PSYCHOLOGY : A Case of Voluntary Ignorance

A Case of Voluntary Ignorance

            That men do not learn very much from the lessons of history is the most important of all the lessons that history has to teach. Si vis pacem, the Romans liked to say, para bellum - if you want peace prepare for war. For the last few thousand years the rulers of all the world's empires, kingdoms and republics have acted upon this maxim - with the result, as Professor Sorokin has laboriously shown, that every civilized nation has spent about half of every century of its existence waging war with its neighbors. But has mankind learned this lesson of history? The answer is emphatically in the negative. Si vis pacem, para bellum still is the watchword of every sovereign state, with the possible exception of Monaco. Again, what happens when economic power is concentrated in a few hands? History's answer to that question is that, whatever else it may be, that which happens is most certainly not democracy. But while politicians everywhere proclaim the virtues of democracy (even the totalitarian states are People's Republics), advancing technology is everywhere allowed and even encouraged to work for the concentration of economic power. Small-scale operators in agriculture and industry are progressively eliminated, and in their place advancing technology installs an oligarchy of giant concerns, owned and operated either by private corporations and their managers, or by the state and its bureaucrats.

            It is interesting to note that the men who, in the teeth of history, proclaimed that, if you want peace, you must prepare for war, were the self-same men who solemnly declared that Experience teaches, experientia docet- or, as Mrs. Micawber more aptly put it, "Experientia does it." But as a matter of brute historical fact, Experientia generally doesn't. We got on doing what our own and our father's experience has demonstrated, again and again, to be inappropriate or downright disastrous; and we go on hoping (this time like Mr. Micawber) that "something will turn up" - something completely different from anything which, on the basis of experience, we have any right to expect. Needless to say, it does not turn up. The same old mistakes have the same old consequences and we remain in the same old mess.

            And even when we do permit ourselves to be taught by experience, as embodied in our own or our society's history, how slow, in all too many cases, how grudging and reluctant is the process of learning! True, we learn very quickly the things we really want to learn. But the only things we really want to learn are the things which satisfy our physical needs, the things which arouse and justify our darling passions, and the things which confirm us in our intellectual prejudices. Thus, in any field of science, new facts and new hypotheses are accepted quickly and easily by those whose metaphysical beliefs happen to be compatible with the new material. They are rejected (or, if accepted, accepted very slowly and grudgingly) by those into whose philosophy the new material cannot be fitted - those, in a word, whose intellectual presuppositions are outraged by the facts and hypotheses in question. To take an obvious example, the evolutionary hypothesis and the factual evidence on which it was based were rejected by the Fundamentalists, or accepted only in a Pickwickian sense and after years of stubborn resistance. In precisely the same way the dogmatic materialists of our own day refuse to accept the factual evidence for ESP, or to consider the hypotheses based upon that evidence. From their own experience or from the recorded experience of others (history), men learn only what their passions and their metaphysical prejudices allow them to learn.

            A wonderfully instructive example of this truth is provided by the history of hypnotism in its relations with orthodox medicine - the history, that is to say, of an extremely odd and still unexplained phenomenon in its relations with a body of anatomical and physiological facts, with certain officially sanctioned methods of treatment, with a system (in part explicit, in part tacit and unexpressed) of metaphysical beliefs, and with the men who have held the beliefs and used the methods. At the time of writing (the Summer of 1956) hypnotism is in fairly good odor among medical men. During World War II it was extensively used in the treatment of the psychosomatic symptoms produced by so-called "battle fatigue." And at the present time it is being used by a growing number of obstetricians to prepare expectant mothers for childbirth and to make that blessed event more bearable, and by a growing number of dentists to eliminate the pain of probing and drilling. Most psychiatrists, it is true, fight shy of it; but for that overwhelming majority of neurotics who cannot afford to spend two or three years and seven or eight thousand dollars on a conventional analysis, hypnotic treatment, mainly at the hands of lay therapists, is being made increasingly available. And now let us listen to what a distinguished anesthesiologist, Doctor Milton J. Manner of Los Angeles, has to say about the value of hypnotism in his special field. "Hypnotism is the best way to make a patient fearless before surgery, painless during it and comfortable after it." Dr. Manner adds that, in severe operations, "perfect anesthesia should be attained by employing hypnotism in conjunction with chemical agents. It can then be a pleasant experience, involving no tension or apprehension." But, it may be asked, why bother with hypnotism, when so many and such excellent chemical anesthetics lie ready to hand? For the good reason, says Dr. Manner, that hypnotism "places no extra load on circulation, breathing, or on the liver and kidney systems." In a word, it is entirely non-toxic. Hypnotism, he adds, is epecially valuable in operations on children. Children who have been hypnotized into unconsciousness are more cheerful after surgery, "more alert, more responsive, more comfortable and more co-operative than those who undergo anesthesia produced by chemicals alone." Patients who have suffered severe burns are in constant pain, greatly depressed and without appetite. Hypnotism will relieve pain, improve morale and restore appetite, thereby greatly accelerating the process of healing. Alone or in conjunction with relatively small amounts of chemical anesthetics, hypnotism has been used by Dr. Marmer in every kind of surgical situation, including even the removal of a tumor from the lung. Every anesthesiologist, Dr. Marmer concludes, should also be a hypnotist.

