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

The purely psychical character is still more evident in the frequent hysterical anæsthesias. No one doubts that here the sensations are inhibited only and that the mental influence removes this inhibition without any influence on the sense organs proper. Frequently also organic troubles like stomach diseases appear cured when in reality hysterical disturbances are at the bottom. The stomach may be sensitive to any pressure and may produce severe pains and vomiting on taking any food and everything may indicate a serious local disturbance. Yet hypnotic treatment may quickly remove the symptoms because the whole reaction may have resulted from the shock which perhaps a too hot piece of potato caused. The removal of this mental starting point results in a cure of the apparent stomach disease. Again in other cases, the appearance of a physical cure is given by the creation of psychophysical substitutes. I do not believe that hypnotism or suggestive treatment can influence the brain parts which have suffered from a hemorrhage. Yet the paralysis of the arm, for instance, which resulted from such a breaking of a blood-vessel in the brain may be to a high degree repaired by building up new motor images in the psychophysical system, which become starting points for a new learning of movements. The patient did not understand how to make the most out of those motor paths which had been left. The destruction of the chief channels of discharge had inhibited in his mind the idea of possible movement. He no longer believes that he can move and it needs new suggestions to overcome this inhibition. The curative effect on bodily disabilities is thus often an illusory one.

That does not mean that the field in which psychotherapeutics may work directly on the body is not after all a large and interesting one. Theoretically it is still little open to real understanding. The explanation has essentially to rest on the acceptance of a given physiological apparatus. A certain psychophysical excitement produces by existing nerve connections a certain effect, for instance, on the blood-vessels or on the glands of a certain region, or on a certain lower nervous center. That such apparatus exists, the physiological experiment with persons who are hypnotized to a high degree can easily demonstrate. Their nose bleeds at a command; a blister may arise on a part of the skin which is simply covered with a penny, when the suggestion is given that the penny is glowing hot. With some subjects, the pulse can become slower and quicker in accordance with the suggestion; with some even the bodily temperature can change on order. Our understanding of these indubitable facts indeed does not go further than the acknowledgment that the paths for such central connections exist. That means we simply describe the facts once more in the terms of anatomy. But after all in the same way we rely on the nervous connections, if a thought makes us blush and ultimately if our will moves our arm or if our ideas move our speech apparatus. We do not choose the muscles of our arm, we hardly know them; we know still less in speaking, of the movements of our vocal cords, and in blushing of the dilated blood-vessels. That ideas work on the lower centers of our central nervous system, centers which regulate the actions of our muscles and blood-vessels and glands, must simply be accepted as the machinery of our physiological theory. The connection of such theories with purely physical facts is given by the experience that an electrical stimulation of the nerve may have the same influence as ideas. The electric current, too, can regulate the beat of the heart, or contract and dilate the vessels, or reënforce and relax the contraction of the muscles, or strengthen and weaken the functions of the glands.

Nearest to the psychophysical processes stands the bodily symptom of insomnia. There is no doubt possible that the work of the psychotherapist can be very beneficial in producing sleep by suggestion. That autosuggestions for sleep play an important rôle is popularly accepted. Next to the most immediate means such as lying down, or cutting off sense stimuli, or trying not to think, or avoiding movements, certainly the most well known factor is the expectation of sleep with the belief that sleep will come. This belief may be reënforced to strong autosuggestion which may then overcome other factors that hinder sleep. For instance, I have repeatedly received letters from strangers containing expressions of gratitude with news which under other circumstances would at least not flatter an author. They wrote to me that immediately after reading one or another essay of mine on hypnotism, they fell into deep sleep. Yet as they were always patients who had suffered from insomnia, I was pleased with this unintended effect of my writings. But in most cases a real cure demands heterosuggestion.

