beyond question true that the real importance of psychical insult as a close fellow of physical injury, or the danger from the stresses and other conditions following, should in every case receive a much more thoughtful consideration from all those who have to do with it, than ever has been or is now the rule. We blame and punish those who do not provide against the consequences of the physical injury itself, or against the invasion and development of endangering infectious diseases. But often these, bad as they are, are of little consequence, compared with the results of inadequate or bungling care of the psychical insults, and subsequent untoward impressions and tensions, which so often accompany or follow physical conditions, whether accidental or designed. Certainly, it were better to have a pitted face or a crooked leg than to go through the remainder of life with irrecoverable mental imperfections and distresses. Better a weak back than a weak will; the loss of a member than the loss of normal ambition and hope; better physical pain with the mind free than mental pain with the body useless because of it!

Everything that may be said about prevening the anticipation and prevention of mental invalidism in conditions that are naturally but incidental to physical trauma, may be said, also, and with even greater emphasis, with respect to its connection with the beginning or course of a large number of cases of ordinary illness, including, as these usually do, noticeable weakness, certain depressing autointoxications, incidental effects of use or abuse of various drugs, and more or less prolonged and nearly absolute isolation—favoring conditions that are almost always more or less necessarily experienced. Here the laity, especially if not checked, are liable as a rule to as unhesitatingly as unwittingly convert any sick-room into a fateful "gossip-room" of such a horrifying and dangerous character, that even a well person may wisely shun it for safety if not from choice; while those in authoritative command likewise seem somewhat too frequently not to realize with anything like becoming fullness the deep and abiding injury which inexcusable thoughtlessness, as well as all manner of unwholesome speech and conduct, may so frequently lead to. More than once has life-long soul-sickness been traced to this kind of impression received during an illness, wherein the hapless victim was made to receive impressions of such a deeply searching and staying character, that forever after dire consequences have remained, to either primarily or secondarily afflict with untold and irrecoverable mental pain. Undoubtedly, it not infrequently happens, also, that certain chance speculative remarks of physicians and nurses have altogether more to do in initiating certain painful mental and emotional currents, which afterwards develop untowardly out of all proportion to their importance, than is commonly recognized. The chance remark of a doctor once caused a really well man to go about with his hand over his supposedly diseased heart in such constant painful fear and apprehension, that he almost "went insane," and this for fourteen years, until, in fact, he was relieved by practical demonstrations that he had no such heart-crippling whatever.

Into no sick-room whatever, therefore, should any sort of lugubrious tale-bearer, conceited self-exhibitor, maudlin selfish sympathizer, or self-sufficient or careless professional poseur ever be admitted or allowed to remain, even when the sickness itself is of minor importance, and of inconsiderable duration, and the sufferer as yet appears to be normally minded. When ill, suggestibility is often much heightened or warped; and it frequently does not take long for the sanest invalid to become so profoundly impressed—so stung, or probed, or strained, or painfully awakened—that this may prove, because of the lessened resistance at the time, to be the source of troubles which may develop literally and last forever. Of course the danger varies greatly with different people, as well as with the kind and duration of the shock and stress suffered. Some people are naturally too "thick-skinned" to be easily or much affected by any such thing; but much more frequently than is suspected is it otherwise; so frequently, in fact, that it is by far safer always to keep the atmosphere of every sick-room, from beginning to end, so pure and bracing that the sufferer's mind, as never elsewhere, shall be quite exclusively impressed by what alone is of good report, and consequently uplifting and fortifying. As to the common practise, especially during the most susceptible period of all, that of convalescence, with a view chiefly to mental diversion, of reading or hearing read the common newspapers with all their tales of undermining horrors and wrong, or the "latest" novels which are so af ten but mere travesties of the higher human longings and thoughts and modes of living, scarcely too severe condemnation can be urged. One can never anticipate what untoward atavistic reminiscence may thus be called up, even in the strongest minded, or what former harmful personal experience may thus be made once again distinctively to renew its life; nor can one in either case very probably estimate the permanent vitiation of mental strength and ease which may follow. Better by far most certainly to encourage, instead, the perusal of that literature only which is at once clean, strong, inspiring and rightly awakening, and thus to get the untold benefit of such a veritable "soul-bath" as can certainly be relied upon in so doing. Indeed, there is no question that, when such simple, strong, wholesome sentiments only are thus allowed regularly each day or hour to influence the susceptible mind, it may eventually prove to be more useful in obviating and relieving the "mind diseased," than almost any other simple measure that can be thought of.

