George W 1856-1940 Jacoby.

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in so doing give the surest proof of his own incapa-
bility. He should know that sceptics and persons
of critical discernment will be entirely refractory
to certain ideas, which would be accepted unques-
tioningly by children, by the uneducated, and by
devout believers.

The treatment of hysterical women is often most
diflScult. As we have seen, the psychotherapist
must combat the disorders of his patients from
within the circle of their own ideas. Man, how-
ever, is but rarely able to comprehend the mental
life of woman, which is so different from his own;
when confronted with the labyrinth of female



THE PERSONALITY OF THE PATIENT 281

emotions his wisdom soon fades away. For that
reason the psychic treatment of female hysterics
often is attended by failure when, a priori, success
would be expected.

May these few examples suffice to show how im-
portant for the success of psychotherapy is the
personality of the patient, as well as the ability of
the physician to place himself within the circle of
the patient's mental life. No suggestion can be
effective if it be not adapted to the powers of com-
prehension of the patient, if it be not linked to the
chain of the patient's ideas. Individualization is
the shoal on which the art of many an otherwise
experienced physician suffers shipwreck.



11. SPECIAL APPLICATION OF
PSYCHOTHERAPY

A, The Most Important Methods

The methods of cure employed by the mystics
having been amply characterized as being in part
delusive, in part wilful imposture, we are relieved
from any further discussion concerning them.
Here we will limit ourselves to an explanation of
those methods of psychotherapy which have a
recognized scientific basis. In so doing a dis-
tinction must be made between preventive and
curative treatment

1. MENTAL THERAPEUTICS
Psychotherapy makes use of suggestion above
all else, — that is to say, it annuls functional dis-
orders and symptoms based on fallacious ideas by
arousing opposing ideas, the effectiveness of which
is dependent on the individuaFs inherent disposi-
tion for psychic influence. Whether hypnosis
should be employed to augment that suscepti-
bility to suggestion can be determined only by the

282 .



THE MOST IMPORTANT METHODS 283

conditions in each individual instance. Although
the opinion that every hypnosis constitutes an arti-
ficially produced hysteria is one which we do not
share, the fact remains that the hypnotic state cer-
tainly is a pathological one. If for no other reason
than that, hypnosis, as an aid to suggestion, should
be employed only when the inefficacy of all other
means has been demonstrated. The number of
such instances will be found extremely small by
the psychotherapist who is as authoritative and as
conversant with his specialty as he should be. In *
all cases, too, due weight should be given to the
fact that the active curative agent is never the
hypnosis, but always the suggestion which is im-
planted during the hypnotic state.

Catharsis, another psychotherapeutic method,
differing from suggestion treatment, has gained
recognition during the last few years. The aim
of treatment by suggestion is essentially an aboli-
tion of disordered ideas, the determination of their
cause being considered of little importance. The
newer method, however, endeavors primarily to
trace the disordered ideas to their source by means
of psycho-analysis. The question asked in apply-
ing suggestion treatment is, " How can the obsess-



284 PSYCHOTHERAPY

ing ideas which weigh upon the mind be annulled V*
The first question to be asked under the psycho-
analytic method, however, is, "How have these
obsessions arisen?"

Aristotle regarded the Greek educational idea
of catharsis, that is, the purging of the mind of
inharmonious and disordered emotions, as the main
end of the fine arts, and in particular assigned to
the drama the catharsis of pity and terror as its
chief function. The sound basis for this doctrine
of thus disburdening the mind is made plain by the
common experience of relief obtained by giving
vent to excitement, and of distress which is caused
by forced repression of harrowing emotions.

The psycho-analytic method assumes the func-
tional disorders of hysterics and neurasthenics or
psychasthenics to be attributable in great part to
some marked emotional stress, frequently one of
early childhood which was repressed at the time
it arose and could not be thrown off afterward.
The original stress may be forgotten but the mor-
bid feelings and the bodily disorders which they
cause continue to persist. Psycho-analysis aims
to recall to mind the causative emotional excitation
and, by exciting the patient to a confession, to



THE MOST IMPORTANT METHODS 285

give him an opportunity to free himself and thus
to obtain that relief which we know always ac-
companies all unhampered expression of thought.
The repressed emotions having been discharged,
the patient's mind having been unburdened, all
symptoms resulting from the repression pass away.

