While trying to take advantage of the influence of the mind on the body for therapeutics, it is important to remember that the body has a great influence on the mind. There are many states of mind that are dependent on states of body, and that can be modified only by first modifying the body. Body changes can at least greatly help. In order to use the mind in the therapeutics of conditions in which it would help in the awakening of such vitality as is necessary for the cure, particularly of many of the chronic affections, it is necessary first to dispose the body so that it will not constantly be adding to, or at least emphasizing, an unfavorable state of mind. For this purpose it is important to study definitely and practically the influence that various attitudes, expressions and external manifestations may have in changing the internal feelings. This factor seems trivial when viewed from the standpoint of health, but it is one of the trifles that are very helpful in the predisposition of the patient to get better. Alteratives in medicine, while we have not been able to say just what their effect was, have done much for us, and the influence of body on mind is just such an alterative.

Even those who have insisted most strenuously on the independence of mind from body have always recognized not only the influence of the mind on the body, but also of the body on the mind. Perhaps the most familiar example of this is the well-known liability to dream after eating things that disturb digestion and seem to interfere, probably by congestive tendencies, with the circulation of the brain during sleep. It has always been recognized that mental operations are sluggish for some time after eating, and that a period of depression is likely to follow any excess. The Romans feared the consequences of indigestion so much that, occasionally after they had surfeited themselves with rich food, they took such direct mechanical means as a feather or a finger in the throat to relieve their overloaded stomach, in order that they {101} might not suffer the after consequences, but especially the depression and irritability of mind.

Disposition and Digestion.—The relation of the body to the mind in many other besides the purely animal digestive functions has always been realized. It has always been felt that the disposition of an individual depended to a great extent on his nutrition. Men were not usually approached for favors before their meals, and especially after a long fast, but, as far as possible, requests were made shortly after meals. It has always been recognized that the best time for men to get together in council is, at least so far as amiability goes, shortly after meals. Tiredness was also felt to be an important element in affecting the mind. The tired man, even though he may be hungry, can only eat a hearty meal at the risk of serious disturbance of digestion, for, as a consequence of the fatigue of the body being communicated to the mind, the mental influence which predisposes to good digestion is lacking, and it is easy for serious digestive disturbances to be set up. In a word, body and mind are inextricably involved in all that concerns not only health but good feeling, and these two terms are practically convertible.

Feeling and Expression.—In nothing is the influence of the body on the mind more clear than in the influence of expression upon the disposition. Actors know that if they want to well express a certain feeling, they must arouse that feeling deeply, and the easiest, surest and most direct method of doing so is to fix the features in the expressions that would ordinarily indicate the presence within of these feelings. If we insist on putting our features into the shape which ordinarily expresses sadness, that will be reflected internally, and we shall become as sad as our expression. On the other hand, if the features are drawn, even by force of will, into the state that ordinarily expresses joy or lightness of heart, we shall be tempted more and more to feel that way, until at last even internal melancholy may be dissipated. In the oldest book in the world, "The Instruction of Ptah Hotep," written about 3,000 years before Christ, the old father giving advice to his sons says: "Let thy face be bright what time thou livest," and the literature of every time since then emphasizes the same idea.

This influence of the expression on the mind is an extremely important element in psychotherapy. Men and women must be taught to shake off inner sadness, and over-occupation of mind, by training their facial muscles of expression as far as possible to occupy positions expressive of good feeling, but above all not to let them be fixed in positions indicative of ill feeling. It makes a great difference for the mental state whether a man has the corners of his mouth drawn down or up, or whether they are pulled straight across the face to give the severe, austere expression that some people seem to cultivate. If the corners of the mouth are allowed to droop the glumness and depression is likely to grow deeper. If the lips are curled upward and smile, even though it may be a forced smile, the inner feeling will soon yield to it. Actors are able to counterfeit the reality, but much more than this, as we have said, they realize that, by imitating the externals of the feeling, they awaken the feeling itself within them. This is true for anger and loathing, and for many of the more serious dispositions as well as for those that might be thought more superficial, and hence more controlled by the external muscles.{102}

The Mouth.—It is interesting to realize how different are the expressions of the face as a consequence merely of control of the sphincter of the mouth and its associated muscles. Physiological psychologists have often called attention to the fact that only a few lines are necessary to picture the characteristic human expressions of sadness, joy and severity. If a little droop is given to the line that represents the lips, melancholy is at once expressed, while the upward curve expresses joy, and the straight line severity. These types of human expression are easy to control, and the internal effect of each is soon felt where there is deliberate, or indeliberate, perseverance in its maintenance.

