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

the last hundred years did new justice to the influence of psychological means in the treatment of mental diseases; to be sure, without allowing up to the present day the hope that mental factors as such can cure the grave forms of insanity. The borderland cases and the incipient mild forms alone allow the hope of a cure. Outside of them the work of psychotherapy in the insane asylum meant essentially improvement and relief only. Again, in another direction, the general dietetic influence of sound mental life may be called a part of psychotherapy and this engaged not a few of the leading medical thinkers in all countries during the last century, especially the nerve physicians who gave serious attention to the wholesome engagements of the mind. Finally, might not much be attributed to psychotherapy, which offically belongs to the doctrines of homeopathy?

But we may return to the new heralds of suggestion. Liébeault's book on the artificial sleep in 1866 became the starting point of the new great movement. Yet at first it remained unnoticed. It is claimed that for a long time only one copy was sold. But he continued to make his hypnotic experiments on the poor population of Nancy and they finally attracted the attention of some of the leading medical men there. Bernheim became convinced and Dumont, the physiologist Beaunis joined the movement, and in the eighties we find Nancy the center of hypnotic interest to which medical men from everywhere made their pilgrimage. This latter phase was paralleled by Charcot's studies in Paris, who brought hypnotism into nearest neighborhood with hysteria. And also the later development of the Paris school by Richer, and especially the brilliant work of Janet, kept hysteria in the foreground of the therapeutic interest. Liébeault's experiment had brought the psychology of suggestion entirely into the center of this whole circle of phenomena and this view controlled the development of the last few decades, which was essentially an elaboration of the special treatment of diseases. Forel in Switzerland, Moll and Vogt in Germany, Wetterstrand in Sweden became the chief exponents of therapy by hypnotism. Others, like Dubois, in Switzerland, emphasized more the suggestive treatment through persuasion. In England at first Carpenter, later Hack-Tuke gave serious attention to hypnotism, in Russia Bechterew, and in the last few years the literature on therapy by suggestion became developed in practically all countries. In America Beard, Hammond, and others belong to the older school; Osgood, Prince, Peterson, Putnam, Sidis, and others to the most recent years. At the same time, under the leadership of Kraepelin, Ziehen, Sommer, and others, the methods of the psychological laboratory, especially the reaction and association methods, were made useful for the purposes of psychopathology.

But interest in suggestion does not represent to-day the last step of psychotherapy. The latest movement, which is entirely in its beginning, the development of which no one can foresee, but which promises wide perspectives, is connected with the name of Freud in Vienna. The entirely new turn of psychotherapy is given by the fact that his aim is not to overcome a symptom by suggestion but to make it disappear by removing the ultimate mental cause. He found that large groups of mental disturbances result from a psychical trauma, a disagreeable idea which, inhibited in the mind, becomes the source of mischief and produces phobias and obsessions and hysterical motions. The cure of the symptoms demands the recognition of this first mental accident, which may lie back for years and which may no longer be in the memory of the patient. As soon as this earlier experience is brought to consciousness again, it needs only a natural discharge and a normal expression and the symptoms which it brought about will disappear. Thus the cure itself needs no hypnotism and no persuasion or suggestion but the reawakening of forgotten situations, and only in the service of this effort hypnotism may be used to reënforce the memory. Yet this represents only the first period of Freud's activity, in which he collaborated with Breuer, a phase which is represented by their book on hysteria, in 1895. But there followed a further development which is still more essential. The hysterical disturbance may indeed have started with such an accidental traumatic impression but that does not explain why just this impression had such a strong effect. Other impressions of equal strength and emotional vividness may have passed without leaving any damaging result. And therefore there must be some prior cause in the subject which makes just this particular impression so injurious; and here is the point of Freud's fundamental discovery, which for the layman appears on the surface to have little probability but which has proved of greatest consequence for clinical work. It was found that only those situations become injurious and become starting points for hysterical symptoms which touch on repressed and artificially inhibited ideas of the sexual sphere.

Entirely new perspectives have been opened by these studies. Above all, now for the first time there is in sight a psychotherapy which not only aims to remove symptoms but which really uproots the disease itself. That earlier method of bringing the trauma to consciousness and making it discharge, the so-called cathartic method, removes only the particular group of disturbances but the patient remains a hysteric, and if ever new accidents should happen which would touch again those inmost repressed ideas, new hysterical symptoms would develop. But if we can go back to that starting point, if we can discover those first suppressions of desired gratifications which often most indirectly are related to the sexual sphere, and if we can liberate the mind from those primary strangulated affections, then the patient is really cured. Freud himself practically abstained from the help which hypnotism can give for the reawakening of forgotten experiences, while some of his pupils still prefer this short way to the forgotten memories. His way is, on the whole, to let the imagination bring up any chance material of associated ideas and then to study their connections and follow the hints they give. He calls it the psychoanalytic method. Others prefer the methods of association tests, again others tap the lower layers by automatic writing, but the chief problem remains always to discover those repressed desires and to understand through them the injurious effects of accidental experiences. The whole field of hysteria, and perhaps still more that of the anxiety neurosis, has come into new perspective through this pioneer work which men like Bleuler, Jung, and Stekel have developed in various directions.

