Psychotherapy by Hugo Münsterberg (world of reading .TXT) 📕

In education, for instance, very many different ends might be reached; psychology cannot decide anything. The decision as to the aims of education must be made by ethics, which indeed takes not a causal but a purposive attitude. Only after ethics has selected the aim, psychology can teach us how to reach it. Of course this principle must hold for the physician too. All his causal dealing with the mind presupposes that he has selected a certain end in harmony with his purpose. The only difference is that, in the case of the physician, there can be no possible doubt as to the desirable end; what he aims at is a matter of course, namely, the health of the patient. To desire the health of the sufferer is thus itself a function which belongs entirely to the purposive view of the world, and only in the interest of this purpose does the physician apply his knowledge of psychology or of the causal sciences of physics, physiology, and chemistry. Indeed only with this limitation have we the right to say that the psychotherapist takes the causal,—and that means the psychological,—view of his patient. As far as he decides to take care of the health of his patient, this decision itself belongs to the purposive world and to his moral system. The physician is thus ultimately just like the minister and just like anyone who deals with his neighbor, a purposive worker; but while the minister, for instance, remains on this purposive track, the physician puts a causal system into the service of his purpose. He knows the end, and his whole aim is to apply his causal knowledge of the physical and psychical world to the one accepted end of restoring the health of the patient. He has to ask thus in general: what has psychology to-day to offer which can be applied in the interests of medicine?

It would be an inexcusable narrowness to confine that chapter of applied psychology which is to deal with the psychomedical problems to the work of psychotherapy. Medicine involves diagnosis of illness as well as therapeutics. Between the recognition and the treatment of the illness lies the observation of its development and all this is preceded by steps towards the prevention of illness. In every one of these regions, psychology may be serviceable. Psychotherapy is thus only one special part of psychomedicine. But the situation becomes still more complex by the fact that the illness to be treated or the disturbance to be removed may stand in different relations to the psychophysical processes. The illness may be a disturbance in the psychophysical brain parts, or it may belong to other brain parts which are only in an indirect way under the influence of mental states or which are themselves indirectly producing changes in the mental life. And finally the disturbance may exist outside of the brain in any part of the body, and yet again through the medium of brain and nervous system it may produce effects in the mind or be open to the influence of the mind. Thus we have entirely different groups of medical interests and it would be superficial to ignore the differences.

Both psychodiagnostic and psychotherapeutic studies must be devoted to cases in which the mind itself is abnormal, further to cases in which the normal minds registers the abnormalities in other parts of the body, and finally to cases in which the normal mind influences abnormal processes in the body. These latter two cases have to be subdivided into those where the bodily disturbance still lies in the brain parts and those where it lies outside of the brain. But the situation becomes still more complex by the mutual relations of those various processes. The impulse to take morphine injections may have reached the character of a mental obsession and thus represent an abnormality of the mind, but yielding to it produces at the same time disturbances in the whole body which thus become again external sources for abnormal experiences in otherwise normal layers of the mind.

Of course the interest of the psychologist as such remains always related to the psychological factor, but the relation of the psychological factor itself to the total disturbance may be of most different character. If I diagnose or treat the fixed idea of a psychasthenic, the psychological factor itself represents the disturbance. On the other hand, if I study the pain sensations of a patient who suffers from a disease of the spinal cord, then the sensations themselves, the only psychological factor in the case, are only indications of a disease which belongs to an entirely different physical region; the mind itself is normal. Or, on the other hand, if I try to educate a sufferer from locomotor ataxia to develop his walking by building up in his mind new motor ideas to regulate his coördinated movements, the mind again is entirely normal but the physician needs his psychology on account of the influence which the mind has on the bodily system. Again, we must insist that psychomedicine covers this whole ground. Wherever a psychical factor enters into the calculations of the physician either by reason of its own abnormality or by its relation as effect or as cause to a diseased part of the body in the brain or without, there we have a psychomedical task, and as far as it is therapeutic, we have psychotherapy.