Third, let us now consider another different yet quite as prolific source of mental pain and its resulting invalidism, namely, that which is to be found in the ever-insistent consciousness of misfit into the ever-growing complexity and demands of the life of to-day, the necessarily consequent failure to realize what has been legitimately expected and striven for, and all the mental wear and tear which so necessarily follows or accrues.

For instance, when a sensitive man actually finds himself buffeted about in this world, with little or no ability to get anything like a sure foothold, and can think of no definite prospect of final prosperity for his encouragement, he naturally enough wears out his will-power as well as his sense of well-being long before his time, and consequently becomes the unresisting if not fully assenting prey to every depressing and perplexing influence about him. Or, when a woman finds that all her unique wealth of natural instincts and endowments promises to be of little demand in this conventional world, and so must go from day to day to tasks from which she derives little profit and no inspiration, she also rapidly develops a mental and emotional pain and weakness—a veritable soul-sickness—so deep and abiding, often, that the wonder is that either she or so many of her sisters ever have the courage requisite to go on and achieve so successfully as they do. Of course it were easy to say that the needed refitting in many of these cases is practically impossible; or that, even ideally, it is altogether too elevated, in any case, to be within ordinary application. Of course, too, every step on the way to securing the necessary changes of attitude in the individual's mind toward the real possibilities of his unusued or wrongly used powers and toward full acceptation of suggested ideals, or toward the determined devotion that sees success from the beginning, no matter how far from the purposed end—every step of this long way may only too generally prove, not only very arduous, but quite too discouraging for weak and wavering humanity to progress therein, or to succeed in the end. Yet could everybody as well as the sufferer himself once be led to see how such inappropriate fittings and placings and consequent failures necessarily contribute to the development of mental suffering and invalidism, and especially if they could once get an informed, vivid view of the interfering, destroying character of every such experience in its bearing upon ultimate success and happiness, not alone of the individual sufferer, but of the entire community, in every vital respect, there would undoubtedly result not only a prompt but effectual uprising against the common ineptitude and neglect in this respect. That such a true vision is widely needed is confirmed by the fact that misfit, inadequacy and failure cause so many people to suffer from an inhibition of the powers of right perspective, and to such an extent that they necessarily come, in time, if slowly yet most surely, to the point where they can not see the comparative virtue of the strength they still have, and the work they still can do, even as they think upon and especially feel upon so uncomfortably, what they originally expected of themselves in the great battle of life.

From these and many another supporting observation, easily and everywhere to be had, it is perfectly legitimate to conclude, beyond reasonable doubt, that mental pain and its resulting invalidism is quite naturally the necessary outcome of a great variety of causes, which may be contributed to, usually, by almost every influence that either bad heredity, accident, disease, wrong education, personal over-stress, or failure, or future uncertainty, may happen to afford. Besides, in many instances, we may unhesitatingly believe that these causes may be almost viciously, if never so unwittingly, supplemented by parents, children, relatives far and near, neighbors and friends, clergymen and physicians, gossips, fools and scandal-mongers, and all others who may as potently as unwittingly conspire to produce and prolong it. Moreover, we may note that there often exists constitutionally, or that there has been developed through disease or accident, certain definite phases of an imperative tendency toward an abnormal sensitiveness to every painful or unusual impression, so much so that when this comes to be actually coupled with an over-developed fear of consequences, it may most unexpectedly make the sufferer all too ready to fall in with almost every possible kind of trend toward this form of invalidism, and to gradually become most thoroughly a coward, or even quite panicstricken, from the very first suggestion of subsequent trouble. That with such a constitution and with such a "push" from untoward influences of so many kinds, every temporary attack of mental pain, from no matter how insignificant a cause, may help the sufferer eventually to slide into the chronic state of mental disease, especially when day by day serious measures for relief are unsuccessful, is plainly beyond question. Thus, a pain in the back, not overcome by sufficiently strenuous or prolonged measures, may quite as easily become evidence of "spinal disease," as pain nearer the front may become a surety of "ovarian cyst"; or higher up, of "cancer of the stomach"; or at the back of the head, of "disease of the brain." And once let such a wrong notion become fixed in the mind, especially of both patient and attendants, as it often does, and then be reinforced by reference to it, or by any set of persistent untoward circumstances, as all too often is the case, temporary or permanent disease of mind may follow, in the natural course of events, as surely as night the day, and with scarcely ever a bright morning in prospect.

