Psychotherapy - Hugo Münsterberg (top 5 books to read txt) 📗
- Author: Hugo Münsterberg
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Only a short time ago I dealt with a young man whom his parents and a chauffeur had accompanied to Boston, exclusively for the purpose of watching him constantly while I was to attempt to cure him from excessive whiskey drinking. The chauffeur accompanied him from his room in the Boston hotel to the threshold of my laboratory. All through the day he was with his parents, and at the hotel the management had given the strictest orders not to sell any drink to the young spendthrift. He was an earlier student of mine and had attached himself to me with such an apparent sincerity as removed every possible doubt of his pledge. Intentionally I had not even asked him for a pledge not to drink but only for a pledge to confess to me the next day if he ever should take any alcohol. In a tentative way I suggested to him in a half hypnotic state on the first day that he would feel disgust for whiskey. I did not expect much of an improvement before at least three or four treatments. I was therefore most surprised when he most solemnly assured me the next day that he awoke in the morning with an assured feeling that he should never touch whiskey again and that he had not the slightest desire for it. Instead of a systematic development of suggestions, I confined myself therefore to a mere repetition of the treatment of the first day and as every morning the same assurance came forth, there seemed to be no need for any variation. It was not before the fifth day that I discovered that he had taken from the start a pint of whiskey every day. When he first arrived he had bribed a laundress of the hotel to bring to his room every day the whiskey hidden in the laundry and he drank it during the night. Then I declined any further participation.
The danger of deceit is of course less imminent when not the family but the patient himself takes the initiative. Yet even here distrust is wise. The patient has sometimes the most sincere intention to be cured, but under pressure of his craving he admits compromises which he hides from the physician. Having reduced the large quantity of alcohol to which he was accustomed, he hides the fact that he yet takes a few drinks, which he thinks cannot prevent the cure. Yet inasmuch as a complete cure has to rely on psychical factors, this consciousness of deceiving even with small transgressions interferes badly with progress and, inasmuch as the cunningness of the patient is itself a symptom of the disturbance, the strongest possible precaution is advisable at the beginning. For that reason it is also not best to begin at once with complete prohibition, but to lead to a total abstinence in about one week. But certainly in the case of every drunkard, total abstinence is the only desirable goal. A pronounced drinker ought never to be transformed simply into a moderate one. The return to intemperance would result rapidly. On the other hand it would be unfair to deny that psychotherapy has cured the symptom if the desire really once disappeared completely, even if, after years, new temptations develop a new desire. I myself had diphtheria three times in my life; my constitution is thus probably especially favorable to that disease but I do not estimate less the fact that I was perfectly cured the second time, in spite of the fact that I caught it a few years later a third time. To be sure, such experiences of relapse cannot be spared any psychotherapist. I may give a typical instance.
A well-known professional man of fifty years, through a long bachelorhood, was accustomed to close his work at four o'clock and then to sit comfortably in his study with a book and an unlimited supply of brandy. He took one cognac after another and every evening he was completely intoxicated. He married a young wife and felt the need of changing his habits, the more as he himself saw symptoms of his excess which alarmed him. When he came to me, I saw that he was seriously wishing to give up, and he understood himself that there was only the one way, namely, complete abstinence. He felt that he could not reach it by his own will power alone and sought my aid. I hypnotized him six times, suggesting at first a reduction to four drinks, then to two, then to one and then to pure mineral water. I concentrated my effort on stirring up the antagonistic attitude, the dislike of the smell of brandy and the aversion to its taste. The effect was excellent. After the fifth time the mental torture which he had felt in the first afternoons had completely disappeared. I considered further hypnotizing superfluous and felt sure after the sixth time that the man was cured. For about a year he remained abstinent, but in the meantime his professional life brought severe disappointments, and with cool consideration he decided that he might have at least some pleasure from life and forget its miseries. Accordingly after a year he determined again to take some brandy in his study, and of course, that led rapidly to an increase of the dose and today he is probably at the old point. And yet it may be said with correctness that psychotherapy had done its duty. If at the right moment before he took the first step again, even the slightest counter-suggestion had been applied, the disastrous second development could have been easily avoided.
