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THE PHYSICIAN.-NO, VJII.
Of the Infuence of the Imagination on Bodily Health. None of the faculties of the mind present phenomena so singular and so contradictory as the imagination. This faculty, given to us as our kindest friend in this mortal life, often so poor in reality-to which we owe a relish for existence, comfort in the hours of affliction, and the enhancement of our happiness--through which we acquire a lively sense for the good and the fair, for truth and virtue, so long as we can keep it within due bounds—is liable, when it exceeds them, to become the most cruel of tyrants, robbing us of peace, happiness, nay even of life itself. It is, therefore, one of the most important maxims of our morals, to be continually upon our guard against its vagaries, and to order matters so as always to maintain a certain ascendancy over it. But this rule is not less important for our physical nature, as I shall demonstrate in this paper by some remarks on its powerful influence, and particularly by a circumstance which occurred in my own experience.
Numberless are the gradations through which that extraordinary disease which affects the imagination proceeds, as well as the masks which it assumes. From the first momentary conception that we feel something as real which does not exist, to absolute insanity, or the total derangement of the mind, there are innumerable stages, founded on the degree of the disease, on its causes and on the peculiar constitution of the patient. A great portion of what are commonly called hypochondriac or hysteric attacks, and nervous complaints, originate solely in a diseased imagination. People are accustomed to laugh at such sufferings when they are known to proceed from this cause; but their mirth is exceedingly ill-timed. I know not, in truth, a more dreadful and more real disease, than that in which the essence of our being itself suffers; for it is ten times as easy to bear a real evil as an imaginary one. In the former case I have always resources left within myself;--and with some effort of the powers of my soul, it is always possible for me to consider the evil as something distinct from and foreign to myself;—in the latter, the only thing that can afford me consolation and encouragement, my soul, is itself diseased, and my sufferings are actually a part of my being. In real evils, if the fundamental cause be removed, we may look forward with confidence to relief; but in the other case, the complaint of the soul must be combated and cured, and here the most efficacious remedies are of no avail, unless they operate upon the imagination.
In such unfortunate persons the real feelings are every moment confounded with their reveries; they see nothing aright, because they are accustomed to look at every thing in the mirror of their imagination alone. They come at length to such a pass, as either no longer to trust their senses, and thus live in continual contradiction with them. selves, or become a ball, with which the imagination plays the most extravagant games; and present phenomena, that, to the sober rational mind, appear wholly incomprehensible. In this way, then, it is possible for one to fancy himself a barley-corn and in constant danger of being swallowed by the fowls ; for a second to consider himself
as one of the persons of the Godhead; for a third to be firmly convinced that he is made of glass and cannot be touched without breaking; and for a fourth to imagine himself the knave of spades, and that he ought to take special care to keep out of the way of the king.
Hence arises the extraordinary disease, which causes people to see themselves double, and of which I witnessed a remarkable instance, where the second self was inexpressibly troublesome, appearing every where and at very unseasonable times to the wretched original, and reducing him by its incessant annoyance almost to despair : and yet, be it observed, this was a man who possessed his perfect understanding, and was extremely regular and clever in business. It is not, however, to be denied, that the cause of this phenomenon is sometimes independent of ourselves, and may originate in a particular refraction of the
rays of light, as is proved by the example of a celebrated anatomist. He was engaged one evening in his laboratory, where the atmosphere was filled with effluvia from a great quantity of anatomical preparations and subjects. Happening to raise his eyes, he perceived his own figure sitting at the opposite extremity of the room. to examine the phenomenon more minutely, and went towards it, but it disappeared : on returning to his former place, he again saw it. He went to another corner, from which it was again invisible. In short, he ascertained that it depended entirely on the angle of incidence of the rays of light, and that, consequently, the apparition owed its existence to the vapours in the room, which, with the aid of the evening sun, acted like a mirror.
Through the influence of the imagination, dreams and presentiments may prove fatal : and I have always considered it as one of the most dangerous symptoms, when a patient or his friends have informed me that he has shortly before had a dream or a token of his death, or that he has seen an apparition, which has announced that he had not long to live. This was, on the one hand, a positive proof that the disease is deeply, very deeply seated in such a person, and that before it actually broke out, his nervous system and the source of his conceptions must have been greatly deranged, in order to admit of such vivid fancies : and on the other hand, I could reckon upon it with the greater confidence, that the firm conviction of death would render the disease more formidable and the remedies less efficient, and that in particular it would paralyse the curative energies of nature, without which all the skill of the physician is totally useless.
