Psychotherapy

"Psychotherapy. \- The modern branch of medicine to which has been given the name of "psychotherapy" may be regarded as covering all attempts made to mitigate or remove such symptoms as may be attributed to the operations of an unhealthy mind. These symptoms may be mental, for instance confusion of mind, or delusions, or obsessions, and may not be associated with any bodily symptoms or only with such as are trifling. On the other hand the symptoms may be bodily, for instance paralysis, or some form of loss of sensation, or indigestion, and may not be associated with any but trifling mental symptoms. The treatment of symptoms due to mental illhealth by physical agents such as rest, exercise, change of climate, baths, electricity or drugs is not psychotherapy.

Psychotherapy has been practised in all ages, sometimes upon those patently suffering from mental or moral disorders, but perhaps even more often upon those whose symptoms in fact depended upon mental or moral weakness or disorder but in whom the affection appeared, from the superficial character of the medical knowledge of the moment, to be due to organic disease of the body. In such cases psychotherapy has enjoyed considerable success, whether practised in connexion with religion and philosophy or with superstition and charlatanism (see Faith Healing, 10.135). Under circumstances such as these there has always been, and indeed still is, a formidable admixture of the miraculous, and it is not intended here to examine systems like that of Christian Science or the miracles of Lourdes. The term " psychotherapy " is of comparatively recent origin and has received wide acceptance in that it usefully stands for treatment based upon scientific psychology, normal and morbid. Three methods of psychotherapy will here be considered, from the purely medical point of view: those of Moral Suasion, Suggestion and Psycho-analysis.

Moral Suasion is historically the oldest method, and was advanced to a high level of excellence by the Stoic Philosophers. Illness, whether mental or physical, involves, to an extent depending upon the circumstances of the case and the character of the patient, pain and discomfort, disability with the fear of its consequences upon economic and social position and the fear of death. It is principally in the relief of discomfort and pain that persuasion has its success. Many patients are seriously alarmed at any abnormal feeling in any of their organs, are apt to call such feelings painful and to colour their descriptions with such adjectives as " awful " and " terrible." Others will ascribe symptoms of a commonplace character to serious disease of some important organ, - for example, when flatulence is mistaken for heart disease or turbid urine or pain in the back is regarded as indicative of kidney disease. Merely to induce such patients to be more precise in language and then in simple terms to offer some proximate explanation of their symptoms will often, without the association of any remedial agent, place their ideas in better proportion and mitigate or abolish their pains. Therapeutics have, very naturally, up till quite recent times been dominated by the endeavour to treat the symptom of which the patient complains rather than to attack the disease which is producing the symptom. For the most part treatment has been either by frankly miraculous methods or by those which have been in part empirical and in part miraculous, that is, by those in which some wonderful and unknown factor has seemed to cooperate with the supposed remedy. It has more recently become increasingly apparent that remedial agents not uncommonly owe their seeming success firstly to the fact that most disorders pass away whether treated or not, and secondly to the fact that the mental attitude of the patient can in itself assist at his cure and that this attitude may in many persons be modified for good or ill by the physician or other attendants of the sick man. Galen long since pointed out that " when the imagination of a sick man has been struck by the idea of a remedy, which of itself is without efficacy, it becomes endowed with beneficent power." The method of persuasion seeks to use this recuperative power which lies in the patient's mental field and to set it to work either without or with the assistance of physical agents. It seeks by reasonable explanation to impress upon the patient that his symptoms are transient and that his malady is curable, that it is important for him to aid in his own cure by taking a balanced view of the ills which afflict him and to face them with hope and courage. There is not, as in treatment by suggestion, an endeavour to impose an authoritative assertion to be blindly accepted as a matter of faith, but an endeavour to secure the penetration of an idea by the power of reason, to discuss the situation with the patient and to obtain his acceptance of the case as put forward by the physician. The fear of the disabling effect of illness may also be dealt with by the physician, who may point out, where he is so justified, that on recovery the disability will pass away or that if any be left it will be of an entirely trifling character. In serious disablement and in cases of which the end is likely to be death, it becomes the duty of the philosopher and the priest to fortify the courage and resignation of the patient. Not infrequently, however, the physician, willing or not, has himself to assume their functions and to adapt his exhortations to the needs of men of various creeds and levels of culture.