            So much for hypnotism today. Now let us turn back to the past and see what lessons the history of hypnotism has to teach. Among the books in my library are two rather battered volumes-Mesmerism in India, by James Esdaile, M.D., first published in 1846, and Mesmerism, in its Relation to Health and Disease, and the Present State of Medicine, by William Neilson, published at Edinburgh in 1855. Esdaile was a Scottish physician and surgeon, who went out to India as a young man and was put in charge of two hospitals in Bengal - one a hospital for prisoners in the local jail, the other a charity hospital for the general public. In these hospitals and, later, in a hospital at Calcutta, Esdaile performed more than three hundred major operations on patients in a state of hypnotic (or as it was then called, "mesmeric" or "magnetic") anesthesia. These operations included amputations of limbs, removals of cancerous breasts, numerous operations for varicocele, cataract and chronic ulcers, removals of tumors in the throat and mouth, and of the enormous tumors, weighing from thirty to more than a hundred pounds apiece, caused by elephantiasis, then exceedingly prevalent in Bengal. Esdaile's Indian patients felt no pain, even during the most drastic operations. What was still more remarkable, they survived. In 1846 - the year in which Esdaile published his book - Semmelweiss had not yet taught his students to wash their hands when they came from the dissecting room to the maternity ward, Pasteur was years away from his discovery of bacterial infection, Lister, a mere boy in his teens. Surgery was strictly septic. In the words of a historian of medicine, "suppuration and septic poisonings of the system carried away even the most promising patients and followed even trifling operations. Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, feared the very name of hospital, and the most skillful surgeons distrusted their own craft." Before the advent of ether and chloroform (which began to be used about 1847), the mortality of patients after surgery averaged twenty-nine per cent in a well-run hospital and would rise, when the streps and staphs were more than usually active, to over fifty per cent. Chloroform changed the techniques of surgery, but not, to any marked extent, its results. The agonies of the fully conscious patient "had naturally and rightly compelled the public to demand rapid if not slapdash surgery, and the surgeon to pride himself on it. Within decent limits of precision, the quickest craftsman was the best." (There were famous specialists who could perform an operation for stone in fifty-eight seconds flat.) Thanks to chloroform, "the surgeon was enabled to be not only as cautious and sedulous as he was dexterous, but also to venture on long, profound and intricate operations which, before the coming of anesthetics, had been out of the question. But unfortunately this new enfranchisement seemed to be but an ironic liberty of Nature, who with the other hand took away what she had given." Bigger and better operations were performed under chemical anesthesia, but the patients went on dying at almost the same ghastly rate. In the twenty years following the introduction of chloroform and preceding Lister's advocacy of aseptic surgery, the death rate from postoperative infections fell by only six percentage points - from twenty-nine in every hundred cases to twenty-three. In other words, almost a quarter of every Early Victorian surgeon's clients were still regularly slaughtered. Chloroform had abolished the pain of operations, but not the virtual certainty of infection afterwards, nor the one-in-four chance of a lingering and unpleasant death.

