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

of psychical treatment and leave the carrying out to a well-meaning minister or any other medical amateur who schematically follows the indicated path. The finest adjustment has to come in during the treatment itself and the response of the patient often has to suggest entirely new lines of procedure. More than in any other field of medicine, the physician himself has to extend his influence far beyond the office hours and the strictly medical relations. And yet, on the other hand, there is no department of medicine in which the treatment might not profit by the psychotherapeutic influence. With a few vague words of encouragement mechanically uttered, or with a routine of tricks of suggestion by bread pills and colored water and tuning forks, not much will be gained even in the ordinary physician's practice. Subtle adjustment to the personal needs and to the individual conditions is necessary in every case where the psychical factor is to play an important rôle. It cannot be denied that the one great obstacle in the work of the routine physician is the lack of time and patience which is needed for successful treatment. To prescribe drugs is always quicker than to influence the mind; to cure a morphinist by hyoscine needs less effort than to cure him by suggestion.

The first method to bring back the psychophysical equilibrium is of course the one which is also demanded by common-sense, namely, to remove the external sources of the disturbance. External indicates there not only the outer world but also the own body outside the conscious parts of the brain. If we take it in the widest meaning, this would evidently include every possible medical task from filling a painful tooth to operating on a painful appendix, as in every case where pain results, the mental equilibrium is disturbed by it and the normal mental life of the patient reduced in its efficiency. But in the narrower sense of the word, we shall rather think of those sources of trouble in the organism itself which interfere directly with the mental functions. The examination of any public school quickly leads to the discovery that much which is taken for impaired mental activity, for lack of attention, for stupidity, or laziness may be the result of defective hearing or sight or abnormal growth of the adenoids. Growths in the nose may be operated upon, the astigmatic or the short-sighted eye may be corrected by glasses, the child who is hard of hearing may at least be seated near the teacher; and the backward children quickly reach the average level. No doubt in the life of the adult as well, often almost insignificant and from a strictly physical point of view unimportant abnormities in the bodily system, especially in the digestive and sexual spheres, are sources of irritation which slowly influence the whole personality. To be sure, the brain disturbance may have reached a point where the mere removal of the original affliction is not sufficient to reinstate the normal balance of mental energies, but wherever such a bodily irritation goes on, it is never too late to abolish it in the interests of psychotherapy.

The less evident and yet even more important source of the painful intrusions may lie outside of the organism in the social surroundings and conditions of life. Most of that has to be accepted. The physician cannot bring back the friend who died or the fortune which was lost in speculation or the man who married another girl. He will even avoid suggesting far-reaching social changes in the private life of the patient, changes like divorce in an unhappy marriage or the breaking of the home ties, however often he may get the impression that such a liberation would stop the source of the mental trouble. He will be the more careful not to overstep his medical rights as he seldom has the possibility to judge fairly on the basis of the one-sided complaint, and the probability is great that the character and temperament of the complainant may be a more essential factor of the ailment than the personalities which surround him. Yet even the conservative physician will find abundant opportunities for advice which will remove disturbing energies from the social surroundings of the sufferer. Even a short release from the burdening duties, a short vacation from the incessant needs of the nursery, a break in the monotony of the office, may often do wonders with a neurasthenic. Often within a surprisingly short time the brain gathers the energies to overcome the frictions with unavoidable surroundings.

Yet here the physician has to adjust the prescribed dose of outing very carefully to the special case. We may be guided by the psychological experiments which have been made in the interest of testing the fatigue induced by mental work. If perhaps four hours of concentrated work are done without pauses, experiment shows that the quality of the work deteriorates, measured for instance by the number of mistakes in quick calculation. If certain relatively long pauses are introduced, the standard of work can be kept high all through. But if frequent pauses are made, and each short, the result is with many individuals the opposite. The experiment indicates that these frequent pauses are working as interruptions which hinder the perfect adjustment to the work in hand. That is suggestive. Our neurasthenic may complain about the life which he has to live and yet after all he is frequently so completely adjusted to it that it may not be in his interest to remove him far away from the conditions which cannot ultimately be changed but to which he has to return. The instinct of the physician has to find the middle way between a temporary removal of irritation which really allows a development of new energies and a mere interruption which simply damages the acquired relative adjustment. Every cause of friction which can be permanently annihilated for the patient certainly should be removed.

