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

On the whole, there is a far-reaching independence between the apparent mental variations and the seriousness of the brain affection. Light hysteric states may produce a strong absenting of the mind while severe epileptic conditions of the brain may be accompanied by very slight mental changes. Every neurasthenic state may play havoc with mental life, while grave brain destructions may only shade slightly the character or the intellect. To deal with the mental changes as if they belonged to a sphere by itself, to the soul which is well or ill through its own independent alterations without steadily relating the changes to the total organism, leads therefore necessarily to failure. The mind reflects only symptoms of the disease; the disease itself belongs always to the organism. Psychotherapy has suffered too much from the belief that the removal of mental symptoms is a cure of disease.

Certainly the psychophysical symptoms may often stand in the foreground of the disease, and in that case it may be left to the special needs whether we deal with them as psychical or as physical changes. Even the patient may be made to see them in one or the other way in accordance with his special needs. To tell him that his brain cells are in disorder and that they can be cured will be the right thing for him who takes only the introspective view of his suffering and is in despair because his own will seems powerless to overcome those mental changes. For the next patient, the opposite may be wiser. The belief that his brain is ill may have induced him to give up effort of the will instead of helping along by steady self-suggestion. He will be helped more if he understands that his mind is working wrongly. But the full truth is that both mind and body are in disorder; the function of the disturbed brain cells accompanies the ineffective will, and to reënforce the will means to bring into equilibrium again the disturbed brain cells. For the psychotherapist the temptation of giving the attention to the mental symptoms only is strong. The more firmly the physician sticks to the standpoint of psychophysiology, the better he will see ailment and cure in their right proportion.

This demand for the consideration of the whole personality, mind and body, ought not to be influenced by the popular separation between organic and functional diseases. If we call organic diseases of the mind those in which the mental disturbance is the accompaniment of a brain disturbance, and functional those in which no brain disturbance exists, we leave entirely the ground of modern psychology. As soon as we believe that the mind can be disturbed without a change in the functions of the brain, we give away all that which has brought scientific order into the study of psychological existence. Every mental disturbance corresponds to a disorder in the brain's functions. But there cannot be a change in the functions of the brain without a change in its structure. Thus we must claim that all those so-called functional disturbances like neurasthenia and hysteria, fixed ideas and obsessions, phobias and dissociations of the personality, as well as the typical insane states of the maniac or paranoiac have their basis in a pathological change of the anatomical structure of the brain. This postulate cannot be influenced by the fact that the microscope has been unable to detect the character of most of these changes.

Of course all this does not exclude its being perfectly justifiable to separate those diseases for which a definite destruction of the brain parts can be detected, as in paralysis of the brain, from those where that is impossible. We may also expect that those disturbances in the brain which we cannot as yet make visible, may allow more easily an organic repair and thus a restoration to the normal functions. Just as a disjointed arm may be brought to function quickly again, a broken arm slowly, an amputated arm never, each brain cell too may suffer lesions which are reparable in different degrees. But it is evident that it remains then an entirely empirical question whether the invisible damage allows repair or not. We have no right to say that where the destruction cannot be seen under the microscope there is no organic change and the disturbance is therefore only a psychical one and can be removed by mental means. All changes are physical and experience has to decide whether they are accessible to psychological influences or not. States like epilepsy may not allow any recognition of definite brain destruction and are yet on the whole inaccessible to mental influence, while many a brain disturbance with visible alterations, resulting perhaps from anæmia or hyperæmia, may be caused to disappear. If on the other hand we say that we can cure with psychotherapeutic means only the functional brain diseases and define as functional simply those diseases which can be cured by such means, we move, of course, in the most obvious circle and yet just that is the too frequent fate of the discussions in certain quarters.

