Popular Science Monthly/Volume 75/October 1909/The Emmanuel Movement from a Medical View-Point




IN matters pertaining to the preservation of health, and the cure of disease, it is a fact of common observation that people in general, and educated people in particular, are very apt to seize eagerly upon every new theory or practise that is confidently announced as able to dispel their ills; and all the more eagerly if, in disregard of science and experience, it is strongly flavored with the mystical and miraculous.

The most remarkable modern instance is the extraordinary growth and acceptance of Eddyism, or so-called christian science, and so confident are its claims and so long its list of undisputed victories that they overshadow, and actually seem to make us forget, the real progress of medical science, which continues uninterruptedly, but without any such flourish of trumpets and beating of drums.

Let us remind ourselves for the moment that scientific investigation has established the presence in the world of certain poisons, whose effects on man have been carefully studied and can be confidently predicted, like strychnia, prussic acid, arsenic and opium; that it has furthermore discovered certain other poisons in the animal world, like the bacillus of tuberculosis, of anthrax, of cholera, of diphtheria, the Plasmodium of malaria and the spirochæte of syphilis, equally poisonous to man with the mineral and vegetable poisons, and capable of producing equally definite and specific effects.

It may not have been part of the intent of creation that man should be harassed by the latter any more than by the former; but the conditions of life and of civilization have made us very vulnerable through our appetites. Intended or not, these specific causes of disease are here; and medical science has not only demonstrated their existence, but has further proved beyond cavil that by their isolation and exclusion the diseases which they cause may be limited, and even be prevented from spreading from person to person.

Scientific medicine has further shown that the vital parts of our bodies are subject to certain degenerative changes induced by exposure, by imprudent habits of eating and drinking, by unnatural modes of living, by inheritance, or simply by age itself. Such are the degenerations of the brain, the heart and blood vessels, the liver, pancreas and kidneys; conditions which are accompanied by demonstrable changes in the structure of these organs, are often progressive in character, and usually incapable of repair.

There is, however, a third class of diseases, which medical science has thus far been unable to classify with the infections or the degenerations; nevertheless, very real and very common, to which it has applied the term functional disorders. These present no demonstrable organic lesion, and very many of them seem to have their origin in psychic rather than in physical causes.

It is from this latter class that the superstition and quackery of all ages have largely derived their support. To be sure, science is gradually invading even this field, and finding a physical basis for conditions which it has been hitherto unable to classify.

It is clear, however, to scientific men that there is a large class for which no physical basis is likely to be found, which will always be the subject of much philosophical speculation and mysticism. Of late, a most interesting attempt has been made to employ science, religion and hypnotic suggestion, under the guise of psychotherapy, in the study and treatment of these cases, and I thought that perhaps it would be interesting to look for a few moments at the so-called Emmanuel movement from a medical viewpoint.

The underlying principle of mind or faith healing is by no means new; it is probably as old as the race. It is the same principle that underlay the sacrificial offering of the ancients, and that underlies the pilgrimages to Lourdes, and the shrine of St. Anne de Beaupré. One of the earliest analogous movements, to that of which we now hear so much, was that of Mesmer in the latter part of the eighteenth century.

“By the discovery of a universal fluid, in which life originates, and by which it is preserved, and by the power of regulating the operations of this fluid”—he claimed to be able to cure the most intractable diseases; and although a scientific commission, including our own Benjamin Franklin, was appointed to investigate his claims, and reported that they could find no evidence of any such fluid or special agency emanating from him or his baquet, while, if blindfolded, his patients proved susceptible to its influence only when they believed that they were within its influence, whether they really were or not; still it had for many years an astonishing vogue and following.

In the hands of his pupils animal magnetism, or mesmerism, as it was called, was found to be capable of producing a state of profound insensibility in some individuals and a state akin to somnambulism in others. The subjects were made to do all sorts of unnatural things, and to endure the severest pain without flinching. A number of surgical operations were performed upon patients, who were placed under its influence, and it was the subject of much medical speculation and discussion.

But so thoroughly tainted with fraud was it found to be, in the extravagant and unwarranted claims of its practitioners, that it soon fell into the hands of charlatans and traveling showmen, and thus into general discredit.

