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

Every thought of the physician moves in a world the structure of which is determined by the thought forms of cause and effect. He knows the effect which he wants to produce; it is the restitution of the organic equilibrium. He studies the causes which can secure that end. And again the disturbance of the equilibrium itself, the disease, is for him an effect which he seeks to understand by an analysis of the preceding causes. The means which he applies can therefore be valued only in reference to their efficiency; no other point of view belongs to his world. The religiously valuable may be indifferent or even undesirable in the interplay of causes, and the morally indifferent may be most important for the physician's interests. The religious emotion accordingly has to stand in line with any other mental excitement or with a hundred physical means which the laboratory and the drug store supply. The physician will welcome the methods of treatment without reference to metaphysical systems or to religious beliefs. To him it is an empirical fact that many disturbances of mind and body which interfere with the equilibrium of life can be repaired by influences on certain psychophysical organs. A part of these repairing influences he finds in the sense stimuli, for instance, of spoken or written words which reach the brain and awaken associative and reactive processes. He finds further that these influences can be reënforced in their effectiveness by certain general conditions of the nervous system and again finds that these can be secured partly by sense impressions, and once more especially by words.

It is a matter of course to the physician that application of any sense influence on the brain demands a most subtle analysis of the psychophysical situation. Therefore he gives no less attention to the disentangling of the whole history of the individual brain, to its stored-up energies and to its mental possibilities. If he knows the psychophysical status, and finally if he knows the means of influencing those psychophysical organs which stimulate or inhibit the disturbed central parts, he can foresee the psychophysical effects with a certain definiteness. Thus everything depends upon the sharpest possible, almost microscopic, mental analysis, together with a most thorough examination of the whole nervous system and the most careful calculation of the mental influences applied. The vagueness of the religious appeal transforms itself into an exact calculation and the unity of the soul which seeks spiritual uplift transforms itself into a mental mechanism of bewildering complexity, and yet not more complex than the physical organism, to which for instance, the chemical means of the physician administer. To-day medical science is certainly only in the beginning of this great movement. Especially the analysis of the psychophysical conditions still lacks a sufficient refinement of method. But at least the causal principle is now fully recognized and the scientific man of today no longer doubts that this whole play of psychotherapeutic processes goes on as a causal process in the psychophysical system of the individual without any mysteriousness, without any magnetic influences, without any miraculous interference, without any agencies except those which are working in our ordinary mental life in attention and reaction, in memory and sleep.

It is surprising how late this recognition appeared in the history of human knowledge. It occurred here as in so many places in the history of human civilization that the simple is the late outcome of the complex. Just as in technique the apparatus often began in a complex, cumbersome way and then became steadily simplified, so it is with explanations. The complex machinery of cosmic influences and obsessions by demons and magnetic mysteries was at first necessary until the simple explanation was found that all the results depend upon the working of the mind itself. Yet in technique and explanation alike, such progress to the simpler means always at the same time the making use of much richer knowledge. To explain an obsession or a sleep state by the agencies of evil spirits or magnetic fluids is certainly an unnecessary side conception. But to understand it from the working of the mind presupposes after all the whole modern physiological psychology, and thus had to be the latest step.

The effects themselves were certainly observed in all times. Even the phenomena of hypnotism date probably back some thousands of years, however difficult it may sometimes be to discriminate between the artificial hypnotic states and hysteric or hystero-epileptic occurrences in the past. Certainly it may be acknowledged that the Yogi in India cultivated in the most remote times the methods of autosuggestion which evidently led to hypnotic states, and everywhere around the Mediterranean, antiquity knew the hypnotizing effect of staring on polished metals and crystals. So in Egypt, so in Greece and Rome; and it has often been claimed that the priestesses of Delphi and the sibyls of the Romans were in states of hystero-hypnotic character. As to the therapeutic use, especially the Greek physicians applied hypnotic means. Excited patients were brought to repose by methods of stroking. The efforts to explain scientifically the mysterious powers which men can gain over the mind and will of another begin at the end of the Middle Age and were developed quite naturally from the prevailing astrological doctrines. Astrology worked on the theory that the human fate depends upon the stars. These stars have an effect on the human organism. That proves that an influence can exist between distant bodies. It is, therefore, not more surprising that one organism can also have an influence on another organism. Well known since antiquity were such influences from one object to another, as in the case of the magnet. Thus there may be a kind of magnetic power which creates relations between all objects in the universe.