Hence, also, actual diseases may, through the influence of the imagination, be aggravated by the most unusual and dangerous symptoms, nay be produced solely by it. In such cases the physician is not likely to find much assistance in books ; nor must he expect much success from any attempt to prove to the patient that his disorder is wholly imaginary. The only thing that can extricate him from the dilemma is a lucky thought, some method of diverting the imagination to a different object, or which at least is capable of rendering its consequences innoxious, or of neutralizing its convictions by means of themselves.
It is well known how a man was cured who fancied that he was dead, and refused all sustenance. His friends deposited him with all due formalities in a dark cellar. One of them caused himself soon after
wards to be carried into the same place in a coffin, containing a plentiful supply of provisions, and assured him that it was customary to eat and drink in that world, as well as in the one which they had just left. He suffered himself to be persuaded, and recovered.—Another, who imagined that he had no head, (a notion that is not so common as the reverse) was speedily convinced of the real existence of his head, by a heavy hat of lead which was set upon it, and which by its pressure, made him feel for the first time, during a long period, that he actually possessed this necessary appendage.—But the most dangerous state of all is, when the imagination fixes upon things, the lively representation of which may finally induce their realization. Of this sort was a case which fell under my own professional experience, and which affords one of the most striking proofs of the power of an overstrained imagination.
A youth of sixteen, of a weakly constitution and delicate nerves, but in other respects quite healthy, quitted his room in the dusk of the evening, but suddenly returned, with a face pale as death and looks betraying the greatest terror, and in a tremulous voice told a fellowstudent who lived in the same room with him, that he should die at nine o'clock in the morning of the day after the next. His companion naturally considered this sudden transformation of a cheerful youth into a candidate for the grave as very extraordinary: he enquired the 'cause of this notion, and, as the other declined to satisfy his curiosity, he strove at least to laugh him out of it. His efforts, however, were unavailing. All the answer he could obtain from his comrade was, that his death was certain and inevitable. A number of well-meaning friends assembled about him, and endeavoured to wean him from his idea by lively conversation, jokes, and even satirical remarks. He sat among them with a gloomy, thoughtful look, took no share in their discourse, sighed, and at length grew angry when they began to rally him. It was hoped that sleep would dispel this melancholy mood; but he never closed his eyes, and his thoughts were engaged all night with his approaching decease. Early next morning I was sent for. I found, in fact, the most singular sight in the world—a person in good health making all the arrangements for his funeral, taking an affecting leave of his friends, and writing a letter to his father, to acquaint him
а with his approaching dissolution, and to bid him farewell. I examined the state of his body, and found nothing unusual but the paleness of his face, eyes dull and rather inflamed with weeping, coldness of the extremities, and a low contracted pulse-indications of a general cramp of the nerves, which was sufficiently manifested in the state of his mind. I endeavoured, therefore, to convince him, by the most powerful arguments, of the futility of his notion, and to prove that a person whose bodily health was so good, had no reason whatever to apprehend speedy death: in short, I exerted all my eloquence and my professional knowledge, but without making the slightest impression. He willingly admitted that I, as a physician, could not discover any cause of death in him ; but this, he contended, was the peculiar circumstance of his case, that without any natural cause, merely from an unalterable decree of fate, his death must ensue ; and though he could not expect us to share this conviction, still it was equally certain that it would be verified by the event of the following day. All that I
could do, therefore, was to tell him, that under these circumstances I must treat him as a person labouring under a disease, and prescribe medicines accordingly. “Very well,” replied he,“ but you will see not only that your medicines will not do me any good, but that they will not operate at all.”
There was no time to be lost, for I had only twenty-four hours left to effect a cure. I therefore judged it best to employ powerful remedies in order to release him from this bondage of his imagination. With this view a very strong emetic and cathartic were administered, and blisters applied to both thighs. He submitted to every thing, but with the assurance that his body was already half dead, and the remedies would be of no use. Accordingly, to my utter astonishment, I learned when I called in the evening, that the emetic had taken but little or no effect, and that the blisters had not even turned the skin red. He now triumphed over our incredulity, and deduced from this inefficacy of the remedies the strongest conviction that he was already little better than a corpse. To me the case began to assume a very serious aspect. I saw how powerfully the state of the mind had affected the body, and what a degree of insensibility it had produced ; and I had just reason to apprehend that an imagination, which had reduced the body to such extremity, was capable of carrying matters to still greater lengths.