Such considerations as these, consequently, make the question as to what may be done to prevent the development of such a condition, or to successfully minister to it eventually, an altogether most serious matter, especially in cases where not only the sufferer's own conditions and tendencies, but those of the entire environment, have to be considered.

In the first place, there can be no question that every case of a mind diseased should be as carefully investigated and as thoroughly understood as possible, and this from the very beginning. No sort of off-hand, "intuitive" pseudo-diagnosis should ever be relied upon as a basis either of prevention or remedy; the "case" is always really too complex to admit of any such guess-work whatever. Yet it is owing to just such a want of adequate investigation and accurate diagnosis that many a sufferer from mental pain has not only not received needed prevention or relief from his would-be ministrant, but has adversely most ignorantly or presumptuously been given abundant time to sink deeper and more permanently into his misery—so deep, in fact, so overwhelmingly, many times, that afterwards the utmost skill can be but partially successful—every really opportune moment having thus been allowed to pass forever by! Altogether and always, mental pain is too serious and dangerous a matter ever to be thus looked upon indifferently or ignorantly, or to be foolishly and fatally experimented with by not fully prepared remedialists.

In many instances, also, it seems to be altogether too readily assumed that what are called "imaginary" forms of this affection may be similarly slighted and mismanged—in fact, trifled with—without much thought as to what may be the consequence in the end. Indeed, it seems often to be considered as evidence of some kind of superior wisdom, to pronounce the sufferings of a given case as "purely imaginary," and so not to be "encouraged" by any sort of attention whatever. As a rule, however, it may be absolutely taken for granted that sick people, including the uncounted number of but-half-sick people, and those too who are said to "imagine" their illness, do not repeatedly or persistently make complaints without reasons that, when once understood, are seen to be really good and sufficient; and that every complaint of seemingly imaginary suffering has always something very real beneath it, which should at least be accurately ascertained and properly considered, before the sufferer is either condemned or ignored. Recent investigations into the true nature of the inner life, especially as this has been unsuspectedly determined by accidental shock and stress while yet in the plasticity of its very early stages, have thrown much light upon many of these perplexing types of mental invalidism in older people; and it is more than probable that further scientifically directed research will make still clearer much that is now so obscure and inexplicable. Hence, it must legitimately follow that every sort of shallow conception of mental pain will in time give way to conceptions that will be much more nearly correct, as they will be less cruel and dangerous.

However this may be, one need not hesitate to affirm to-day that we already know enough to make it absolutely unjustifiable in any case to make a "snap" diagnosis in favor of some "imaginary" disease which may be ignored or crudely managed, as ignorance, or whim, or presumption may dictate. If it be criminal to misinterpret or neglect physical ailments, it certainly is no less so thus to seriously neglect or bungle the more delicate matters of the diseased mind.

At the outset, then, every sufferer from mental distress has one inalienable right as well as the greatest need, namely, that his trouble shall be thoroughly understood, and that this understanding shall be based upon adequate investigation of all the facts involved in its origin and development. This, for one very important thing, will reveal unmistakably that every one of these poor sufferers from dire inadequacy, apprehension or discouragement, and from slowing and shallowing of faculties, and glooming of every outlook, are really experiencing a kind of suffering whose original and persisting causes are not less real than are those of physical suffering, although such causes may often, if not always, lie altogether too deep in the personality to be either self-discovered, or "intuitively divined," or superficially or too promptly judged. Again it will soon appear, even not less convincingly, that if such sufferers presume to rely upon self-investigation or self-treatment alone, or upon the offers of even the shrewdest ignoramus or most devoted" curest," they will most likely find themselves from the first but painfully misled and thwarted at every step, and eventually becoming more and more deeply sickened and more thoroughly discouraged than ever. It must be remembered that this kind of pain, the pain of mental disease, is always so indissolubly a part of the innermost self and bound up with its every impulse and movement; is withal so unexpectable and incalculable, so dominant and threatening, so undermining and degrading, and positively intrusive; in fact, so devilish and selfishly excluding; so monopolizing in all its tendencies and demands, that the sufferer must necessarily find himself, no matter how skilful in even his most resolute attempts at self-relief, much more frequently in the position of one who would lift himself by tugging at his boot-straps, than otherwise, and eventually not thus to be especially helped, no matter how much he tries; while as to the outcome of the hit-or-miss remedies and practises of every sort of unqualified remedialist, whether "regular" or otherwise, to which the discouraged invalid so often goes, it must be said that ultimate failure applies equally often, and with even more force. Practically speaking, it quite regularly occurs in these cases that there develops eventually the firm, almost immovable conviction of the futility of everything which might otherwise promise relief—a conviction that correspondingly adds to the peculiar kind of dejection and endangering, which, in turn, develops into a chronicity that may evade every attempt at remedy, later on.

