But as the patient has frequently no tendency to do this, his doctor must guide him. In many cases of imperative ideas, either with or without a feeling of dread, the evil may be combated by gradually and methodically increasing the pressure brought to bear on the patient. In a case of agoraphobia the doctor should recommend the patient to gradually increase the length of his walk, or to take a companion with him at first - this generally does away with the feeling of fear, - and then to increase the distance from the companion gradually. I have often seen this method succeed with people who were afraid of railway-travelling. This enables the patient to take longer journeys, and it is often noticeable that people who have made some little progress in this way get on rapidly afterwards. For instance, when a patient who could only remain a few minutes in a train gradually becomes able to stay in one for half an hour, the transition to journeys lasting days and nights will be very rapid.

1 It often happens that the effect of suggestion is favoured by telling the stammerer that the doctor who is treating him formerly suffered in the same way and was cured by the method he advocates.

Another phenomenon, often closely connected with imperative ideas, may also be beneficially influenced by gradually increasing the patient's energy. Many patients who suffer from imperative ideas feel a constant impulse to talk about their malady. This is very trying to those about them, and gradually alienates any sympathy. In such cases it will prove beneficial to the patient and his surroundings little by little to teach him self-control. I have often observed that patients who are given permission to talk about their complaints for a specified time, such as an hour twice a day, never take advantage of the permission, even in those cases where they were formerly in the habit of complaining about the imperative ideas that troubled them, every time they met a relative. Even if this treatment fails to bring about any improvement in the patient's disease it is none the less of importance, for it prevents him from annoying his relatives with constant complaints, and thus enables him to retain their sympathy.

This circumstance must not be underrated, for there is a limit to the forbearance that relatives can be expected to exhibit.

Volitional therapeutics, especially the exercise of the internal activity of the will, of course often greatly taxes the patient's powers. From this it should be evident that it will generally be as well to explain to the patient the purport of the treatment he is to undergo, especially when the disease that he is to assist in eradicating is not precisely irksome to himself. This refers particularly to the affections included in the generic term sexual perversion. I shall enter into a somewhat detailed discussion of this point, because, in the first place, the treatment- of sexual perversion by the influence of the activity of the patient's own will constitutes a paradigm for therapeutics of this nature; and, in the second place, because the importance of volitional therapeutics in combating such affections has been very much underestimated. When a person suffering from perversion - a hernosexual, for instance - is to be cured by the activity of his own will, he must be addressed in something like the following terms: - "All sexual thoughts, whether normal or perverse, may be divided into two groups according to their mode of origin - the voluntary and the involuntary. The latter often arise without its being possible to state the cause.

An accidental meeting with a sympathetic person, a sentence in an otherwise harmless book, or an organic stimulus such as the accumulation of semen will often arbitrarily arouse sexual ideas. But sexual ideas are frequently produced voluntarily. People try to create voluptuous feelings by recalling past events of an exciting nature and giving free scope to their imagination. It is hardly possible for there to be a normal man who has not at times let his fancy run on such subjects. And this applies equally to the perverse as to the normal individual." The method by which perversion is to be combated must depend upon a distinction being made between voluntary and involuntary sexual ideas, The victim of perversion cannot fight involuntary ideas successfully, but he should concentrate all his energy on avoiding the voluntary creation of perverse fancies. Indeed, whenever perverse ideas crop up involuntarily, he must endeavour to suppress them by an effort of will. It is immaterial, in this respect, whether the patient endeavours to create normal sexual pictures in his mind or betakes himself to some occupation that will distract his attention, provided he does his utmost to suppress perverse mental images.

Although the vast majority of patients assert that the perverse thoughts arise involuntarily, there can be no doubt that the voluntary ones must first be got rid of if we are to succeed in suppressing such as are involuntary. But in addition to this we must exert ourselves to make the patient sensitive to normal sexual stimuli. For this purpose he should either be led from time to time to direct his attention to normal sexual processes, or else should be occasionally given an opportunity of testing his capacity to react to normal sexual stimuli. This can, for instance, be accomplished in the case of a homosexual man by placing him in the right kind of female society. The chief point, however, is not, as some occasionally assume, that the homosexual individual should seek intimate heterosexual intercourse, but rather that he should learn to react to the charms of persons of the opposite sex by frequently associating with them. There can be no manner of doubt - and this refers equally to the homosexual, the paedophile, the fetishist, the masochist, and the sadist - that many persons can be brought in this way to lead a normal sexual life without any suggestive treatment The central idea of the treatment is that the patient should avoid the voluntary induction of perverse sexual notions, and should also attempt to combat any that may arise involuntarily; on the other hand, he ought to force himself to create normal sexual ideas.