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

It cannot be denied that the Christian church takes in hand there once more a work which belonged to it through centuries. But they were centuries in which the priest was in a certain degree the physician, just as he was the educator and teacher, simply because in the church there was centered all cultural influences which the community knew. The complexity of modern times has for centuries demanded the opposite system. Centralization is allowed only to the purely administrative influence of the state, while all the active functions are divided among specialists. We rely on the expert in education, we demand the expert in medicine: is more gained or lost if the religious leader now again suddenly undertakes a part of the functions which belong to the physician? It is true that the ministers of this school do not propose to undertake the physician's work to its full extent. They leave to him the first and in some respects most important step, the diagnosis, and abstain from the treatment of such cases as the physician declares inaccessible to psychical influences. They do not heal cancer and phthisis like the Emmanuel Movement in England or like the mental healers in America.

But is not perhaps just this compromise dangerous in another direction, inasmuch as it awakens a feeling of safety in those who feel in sympathy with scientific medicine? They have passed the hand of the physician and believe accordingly that because their illness is recognized as functional, the minister can really perform all that ought to be done. Is this belief justified? At the threshold, it occurs to every one that such a diagnosis by physicians may be erroneous and that the chances for such error are under the conditions of the church clinic much greater than under the conditions of a regular medical treatment. The diagnostician who treats the patient himself has ever new chances to remodel his diagnosis and to correct it under the influence of therapeutic effects. The danger is great that under the proposed conditions, the activity of the physician will be superficial, because he is deprived of his chief means, the constant observation. But we may abstract from this possibility of error. Does the fact that the disease is one the symptoms of which may yield to psychical treatment really make it advisable that the further treatment be handed over to the clergyman? To begin at the beginning, the usefulness of psychical treatment does not at all exclude the strong desirability of physical treatment at the same time. The emphasis which is laid on religious persuasion and inspiration, on prayer and spiritual uplift practically excludes the use of baths and douches, of massage and electricity, of tonics and sedatives. And yet it is not caprice or sham when every well-schooled medical specialist applies such means in the treatment of these so-called functional diseases of the nervous system. The minister applies and can apply only one of many possible methods for cure and yet, if we really want to make use of the resources of modern knowledge, we have to adapt most carefully all possible means to the individual case. If we take the strictly religious standpoint the situation is of course different, but if we speak of psychophysiological effects, we may acknowledge the healing influence of prayer and yet rely in the special case still more on bromide or strychnine. Yet the religious psychotherapists not only neglect the physical help but usually emphasize the antagonism. Some of the strongest supporters proclaim it as a non-drug healing, thus deciding adversely about a medical method regarding which they have no means at all to judge.

Parallel to this neglect of physical theory goes, of course, the neglect of the physical factors in the disease. The physician may have justly diagnosed that the case is "merely" neurasthenia or hysteria and not a brain tumor or paralysis of the brain. Yet that does not mean in the least that a real treatment which remains in harmony with the progress of modern medicine ought to ignore the hundred physical elements which enter daily into the disease. There are the most complex digestive problems involved which demand a thorough understanding of chemical metabolism, there are still more complex problems of the sexual organs which the minister certainly ought not to discuss with his female parishioners, there are bacteriological questions, there are questions of the peripheral nervous system and sense organs; in short, questions which belong to a world into which the minister as minister has never looked. Even if he believes he might gather in an amateurish way some information as to those questions which lie so far from his experience as student of divinity, how can his half-baked knowledge compare with the experienced study of the regular physician? Such physical questions cannot be settled by the preparatory examination of the physician; they come up every day during the treatment and what the spiritual diet which the minister offers may help, may at the same time be ruined by the physical diet about which the minister without chemistry cannot judge.