My experience indicates the best results where the suggestions are from the start directed as much against the unfavorable social conditions, with their temptations and impulses to imitation, as against the alcoholic beverages themselves. On the whole it is easier to break the vicious drinking habits of the social drinker than those of the lonely drinker, a point which ought to be well considered in settling the complex problem of prohibition versus the temperance movement.
The situation of alcoholism repeats itself in still more ruinous forms with morphinism and cocainism, vices which grow in this country to an alarming degree. The psychotherapeutic treatment of such drug habits demands much patience and much skillful adjustment to the psychological conditions. Its general difference from the treatment of alcoholism is given by the circumstance that any too rapid withdrawing of the drug is certainly dangerous, if the organism is adjusted to a relatively strong dose. On the other hand, I may say that I have not seen a single case in which a really patient and insistent treatment of morphinism has not been successful, even if the destructive dose of forty grains a day had become habitual. The condition is only that the patient himself have the best will, a will which yet is not strong enough to win the fight without psychotherapeutic help. But no one ought to expect that the psychotherapist can secure miracles like some of the pill cures which treat the drug fiend in three days. Moreover neither physician nor patient ought to believe that the worst is to come at the beginning. On the contrary, it is the end which is hardest, the reduction of the small dose to nothing. As illustration, I give an extreme case.
A man who was formerly station master on a railroad had been operated on in a hospital after an accident, and as some pain in the hip remained which disturbed his sleep, the physician of the hospital gave him some morphine and provided him with the material for morphine injection after leaving the hospital. Then began the usual story. He became more and more dependent upon his injection, the dose was steadily increased, he found unscrupulous physicians who yielded to his demand for morphine prescriptions; he lost his position with the railway by the growing effects of the morphine poisoning, he became divorced, sank lower and lower, his daily dose fluctuating between thirty-five and forty grains a day, and when he came to me, he presented a picture of the lowest type of hopeless manhood. He spent practically the whole day in bed and was only able to totter slowly along with a cane. He assured me that life was hell for him. He could not sleep, he could not eat, he could not think, he had made up his mind to commit suicide if I could not help him. I foresaw that it would in the best case demand months of insistent energy to make a man out of that unfortunate wreck. He had gone through three different morphine cures in three sanitariums and none had helped him, and every physician whom he had consulted had declared his case as beyond any physical cure. I decided to make the somewhat disproportionate sacrifice of time in order to study whether even such an extreme case of morphinism is accessible to psychotherapeutic treatment. Four months later, he left my laboratory looking like an athlete, strong and vigorous, joyful and energetic. For three weeks he had not received any morphine, had good appetite, slept well, and had happily married. As his wife was a trained nurse, she will take good care that no new slip shall ever occur.
There was nothing remarkable in those four months of treatment. He was easily hypnotized, and I hypnotized him at first every day, then every second day, then every week. It was without difficulty that I reduced the forty grains to about six grains a day. Then the struggle began. To test the case as a strictly psychological problem I left the effort entirely to his own will, that is, I did not deprive him of the morphine supply but left the regulation in his own hands. During that whole winter he had a bottle with a thousand morphine tablets standing on his desk. Thus he would have been entirely able to satisfy any craving, but by his own will he followed my suggestions and never took more than I permitted. It meant a terrible struggle. The tortures which he had to pass through were perhaps worse than those which he had experienced at the time of his lowest downfall. They came to a focus when he tried to go from five grains to three grains a day and then again when he approached half a grain. From there he had to move to a fourth of a grain, then to an eighth, and even that had still to be divided into four different doses which were then reduced to three, to two, and finally to one dose and ultimately to injections of warm water. A rapid increase in general strength and a return of appetite for food began when he had reached the five grain limit. I did not allow on any occasion the introduction of a substitute. On the other hand, I added every day suggestions covering the various secondary symptoms, especially the pains in the stomach and the feelings of faintness and the emotional depression.
There, is no doubt that under favorable conditions, especially if the dose of morphine is not too strong, autosuggestion can bring about a similar effect. A reduction of ten per cent every week can be carried through, if a pledge is given to one's self in a drowsy state. The great value of autosuggestion showed itself not seldom in the fact that morphinists who had applied to me by mail for a cure in the mistaken belief that I do work in a professional way for payment and who
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