George W 1856-1940 Jacoby.

Suggestion and psychotherapy online

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will be found mainly to be hyperemia of the brain
due particularly to active and manifold interests,



THE MOST IMPORTANT METHODS 301

disturbing sensory impressions, and a direct ob-
session, the fear of being unable to sleep. In such
cases, too, suggestion, aided perhaps by the exclusion
of all sensory stimuli through plugging the ears and
covering the eyes, is an excellent means for the relief
of sleeplessness and the exhaustion which follows.
Frequently that exhaustion alone furnishes the soil
for the development of neurasthenic disorders.
Besides actual mental disorder, we often find that
overstrain, worry, speculation, domestic troubles,
etc., cause business men, officials in responsible
positions, and physical workers to break down from
exhaustion and render them unable longer to
fulfil, through exercise of will power, the duties
devolving on them.

In such cases mental repose must be brought
about not only through sleep at night, but through
relaxation of the entire nervous system by day.
Even when no symptoms of excitation or paralysis
are present, but when character and emotions alone
seem altered, a certain laxness and diminished en-
ergy exist, weakness of memory manifests itself,
the indication or urgent need for relaxation is given,
and the necessity for complete change from custom-
ary life and activity becomes apparent. Patients



302 PSYCHOTHERAPY

so ajfflicted must have rest; that is the fundamental
requisite for recovery. But they also require diver-
sion, and that can be obtained only in altered
surroundings in which nothing will remind them
of their troubles and worries. The new impres-
sions which they receive act in the form of sugges-
tion therapy on the disturbing obsessions, which
disappear under the influence of brain repose as
soon as exhaustion has been overcome and weak-
ness of will has given way to renewed self-confidence.

This brings us to the question of mental exer-
cise as a therapeutic factor. All in all, it may be
stated as a rule that treatment should begin in
accordance with the principles of relaxation, and
subsequently there should be added exercise in
accordance with the opinion which observation
has justified in regard to the patient's powers of
resistance.

As already mentioned, perimetric examination
furnishes a reliable gauge for estimating the prog-
ress achieved through psychotherapy, for this test
of the visual field permits recognition of the exist-
ing degree of brain fatigue. Under normal con-
ditions the visual field of a rested brain has a cer-
tain defined compass, which becomes restricted in



THE MOST IMPORTANT METHODS 303

proportion to the augmenting of fatigue. The
rapidity with which such restriction takes place,
when compared with the time previously noted as
being required to produce the same result under
similar conditions and like demands on brain
activity, furnishes a measure of the constancy or
inconstancy, the increase or decrease of brain
fatigue. Certainly this graphic method is more
exact than any form of intellectual test.

Mental exercise, not improperly termed brain
gymnastics, will be employed in a different manner
for therapeutic purposes, of course, from that appro-
priate to discipline in health. When our object is
the restoration of patients to former mental capa-
bilities, enforced activity, which might be borne by
a healthy person without detriment, may cause
trouble instead of being helpful. Mental training in
a sick person is much more troublesome than in a
healthy one, and requires a clearer understanding of
the functional disturbances which are apt to occur
in the course of sensory impressions and memory
associations, and in the sphere of the emotions and
the will. Then, too, the pedagogue not medically
trained often errs in enforcing exercise where re-
pose or relaxation should have been advised.



304 PSYCHOTHERAPY

Good and quick results are sought in order to
show starding progress, but the reverse is attained.
Exercise and relaxation must go hand in hand with
correct judgment. Even the physician can de-
termine only by much practice and long experi-
ence when the one and when the other is to be
employed, when memory and intellect or when
emotions and will are to be influenced the more.
That well-planned mental exercise can correct
functional disturbances, can retrieve lost powers of
action, is shown not only by certain aphasics who,
through re-education of the other side of the brain,
have again learned to talk, but also by those neuras-
thenics and hysterics who, through psychotherapy,
have gradually subjugated their obsessions and
"imaginary,'* though none the less painful, suffer-
ings through strengthening of their wills.

As we already have intimated, psychotherapeutic
success often is not attained, merely because the
physician or educator fails to individualize, to
adapt his method to the specific case. It is a
great mistake, as Heller justly says, to employ a
certain method without considering the psychic
changes in comportment which take place in the
course of the treatment. Far too little attention



THE MOST IMPORTANT METHODS 305

may be given to the manifold psychic changes to
which the patient is subject and to the fact that the
progress obtained by means of relaxation and exer-
cise does not always correspond to that methodical
gradation which the physician or educator has
planned for. Not infrequently a patient will re-
act to psychic impressions in a manner different
from what analogy to a former similar experience
would lead one to expect. Then it is that the
physician or educator can demonstrate his capa-
bilities by modifying his method according to the
varying reaction powers of one and the same or
of different individuals, without ever losing sight
of the object of his work. He who lacks the requi-
site persistency to await the effect of methodical
mental relaxation and exercise is likely to become
disheartened by the absence of expected results, to
have recourse to newer and newer methods, and
then to achieve nothing more than the production
of disturbing complications which lead far from the
desired purpose.