Thus in recent decades the thorough work of scientific physicians has developed a psychotherapy of considerable extent and of indubitable usefulness, far removed from the simultaneous efforts of the churches and of the popular mental healing cures. A number of eminent men in all countries have tested the methods and have published the results. But the curious side of it is that all this is essentially a movement of leaders while the masses of the profession hesitate to follow. It is a set of officers without an army. Every large city has one or another specialist who applies suggestive therapy, one or another nerve specialist who hypnotizes, but the average physician moves on without any serious effort to utilize psychotherapy. It is as if the prescription of the modern chemical drugs were confined to some leading scholars in the country, while the thousands abstained from it in their office work and in their family practice. In reality psychotherapy ought to be used by every physician, as it fits perfectly the needs of the whole suffering community. Its almost exceptional use in the hands of a few scholarly leaders deprives it of its true importance. It is the village doctor who needs psychotherapy much more than he needs the knife and the electric current.

Why does the medical profession on the whole show this shyness in the face of such surprising results? In other fields they do not show any reluctance in taking up the newer developments of method. Even the Roentgen ray apparatus has quickly won its way, and psychotherapy is less expensive. To be sure, the most important reason is probably one which is most honorable. The physicians do not like to touch a tool which has been misused so badly. Psychotherapy has come too much into the neighborhood of superstition and humbug. Where miracles are performed, the man of science prefers to leave the field. The less one knows about those groups of problems, the less one is able to see the sharp demarcation line between true scientific studies, for instance, in hypnotism, and the pseudo-scientific fancies of psychical research. Experiments in suggestibility are then easily mixed with experiments in telepathy, and those go over by gradual degrees to clairvoyance and premonitory apparitions, and from there the way is not far to the reappearance of the dead and the routine performances of the spiritists. It seems to many as if there is no point where they have a reason to stop. If they begin with such abnormal phenomena at all, it seems as if they are necessarily carried over to all the mysteries of supernatural energies. Even the competition with Christian Science, and other mental healers whose judgment is not hampered by any previous study of medicine, might seem rather unattractive to the serious physician.

Further not a few have the impression that such suggestive treatment directly demands from them that they also begin to humbug their patients or to throw out suggestions which they themselves do not believe, in short, that they be brought down to the level of the miracle performer. Yet, however much all that speaks in favor of the conscientious instinct in the physician, it is ultimately based upon a misinterpretation. The line between real science and its counterfeit is here as everywhere a distinct one, and the true man of science ought not to hesitate in doing his duty from fear that he might not be discriminated from the charlatan. A well-conducted psychotherapeutic treatment as a scientific physician ought to carry it out, is entirely different in meaning and appearance, from the first step of diagnosis to the last treatment of after-effects, from every unscientific faith cure. It is also in no way necessary that the psychotherapist ever leave the path of complete sincerity. There is no reason at all for promising that the patient will be entirely cured if the physician believes that a real cure through suggestion is impossible. The more the true physicians undertake psychotherapeutic work, the more it will carry with it that dignity which is now too often lost by the predominance of those who treat without diagnosis and cure by mere appeal to superstition.

All that does not mean that other motives do not hold the physician back. Not seldom he is afraid of unfavorable consequences. He does not feel sure that, for instance, a deep hypnosis is without dangerous results or that he will be able to produce it in the technically correct way. But all these objections mean nothing but insufficient acquaintance with the facts. Of course every technique needs its period of preparation for the task, but it is now sufficiently demonstrated that hypnotism carried through in a scientific spirit will never have any injurious consequences. The morphine injection and the Roentgen rays are by far more dangerous. Those who think that for hypnotizing especially inborn power is needed stand, of course, outside of a serious discussion. They do not even know the elements of the modern theories. Every physician has in himself the necessary means for a psychotherapeutic treatment in every form.

More scientific insight belongs to the argument that most of these psychotherapeutic schemes are essentially for treatment of symptoms. We have acknowledged that throughout. The possibility of a relapse or of a new