Psychotherapy and The Community

XIV

PSYCHOTHERAPY AND THE COMMUNITY

Both the physician and the patient find their place in the community the life interests of which are superior to the interests of the individual. It is an unavoidable question how far from the higher point of view of the social mind the psychotherapeutic efforts should be encouraged or suppressed. Are there any conditions which suggest suspicion of or direct opposition to such curative work?

Of course society has to be sure that no possible misuse and damage are to result from such practice. Fears in that direction have been uttered repeatedly, but from very different standpoints. One which is perhaps most often heard in popular circles results from an entire misunderstanding and deserves hardly any discussion after our detailed study of the processes involved. It is claimed that suggestive power, especially in the form of hypnotization, may be secretly misused to make anyone without his knowledge and against his will a passive instrument of the hypnotist’s intent. Often this is coupled with telepathic fancies. The hypnotist is believed to have mystic power to bring any person in a distant region under his mental control and thus to be able to carry out any sinister plans by the help of his innocent victim. All hypnotizing therefore ought to be interdicted by the state. The presuppositions of such a view are, as we know now, entirely absurd. We know that hypnotism is not based on any special power of the hypnotizer; there is no magnetic fluid in the sense of the old mesmerism. The imagination of the hypnotized person is the only hypnotizing agency. Thus no one can be hypnotized without his knowledge or against his will. The story of telepathic mysteries which is often brought before the public is probably always the outcome of a diseased brain. It is indeed a frequent symptom in paranoia and other insanities that the patient who feels abnormal organic sensations and abnormal unaccountable impulses interprets them as influences of a distant enemy. Whole pamphlets have been written with elaboration of such insane misinterpretations and requests to legislatures have been made in that spirit, but the physician recognizes easily throughout the whole argumentation the well-known phenomena of the mental disease.

To be sure, while no one can be hypnotized against his will, many a person is liable to accept suggestions from others and thus to carry out the wishes of others almost without knowing and certainly without willing that the other mind interfere with the interplay of the own motives. But if we were to strike out all suggestive influences from social life, we should give up social life itself. Suggestion is given wherever men come in contact; in itself it is neither good nor bad. The good resolution and the bad one can be suggested, the good example and the bad can be effective; both encouragement of the noble and imitation of the evil may work with the same mental technique. Certainly there are some persons who have a stronger influence than others on the imagination of those with whom they come in contact; their expression awakens confidence, their voice and their words reach deeper layers of the mind, their calmness and firmness overwhelm more easily the antagonistic ideas. But the chief difference lies after all in the different degrees of suggestibility among those who receive such impressions. The easily suggestible person cannot be protected by any interdict; he may catch suggestions everywhere, any advertisement in the newspaper and any display in the shop-window may overrun his own intentions. What he needs is training in firmness. The application of reënforced suggestion or even of hypnotism in the doctor’s office is even for him no possible source of danger.

On a higher level are objections which come from serious quarters and which are not without sympathy with true science. In recent times this opposition has repeatedly found eloquent expression. It is an objection from the standpoint of morality, belonging therefore entirely to the purposive view of the mind, but we have now reached a point where it is our duty to do justice to this purposive view too. As long as we discussed the problem entirely from the stand point of the physician, no other view of mental life except the causal one could be in question. As soon as we look at it from the standpoint of the community, it becomes our duty to bring the causal and the purposive view into harmony, and it would be narrow and short-sighted simply to draw the practical consequences of a naturalistic view of the mind without inquiring whether or not serious interests in the purposive sphere are injured. If there is moral criticism against suggestive therapy, it is the duty of the community to consider it. This opposition argues as follows: Hypnotic influence brings the patient under the will control of the hypnotizer and thus destroys his own freedom. Whatever the patient may reach in the altered states is reached without his own effort, while he is the passive receiver of the other man’s will. His achievement has therefore no moral value, and if he is really cured of his drunkenness or of his perverse habits, of his misuse of cocaine or of his criminal tendencies, he has lost the right to be counted a moral agent. It would be better if there were more suffering in the world than that the existence of the moral will should be undermined.

