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

mutual influences, but consciousness remains the same throughout. It remains the same, just as we do not change consciousness if we feel ourselves in one hour as members of our family, in the next hour as professional workers in our office, again later as social personalities at a party or as citizens at a political meeting or as æsthetic subjects at the theater. Each time we are to a high degree a different personality, the idea of our self is each time determined by different groups of associations, memories, emotions, and impulses. The differentiation is to be considered as normal only because broad memory bridges lead over from one to the other. The connection of the various contents with the various ideas of the own personality constitutes thus in no way a break of consciousness itself and relegates no one content into a subconscious sphere.

Finally the same holds true, if the idea of the personality as content of consciousness in the patient is split into two simultaneous groups, of which each one is furnished with its own associations. Yet the interpretation here becomes extremely difficult and arbitrary. Take the case that a patient in severe hysteria at our request writes down the history of her life. We should not hesitate to say that she is doing it consciously but now we begin to talk with her and slowly the conversation takes her attention while her pencil is continuing to write down the connected story of her youth. Again the conversation by itself gives the impression of completely conscious behavior. As both functions go on at the same time, the person who converses does not know what the person who writes is writing, and the writer is uninfluenced by the conversation. Various interpretations are possible. Indeed we might think that by such double setting in the pathological brain two independent groups in the content of consciousness are formed, each one fully in consciousness and yet both without any mutual influence and thus without mutual knowledge. In the light of such interpretation, it has been correctly proposed to speak of coconscious processes, rather than subconscious. Or we may interpret it more in harmony with the ordinary automatic writing or with other merely physiological reactions. Then we should suppose that as soon as the conversation sets in, the brain centers which control the writing movement work through channels in which no mental factors are involved. One of the two characteristic reaction systems would then be merely physiological. We saw before that the complexity of the process is no argument against the strictly physiological character of the event. That various activities can coexist in such a way that one of them may at any time slide down from the conscious centers to the merely physical ones, we all know by daily experience. We may go home through the streets of the busy town engaged with our thoughts. For a while the idea of our way and of the sidewalk is in our consciousness, when suddenly we reach our house and notice that for a long while we have no longer had any thought at all of the way. We were absorbed by our problems, and the motor activity of walking towards our goal was going on entirely in the physiological sphere. But whether we prefer the physiological account or insist on the coconscious phenomena, in either case is there any chance for the subconscious to slip in? That a content of consciousness is to a high degree dissociated or that the idea of the personality is split off is certainly a symptom of pathological disturbance, but it has nothing to do with the constituting of two different kinds of consciousness or with breaking the continuous sameness of consciousness itself. The most exceptional and most uncanny occurrences of the hospital teach after all the same which our daily experience ought to teach us: there is no subconsciousness.

PART II

THE PRACTICAL WORK OF PSYCHOTHERAPY VII

THE FIELD OF PSYCHOTHERAPYContents

We have discussed the psychological tools with which the psychotherapist has to work but we have not spoken as yet of psychotherapy itself. All that we have studied has been by way of preparation; and yet the right preparation is almost the most important factor for the right kind of work. To rush into psychotherapy with hastily gathered conceptions of mental life may be sometimes successful for the moment, but must always be ultimately dangerous. It is often most surprising what a haphazard kind of psychology is accepted as a basis for psychotherapy even by scientifically schooled physicians who would never believe that common sense would be sufficient to settle the problems of anatomy and physiology; as soon as the mind is in question, no serious study seems needed. Can we be surprised then that in the amateur medicine of the country within and without the church any fanciful idea of mental life may flourish? If we are to recognize the rights and wrongs of psychotherapy in a scientific spirit, a sober analysis of the mental facts involved was indeed at the very first most essential. Now we can easily draw the conclusions from our findings.

We recognized from the start the fundamental difference between two different attitudes which we can take towards the inner life of any personality, the purposive view and the causal. We recognized the sphere to which each belongs and we saw that all medical treatment demands the causal view, thus dealing with inner life as part of the causal chain of events. Each inner experience became therefore a series of so-called contents of consciousness. These contents can be described and must be analyzed into their elements. The basis of psychotherapy is therefore an analytic psychology which conceives the inner experience as a combination of psychical elements.