It had, however, a great influence in the development of spiritualism and also of hypnotism, although the latter did not obtain its first scientific recognition until many years later, through the work of the eminent French neurologist, Charcot.

This same doctrine of the susceptibility of the individual will to the influence of suggestion or authority is the very foundation of christian science. It underlies the time-honored and well-nigh universal use of the placebo by the medical profession, like the historical brown-bread pill of Dr. Jacob Bigelow, and is the curative agent in most of the well-known proprietary medicines. It is reflected in that old French saying that medicine sometimes cures, often relieves and always comforts.

Physicians have always made use of it, and especially the now much-neglected family doctor. His intimate knowledge of the heredity, habits, social and domestic life of his patients gave him a peculiar advantage in discriminating between their mental and their physical ailments; while the confidence, nay, almost reverence with which his families regarded him gave an authority to his counsel that was seldom questioned.

"His father was here before him," Mrs. Macfadyen used to explain, "atween them, they've had the countyside for weel on tae a century; if MacLure disna understand oor constitutions, wha dis a'wud like tae ask?"

And this simple faith has given the country doctor his one opportunity through all the world, and for many hundreds of years, to practise what we now call psychotherapy. Perhaps he did it unconsciously and in an amateurish sort of way, as Dr. Cabot says, but he did it, is doing it and has done it with great success.

The use of psychotherapy, or mind cure, in a purely scientific way, in the practise of medicine has been tried with conspicuous success for many years by Dubois, in Berne, and Bramwell, in England. "Our endeavor," says the former, "is to raise up these patients, to give them confidence in themselves, and to dissipate their fears and autosuggestions." They do this by making a direct appeal to the patient's reason, by trying to train his will, by trying to make the dominating idea of his ego one of health and strength, not of weakness.

Another factor in the development of this new movement is the renewed interest in the old command, to love thy neighbor as thyself; the awakening of a sense of responsibility of the more fortunate for the less fortunate, in the world they both live in.

One of the striking features of our economic development is the disappearance of the small community and the small business, with the personal interest of each in all, employer and employed; and in its place we see the herding together of great masses of people in our large cities, each class by itself; the corporation taking the place of the individual owner, and the growth of vast business enterprises, with its inevitable loss of personal interest and sense of personal responsibility.

The old relation of the physician to his patient has also changed; partly because of the growth of the specialties, partly from the growth of the hospital and dispensary, where the great number of patients makes an investigation into each one's individual circumstances and surroundings easier to neglect than to follow up; but more largely still, to that want of intimate acquaintance and the mutual confidence bred of intimate acquaintance incident to life in a large community.

To meet this problem and to help the less fortunate, who, as a class, suffer most from this change, we have the growth of settlement work, of personal service, the better administration of charities, the getting closer to the personal life of the unfortunates, with a better knowledge of their trials, hopes and disappointments, giving more advice, counsel, sympathy and practical help and less alms.

We have, of course, a class of nervous invalids, whose condition is the result of the strain of business and pleasure; but another, and much larger class, whose condition is due to ignorance, misfortune and actual hardship. Hospital men are beginning to recognize that simply a thorough physical examination with a prescription for some medicine and a few hurried words of advice are not enough; that much of our effort and of our hospital endowment has been wasted, because we did not know anything about the conditions under which our patients lived; did not know whether our advice could be followed or not and, even if it could, did not follow them up, see that they understood it and that the instructions were carried out.

To order for one patient a diet that he cannot possibly procure; for the next, a vacation that he is too poor to take; to forbid the third to worry, when the necessary cause of worry remains unchanged; to give the fourth directions for an outdoor life, which you are morally certain he will not carry out; to try to teach the fifth (a Jewish mother) how to modify milk for her baby, when she understands perhaps half what you say and forgets most of that half;—this makes a morning's work not very satisfactory in the retrospect to anybody.

We see at once the necessity of getting back to the old idea of the physician, as the friend, adviser and guide of his patients; to a closer personal relation between physician and patient, and where, as in a large hospital clinic, this is impossible, an organization which, under his direction, shall follow his patients to their homes, see what is possible to be done in the way of carrying out his instructions, how it may be best accomplished, and see that it is accomplished.

In this line, the work of the social service department of the Massachusetts General Hospital, under Dr. Cabot's direction, is a conspicuous example of how these reforms may be brought about.