No one ought to take such arguments lightly. The spirit which directs them is needed more than anything else in our time of reaching out for superficial goods. No one can insist too earnestly that life is worth living only if it serves moral duties and moral freedom and is not determined by pleasures and absence of pain only. Those who set forth this argument are entirely willing to acknowledge the profound effect which suggestive therapeutics may create. More than this, they have to acknowledge it to gain a basis for their attack. Just because the hypnotizer can entirely change the desires and passions, the habits and perversities of the suffering victim, he seems to them a moral wrongdoer who negates the principle of human freedom. A forcible book of recent days calls the suggestive power of the psychotherapist "The Great Psychological Crime." It says to the hypnotist: "By your own testimony, you stand convicted of applying a process which deprives your subjects of the inalienable right and power of individual self-control. In proportion as you deprive him of the power of self-control, you deprive him of that upon which his individual responsibility and moral status depend. In proportion as you deprive him of the free control and exercise of those powers of the soul upon which his individual responsibility and moral status depend, you thereby rob him of those powers upon which he must depend for the achievement of individual immortality."

But this censure too is entirely mistaken, not because it urges the purposive views against the causal but because it is in error as to the facts. Such critics are fully under the influence of the startling results which are reached; they do not take the trouble to examine the long and difficult way which has had to be traversed with patience and energy. It is quite true that if I hypnotize a man and suggest to him to take up after awaking the book which lies on my table, he follows my suggestion without conflict and in a certain sense without freedom. He feels a simple impulse to go to the table and lift the book and, as no stronger natural desire and no moral objection stand in the way, he carries out that meaningless impulse and perhaps even invents a foolish motive to explain to himself why he wanted to look at that book. But after a long experience, I have my doubts as to whether a man was ever cured in such a way by hypnotism of serious disturbances and of those anomalous actions which the critics want to see overcome by the patient’s own moral efforts. On the contrary, every suggestion has to rely on the efforts and struggles of the patient himself and all that the psychotherapists can give him is help in his own moral fight. His own will is presupposition for being hypnotized and for realizing the suggestion. If again and again I hesitate to undertake new cases, it is just because I have to see during the treatment too much of this daily and hourly striving against overpowering impulses. The joy of removing some obstacles from the way of the patients is too much overshadowed by the deep pity and sympathy with their suffering and craving during the whole period of successive treatments. To make a man fight where despair is inevitable, and where the enemy is necessarily stronger than his own powers, can certainly not be the moral demand. Morality postulates that everyone find conditions in which he can be victorious if he puts his strongest efforts to the task.

In our discussion of the mental symptoms I reported as an illustration of the suggestive treatment of the drug passion the case of a morphinist. To make clear this purposive side of the case as against the causal one which alone interested the physician, I may add a few features to the short report as a typical example. When that man left my laboratory for the last time to go out to work and happiness, you might well have believed from his joyful face that it had been an easy and pleasant time in which hypnotic influence smoothly removed from him the dangerous desire for morphine. In truth it was the result of four months of the most noble and courageous suffering and struggling. He had been for years a slave to his passion. To quote from his little autobiography: "When I realized that I was addicted to morphine, I was at first not at all worried as I did not then understand the real horror of the thing, and did not then realize all the future suffering and misery that is coming to anyone who is the user of opium or any of its alkaloids. For the first few months, I found great relief after every injection of morphine, but soon I could not get the same easy feeling and could eat but very little and what sleep I got was in the daytime. I finally went to the sanitarium of a doctor but it was simply a money-making business for him; if he ever cured anyone, I never heard of it. I then tried another one; it was the same kind of a place as the former. When I first went to see the professor in the Harvard Psychological Laboratory, I was using between thirty-two and thirty-eight grains of morphine daily. He put me under his treatment October 6th and that day cut me down by hypnotic treatment to nine grains a day or three doses of three grains a day. I took my hypodermic as directed, but on the following day I lay on the bed too exhausted to get up even to get around the room, and I could not eat and only drank a very little water. The desire for the drug was something terrible. But in about four days I got used to the loss of so much morphine and stayed on this amount for a week, seeing the professor every other day for hypnotic treatment and then returning to my room where I spent twenty-two hours of the twenty-four on the bed, but did not sleep more than two or three hours a day. At the end of the week I was cut off by hypnotic suggestion half a grain and this put me to fighting the desire again. This lasted two or three days and then I began to feel better and began to sleep a little more. But at the end of the week I was cut off another half grain, and the whole fight would have to be begun over. These reductions of the dose were made a week apart and sometimes only two days. The worst time of all was a cut from four injections of a fourth of a grain each to four of one eighth of a grain each, which was about January 10th. At this time I had the worst two days of my life. I tried whiskey, but it gave relief only for about half an hour and then the desire was worse than ever."

