THE MODERN MEDICINE MAN

Medicine, like other natural phenomena tends to the cyclic. Having passed safely through the drug period of evolution, both allopathic and homeopathic, into the no-drug state of so-called “preventive medicine” which has nothing to do with medicine as the word is commonly understood, this ancient mystery of the cure of bodies is now reunited to its equally ancient but long alienated mate the cure of souls, and this bewildered generation is confronted with the amazing spectacle of the lion of science and the lamb of religion lying down together. Whether the ultimate resting place of the lamb will be inside the lion is not yet disclosed to the anxious and inquiring mind. Again the priest and the physician are combined in one person, and we see before us the modern counterpart of the antique medicine man who exorcised the devils that possessed and tormented the soul and the body, and by sorcery and incantations treated impartially diseases of the spirit and of the flesh. Again the accepted cure for blindness is to “go and sin no more.”

It is especially that borderland where soul and body meet and fuse in what a recent treatise on the diseases of the nervous system calls “the psychic or symbolic system” that the modern medicine man takes as his province. In this No Man’s Land he is master of all he surveys, and his sextant comprises the universe in its angle.

We are prone to think of diseases of the mind as a specialty of modern life. But the briefest review of history would indicate that these symptoms of maladjustment to the environment have been evident from the earliest times. Adam and Eve are said to have developed “paranoiac delusions of persecution,” a kind of manie à deux, accompanied by hallucinations of vision described as “seeing snakes.” Their elder son was afflicted with a “homicidal mania,” while the younger was apparently a case of “constitutional inferiority.” Noah was a well recognized “alcoholic,” Job was subject to severe “depressions,” Nebuchadnezzar exhibited “praecox dilapidations of conduct” and Saul was a pronounced “manic-depressive.” The Bible contains many edifying and well worked-out case histories with prescriptions for the treatment of such difficulties. It was Isaiah who outlined the newer method when he said, on the highest authority, “Come now, and let us reason together, saith the Lord: though your sins be as scarlet, they shall be as white as snow.”

It was perhaps through dwelling on his own race history and literature that the newest prophet in Israel, the famous, to some infamous, Viennese professor, Sigmund Freud, came to invent the latest prophylaxis for mental disorders, now widely known under the name of psychoanalysis, at present the best recognized specific for many mental disorders, and particularly for those orgies and “hang-overs” of the soul, the “manic-depressive psychosis.”

This is the chief of the new designations for one of the old diseases, the failing reserved for the especially refined and subtle mind, the form of complex developed most frequently in the most delicate psychological machinery. This psychosis is the protest of the winged spirit against the humdrum dead levels of the main-traveled roads, a near relation to the “hysteric” refuge of the æsthetic nature from the vulgarities of everyday life, the “præcox” preference for childhood’s happy hour, and the “paranoiac” escape from the banalities of a society composed too exclusively of well-meaning, friendly but unbearably tiresome folk. All these phenomena are but the outbreak of the higher nature, the reaction of the superman, that creature of light and air, to the dullness and dreariness of this underworld, in which the chrysalis drags out its drab and worm-like existence before the emergence of the butterfly.

In view, however, of the stubborn fact that the superman must continue to exist (unless indeed non-existence is the state preferred) in a world made up largely of subnormal, or even more deadly normal beings, the overbred and super-sensitive must seek some form of reconciliation to the fundamental absurdities that pass for real life, must even submit to something in the nature of a “cure” for the disease of superevolution, some esoteric bloodletting process as it were, in order to restrain the impulse to skip like a lamb in the sun on the hillside, and confine the gait to an anemic crawl along the narrow path of the commonplace.

Psychoanalysis appears to be the “indicated” treatment for these adjustment difficulties, and it is the purpose of this article to suggest to the as yet uninitiated some of the novel features in the mechanism of this psychotherapy, and to offer a few reflections thereon.

To assume the greater ease of the first person singular, I should perhaps say in passing, or by way of apology, that if I appear somewhat unduly and indecently personal in my observations on the new psychology, it is a habit fastened upon me by a half year of indulgence in an orgy of such voluble self discussion and analysis as I had previously fondly fancied to exist only in young ladies’ boarding schools. Figure to yourself, if you can, the inevitable result of conversing about your “soul,” and unburdening all its secrets and reserves in tri-weekly sessions with an inquisitive stranger! The process is a throw-back to those unsophisticated days when the Knight of La Mancha and a group of other romantics, met for the first time by accident in a country inn, whiled away the long evening in the unrestrained and interminable narrations of their lives and loves, complacently revealing to one anothers’ sympathetic and, one would imagine, sometimes startled gaze, the secret springs of their existence.