            Meanwhile, what was happening in Bengal? The answer is startling in the extreme. In a debilitating climate and among sickly and undernourished patients, Doctor Esdaile was performing major surgery without any deaths on the operating table (a distressingly frequent event in the early days of badly administered chloroform) and with a mortality from postoperative infection of only five per cent. How are we to account for this extraordinary state of affairs? First of all, Esdaile never allowed his patients' morale to be undermined by apprehension. The men and women who came to him were not told in advance when they were to be operated, nor even, in many cases, that an operation would be necessary. After examination by the surgeon, they were taken into a dark room, asked to lie down on a couch, and then put to sleep by "magnetic passes," which were made by relays of orderlies, who would work on the patient, if it seemed necessary, for three and four hours at a stretch. When the passes had taken effect and the patient was in a deep hypnotic coma, he would be taken into the operating room, have his leg cut off, or his forty-pound elephantiasis tumor removed, be stitched up and carried, still unconscious, to his bed. In most cases patients remained in trance for several hours after being operated, and would wake up unaware of what had happened and feeling no pain whatever. In the days that followed they were frequently re-mesmerized, and so spent most of their time in a state of trance. But in trance, as in natural sleep, the vis medicatrix naturae, nature's healing power, is able to do its work with the greatest possible effectiveness. The agitated and anxious ego is put to sleep and can make no trouble; left to its own devices, the autonomic system or Vegetative Soul (as it used to be called) goes about its business with infallible skill. In order to be freed from pain and self-consciousness, Esdaile's patients did not have to be poisoned by narcotics and analgesics; thanks to hypnotism, they were spared most of the miseries that normally follow an operation, and, thanks to hypnotism, their resistance was raised to such an extent that they could easily get the better of the deadly microorganisms associated with septic surgery.

            Five deaths to every hundred operations - it was the biggest medical news since the days of Hippocrates! But when Esdaile published the facts, what happened? Were his colleagues delighted? Did they hasten in a body to follow his example? Not at all. Most of them were extremely angry when they heard of his achievement, and the bigwigs of the faculty did everything in their power to prevent Dr. Esdaile from continuing his beneficient work and, when that proved impossible (for Esdaile was backed up by the Governor General of India), to suppress the, to them, embarrassing and distasteful facts.

            Doctor James Simpson, the first surgeon to advocate the use of chloroform and a most courageous crusader, in the teeth of Fundamentalist opposition, for painless childbirth, was at first intensely interested in mesmeric anesthesia. In a letter to Esdaile he wrote that he had "always considered the few deaths out of so many formidable operations one of the most remarkable things in the history of surgery." Furthermore, says Esdaile, "Dr. Simpson sent me a message that I owed it to myself and my profession to let my proceedings be known in England, and that, if I wrote an article, he would get it published in the journal he was connected with. I therefore sent him an account of one hundred and sixty-one scrotal tumors removed in the mesmeric trance." This paper was rejected on the ground that parts of it had appeared (in a greatly garbled form) in another medical journal. "A more general paper was offered; but after some compliments and considerable delay," Esdaile was informed that Dr. Simpson's brother editors had declined it as "not being sufficiently practical." "One of the most remarkable things in the history of surgery!" is Neilson's justifiably bitter comment. "Namely, how to reduce 23 per cent of deaths to 5 per cent - not practical." And he adds that "it is very curious that, when Dr. Simpson professed to publish an account of all the means that have ever been used to prevent the pain of operations, he quite forgot to mention mesmerism."

            This sort of thing had happened before Esdaile's day and was destined to happen again, and yet again, thereafter. Doctor John Elliotson, an eminent physician and Professor of Physiology at the University of London, had been derided and boycotted for his advocacy of mesmerism in surgery and general practice. Some of his critics had gone so far as to assert that a mesmerized man who had a leg amputated without showing the slightest sign of discomfort was a mere impostor - pretending that he felt no pain just to annoy the orthodox doctors. And one of them, Doctor Copland, solemnly declared that "pain is a wise provision of Nature; and patients ought to suffer pain, while their surgeon is operating; they are all the better for it and recover better." Later on, when the anesthetic properties of ether and chloroform had been discovered, the first reaction of many doctors was not to give thanks that the pain of operations had been abolished. No, their first reaction was to gloat over the discomfiture of the mesmerists. "Hurrah!" wrote Robert Listen, the first surgeon to perform an operation under ether. "Rejoice! Mesmerism and its professors have met with a heavy blow and great discouragement." More soberly, but with equal satisfaction, the official Lancet smugly editorialized: "We suppose that we shall hear no more of mesmerism and its absurdities." And, in effect, the absurdity of a five per cent death rate was not heard of again until Lister discovered that, if the surgeon used aseptic methods, the patient could survive in spite of lowered resistance and systematic poisoning by chemical anesthetics, narcotics and analgesics.