In this way every few days I gave the poor fellow under hypnotic influence the suggestion to reduce the dose of morphine in a prescribed way, and with enormous effort he withstood his craving for more, in spite of the fact that he had during all this winter a bottle with a thousand tablets of morphine, prescribed by an unscrupulous physician, in his writing desk. He was thus at every moment during the day and night in full possession of the deadly poison with which he could have fully satisfied his craving. It was a moral victory when he finally reached the point at which he went for several weeks without any desire for morphine and finally presented the remaining tablets to a hospital. And yet there would not have been the least chance for his winning this ethical victory without the outer help of the hypnotist. We do not eliminate the moral will but we remove some unfair obstacles from its path. We have no mystic power by which our will simply takes hold of the other man’s will, but we inhibit and suppress by influence on the imagination those abnormal impulses which resist the sound desires. If that were immoral, we should have to make up our minds that all education and training were perverted with such immoral elements. Every sound respect for authority which makes a child willing to accept the advice and maxims of his elders is just such an influence. If it were really a moral demand that the will be left to its own resources and that no outside influence come to strengthen its power or remove its hindrances or smooth its path, then we ought to let the children grow up as nature created them and ought not to try to suppress from without by discipline and training, by love and encouragement, the willful impulses and the ugly habits. Even every good model for imitation is such a suggestive influence from without and every solemn appeal to loyalty and friendship, to patriotism and religion, increases the degree of suggestibility. That is the glory of life that the suggestive power may belong to moral values instead of mere pleasures, but it is not the aim of life to remain untouched by suggestion. And he who by suggestion helps the weak mind to overcome obstacles which the strong mind can overthrow from its inborn resources works for the good of the individual and of the community in the spirit of truest morality.

Much more justified than such ethical objections are the fears which move entirely in the causal sphere. It must be acknowledged that a method which has such powerful influence over the mind that it can secure ideas and emotions and impulses which the own will of the patient cannot produce, ought to be allowed only to those who are prepared for its skillful use. To hypnotize or to perform any persistent psychotherapeutic treatment may thus be dangerous, if it is done by the unfit. We have discussed before the injuries which might result from the administration of such powerful psychotherapeutic effects through the best meaning minister, but we can extend this fear to anyone who has not systematically studied medicine and to a certain degree normal and abnormal psychology. The possibilities of overlooking symptoms which ought to suggest an entirely different treatment, or of adjusting the treatment badly to the special physical conditions, or of ignoring the desirable physical supplement by drugs, or of creating unintentionally by suggestion injurious effects, are always open when medical amateurs undertake such work. Certainly there is no physician who is not liable to make mistakes, and a physician who has never given any attention to psychology and psychiatry would also be a rather poor agent of psychotherapeutic methods, but the probability is that such a physician would simply abstain by principle from all psychotherapeutic methods; his mistake only begins if from his lack of acquaintance with the subject he draws the conclusion that the method itself is undesirable. That his real preparation ought to include psychological studies we have pointed out before, and the time seems ripe for the community to urge such a reform of the studies.