Fig. 1. Three abstract faces.

The Eyes.—A typical example of the influence of the mind on the body is to be found in the use of the eye muscles, especially the oblique muscles. Of definite and important use for many purposes, they are especially employed to attract attention by means of the eyes. Coquetry has used them to express various phases of sex attraction. We all know the picture of the young woman who "makes eyes." It is interesting, however, to set solemn people imitating these exercises of the oblique eye muscles. For most people it is practically impossible to use these muscles without a corresponding quasi-demure setting of the features, commonly associated with those who use them most. There is even likely to be a certain attitude of mind aroused corresponding to the setting of the features in a particular way. While this is true for almost any other expressive state of the countenance, it is not so easy to demonstrate as is this.

The use of the superior recti muscles has also a definite effect upon the disposition. One of the pleasures of walking in a well-kept forest where the trees meet high overhead, is that the eyes are inevitably attracted upward to range among them, and there is a corresponding elevation of feeling. Bernard Shaw once said that it was impossible to enter a Gothic church without an elevation of the spirit, because the eyes were surely attracted upward by the height of the nave, and a corresponding uplift of feeling ensued. During a period of glumness it is apparently impossible to keep the eyes raised. People who are depressed and "cast down," as the expression is, invariably keep their eyes downward, and just as soon as a man "looks up and not down" there is a lifting of the depression. Even such apparently trivial muscular actions as this may influence the mind, and thus react upon the physical system generally.

Wrinkles.—Many influences of the body on the mind group themselves in the muscles of expression around the eyes. Wrinkles, for instance, are originally a habit of mind, and then the emphasis of this, in the muscles of the face, is reflected back to deepen still further the dejection or nervous unrest that originally causes them. It is surprising to see what an influence it has on patients who go round much with wrinkled foreheads, to have them give over the practice and discipline themselves to appear with uncorrugated superciliary muscles. St. Ignatius Loyola, the founder of the Jesuits, and one of {103} the wisest managers of men that ever lived, has emphasized in one of his rules that "wrinkles on the forehead and still more on the nose" are a sign of interior disquiet and must not be seen. He realized that the interior feelings could be influenced by suggestion at least, by having those who indulged in wrinkles keep their foreheads and noses smooth. Most of the expression of the face is concerned with the eyebrows and neighboring regions, and people should occasionally be asked to look at themselves in the glass, so as to rid themselves of habits of expression indicative of a disturbed mind, for this will do much to help to relieve the mental disturbance.

Attitudes and the Mind.—With regard to the influence of the body on the mind, and the stimulating mental reaction that follows even a pose of well-being and good feeling, perhaps nothing affords more striking evidence than the effect of assuming the expressions and attitudes usually associated with various states of mind and then noting the results. If a man throws his shoulders back, and takes in long breaths of air, expanding his chest and stimulating his circulation, his whole body as well as his mind feels the effect. A slow walk with bowed shoulders and head, while one moodily turns over all the possibilities for ill in the life around, does very little good, while a brisk walk with head thrown back, shoulders erect, brings a man home with mind and body both ready to throw off temporary obstacles of all kinds, and in addition to the fact that the mental depression has disappeared, to some extent at least, all the physical functions will be accomplished better than before.

Tears and Feeling.—Some of the usual translations of the meaning of external expressions are not justified by what we know of their actual purpose and effects. For instance, tears are supposed to be a sign of deep grief. Except in the very young they are not, as a rule, to be thus understood. As we grow older they are much more frequently a sign of deep feeling that is usually quite pleasurable. It is almost impossible for a human being to be touched deeply without a glistening of the eyes that readily runs over into tears. A mother who is proud of something that her children have done is quite sure to have tears in her eyes. If she is present at a successful musical or dramatic performance given by a son or a daughter, especially where there is something of a triumph for them, she is sure to have tears in her eyes. There are few mothers who fail to be moved in this way when their children take prizes, or when some one writes to tell them how well their children are doing. Tears, indeed, far from being a sign of sadness, usually in adults indicate profound joy.

