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

The same holds true for the purely intellectual engagements. The work which the scholar undertakes should not be measured by the effect which the same appeal to concentrated attention would make on the average man of practical life. There, too, an adjustment to the demand has resulted during the whole period of training and professional work. Every effort should be estimated with reference to the standard of the particular case. This relativity of the mental reaction on the demands of life must always be in the foreground of the psychotherapeutic régime. Even the best physicians too often sin against this principle and accuse the life which a man or woman leads as too exhausting and overstraining simply because it would be overstraining and exhausting to others who are not adjusted to that special standard. Simply to withdraw a patient from the one kind of life and to force on him a new kind with new standards may not be a gain at all. A new adjustment begins and smaller differences from the standard may bring about the same strong intensities of reaction as the large differences brought before. Complete rest, for instance, for a hard brain-worker hardly ought to be recommended unless a high degree of exhaustion has come on. If routine prescriptions are to be admitted at all, they should not be complete rest or complete change of life for any length of time but a continuation of the life for which adjustment has been learned with a reasonable reduction of the demands and stimulations. The intellectual worker ought to decrease his work, the overbusy society woman ought to stay in bed one day in the week, the man in the midst of the rush of life ought to cut down his obligations, but probably each of them does better to go on than simply to swear off altogether.

Their rest ought to have the character of vacation; that means interruptions without the usual activity ought to be short periods spent with the distinct feeling that they are interruptions of that which must last and that they are not themselves to become lasting states. Thus the inner adjustment to the work ought to be kept up and ought not to be substituted by a new adjustment to a less exacting life. In this way the episode of the vacation rest ought to be in a way included in the strenuous life almost as a part of its programme. Strenuosity must not mean an external rush with the gestures of overbusy excitement, but certainly the doctrine of the lazy life is wretched psychotherapy, as long as no serious illness is in question. By far the best alteration is, therefore, even in the periods of interruption, not simply rest but new engagements which awaken new interests and stimulate neglected mental factors, disburdening the over-strained elements of mental life. The most effective agency for this task is contact with beauty, beauty in nature and life, beauty in art and literature and music. To enjoy a landscape ought to be not merely a negative rest for the man of the office building, and good literature or music absorbs the mental energies and harmonizes them. In the second place come games and sport, which may enter into their right if fatigue can be avoided. Harmonious joyful company, as different as possible from the depressing company of the sanitariums, will add its pleasantness.

While the advice of the physician ought thus to emphasize the positive elements which work, not towards rest, but toward a harmonious mental activity, we must not forget some essential negative prescriptions. Everything is to be avoided which interferes with the night's sleep. Furthermore, in the first place, alcohol must be avoided. There cannot be any doubt that alcoholic intemperance is one of the chief sources of brain disturbances and that the fight against intemperance, which in this country is essentially the fight against the disgusting saloon, is a duty of everyone who wants to prevent nervous disaster. There may and must be divergence of opinion as to the safest way to overcome intemperance. The conservative physician will feel grave doubt whether the hasty recommendation of complete prohibition is such a safe way, whether it does not contain many conditions of evil, and whether the fight against the misuse of alcohol will not be more successful if a true education for temperance is accepted as the next goal. But for the man of neurasthenic constitution and for any brain of weak resistance, the limit for permissible alcoholic beverages ought to be drawn very narrow and in such cases temporary abstinence is usually the safest advice. Individual cases must indicate where a glass of light beer with the meal or a glass of a mild wine may be permissible. Strong drinks like cocktails are absolutely to be excluded. In the same way a strong reduction is advisable in tobacco, tea, and especially coffee. A complete withdrawal of all stimulations to which a nervous system has been accustomed for years is not wise, or at least mild substitutes ought to be suggested, but if coffee can be ruled out at once, often much is gained. In the same way all passionate excitements are to be eliminated and sexual life to be wisely regulated. An especial warning signal is to be posted before all strong emotions, and if the patient cannot be asked to leave his worry at home, he can at least be asked to avoid situations which will necessarily lead to excitement and quarrel and possible disappointment.