All that involves the conviction that even the experimental psychologist as such is not prepared to enter into medical treatment; and a "Psychological Clinic," managed by a psychologist who is not a doctor of medicine, is certainly not better than a church clinic. I cannot even acknowledge the right of psychologists to make hypnotic experiments merely for the psychological experiment’s sake. Nobody ought to be brought into a hypnotic or otherwise abnormal state of mind if it is not suggested by the interests of the subject himself. Science has the right to make hypnotic experiments, or experiments with abnormal mental states, only under the one condition that a physician has hypnotized the subject in the interests of his health and that the patient has agreed before hand to allow in the presence of witnesses certain psychological studies. Needless to say that any hypnotization for mere amusement and as a parlor trick ought to be considered as criminal.

On some other objections which interest the community as such we had to touch before, and there is no need of returning to them with any fullness of argument. We spoke of the danger which the mental cures carry with them when they are based on any particular creed, and especially when they are tied up with a semi-religious arbitrary metaphysics. What is gained if some nervous disorders are helped by belief, if the belief itself devastates our intellectual culture and brings the masses down again to a view of the world which has all the earmarks of barbarism? That is indeed one of the central dangers of all non-medical suggestive cures, that while any belief may cure through the mere emotional power of the act of believing, the content of the belief gains an undeserved appearance of truth. Any absurd superstition can become accredited because its curative value may be equal to a truly valuable suggestion. The intellectual life of the community would have to suffer greatly if the way to be freed from bodily suffering had to be the belief in the metaphysical doctrines of Mrs. Eddy’s "Science and Health." From a cultural viewpoint, too, suggestive therapeutics must stand the higher, the more sharply it is separated from special philosophical or religious doctrines. No theory of the world and of God ought to gain authority over the mind from such an external motive as a belief in its curative effects. Freest from such implications is certainly the hypnotic method of the physician who does not need the strong religious reënforcement of the suggestion because he reënforces instead the suggestibility of the patient by slight influences on his senses.

Even where sound religion without superstition and without pseudophilosophy stands behind the therapeutic work, the community will not give up the question whether the church does not necessarily neglect by it the interests which are superior. The community becomes more and more strongly aware that too many factors of our modern society urge the church to undertake non-religious work. Social aid and charity work ought to be filled with religious spirit, but to perform it is not itself religion. Still more that is true of the healing of the sick. Whether or not such expansion of church activity in different directions saps the vital strength of religion itself is indeed a problem for the whole community. The fear suggests itself that the spiritual achievement may become hampered, that in the competition of the church with the other agencies of social life the particular church task may be pushed to the background, and that thus the church in imitating that which others can do just as well or better loses the power to do that which the church alone can do. The final outcome is therefore practically in every way the same. From whatever starting point we may come, we are led to the conviction that the physician alone is called to administer psychotherapeutic work, but that he needs a thorough psychological training besides his medical one.

But the interest of the community is not only a negative one. Society does not only ask where psychical treatment can be dangerous, but asks with not less right whether the scheme and the method might not be fructified for other social ends besides the mere healing of the sick. If psychotherapy demonstrates that for instance hypnotism makes possible the reshaping of a pathological mind, it is a natural thought to use the same power for remodeling perhaps the lazy or the intemperate, the careless or the inattentive, the dishonest or the criminal mind. Both educators and criminologists have indeed often raised such questions, and social reformers have not seldom seen there wide perspectives for social movements in future times.

There can be no doubt that the possibility of such remodeling activity is given, but as far as education is concerned certainly grave misgivings ought to be felt. When we spoke of the treatment of the sick, we had always to emphasize that the suggestion cures symptoms but not diseases. In the same way hypnotic suggestion might reënforce a single trait but would not reform the personality of the child. Yes, the artificial reënforcement of such special features would deprive education of that which is the most essential, namely, the development of the power to overcome difficulties by own energy. Wherever a reasonable amount of own will force and attention can be expected to overcome the antagonistic influence, there artificial hypnotic influence ought to be avoided. Everything ought to be left in that case to suggestions within normal limits, in the form of good example and persuasions, authority and discipline, love and sympathy. That holds true even for very slight abnormalities which seem still within the limits where the own energies can bring about the cure. For instance, I have steadily refused requests of students and others to use hypnotism for the purpose of overcoming merely bad habits, such as the habit of biting the nails. A child who finds some difficulty in sticking seriously to his tasks might learn now this and now that under the influence of hypnotic suggestions but he would remain entirely untrained for mastering the next lesson. In the same way some naughty traits might be artificially removed but the child would not gain anything towards the much more important power of suppressing an ugly tendency by his own effort. All that finds its limits where the inhibitions or obstacles in the brain of the child are too strong possibly to be overcome by the own good will, but in that case we already stand in the field of abnormal mental life and then of course psychotherapy has its right. The feeble-minded and the retarded child, the perverse child and the emotionally unstable child, belong under the care of the physician, and in such a case he ought not to hesitate to use the whole supply of psychotherapeutic methods which are at his disposal.

