Psychotherapy, Hugo Münsterberg [dar e dil novel online reading txt] 📗

title="[Pg 210]"> that the result may be a moral man with a crippled nervous system, a believer with psychasthenic symptoms. From the point of view of the church, there cannot be too much religion; from a therapeutic point of view, religion works there like any other nervous remedy of which five grains may help and fifty grains may be ruinous.

Moreover this power of inhibiting the little troubles of the body and of bringing to work and effectiveness the deepest powers of the mind belongs not less to any other important idea and overpowering purpose. The soldier in battle does not feel the pain of his wound, and in an emergency everybody develops powers of which he was not aware. The same effect which religion produces may thus be secured by any other deep interest: service for a great human cause, enthusiasm for a gigantic plan, even the prospect of a great personal success. Thus in a psychotherapeutic system, religion has only to take its place in line with many other efforts to inhibit the feeling of misery and to reënforce will and self-control by submission under a greater will. That in the case of religion this submission, from an entirely different purposive point of view, also has a moral and religious value, has in itself no relation to the question of its therapeutic character. It ought not to lead to any one-sided preference, inasmuch as religiously indifferent agencies may be in the particular case a more reliable means of improvement. Moreover the psychological symptoms are, after all, only a fraction of the disease and very different bodily factors, digestion and nutrition, heart and lungs and sexual organs may be most intimately connected with the disturbance of the equilibrium. Medicine today no longer believes that hysteria originates in the diseases of the uterus or that neurasthenia necessarily results from insufficiencies of the stomach, but it would be a graver mistake to believe that mental factors alone decide the progress of the disease, however prominent the mental symptoms may be in it.

From the physician's encouragement and the minister's influence towards new faith in life, a short way leads to the influence of suggestion. It is on the whole the way which leads from the general psychotherapeutic treatment to the specific one directed against particular symptoms.

IX

THE SPECIAL METHODS OF PSYCHOTHERAPYContents

Of course there is no abrupt division between special and general methods. Yet the different tendency is easily recognized, if we turn only, for instance, from the mere sympathy and encouragement to the method of reasoning with the patient about the origin of his special complaint. Just now the medical profession moves along this line a great deal. Of course no well-trained psychotherapist will make the blunder of arguing with the insane. To dispute by argument with the paranoiac and to try to convince him would not be only without success, but easily irritating. This does not mean that the not less amateurish way ought to be taken of accepting his delusions and appearing to be in full agreement with him. A tactful middle way, preferably a disciplinary ignoring attitude, ought to be taken. But it is entirely different with the mental states of the psychasthenic. The mere statement and objective proof that his obsession is based on an illusion would be ineffective. He knows that himself, but he may take the disturbance as the beginning of a brain disease, as a form of insanity, as a lasting damage which lies entirely beyond his control. Now the physician explains to him how it all came about. He shows to him that the symptoms resulted merely from autosuggestion or are the after-effects of a suggestion from without or of a forgotten emotional experience of the past. That is a new idea to the patient and one which changes the aspect and may have an inhibitory influence.

Of course, the patient does not accept the explanation at once. He feels sure that he is not accessible to suggestion and that he has least of all a tendency to autosuggestions, but the skillful psychotherapist will find somewhere an opening for the entering wedge. He may develop to the patient the modern theories of the origin of neurotic disturbances, all with entire sincerity and yet all shaped in a way which gives to the special case an especially harmless appearance. He may even enter into experimental proof that the patient is really accessible to autosuggestions. A very simple scheme for instance is to put some interesting looking apparatus with a few metal rings on the fingers of the subject and connect it with a battery and electric keys. The key is then pushed down in view of the patient and he is to indicate the time when and the place where he begins to feel the galvanic current. The feeling will come up probably very soon in the one or the other finger, and as soon as he feels sure that the sensation is present, the physician can show him that there was no connection in the wires, that the whole galvanic sensation was the result of suggestion.