The method of treatment by psycho-analysis re-
ceived much attention from Sigmund Freud, whose
name we have mentioned in the chapter on dreams.
Breuer, how^ever, and not Freud, is the originator
of this cathartic method, which has met with much
just criticism but which contains so much of in-
terest that we cannot refrain from giving more
details concerning it.

A female patient in a state of mental aberration
was observed by Breuer to be muttering words
which apparently were fragments of a subcon-
scious train of thought. This patient was hyp-
notized, and the words which she had spoken were
recited by Breuer. Little by little, through thought
association, he was able to revive in her distressing
recollections of childhood which seemed to have
passed from her waking consciousness. When a
number of such recollections had been revived and
expressed, she appeared relieved and restored to a



286 PSYCHOTHERAPY

normal mental state; after a time her feeling of
relief was supplanted by another aberration, which
was removed in the same way. Only after the
patient had given vent to all her distressing remi-
niscences was complete and permanent cure at-
tained. While thus treating this patient, Breuer
learned in a disconnected way of severe emotional
excitement which had occurred years before and
which she had been obliged to repress in considera-
tion of her father's fatal illness. Nearly all the symp-
toms of her subsequent sickness represented, as it
were, a sediment of those distressing experiences, a
consequence of the stimulus produced through those
emotions, which, having merely been repressed, had
lain dormant in her subconsciousness during all that
time. The undischarged emotions continued to
persist in part as a permanent taint of mental life
and a source of apprehensive unrest, and in part
had been transformed into expressional movements,
which in this case constituted the symptoms of
disease. At one time, when a glass of water was
offered to her after she had complained of thirst, she
gave vent to an expression of repugnance and re-
fused to drink, but she did not volunteer an ex-
planation for her strange behavior. Later, in



THE MOST IMPORTANT METHODS 287

hypnosis, she said she once had seen a dog drink
from a glass, but through consideration for the
animaFs owner she was obliged to repress her
feeling of disgust. A noteworthy point in the his-
tory of this case is the circumstance that a feeling
of relief followed the hypnotic disclosures only when
they were accompanied by outward evidences of
emotion, while the revival in consciousness of a
distressing experience, when unaccompanied by
such disburdenment, left all the symptoms of dis-
ease unaltered; the repressed and pent-up emotions,
in fact, remained as a source of suffering until at
some opportune moment they found an oudet
through an " explosion " of more or less intensity.

This case corroborates the statement previously
made that a train of thought brought to light
through hypnosis consists essentially of memory
images, and not of new ideas suddenly acquired in
some mysterious manner. The memory pictures
remain in subconscious abeyance simply because the
subservient thought associations are not stimulated.
As we have seen, one word or another, used at the
proper moment, will suffice, by means of stimula-
tion of association fibres, to arouse the latent im-
ages to full activity. Complete loss of remembrance



288 PSYCHOTHERAPY

can take place only where association fibres have
been disconnected or where the nerve elements in
which the memory pictures were stored have been
destroyed.

Breuer's method of cure through catharsis, the
production of a discharge of the pent-up emotions
which were the original cause of the existing trouble,
has been not only elaborated, but also, in so far as
he rejects the use of hypnosis, modified by Freud.
The latter obtains concentration of the patient's
thoughts upon his inner life through exclusion of
all distracting sensory stimuli. Then, laying his
hand on the patient's forehead, he asks him to
search for memories apparently lost, and perhaps
reaching back into early childhood. He does not
regard it as necessary to use hypnosis to eliminate
resistance on the part of the patient, but considers
it suflScient to assure him positively that he will
remember. These memory explorations are aided
by Freud through employment of the association
law, by mentioning or writing certain words and
requesting the patient to mention other words
directly related. For instance, the word "ship,"
through thought association, leads to the words
"water," "harbor," "sea-sickness," etc. The re-



THE MOST IMPORTANT METHODS 289

sponse is unhesitating and quick where inconse-
quential matters are concerned. A deUberate,
carefully studied answer shows that a sore point,
one which the patient tends to cover, has been
touched. To overcome such resistance and hesi-
tancy requires much tact and ability on the part of
the investigator, and success can be attained only
where the full confidence of the patient has been
won.

