But there are further considerations that elucidate the influence of mental processes on the symptoms of organic diseases. We know that pain often disappears, or becomes less appreciable, when the patient's attention is diverted from it. We know, further, that hypnotic suggestion can render a subject insensitive to the prick of a pin; indeed, minor surgical operations can be carried out painlessly in this way, although there certainly must be a certain amount of organic irritation which would otherwise cause pain. We must remember that a peripheral stimulus alone does not suffice to set up a sensation of pain; that only happens when central processes are set going by the peripheral stimulus. We know, further, that central processes mutually influence each other; the sensation of pain can be just as easily prevented by hypnotic or non-hypnotic suggestion as by diverting the subject's attention. These processes which have been observed after operations may also be expected to take place in cases of organic disease; and this may sometimes explain the symptomatic improvement which follows hypnotic suggestion and other psycho-therapeutic remedies in spite of the persistence of the organic disease.

Finally, many successful results can be explained by the fact that central processes (ideas, feelings, emotions) have a peripheral effect; the idea of a tasty dish causes a flow of saliva, shame leads to blushing, and fright to pallor; fear often has a great influence on peristalsis - we know that diarrhoea is a frequent consequence of dread and anxiety. It is sometimes epidemic among soldiers when they have to face fire. These things being so, we can understand that psycho-therapeutic processes at least produce a change in peripheral functions.

The attempts that have hitherto been made to explain these successes depend on the improvement that has resulted in many organic diseases from psycho-therapeutic measures, and must be kept quite distinct from the view that mental influence produces an anatomical change in a diseased organ directly.

I certainly do not deny that mental processes may set up organic change; in fact, I readily admit it. The facial expression of a subject mentioned by me on page 114 is a case in point. We further know that chronic emotions affect both personality and physiognomy - grief and care alter the facial expression. Dr. Weiss, also, holds that we should not curtly dismiss the possibility of hypnosis producing organic changes, and supports his view by referring to instances of the hair turning white from fright, and also to a case in which he saw a woman suffer from herpes labialis as the result of a sudden shock. Many other instances could be adduced to bear out the fact that such effects arise from mental influence. We accept mental strain, worry, and care as causes of mental disease; yet mental diseases are organic diseases of the brain, although we are seldom able to establish the nature of the organic change. I may further mention those cases in which a blister, or some other organic change, is produced by the suggestion that an epispastic has been applied. But in spite of all those objections raised by sceptics, I do not deny the influence of mental processes on the anatomical structure of our organs.

Unfortunately, we are unable to make any practical use of this influence, because it has not yet been proved that we can arbitrarily bring about those anatomical changes that are necessary to ensure the cure of organic disease.

A totally different view has certainly been expressed on this subject. Many earnest investigators - such as Delbceuf, Braid, and Hack Tuke - have expressed the opinion that organic diseases may be improved by suggestion, and they have given cases in support of their view. Recent investigators, especially Bernheim, have kept aloof from this view. I only mention this because Binswanger and Seeligmiiller mistakenly represent Bernheim as having maintained that the original organic injury is done away with by suggestion. Uncritical investigators have certainly reported many cures of organic affections by suggestion. Among such stories may be mentioned the supposed removal of warts by sympathetic remedies. Whether in such cases the organic affection is cured by mental influence or the warts disappear spontaneously appears to be a matter of detail. But we have much more right to doubt the professed cure of incurable diseases as related by charlatans. All depends upon the question whether the disease really existed or not. When quacks announce the miraculous cure of "cancer, tabes dorsalis," and similar affections by such methods as animal magnetism, we are compelled to ask how was the diagnosis arrived at? Quacks often assert that the diagnosis was made by a scientific doctor.

But that is no proof that such a diagnosis was ever made. Statements made by patients are anything but conclusive on this point; such people seem to take a delight in representing that they had been given up by some doctor. One thing is certain: it has never been proved that psychic methods bring about those changes necessary to cure an organic lesion.

Even if we cannot engender a trust in the psycho-therapeutic treatment of organic disease, it would nevertheless be a great mistake to ignore the value of certain mental methods. To satisfy the indicatio causa/is, psycho-therapeusis must be taken into consideration in those cases in which mental influence has been a contributory cause. This does not merely refer to functional diseases such as neurasthenia, but also to organic affections. The injuriousness of mental influence in cases of progressive paralysis is recognized even by those who consider syphilis the prime cause of the disease. C. Wollenberg includes mental strain among the causes of paralysis; also the exhaustion that is caused by the restlessness of modern life - competition, increased personal responsibility, and all the worries and deceptions of business undertakings. Kraepelin thinks that the attendants in lunatic asylums are often injured by their employment which tends to render them subject to degenerative psychoses. The same author also thinks that "emotional excess" has its significance.