Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGIXAL COMMCNICATIONS. 29
the same way, the removal of hysterical perhaps be cailed suggestive-persuasion, as
symptoms by suggestion leaves the patient it combines the characteristics of each as
just as before with regard to his reurastbe- defined by the writer elsewhere. (20) It
nia, mental debility, etc. is these cases which have given rise to so .
The tics, obsessions, feelings of inade- much difficulty in laying down a clear symquacy,
timidities, scruples, ereutophobia, tomatology of the two affections: they are
agraphobia, and other morbid fears, as the hystero-neurasthenics of the older wriwell
as the impulses to steal and to act or ters: and are by some still erroneously callspeak
obscenely and towards meaningless ed neurasthenics. The most coiispicuous
flights, all of these belong to the psychas- recalcitrant in this respect is Dcjerine, (2)
thenic constitution, often called the obes- who refuses to apply the cognomen of hys-"
sive slate or /y.vf de double from its charac- teria to \h& false gasiropaihs whom he cures
teristic symptom of uncertainly. Any of after the method of Dubois of Berne. (22)
these symptoms, however, may be produced This method which both Dubois and Dejein
a non-psychasihenic individual by sug- rine call persuasion, is conclusively shown
gestion. In this case, however, it can be by Levi and Bayot, not to differ from the
as easily removed by the same means, thus suggestion of I^ernheim, and is practiced
distinguishing it from the true obsessive by them with great success, and in this
phenomenon, which is accompanied by country by Taylor of Bcston, and others,
dread of its occurrence and is quite una- The false gastropaths are in reality neurasmenal)le
to suggestion (19). thenic only secondary to the malnutrition
Now none of the preceding symptoms is caused by their fixed idea they cannot diessential
to the neurasthenic state, which is gest. {2i) This fixed idea generally arises
a mere fatigue entirely irremediable by jisy- bv suggestion, that is, is hysterical, and is
cho-lherapeutic measures. It is true that thus curable by suggestion. It is usually
in a fatigued condition the suggesliliility of medical origin, (24) and is the conseof
everyone augments; and a neurasthenic (juence of the temporary dyspepsia for
sometimes from mere tiredness will not re- which a doctor is consulted who does not
sist solicitations to which in his normal recognize the necessity of wiping out the
state he would refuse to respond. It is also suggestion of disease induced by the pretrue
that in his astlienic condition the cautions he advises the patient, and who
easier course is sometimes to allow himself is ignorant of the inhibitory effect of anxto
be cheered up even against his own bet- iety at meals upon the flow of gastric juice,
i ter judgment and to declare that he is bet- 2.t) A smaller proportion of false gaster
from the suggestion that he is belter; tropalhies arise secondarily to the shape of
for example, when soldiers are tired out body ( 26) ocurring in the scrupulous psyby
marching, their fatigue may ajiparently chasthenic who has been imbued by certain
be removed by the pyschic agency of music
or the excitement of approaching battle,
of the doctrines which have attached them,
selves to the Christian religion. A still
But it is only apparent, the reaction is all smaller propartion of ner\o-anorexias are
the greater. Similarly with a neurasthenic, the accompaniments of the modifications
encouragement, so often indiscriminately of the internal sensibility termed cenesihopused
by unskilful physicians, is followed athy, (27) and some are episodes in tlie
by still greater dei)ressioii and inadeciuacy. course of a psychosis, more especially de-
IntDxicaled neurones are no more capat)le mentia precox. None of these are true
ponding without injury to added stress neurasthenics, although of course anorexia
is the heart when compensation has is a prominent symptom of tlie neurasthenic
i. The neurologist sees many wrecks state.
u liicli have resulted from the uncalled for The foregoing considerations should enurging,
so inadvisably applied by the laity able an intelligent clinician to exclude by
of psychotherapeutic jiersuiision. the positive sign of suggestiljilty, any hys-
It is true that many so called cases of terical element in a difficult psychoneurotic
nervous break-down go on the shelf merely case, and enable him to undertake its treatfrom
incapacity, or want of desire to resist ment wilh a much clearer conception of the
the auto-suggestion or hetero-suggestion indications to be met in addition,
that they are not well. These are the Symptomatically speaking, psychotherapy
''Jalse neiirastheuics by suggestion;'" and ,\f hysteria resolves itself into skilful suguntil
their health breaks down from the se- gestion; but this only removes the sympclusion
and confinement to which they are loms as they occur or prevents them indiaometimes
ignoranlly subjected, the\' are vidually. It is anal gous to the procedure
curable merely by the removal of the false of excising the guinea worn or expelling
fixed idea that they are neuraslhenic. The the tape worm while leaving the head. Andestrnction
of this fixed idea may require other analogy would be the removal of the
a considerable time; and the process may neurotic areas due to a general infection.