From what we have discovered as to the origin and development and character of mental invalidism, then, it must again be readily recognized that it does not help this sort of individual much, if any better, simply or most elaborately to have said to him, even by the best qualified, "Oh, brace up; be a man!" or anything else of like sententious order; except, perhaps, as a "starter," when it is often undoubtedly invaluable, as is also the temporary good influence of many another similar command, or prayer, or treatment. In respect of this acknowledged initial good, however, it must always be remembered that the sufferer from a mind diseased does not, can not, thrive for very long on any sort of "starter" alone, even when it is given with best intention and high emphasis, and by those otherwise skillful; indeed, it frequently appears that the very effort to "brace up" or otherwise yield to the dominating spirit serves not to secure anything like the promised relief, but simply more firmly than ever to glue attention to the insistent distress, and to contribute immeasurably to its vividness and persistency. Nor does the heartiest promise of "better times" in the future often do much more; for in such cases the sufferer himself sees altogether too clearly how near to pretense or fabrication such a promise probably is, to be able even deceptively to draw comfort or strength or other kind of remedy from it. The fact is, this species of even most authoritative remedial platitudes do not so often touch the real "spot" as is supposed; and usually for the simple reason that the real "spot" is not even suspected by either the remedialist or the sufferer; while the reaction from ever so shrewd remedial adventuring, when it seems to promise the impossible or proves to be fallacious in the end, almost always contributes to a measurable increase of the original distress, or else to the development of some new form—" the slings and arrows of outrageous fortune "having been thus but refurbished and resharpened, rather than effectually blunted and broken, by the insufficiency of remedies and promises, which, being not properly supplemented by others appropriate to the subsequent needs, soon lose even their initial value.

Practically, it is also found in many cases, that it is just a similar kind of wrong management on the part of even those who have heretofore been the most intelligently and skillfully concerned, which has led sufferers from mental invalidism to respond so very frequently, and often so very satisfyingly to themselves, for a time, at any rate, to the offerings and importunities of "irregular" practitioners, and of irregular sects of almost every description. The "mind diseased," not getting expected, and perhaps promised, light through "instruments of precision," and not getting much-needed relief from remedies directed even legitimately to organs and functions of the body alone, often grasps naturally enough at shrewdly proffered "cures" or "healings" which promise satisfaction beyond doubt from no matter what irresponsible source, and with an avidity which, if "foolish," is certainly excusable, if nothing more. Nor can anything else be expected when such a sufferer so painfully remembers that in his great and anxious need he has been time after time to a "regular" physician, only to have the real significance of his mental distress misapprehended, or to have it characterized as "silly," or "imaginary," or "not for me," or of "no consequence whatever," or, as was the case with Lady Macbeth's physician, to hear him affirm that therein the sufferer "must cure herself "; or, perhaps worse still, to be treated by heartless "bluff," placebos, or possibly by hints of a normal defection that needs a priest rather than a physician! Nor, again, can anything better be expected, when possibly in obedience to this same distracting hint, such a sufferer has sought his church, only, as it has seemed to him, to be fed with stones, to be treated with indifference, or to be poisoned with doubts and insincerity, to say nothing of the chill that so naturally comes from sham brotherliness, untrustworthy sisterliness, and all the pain that these mean to the hungry distressed soul. If in such a case the "unorthodox" either in medicine or religion can "make good" where the "orthodox" fails, let there not be unseemly surprise, or charges of foolishness or worse, against those who in spite of such neglect and misunderstanding actually do need relief and must seek relief, even until they find it. Instead, let there prevail everywhere the full measure of righteous humility which is so often really due in the premises. The great "irregular" of all time, it must be remembered, was Jesus of Nazareth; and it was He who is said to have healed the people up and down the whole land, in spite of the "regular" doctors, medical and ecclesiastical, of the time. Of course, this is no tribute to quackery as such, either within or without the "professions"; it simply teaches that any one who would really do right in this important field must by every possible endowment and preparation be first and fully possessed, not only of the proper spirit, the needed sympathy, the untiring determination to understand the actual need and provide the real remedy, but additionally, of the most perfect knowledge of human nature and all its woes that can be obtained by patient, skillful investigation, and by most rational induction from well-authenticated facts. Mere one-sided, incompetent, or vain "irregularity" does not by itself suffice, any more than mere self-sufficient or negligent "regularity." In either case, the deeper the insight, the wider the comprehension, the truer the knowledge, the more direct the skill, the better the results achieved.