That persuasion on these lines is of value as a therapeutic agent there can be but little doubt, but its chief disadvantage lies in its limited scope, in that its appeal is to highly developed and organized faculties, just those faculties with which the neuropathic are not for the most part particularly gifted and which are the first to be weakened in disease. In practice, persuasion is apt to degenerate into partial explanations authoritatively enunciated, in which the physician has to make the best he can of the ignorance of the patient and of his own necessarily meagre scientific acquisitions, and in which pure ratiocination plays a small part. In short, persuasion merges into suggestion.

Suggestion, as a formal method of therapeutics, is but of recent origin (see 26.48). In large measure it has been, from the earliest times, ancillary to miraculous, magical and professional modes of healing. Under other names it has often been the only curative agent and has been used uncombined with physical agents or ritual performances, but for the most part it has been practised in combination with these. Professional or scientific medicine, though seeing no way of escape, has often sought and still seeks to have as little to do as possible with so indeterminate and varying a mode of cure. It struggles after more exact and precise results, in the fond hope that at some distant date each disorder, psychic or somatic, shall either be prevented from occurring at all or if it occurs shall be met forthwith by some one rapidly acting and efficacious medicament.

The first great impetus to the use of suggestion as a formal method of therapeutics came from Mesmer during the latter part of the eighteenth century, and for well nigh a century suggestion, employed as such, was associated with hypnotism (see 14.201). The artificial induction, but not by drugs, of a state in some ways resembling sleep was first called by this name rather before the middle of the nineteenth century, and it was found that the hypnotized person was, in a great majority of cases, in a condition in which suggestions made to him were acted upon with astonishing accuracy either at once or at some subsequent time as determined by the hypnotizer, in short that his suggestibility or capacity for receiving and acting upon suggestion had been much increased. The word " suggestion " used in association with mental therapy has lost some of its precision. Few are agreed as to its meaning: no one can do more than speculate as to the mode of action implied by it. It is common to hear detractors of some cure, whether it be miraculous, or of the character of those relied on by Christian Science, or emanating directly from orthodox medicine, explain it as being " merely " due to suggestion. What is really meant by such an explanation is not always apparent, and it is desirable to restrict the meaning of the term " suggestion " as applied to therapeutics to the process in which it is sought authoritatively to instil an idea into the patient's mind with a view to the relief of some morbid process. From the catalogues of cases set forth by some practitioners it would appear that almost any affection is capable of amelioration or cure by suggestion. A more modest and a more generally held estimate would limit the cases amenable to this treatment to those of functional disorder and of organic disease in which super-added functional symptoms are a prominent feature. The difference between persuasion and suggestion, as indicated above, is that in the former an appeal is made, at least in theory, to the highest levels of the patient's mind, whereas in suggestion (and particularly is this the case when it is combined with hypnosis) directions are delivered to levels of which the patient is only partially conscious, or which he is not aware of as being concerned in the production of his symptoms, or which he does not hold to be capable of activation. in their amelioration, or of which, indeed, he is wholly unconscious. In the endeavour to make use of such levels it is plain that it may be necessary to endeavour to inhibit the operations of those that are higher, since these are occupied largely and sometimes almost wholly by the miseries of the patient.

Suggestion suffers from the essential vice of the older therapy in that it is directed rather to the treatment of the symptom than to the disorder of which the symptom is but part. Movement may, for example, be restored to a paralysed limb, but the mental processes of which the movement is the outcome may nevertheless remain unhealthy. A coordinated purposive action is not wholly explained in terms of the movement ci a limb, but involves preliminary sensual, perceptual, rational and volitional activities, one or several or all of which may be affected. Criticism has largely been directed against the method of suggestion in that it would seem to convert the patient into an automatic machine which responds to activation without knowing what it does or why it does it: there is obedience without reflection or judgment. Whether this be always so or not, the physician in any case is in ignorance as to which part of the whole psychological system he is operating upon; indeed he is ignorant as to which part of it is in a morbid state. Hysteria is held by many psychologists to lie in mental dissociation, that is that the various mental processes do not cooperate harmoniously and that some are active while others are dormant. Suggestion in the hypnotic state seems artificially to procure this very state of dissociation, and in fact is widely held to induce a mental state analogous to, if not identical with, that of hysteria. To avoid so unhappy a result of a therapeutic measure as the establishment of a morbid state, endeavours have been made to practise suggestion when the patient is not under hypnosis, that is, when he is awake. It is nevertheless usual to direct the patient to allow his mind to adopt an attitude of passive receptivity, and when, if he can, he has done this to make suggestions to him. Only so far as the critical faculties are dormant are such suggestions likely to be efficacious, and if the critical faculties are dormant the method is open to such objection as may be made to hypnotism. This mode of suggestion is probably but little removed from the method of persuasion, the physician hoping that his case may be accepted under the guise of suggestion with a minimum of adverse criticism.