The psychoanalytic process begins, I may explain, with such a relating of one’s personal history, occupying many hours, and covering all that one has ever done, said or thought. One starts with reminiscences of the nursery and the kindergarten, and passes on to a detailed description of the coloring, height and contour of one’s first love. As this, in the case of a woman, is supposed to be her father, it is necessary to pause for some time on the aspects of the paternal figure, which affect all her subsequent emotional reactions, according to the well-known course of the so-called “Oedipus complex.” This is the imposing designation for the generally observed preference for each other of mothers and sons and of fathers and daughters, a phenomenon that the new psychologists, who take the common place with a seriousness! deem worthy of the most painstaking examination and erudite elucidation. “The root complex” and “the family romance” are other alluring titles for this parental-filial relation. This sentiment is supposed to modify all the so-called “affective” life. If father happens to be tall and thin and blond, then daughter, having a “fixation” on him, is, for all time to come, particularly susceptible to the attractions of tall, thin, blond men of advanced years. The analyst inquires minutely into the shades of complexion of all the patient’s inamorati in a manner that recalls the familiar “I see a dark man coming over deep water” of the tea-leaves in the tea-cup stage of one’s experience.

After the patient has sternly and heroically resisted the temptation to invent in the interest of her own self-respect, and also in mitigation of the ill-concealed contempt of the masculine practitioner for the paucity of her experience, a few more numerous and more romantic emotional episodes than have actually been doled out to her by a penurious fate, and has completed the short and simple annals of her poverty-stricken heart history, and after the incredulous inquisitor has become at last convinced that there is indeed nothing more to be told, this chapter is closed, and then begins the régime of dreams and “free association.”

The interpreting of one’s dreams seems to furnish the doctor with a secret source of amusement that he tries in vain to dissemble, and as one is only too glad to make up to him in some measure for the hours of obvious boredom that he has endured while listening to one’s apologia pro vita sua, one indulges him by forming the careful habit of grasping firmly by the tail every elusive dream as it tries to whisk around the corner of consciousness during one’s first waking moments, pulling it painfully and resistingly back for close and detailed scrutiny, and laboriously committing to memory and subsequently describing its every feature and function at the next matinée performance at which one makes an appearance.

The chastening discovery of the dreamer who relates his dreams to the professional interpreter is that all that has been carefully withheld from revelation in the related autobiography, is disclosed with the most embarrassing crudity, and that secret sins of which one was quite unconscious are displayed with mortifying clarity. The dream is a mechanism for letting the cat out of the bag, all kinds of strange cats, of the existence of which their harborer was often unaware.

Dreams seem to reveal the dreamer as a hypocritical, evasive, self-deluding coward, unable to face the commonest facts of life, or to call a spade anything less innocent than a parasol, or even to confront his own friends and acquaintances, except by forcing them to masquerade under some so-called “surrogate” form.

My previous personal experience had led me to identify a surrogate as some kind of judge, but I soon learned that this narrow and technical meaning must be replaced by the more general signification of “substitute,” though why the word substitute should not be considered good enough to use in this connection, I never learned. This is but one of the many examples of the perverse preference of the technicians of the new science for strange distortions of words with well recognized and frequently quite different meanings in common parlance. It comes as somewhat of a shock to the beginner to hear all emotion summarily classified as “sexual,” normal filial or parental affection designated as “incestuous,” friendship as “homosexual,” self-respect as “narcissistic” and the life force or will to power as “the libido.” Soon, however, one becomes as resigned to this strong language as to the evolutionary hypothesis, and finds it a no more unpalatable thought that all emotion is derived from sex than that all human beings are descended from an apelike ancestor. That this common use of the exaggerated statement leaves no adequate expression for the more intense emotions fails to disturb a cult that apparently regards all differences of feeling as of degree rather than of kind.

The narration of dreams puts slight work on the dreamer, and sorely taxes the mental resources and the ingenuity of the interpreter, but the real labor, the strenuous and unremitting toil to which the unhappy victim of this ritual is subjected by a pitiless practitioner is in the rigors of what goes by the disingenuous name of “free association.” This may sound like some pleasant if not spicy and highly unconventional pastime, but is in fact and literally a procrustean bed of torture. The helpless patient is forced to remove her bonnet and shawl and recline upon a couch with her eyes closed. Her merciless tormentor retires to a comfortable armchair in a corner of the room. There, because he is out of sight of the patient, he is supposed, according to the workings of the mysterious masculine psychology, to be entirely removed from her consciousness, so that she can concentrate her mind on nothingness, just as if she were alone by the fireside. Then he starts in with something like the following initiation of the third degree: “What are your associations with the word authority?” You are supposed to respond to this irrelevant inquiry with something like the following idiotic emanations, “Government—Washington—the President—Mrs. Wilson—orchids—grandfather’s greenhouse,” and if you are entirely resigned to making a fool of yourself, and can abandon yourself to the spirit of this child’s play, this is what you finally learn to do, after many strenuous efforts to play the game, and the final attainment of a reasonable self-stultification.