Still more complex is the criminological problem. It sounds like an easy remedy for the greatest social calamity, if it is proposed simply to hypnotize the criminal and to supplant his antisocial will by a moral one. And if the absurdity of such a proposal is recognized it seems to many justified to demand such an intrusion at least in the case of the born criminal, even if the occasional criminal cannot be reached. But the conception of the born criminal is also only a label which is superficially used for a great variety of minds. That men are born with a brain which necessarily produces criminal actions is not indicated by any facts. The varieties which nature really produces are brains which are more liable than others to produce antisocial actions. We recognized from the start that the abnormal mind never introduces any new elements but is characterized only by a change of proportions. There is too much or too little of a certain mental process and just for that reason there must be a steady and continuous transition from the normal to the entirely abnormal. Here again we have not a special class of brains which are criminal; but we have an endless variety of brains with a greater or smaller predisposition for antisocial outbreaks. The variations which produce this criminal effect may lie in most different directions.

The brain may be for instance inclined to overstrong impulses, so that any desire rushes to action before the inhibiting counter-idea gets to work. Or, on the other hand, the brain may have unusually weak counter-ideas so that even a normal impulse does not find its normal checking. The fact that selfish and thus antisocial desires awake in the mind is not abnormal at all; only if they are not normally inhibited, the disturbance sets in. Furthermore the associative apparatus of the brain may work especially slowly; it may thus bring it about that the counteracting ideas do not arise in time. Or the emotions of a person may be unusually strong. Or there may be strong suggestibility, by which a bad example or a strong temptation has especially easy access. Or there may be negative suggestibility, by which a moral admonition stirs up a vivid idea of the opposite. In short, there may be a large number of factors, sometimes even in combination, each one of which increases the chances that the individual may come in danger in the midst of developed society. Yet no one of those factors involves just the necessity of crime. The same kinds of brains might simply show stupidity or credulity or inconsiderateness or brutality or stubbornness or egotism, and might by each of those factors decrease their chances in the community without directly running into conflict with the law. The criminal is therefore never born as such. He is only born with a brain which is in some directions inefficient and which thus, under certain unfavorable conditions, will more easily come to criminal deeds than the normal brain.

With the idea of a stereotyped born criminal there disappears also the idea of a uniform treatment against criminal tendencies. That men are different in their power of resistance or in their power of efficiency or in their intellect or in their emotions, we have to accept as the fundamental condition with which every society starts. It would be absurd to remodel them artificially after a pattern. The result would be without value anyhow, inasmuch as our appreciation is relative. No character is perfect. The more the differences were reduced, the more we should become sensitive even for the smaller variations. All that society can do is, therefore, not to remodel the manifoldness of brains, but to shape the conditions of life in such a way that the weak and unstable brains also have a greater chance to live their lives without conflicts with the community.

The situation is different as soon as the particular surroundings have brought it about that such a brain with reduced powers has entered a criminal career. The thought of crime now becomes a sort of obsession or rather an autosuggestion. The way to this idea has become a path of least resistance, and as soon as such an unfortunate situation has settled itself, the chances are overwhelming that a criminal career has been started. If such cases should come early to suggestive treatment which really would close the channels of the antisocial autosuggestion, much harm might be averted. Yet again the liability of the brain to become antisocial would not have been removed, and thus not much would be secured unless such a person after the treatment could be kept under favorable conditions. With young boys who through unfortunate influence have caught a tendency, for instance, to steal, and where the fault does not yield to sympathetic reasoning and to punishment, an early hypnotic treatment might certainly be tried. I my self have seen promising results. But if the impulse has irresistible character in such a way that the good will is powerless, we are again in the field of disease and the point of view of the physician has to be substituted for that of the criminologist.