The term " auto-suggestion " has been used to denote a process in which the patient himself attempts to exercise a salutary influence upon his malady by concentrating his thought upon the idea of his cure or by, as it were, commanding his symptoms to disappear. The operation may be assisted by the withdrawal of the patient to a quiet place, by his placing himself in an attitude of repose and by his endeavour to empty his mind of all ideas save the one which is curative. Given sufficient intensity of purpose a man may by such treatment of himself rise superior to the ills that afflict him, think or act in spite of them, and, indeed, in certain cases annihilate them. It is not, however, given to many to reach success on these lines. Afflicted man seeks two things, one to know what really is the matter with him and the second to obtain succour from forces external to himself; he ardently desires a diagnosis and a healer. The desire for correct diagnosis is necessarily shared by him who aspires to be a scientific physician, prompts the constant search for the cause of symptoms and inspires the hope that, a cause being discovered, treatment will be more radical and effectual. Such ideas have led to the inquiries which of recent years have been instituted into the development of the human mind, both from the racial and from the individual aspects, and have resulted in new methods of mental analysis.

Psychological analysis (or " psycho-analysis ") has been practised by the method of introspection for centuries. It involves the examination of his mind by the individual himself and the attempt to differentiate between such mental operations as those of feeling, knowing, reasoning, wishing and willing. Such inquiries eventuated in difference of opinion and ceaseless controversy as to the spheres of these faculties, as they were called; nor was the introspective method, owing to the difficulty of getting it efficiently practised by patients, of much value in morbid psychology. The newer methods of analytical psychology as applied to morbid mental manifestations, or to such bodily symptoms as might be supposed to be due to disordered mental processes, have addressed themselves to the discovery of a presumedly basic causative idea, its association with other ideas, and its genesis.