Tears, then, instead of being discouraged, should rather be encouraged, unless when indulged in to excess. We realize how trying to health and strength is the stony grief that does not melt into tears. The mother who faints over the sudden death of her child, and who wakes to silent consciousness, is in a dangerous condition until the solace of tears comes to her. Until there are tears, we fear for the effect upon her mind of the grief. The sufferer from melancholia is sad, but a good outburst of tears will, indeed, often mean the end of a prolonged period of melancholia. In the trials of life tears are a consolation rather than an addition to sorrow. In the olden times men wept as well as women, and Homer's heroes thought it not at all beneath their dignity to be seen in tears. Over and over again, the physician learns that while people have been going to "shows" that were supposed to make them {104} laugh and so divert their minds, the best possible effect is derived not from trivial laughter, but from a serious play that touches the heart deeply and makes all who go to it melt a little. Many nervous patients never feel better than after they have had a good quiet cry.

The influence of the serious things of life in producing favorable states of mind is not sufficiently appreciated, or at least has come to be neglected in our day. There is a seeking far and wide for pleasure and diversion that should be obtained near home, through the simple joys of domestic life or intimate contact with others who need us in some way. As has been well said, it is not far-fetched pleasure, but simple joys that are more needed in our time. Nothing so enables the patient to get his, and above all her, mind off self as care for others. This must be expressed, however, in external acts accomplished by ourselves for others to have any deep effect. Doing things for other people deepens the feeling of sympathy, and so makes the mind much more ready to respond to increase of these feelings so profoundly as to displace selfish considerations. Exercise is valuable, but exercise undertaken for a worthy motive, constantly before the mind during the time it is taken, means ever so much more in awakening all the sources of energy that there are in men and women to make life worth living for themselves and others.

Application of Principles.—The best possible source of relief from that combination of mental despondency, and the lack of bodily vitality which so often accompanies it, and which, if not interrupted, may lead to a serious breakdown of mental health, is the discipline of work; above all, work for the benefit, of others, to which one forces one's self gradually but persistently, not with, long intervals, but day after day. The discipline of the asylum and the sanatorium is probably the most efficient curative agent when these cases are at their worst. When the symptoms are beginning, a discipline of a milder character, yet resembling that of the institution, but appealing to higher motives and leading to frequently repeated actions for the benefit of others, will undoubtedly do much to prevent worse developments or make the future condition of the patient less serious than it would otherwise be. Undoubtedly some of the old monastic regulations were efficient in preventing the more serious developments of despondency when the danger to himself and others of the melancholic was not so well recognized as at present.

Laughing Cures.—Every now and then the newspapers announce that some physician has invented a laughing cure, or a smiling cure, or something of the kind. Sometimes these reports are founded on actual occurrences; oftener, perhaps, they are the invention of a reporter suffering from a dearth of news. There is, however, no doubt that a smiling cure will do much to make people, even those who have serious reasons to be depressed, feel better. Every physician knows that if melancholic patients of the milder type can be amused quietly, their depression is modified for the better. Accordingly, we advise them to see farces or lively comedy, and we try to pick out cheerful nurses for them. The depression consequent upon some serious illness can be better relieved in this way than by any tonics or stimulants. For the depression, for instance, that so often follows a stroke of apoplexy, the employment of a nurse with a good human sense of humor and a large sympathy with the humorous side of things in life will do more to arouse a man from the lethargy into which he settles than almost anything else.{105}

With regard to laughing, there is, of course, another element that must be remembered. A hearty laugh moves the diaphragm up and down vigorously, empties and ventilates the lungs, stimulates the heart mechanically by its action upon the intra-thoracic viscera, and is one of the best tonics that we have for the circulation in the abdominal cavity, and probably also for the important nervous mechanisms centered there. Its action upon the lungs is readily recognized. Its influence upon the heart is usually not so much thought of, but deserves even a more prominent place. It is now well known that when patients have gone into coma or the apneic condition that sometimes follows shock, or the administration of an anesthetic, when the heart ceases to beat, the only effectual means of resuscitation is by directly irritating the organ. It has been suggested that if the abdominal cavity is open the surgeon's hands should be passed up and should squeeze the heart through the diaphragm. It has even been proclaimed that tapping on the chest vigorously over the precordium may arouse a heart that has for the moment stopped beating. It is easy to understand, then, that a hearty laugh, by stirring up all the intra-thoracic viscera, stimulates the heart mechanically and sets it beating more vigorously than before. This is one of the reasons why people feel so well after a hearty laugh.