We have referred now to two separate movements; each of which has exerted a large influence in the development of this Emmanuel movement, so-called. First, the development of a healthy suggestion from without or within, with the education of the will, by an appeal to reason, and the cultivation of a right attitude toward life and especially toward health; and, secondly, the attempt to get closer to those who, by ignorance, misfortune, heredity or wrong doing, have become victims of distorted ideas about health and disease, and are unable to extricate themselves without help.

These very real, very active movements have appealed to many churchmen as offering opportunities in which they could be useful to their fellow men; while, at the same time, they would be extending the influence of their church. The first attempt on a large scale and with a complete organization to enlist in this service was by Rev. Elwood Worcester, of the Emmanuel Church, Boston.

He began three years ago with a tuberculosis class under the personal direction of Dr. J. H. Pratt. “The treatment consisted of the approved, modern method of combating consumption, plus discipline, friendship, encouragement and hope; in short, a combination of physical and moral elements.” It was like a regular hospital clinic under the direction and charge of a hospital physician, but having its headquarters not at the hospital, but at the church; and the church cooperated with its visitors and helpers.

The only new thing about it was its connection with the church organization and the opportunity thus given immediately to strengthen the moral and religious character as well as the physical constitution; there was no mysticism, nothing but rational help—and the class was very successful.

So successful was it that Dr. Worcester says:

It convinced us, that the church has an important mission to perform to the sick, and that the physician and the clergyman can work together to the benefit of the community. Accordingly, in the autumn of 1906, we determined to begin a similar work among the nervously and morally diseased.

Our single desire is to give each patient the best opportunity of life and health which our means allow. We believe in the power of the mind over the body, and we believe also in medicine, in good habits, and in a wholesome and well-regulated life.

In the treatment of functional nervous disorders we make free use of moral and psychical agencies, but we do not believe in overtaxing these valuable aids by expecting the mind to attain results which can be effected more easily through physical instrumentalities. Accordingly, we have gladly availed ourselves of the services of skilled medical and surgical specialists, who have offered to cooperate with us.

All patients are referred to these specialists first, and only those found to be suffering from the purely functional nervous disorders are admitted to the classes; this is done to avoid the objection that the employment of psychotherapy “in diseases which obviously require physical interference, may result in death through neglect”; but especially because “disorders of this nature are peculiarly associated with the moral life”—and “moral maladies require moral treatment.”

The philosophy of the movement is simple; the fundamental idea is the existence in each of us of a subconscious or subliminal mind, which is a normal part of our spiritual nature and is responsible for our unconscious and automatic movements, thoughts and motives. It is this subconscious mind which responds to hypnotic suggestion, after the conscious mind has been put to sleep; but even without resort to hypnotism, one of the most important characteristics is its suggestibility, its subjection to moral influence and direction.

The functional disorders of the nervous system such as neurasthenia, psychasthenia, hysteria, hypochondria and the like, are believed to be diseases of the subconscious; caused by a dissociation of consciousness, i. e., by certain portions of consciousness having become detached from the main stream.

By “psychic reeducation, utilization of reserve energy, suggestions given in hypnosis or in states of deep abstraction, there follows a re-association, a synthesis of the dissociated state, and a return to a state of healthy mindedness.” And the susceptibility of the subconscious mind to suggestion is believed to afford the means of accomplishing this.

How this is actually applied in the clinic will be understood better perhaps, if I quote directly from Mr. Powell, one of Dr. Worcester's earliest pupils and imitators.

After the discussion and the prescription of good books the patient is seated in the comfortable morris chair before the fire, which I take care by this time to have burning low—is taught by rhythmic breathing and by visual imagery to relax the muscles, and is led into the silence of the mind by tranquilizing suggestion. Then in terms of the spirit, the power of the mind over the body is impressed upon the patient's consciousness, and soothing suggestions are given for the relief of the specific ills.

In addition to the clinic at which individual treatments are thus given, there is, at Emmanuel Church, a mid-week meeting, at which, after singing and Bible reading, requests for prayer are read and answered, a short, practical address, applying the teachings of Christ to human ills, followed by an hour of social intercourse in the social room of the church. For the benefit of the doctors, ministers, social workers and others who desired to study the movement, a course of lectures was given last summer extending over three weeks, for which a small fee was charged.