Whether pedagogy and criminology are to make use of the services of psychotherapy is thus certainly an open question. It would be short-sighted to overlook the serious obstacles which stand in the way. But while the social life outside of the circle of real disease may better go on without direct interference by psychotherapeutic influences, it is certainly the duty of the community to make the underlying principles of psychotherapy useful for the sound development of society. The artificial over-suggestions which are needed to overcome the pathological disturbances of mental equilibrium may be left for the cases of illness. But we saw that every mental symptom of disease was only an exaggeration of abnormal variations which occurred within the limit of health. To reduce these abnormalities means to secure a more stable equilibrium and thus to avoid social damages, and at the same time to prevent the growth of the abnormality to pathological dimensions. To counteract these slighter variations, these abnormalities which have not yet reached the degree of disease, will demand the same principles of treatment, only in a weaker form. It is in a way not psychical therapy but psychical hygiene. And this is no longer confined to the physician but must be intrusted to all organs of the community. And here more than in the case of disease, the causal point of view of the physician ought to be brought into harmony with the purposive view of the social reformer, of the educator and of the moralist.

The ideal of such mental hygiene is the complete equilibrium of all mental energies together with their fullest possible development. To work towards this end does not mean to aim towards the impossible and undesirable end of making all men alike, but to give to all, in spite of the differences which nature and society condition, the greatest possible inner completeness and outer usefulness. The efforts in that direction have to begin with the earliest infancy and are at no age to be considered as finished; the whole school work and to a high degree the professional work has to be subordinated to such endeavor. Society has further to take care that those spheres of life which stand less under systematic principles, such as the home life of the child and the social life of the man, his family life and his public life, are steadily under the pressure of influences which urge in the same direction.

Harmonious development without one-sidedness, and yet with full justice to the individual talents and equipments, should be secured. That means from the start an effort to secure balance between general education and particular development. The latter has to strengthen those powers by which the boy or girl by special natural fitness promises to be especially efficient and happy. It has to be supplemented later by a wise and deliberate choice of such a vocation as brings these particular abilities most strongly to a focus. Yet this alone would mean a one-sidedness in which the equilibrium would be lost. More important, it would leave undeveloped that power which the youth especially needs to acquire by serious education, the power to master what does not appeal to the personal likings and interests. An equilibrium is secured only if at the same time full emphasis is given to the learning and training in all which is the common ground of our social existence. From the multiplication table to the highest cultural studies in college, the youth is to be adjusted to the material of our civilization without any concession to the emasculating desire to adjust civilization simply to the particular youth. He has to learn learning and not only to play with knowledge, he has to learn to force his attention in adjustment to those factors of civilization which are foreign to his personal tendencies and perhaps unsympathetic. Free election of life’s work and unyielding mental discipline in the service of the common demands should thus steadily coöperate. The one without the other creates a lack of mental balance which is the most favorable condition for a pathological disturbance.

The mere learning is of course on both sides only a fraction of what the community has to develop in the youth. Mental hygiene begins with physiological hygiene. The nourishment of the child, the care for the child’s sense organs, the recesses and the rest from fatigue, and especially the undisturbed sleep are essential conditions. The interferences with sufficient sleep are to a high degree responsible for the later disturbances of the mental life. It must not be forgotten that the decomposition of the brain molecules can never be restituted by anything but rest, and ultimately by sleep. Physical exercise is certainly not such restitution. In the best case it brings a certain rest to some brain centers by engaging other brain parts. The child needs sleep and fresh air and healthful food more than anything else, if his mind is active. The careful examination of the sense organs and of the unhindered breathing through the nose is most important. Even a slight defect in hearing may become the cause of an under-development of attention.

