Psychotherapy - Hugo Münsterberg (top 5 books to read txt) 📗

man's subtle analysis of the replies. That is not seldom sufficient to secure the diagnosis of complex mental variations. The method yields still more if the time for such a reply is measured, but there again not the costly chronoscope of the laboratory is indispensable; a simple stop watch which gives the fifths of a second would be fully sufficient for all practical purposes. From such simple facts of the mental inventory the association experiments may lead to complex questions which slowly may disentangle the confused ideas, for instance, of a dementia præcox, and thus lead to subtle differential diagnosis.

The psychological laboratory alone can also elaborate the methods of studying, for instance, the feeble-minded with all the individual variations. New and ever new methods have been tried; the memory was tested by reading and repeating figures or letters, or colored papers were shown or cardboards of different forms or nonsense syllables, and the powers of remembering were studied. Or the accuracy of arm movements was examined, or the quickness of understanding associated words, or the success in planning a complex movement like throwing a ball at a target, or the tapping of a key in the rhythm of a metronome, or the discrimination and recognition of the pieces in the game of dominoes and many another scheme. The laboratory has to analyze the conditions for such methods and the psychologist has to prepare the means for the use of the physician, just as the chemist has to prepare the sleeping powders. In a similar way the laboratory may furnish means to analyze the mental disturbances by a comparison with the experimental results of artificial influences, for instance, of over-fatigue or half-sleep, of drugs or alcohol, of poisons and emotional excitements. The psychological resolving of the mental symptoms may of course, in the same way, furnish the diagnosis where the mental variation is only a distant effect of a bodily ailment. The changes in the emotions, for instance, may lead to the recognition of a heart disease; lack of attention may be a hint of the overgrowth of the adenoids; irritability or apathy or delirious character of the mental behavior may indicate whether uræmic acid is in the system or an infectious disease: anæmia and undernutrition may be diagnosed and the psychology of fever demands too a much closer analysis with the means of the psychological laboratory than it has received so far.

We have not spoken as yet about those psychological methods which themselves introduce abnormal mental states like hypnotism, and which also not seldom are only means for diagnostic purposes. The hypnotic state may bring to memory forgotten experiences of which the physiological effects may have lasted in the brain and which may have brought injury to the psychophysical system. Hypnotic inquiry can thus lead to the recognition of the first causes in many hysterical states and where hypnotism is not the best adjusted tool, a certain dreamlike staring may be more effective. We have to return to much of that later in full detail because just for instance in hysteria, the clear recognition of the sources and of the character of the disease may at the same time prove to be in itself the right starting point for curative treatment.

We have spoken so far only about the relations of psychology and medicine from the point of view of diagnosis; the relations from the point of view of therapy will make up the second part of this book. We shall describe the methods and the results, the possibilities and the limitations with manifold detail. That is the chief topic of this volume. All that is needed to prepare for this principal problem is on the one side a preparatory clearing up of some fundamental conceptions, especially of those two which have played the chief rôle in the whole discussion, namely the subconscious and suggestion. And on the other side, we may consider at first some fundamental discriminations which steadily influence the inquiries and controversies in the field. I think of the difference between normal and abnormal mental states, between psychical and physical facts in psychotherapy, between functional and organic diseases, and to return to our starting point, between mental and moral influences.

Every curative effort presupposes that the normal state of health has been lost and that a diseased state has set in. Yet the mental analysis suggests still less than the bodily inquiry, just where the normal functioning is really lost. It would be easy to draw a demarcation line if the pathology of the mind introduced any mental features which are unknown in our normal existence, but the opposite is true. No mental disease introduces elements which do not occur in the sphere of health. A degenerated brain cell looks differently under the microscope from a normal one, but the ideas of a paranoiac, the emotion of a maniac, the volition of a hysteric, the memory idea of a paralytic is each in its own structure not different from such elements in any one of us. The total change lies thus only in the proportion; there is too much or too little of it. The pathological mental life is like a caricature of a face—each feature is contained, as in the ordinary portrait, but the proportion is distorted, there is too much or too little of chin or of nose. But who can indicate exactly the point where the distortion of the features constitutes a caricature? Every grotesque change in the relations ruins the healthy state: what makes us sure that the harmony of health is spoiled?