Every psychical disturbance is organic inasmuch as it is based on a molecular change which deranges the function. Some of these changes are beyond restitution; some can be brought back to a well-working structure by strictly physical agencies like drugs or electricity; others can be repaired by physiological stimuli which reach directly the higher brain cells through the sense organs and which we call psychical under one aspect, but which certainly remain physiological influences from another aspect. And these psychophysiological influences of the spoken words or similar agencies are thus indeed for therapeutic effect entirely coördinated with the douche and the bath and the electric current and the opiate. It is a stimulation of certain brain cells, an inhibition of certain others: a subtle apparatus which must be handled with careful calculation of its microscopical causes and effects. That these words from an entirely different point of view may mean a moral appeal and have ethical value, point to moral and religious ideas and reënforce the spiritual personality, lies entirely outside of the psychotherapeutic calculation. As long as the curing of the patient is the aim, the faith in God is not more valuable than the faith in the physician and the moral appeal of no higher order than the influence through the galvanic current. They come in question only as means to an end and they are valuable only in so far as they reach the end. That they can be related to an entirely different series of purposes, to the system of our moral ideas, ought not to withdraw the attention of the psychotherapist from his only aim, to cure the patient. The highest moral appeal may be even a most unfit method of treatment and the religious emotion may just as well do harm as good from the point of view of the physician. Psychotherapy has suffered too much from the usual confusion of standpoints.

Psychotherapy has now become for us the effort to repair the disturbed equilibrium of human functions by influencing the mental life. It is acknowledged on all sides that the most powerful of these influences is that of suggestion. This is an influence which is most easily misunderstood and which has most often become the starting point for misleading theories. Before we enter into the study of the practical effects of suggestion and the psychotherapeutic results, we must examine this tool in the hand of the psychotherapist from a purely psychological viewpoint. The patient may perhaps sometimes profit from suggestion the more, the less he understands about its nature, but the physician will always secure the better results, the more clearly he apprehends the working of this subtle tool. Of course, that does not mean that any psychology is able to explain the process of suggestion to a point where all difficulties are removed, but at least the mysteries can be removed and the effects can be linked with other well-known processes.

Let us be clear from the start that suggestion is certainly nothing abnormal and exceptional, nothing which leads us away from our ordinary life, nothing which brings us nearer to the great riddles of the universe. There is no human life into which suggestion does not enter in a hundred forms. Family life and education, law and business, public life and politics, art and religion are carried by suggestion. A suggestion is, we might say at first, an idea which has a power in our mind to suppress the opposite idea. A suggestion is an idea which in itself is not different from other ideas, but the way in which it takes possession of the mind reduces the chances of any opposite ideas; it inhibits them. It is indeed the best result of any successful education, that the teachings have taken hold of the mind of the young in such a way that all the opposite tendencies and impulses and wishes do not come to development. The well-educated person does not need to participate in a struggle between good and bad motives, for that which has been impressed upon his mind does not allow the other side to come up at all. Our life would be crowded with inner conflicts if education had not secured for us from the start preponderance for the suggestions of our educators.

The love of family and friends, of our country and our party are in the same way such suggestions. We may hear arguments for the other side, arguments which easily convince the man of the other party, but they do not appeal to us: they are emasculated before they enter our minds; they have no chance to overcome the resistance because suggestions stand in their way. No argument will overwhelm the suggestion which religion has settled in our inner life, and from this strongest suggestion which can stand against any temptation of life small psychological steps lead down to the little bits of suggestion with which our daily chance life is over-flooded. Every advertisement in the newspaper, every display in the shop-window, every warm intonation in the voice of our neighbor has its suggestive power, that is, it brings its content in such a way to our minds that the desire to do the opposite is weakened. We do buy the object that we do not need, and we do follow the advice which we ought to have reconsidered. And what would remain of art if it had not this power of suggestion by which it comes to us and wins the victory over every opposing idea? We believe the painter and we believe the novelist, if their technique is good. We do not remember that the inventions of their genius are contrary to our life experience; we feel sympathy with the hero and do not care in the least that he has no real life. The suggestion of art has inhibited in us every contrary idea.

Such daily experience shows us that suggestive power may belong to different men in different degree. There are lawyers whose arguments and whose presentation open our mind, it seems, to any suggestion: while others leave us indifferent; we understand their idea, we follow their thoughts, and yet we remain accessible to opposite influences. There are teachers whose authority gives to every word such