But let us abstract from the bodily aspect. Is the situation really very different for the mental one? The appeal to the religious emotion, the reënforcement of religious faith is from the religious point of view certainly the one central effort from which everything has to irradiate. The unity of this controlling thought is the glory of such inspiration. But as soon as we handle this thought as a psychotherapeutic remedy, destined to restitute the disturbed psychological equilibrium, it becomes evident that the very uniformity of it makes it a clumsy, inadjustable pattern. If there is anything which impresses the careful student of psychology, it is the over-rich manifoldness, the complexity of mental life. Even the simplest content of consciousness is a tissue woven from millions of threads and any stereotyped influence means crudeness and destruction. The minister's attitude towards inner life is there directly opposite to that of the psychologist. He cannot enter into those endless interplays of associations and memories, or inhibitions and sensations and impulses, he cannot examine from which remote psychological sources those ideas have arisen, how the feelings become disturbed and the judgments sidetracked. He should not analyze even if he could, because his whole aim is to synthesize. He asks for the meaning and not for the structure, for the aims and not for the elements. His therapeutic effort is therefore not even directed towards a careful rebuilding of the injured parts of the mind, but it is nothing more than a general stimulation to the mind to help itself. By touching on one of the deepest emotional layers of the mind, the layer of religious ideas, the minister gives to the soul an intense shock and expects that in the resulting perturbation, everything will be shaken and may then settle itself by its own energies in a healthful way. It is a fact that that can sometimes happen and under certain conditions the chances for it are even favorable. Under many other conditions the chances are unfavorable and the result does not happen at all.

But whether or not a cure results, in any case it is certainly not an effort which can be said to be in harmony with modern science. The idea of science is always to understand the complex from its elements and to restore the disturbed complex object by recognizing the disturbances in the elements and by bringing those disturbed elements into right shape again. Certainly the psychologist, too, in examining carefully the injured mental mechanism may discover emotional injuries which might be cured by the introduction of religious ideas, but he will not give to them a value different from the introduction of any other ideas and emotions, for instance, those of art and music and poetry, those of social company or civic interest, of travel or sport or politics. Each may have its particular value and to cure every mind with religious emotion would be from a psychological point of view as one-sided as it would be to cure every disturbed stomach by milk alone. Moreover in very frequent cases, for instance, of neurasthenia or hysteria or psychasthenia, such wholesale remedies can form only the background of the treatment, but all the details have to be furnished with reference to a most subtle analysis of the special symptoms, and a particular organic symptom or a particular memory idea or a special inhibition by a well-selected counter-idea will do much more than any great emotional revival.

Stereotyped religious appeal is not only insufficient in an abundance of cases—it must never be forgotten that those who nowadays go to the minister for their health are already selected cases more open to religious suggestion than the average—but can easily be decidedly harmful. Of course that holds true for every physical remedy too, and the judgment of the exact limit is one of the chief duties of the physician. It holds also for the other mental factors like sympathy. A certain amount of sympathy may save a neurasthenic from despair, and only a little more may make his disease much worse and may develop in him a consciousness of misery which makes him a complete invalid. Still more is it true for the religious emotion, from the standpoint of nervous physiology the strongest next to the sexual emotion, that it can be the healing drug or the destructive poison. Everything depends upon the degree of the intrusion and upon the resistance of the psychophysical system. From a purposive point of view there cannot be faith enough, from a causal point of view there can easily be too much of the faith emotion. Religious fervor has at all times helped to create hysteria and to develop psychasthenias. It cannot be otherwise. A group of ideas which has such tremendous power over man must easily be able to produce inhibitions and exertions which become dangerous to a nervous system the constitution of which is pathological. To leave such a dangerous and powerful remedy entirely in the hands of men who by their profession must aim towards a maximum dose of religious influence can certainly not be in the interests of the patients or of the community.

Even the whole technique of this movement awakens the fear of possible harmful consequences. On the one hand we have the movement itself as a popular suggestion for the suggestible masses. The patient who seeks the help of a scientific neurologist hardly becomes a center of psychical contagion, but the church services for the sick offer favorable conditions for an epidemic development of hysterical symptoms. But more important are the influences on the individual patient. The whole purpose of the treatment demands the highest possible degree of suggestibility brought about by the ministerial persuasion. But it is evident that this degree of suggestibility means at the same time the most fertile soil for every chance suggestion and for influences which are perhaps entirely unintended. The physician and the psychologist, considering the mental state with reference