I have often found it of great assistance that the patient should form sexually normal ideas shortly before going to sleep. This frequently appears to act beneficially in bringing about dreams that are normal from the sexual point of view, which, it is well known, hardly ever occur in cases of perversion.

It is perfectly clear that the activity of the will can only be employed in combating sexual perversions where the patient is endowed with moral strength of a high order. A person who is sexually perverse will be as little inclined to avoid dwelling on lascivious ideas as is the normal individual to turn away from agreeably voluptuous thoughts. The real danger consists in the disinclination of the patient to give up sexual fancies congenial to himself, and to substitute for them a set of ideas which are just as unsympathetic to him as would be the perverse notions to a normally constituted man. But experience teaches us that many of the perverse do develop the necessary energy. And experience also proves that in many of those cases - especially of young people - in which the patient co-operates with his medical adviser, the result is thoroughly satisfactory. When the patient avoids all voluntary perverse fancies, normal sensation not infrequently ensues.

I have only given sexual perversion as an example; there are many other cases in which much can be accomplished by voluntary efforts at suppression - such, for instance, as idiosyncrasies of auto-suggestive origin, and all kinds of psychogenic disturbances.

The foregoing considerations show the close connection that subsists between volitional therapeutics and habit. We are able to attain the power of influencing all kinds of mental processes by regularly and methodically employing the will; we are further able to modify the functions of the body very considerably by increasing the influence of the will, as we saw, for instance, in the case of muscular activity. . It is even possible to acquire an influence over functions not controlled by the conscious will - those of the bowels, for instance. It is possible by inducing a habit to bring about action of the bowels in the chronic constipation from which so many nervous people, and sometimes even whole families, suffer. A remedy that is often recommended consists in advising the patient only to go. to the closet at a specified hour every day and also to resist to the utmost any inclination in that direction at other times. We often observe when employing this method that although, in many cases, the patient may not at first have a motion at the specified time, he gradually gains such control over his bowels that one very soon occurs regularly at the time intended.

On the other hand, many people bring on constipation from a false sense of modesty; this occurs, for instance, with school-girls who are often ashamed to let their companions know that they could possibly be troubled with a natural function of that kind. Frequent suppression of the natural desire to defecate gradually sets up a sluggish action of the bowels and finally brings on chronic constipation prove harmful to a pampered individual. These facts must be taken into special consideration where children are concerned, for it is only in this way that the latter can be made resistant.

Powerful or sudden emotions have also been known in many cases to exert a favourable influence on health. Hysterical paralyses have been cured by horror. A well-known historical instance is that of the son of Croesus, who recovered his speech when he saw a soldier attempting to kill his father. Fright is also sometimes of service. Hack Tuke relates that an epidemic of somnambulism in a school stopped directly a couple of buckets of cold water had been thrown over one of the pupils just as he was beginning to walk in his sleep. Boerhaave brought an epidemic of convulsions to an end by threatening to use the actual cautery. Every practitioner of experience has observed some similar occurrence, though often only by accident. But we must, as a rule, be very cautious in the use of sudden emotions, especially horror, for the consequences may be serious and cannot always be foreseen. It is certainly more frequently possible to utilize fear as a therapeutic, at least indirectly. Many patients only follow the advice given them when the consequences of disobedience are brought home to them.

A patient of mine who was suffering from alcoholic neuritis, and who was at the same time convinced that he could not do without alcohol, became an abstainer directly I told him, in strict accordance with the truth, that otherwise his paralysis would get worse and locomotor disturbances set in. The faradic brush, so often used in therapeutics, in many cases only has a mental influence, and that either by suggestion or, as Rosenbach points out, by the patient's fear of the pain that a repetition of its use would again bring on. It cannot be doubted that the hope of reward or the fear of refusal in respect to some special wish may induce the patient to exert greater energy in the direction desired. This may be observed even in the case of functions that take place involuntarily - nervous vomiting, for example. A patient troubled in this way sometimes ceases to be sick when she is told that she will have to be fed in a very unpleasant way artificially, perhaps per anum, should the vomiting continue. Again, a patient suffering from all kinds of tics will work all the harder to suppress them if it be hinted that he will be rewarded by a visit to the theatre or some other form of amusement.

Nevertheless, we must not fail to recognize that ethical considerations impose certain restrictions on a medical man. The psycho-therapeutic use of fear must never partake of the character of a punishment, for no doctor is ever justified in inflicting that. No matter how far a medical man's rights may be thought to extend, we must at least exclude from the sphere of his activity the power of inflicting anything that bears even the remotest resemblance to an indignity, under which head the question of the infliction of punishment by a doctor certainly comes. Such matters must be left to the proper authorities.