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

obsession is thus to a high degree open, and that is certainly a discouraging feature. Yet we have seen sufficiently that as soon as the symptoms are removed, there is no lack of means, also by psychotherapy, to prevent the recurrence. Moreover, to remove the present symptoms is in any case a great gain and in many cases a decisive gain. And whatever can be secured by such methods is of such a character that hardly any other method could have been substituted. It can be said with certainty that hundreds of thousands leave the offices of their doctors every year without relief where relief could be secured by psychotherapeutic means.

To be sure, one reply of the physicians is not infrequent and carries some weight. Psychotherapeutic methods demand much time and patience and skill. To relieve a cocainist of his desire by mere suggestion may demand an assiduity which the average physician simply cannot afford; and nothing requires more time than a real use of Freud's psychoanalytic method. Hours and hours of conversation about the most trivial occurrences have to be spent to relieve the repressed ideas and to give them a chance for a free ascension. It cannot be denied that most of the really illuminating work in all these fields has been done by scholars who combine a strong theoretical interest with their effort to cure the patients, and who therefore examine and treat the individual case primarily from the wish to get new insight into the laws of nature. The average physician whose time is his income may be the less willing to enter into such time-devouring schemes, as the patients too easily may think that the physician did not do much for them when he simply was sitting down and gossiping with them.

Yet after all, behind all of it stands one motive which has held back the development of psychotherapy in the medical profession more than anything else. The physician feels instinctively that a real success can be reached in every one of these fields, only if he possesses a reasonable amount of knowledge of psychology. He feels that wherever he touches the patient's body, examines his lungs or his heart or his reflexes, that a large background of anatomical knowledge and of general pathology gives meaning to every single observation. But in the field of mental abnormities, in the whole world of ideas and emotions and volitions, he simply lacks that background. Everything seems to him without reference to real knowledge. He feels as amateurish as if he were to operate on the abdomen without knowing its anatomy. He is instinctively aware that even the simplest mental life represents a bewildering complexity and that to stimulate ideas or feelings or to suppress emotions, to inhibit volitions, must demand always a most subtle disentanglement of the most widely different components. He abstains from approaching that ground at all rather than to blunder by his ignorance of psychology. And after all, he is right. But is he right in allowing that ignorance? Can the medical profession afford to send into the world every year thousands of young doctors who are unable to use some of the most effective tools of modern medicine, and tools which do not belong to the specialist but just to the average practitioner, simply because they have not learned any psychology?

Indeed the times seem ripe for a systematic introduction of psychological studies into every regular medical course. It is not a question of mental research in the psychological laboratory where advanced work is carried on, but a solid foundation in empirical psychology can be demanded of everyone. He ought to have as much psychology as he has physiology. Moreover the psychological study ought not to be confined to the normal mental life. Again we do not speak of psychiatry. What is needed is abnormal psychology, entirely independent of the therapeutic interests of the alienist. The mental variations within the limits of normal life and the borderland cases ought to be studied there as well as the complete derangements. The ideal demand would be that the future physician should spend at least a year of his undergraduate time on empirical psychology, especially on experimental and physiological psychology. He would take perhaps half a year's lecture course on the whole field of psychology as covered in the English language by the well-known text-books of James, Wundt, Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus, Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the course ought to be either advanced psychology entering into the more complex phenomena or a practical training course in elementary laboratory psychology as indicated for instance by Titchener's "Experimental Psychology. A Manual of Laboratory Practice." If the undergraduate can possibly afford the time in his college course, he ought to add courses which either lead him towards the philosophical problems of psychology or towards the comparative aspect of psychology. If he can find time for a year of post-graduate work between college and medical school, he could hardly spend it more profitably than by a year of research in a well-conducted psychological laboratory to become really acquainted with an independent analysis of mental states. On the other hand in the medical school, room must be found for a course in abnormal psychology, which of course presupposes a thorough knowledge of normal psychology and, if possible, follows the courses on nervous diseases and precedes the course on psychiatry.

