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On the basis of the foregoing sketch of the libidinous forces involved in consciously induced auto-suggestion, it is possible to judge the value of this method of prophylaxis and psychotherapy. It is necessary first, however, to be sure of the meaning of the practice to be judged. Both the terms 'imagination' and 'auto-suggestion' seem to be ambiguous and even to refer to widely different mental processes. We cannot therefore be satisfied with M. Coué's sincere purpose to replace wrong imagination by right thought, unless we are sure that the 'right' is also the psychophysically healthy. It is best for our purpose to avoid ethical terms, and to consider the auto-suggestive imagination in its action upon the libido.

Sometimes and in some persons auto-suggestive imagination is a repressive force in the service of the conscious ego-ideal with its inhibitory action upon the libidinous impulses. The effect of auto-suggestion in this sense is to increase the ego-dominance. At other times and in other persons auto-suggestive imagination is used as an expressive force in the service of the unsatisfied libido of auto-erotic and allo-erotic complexes. The effect of auto-suggestion in this sense is to increase the libido. dominance.

Referring to auto-suggestions that produce symptoms similar to the neuro-psychic inhibitions of hypnosis, Dr Ferenczi inclines to assume a far-reaching analogy between the psychical mechanism of these autosuggestions and the mechanism of psycho-neurotic symptoms1. This analogy seems to be true of auto-suggestion in the first, but not in the second meaning I have given above. The auto-suggestion which removes the alcoholic indulgence of unconscious homosexuality must increase the neurotic repression; whereas the auto-suggestion that removes the fear of indulging exhibitionistic libido on the stage must reduce the neurotic repression.

It is clear then that auto-suggestion cannot be recommended as the best aid to health, if it is either of the repressive kind or of the expressive kind when this is used (a) to promote regression to infantile narcissism, (b) to weaken the reality principle, (c) to replace the search for the hidden causes of ill-health by an ignorant removal of pain and incapacity, and (d) to encourage the delusion of omnipotence, for which such words as 'difficult,' 'impossible,' 'I cannot,' will disappear2. Indeed it cannot be recommended at all as a substitute for Psycho-Analysis where this causal treatment can be had. The danger of the repressive kind of auto-suggestion is most manifest precisely in its educational application, as proposed by Mr Brooks on p. 107. The parental suggestions for good behaviour 2 Harry Brooks. Ibid. p. 26.

1 Ibid. p. 72.

whispered into the ears of sleeping children, and the imposition of moral taboos by unanalysed teachers would greatly increase the amount of neurosis in the future. It is equally unsatisfactory as a method of dealing with moral delinquencies in ignorance of the unconscious impulses expressed therein.

Induced auto-suggestion can be most safely used (a) for the removal of the slight neurotic symptoms that occur in approximately normal persons under exceptional conditions of strain. The most permanent results of this method are probably secured in civil cases that resemble the war cases in so far that neither the constitutional nor the infantile factors in neurosis would cause an unbearable repression unless unusually severe shocks or accidentally harmful suggestions occurred in adult life; (b) for the involutionary cases that preserve the relics of a bygone conflict by the habit of repetition, and (c) for un-analysable persons.

The chief value of the suggestion movement, is to draw attention to the fact that, in modern civilization, the social, economic, and moral restraints cause an increase of sado-masochism, depression, envy and fear, that play an important part either in the formation or in the neurotic complication of almost all disease; and that immunity to psychical and physical infection from without, depends on the removal of the unconscious causes of inefficiency within.

CRITICAL NOTICE.

Second Report of the Miners' Nystagmus Committee. London: published by His Majesty's Stationery Office. pp. 33. Price 9d. net.

The Second Report of the Miners' Nystagmus Committee confirms some of the findings enumerated in the First Report without elucidating them. Its chief value lies in the fresh evidence collected by Mr Pooley, who is responsible for the whole of it. He has made a laborious research into the possible relationship of nystagmus and errors of refraction, and his results should settle finally that such a relationship does not exist. This was anticipated in a critical notice of the First Report, for reasons therein given, and a convincing proof is now forthcoming.