Certainly we cannot settle it by mere statistics. The norm never means merely a majority. Even if the overwhelmingly larger part of mankind suffered from phthisis, the few who were free from it would be recognized as well and all the others would be considered ill. In mental life still more, no one ought to propose that the exceptional function is the symptom of disease. The few persons who never had a dream in their lives differ much in their mental experience from the large majority and yet their peculiarity is certainly not a symptom which needs curative treatment. The only real test of health is the serviceableness to the needs of life. We have an unhealthy state of the personality before us wherever the equilibrium of the human functions is disturbed in a way which diminishes the chances of existence, and the seriousness of the ailment depends upon the degree of this diminishing power. Seen from a strictly psychological point of view, we must expect thus a broad borderland region between the entirely normal well-balanced mental life and that unbalanced disorder of functions which really interferes with the chance for self-protection and effectiveness. That the melancholic who declines to take any nourishment, or the paranoiac who misjudges his surroundings, is unable to secure by his own energies the safety of his life cannot be doubted. The balance is completely destroyed and the will and the intellect of the physician and of the nurse must be substituted for his own mental powers, if his life is to be prolonged at all. But the misjudgment and the depression of the insane are only an exaggeration of that which may occur in any man.

There are therefore thousands of steps which lead from the normal error or regret to the destructive disturbance. Everyone knows persons whose pessimistic temperament makes them inclined to an over-frequent depression, or others whose silly disposition brings out constantly those emotional tendencies which the maniac shows in an exaggerated degree. The stupid mind shows those lacks of association and connection which reach their maximum degree in the mind of the idiot. We know from daily life the timid, undecided man who cannot come to a will impulse; the hasty man who rushes towards decisions; the inattentive man who can never focus his consciousness; and the overattentive man who can never dismiss any subject; the indifferent man on whom nothing produces evident impression and feeling; the over-sensitive man who reacts on slight impressions with exaggerated emotion; and yet every one of such and a thousand similar variations, needs only the projection on a larger scale to demonstrate a mental life which is self-destructive. The silly girl and the stupid boy, the man who has the blues and the reckless creature, are certainly worse equipped for the struggles of existence than those who are intellectually and emotionally and volitionally well-balanced. They will take wrong steps in life, they may be unsuccessful, their stupidity may lead them to the poorhouse, their recklessness may lead them to the penitentiary. And yet we do not speak of them as patients because their disproportionate mental features may be sufficiently corrected by other mental states which are perhaps more strongly developed.

Further, inasmuch as human life just in its mental functions is related to its social surroundings, much must depend on the external conditions, whether the disproportion and abnormality has to be treated as pathological. The mind which may find perhaps its way under the most simple rural conditions would be unable to protect life under the complex conditions of a great city. The man who in certain surroundings may appear a crank has to be treated as a patient in a different set of life conditions. Wherever psychotherapeutic work is in question, perhaps nothing is more important than to keep steadily in mind this continuity between normal and abnormal mental features. The mental disturbance must constantly be looked upon as a change of proportions between functions which, as such, belong to every normal life. We have to train and to develop, and thus to reënforce, that which is too weak, and we have to drain off and to suppress and to inhibit that which is too strong.

Yet just this functional view of disease must remind us strongly from the beginning that it would be utterly in vain to draw any demarcation line between psychical disturbances and physical ones. We have seen from the start that from the point of view of physiological psychology, there can be no psychical process without an accompanying physiological process in the brain. Every disturbance in mental actions is thus at the same time a disturbance in the equilibrium of nervous functions. Yet that alone would not exclude the possibility of considering some diseases, for instance, exclusively from the mental side, and we should be justified in doing so if those parts of the brain which are the seat of the mental processes could remain in the diseased state without influence on other parts of the nervous system and of the whole body. In such a case it would indeed be sufficient to consider the psychophysical disturbance from the psychological point of view only, that is, to speak of the disease as a disorder of intellect, of emotion or will, without thinking of changes in the brain cells. But such isolation does not exist in nature. Not only the bodily factors like nutrition and circulation and sexual functions have a thousandfold influence on the psychophysical processes, and these in turn change the vegetative functions of the body, but especially the other parts of the brain and nervous system can be affected in most different ways. If we want to consider whether a certain variation of the personality demands curative treatment, we certainly cannot confine ourselves to the mental variations. They are after all only parts of the whole group of changes in the organism and are thus symptoms of a disease which has to be studied in its totality. The mental symptoms alone may be relatively slight variations, which in themselves might be sufficiently balanced not to disturb the equilibrium of life, and yet they may be symptoms of a brain disturbance which as a whole must interfere with the safety of life.