Even slight swallows of water act as a distinct heart stimulant. When people have fainted, a succession of swallows of water, each of them acting as a heart tonic, is one of the best methods that we have of stimulating the heart's action. It is usually said that this action is a consequence of the reflex from the terminal filaments of the vagus nerve running back and reflected down again to the heart. To me it has always seemed that the swallowing action had a direct mechanical effect upon the heart, because the esophagus passes so close to it in the thoracic cavity.

Man is the only animal that laughs, and, as the old philosophers point out, he might very well be defined as animal risibile with just as much truth as by the words animal rationale. It requires reason in order to have a sense of humor. The higher the reason, the more the humor. Peasants and the uneducated have, as a rule, a very undeveloped sense of humor. It is the highly educated man of deep intellectual powers who catches all the humor of a situation, and, though his expression of it may not be loud, it is deep and helpful at moments of depression. Humor is, of course, very different from wit, which is biting and which seems almost to be shared by the animals, if we can judge from the fact that they appear, occasionally, to play practical jokes upon one another.

It seems almost absurd that a physician should tell patients that it will do them good to practice smiling, to take every possible opportunity to laugh, and even to take frequent glances into a looking glass, to see that they are not pulling long faces. The difference between a feeling of melancholy and one of gladness consists mainly in the position of the outer angles of the mouth. The putting into practice of the maxim, not to let the sad lines dominate the countenance, but to insist on keeping the others there as far as possible, means much for the correction of internal feelings of depression and discouragement that may be badly interfering with the flow of nerve impulses from the brain to the body.

Mouth Breathing.—Since Meyer's discovery of the overgrowth of the {106} lymphoid tissue in the pharynx, we have learned to appreciate how important is mouth breathing, even for the intellectual life. We all knew before, and indeed from time immemorial it was well understood, that, as a rule, people who went around with their mouths open were of low grade intelligence. All sorts of methods were used to teach these young people to keep their mouths shut. They were reminded of it at home, they were told about it at school, and, if they married, their wives tried to keep them from this apparent manifestation of lack of intelligence. Of course, they were not, as a rule, able to carry out the well-meant intentions of their friends and advisors. The mouths were kept open because they could not breathe normally through their noses, and so respiration had to be accomplished by the only other available avenue. As a consequence of the open mouth, the lips were inclined to roll out somewhat, and certain indications of the human physiognomy were supposed to be associated with these thick lips.

Now we know the real meaning of the condition. Mouth breathing is possible, but it is inadequate. Insufficient respiration leads to insufficient oxidation of tissues, and to lowered vitality in all structures, and this is particularly notable in the brain, as well as in certain other higher structures. It is not because the individuals are lacking in intelligence that their mouths are open, but because the same reason that compels the open mouth also affects their intellectual activity. The blocking of nasal respiration lowers vital activity of all kinds. Hence the lowered intellectual vitality. The thick lips, which are supposed to be characteristic of a certain passionateness of nature, and which usually are associated with a lack of thorough control over animal inclinations, probably owe their significance to the fact that this special peculiarity of feature usually accompanies mouth breathing, and that the individual who labors under this deficient respiration, is likely to lack control to at least some degree. There is even a question whether the deficient oxidation is not likely to be much more notable in its effect upon the higher faculties than on the lower, and as a consequence the latter develop somewhat to the detriment of the former.

These studies in physiognomy may, indeed, be correlated in many ways with distinct physical conditions instead of as formerly with the general constitution of the individual. For instance, large protruding eyes used to be said to be characteristic of nervous, timid, sensitive individuals, easily scared, and not well able to take up the harder parts of the battle of life. Now we know that this feature is usually associated with an excess of secretion of the thyroid gland, and that the nervousness is not a matter of character so much as it is due to the disturbance of internal metabolism consequent upon this interference with the proper function of an important organ. It might well be called a slight thyroid intoxication. In large amounts it produces all the symptoms of Graves' disease.