If, however, as is likely to be the case, you are a more or less feminine person, instinctively unwilling to exhibit your mind in déshabille, and fatuously intent with a persistency worthy of a better cause on making a good impression on the only person present, you learn to use these opportunities to tell him everything to your credit that you can think of, and by carefully working out, preferably in advance, a chain of passable associations, to present yourself, your character, and your career in the most favorable light. The wide range of possibilities in this process that are open to the designing patient seems to be scarce dreamt of in the philosophy of the gross masculine mind.

This brings me by easy and inevitable stages to the important topic of the “transference.” To the unenlightened this may be defined as the mock modest and deceptive designation invented by the psychoanalyst for the more or less ardent affection for himself that he cold-bloodedly sets out to inspire in his victim. The doctor, for the benefit of his patient, temporarily transfers to himself and appropriates the devotion which normally belongs to father, brother, husband, son or lover. To be sure, it is to remembered that as there is no such word as friendship in the psychoanalytic vocabulary, an attitude of confidence or admiration must be represented in terms of a deeper sentiment.

Of course what happens is that the patient mistakes for an attachment of the heart what is in reality only an intimacy of the mind, because such an abandon of reserve is indissolubly associated in the feminine mind with the ties of affection. According to the true Jamesian psychology, she loves because she confides, instead of confiding because she loves. How a poor man patient manages can only be surmised, but there are indications that the knowing of the sex furtively seek the ministrations of a woman analyst.

Apparently the theory on which all the varied forms of this treatment are based is that the catharsis of the mind is essential to mental health, the emptying of all that is in it, the expulsion of dead matter. The nausea of the soul is relieved like its physical analogue by freeing it from the undigested matter, the “repressions,” that lie so heavily upon it. The self-contained nature that refrains from spilling over and strives to maintain itself without recourse to the safety valve of confidence must in the end unload its burden.

After the destructive process is completed and the ground cleared for the constructive measures that are to rear the temple of the “mens sana in corpore sano,” the heavier half of the work remains to be done; for the gigantic task to which the practitioner of the new prophylaxis sets himself is nothing less than the reconstruction of the character of the patient. Indeed, a recent work on psychoanalysis has for its title The Mechanisms of Character Formation. The conversions that the Rev. Mr. Sunday and his less notable peers are wont to accomplish in an hour, these painstaking scientists patiently bring about in from some scores to some thousands of hours of equally strenuous labor. I am informed that the cure of the first case of a certain type undertaken by one of these under-studies of the Eternal, actually consumed two thousand hours, and that the cure of the specific disease required the entire reconstruction of the character of the sufferer. Presumably the bill for “professional services” involved in this beatification was $20,000. One wonders whether the character that resulted was worth the price. The consulting room of the psychoanalyst is the new Beauty Parlor where those dissatisfied with their mental and moral physiognomy may have the lines of stress and strain smoothed away, and may gain the roses and lilies of a rejuvenated spiritual complexion. Unhappily I am unable to speak at length and with authority on this phase of the treatment; for I am at present only just entering upon the period of metamorphosis. I see dimly, “as through a glass darkly,” my own apotheosis looming ahead, but the road to that celestial height looks a long and weary and appallingly expensive journey.

It is the time element that perhaps most impresses and depresses the student of the new prophylaxis. In a recent paper by a competent psychiatrist the writer refers as follows to the impracticability of studying a group of cases in a public hospital on the plan of getting the patients to understand and explain their own difficulties:

At the rate at which the best of the psychoanalysts work, it would not be possible properly to study in the course of the year more than a dozen cases. Furthermore, the results of such work are of importance purely for the individual, and no generalization can be drawn therefrom…. Also, no generalization being possible, it is a matter of piece work; to study one hundred cases according to this method would require the efforts of fifteen to twenty psychologists on full time for many months.

In the opinion of the faithful, Freud, the inventor of psychoanalysis, is to psychiatry what Darwin was to biology, but as Darwin’s theory of evolution required more aeons than the geologists were able to oblige him with, so Freud’s method requires more time than the calendar affords. Darwin’s theory of the variation of species had to be modified by the theory of mutations or sports. Freud’s methods, to be workable, must be adapted in some way to the indisputable fact that there are only twenty-four hours in the day, and only three hundred and sixty-five days in the year.