The first part of the Report is devoted to Mr Pooley's survey of the disease generally. He mentions the astonishing difference in the incidence and effect of nystagmus on the Continent and in Great Britain. It is worth while summarising once more some of the observations made. In France, Belgium, Germany and England the number of men affected by the disease amounts roughly to about a quarter of the total number of miners employed. "In America, where no compensation is given, little is heard of incapacity due to nystagmus, or indeed of the existence of the disease." In Germany the incidence of claims was 0.3 per cent. from 1905 to 1913. In the latter year a decision was come to that only serious cases of nystagmus were entitled to compensation; the percentage then fell to 0.18, and has fallen since the War to 0-03. In Belgium, where the method of compensation has been unaltered throughout, the incidence has remained at 0-2 per cent. (Stassen), 0.05 to 0-03 per cent. (Coppez). In France Dr Dransart in 1913 gave the incidence of severe cases as 0.15 per cent. In Great Britain the disease was made a ground for compensation in 1907, and a level for fresh claims was reached in 1911. In 1913, a new official definition of the affection was made, excluding the necessity for oscillation of the eyeballs to be present in the diagnosis. The effect was to include cases claiming compensation for psycho-neurosis. Claims for incapacity immediately rose, and have continued to rise especially during the War. Such an increase of fresh claims has not occurred in other countries.

In the face of this astounding fact, it hardly seems worth while for Mr Pooley to have spent so much time and energy upon the investigation of the relationship of errors of refraction to miners' nystagmus, unless there be some national or racial difference in the shape of the eyeball. Such a difference has never been suggested, at any rate between ourselves and our nearest Continental neighbours, notwithstanding the fact that in France, for instance, the wearing of glasses for eyestrain is very uncommon as compared with England. But Mr Pooley's work has a much wider application than he claims for it, and the time will come when his results will be quoted effectively by those who believe that the present method of trying to cure a round score of psycho-neurotic symptoms by means of glasses is unworthy of a scientific profession.

Under the heading "Conclusions" he classifies the cases into two groups. (1) Severe cases of the type recognised as incapacitating in France and Belgium. This group has not increased in these countries in recent years, and appears even to have diminished as safety lamps have improved. (2) Cases in which the psychological element largely predominates. This group is the one which has increased the reported cases.

In view of this important fact, which seems to be indisputable, one looks eagerly for an indication of the Committee's intention to turn its energies to the task of solving the psychological problem, but in vain. In the Introduction the Committee state that they are continuing their work and have some investigations in view which will deal further with the physiological problems involved, but from all the evidence contained in their report it would appear that a psychological investigation would be more fruitful, and surely the best way of perpetuating the memory of their former colleague, Dr W. H. R. Rivers, who was deeply interested in the psychological aspect of the disease, would have been to appoint a competent psychologist to find out the significance of the symptoms, ocular and otherwise, which make miners' nystagmus such a mystery. And this brings one to the question as to the meaning of the actual nystagmus, the oscillation of the eyeballs. The official definition of the disease allows the diagnosis to be made in the absence of oscillation. It follows either that nystagmus is an unimportant physical eccentricity, or it is a part of a psycho-neurosis. All the evidence points to its not being a cause of the nervous symptoms. The Committee appear to have neglected the opposite point of view, that nervous stress may produce the nystagmus. The latter, as has been already stated, occurs very frequently amongst miners generally. If it be granted that it is a psycho-neurotic symptom, a first stage in the development of the disease, one can easily understand the great difference in the relative incapacitating influence in Great Britain and Continental countries. In the latter the man must "get on or get out." In the former he gets compensation, and having first been persuaded officially that he is unfit, he accepts the suggestion, and actually becomes so. The same process has been observed constantly by medical officers attached to the Pensions Boards. A wrong diagnosis in the first instance, followed by a pension, ends in permanent disability, the difficulty of getting work at the present time assisting the neurotic trend. One wonders what would happen if nystagmic miners were paid handsomely to return to work instead of being paid to refrain from it. Apparently the course adopted in Germany and elsewhere has had a strikingly beneficial effect.