Bodily Conditions and Stupidity.—We have many illustrations of the influence of the body on the mind, when purely physical causes work rather serious results on disposition and character and energy. A typical example was the so-called tropical anemia which existed in Porto Rico when the Americans took possession of the island. There were so many cases of it that out of about 25,000 deaths reported in 1903, nearly 6,000 were from so-called anemia. Investigation of the conditions soon revealed the real cause. It had been {107} thought to be due to a combination of the climate, malaria and the lack of nutrition on the part of the country people. The people were absolutely without ambition, they had no energy, they seemed scarcely able to keep body and soul together, and they cared for nothing except to get just enough to supply them with a meager sustenance. Of incentive to lift themselves up, there was none. This was largely attributed by the first Americans who went to the island to the conditions which had existed under Spanish rule, as the Spaniards had not encouraged manufactures or industries in the island, and had left the people without any incentives to the awakening of enterprise or initiative.

Hook-Worm Disease.—Before long it was found that the real reason for the anemia of the Porto Ricans was the presence in their intestines in large numbers of the so-called hook-worm. These worms exhausted the vitality of the sufferers and left them without surplus energy and, indeed, with scarcely enough life to care whether or not life itself continued. It was not a moral condition, but a very definite physical cause that was at work. Shortly afterwards it was found that the same disease existed in our Southern states among the so-called "poor whites." Before this, these people had been supposed to be a characterless, unambitious, lazy people, who cared not to get on, who had sunk to about the lowest depths possible for civilized people, and who were quite satisfied to remain there. The discovery of hook-worm disease among them, however, soon made it clear that their laziness was the result of the drain upon their systems due to the presence of thousands of hook-worms. When these were removed, if nature was not already exhausted, the "poor whites" became normal human beings once more with ambition and initiative.

This story of pathology influencing racial qualities is not new in the history of the world. It is not improbable that even certain periods of decadence in Egyptian history which have ordinarily been attributed to the so-called running out of particular ruling races or families, or to the degeneration of the people consequent upon luxury, were really the result of the spread of the hook-worm disease through certain portions of Egypt. Dr. Sandwith, who has studied the disease very carefully in Egypt, is sure that it has existed there for at least four thousand years, and that the descriptions of certain affections which occurred in Egypt in historic times were really due to the same cause as now is known to produce the so-called Egyptian chlorosis, the name that was used for hook-worm disease in Egypt. Workers in soil, and in mines and in tunnels, are especially likely to be affected by it, and whenever it is neglected it spreads rather widely, as is seen in the mines of Germany and Hungary at the present time. As the cause was unrecognized in the olden time, it is possible that periods of supposed lassitude among the people were really due to infection by this parasite.

Malaria and Degeneration.—In recent years it has come to be generally recognized that the decadence of Greece, for instance, was not due to moral causes so much, perhaps, as to physical reasons. During the classic periods in Greece there are no traces of malaria. After the invasion of Sicily, the expedition against Syracuse and other attempts on the part of the cities of Greece to spread their dominion, malaria seems to have been introduced among her people, and as the anopheles mosquito was already there, the malaria spread widely, and in the course of a century affected so many of the people that their energy and ambition and initiative were to a great extent destroyed. {108} It is well known that these effects often occur as a consequence of malaria, and as generation after generation is affected by the disease, are emphasized more and more. The relaxing effect of tropical climates, of which we have heard so much, and which is supposed after a time to bring about the inevitable production of a race eminently lazy and careless of the future, is probably much more due to certain affections, such as malaria and those consequent upon animal parasites, than to any constitutional change that has taken place in the body, or any profound corresponding change in the mind. It is a case of the body influencing the mind and producing an apparently different race from that which existed before, though all this may be changed for the better by some even slight amelioration of bodily conditions.

In any attempt, then, to influence the human mind in order to use its power and its reserve energy for therapeutic purposes, the place of the body and its influence upon the mind must always be remembered. It is quite impossible to lift people up to enable them to use their mental reserve force if they are living in discouraging physical conditions, which use up so much of energy as to make it impossible to have any to spare. Many of the phases of mental discouragement and lack of initiative which are reflected in what we call lowered resistive vitality and lack of immunity to infection, are really consequent upon physical states representing a drain upon the system that can be removed, or at least greatly improved, if they are discovered and properly treated. Victims of chronic malaria and of hook-worm disease cannot be lifted up by psychotherapy. Neither can sufferers from other forms of chronic physical debility. After the removal of the debilitating cause, however, mental influence may be brought to bear to encourage them to rise to their opportunities, to literally take on new life, and gradually accumulate reserve energy that will enable them to accomplish, not only the average work of mankind, but even better, in the reaction that comes with the new feeling of physical energy. And what is thus true in these extreme cases is even more true of minor ailments and conditions.