A careful mathematical calculation of the number of hours required to cure a psychosis by this new prophylaxis reveals an alarming disproportion between the minute number of physicians available, and the incalculable number of patients requiring their ministrations. One of the most ardent devotees of the new method is a practitioner who, according to the testimony of a confrère, enters upon his daily endurance test at 9 A. M. and without any luncheon psychoanalyzes continuously until 7 P. M. As the ordinary patient is supposed to require three hours a week of this treatment, for about five months, the doctor can, by working ten hours a day, treat twenty patients in one week, or allowing him two months vacation in summer (and he will need it) handle forty patients in one year. This, alas, is but a drop of medicine in the bucket of disease, and unless, by some homeopathic adaptation of the five-hundredth-dilution principle, we can make our medicine go farther it is only a limited number of the rich and leisure class who can ever be cured by these new methods. This is the prostrating situation that confronts the humanitarian—a little group of healers bravely but hopelessly taking up arms against a sea of mental troubles.

One cannot help wondering whether such exhaustive thoroughness is really essential. It seems sometimes to the disillusioned seeker after truth that the relation of the conscious life history, the revelation of the unconscious through dreams, the display of the mental processes through “free association,” are but the hocus-pocus devised for keeping up the conversation between the analyst and the analyzed—a crude, clumsy, masculine technique for discovering, by somewhat labyrinthine methods, the essence of the personal quality of an individual. Might not this be obvious in a few hours of ordinary intercourse to a person of intuition, practised in the art of plucking the heart out of a mystery, instead of chopping up the whole anatomy to get at it?

The expenditure of time and effort and money required to gain the occult ends of what seems like a blind and blundering process, is certainly colossal. What the patient puts into it is comparatively unimportant. A fool and his money might as well be parted sooner as later, and the time of the patient, especially in the state of depression in which he ordinarily seeks treatment, is worth so little that killing it is as good a use as any to make of it. But think of the physician—a man of parts, of much general and special education, who has added to a large professional equipment the complicated technique of a laborious method that only a German thoroughness gone stark and staring mad, could perpetrate on a makeshift world, which, with all its failings, has not lost its sense of humor or its perception of the relative value of things mundane, and does still discriminate between time and eternity. Think of a first rate mind expending itself for hours on end in the minute scrutiny of some trivial neurotic mentality, probably as like as two peas to thousands of other equally insignificant particles of matter that pass for individual organisms.

If indeed the interest in another personality is the essence of the “cure,” one is tempted to ask why these egocentric erotomaniacs should not derive the same and mutual benefit from interesting themselves in one another? Why not pair them off, male and female as originally created, and embark them together on this ark of refuge from the deluge of the common life in which they are drowning? Let them sit by the hour, the day, the week, and talk about their “souls,” relate to each other’s absorbed attention their life history, interpret each other’s dreams, and join in the freest of “free association.” Let the blind lead the blind, the sick heal the sick, the erotic love the erratic, and silly soul mate with silly soul, leaving the authentic souls of the doctors to be saved from stultification, and their talents used for the benefit of human beings who are really and truly suffering.

But, alas, there seems to be no such easy panacea for mortal ills: for to attain its ends the process must apparently be presided over by a superior if not superhuman intelligence. And the patient, if scientifically or benevolently minded, can take comfort in the thought that his case is perhaps sufficiently different from any hitherto handled to enable the investigator to benefit almost as much as the patient by the experience. Perhaps the months that the biddable patient who has overcome his “resistances” devotes to coöperating with the scientific explorer, may be reduced to weeks in the treatment of the next like-minded individual who submits himself for treatment by the more practised practitioner. I recall my despairing comment upon a doctor’s tale of the case that it took two thousand hours to cure, and the reassuring response that, now that the technique had been worked out and published, any competent person could turn the trick in from one-tenth to one-twentieth of the time.

The psychoanalytic approach to mental prophylaxis is perhaps still, after twenty years of groping progress, in the experimental stage. The few bold spirits who have braved the ridicule of their conservative confrères, and left the main travelled roads, are hardy pioneers blazing trails and treading out paths that will in time be easy traveling. It is inevitable that in the delicate operations by which these spiritual sawbones are mastering the mystery of this new art of the vivisection of the soul, they should sometimes cause pain or even cut in the wrong place. But they are inspired by a very human sympathy for their victim-beneficiaries, and are rapidly learning their way about the spiritual anatomy, and discovering the skillful use of mental anæsthetics.

The strangest thing about this extraordinary process is that it really does cure the mind diseased. Where and what, one asks, and continues to ask, is the nexus between treatment and cure. Has any patient, however completely recovered, ever found out? Do the practitioners of this occult ritual know themselves, or have they simply hit on a practical technique, without a comprehension of a rational philosophical basis for its major operations? Is this like early groping experiments with “animal magnetism,” or mysterious forms of electricity which brought results long before an understanding of the reason of their success was arrived at? However this may be, it still remains true that, judged by its results, the new method, however dark and devious, must still be acknowledged to have attained a success, not sporadic and accidental, but continuous, consistent and increasing, and apparently, though incomprehensibly, connected as effect to cause with the procedure which has been sketched, or shall I say caricatured, in the foregoing pages.