Such is, in brief, the theory of the practise of the Emmanuel movement, so-called. It attempts to relieve certain disorders, which have a mental or moral origin, by the use of suggestion, reinforced by an appeal to the patient's religious faith, and it invokes the aid of medical science to eliminate those disorders which have a purely physical organic basis. Except for this appeal for the help of science and the recognition of science which it contains, there is absolutely nothing in the movement that is new.

In the first place, these so-called functional diseases do really exist; although it is true that the class has been growing constantly smaller under the influence of scientific investigation and discovery. Still, it is also true, now, as in the middle of the eighteenth century when Dr. John Atkins wrote, that “many distempers, especially of women that are ill all over, or know not what they ail, have been cured, I am apt to think, more by a fancy to the physician than his prescription.”

Every doctor is familiar with the patient whose physical ailments are quite insignificant when compared with the exaggerated importance with which his mind or imagination has invested them. Every medical man recognizes how little physical basis there is for the worry, fear, doubt and melancholy with which so many of his patients are obsessed. We all appreciate how often that symptom-complex, which goes to make up what we call the neurotic temperament, is found in cases in which the most rigid physical examination fails to reveal any indication of organic disease.

In this class we find kindred conditions, which have at different times borne a great variety of names, such as nervous prostration, neurasthenia, psychasthenia, hysteria, hypochondria, or melancholia, while in other cases we are content with the simpler definition of disturbed mental equilibrium or deviation.

It seems impossible to classify these cases accurately, because there is no really scientific basis upon which a classification can be made; and the invention of new names to define certain types is not as important or as progressive as it seems.

In speaking of these names, Dubois says: “The name neurasthenia is on everybody's lips; it is the fashionable disease. But I am mistaken, the disease is not new, it is the name by which it is known that is changed. We now designate by this name, a combination of symptoms known through all time.” What we must not lose sight of is that there are diseases of the mind, or imagination, or nervous system, in which no physical deviation from the normal can be found, but which are none the less real, none the less distressing, and that they tax the skill, resources and patience of the attending physician almost to the breaking point.

Furthermore, it must be observed that these are the cases in which psychotherapy, whether practised by means of the placebo, or through the agency of christian science, or the Emmanuel movement, is preeminently successful.

In the second place, if we study carefully the causes of these conditions, we shall find them in the two great classes into which Charcot has divided them. “The neuroses,” he says, “arise from two factors, the one essential and invariable, neuropathic heredity; the other, contingent and polymorphic, the provoking agent.”

In the latter belong our doubts and fears and worries, as well as the other more easily controlled factors in the causation of these purely functional nervous disorders. But even in the case of heredity, it is more the unstable nervous equilibrium that is transmitted than the specific form in which it is manifested in any individual case; and this unstable equilibrium is capable, in no small degree, of being influenced by reeducation along the lines of which we have been speaking.

“In neurasthenia," says Dubois, “we find general debility; sometimes it is physical, sometimes intellectual, but above all it is moral.” In other words, it is a wrong view-point, a weakness of the will power of the individual, an inability to throw off the unduly insistent habit, or thought, or motive.

In a few words, Carpenter explains the long list of epidemic delusions of history, the form of which has changed from time to time, although many of their characteristics have been common to all; such as mesmerism, magnetism, spiritualism and the like, by saying that “The condition which underlies them all is the subjection of the mind to a dominant idea.”

The trouble is that in the case of these delusions, as well as in the case of the neurasthenic, the dominant idea is pointed in the wrong direction; and the Emmanuel movement simply aims by a process of reeducation through suggestion, autosuggestion or, if necessary, hypnotism, to change this direction.

In the treatment of these cases of functional disorder of the nervous system, doctors, psychologists and Emmanuelists, all agree in attempting to continue the subjection of the mind to a dominant idea; but try, each in his own way, to make that idea stand for health, for right living and right thinking, for cheerfulness, in a word, so to direct it that it shall always look for the doughnut, not the hole.

But, while agreeing thus far, a fundamental difference of opinion is disclosed, as soon as we take up the question as to by whom this work can best be done; by the doctor or by the clergyman. The lines, however, are not strictly drawn between the two professions, because some medical men see no impropriety in asking and encouraging the assistance of the church, while many churchmen deprecate the entrance of the church, as an organized body, into new and untried and disputed fields of activity.

