Of course we must make all possible use of every psychotherapeutic factor, especially of the explanatory method as I have described it. The last remarks I made on this subject were merely intended as a warning against exaggeration.

I now come to the discussion of volitional therapeutics. This is often confused with explanatory therapeutics, and even Rosenbach and Eschle do not make a proper distinction between the two. Although both methods are sometimes used together as "educational therapeutics" - there are many cases in which the patients can only be induced to exercise their will by first of all instructing them as to the necessity of this procedure, - they may be employed independently. As far as volitional therapeutics is concerned, we must remember that the activity of the will is of two kinds - the external or objective, which is shown in the external movements and actions that depend upon the will, and the internal or subjective, which can arbitrarily arouse mental processes, such as ideas, feelings, and emotions. Both the external and the internal activity of the will may excite or inhibit; the will can cause movements and actions, or check them; in the same way it can, within certain limits, arouse ideas, feelings, and emotions, or suppress them. One part of volitional therapeutics is, historically, closely connected with hypnotism, but some of its branches, have developed independently.

We come across the external activity of the will in the form of active mental gymnastics long before the days of modern hypnotism; and that, too, as a branch of physical therapeutics, although it might equally well be included in psychotherapeutics. For instance, the attempts that have long been made to improve the conditions set up by apoplexy by means of exercises really constitute an employment of the activity of the will. This branch of psycho-therapeutics has long been used for disturbances of speech following apoplexy, the patients being instructed to repeat sentences and go through other exercises. Whether the compensation produced is organic or functional in such cases - we are following Luciani's scheme - has no bearing on the inclusion of this method of treatment in psycho-therapeutics. Moreover, hypnotism has not been without influence on the external gymnastics of the will. The name of this branch of treatment is occasionally associated with hypnotism. Under the name of suggestion-gymnastics Lehmann has described a method of gymnastics for the paralyzed with the object of rendering non-conductive but undestroyed paths permeable by the will.

The chief point is for the patient to concentrate his will as much as possible on the movements to be performed, and to learn to believe in the results of his own activity. Frenkel has also recommended that the treatment of ataxy should be considered a branch of psycho-therapeutics. Our object should be to restore the lost power of co-ordination by exercises in which the mind plays the greatest part. Of course it is of the greatest importance that the patient should concentrate his whole will on the correct co-ordination of the movements he is told to carry out. Granted that the influence of hypnotism on muscular gymnastics is not to be denied, it is of much greater importance where the inhibitive effect of the external activity of the will is concerned. It has frequently been used in recent times to suppress convulsive movements, and often gives good results in cases of chronic chorea, though it is less effective when the complaint is acute. But it is particularly useful in all other kinds of convulsions, especially such as are termed tics.

Meige, Feindel, Brissaud, Oppenheim, and others have given examples of the great efficacy of will-gymnastics. The influence of the will must be methodically strengthened by at first limiting the suppression of the unpleasant symptom to only a few moments, indeed only to seconds, and then gradually increasing the duration of the effort. It will always be possible to increase the effect by using all kinds of accessory measures, such as making the patient look in a mirror while he is performing the exercise, as he would otherwise fail to notice the involuntary movements he makes. It is also important to let the patient rest for a time after his attention has been kept fixed. Although this branch of psycho-therapeutics has been greatly furthered by hypnotism, it is not altogether new. In former times people were often enough somewhat hazy as to the psycho-therapeutic character of this method of treatment. I remember the treatment of writer's cramp that was recommended by the writing-master Julius Wolff a long time ago, and which consisted in a combination of massage and gymnastics. The treatment of stammering also has its place here. The exercises in breathing and speaking that are set a stammerer likewise serve to strengthen the influence of the will on the motor sphere of speech.

The treatment of stammering, moreover, shows how little we are able to separate the suggestive element from other influences. Apart from the fact that a patient is often influenced suggestively when the doctor who is treating him holds out the possibility of his being cured by exercises in talking, we have to consider that such exercises as well as the whole milieu tend to strengthen his trust in his own capabilities.1

But it is especially in its relation to hypnotism that the importance of the internal activity of the will has been recognized as a mental remedy. Certainly it had already met with popular commendation. Anybody suffering from pain was told he should not think of it, but pull himself together. But no methodical efforts were made to strengthen the patient's energy. In this respect hypnotism cleared the way. By showing how much can be done by hypnotic suggestion, it raised the question whether the same results could not in many cases be obtained by the action of the patient's own will. In many cases this question must be answered in the affirmative, although it may often happen that a methodical strengthening of the will is first of all necessary. I must here refer to what Payot, who has thoroughly discussed the therapeutic employment of the will, has said of the influence of the latter on the sequence of ideas. He has rightly pointed out that every recollection that is not from time to time repeated gradually fades, and finally disappears from memory. We are to a great extent master of the attention we pay to anything, and we might easily eliminate a memory-picture by striving to resist its recurrence.