            But mesmerism and its absurdities were observable facts and, in spite of everything, they refused to disappear. It therefore became necessary to legislate against them. For almost half a century after the publication of Esdaile's book, any English doctor who made use of hypnotism ran the risk of being hounded out of his profession. It was not until 1892 that the British Medical Association officially admitted the reality of hypnosis and officially sanctioned hypnotic treatment.

            In France hypnotism fared better than in England. The first Royal Commission on Mesmerism (of which Benjamin Franklin was a member) had denied the existence of the "magnetic fluid," which was supposed to account for the phenomena of hypnotism, but had not pronounced on the reality of the physical and psychological phenomena induced by mesmeric procedures. The second commission pronounced in favor of mesmeric treatment. The third, dominated by the orthodox party, pronounced against mesmerism. Later, Charcot tried to prove that hypnosis was a form of hysterical epilepsy. But in spite of everything the practice of hypnotism continued and, at the close of the nineteenth century, was being extensively used for the relief of pain and the cure of sickness. Today, strangely enough, hypnotism is almost unknown among medical circles in France. It is as though such pioneers as Liebault and Bernheim had lived and labored in vain. The remarkable successes achieved by those men and their followers have been more or less completely forgotten.

            These ups and downs in the popularity of hypnotism are characteristic of its history in every country. At one moment hypnotism seems to be on the point of entering medicine as a widely used form of therapy; then, a few years later, the public and the professional men seem to lose interest in this kind of treatment, which is either quietly ignored or else denounced as dangerous or vaguely immoral. In the United States, for example, hypnotism enjoyed wide popularity in the years following the Civil War. Three quarters of a century ago the editor of the American edition of Deleuze's Treatise on Animal Magnetism could write as follows: "Probably there is not a city nor village in North America where there could not be found at this time - 1878 - one or more magnetizers. Usually one is to be found in every family." Very few of these magnetizers were medical men; for most American doctors disapproved of hypnotism almost as heartily as did their British colleagues. But, medical or non-medical, the hypnotists existed and were evidently plentiful. By the turn of the century, however, the American magnetizer was already a rare bird, and by the early Twenties the species was almost extinct. Today, it seems to be on its way back. Within a few years, if present trends persist, every city and village in North America may have its medical or dental hypnotist, every family its practitioners of autohypnotism and mutual suggestion.

            Why has the history of hypnotism been so strangely checkered? Why is it that, in the words of a great psychologist, the late William McDougall, "in spite of the frequent occurrence of states identical with or closely allied to hypnosis, some three centuries of enthusiastic investigation and of bitter controversy were required to establish the hypnotic state among the facts accepted by the world of European science"? The answer, as I have already suggested, is that most of us believe only what our interests, our passions and our metaphysical prejudices permit us to believe. "As Hobbes has well observed, if it were for the profit of a governing body that the three angles of a triangle should not be equal to two right angles, the doctrine that they were would, by that body, inevitably be denounced as false and pernicious. The most curious examples of this truth have been found in the history of medicine. This, on the one hand, is nothing more than a history of variations and, on the other, a still more wonderful history of how every successive variation has, by medical bodies, been first furiously denounced and then bigotedly adopted." So wrote an older contemporary of the persecuted mesmerists, the Scottish philosopher and essayist, Sir William Hamilton (who, like every intelligent man of the period outside the medical profession, took a lively interest in the phenomena of hypnotism). It should be added that the "profit" of a professional body is not to be measured exclusively in terms of money and power, or even of prestige. There are vested interests not only in the fields of economics and social position, but also in the field of pure ideas. That a beautiful and genuinely antique theory should be ruined by some new, coarse, essentially vulgar fact of mere observation seems quite intolerable to a mind brought up in a proper reverence for words and consecrated notions. And it goes without saying that, if the threat to a beloved theory should at the same time be a threat to personal reputation, this resentment will be raised to the pitch of outraged disapproval and a burning, righteous indignation. This was clearly recognized by one of the early historians of science, John Playfair, who noted that new ideas, new observations and new methods "must often change the relative place of men engaged in scientific pursuits, and must oblige many, after descending from the stations they formerly occupied, to take a lower place in the scale of intellectual improvement. The enmity of such men, if they be not animated by a spirit of real candor and the love of truth, is likely to be directed against the methods, observations and ideas by which their vanity is mortified and their importance lessened."

