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

in good health, without nervous history and without other nervous symptoms, suffered vehemently by the persistent recurrence of a visual image which entirely absorbed his attention. He knew exactly the development of his trouble. A woman acquaintance of his had committed suicide by poisoning herself. He knew her slightly and the emotion of personal loss played hardly any rôle in the case. But he had met her at a gay dinner a short time before her death. The news of the suicide came to him when he was overtired from work. The idea of the contrast between seeing his friend partaking of the dinner and imagining her drinking the poison gave him a strong shock. There was hardly any grief mixed in. He remembers that he shivered at the thought of the contrast, and in that moment the visual image of the woman raising a glass of poison to her mouth flashed into his mind and thus became almost a part of the shock. From that time on, the memory image of this scene returned more and more frequently. At first it associated itself with any chance mentioning of death or suicide and to a very slight degree with the idea of a meal. More and more any element of a meal and of social life, the word soup or meat, the word gown or dance, brought up at once the picture of the woman, which had in the meantime lost every element of personal relation. Any sad thought of her ending had faded away. It remained merely a troublesome impression. The man fought against it by trying to suppress the idea but the more he fought against it, the more insistently it rushed forward through new and ever new association paths. Any advertisement in the newspaper referring to food, anything in a shop window referring to ladies' dresses, any household utensils related to a meal, and especially the meals themselves, forced the visual image into the centre and captured the attention to such a degree that a confusing distraction from the real surroundings resulted. The struggle against the idea became more and more exasperating, made life a torture, almost suggested despair, even faint thoughts of suicide, and especially a growing fear that it was a symptom of the beginning of insanity.

When he came to me, a number of physical cures, especially bromides and electricity, had been tried in vain by the physician. Some weeks in the country had not changed the distress. He came to me with the direct request as a last resort to try hypnotic treatment. I found in spite of the fact that he and his physician had constantly spoken of visual hallucinations that the visual image had no hallucinatory character at all, that is, he never believed that he saw the image of that woman as if it were actually present, he never took the product of his imagination for reality, nor had it the vividness and character of reality. It was hardly more vivid than any landscape which he tried to remember, only that it controlled the interplay of ideas in such a persistent way. I found that he was a strong visualizer and easily suggestible. I told him beforehand that I should hypnotize him only to a slight degree, that he would not lose consciousness, that he would remember everything which I told him. Then I asked him to lie down and had him gaze on a crystal only for half a minute, then close the eyes. I asked him to relax and to think of sleep. With the two blunt points of a compass, I touched his two cheeks at corresponding places, then his forehead. And now I told him that I would begin with the hypnotic influence. I put my hand on his forehead and spoke to him in a monotonous way, saying that he felt a fatigue in his shoulders, and in his arms, creeping over his whole body and assured him that he was now fully hypnotized. To what degree he really was hypnotized cannot be said as no effort was made to test it by any experiments, thus avoiding any possible reaction against the feeling of submission. Expression and breathing indicated a slight hypnoid state. Then I removed my hand and spoke to him in a warm and assuring way.

I told him that in future he would give his full attention to his meal, and not give the slightest attention to any image of his friend. If he should think of the friend the memory would appear indifferent, he would not even notice the image and would give his whole mind to the objects with which he was engaged. In the same way, when he should be reading newspapers or looking in shopwindows, his whole attention would belong to that which he really perceived. Any passing inner image would be ignored. Then I awoke him from his sleep. He was unwilling to believe that he had been in hypnosis at all. I told him that the effect would prove it and in his fully wakeful state I explained to him why there was not the slightest fear of insanity justified, that it was a psychasthenic state resulting from fatigue and shock and from a wrong attitude of his attention during the past months, and then I asked him to return the next day. Intentionally I had not given the suggestion that the image would disappear. I could not expect it would disappear entirely after a first treatment and even a faint appearance of it would have at once fascinated the attention and brought about the whole disturbance of the equilibrium which might become habitual. Instead of it I gave the impulse to the counter-idea, that is, I reënforced the attention towards that which he really saw around him and thus withdrew the attention from the rival image in the mind. The success was complete. He came the next day in a much happier frame of mind, reporting that he still had seen the image of the woman every few minutes, especially strongly at the breakfast table, but it had no longer troubled him. It was more in the background of consciousness, sometimes it appeared transparent, it no longer held his attention, and he felt free to give his full attention to the actual surroundings.

On that basis I hypnotized him the second day and he had hardly heard me saying that he ought to try to sleep when he was evidently in a much deeper hypnotic state than the first time. Again I suggested only the opposite attitude, the positive turning to the surroundings and the complete neglect and indifference for the possible memory image. This time the effect was still stronger. On the third day he reported that he still saw the image but he no longer minded it, as it was like a veil through which he looked at real objects and that left him entirely indifferent. His mind was hardly engaged with it any more. The real spell of the attention was broken. On the basis of this situation, I took the last step and suggested that the image of the woman would disappear altogether and would not trouble him any more. In the next twenty-four hours, it still returned two or three times, but colorless and faint. The following day I was able to eliminate it altogether. Even when the last trace of the inner struggle between the memory and the perceived surroundings had disappeared, I went on with two hypnotic sittings to give stability to the new equilibrium, to insist that the image would not come back and to settle completely that inner repose with which every fear of possible disease evaporated. I feel sure that the cure would not have been reached so quickly, possibly not at all, if the second suggestion, the disappearance of the image, had been given at the first step. The improvement was secured because the antagonistic process itself was used for the suggestion. On the other hand, there was no doubt that in this case the strong will of the patient or suggestion in a normal state would not alone have been sufficient. The hypnotic treatment was indicated by the symptoms and justified by the results.

I may take another typical case in which also the obsession was brought about by an idea without emotional value or at least by an idea which had lost its emotional character; the idea came somewhat nearer to hallucination, but had its chief elements on tactual ground where the transition from image to hallucinatory perception is easier. I add this case to demonstrate that hypnosis is not the only open way of treatment in such cases and that the variations must always be adjusted to the special conditions. The case gains importance by the fact that the patient was himself a physician well trained in mental observation.