One thing should be clear at the outset, and it is emphatically set forth in the introduction to Dr. Worcester's book.

The church should not undertake this work without the cooperation and assistance of the best possible medical advisers. It is a scientific work, based on the knowledge derived from the study of medicine and psychology, and its favorable results are not miracles, to be exploited for the glory of religion. They can be obtained only in cases in which no organic pathology is found to exist, in cases carefully selected, after rigid and strictly scientific examinations.

Remember that the goal is reeducation into right habits of thinking and living; and in this process of reeducation, judged by their results, there is little to choose, between the efficiency of the agnostic Dubois and the ecclesiastical Worcester.

That this process of reeducation can not be accomplished by hypnotic suggestion is the firm belief of the medical profession, especially the neurologists. That a state of hypnotic susceptibility can be induced in most people by a will that is stronger than their own is not doubted; but that it is safe, or that its results justify its use as a therapeutic measure, is stoutly denied.

Hypnotism has been known since Braid in 1842, and every now and then it rises up on a new wave of interest and popularity, often in a new guise; but so far as its therapeutic value is concerned, we have as yet derived from it no safe practical assistance.

If not by hypnotism, then how shall we seek to accomplish this reeducation—shall it be by an appeal to reason, or to faith? Unless by faith is meant religious faith, it has been and will always be done by medical men, acting through both agencies; by strong men, confident in their own powers, and able to impress others with the same confidence and faith in the truth, sincerity and accuracy of their opinions.

Examples of this use of psycho-therapeutics have been common enough in the practise of every successful physician. That he has been working at an increasing disadvantage is probably true; due partly to the growth of specialism, and also to the complexity of modern life, which, as has been already indicated, means the loss of that personal relation and sympathy between patient and physician which used to be common; but to an even greater extent is this disadvantage the result of the extraordinary development of the more material and scientific side of disease.

For example, Dr. Cabot complains, and with too much reason, that the psychological side of tuberculosis has been largely disregarded. “We have tried to have our patients live almost by bread alone—actually by milk and eggs alone, in some cases.

The effect of idleness upon the will, of a discouraging and unlovely health resort on the spirits, of an empty outlook for the future—all these have been largely disregarded. Put him in the open air, and fatten him up, we say,—so far, so good. But he has a mind, as well as a body; a future, as well as a present—and neither element can be neglected.”

Then, too, the study of the treatment and means of prevention of the infections and degenerations, and the brilliancy of its results, have tended to make us impatient with the less prompt response of the neurotic. We medical men have been tempted to speak sternly, as did the King in Alice in Wonderland, who told the poor hatter, who was trembling before the throne: “Don't be nervous, or I'll have you executed on the spot.” So we have been tempted to say to the unduly nervous patient: “You are not sick; don't be nervous, or you'll make yourself sick”—good advice, but, like much that we have to listen to, badly given.

We must look deeper into the causes of the nervousness, and suggest something to take their place. The profession is already awakening to this defect in its practise, and one of the benefits of christian science and the later movement is the stimulus which it has given the medical profession, to take up again, in its new light, a work which it always used to do, and which still is a part of its duty; a part of its very raison d'être.

A recent editorial in the Boston Medical and Surgical Journal says:

That the profession at large needs instruction in the practise of psychotherapy we are willing to admit; we believe that such instruction should be given at medical schools, to the end that the limitations as well as the possibilities of mental treatment should be laid down, so far as our present knowledge permits.

The University of Wisconsin has already established a chair of psychology and medicine; the Phipps fund of $500,000 will soon be available for a similar course in the Johns Hopkins University, and Dr. Morton Prince offers a course in psychotherapy this winter at the Tufts Medical School. In the great field of hospital and dispensary practise much has been accomplished in the same direction by the introduction of the social-service department, as at the Johns Hopkins, the New York Post-graduate and the Massachusetts General Hospitals.

From these considerations I think there can be no doubt but that the doctor has, can and ought to do this work; the next question is, in how far it can and ought to be done by the church. We all agree that the underlying causes in very many of these functional nervous disorders are moral causes. We all recognize the strong religious side in human nature. We have all seen in our own experience, or that of some of our friends, the peace and satisfaction of mind to be derived from a strong religious faith.