But the final aim was the causal connection. The appearance and disappearance of those millions of elements and their connection had to be explained. We recognized that such an explanation of the contents of consciousness was possible only through the connections between the accompanying brain processes. Every psychical change had to be conceived as parallel to a physiological change. The psychology which is to be the basis of psychotherapy had to be therefore a physiological psychology.

We recognized that these psychophysiological processes were processes of transmission between impressions and expressions, that is, between incoming nervous currents and outgoing nervous currents, between stimuli and reactions. Thus we have no central process which is not influenced by the surroundings and which is not at the same time the starting point of an action. We have normal health of the personality as long as there is a complete equilibrium in the functions of the organism which adjusts the activities to the surroundings. Every abnormality is a disturbance of this equilibrium. A psychology which is the basis of psychotherapy thus conceives every mental process in relation to both the ideas and the actions; it avoids all one-sidedness by which the mind is cut off either from its resources or from its effects. The relations to the impressions are usually the less neglected: and we must the more emphasize the fact that the psychology needed for psychotherapy knows no mental fact which does not start an action and that every change in the system of actions involves a change in the central experience. Wherever this equilibrium of adjusted functions is disturbed, some therapy of the physician has to set in: whether psychotherapy is in order depends upon the special conditions.

We have recognized that there are no mental facts outside of those which are in consciousness and that from a psychological point of view consciousness itself does not have different degrees and different levels, that all varieties of experience refer thus only to the special content and its organization. There is thus no subconscious. On the other hand, we saw that there is no conscious experience which is not based on a bodily brain process. By these two fundamental facts of scientific psychology, every possible psychotherapy gets from the start its clear middle way between two extreme views which are popular today. The one school nowadays lives from the contrast between consciousness and subconsciousness and makes all psychotherapy work with and through and in the subconscious. The other school creates a complete antithesis between mind and body and makes psychotherapy a kind of triumph of the mind over the body. Practically every popular treatise on psychotherapeutic subjects in recent years belongs to the one or the other group; and yet both are fundamentally wrong. And while, of course, this mistake is one of theoretical interpretation, it evidently has its practical consequences. The fantastic position allowed to a subconscious mind easily gives to the doctrine a religious or even a mystical turn and the artificial separation between the energies of the mind and those of the body leads easily to a moral sermon. Whether this amalgamation of medicine with religion or with morality may not be finally dangerous to true morality and true religion is a question which will interest us much later. Here we only have to ask whether it is not harmful to the interests of the patient and thus to the rights of medicine, and indeed that must be evident here at the very threshold. Both schools must have the tendency to extend psychotherapy at the expense of bodily therapy and to narrow down psychotherapy itself to a therapy by appeals which in the one case are suggestions to the subconscious and in the other case persuasions and encouragements to the conscious will. As soon as we have overcome the prejudices of those two rival schools and have recognized that both are wrong, that there is no subconscious and that there is no psychological fact which is not at the same time a physiological one, we see at once that this common procedure of both schools is unjustified and dangerous. Mental therapy and physical therapy ought to be most intimately connected parts of the same therapeutic effort and mental therapy includes by far more than mere suggestions and appeals. All that involves of course that its systematic application belongs in the hands of the well-trained physician and of nobody else, but on the other hand, it involves that every physician ought to be well schooled in psychology.

As soon as a disturbance to be cured is considered as a lack of equilibrium in psychophysical functions, every mental influence, every suggestion and appeal becomes itself an excitement or an inhibition of nerve cells. The sharp demarcation line between a psychical agency and a physical one disappears altogether; the spoken word is then considered as physical airwaves which stimulate certain brain centers and in the given paths this stimulation is carried to hundreds of thousands of neurons. The protracted warm bath or the cold douche influences, too, large brain parts by changing the blood circulation which controls the activity of those neurons; or the bromides absorbed in the digestive apparatus, or the morphine injected, also reach the neurons and again have a different kind of influence on them, and the electric current may stimulate the nervous system in still a different way. It may be, and under many conditions certainly is, essential to influence the brain cells just in that particular way which results from the spoken word, but there too the causal influence remains a function of the physical effect and thus by principle there is no sharp separation from other physical means. Thus to believe in psychotherapy ought never to mean that we have a right to make light of the other means which, as experience shows, may help towards the treatment of disturbances in the central equilibrium. Suggestions and bromides together may secure an effect which neither of them