More important than mere physical hygiene is the demand that a sound character and a sound temperament are also to be built up, at the side of a sound interest. Here again everything depends upon a wise balance between the development of that which is given by nature to the particular individual and the reënforcement of that which society demands and which belongs therefore to the common equipment. The emotional stability and emotional enlargement of the mind is perhaps most neglected in our educational schemes. On the one side it demands a systematic discipline of the emotions, on the other a healthy stimulation of emotions. Here is the place where imagination in play and later in art come in. The biological value of play always lies in the training for the functions of later life, and especially for the emotional functions. The play of our children is too little adjusted to this task. For this reason it leaves too many unprepared for the world of art and for the emotional experiences of real life. Both lack of emotional discipline and narrow one-sidedness of emotions interfere with the harmonious development. Destructive emotions like terror ought to be kept away and not needlessly brought near by uncanny stories and mystic superstitions. It is the healthy love and sympathy of the home which contributes most strongly to the normal development of emotions. Again in the field of will, we want the strong, spontaneous, independent will which is not frightened by discomfort and not discouraged by obstacles, and yet we want the will which is not stubborn and selfish but which subordinates itself to the larger will of the social group and to the eternal will of the norm. There is no balance where independence and subordination do not supplement each other. A wide education not only trains for both but also secures habits which work as autosuggestions in both directions.

But all this harmonious development of intellect and temperament and character has to go on when the school days are over and just here begins the duty of the community as a whole. The special functions of the teachers have to be taken up by the public institutions. The whole social life must shape itself in such a way that everyone finds the best possible chances to perfect this harmonious growth. In the field of the intellect, the community must take care that thoroughness of training and accuracy of information is rigidly demanded and not thrust out by an easy-going superficiality. The expert ought to replace the amateur in every field. Every society which allows successes to superficiality diminishes its chances for mental health. Yet while thoroughness demands concentration in one direction, society must with the same earnestness insist on well-rounded general education and continuity of general interests through life. Literature and the libraries, the newspapers and the magazines play there a foremost rôle, and again the mental health of the community has to pay the penalty if its newspapers work against general culture. In the emotional field art and music, fiction and the theater on the one side, the church on the other side, remain the great schools for a development of sound emotions. Where literature becomes trivial, where the stage becomes degraded, and where the church becomes utilitarian and uninspiring, great powers for possible good in emotional education are lost. But with this enrichment of feelings the disciplinary influence too has to go through the whole social life. Where art is sensational and the church hysterical,—in short, where the community stirs up overstrong feelings,—the wholesome balance is lost again. In a similar way the public demands should throughout stimulate the energy and ambitions and initiative of the man, and yet should keep his desires and impulses in control.

Few factors are more influential in all these directions than the administration of law. Sound sober lawmaking and fair judgment in court secure to the community a feeling of safety which gives stability to emotions and feelings. The disorganization which results from arbitrary laws, from habitual violation of laws, from corruption and injustice works like a poison on the psychophysical system. A similar unbalancing influence emanates from overstrong contrasts of poverty and comfort. A poverty which discourages and leaves no chances and a wealth which annihilates the energies and effaces the consciousness of moral equality, create alike pernicious conditions for mental balance.

Unlimited furthermore are the influences which depend upon the sexual ideas of the society. It is the sphere in which it may be most difficult to indicate the way towards a development without dangers. There is no doubt the arbitrary suppression of the sexual instinct must be acknowledged as the source of nervous injury while indulgence may lead to disease and misery. But in any case frivolous habits and easy divorce contribute much to the unbalanced life which ruins the unstable individual. Not less difficult and not less connected with the mental hygiene is the alcohol problem. For normal adult men mild doses have through their power to relieve the inhibitions undeniable value for the sound development of the community. Its intemperate use or its use by young people and by pathological persons is one of the gravest dangers. Whether intemperance ought to be fought by prohibition or rather by an education to temperance is a difficult question in which the enthusiastic women and ministers, backed by the well justified fears of psychiatrists, will hardly be on the same side as the sober judgment of scientists, unprejudiced physicians, and historians. In any case the saloon and its humiliating indecency must disappear and every temptation to intemperance should be removed. Above all, from early childhood the self-control has to be strengthened, the child has to learn from the beginning to know the limits to the gratification of his desires and to abstain from reckless over-indulgence. With such a training later on even the temptations of alcoholic beverages would lose their danger. Not less injurious than the strong drinks are the cards. All gambling from the child’s play to the stock exchange is ruinous for the psychophysical equilibrium. The same is true of any overuse of coffee and tea and tobacco, and as a matter of course still more the habitual use of the drugs like the popular headache powders and sleeping medicines. The life at home and in public ought to be manifold and expansive but ought to avoid over-excitement and over-anxiety. A good conscience, a congenial home, and a serious purpose are after all the safest conditions for a healthy mind, and the community works in preventive psychotherapy wherever it facilitates the securing of these three factors.