The earliest signs of mind in the individual have the character of reflexes, that is, that upon the reception of a certain stimulus by the organism a particular series of movements ensues. Some of these pass by the name of instincts, are of a complicated character, and appear to occur without previous experience and without education or direction from without. Very early, however, in the history of the child the play of instinct is controlled, repressed or supplanted by positive injunctions from others, by the inculcation of habits, by lines of thought and conduct suggested to him by his observations of those about him, by his desire to imitate their doings and to repeat their sayings, and by his personal experience. The purely natural development of the child is interfered with in order that he may be fitted for life in a civilized society. During this process certain actions initially pleasurable come to be regarded as unconventional, or repre hensible, or shameful, or immodest, or all of these together, and so gradually rules of thought and conduct come into being. Almost all, and perhaps all, thoughts and actions are associated with some emotional tone, that is, with feelings of pleasure or displeasure or pain. Such feelings are of varying intensity, being in some cases so weak that they can scarcely be discerned and in others so powerful as to occupy and command the entire personality. During the education of the child a separation may be brought about between an action and the associated emotional tone or affect, as it is termed. If a child has learnt to regard a pleasurable act as blameworthy and in fact acts no longer in this particular way, the affect which was associated with the act may become partially or wholly detached from it and may perhaps be replaced by its opposite. It is one of the hypotheses of psycho-analysis that a dissociated affect of this character may produce symptoms at once or in later life, either because the affect has not been passed on to some other important or more legitimate object of activity and remains as a quantum of unused psychic energy, or because it has become attached to a substitute for its original partner of unworthy or ridiculous character. The gradual passing on of affects from lower levels of activity to those that are higher has been called sublimation, and their progress from the satisfaction of very lowly bodily wants to the highest ethical and aesthetic acquirements of the mind has been elaborately examined. The failure in attachment of an affect to any sort of substitute for its original partner may result in those indefinite emotional states, sometimes of a distinctly morbid character, in which the individual may be happy or miserable or excited or apathetic for no reason which is obvious to himself or to anyone else; while the attachment of affects to somewhat trifling and comparatively valueless objects is seen in the inordinate interest taken by some in domestic pets, bric-a-brac, pastimes, or fantastic and inane social entertainments. Sometimes, however, the affect remains unconverted and still attached to the original act, so that a conflict arises between the primitive and personal desires on the one hand and desires of later acquisition weighted with civilized, ethical, legal and religious authority, on the other. Many such conflicts are plainly carried on in full consciousness, and are examples of the lust of the flesh against the spirit and of the spirit against the flesh and of the contrariness of the one to the other, but others are by no means so obvious, and their existence may only betray itself by trifling, though odd, deviations from ordinary conduct, by unexplained prejudices and habits, or by symptoms of functional nervous disorder or by, the yet more pronounced symptoms of insanity. The conflicts which lie in the field of consciousness may largely be dealt with, in so far as they come under the notice of the physician, in that field. The mere disclosure to another of the existence of a conflict may suffice to produce a therapeutic effect, and this may be further enhanced by the discussion of the subject and its illumination by another mind, but there are conflicts in which the opposing elements and their origin and genesis are not apparent or recognized or indeed discoverable without much labour. Such conflicts are said to lie in the field of the unconscious and to be due to the persistence in that field of repressions made at that time of life when the instinctive desires of the individual, tutored by early environment and education, have undergone a process of restraint. By a wide, and as it seems to some, unnatural extension of the term " sexual " the interest of the infant in its excretory functions and its relations with its parents is ascribed to the sexual instinct, and is that which, owing to existing social conventions, is most subject to repression. It is held that the relations of the child to his mother have an element of sexuality hitherto not determined. Hence the frequent occurrence of such terms as the " Oedipus Complex " and " incest " as descriptive of certain infantile affects. It is further held that the earliest interest of a child in itself is of a sexual character, that it is " auto-erotic." Progress is made from this stage to another in which the child's sexual admiration for himself is termed " narcissism "; then to one in which the interest is extended to other members of his own sex, and finally to one in which sexuality becomes centred upon the normal object, that is upon the opis in it a something which has been termed the " censor " which posite sex. This development may be arrested at any point, and seeks to prevent the emergence of unacceptable affects from the the arrest may later in life be displayed in various sexual perverunconscious into the sub-conscious and thence into the consions. If a person in whom such an arrest has occurred, say, at scious. To this " censor " is also attributed powers of transthe stage of homosexuality, is living in a civilized society, mutation of ideas and symbolization which render the crude and difficult internal conflicts are likely in later life to ensue between unpalatable operations of the unconscious less unacceptable to the strength of his desires and his fear of outraging both social the conscious. The examination of dreams by the analytic convention and legal enactment; or, owing to the fixation of his method is held to have demonstrated the existence of such affect upon an object, not the normal end object of the sexual operations. The ideas of a given dream are one by one examined, instinct, he may find himself impotent in his relations with one with a view to the discovery of their associations, that is of their of the opposite sex. The efforts of psycho-analysis are directed immediate relation with other ideas, and it is found that the towards the discovery of repression, arrest of development and manifest content of the dream is but a condensation of a much the conflicts which are thus generated. If these can be brought wider range of ideas and only indirectly and allegorically to light there is hope that further development may occur, that expressive of them. The dream is found to be the expression unattached or badly attached affects may find appropriate and of an affect whose existence may perhaps not hitherto have fitting objects, and that conflicts may be resolved by the cobeen recognized and whose passage into the conscious has been ordinating action of the conscious. prevented. On these points also there is not a complete con Analysts are not, however, in complete agreement as to whether sensus of opinion, and by some the analysis of dreams is held to sexuality is the sole or essential cause of functional nervous disclose not only or so much the expression of the most primitive symptoms. Some find in the desire of the individual to express affects but also the ends which the individual in fact desires but his influence upon others, or his " will to power," an active of which he is but unconfessedly and dimly, if at all, aware. determining cause of the internal conflict which arises when Indeed the interpretation of dreams seems not infrequently to he finds himself in opposition to social conventions and to such depend not so much upon a thoroughgoing analysis as upon activities of those about him as tend to impede his progress. the psychological views and imagination of the interpreter.

