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

A physician had acquired the habit of using and misusing cocaine for the treatment of a disease of his nose. The habit grew to a craving for cocaine while the cocaine itself poisoned the brain. Acoustical hallucinations began; he heard voices from every corner of the room, and on the street the voices took persecutory character. He connected them with his brother living in Europe, heard his voice in the denunciations, and developed a pathological system of ideas around the central thought that his brother had a telepathic influence on him. His reason succumbed, he lost all consciousness of delusion, and believed himself really to be under the control of the absent brother. When he came to me he had been without sleep and without food for several days, and he was not seeking my help to get rid of the mental disturbance but to overcome the power of his older brother. He did not connect the fear at all with his misuse of cocaine. When I discovered the rôle which the cocaine played, I determined to try the suggestive influence, the more as I found that he was in a half-hypnotic state as soon as he had entered my room. I suggested to him to sleep and to take food and to reduce the cocaine dose by a fourth. The next day he was an entirely different man by the effect of ten hours' sleep and a large breakfast. Now I concentrated my efforts on the reduction of the cocaine. After ten days of hypnotic treatment he gave up cocaine entirely, after three weeks the voices disappeared and slowly the other symptoms faded away. The pathological idea of the telepathic influence lasted a while after the voices had gone until this idea, too, yielded to suggestion. It still took six weeks before he himself felt that he was entirely normal.

The way in which the average physician nowadays neglects the simple tool of suggestive treatment, when it can be used for the protection of society, is perhaps nowhere so reckless as in the case of the morphinist and cocainist. To give a typical case of this neglect I may mention that of a highly intelligent young man who had been in the habit of using both cocaine and morphine for ten years when at his own request he was sent to a New York hospital. He had been taking alternately morphine for a year or two, then cocaine for a year or two, and had sometimes alternated and sometimes combined both in an irregular way. When he entered the hospital in May, 1908, he was in a cocaine period and was taking the enormous dose of one hundred and eighty grains of cocaine every day. In the hospital they withdrew the drug altogether. During the first weeks, he was entirely sleepless. They energetically refused him any substitutes and after six weeks he began to feel comfortable. He gained steadily in weight and after three months, when he left, he had gained fifty pounds, felt entirely comfortable, and seemed in all respects normal again. Before twelve hours had passed after leaving the hospital, he had again taken thirty grains of cocaine and ten grains of morphine, and this dose rapidly grew until after a few weeks it again reached a hundred grains of cocaine and up to sixty grains of morphine a day. Then came the complete breakdown. If that man in the last two or three weeks of the hospital treatment, when he felt entirely comfortable and normal and had gained his normal weight, had received even a slight suggestive treatment suppressing any desire for cocaine or morphine, he would easily have been saved. To let such a man after a drug career of ten years go out again to the places of his old associations, where the desire had to be stirred up, is inexcusable at a time when psychotherapeutics has won its triumphs in this field. It might have been sufficient to give him preventive treatment at least for the first three days of his freedom. And such a case is typical of hundreds.

The overstrong impulse and overstrong desire finds its counterpart in the abnormal lack of energy and lack of attention. The patient—and it is especially the neurasthenic patient—has lost his usual strength, he shrinks from every undertaking, he cannot decide upon any action, he needs a disproportionate effort for the smallest task, and cannot concentrate his attention in spite of his best will. The varieties of this lack of power and inertia are familiar to every physician. They certainly often need much more than merely psychotherapeutic treatment, although on the physical side no schematic method is admissible. The laziness of the anæmic needs a different treatment from the laziness of the exhausted but in every case psychological factors can be of decisive influence, whatever the physical and chemical treatment besides them may be. A few letters may again illustrate the varieties. Here again there is no sharp demarcation line between the normal and the abnormal. Letters like the two following, for instance, are hardly letters of patients. They show a variation which is still entirely within normal limits and yet a source of suffering; it is a disturbance which usually can be removed by psychotherapeutic means.