For the average future physician, it would be wiser to omit even the psychiatry studies than those in abnormal psychology. The latter ought to lead him far enough to discriminate early between a mere neurasthenia, for instance, and a beginning of insanity. As soon as the discrimination is perfected and insanity is found, he has to give the case out of his care anyhow and hand it over to the specialist and to the asylum. The knowledge of psychiatric treatment is, therefore, not essential for the average practitioner. But no one can relieve him from the responsibility for those borderland cases, for the hysterias and psychasthenias and neurasthenias, and he can never master them without normal and abnormal psychology. Moreover it must not be forgotten that mental factors may enter into every disease. The psychology of pain, for instance, and of comfort feeling, the psychology of hunger and thirst, of nausea and dizziness, the psychology of the sexual feelings, the psychology of hope and fear, of confidence and discouragement, of laziness and energy, of sincerity and cunningness play their rôle in almost every sick room. And if the physician haughtily declares that he does not care for the methods of suggestion, it might justly be asked whether he can be a physician at all if he does not apply some suggestions; yes, if his very entrance into the sick room does not suggest relief and improvement from the start. The introduction of a serious study of psychology is the most immediate need of the medical curriculum. Instructorships in abnormal psychology must be created in every medical school; institutes for psychotherapy should soon follow. But in all this, there is nowhere to appear any artificial antithesis between mind and body, any more than between organic and functional diseases; we have discussed all that with full detail. Only the physician who has a thorough psychological preparation can fulfill the manifold demands which modern life must raise; he alone is prepared to coöperate with the other factors of the community in the development of a sound and healthful nation, to work towards the hygiene of the nervous system and of the mental life; and to correct the injuries which the perversities of our civilization inflict.

In all that he will not avoid the comradeship of the clergyman. He will, of course, not forget the fundamental difference of attitude between them, he will not forget that the minister seeks for the meaning and values of inner life while he, the physician, has to consider that same inner life from a causal point of view and thus has to work with it as with natural material for the normal functioning of the organism. But the interrelation between them can be intimate in spite of the difference of their standpoints. The minister, to be sure, ought not to consider health as such as the greatest good, but he will not forget that a wholesome devotion to ideals cannot be carried through when the attention is absorbed by the sufferings of the body and the mental powers are debilitated. Only in a sound mind the full ideal meanings of life can be realized. The minister must therefore seek the health of his congregation not because health is the ideal of life but because the true ideals cannot be appreciated by the mental cripple. On the other hand, the physician from his standpoint should in no way feel it his duty to play the amateur minister and to put emphasis on the spiritual uplifting of his patients. But he knows well that not a few of the suggestive influences which are needed for the relief from disease are most effective when an emotional emphasis can be given to the suggestions and that this emphasis is for large numbers most powerfully supplied by the religious emotion. Thus the minister will be a very important assistant to him and the church will most successfully do for many patients what for other patients perhaps travel or music or the theatre, sport or social life, may do.

Just in the relation to the church, the physician will need subtlest discrimination, and he will not forget that while even a strong religious emotion may be without damage for a normal man, it may well be injurious to the unstable brain. But if the physician uses tact and wisdom, he will be surprised to find how often the religious stimulation can indeed be helpful for his purposes and the division of labor demands that this be supplied not by himself but by the minister. He will advise the consulting sufferer to seek the influence of a godly man who awakens in him upbuilding wholesome emotions and volitions. The minister may in this way very well become the assistant of the physician. But whether this coöperation is looked on from the one or from the other point of view, in every case it needs absolute clearness. Nothing is gained and too much is lost if the two functions are carelessly mixed together. It is never the task of the minister to heal a mind and never the task of a physician to uplift a mind. One moves in the purposive sphere, the other in the causal sphere. Their friendship can seriously endure only as long as they remain conscious of the fact that they have two entirely different functions in the service of mankind.

XIV

PSYCHOTHERAPY AND THE COMMUNITYContents

Both the physician and the patient find their place in the community the life interests of which are superior to the interests of the individual. It is an unavoidable question how far from the higher point of view of the social mind the psychotherapeutic efforts should be encouraged or suppressed. Are there any conditions which suggest suspicion of or direct opposition to such curative work?

Of course society has to be sure that no possible misuse and damage are to result from such practice. Fears in that direction have been uttered repeatedly, but from very different standpoints. One which is perhaps most often heard in popular circles results from an entire misunderstanding and deserves hardly any discussion after our detailed study of the processes involved. It is claimed that suggestive power, especially in the form of hypnotization, may be secretly misused to make anyone without his knowledge and against his will a passive instrument of