When the rightly endowed, fully prepared ministrant to a mind diseased has once been given a case of mental suffering in hand—one whose investigations have led him as accurately as possible to differentiate it from the truly alienated cases that can only be cared for in protective institutions—he is at once often confronted with conditions that tax his insight perseverance and skill, not only to an almost unwonted degree, but far beyond the comprehension and consequently the sympathy of his employers. Frequently, also, he has to contend with varied and numerous and unexpected misleadings and coverings up of facts which may be mostly owing to a previous false diagnosis; or, he finds the patient's normal ideation more or less in a state of irrecoverable atrophy or decay; or, that there is perverted emotionalism quite beyond understanding and of a continuously disastrous nature; or that the will power has been so frequently strained and wrongly directed that it can be relied upon for scarcely any good effort at all; or, so frequently, all these in most perplexing combination. In fact, the case is always one where the whole organism is more or less under the spell of the mental distress, and consequently has a minimum of recuperative forces at command. Even almost every physical function is apt to be so lowered and perverted that, in turn, they may contribute to the disease of mind and to the resistance to be overcome. In fact, the case is one of "sickness all through"; and the remedy and management must be based upon this comprehensive vision, or failure will almost inevitably result.

Hence the wise remedialist will never neglect to at once institute every sort of hygienic, sanitary and therapeutic measure, which may be rationally indicated. Failure here is folly unmitigated; and no assumed "special" or "exceptional" ability that presumes to get along without due attention to the physical as well as mental functioning can make it otherwise, try and promise as one may.

Having first, then, given due consideration to the conditions and needs of the entire case, the wise ministrant to the mind diseased will next, and at once, seek to understand in detail the changes from the normal psychology which are the immediate sources of the distress. Here, again, ability to investigate with a penetration and thoroughness that only the trained scientist can comprehend is the next great duty which he owes both to his patient and to himself. To accomplish this, he will bring all that his life, his reading, his special training and experience have taught him; will exercise all the mental and moral qualities of which he is possessed; will devote himself in every manner practicable, not only to relieving the present distress, but to arousing such latent and stifled mental functions as will in due season contribute of themselves to help to overcome that which is abnormal, and substitute normal thoughts and feelings in its stead. In all this he will need and should have the full confidence and intelligent help of those who are related to or responsible for the one afflicted. On the contrary, every attempt on the part of these latter to assume or restrict his proper functions, or to cover up that which should be told, or to interpose with their own cross purposes and perverting schemes, will only serve to embarrass him, and to hinder his patient's recovery. This needs to be said everywhere and repeatedly; for it has not even yet come to pass that such a necessary harmony of opinion and action is always to be relied upon. In general, it should always be remembered that the problem presented by instances of a mind diseased is really so complex, and often so unresolvable at best, that the intuitions, the careful watching, the knowledge and the devoted skill of every one concerned, are none too much for obtaining the best possible results.