Others again seek to find conflicts not so much in the past Another method of exploration is that by free association. development of the individual as in the difficulties which arise The patient is placed in a comfortable position and is directed when he endeavours to attain such ideal ends as he has proposed to close his eyes and then to say whatever idea comes into his to himself. But whatever the value attached to the elements head, no matter how absurd or rude or otherwise offensive it of causation of morbid states there is general agreement that it may be. Ordinary volitional precautionary control being in this is not only the conscious field with its obvious conflicts which way relaxed, vent is given to the repressed content or at least has to be explored but that the unconscious field should also various groupings of ideas are disclosed. Analogous results are be examined in as much detail as is possible. obtained when, owing to intoxication or disease, patients reveal The form of the content of the unconscious and of the conscious trains of thought remote from those to which in healthy states mind appears to be determined by analogous processes. Percepthey give utterance, the very existence of which has been untions are apparently not invariably noted by the conscious. known to them and which when known is repulsive. It is not an uncommon experience to discover perceptions which A third method of analysis is that by the " time-association " must have been made at a certain time and place which only test. In this again the patient places himself in a comfortable well up into consciousness at some later date, while the details position and relaxes his attention to what is going on or to any of a perception which were not clear or even considered at all particular line of thought so far as is possible. He is directed to at the time they were received, may be placed in their true listen to certain words pronounced by the analyst, and on hearing position by analysis. In certain morbid states, for instance, one forthwith to say the word which first arises in his mind. The delirium and mania, memories of events and even of languages time between the signal word and the reply is noted. Normally which have been forgotten for many years, may be recovered. the length of time is two to three seconds, and if it is prolonged Such memories lie in depths of mind to which the term " unor if after some 45 seconds no reply has been given the reaction conscious" alone seems applicable. Constructive ideation and is considered to be worthy of further examination and to indicate ratiocination appear also to proceed in the unconscious mind. the existence of a group of ideas associated with a definite and Problems which have been propounded and set aside for a while perhaps marked emotional tone, that is, with a " complex," as receive, as it were suddenly and unexpectedly, a solution; indeed such a group has come to be technically called. But the time such solutions are recorded as having been reached during sleep. element is in fact not the only one of importance in this test, Similarly the execution of works of art, pictorial, musical or since the character itself of the reply word is put to valuation. literary, is, especially in the case of genius, often effected without Test words may elicit replies of a rhyming character, or altogether immediately preceding conscious mental effort, while the ideas commonplace, but on the other hand they may be so inconof preachers, orators, wits and ordinary conversationalists sequential and unexpected that a surmise at once arises that they often seem voiced automatically. Indeed the obtrusion of conimply the existence of a complex.

scious effort not uncommonly mars rather than enhances the Such then are the methods adopted in analysis, and it must value of artistic expression. Conventionally the term "subbe plain that if carried out in detail they must necessarily occupy conscious" has become restricted to those states of mind which, a considerable amount of time. Unhappily in practice analysis though not at the focus of conscious thought, can be brought to is apt, owing to the limitation of available time, to be slip-shod, that focus at the will of the individual, but the differentiation while deductions are hastily drawn from hastily gathered data; between such states and those which are brought to consciousthis is by so much the greater a misfortune in that the outness only at exceptional times or by analytic methods seems to standing merit of analysis lies in its claim to be something of be of a very indeterminate nature. A much more particular an exact method of examination and thus to supply in psychomeaning is assigned to the unconscious by some who make of it therapy a way of discovering, and so of treating, the basis of the a rather sharply defined collection of primitive and instinctive symptoms complained of. Though an analysis may not be infantile affects. Whatever may be the view adopted on this thorough or the results of a thorough analysis may be incorrect, point, there is but little division of opinion as to the view that yet some amelioration of symptoms may occur, and in such an the affects which impel conduct, whether primitive or elaborated event it is possible that the process of cure is somewhat similar and sublimated, lie to a great extent in the unconscious, and the to that obtaining in treatment by suggestion. Though in an search for and examination of these affects when brought into impartial analysis the physician should be little more than a consciousness constitute the great merit of knowledge of self. recording machine, it is extremely difficult for him to avoid Not only does the unconscious seem to contain the powers making, or at least being the occasion of, suggestions. The already alluded to, but it has been sought to establish that there I patient seeks a cure at the hands of one whom he regards as having special knowledge; he is hopeful of a good result and is prepared to act upon the advice proffered. In a multitude of cases such factors seem to constitute the essentials of the cure, while the subsequent particularity of method is but of secondary importance; and however much analysis may scorn suggestion, and it does so quite ostensibly, it, like other methods, can hardly hope to escape such vitiations of its pure practice. In analysis the patient must necessarily feel a more than ordinary degree of confidence in one to whom, through a species of psychic vivisection undergone by himself, he is prepared to reveal such facts about himself as the penitent reveals only under the safeguards of the seal of confession, and indeed possibly to go further and reveal much more that is revolting and that is not present in consciousness. Such confidence in itself implies a faith which would move mountains and a mental state singularly receptive of suggestion. From deductions based upon their experience some analysts regard an examination as incomplete until and unless a sexual complex has been discovered. This probably accounts, at least in part, for the fact that the time occupied runs sometimes into years, and that even then the results are not wholly illuminating and satisfactory: while it almost certainly does account for an unfortunate persistence of thought along sexual lines which sometimes develops in patients treated by this method. It is, however, in the detailed elaboration of investigation and in the consequent establishment of unsuspected relationships between ideas and trends of thought and action that the undisputed merit of later psychological methods is to be found. Hitherto psychological examination of the normal mind has for the most part been by the subject of the subject, that is, the subject has been artificially objectified by itself; while examination of the abnormal mind has mostly been confined to the conscious superficies. Analysis has made examination both of the normal and of the abnormal a definite study of objective mental phenomena.