Pomponnazi explained thus at the end of the fifteenth century the therapeutic effects of the human soul by the mutual influence which stars and men have on each other. This theory comes to much more important development in the writings of the physician Paracelsus. One individual by the power of his effort can influence the will of another individual, can fight with it, and suppress it; and all through energies which are analogous to the magnetic power which binds stars and men. In the middle of the seventeenth century, Helmont connects this power of magnetic attraction and repulsion with an ethereal element which penetrates all bodies and keeps them in motion. Through it man, too, can by his mere imagination work on other men. This will can also be effective on drugs which get through it a special therapeutic power. Somewhat different was the theory of a Scotch physician, Maxwell, in the second half of the seventeenth century. The ethereal spirit, which is identical with light, can be artificially cumulated in any organism and that secures its health. As one man can influence this vivifying ether in any other man, he can produce cures even from a great distance. All diseases are merely reductions of this ethereal spirit in the organism.

But the general stream of the explanation continued in the direction of the magnetic doctrine. It was especially Mesmer in the eighteenth century who, in a long life of fantastic mysticism and yet of universal serious study, surely contributed much to the development of the theory. He had started to use, like others, the magnet in his medical practice. But he discovered that the same therapeutic successes could be gained without applying the magnet itself, but by simply using his own hands. The patients became cured when he moved his hands slowly from their heads to their feet. The magnetic power was therefore evidently in man himself. It was an animal magnetism in opposition to the mineral one which belonged to the magnet and to the stars. He believed further that he was able to infuse this magnetic power into any lifeless thing, which would then have curative influence on the nerves. There can be no doubt that, whatever may have been the value of his theories, he cured a large number of patients, evidently producing a state which we would call today a hypnoid state and often simply appealing to the natural suggestibility of the impressionable minds. Among his pupils, usually called mesmerists, was Puysèyur, who discovered, in 1784, the state which was called artificial somnambulism, a kind of sleep in which the ideas and feelings of the magnetized can be guided by the magnetizer. Here evidently was the first recognition of the psychotherapeutic variation which we call today hypnotism. There followed a period in which the scientific interest of the physicians was somewhat sidetracked by an unsound connection of these studies with mystic speculations and with clairvoyance. But especially in Germany animal magnetism in Mesmer's form and in the form of artificial somnambulism grew in influence through the first decades of the nineteenth century and succeeded in entering the medical schools. The reaction came through popular misuse. At about the third decade of the century, interest ceased everywhere.

The Portuguese Faria insisted in 1819, practically as the first, that all those so-called magnetic influences, including the delusions, the amnesias after awaking, and the actions at a command, did not result from a magnetic power but from the imagination of the subject himself. He believed that the effect depended upon a disposition of the individual which resulted from a special thinness of blood. He abstained therefore from the magnetic manipulations and produced the somnambulic state by making the patients simply fixate his hands and by ordering them to sleep. Thus he is the first who understood these changes as results of mental suggestion. The next great step was due to the English surgeon, Braid, who in the forties studied the magnetic phenomena and like Faria insisted on the merely mental origin of the abnormal state. He proved that a person can bring himself into such an artificial state and that it is therefore entirely independent of energies from without. He examined especially the influence of staring at a shining object, a method which not seldom was called Braidism. He also introduced the word hypnotism. In America mesmerism was generally known under the name of electrobiology; and Grimes in particular came to results similar to those of Braid. Yet the influence of these movements on the medical world remained insignificant until a new great wave of psychotherapeutics by means of suggestion began in France in the sixties.

Of course this development from astrology to magnetism and from magnetism to hypnotism represented only one side of psychotherapy. Parallel to it goes the progress in the treatment of the insane. In the first half of the eighteenth century, they are still on the whole thrown together with the criminals but the more the disease character of the disturbance is acknowledged, and the more special hospitals for the insane are created, and finally the more the humane treatment in them supersedes the brutal, the more psychotherapy enters into the work. England showed the way. Especially Arnold, Crichton, and Perfect became influential; and soon Pinel and Esquirol followed in France; and Reil and Langermann in Germany. Reil recognized clearly at the threshold of the nineteenth century that "Both psychical and physical diseases may be cured by psychical means, but at the same time psychical diseases may also be cured by physical means." And in his "Rhapsodies," rhapsodies on the application of psychical methods in the treatment of mental disturbances, he declared, "that the medical Faculties will soon be obliged to add to the two existing medical degrees still a third, namely, the doctorate in psychotherapy." This stream became broader and broader and every new development of psychiatry in