With respect to all the "newer" and promisingly better methods of management of a mind diseased, with respect to its own especial needs—those that have been devised by more recent investigators—it may be said, in a word, that they all seek to be based upon strictly scientific methods, and so to become more and more reliable and eventually trustworthy to an extent heretofore unknown. The first thing one notes is that it seems settled beyond question that in all these cases there shall be secured at once a most complete and searching, yet of course judicious, "scientific confession," or more properly scientific riddance through confession, of all the deeply hidden harmful feelings, thoughts and habits, that so often are really the basis of the painful mental superstructure which has supervened. In almost all this class of sufferers some such kind of revealing of the underlying sinful, or shocking, or stressful life, is found to be the best method of preparing the way for the subsequent, constructive measures which may then seem necessary. Hence, for this purpose, much attention is now given, for instance, to invoking the recollection of all the startling and harassing dreams which so often give darkness and pain to the easily impressed mind, and then to their true interpretation as affecting the waking life. Likewise, even though it be through hypnotic and allied means, it is often sought thoroughly to recall and expunge from the uttermost depths of being any and every other sort of earlier experience, whether these may have been sinful, accidentally shocking, or freighted with some kind of awful stress, in order that the sufferer shall no longer remain the unconscious victim of these "subliminal," most vicious enemies, as sorely as before. In fact, the "new method" implies that most of these cases have, to begin with, profound need of what may well be termed a "drastic psychical catharsis"; and considerable experience shows that, once having secured this, such people are, at least for the time being, very apt to be relieved from their pain, begin to be noticeably ambitious and vigorous, beget new hopes and enterprises, and otherwise to astonish both their friends and themselves with unexpectedly rapid, at least temporary, improvement.

But it must always be remembered that even the most intelligent use of even this most scientific initiatory method does not often serve other than as a very serviceable prerequisite to imperatively needed subsequent measures, whose main object should be, not only as thoroughly to fill the vacancy thus made by evulsion of the destructive evil as possible, but also to put something more constructive and permanent in its place. Closely investigated, the human mental activities seem largely to be built upon a system of self-mimicries ("auto-mimesis"), which fact may often be very wisely taken advantage of in dealing with its abnormalities, especially of the curable order. If through some untoward experience or constitutional "predisposition," a painful and dangerous "copy" has some time been deeply set in the mind, and subsequently this has got into the vicious habit of being reproduced in endless repetition, and so beyond self-correction, not only has this important fact a most imperative need to be duly noted, and considered, and acted upon, from first to last, but also has the equally important fact, that almost every remediable instance of a mind diseased actually has this peculiarity, and attention to this may often reveal the right clue as to what will eventually do the most good and do it most promptly and permanently.

Remembering these facts, then, it is soon found that in very many cases indeed the most practical thing to do, after the preliminary mental cleansing has been effected, is at once almost obtrusively to proceed to introduce into the sufferer's mind a greater or less number of most definite, clear, interest-laden, moving, and if possible unusual ideas, which, being by the sufferer supposed to emanate from the mind of some one whom he looks upon as more of an authority than he is capable of being by and for himself, will be allowed to make their way unhindered, so deeply as to become an efficient counter-effecting force, and thus bring about the thoroughly neutralizing and substitutive effect required. In this way, a new copy, which is at once characterized, both by fresh interest and constructive imagery, may be so powerfully and timely, and likewise so aptly, repeated, that duly the mind will almost unconsciously begin to imitate this instead of the old copy, and thus in time will become both successfully refurnished and reinvigorated, and consequently relieved, as well. Undoubtedly such a course, especially if unremittingly enlarged upon and enriched by all such determined, luxurious effort on the part of the sufferers themselves, as will perpetuate the original effect, even until such time as their dried-up mental soil shall be made once more to teem as it should with spring-like rejuvenescence of every old activity, as well as with the germination and growth of as many new interests as possible—undoubtedly such a course will succeed where many another may fail. In this there will often be surprisingly exemplified the fact that it is the inner, emotional and intellectual life, rather than the outer physical life, which pulls men and women down, as well as keeps them up; and that in connection with a decided change in the character and direction of these there may always he expected, whenever possible, a corresponding constructive response to whatever change in environmental conditions may be considered useful, in addition.

Having thus made a right beginning and got well on the road to practical success, it is simply wonderful what a capable, intelligent, wholesome "minister to a mind diseased" can thus do, for many of these cases, where there is such a malign and persisting interference with the life of all the affective as well as effective faculties of the sicksoul, as is here to be found. Like the gentle dew from heaven is his mere coming and presence often; often, too, like a strong tower of defense and offense, is the "presence" he leaves behind; like a veritable "new birth," does it soon amount to; like a complete regeneration in the end, in many instances.