The psychodiagnostic research lies outside of the compass of our book, but we cannot emphasize sufficiently the great importance which belongs to that work. Moreover, just in the field of psychodiagnostics, the methods of the modern experimental psychological laboratory are most promising and successful. Let us not forget that we deal with such psychological factors even when we test the functions of eye and ear and skin and nose by examining the sensations and perceptions. The oculist who analyzes the color sensations of a patient and the aurist who finds defects in the hearing of the musical scale and discovers that certain pitches cannot be discriminated, is certainly dealing, for diagnostic purposes, with the material that the psychological laboratory has sifted and studied. Even that sensation symptom which enters into so many diseases, the sensation of pain, belongs certainly within the compass of the psychologist and it is only to be regretted that the systematic study of the pain sensations, mostly for evident practical reasons, has been much neglected in the psychological laboratory.

The psychologists have been at work all the more eagerly in the fields of association and memory, attention and emotion, habit and volition, distraction and fatigue. Here subtle methods have been elaborated, methods which surely common sense cannot supply, and which showed differences of mental behavior with the exactitude with which the microscope reveals the hidden differences of form. If physicians are slow in accepting the help which the psychological laboratory can furnish, it may be in good harmony with the desirable conservative policy in medicine, but finally the time must come when this instinctive resistance against new methods will be overcome. The recent attachment of psychological laboratories to certain leading psychiatric clinics is a most promising symptom. Yet the diagnostic studies with the means of the psychological laboratory cannot be confined to the cases of mental disease. The mild abnormalities of the mind, and especially the nervous disturbances which exist outside the field of insanity, demand this support of psychology much more. And even the normal personality will be more safely protected from disease and from social dangers for its mental constitution if the resources of experimental psychology are employed. The more we know of the psychological constitution of the individual, the more we can foresee the development which is to be hoped for or feared and which may be encouraged or retarded.

The psychologist may determine, for instance, the degree of attention with its resistance against distracting stimuli, the power of memory under various conditions and on various material, the mental excitability and power of discrimination, the quickness and correctness of perception, the chains of associations, the rapidity of the associative process for various groups, the types of reaction, the forming of habits and their persistence, the conditions of fatigue and of exhaustion, the emotional expressions and the emotional stability, the time needed for recreation and the resistance against drugs, the degree of suggestibility and the power of inhibition: and every result in any of these lines may contribute to the diagnosis and prognosis of cases. The chronoscope here measures the reaction times and association times in thousandths of a second; the kymograph, by the help of the sphygmograph, writes the record of the pulse and its changes in emotional states, while the pneumograph records the variations of breathing, and the plethysmograph shows the changes in the filling of blood vessels in the limbs which is immediately related to the blood supply of the brain. Here belongs also the ergograph, which gives the exact record of muscular work with all the influences of will and attention and fatigue, the automatograph which writes the involuntary movements, especially also the galvanoscope which may register the influence of ideas and emotions on the glands of the skin, and thus lead to an analysis of repressed mental states, and hundreds of other instruments which are used in the psychological laboratory.

Yet it would be misleading to think only of complex apparatus when experimental psychology is in question. An experiment is given whenever the observation is made under conditions which are artificially introduced for the purpose of the observation. Thus there is no need of the physical instrument. If I bring a spoonful of soup to my mouth at dinner and I become interested in the combination of warmth sensation and touch sensation and taste sensation and smell sensation, then I have performed an experiment if I take one more spoonful of soup just for the purpose of the observation. The physician too may carry out important psychological experiments, without needing the outfit of a real laboratory. Association experiments, for instance, promise to become of steadily growing importance. To make them serviceable to the problems of his office, nothing but a subtle psychological understanding is needed, inasmuch as any routine work schematically applied to every case alike would be utterly useless. Give your man perhaps a hundred words and let him speak the very first word which comes to his mind when he hears the given ones. You call rose, and he may say red or flower or lily or thorn; you call frog and he may answer pond or turtle or green or jump, and if you choose your hundred words with psychological insight, his hundred answers will allow a full view of his mental make-up. This is an experiment which does not require any instruments at all but a