The psychotherapist's task is made still more
difficult through Freud's assumption that all symp-
toms of hysteria have their inception in the sexual
sphere — more particularly in unrequited love or in
unsatisfied erotic desires. Among the cases de-
scribed by Freud is the following:

A cultured, elderly unmarried woman presented
all symptoms of severe hysteria. Through psycho-
analysis there was obtained, little by little, a con-
fession that she had loved a man who subsequently
married her sister. At the sister's death, which
soon followed, a desire forced itself upon her that
her brother-in-law, now free, would marry her.
This wish, unworthy of her moral thought and
training, was forcibly repressed. The result of
this repression was a manifestation of hysterical



290 PSYCHOTHERAPY

symptoms which represented, as it were, a bodily
equivalent of the undischarged psychic injury that
continued to persist long after the primary emotional
excitement had faded away.

In another case, also involving an elderly spin-
ster, the patient accused herself of crimes of all
sorts whenever similar happenings were the topics
of conversation or newspaper notices. As a result
of careful interrogation, Freud ascertained that
these obsessions had arisen in consequence of
sexual aberrations which followed a disappoint-
ment in love. Both those patients recovered
through the use of catharsis.

We are quite ready to believe Freud's statement
that, owing to the delicate nature of the emotions
which originally gave rise to the hysterical symp-
toms in those cases, a confession could be obtained
only with great difficulty, but we are not so willing
to adopt his generalization that the more pronounced
the primary repugnance to confession may be in
consequence of modesty, the greater will be the
subsequent disburdenment and the more complete
the recovery.

As we have seen, the course pursued in psycho-
analytic treatment is quite different from that



THE MOST IMPORTANT METHODS 291

followed in suggestion therapeutics. The latter,
Freud says, has given him not one permanent suc-
cess, and he adds that symptoms only have been
temporarily obscured thereby. We can easily un-
derstand the astonishment of Breuer and Freud
following their discovery that symptoms of disease
disappear permanently as soon as those painful
experiences which have given rise to bodily dis-
orders are recalled to the patient's mind and the
patient has been induced to give vent to the emo-
tional processes originally repressed.

Whether suggestion therapy, the aim of which is
to combat hysterical and neurasthenic obsessions
by arousing healthy antagonistic ideas, has met a
rival in this therapeutic method of psycho-analysis
must remain a mooted question, in regard to which
the unprejudiced critic cannot but have serious
and warranted doubts. In our opinion the very
basis on w^hich this method is founded, the explana-
tion given by the authors for the origin of hysteria,
is unsatisfactory. Every one at some time or other
is obliged forcibly to repress certain emotions and
to prevent them from becoming manifest. That,
in persons of strong will power, accustomed to self-
discipline, will cause no ill effect, but where persons



292 PSYCHOTHERAPY

become hysterical as a result of such repression it
is a sign that they already have had an unstable
nervous system and would have developed hysteria
not only in consequence of disappointment in love
and unsatisfied erotic wants, but quite as easily
from any other emotional disturbance. There-
fore, distressing experiences of a sexual character
must not be looked on as the sole factor in the
production of hysteria, particularly because, as
Dercum very correctly maintains, hysteria is en-
countered in very young children and in very old
people, in whom there can be no question of sexual
aberrations.

Freud undoubtedly has overestimated the sig-
nificance of distressing erotic experiences in the
production of hysteria. While one person will
undergo such experiences and remain healthy,
another who does not have them will become a
hysteric after fright or any other psychic shock,
essentially in consequence of his lowered powers of
nerve resistance. Freud was misled into unwar-
ranted generalizations by the accidental discovery
through psycho-analysis of the existence of a sexual
causative factor in the hysteria of many of his
patients. The errors into which he has fallen are



THE MOST IMPORTANT METHODS 293

quite manifest, and there can be no doubt that in
many of his patients he has, through the questions
asked during his memory explorations, suggested
matters which previously had been foreign to the
patient's mental processes. Thus one woman, hav-
ing confessed to Freud certain sexual errors of youth,
subsequently admitted to Loewenfeld that those
excesses never had taken place. There can be no
doubt that the mode of applying this method is one
which will easily convey suggestions to the patient
though they are unintended by the physician.
This fact would also explain the uniformity of re-
sults which Freud and his school are obtaining.