Many diseases in general and many functional nervous disorders and mental affections in particular get better or well by a natural process of cure, and it is difficult to distinguish among the antecedents of the process of betterment those which especially have a causal relationship with it. Some such are artificial and have been devised on various grounds, - religious, magical, philosophical and scientific, - for therapeutic purposes; but the essential difficulties in therapeutics are to determine the efficacy of such artificially introduced antecedents and whether the desired result might have been attained without them. Hence the remarkable discrepancies of opinion as to the value of modes of treatment, even when they have been originated and practised by those trained in scientific method and of ample knowledge. The frequent apparent absence of adequate physical factors in the causation of many functional nervous and mental diseases, the dualism which distinguishes between the spheres of action of mind and body, and the apparent potency of the psychic activities of one person directed upon the mental state of another, combine to justify the practice of psychotherapeutics. Nevertheless, even with a proper respect for most recent developments, it is still difficult to be sure as to which is the most successful method, or whether a combination of physicoand psychotherapeutics may not be better than either alone. It is strange to note how exceedingly exclusive the methods of therapy are apt to be. Those who perform miracles or heal by processes such as those of Christian Science claim no technical skill in medical diagnosis or any regard for it, but variation in treatment according to variation in diagnosis or at least according to the various aetiological factors discovered might be expected from the scientifically trained. Nevertheless too frequently the persuasionist, the hypnotist or the analyst apply their methods, much in the way that their precursors of long ago applied their nostra, with entire lack of discrimination. Perhaps lying behind their particular methods there is a common factor, one of personal influence, in which certain outstanding practitioners excel and which the remainder conspicuously lack. That there is such a factor is apparent when an ignorant practitioner is seen to be highly successful and one who is learned to be unsuccessful.

In truth, however, the nature of this influence, like so many of the antecedents of improvement in cases of functional nervous and mental disorders, is at present unknown. There must be a very considerable advance before we obtain accurate knowledge of the relative value of the many therapeutic factors that are perhaps concerned. At present treatment is largely haphazard, and improvement is ascribed to the treatment, if any, immediately preceding it; treatment which, maybe, has nothing whatever to do with the improvement that occurs.

## LITERATURE

The most important works on psycho-analysis are four by S. Freud, the most prominent investigator of the subject, translated for English readers by Brill: Collected Papers on Hysteria  (1912), The Interpretation of Dreams (1913), The Psychopathology of Everyday Life (1914) and Three Contributions to the Theory of Sex  (1918). Brill has given a good account of these in his Psycho-analysis. Jung's deviation from Freud's position is set forth in Collected Papers on Anal y tical Psychology, edited by Constance E. Long (1917). Dream Psychology by M. Nicoll (1920) expounds an interpretation of dreams of a less sexual character than that given by Freud. P. Janet criticised the methods and findings of psycho-analysis; in his report to the 17th International Congress of Medicine (Proceedings of the Congress, Sect. 12, pt. I, p. 13). This criticism is somewhat elaborated in Janet's Les Afedicati-ons Psychologiques  J (1919). On hypnotism the following works are good and ample:. M. Bramwell, Hypnotism (1913); A. Forel, Hypnotisme (tr. by H. W. Armit 1906); C. Lloyd Tuckey, Treatment by Hypnotism and Suggestion (7th ed. 1921). On persuasion the following may be commended: Paul Dubois, De l'Influence de l'Esprit sur le Corps (Engl. tr. 1910) and L'Education de Soi-mime (Eng. tr. 1911); J. Camus and P. Pa,niez, Isolement et Psychotherapie (1904); J. Dejerine and E. Gauckler, Psychonevroses (1911). A book from a distinctively Christian point of view i-, the Spiritual Director and Physician by Rev. V. Raymond, tr. by Dom Aloysius Smith (1914). (E. D. M.)