Of course, it might be naturally supposed that the first and surest step toward securing recovery, especially from the woes peculiar to the misfit, would be simply to get them out of their inappropriate environment and wrong calling into a place and work more suitable for their endowment and preparation. And so it would be and is, in a comparatively few or perhaps many cases. But with the rest it is almost universally the fact that for so long a time have they been bred and trained in the midst of unrealization and unsatisfaction and consequently of rebellion and despair, and not less important in the direction of atrophy and negation of powers, that even when their outward circumstances have once been most wisely mended they do not respond nearly so constructively as might naturally be expected. Mostly, such people need a change of life within before they can satisfactorily appreciate and constructively respond to a change of life without. Until this change is accomplished—until the intellect and emotions and expectancies have been given at least a new direction—outer changes are much more likely, particularly in adults, to result in some or all of the unexpected disappointments which every other kind of unwise experimentation is everywhere so apt to see.

Having, then, as thoroughly cleared the sufferer's mind of every affecting and destructive idea and feeling as possible, and skillfully filled it with certain other ideas and feelings, which should be selected entirely for their own constructive, curative and inspiring qualities, it follows with equal necessity that the good work should not stop here, by any means, but rather should be supplemented unremittingly by most persistent use of every such well-selected, strong, wholesome, comprehensive measure, such as change of environment, work, study, reading, etc., as will naturally effect, step by step, the completion and fixity of the mental and emotional reorganization so obviously needed. For, no matter how effective the initial catharsis and substitution may be, if the remedialist does not know enough or has not spirit enough to follow up this concededly important ministry by subsequent adaptive effort, persisted in until the end is attained, his labor will be mostly in vain. Here it is, undoubtedly, that so many of the "practitioners" of the various systems of "transcendental medicine," pseudo-science, rampant humbuggery, "queer" theology, and vicious imposition generally, are not able to secure the permanent results predicted of them from their temporary success. Many of these can give and often do give a good enough start toward relief to warrant the confidence which such a course engenders; but they break down entirely as soon as anything additional is required, and so, either lose their influence at once, or else are forced, by maintaining a series of illusions which in time fatefully show themselves to be such, to continue to doggedly sustain some other sort of equally temporary measure, if not base imposition, which deservedly brings its dire reward upon their heads in the end. In these cases a single measure or practise of any kind, no matter how good or true, when persistently inculcated or exercised without timely and appropriate variation or addition, soon comes to the end of its chief usefulness; for the nature of the human mental and nervous organization predetermines that atrophy and decay in the realm of feeling and willing just as surely follow closely upon the over-exercise which produces an initial hypertrophy, as it does similarly in the physical realm. But the ignorant or indifferent practitioner does not consider this; and so pushes on unvaryingly with his initiatory measures only, or with others of similar or greater misleading import, and consequently finds that the original condition of his patient often comes to have duly added thereto, certain other abnormalities, which, although newly acquired, may yet prove to be not less distressing or less persistent than the original ones. So trite an injunction, then, as "Overcome evil with good" when applied to the needs of a mind diseased, is thus seen to necessitate a right kind of persistent overcoming, wherein the void repeatedly secured by eliminating the evil is continuously filled with restorative "good," the strength gained from time to time is constructively exercised, and all the psychic pathological conditions are thus led or made to give way eventually to normal states and activities.

Perhaps this is quite sufficient to enable us to conclude, finally, that permanent satisfactory results in this important field of remedial ministry can seldom be secured, unless due attention be given, first, to getting at the real sources of the sufferer's breakdown; second, to correcting, contributing and hindering physical diseases; third, to purging offending mental imagery, and eliminating the deeper origins of pathological fears and distrusts and consequent exhaustion and pain; fourth, to making, and from time to time, remaking, as profoundly constructive impressions as possible; and, fifth, to reeducating and repractising every mental and emotional factor in such a sure way that eventually comprehensive reorganization is permanently effected, and the deeper, truer self is made to regain its normal attitude towards the world in which it finds itself, as well as the strength and habitual new activities which will enable it to maintain itself against subsequent insult and stress—in fact until the mind is once more as full of ease, as it was at the beginning full of dis-ease.