One cannot understand the Committee's persistence in classifying the cases according to the severity of the physical signs when throughout their Report such emphasis is laid upon the psycho-neurotic factor. After all, their function is to elucidate the nature of the disease, and thereby enable the country to avoid the waste of a million of money and to avert the secondary consequences of illness and incapacity in the men themselves. It is admitted on almost every page that no single physical sign can be taken as a guide to the severity or incapacitating effect of the disease. Nystagmus itself, in this respect, is summarily excluded on p. 19, where it is stated that "We are of the opinion that a test which encourages examination by the movements of the cornea only is unsatisfactory." Yet no effort is made to establish a formula dealing with the one great incapacitating part of the affection, the psycho-neurosis. The evidence in favour of doing so is overwhelming. The point was conceded

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in 1913, when the official definition of Miners' Nystagmus was altered to include the words whether the symptom of oscillation of the eyeballs be present or not." The Continental authorities still deal with it as a local disease. At home we have gone further practically only as far as compensation is concerned. Our scientists still cling obstinately to the idea that the nystagmus is the chief thing to be considered, and show the limited vision of the vast majority of the medical profession, who, for instance, regard asthma as a disease of the respiratory system because there is some difficulty in breathing under certain conditions. It is difficult to understand why this should be so, in the face of the facts collected. The result of the unsympathetic, but in practice very satisfactory attitude of the Belgian, French and German authorities towards the psychical symptoms has been alluded to. Abroad the latter are disregarded and not compensated, with the result that the disease is stationary or tends to diminish. In Great Britain they are compensated, and not investigated, with the result that the disease has steadily increased. On p. 18 one finds that "Indemnity Companies point out that the death-rate of those in receipt of compensation for miners' nystagmus is high, and ascribe the mortality to other intercurrent disease." Surely the natural inference to be drawn from this is, that a man who cannot face the stress of life below ground, presumably owing to low vitality, sooner or later accepts the easier conditions of life offered by compensation, gets into a backwater, and is more likely to suffer from literally any disease under the sun! This is nothing new. It is merely stating a fact familiar to everyone who has given a thought to the theory of immunity. The great questions to be solved are--Why do the British become incapacitated more than the Continental races, why do some British suffer and not others, and what has compensation to do with it?

A stimulus to tackle the problem from the point of view of the man and his reaction to his environment should have been forthcoming from one statement alone. On p. 21 one finds that out of 650 incapacitated men, 17 per cent. were over sixty years of age, though the normal proportion of men over sixty working underground is 3-4 per cent. Fifty-one of these men showed no physical signs, the symptoms being merely alleged. Again "the percentage of men not at work was found to increase with the age of the cases," and, "the duration of incapacity was found to lengthen with advancing years." In other words, it is a disease of old age, either actual or premature. A man may retire from the struggle of life at a very early age; no matter what his years, his reaction is senile.

A highly suggestive table is that given on p. 22, dealing with the relation between duration of incapacity and the presence of physical signs. It shows that the number of men disabled for two to five years was much higher than for any other period, that there was a gradual rise from a one to three months' incapacity until the two to five years' period was reached, and then a pronounced fall for the longer periods. Taking the percentage of cases showing oscillation, head tremor, and lid spasm in the same men, Mr Pooley shows a steady fall in incidence of the first condition, but a rise in the second and third from the six to twelve months' incapacity until the two to five years' incapacity is reached, and then a fall to zero. It is interesting to note that the latter two physical signs were more frequently present in those cases whose incapacity had run for two to five years, and that such cases were the most numerous in a body of 650 men investigated. In the great majority of these cases the illness had lasted from one to five years. Compare this with the Continental

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