All our inquiries, as to the cause of his belief, had hitherto proved abortive. He now disclosed to one of his friends, but in the strictest confidence, that the preceding evening, on quitting his room, he had seen a figure in white, which beckoned to him, and at the same moment a voice pronounced the words :-" The day after to-morrow, at nine in the morning, thou shalt die!" and the fate thus predicted no thing could enable him to escape. He now proceeded to set his house in order, made his will, and gave particular directions for his funeral, specifying who were to carry and who to follow him to the grave. He even insisted on receiving the sacrament a wish, however, which those about him evaded complying with. Night came on, and he began to count the hours he had yet to live, till the fatal nine the next morning, and every time the clock struck, his anxiety evidently increased. I began to be apprehensive for the result; for I recollected instances in which the mere imagination of death had really produced a fatal result. I recollected also the feigned execution, when the criminal, after a solemn trial, was sentenced to be beheaded, and when, in expectation of the fatal blow, his neck was struck with a switch, on which he fell lifeless to the ground, as though his head had been really cut off: and this circumstance gave me reason to fear that a similar result might attend this case, and that the striking of the hour of nine might prove as fatal to my patient as the blow of the switch on the above-mentioned occasion. At any rate the shock communicated by the striking of the clock, accompanied by the extraordinary excitement of the imagination and the general cramp, which had determined all the blood to the head and the internal parts, might produce a most dangerous revolution, spasms, fainting-fits, or hæmorrhages ; or even totally overthrow reason, which had already sustained so severe an attack.
What was then to be done? In my judgment every thing depended on carrying him, without his being aware of it, beyond the fatal moment; and it was to be hoped that as his whole delusion hinged upon this point, he would then feel ashamed of himself and be cured of it. I therefore placed my reliance on opium, which, moreover, was quite appropriate to the state of his nerves, and prescribed twenty drops of laudanum with two grains of hen-bane to be taken about midnight. I directed, that if, as I hoped, he overslept the fatal hour, his friends should assemble round his bed, and on bis awaking, laugh heartily at his silly notion, that, instead of being allowed to dwell upon the gloomy idea, he might be rendered thoroughly sensible of its absurdity. My instructions were punctually obeyed: soon after he had taken the opiate, he fell into a profound sleep, from which he did not awake till about eleven o'clock the next day.
• What hour is it ?” was his first question on opening his eyes; and when he heard how long he had overslept his death, and was at the same time.greeted with loud laughter for his folly, he crept ashamed under the bedclothes, and at length joined in the laugh, declaring that the whole affair appeared to him like a dream, and that he could not conceive how he could be such a simpleton. Since that time he has enjoyed the best health, and has never had any similar attack.
Many instances are known of persons who, though not ill, have predicted their death in one or in a few days, and have died exactly at the time which they foretold. In former ages, when it was the fashion with the great to keep an astrologer and to consult the stars respecting the time of their death, many illustrious personages expired in the year and month predicted by their soothsayers, and the belief in their prophetic faculty was thereby not a little strengthened. In this, however, I find nothing extraordinary, and, indeed, contemporary writers explain the matter in a perfectly natural way. The good folks actually died of the prophecy; and this is one of the cases in which the prediction of a thing is the only cause why it really happens. It requires more than ordinary levity or strength of mind, to be told by a person whom we regard as possessing superior intelligence, that it is a mathematical certainty that we shall die at a stated_time, without being shocked and filled with anxiety for the result. Every day that brings us nearer to the dreaded moment must augment our uneasiness, and the derangement of health inseparably connected with it. Fear is the most subtle, the most fatal of poisons : it paralyses all the faculties; it destroys the noblest energies of our nature, and keeps the nervous system in a state of such constant tension, that it cannot but be considered, if not as itself a disease, at least as the most dangerous foundation for diseases. Should we be attacked in this mood with any slight indisposition, it may be exceedingly aggravated by the depression of the spirits and the prostration of the animal powers; and in this manner a cold miay degenerate into a most malignant, nay fatal, nervous fever. Thus it is, that in times of general calamity, in epidemic diseases, and in long sieges, fear so dreadfully augments the mortality, because each is apprehensive of experiencing the same fate which he sees diffused far and wide around him.
I knew an instance of a man, who was by no means superstitious, and for whom some person had, in his youth, done the disservice to cast his nativity and to predict the year of his death. He laughed at the prophecy till the specified year arrived; he then began to be ma