Such a method demands patience and good will. The prejudices and deeply-rooted hypochondriac ideas, foolish theories of the patient and pessimistic emotions which have become habitual, must be removed piece by piece until the central symptoms themselves can be undermined and explored. It often takes hours of careful and fatiguing reasoning, in which at any time the patient may suddenly slip back to his old ideas. Yet if the explanatory arguments have once succeeded in making the patient himself believe firmly that his whole trouble resulted from suggestion only, the inhibitory effect of this idea may be an excellent one. The only serious defect of the method is that it often does not work. The credit which neurologists of today give to its effectiveness seems to me much too high. Even slight neurasthenic and psychasthenic disturbances remain too often in complete power when the patient is fully convinced that they originated with an emotional excitement which has long since lost its feeling value or that it resulted from a chance suggestion picked out from indifferent surroundings. The patient knows it and yet goes on suffering from the fruitless fight of his will against the intruder. Where mere reasoning is entirely successful, I am inclined to suspect that an element of suggestion has always been superadded. The authority of the physician has created a state of reënforced suggestibility in which the argument convinces, not by its logic but by its impressiveness.

This element of suggestion is quite obvious when the argument takes the form of persuasion, a psychotherapeutic method which has found its independent development. Whoever seeks to persuade relies on the mental fringe of his propositions. The idea is not to work by its own meaning but by the manner of its presentation, by its impressiveness, by the authority, by the warmth of the voice, by the sympathy which stands behind it, by the attractiveness with which it is offered, by the advantages which are in sight. Thus persuasion relies on personal powers to secure conviction where the logic of the argument is insufficient to overcome contradictions. But just for that reason persuasion is after all only a special kind of suggestion.

Other methods work on the same basis. Prominent among them is the psychotherapeutic effect of a formal assurance. The psychotherapist assures the patient that he will sleep the next night or that the pain will disappear or that he will be able to walk with such firmness that the counter-idea is undermined. It depends on the type of patient whether such suggestions of belief work better when it is assured with an air of condescension, spoken with an authority which simply ignores every possible contradiction, or with an air of sympathy and hope. Experience shows that it is favorable to connect such assurance with the entrance of a definite signal. "You will sleep to-night when the clock strikes ten," "The pain will disappear when you enter the door of your house," or perhaps, "Read this letter three times quietly in a low voice, and at the end of the third reading your fear will suddenly stop." Psychological insight will further decide whether it is wiser in the particular case to assure the patient of the resulting effect or rather of the power to bring about the effect. With some people, it works better to insist that the result will happen, with others to promise that they themselves can secure it; in the one case they feel themselves as passive instruments, in the other as real actors. To some hysterics, it is better to say: "You will walk," to others, "You can walk."

This belief in the future entrance of a change frequently demands an artificial reënforcement. There belongs first the application of external factors which awaken in the background of the mind the supporting idea that something has been changed in the whole situation or that some helpful influence has made the improvement possible. Medicines of colored and flavored water, applications of electric instruments without currents, in extreme cases even the claptrap of a sham operation with a slight cut in the skin, may touch those brain cells which words alone cannot reach with sufficient energy and may thus secure the desired psychophysical effect. The patient who by merely mental inhibition has lost his voice for weeks may get it back as soon as the physician has looked into his larynx with a mirror and has held an electrode without battery connection on the throat. Another way of helping by make-believe methods is to give the impression that a decided improvement is noticeable. The uneducated patient believes it easily when the physician at his very entrance into the office expresses his surprise about the external symptoms of a change for the better, perhaps seen in the color of the skin or the shading of the iris in the eye and reaffirmed by some pseudotests of the muscle reflexes. All that is not very edifying and the decent physician, who justly feels somewhat dragged down to the level of the quack in applying such means frequently, will abstain from them wherever possible. He knows that in the long run, even the psychasthenics are best treated with frankness and sincerity and he will therefore only in exceptional cases resort to such short-cut treatment by making believe. Yet that it is sometimes almost the only way to help the patient cannot be denied.

A neater way to secure the sufferer's belief in the possibility of a cure is by securing the desired effect at least once through little devices. As soon as it is once reached, the patient knows that it can be reached and this knowledge works as a suggestion. The hysteric who cannot speak when he thinks of his words, or who cannot walk when he thinks of his legs, may by the skillful physician be brought to a few words or steps before he himself is aware of it by completely turning his attention to something else and producing the stimulus toward the movement in a reflex-like way. Still more successful is the effort to resolve the inhibited action into its component parts and to show to the patient who cannot perform the action as a whole that he can go through the parts of it after all. As soon as he has passed through a few times, a new tactual-visual image of the whole complex is secured for his consciousness and this image works then as a new cue for the entire voluntary action, overcoming the associated counter-idea.

Another excellent way to overpower a troublesome idea or impulse or emotion is to reënforce the opposite idea by breaking open the paths for its motor