            If the Early Victorian doctors hated mesmerism, it was because it threatened their vested interests in such time-hallowed therapeutic methods as blood-letting and pill-prescribing, and at the same time their vested interests in a time-hallowed philosophy of man and the universe, which had no place in it for the odder phenomena of human psychology. Moreover, they felt that they could not give up these methods or modify this philosophy without gravely injuring their professional dignity. "If mesmerism be true," wrote Esdaile, "the doctors, old and young, will have to go to school again; and this is what constitutes the bitterness of the mesmeric pill." (Substitute "parapsychology" for "mesmerism" and "para-psychological" for "mesmeric" - and you have here an explanation of the refusal, on the part of some contemporary scientists, to consider the vast accumulations of evidence in favor of the reality of ESP.)

            The extreme bitterness of the pill accounts for the extreme violence of the medical diatribes against the new observations and the new methods of treatment, along with all those who had had anything to do with them. It is a violence comparable to that which, all too frequently, has characterized the controversies of clergymen. The doctors loathed the mesmerists with a full-blown odium theologicum, a theological hatred. In his volume of 1855, William Neilson quotes many examples of this truly religious intemperance of language. Disdaining argument and paying no attention to facts, the anti-mesmeric contributors to the Lancet and the Medical Times confined themselves exclusively to abuse. "While pursuing their frauds among lunatics and fools, mesmerists give us neither umbrage nor disquiet; but within the walls of our colleges (there were mesmerists of the highest scientific eminence at the Universities of Edinburgh and London) they are scandalous nuisances and an insufferable disgrace." Elliotson and his followers practice "a harlotry which they call science." Worse still, they refuse to bow to the authority of those licensed repositories of ultimate truth, the doctors. Instead, they make their appeal to mere reason and uncensored experience, with the shocking result that they have found enthusiastic supporters in every class of society - "the pert folly of the nobility, the weakest among the literary people, high and low ladies, quack clergymen (among whom, it may be remarked, were several bishops and even an archbishop), itinerant lecturers and exhibiting buffoons." To sum up, mesmerism is merely a compound of "quackery, obscenity and imposture, and its advocates are at the best deluded idiots, at the worst swindling knaves."

            In one of its aspects, as we have seen, the history of medicine is the history of variations - the history of fads pursued and then rejected, of fashions adopted with enthusiasm and then quietly dropped in favor of some more modish style of diagnosis or of treatment. When all these fads and fashions are strictly physiological, the change from one to another can be made without difficulty and without any feeling of mental distress. But where non-physiological factors are involved - factors which cannot be explained in terms of the prevailing medical philosophy - changes of fashion are painful and the resistance to change is stubborn and often violent. Hypnotism involves non-physiological factors; consequently the reality of hypnosis and the value of hypnotic treatment were vehemently denied by the official spokesmen of the medical profession. That the ban upon hypnotism ever came to be lifted was due to a variety of causes. First of all, the metaphysical susceptibilities of the doctors were soothed by the work of Professor Heidenhain. This German researcher was able to convince himself and his colleagues that hypnosis was always the result of strictly physiological causes. It didn't happen to be true; but, to use the religious phraseology which seems appropriate to the case, it was highly edifying, it brought comfort to the troubled spirit of the doctors, and it helped, incidentally, to make hypnotism respectable. Meanwhile intensive research into the nature of mental illness was being carried on, especially in France and Germany, and the idea of subconscious mental activity gradually forced itself upon even the most physiologically minded psychiatrists. Within the enlarged framework of medical philosophy, hypnosis, though still unexplained, began to make a little more sense. But then - fortunately in some ways, unfortunately in others - the great Doctor Freud made his appearance. Freud banned hypnotism from his system of psychotherapy and, as an entirely illogical consequence of this ban, hypnotism came to be largely neglected in surgery and general medicine, where it is of such inestimable value as a nonpoisonous anesthetic, as a raiser of resistance to infection, as an improver of morale, as a promoter of healing and an accelerator of convalescence.

            Wars tend to stimulate medical advance, at any rate in those countries which have escaped severe devastation. The current revival of interest in hypnotism is in part due to its successful employment in military hospitals. Medicine has now returned to the position once occupied by Esdaile and Elliotson. That it should have taken four generations to reconquer that position is certainly unfortunate. But better late than never.

(From Esquire Magazine)