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

expression. The effort to hold the counter-idea before consciousness may be unsuccessful so long as it is only an idea which tries in vain to produce any motor effect; but if the action itself has been repeatedly gone through, the idea will find it easier to settle and it becomes vivid in proportion to the openness of the channels of motor discharge. This holds true even for emotional states. A certain word perhaps picked up by the psychasthenic in a particular experience may produce whenever it is seen a shock and a depressing emotion. If we ask the patient to go artificially through the movements which express joy and hilarity, make him intentionally grin and open wide the eyes and expand the arms and inhale deeply, and after training this movement complex of joyful expression, speak the dreaded word at the height of the movement a new feeling combination clusters about the sound and may overcome the antagonism. Sometimes you will give to the desirable idea sufficient strength by mere repetition, sometimes you force the attention better by unusual accentuation, connecting the suggestion with a kind of shock. From here it is only one step to the suggestion in the form of a sharp order which breaks down the resistance just by its suddenness and loudness, supported perhaps by a quick arm movement which gives a cue for imitative reflexes. In the case of a youngster even a slap may add to the nervous shock; also a sudden clapping of the hands may favor effectiveness of the suggestive order.

Often it is wise to give the suggestion, not from without but to prescribe it in the form of autosuggestions. For instance, advise the patient not only to have the good will and intention of suppressing a certain fixed idea or by producing a certain inhibited impulse but to speak to himself in an audible voice, every morning and every evening, saying that he will overcome it now. Here, too, the autosuggestion may become effective by the frequency of the repetition or by the urgency of the expression or by the accompanying motor reactions. As a matter of course any associations which reënforce the idea may be used for assistance. Especially near-lying is the appeal to the man's conscience, but just such associations which touch the idea of the own personality and its deepest layers of feelings are always risky. They may touch and stir up old memories which interfere with success or they may awaken a feeling of contrast between duty and fulfillment which may disturb the whole equilibrium. If the physician knows that the good-will of the patient is insufficient to overcome the pathological disturbance, he ought not to make him feel ashamed or guilty, and that not only for moral reasons but also for strictly psychotherapeutic reasons.

In certain easily recognizable cases, it is essential to give the suggestion with avoidance of any emphasis, only as a hint, passing as if the suggestion almost slipped from the tongue of the doctor without his real intention. The hysteric who is resisting the suggestion which is intentionally given to her is sometimes surprisingly trapped by a half-hidden suggestion, perhaps not spoken to the patient herself at all but spoken in a low voice to a colleague in the room. Sometimes we have to trick those who suffer by "negativism," that is by an obstinacy which exaggerates that of the ordinary stubborn man. In such cases the suggestion not to perform an action works best if we want the action performed. There is hardly an end to the list of such methods for bringing beliefs and attitudes with suggestive power to the mind of the sufferer. Definitely to describe the conditions under which the one or the other form ought to be applied would be no wiser than to tell a statesman what steps are to be taken in every possible diplomatic situation. The instinctive selection of the right means among the many possible ones characterizes both the true statesman and the true doctor.

So far we have spoken only about the character of the suggestion, presupposing that the receiver remains in his natural state. This presupposition is certainly often entirely correct, but as far as it is correct, the results of the suggestion vary greatly with the different individuals. On the whole, we might say that such suggestions given to the subject in his normal state are effective only when the subject is by nature a suggestible being. In considering the psychology of suggestion, we recognized at once that the degree of natural suggestibility varies excessively. The non-suggestible mind is only to a slight degree influenced by any of these proposed forms of suggestion as long as the suggestibility itself is not heightened. To be sure, the question whether the person is suggestible by nature or not cannot be settled simply by his own impression. Many of the most suggestible persons believe firmly that they are superior to any suggestive influence.

To bring suggestions to greater effectiveness and to exert their influence practically upon every possible subject, we have thus not only to give suggestions or to advise autosuggestion but in both cases we have to secure, especially for the naturally less suggestible patients, a somewhat heightened suggestibility. Yet no one can overlook that some of the methods which we described have in themselves the tendency to reënforce the mental suggestibility. Those methods of emphasis and order, of assurance and make-believe, of practical training and of awakening counter-ideas, of persuasion and even of reasoning, wherever they are in a high degree successful probably always gain a certain part of their success by the increased suggestibility which the whole situation brings with it.