It is a powerful force for the uplifting of man, mentally and morally. This appeal to religious faith is, however, but one of our means of reaching nervous invalids; it is not always the most promising, nor is it always applicable; but it is the only one which affords any excuse for the entrance of the church into the fields of psychotherapy.

If, as has been said by one of its stoutest medical defenders, the aim of the Emmanuel Church work is only “to educate the religious faith, and to train the moral capacities of nervous invalids, sent to it by the physicians of the community for that very purpose,” there would be much less room for criticism. The work would then be done in the same quiet, unobtrusive way that the medical profession believes that all such work should be done.

But when it comes to lecturing weekly, to hundreds of laymen and women at the church, and to going about from city to city explaining to lay audiences the nature of the work and encouraging imitation, as is being done by the projectors of this Emmanual idea, the medical profession at large views with alarm the superficial manner in which a complex medical problem is presented, and sees in it strong elements of quackery and charlatanism, and the danger of great harm from its practise.

Education of the reason and strengthening of the will would seem to be more promising means of securing a nervous equilibrium than an appeal to the emotions. Even though this work has been, and is being done by the general practitioner, as we have already seen, it is probably true that in many cases, at least, it is a work in which he would welcome the assistance and advice of a specialist. But how much better fitted to give that help is the expert in diseases of the brain and nervous system who has studied psychology, than he who has studied psychology alone, or taken it up as a side issue to his study of theology and of church administration.

On this point there would seem to be little chance for disagreement. The safest counselor in all medical matters is he who has first grounded himself in normal and abnormal anatomy, in normal and pathological physiology and in the theory and practise of medicine as a whole, and then upon this foundation has made a thorough and exhaustive study of his special department; not the man who has followed a post-graduate course of lectures for a few weeks, or even months, nor the man whose psychological study has been incidental to his ecclesiastical training.

To quote again from the Boston Medical and Surgical Journal:

The only knowledge which is of value in the field of abnormal psychology and mental therapeutics has been gained from the laborious investigations of psychologists and physicians. This, all are free to use; but that its use is best safeguarded, and likely to be productive of the best results, in the hands of men with a general medical training will not generally be denied.

In sympathy with this feeling the best medical opinion is already alienated, and it is apparent that the movement must get along without the very cooperation upon which its originators laid such emphasis; yet it is doubtful if they will recognize this, for they seem disposed to show the same lack of discrimination in the selection of their medical authorities that is manifested by the opponents of vivisection.

It ill becomes a medical man to undertake to say what the effect of this movement may be on the church itself. It is entering a field that has always been occupied by medical men in an empirical way; and with the advancing knowledge of psychology and psychotherapy, they have demonstrated their ability and willingness successfully to cultivate it, wholly independent of church and religion. It is certainly not desirable that this independence should be too complete; but neither is it at all desirable, for the reasons above given, that the medical and scientific part of the work should be incidental and secondary to the religious.

The point which Dr. Worcester seems to me to miss is this: That these disorders, though not accompanied by any structural lesion, are, nevertheless, deviations from the normal brain function, and, as such, are to be studied and treated by those who have a thorough knowledge of the normal anatomy and physiology, and the pathological anatomy and physiology of the brain; and that the assistance of religion in this work, great and invaluable as that often is, should be strictly subordinate, just as it is subordinate, though very helpful and often necessary, in the conduct of the tuberculosis clinic, in his own church.

It is difficult to see where the church has any material advantage in the competition, and as the movement spreads into the hands of those with few qualifications and with greater independence of sound medical counsel, it seems not unreasonable to predict its ultimate failure and general discredit.

However, the Emmanuel movement has done good, just as the popular interest in hypnotism and christian science has done good. They emphasize and make clear the value of mental therapeutics, and spur the doctor and psychologist to renewed study of its nature, limitations and practical application. It will also serve, perhaps, to recall the practising physician from too cold a materialism; and to prevent a dehumanized scientist from taking the place of the doctor of the old school.

It is undoubtedly true that there has been a strong tendency to give undue attention and attribute undue importance to the interesting pathological problem presented in each case, and too little attention to its humanitarian aspect. We must not let the scientist push to one side the samaritan. Such is the lesson to be learned—more real human sympathy and help from the doctor, but not a “medicalized clergy.”