Emotional shocks sufficiently violent to produce
hysteria usually are graven deeply upon the memory,
and hardly ever are forgotten to such an extent
that they can be resurrected from subconsciousness
only by means of an arduous psycho-analytic pro-
cedure. With that statement, however, we do not
by any means deny the possibility of a disappear-
ance from memory of an emotional occurrence
while the secondary bodily disorder caused by it
continues to persist. It is also very possible the
patient may always retain consciousness of the dis-
turbing experiences through which he has passed.



294 PSYCHOTHERAPY

but carefully conceals them. Such persons merely
refrain from acknowledging what they think would
lower them in another's estimation. Were this not
so, we could not understand why they do not bring
about catharsis through confession without the aid
of a physician and thus rid themselves of their
distress.

A final argument against the practicability of the
psycho-analytic method of treatment is the amount
of time which its exercise requires. The length of
each single sitting necessarily is great, for nothing
can be done until the patient has attained proper
emotional composure, has overcome any existing
depression or confusion, and manifests the neces-
sary interest in the interview; even then he unfolds
reminiscences of painful nature only piecemeal, so
that, as Freud himself- says, three years may pass
before a complete recovery is established. That
psycho-analysis, under such conditions, should sup-
plant suggestion as a therapeutic method seems
hardly credible, and that the newer method will in
course of time be modified and made more prac-
ticable seems doubtful.

Mention must be made here of the fact that
Freud believes dreams to have a certain influence



THE MOST IMPORTANT METHODS 295

upon the production of functional nervous disorders.
For this reason he endeavors by means of psycho-
analysis to recall to memory the dream experience
which has been dislodged into co-consciousness and
to incite the patient to free expression of words.
As Dercum very justly remarks, the same grounds
upon which psycho-analysis has been opposed are
applicable to dream analysis and to the role of a
psychotherapeutic factor which is attributed to it
by Freud. Although justification is wanting for
attributing the causation of functional nervous dis-
orders to dream experiences, unless perhaps it be
those dream experiences which are the product of
an already diseased nervous system, Freud again
falls into an error in considering all dream experi-
ence without exception to relate to erotic matters.
Certainly this view is often correct, especially in
relation to young people, but Freud's generaliza-
tion assuredly is no more than a gross exaggeration.
Furthermore, as we have already seen, the psycho-
analytic method also will suggest dream experi-
ences which actually have never taken place and
consequently could not have been the cause of the
functional nervous disorder that exists.

A third psychotherapeutic method consists in the



296 PSYCHOTHERAPY

proper apportionment of mental rest and exercise.
Inasmuch, however, as the word "rest" indicates
a cessation of activity, which cannot be attained
during the waking state, the word "relaxation"
seems better to convey the meaning we have in mind.

Mental relaxation and exercise comprise not only
direct suggestive influence, but also those factors
which usually are termed educational. The neces-
sity for relaxation and exercise is proved by the
fact that the functional capability of every organ
suffers through inactivity as much as through over-
activity. An organ wastes away when it is not
called into action at all, just as surely as it wastes
away when excessive demands are made on it.
Moreover, this applies quite as much to the brain,
the organ of the mind, as it does to the muscles
and the other organs of the body.