This reënforcement of the psychophysical readiness for suggestions results indeed quite directly both from expectation of the unknown and of the half-way mysterious, and from the confidence in the doctor. Of course it can work very differently. The expectation can upset the nervous system and produce unrest instead of suggestibility and, instead of confidence, the patient may feel that discouraging diffidence which settles easily upon those who have tried one fashionable physician after another. But where there is real confidence, based perhaps on the fame of the doctor and on the reports of his powerful achievements, there the conditions for effective suggestions are greatly strengthened. Still better is it if this confidence in the man is combined with a sincere hope for recovery. To lie down on a lounge on which hundreds have been cured fascinates the imagination sufficiently to give to every suggestion a much better chance to overcome the counter-idea. The expectation that something wonderful will happen can even produce an almost hypnoid state. The effect will be the greater, the less the barriers of systematic knowledge hinder the entrance of suggested ideas. The uneducated will on the whole offer less resistance to suggestions, just as superstitions find the freest play in the minds of the untrained. It is not by chance that the earlier epidemics of pathological suggestibility have on the whole disappeared with the better popular education. In a similar way work fatigue and exhaustion. The resistance has grown weaker, the suggested idea goes automatically into activity.

Skillful artificial means can still surpass the effect of these natural conditions. Here belongs everything which accentuates the authority and dignity of the originator of the suggestion. The psychologically trained physician has no difficulty in heightening the effect by simple surprises, if he cares for such tricks. If the patient for whom a mental treatment is recognized as necessary shows himself too skeptical to submit to the powers of the psychotherapist, such captivation of his belief can easily be secured. Let the man perhaps fixate a penny on the table with his right eye, while the left is closed and you show him that you can make another penny suddenly disappear when you move it a certain distance to the right and appear again when you move it still further. As the man has never heard of the blind spot in the retina, he accredits you with a special power. Many similar psychological illusions can well be used to prepare the mind for unsuspected healing powers.

Still stronger is the effect of personal contact. The psychophysiology of love indicates the most complex influence which contact sensations have on the whole nervous system and especially on the vasomotor apparatus of the body. Probably such vasomotor effect enters in, changing the blood circulation in the brain, when a personal contact between the transmitter and receiver of the suggestion is brought about. If the physician's hand rests quietly on the forehead of the patient who lies with closed eyes, or if he holds for a long while the hand of the patient, he may secure a nervous repose and submission which gives to the suggestions the most fertile soil. Needless to say that here again everything depends upon the accessories. An unsympathetic doctor may be entirely powerless where his neighbor has complete success. Neither a lifeless hand nor an agitating one will bring the desired repose, neither a cold nor a rough one. There must be strength and energy and even discipline, and yet sympathy in the pressure of the fingers. Again a psychologically different effect and yet one often to be preferred results from mild stroking movements, the stroke always to be repeated in the same direction, never up and down. The slow change in the position of the tactual sensations evidently produces a rather strong influence on the equilibrium of nervous impulses, and here again vasomotor reflexes seem to arise easily. Another variety of such bodily influences is given by artificial changes of the positions, for instance by bending the head of the subject backward while the eyes are closed. It may be that a certain lack of balance sets in in which the self-equilibrium is disturbed and an external influence can thus more easily get control of the psychophysical system. Again a certain monotony of speaking may easily add to the increase of the suggestibility.

Everyone knows that another most fruitful cause of this change is any mystic inspiration, any emotion in which the individual feels himself in contact with something higher or larger or stronger. Of course, the church can secure this effect easily, and here again the maximum will be reached if a bodily contact with the symbol of religious exaltation can be established. The patient who can touch the relics of the saints or bathe in the waters of Lourdes or at least feel on his forehead the hand of the minister, is wrought up to a state of suggestibility which makes suggestions easily effective. The objective value of religion again has nothing to do with it, as exactly the same effect can result from the most barbarous superstition. The amulets of a gypsy might secure the same resetting of the psychophysical system which the most sacred symbols awaken, and even many an educated person is unable to cross the threshold of a palmist or an astrologist, or to attend the performance of a spiritist, or to sit down with a purchasable trance medium without feeling an uncanny mental state which is objectively characterized by an increased suggestibility. But finally, the same effect sets in when the symbols of other emotional spheres are applied, perhaps for the patriotic soldier the flag of his country.

All the states of increased suggestibility which we have characterized so far still remain within the limit of normal wakefulness. We may turn now to the methods of the psychotherapist which produce in the interest of the suggestions an artificial state. However we have no right superficially to claim that the effectiveness of the suggestions is always greater in such unnatural states. On the contrary, we know that sometimes well applied suggestions work on wide-awake persons with increased suggestibility more strongly