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

A boy of twelve years when he was brought to me showed the mental powers of a stupid child of four. In a silly way he repeated every question which he heard without answering it; he talked steadily to himself in a nonsensical manner, mostly repeating nursery rhymes without end, never holding his attention to anything in the room, giving the impression that there was no attention whatever. The boy was a child of rich parents; he had his own teachers, but was for a large part of the year under the influence of the parents only, who very naturally yielded to every desire of the unfortunate child. I insisted on a complete change of the education. It was my effort to build up the mind by a rigorous training and by development of the power of inhibition. I absolutely forbade any meaningless material like the nursery rhymes, insisted that the child should never be allowed to talk to himself, and whenever he began to speak to himself he was to be addressed sharply, and if he yet went on, to be slapped on his hands. In the same way he was not allowed to repeat a question, but the question was repeated until he answered it, the question always formulated in simple words. He was forced to go through simple reading and writing without being allowed to make his silly diversions. His whole life was brought under strict discipline and no parental indulgence was permitted. Six months later the child was completely changed. It seemed as if he had gone through an improvement of three years. I regulated the whole of his elementary studies in accordance with the successful principle. The training of inhibition stood in the foreground and every haphazard reaction was severely rebuked. The summer vacations spent with the parents in the fashionable surroundings, to be sure, had always a retarding influence, but the main part of the year in which it was possible to carry through the strict discipline showed such steady and inspiring progress that the boy, while of course feeble-minded for life, can yet live externally a harmonious life.

A systematic training of the power of inhibition is indeed the fundamental factor in all psychotherapeutic treatment when the disturbance is in the volitional sphere, but the inhibition is secured most safely by reënforcement of the antagonistic attitude. From these volitional variations on the one side, from the ideational disturbances on the other, only a few steps lead to those dissociations of the personality which are characteristic of many graver cases of hysteria. But to give to them any adequate analysis, it would be insufficient to refer in this brief way to particular cases. Psychopathological literature possesses some excellent analyses of such complex disturbances. As I said before, I abstain entirely here from such complex phenomena, as they enter too seldom into the sphere of the practitioner and as the bewildering manifoldness of their symptoms does not allow us so easily to recognize the fundamental principles which alone were to be illustrated by our short survey of practical cases.

The discussion of the bodily symptoms which may yield to psychotherapeutic treatment, naturally forms only a short appendix to our discussion of the mental symptoms. Our interest was from the beginning essentially a psychological one. I shall have to be the more brief as my personal experience in the treatment of bodily diseases through mental therapy is entirely secondary and accidental. The psychological laboratory would, of course, be an entirely unfit place to struggle with diseases of which the chief symptoms are not psychophysical. Yet in spite of frequent testimonies of well-known physicians to the contrary, I am still inclined to think that this is also the situation at large. I think that in medicine in general the psychophysical effect of mental treatment is by far more important and by far more extended than the healing effect on diseased peripheral organs. Of course these peripheral parts of the body may be favorably influenced in an indirect way by the mental treatment; we shall have to take notice of this important result but that is strictly not a therapeutic effect on the bodily symptoms. Moreover, purely psychical effects may give an impression as if the bodily symptom itself has been removed.

To begin with the latter case, it is especially the inhibition of pain which easily makes one believe that a bodily disturbance is successfully treated. I have repeatedly seen cases in which I tried by suggestion to soften the pain resulting from a peripheral disturbance like inflammations, rheumatism, decayed teeth and so on. The effect was often such a total disappearance of the pain that the patient himself was inclined to believe that the objective disease had been ended, while in reality the state of the diseased organ was not changed at all. It has often happened that I tried to cure a person of certain mental symptoms by suggestion, ignoring entirely the existence of some pain resulting from a bodily disease with which I had nothing to do. Yet the suggestion of improvement seemed almost to irradiate and the pain disappeared in spite of having been ignored by the hypnotizer. For instance, I treated a woman who suffered from psychasthenic obsessions, fearing all the time that something would happen to her child. I did not give any direct attention to the fact that she had had for years a painful disease of the bladder for which she was constantly treated by a specialist. But while I did not mention the bladder in my hypnotic suggestion, yet the abdominal pain disappeared together with the obsession and the situation might easily have suggested that the bladder trouble was a nervous one which had been cured by the hypnotic sleep. The fact was that the bladder disease was not influenced by the mental treatment at all, and needed a continuation of the same local treatment. It was only the psychophysical pain in the brain which had been inhibited.

Quite parallel to the disappearance of the organic pain sensation is the arising of a general feeling of improvement. This organic sensation of general betterment may again be a strictly mental occurrence without any objective reference to a real improvement in the bodily conditions. Yet again that easily gives the impression of an important change in the bodily conditions themselves. The miraculous cures of various diseases through mystic agencies generally belong to this category. There is no doubt that often the migrating charlatans who advertise themselves by a free treatment of the sick and invalids on the theater stage of small towns, produce momentary effects which are sufficient to deceive. The quack handles the diseased organ, perhaps a goiter or a leg crippled by rheumatism, with a cruel rudeness and overwhelms the suggestible mind so completely that the first autosuggestion is that of a complete change, and that means cure. The disastrous results follow later. But from such barbarisms we come by gradual steps to the suggestion of improvement where the feeling of betterment can be in itself an important factor for the cure. Yet even there we must not mistake the possible secondary effect of a mental change from a psychotherapeutic cure of the bodily disease.

Not seldom the removal of physical disability seems secured as soon as certain mental disturbances are removed. There is no reason to believe for instance that suggestion can have an important influence on a diseased sense organ, and yet hypnotic influence and even autosuggestive influence can under certain circumstances greatly improve seeing and hearing. Especially in the field of hearing the central factor is of enormous importance. Hyperæmic and anæmic conditions in the brain centers of hearing control the vividness of the received sound. The patient who cannot hear a certain watch more than one foot distant may be able to hear it after some glasses of wine at a distance of three or four feet. Thus it is only natural that a hypnotic influence can produce similar changes on