This negative remedy demands its positive supplement. The patient must be brought under conditions and influences which give fair chances for the recuperation of his energies. Too often from the standpoint of the psychologist, the prescription is simply rest. As far as rest involves sleep, it is certainly the ideal prescription. There is no other influence which builds up the injured central nervous system as safely as sound natural sleep, and loss of sleep is certainly one of the most pernicious conditions for the brain. Again rest is a great factor in those systematic rest cures which for a long while were almost the fashion with the neurologist. Experience has shown that their stereotyped use is often unsuccessful, and moreover that the advantage gained by those months spent in bed completely isolated and overfed is perhaps due to the separation and changed nutrition more than to the overlong absolute rest. Yet used with discrimination, the physiological and the psychical effect of lying in bed for a few weeks has certainly often been a marked improvement, especially with young women. But more often the idea of rest in bed during daytime is not meant at all when the nerve specialist recommends rest to his over-strained patient. It is simply meant that he give up his fatiguing daily work, even if that work is made up of a round of entertainments and calls and social engagements. The neurasthenic and all similar varieties are sent away from the noise of the city, away from the rush of their busy life, away from telephones and street cars, away from the hustling business and politics.

Indeed it is the dogma of most official and unofficial doctors that the restlessness and hurry and noise which all are characteristic of the technical conditions of our time are the chief sources of the prevailing nervousness. There was no time in the history of civilization in which the average man was overwhelmed by so many demands on his nerve energy, no time which asked such an abundance of interests even from the school child. The wild chase for luxury in the higher classes, reënforced by the commercialism of our time, the hard and monotonous labor in our modern mills and mines for the lower classes, the over-excitement brought to everybody by the sensationalism of our newspapers and of our public life all injure the brain cells and damage the equilibrium. That is a story which we hear a thousand times nowadays. Yet it is doubtful whether there is really much truth in such a claim and whether much wise psychotherapy can be deduced from it.

We may begin even with the very justifiable doubt whether nervousness really has increased in our time. Earlier periods had not so many names for those symptoms and were not able to discriminate them with the same clearness. Above all, the milder forms of abnormities were not looked on as pathological disturbances. If a man has a pessimistic temperament, or has fits of temper, or cannot get rid of a sad memory idea, or imagines that he feels an illness which he does not have, or has no energy to work, even today most people are still without suspicion that a neurasthenic or a psychasthenic or a hysteric disturbance of the nervous system may be in its beginning. Earlier times surely may have treated even the stronger varieties of this kind as troublesome variations in the sphere of the normal. On the other hand, there can be no doubt that, for instance, the Middle Ages developed severe diseases of the nervous system in an almost epidemic way which is nearly unknown to our time.

As to the conditions of life itself, there are certainly many factors at work which secure favorable influences for our cerebral activity. The progress of scientific hygiene has brought everyone much nearer to a harmonious functioning of the organism, and the progress of technique has removed innumerable difficulties from the play of life. Of course, we stand today before a much more complex surrounding than our ancestors but still more quickly than the complexity have grown the means to master it. We have to know more: yet the effort has not become greater since it has become easier to acquire knowledge. We have to endure much disturbing noise, and yet we forget how the sense organs of our forefathers must have been maltreated, for instance, by flickering light. We are in a rush of work and stand in thousandfold connections; and yet the neural energy which is demanded is not large because a thousand devices of our technical life have become our obedient servants. There is no nation on earth which is more proud of its rush and its hurry than the American people; and yet what an abundance of time is leisurely wasted that would have to be used for work if the country could not live from its richness. Moreover our life has probably become cooler, there is less emotionalism, less sentimentality, more business-like attitude, and that all means less inner friction and excitement; in public life too, less fear of war and less religious struggle. All has become a question of administration and efficiency. Our time is certainly not worse off on the score of neurasthenia than its predecessors.

Above all the intensity of mental stimuli is always relative. The psychologist knows the experiments which determine that we perceive the difference of impressions as alike when the stimuli are proportional. If I have a ten-pound weight in one hand, I may find that I must have one pound more in the other hand to discriminate the difference. Now if I take twenty pounds in the one hand, then it is not sufficient to have one pound more in the other, but I must have twenty-two pounds in the other to feel a difference, and if I