By relaxation of an organ is meant the relieving
of that organ, so far as possible, of the part which
it takes in the operations of the general organism,
and the facilitation of those activities of which it
cannot be relieved. We therefore endeavor to put
the entire body in a state which will make as few
demands as possible on the affected organ, and that
only under conditions as favorable to that organ as



THE MOST IMPORTANT METHODS 297

they can be made. By exercise, on the other hand,
we understand all those means which will cause an
organ to accomplish more than it has previously,
the increased activity, however, not being the result
of a single output of energy due to strong stimuli,
but an evidence of permanently augmented effec-
tiveness. In that permanent effectiveness lies the
difference between increased activity due to stimu-
lation and that caused by exercise or training. A
sharp dividing line does not exist, since stimulation
of an organ naturally will cause an exercise of func-
tion. Different individuals react differently to the
same kind of stimulation; the stimulus which is
physiological for one person may be pathological
for another. All exercise produces fatigue and
thus necessitates recuperation. When recuperation
takes place in a perfect manner, the organ exerted
has become slightly more capable than it was at
first; but if recuperation has been inadequate, the
organ has been weakened, and not strengthened,
through the exertion. To find the happy mean,
to regulate exercise according to individual re-
quirements, is a task which the physician can ac-
complish only if he has the proper appreciation of
the patient's varying powers of adjustment.



298 PSYCHOTHERAPY

Application of the principles which govern re-
laxation and exercise of those bodily organs whose
healthy functioning produces healthy mental action
must be regulated by regard for the intimate con-
nections which exist between brain, spinal cord, and
peripheral nerves. Not one of these can be treated
individually. Relaxation and exercise of the brain
react upon the rest of the nervous system, just as
relaxation and exercise of spinal centres and per-
ipheral nerves react upon the brain. This inter-
action of the various parts of the nervous system
takes place, as we have seen in the paragraph on
reflex excitability, according to well-defined laws.
It is true this has been proved with certainty only
in relation to the transmission of sensory stimuli
to motor nerves, but enough observations indica-
ting interaction between the central and peripheral
parts of the nervous system exist to warrant fully
the conclusion that action on one part of the ner-
vous system influences the entire system. The at-
tempt artificially to divide the nervous system into
brain, spinal cord, and peripheral nerves for the
purpose of treating a single part, the functional
disturbance of which for the time being dominates
the entire clinical picture of disease without acting



THE MOST IMPORTANT METHODS 299

on other parts, is therefore inadmissible, because
practically it cannot be a success.

In a book on psychotherapy stress naturally must
be laid on psychic treatment, and the supporting
curative factors can only be considered incidentally.
That restriction should be kept in mind in the read-
ing of the following paragraphs.

As stated, relaxation does not mean rest, for
complete rest and inactivity of the nervous system
is impossible; a certain activity is a vital condition
of the organism. An especially important form of
relaxation is sleep. This, as Hoffmann pertinently
says, is the form of relaxation which nature itself
demands, and by means of which the brain always
becomes rejuvenated. Sleep is of more importance
than food. We may do without nourishment for
weeks, but only a few days of sleeplessness will
lead to exhaustion. Numerous experiments, es-
pecially those made on young dogs, have proven
this to be a fact. Sleeplessness, as is well known,
is one of the most common and most distressing
symptoms of many diseases. It may be shown by
statistics that many suicides and attempted suicides
are the result of sleeplessness, together with the
exhaustion which accompanies it.



300 PSYCHOTHERAPY

Depth and fastness of sleep may be demonstrated
graphically. Following Fechner's proposal to take
the intensity of the sensory stimulus required to
awaken a person as the gauge of intensity of that
person's sleep, Kohlschiitter has devised a means
through which the sound impressions used for such
an awakening are registered in the form of a curve
upon a plate. The sound is produced by a pen-
dulum striking with varying force on a plate,
causing tones of corresponding intensity. These
experiments of Kohlschiitter permit us to recognize
a typical "neurasthenic curve" which shows that
neurasthenics often awaken too early in the morn-
ing — in other words, their sleep is interrupted by
the slightest sound and they are refreshed for the
duties of the coming day only when they obtain a
second period of sleep.

A conscientious physician will not combat sleep-
lessness by the mere administration of narcotics,
which always have more or less deleterious asso-
ciated action, but will endeavor to ascertain the
causes of the insomnia and, if possible, to remove
them. Those causes, when functional in character,


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Online LibraryGeorge W 1856-1940 JacobySuggestion and psychotherapy → online text (page 15 of 18)