For that end society may take over directly from the workshop of the psychotherapist quite a number of almost technical methods. Suggestion is one of them. The means of suggestion through education and art, through the church and through public opinion, through example and tradition, and even through fashion and prejudices, are millionfold, but not less numerous are the channels for antisocial and antihygienic suggestions. No one can measure the injury done to the psychophysical balance of the weaker brains, for instance, by the sensational court gossip and reports of murder trials in the newspapers for the masses. But while the influence of suggestion is on the whole familiar to public opinion, the community is much less aware of another factor which we found important in the hands of the psychotherapist. We recognized that mental disturbances were often the result of suppressed emotion and repressed wishes. For the cure the psychotherapist has to aim toward the cathartic result. The suppressed ideas had to be brought to consciousness again and then to be discharged through vivid expression. Society ought to learn from it that few factors are more disturbing for the mental balance than feelings and emotions which do not come to a normal expression. It is no chance that in countries of mixed Protestant and Catholic civilization, the number of suicides is larger in Protestant regions than in the Catholic ones where the confessional relieves the suppressed emotions of the masses. This is also the most destructive effect of social and legal injustice; emotions are strangulated and then begin to work mischief. The community should take care early that secret feelings are avoided, that the child is cured from all sullenness which stores up the emotion instead of discharging it. Certainly all education and social life demands inhibition and also the child has to learn not to give expression to every passing feeling. To find there the sound middle way is again the real hygienic ideal. Too much in our social life and especially in the sphere of sexuality forces on the individual a hypocrisy and secrecy which is among the most powerful conditions of later mental instability.

Of course the background of a hygienic life of the community remains the philosophy of life which gives unity to the scattered energies and consequently steadiness to the individual through all his hazards of fate. It might seem doubtful whether society could get the prescription for such a steady view of the world also from the workshop of the psychotherapist. To the superficial observer the opposite might seem evident, as every word of our psychotherapeutic study indicated that that is a view of life which makes man’s inner experience simply an effect of foregoing causes. All life becomes a psychophysical mechanism and from that point of view man’s thinking and acting become the necessary outcome of the foregoing conditions. Nothing seems more unfit to give a deeper meaning to life and a higher value. And yet if there was one thought which controlled our discussion from the beginning, it was certainly the conviction that this causal view itself is only an instrument in the service of idealistic endeavors; the reality of man’s life is the reality of will and freedom directed towards ideals. One of these ideals is the reconstruction of the world in the thought forms of causality. In the service of our ideals we may thus transform the world into a mechanism: out of our freedom we desire to conceive ourselves as necessary products. Whenever we aim to produce changes in the world, we must calculate the effects through the means of this causal construction, but we never have a right to forget that this calculation itself is therefore only a tool and that our reality, in which our duties and our real aims lie, is itself outside of this construction. The psychotherapist wants to produce effects inasmuch as he wants to cure disease. He is therefore obliged to adjust his work as such entirely to the causal aspect of man, as soon as he wants to seek the means by which he can reach the end. But even the fact that he decides in favor of those ends, that he aims towards their realization, binds him to a world of purposes, and therefore, he, too, with his whole psychophysical work, stands with both feet in a reality of will which is controlled not by causes but by purposes, not by natural laws but by ideals.