There is room for any variety of effects; often they enter immediately. The other day I gave sleep suggestion to a young woman who had overworked herself in literary production. For months she had not slept more than three or four hours a night and even that only after taking narcotics. I intentionally did not allow her to come into a hypnotic sleep but kept her fully awake, increasing her suggestibility while her eyes were wide open. I suggested to her to take a walk, then to eat her dinner, and after that to go to bed at once. She went to bed at seven o'clock and slept without waking until ten o'clock the next morning, and after fifteen hours' sleep she was like a different being. A regular eight hour sleep is sometimes secured, even where no immediate direction has been given for it. On the other hand, I cannot deny that I have sometimes been entirely unsuccessful in securing better sleep by the first three hypnotic treatments. When the first three treatments were unsuccessful, I always gave it up on account of lack of time. Yet the experience of others shows that in such cases, often after a long continued hypnotic treatment insomnia yields to suggestion. One of the great factors which work against the mental treatment is the habit of so many sufferers of relying on their sleeping powders which, to be sure, remain effective only by increasing the dose and thus finally by making them dangerous. Every chemical narcotic has in itself suggestive power and strengthens the belief of the sleep-seeker that he cannot find rest without his dose. To overcome the monopoly of the opiates is one of the most important functions of psychotherapy.

It is not surprising that the relations of psychotherapy to sleep show such a great variety. The factors which coöperate in normal sleep are many and the disturbance can have very different character. We had to speak of the psychophysics of sleep when we discussed the theoretical relation of sleep to hypnotism and insisted that it is misleading to consider hypnosis simply as partial sleep. We claimed a fundamental difference between the selective inhibition in hypnotism and the general reduction of functions in sleep. To understand sleep, we have to recognize it as one of the fundamental instincts, comparable with the instinct for food or for sexual satisfaction. Every one of such instincts has a circular character. Mental processes, subcortical processes, and physical effects are involved in such a way that each reënforces the others. The physical effect of the sleep instinct, comparable with the pepsin secretion in the food instinct, or with the hyperæmia of the sexual organs in the sexual instinct, is a change in the cortex by which the sensory and motor brain centers are put out of action. What kind of a change that is, is quite indifferent. It may be a chemical one but more probably it is a circulatory one. Let us say it is a contraction of blood-vessels which by the resulting anæmia makes the sensory centers unfit for perception and the motor centers unfit for action. In this way the brain becomes protected by sleep against the demands of the surroundings. The mental reactions are eliminated and the central nervous substance has an opportunity to build itself up. This protective physical activity is now evidently itself controlled by a subcortical center, just as secretion and sexual hyperæmia are controlled. This center probably lies in the medulla oblongata.

Some theorists, to be sure, are inclined to think that the fatigued brain cells enter directly through their exhaustion into the protective sleep state. But that simplifies the situation too much. It is quite true, as these theorists claim, that monotonous stimulation of the senses produces sleep. But it is evident that the sleep occurs even then not only in the particular overtired brain cells. A monotonous stimulation of the acoustical center raises the threshold of perception for all the senses and brings sleep to the whole brain. This control of the whole apparatus is thus surely regulated by one definite center. But this lower center, which controls the anæmia of the cortex, is itself directly dependent again upon a mental condition, the mental experience of fatigue. The fatigue sensation, which is possibly the result of toxic processes, works on that lower sleep center, just as the appetizing impression or the sensual images work on the centers of the other two instincts. On the other hand this protective blood-vessel contraction creates again as in the other cases a characteristic organic sensation, the sensation of rest which arises when the threshold of perception and activity is raised. The world begins to appear dim and far away, no impulse for action excites us. This organic feeling of rest associates itself with the fatigue feeling. The fatigue sensation, the subcortical sleep center, the contraction of the vessels in the cortex, and finally the rest sensation form together the complete circle. The difficulty which arises in this case lies only in the fact that the cortex gone to sleep annihilates also, of course, the fatigue sensation and the rest sensation. For that reason the real circle can appear only in the preparatory stages of sleep. As soon as sleep itself sets in, the circle is broken. The circle character of every instinct must lead the physical effect upward to a higher and higher degree. Not to become excessive, the physical effect must be checked somehow. In all other spheres, it finds its end in satisfaction, for instance, by eating or by the sexual act. In sleep the circular process ends automatically by its own effect as soon as complete sleep is reached. Its causes, the fatigue and the rest feeling, are stopped, as soon as the effect, the anæmia, is secured.

We see now how widely different starting points can lead to sleep and can understand from it how widely different disturbances can prevent sleep. Sleep must result when fatigue