Collected Essays

Miltown. Insofar as they facilitate the specifically psychological treatment of mental disorders, these tranquilizers may prove to be extremely valuable. Even as symptom stoppers they have their uses.

The green oasis among the jets and the rockets is crammed to overflowing. So are all the other mental hospitals of the Western world. Technological and economic progress seems to have been accompanied by psychological regress. The incidence of neuroses and psychoses is apparently on the increase. Still larger hospitals, yet kinder treatment of patients, more psychiatrists and better pills—we need them all and need them urgently. But they will not solve our problem. In this field prevention is incomparably more important than cure; for cure merely returns the patient to an environment which begets mental illness. But how is prevention to be achieved? That is the sixty-four-billion-dollar question.

(From Esquire Magazine)

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