It is one of the surest tests of psychotherapeutic skill to discriminate wisely whether one or the other of these features of general treatment ought to be emphasized. They usually demand more insight than specific forms of psychotherapy like hypnotic suggestions. These general efforts are also much more directed against the disease itself where the specific methods are merely directed against the symptoms. The separation from disturbing surroundings, the reduction of engagements and work, the complete rest, the suppression of artificial stimulants, the enjoyment of art, of nature, of sport, the distractions of social life, each might be in one case a decisive help and indifferent, perhaps even harmful in another. All is a matter of choice and adjustment to the particular needs in which all the personal factors of inherited constitution, acquired adjustments, social surroundings, temperament, and education, and the probable later development have to be most tactfully weighed. Yet this general treatment may take and very often ought to take the opposite direction, not towards rest but towards work, not towards light distraction but towards serious effort, not towards reduction of engagements but towards energetic regulation. We said that it was an exaggeration to blame the external conditions of our life, the technical manifoldness of our surroundings as the source of the widespread nervousness. The mere complexity of the life, the rapidity of the demands, the amount of intellectual effort is in itself not dangerous and our time is not more pernicious than the past has been; but it is perhaps no exaggeration to say that our time is by many of its features more than the past tending towards an unsound inner attitude of man.

Much of the present civilization leads the average man and woman to a superficiality and inner hastiness which undermines sound mental life much more than the external factors. We look with a condescending smile at the old-fashioned periods in which the demands of authority and discipline controlled the education of the child and after all the education of the adult to his last days. We have substituted for it the demand of freedom with all its blessings, but instead of the blessings we too often get all its vices. A go-as-you-please method characterizes our whole society from the kindergarten to the height of life. We eulogize the principle of following the paths of own true interest and mean by that too often paths of least resistance. Study becomes play, the child learns a hundred things but does not learn the most important one, to do his duty and to do it accurately and with submission to a general purpose. The power of attention thus never becomes trained, the energy to concentrate on that which is not interesting by its own appeal is slowly lost, a flabby superficiality must set in which is moved by nothing but the personal advantage and the zigzag impulses of the chance surroundings. He who has never learned obedience can never become his own master, and whoever is not his own master through all his life lacks the mental soundness and mental balance which a harmonious life demands. Flippancy and carelessness, haphazard interests and recklessness must result, mediocrity wins the day, cheap aims pervade the social life, hasty judgments, superficial emotions, trivial problems, sensational excitements, and vulgar pleasures appeal to the masses. Yellow papers and vaudeville shows—vaudeville shows on the stage, in the courtroom, on the political platform, in the pulpit of the church—are welcome, and of all the results, one is the most immediate, the disorganization of the brain energies.

A sound mind is a well-organized mind in which a controlling idea is able to inhibit the opposites and is in no danger of being overrun by any chance intrusion into the mind. This power is the act of attention. An attention which is trained and disciplined can hold its ideas against chance impulses. An untrained attention is attracted by everything which is loud and shining, big and amusing. The trouble is not with the rush and hurry of the impressions which demand our attention; the trouble is with our attention which seeks a quick change of new and ever new impressions because it is not disciplined to hold firmly to one important interest. We want the hundred short-cut superficial magazines because we lack the energy to study one large volume; we want the thousand engagements because we are not concentrated enough to devote ourselves fully to one ideal task. The strong mind may find its sound adjustment even without such training for concentrated attention through obedience and discipline but the weak mind has to pay the penalty. For not a few it will mean social disaster. Yet our society is sufficiently adapted to this state so that it gives some good social chances to the superficial too, and this not only to the rich, but to those on every level. Only the nervous system cannot so easily be adjusted to the new régime. The loose interplay of the brain cells without the serious training of discipline must involve disorganization of the mind-brain system which may count often most powerfully in those spheres in which the mere needs of life are felt the least. There is only one great remedy: discipline, training for concentrated attention, for a work in submission of will to a