These considerations admit of but one deduction
— that institutions conducted and supervised by
physicians of specialized training constitute the
proper place for the application of such methodical



306 PSYCHOTHERAPY

relaxation and exercise of the brain and the nervous
system. Patients in such institutions are freed
from all injurious influences such as errors in train-
ing, noxious suggestions, inappropriate literature,
and other things which permit nervous disorders
to thrive. Furthermore, such sanatoriums, a num-
ber of which have been in existence for many years,
particularly those in Germany, are equipped with
all psychotherapeutic appurtenances and accesso-
ries, not the least of these being an equipment for
treatment by means of exercise and occupation.

By means of work adapted to the capabilities
and tendencies of the individuals and allotted in
accordance with the principles of relaxation and
exercise, their attention is distracted from their
nervous disorders; encouraged by successful labor,
the patients regain self-confidence and again find
pleasure in life. That alone means that much has
been accomplished, but, in addition, altruistic
feelings are aroused through the work which the
patients voluntarily furnish in agriculture, horti-
culture, or craftsmanship, and which they know
contril)utes to defraying the necessarily high cost
of the institution and thus accrues to the benefit of
other sufferers.



THE MOST IMPORTANT METHODS 307

No matter how excellent the organization of such
a sanatorium, no matter how great its reputation,
its one aim must be to lead the patient, by means
of relaxation and exercise, not only to his former
condition of health, but also to a recognition of
the manner in which he may successfully combat
in the future the damage which is the necessary
accompaniment of 4II industrial competition.

2. PSYCHO-PROPHYLACTIC TREATxMENT

The subject-matter of the preceding chapter in
part covers the ground of psycho-prophylaxis.
Mental relaxation and exercise not only serve as
co-operative factors in the re-establishment of
functional activity of the brain and the rest of the
nervous system, but also act as a remedy through
which persons suffering from congenital or acquired
nerve weakness become better qualified to resist
threatened psychic dangers. Thus psychotherapy
follows the principle which governs all other
branches of therapeutics, that prevention of disease
is better than cure.

The task of psycho-prophylactic treatment is
essentially educational, its object being not so
much the cultivation of the intellect as the forma-



308 PSYCHOTHERAPY

tion of character and will power. Through edu-
cation, says Hoffmann, is furnished the basis for
enhancement of the productive capability of our
most important organ, the brain.

We have learned that a person feels what he
conceives if he is once convinced of the truth of
his conception. Under those conditions he may
feel that he is sick and pass through all the qualms
of suffering, even when all organs are healthy and
when he has not been exposed to an external in-
jury or disease-producing agency. The sufferings
of the neurasthenic or the hysteric represent bitter
actualities even when the ideas on which they de-
pend have no foundation in fact — that is, are
purely imaginary. Hence it must be apparent
that education may produce, as well as it may re-
move, predisposition to disease, and that the natural
sciences are correct when they require education
to be governed, not according to transmitted pat-
terns, but in accordance with our comprehension
of the nature of brain and nerve activity.

This is not the place for a consideration of the
reasons for the persistent increase of neurasthenia.
Perhaps many individuals do break down prema-
turely, not in consequence of any hereditary taint or



THE MOST IMPORTANT METHODS 309

life amid specially unfavorable hygienic surround-
ings, but because they have been forced to exert
themselves beyond the measure of human capabil-
ity. Perhaps, too, such breakdown is the result of
that constantly augmenting craving for self-gratifica-
tion and pleasure which has permeated all social
classes and which, through over-satiation, leads to a
search for ever more and more pernicious means of
stimulation. While both those factors may be recog-
nized as operative causes, the explanation, in my
opinion is to be sought in the inability of the aver-
age brain to adapt itself with sufiicient quickness
to the gigantic progress and the rapid changes
which conditions of life now are undergoing.
This seems to me at any rate to be the most plausi-
ble explanation for the increase of neurasthenia
among those people who are dependent on their
own labor for their means of subsistence. As a
matter of fact, the number of weaklings is increas-
ing; one-sided cultivation of the intellect is per-
mitting the emotions to wither; the ethical side of
character and formation of will power is becoming
more and more neglected, and mastery of the lower
passions is less common than ever before. Edu-
cation's first duty is to counteract such palpable



310 PSYCHOTHERAPY

evidences of degeneration. The annals of the
history of civihzation teach us in unmistakable
terms that races as well as individuals irreparably
decline when the germs of degeneration, strength-
ened by hereditary influences, are permitted with-
out hindrance to proliferate.

Psycho-prophylaxis can do even more toward
better fitting adolescent youth for its struggle for
existence in making the interactive relations be-
tween body and mind, — more especially the re-
action which the psychic state exerts on the course
of bodily processes, — serve for methodical discipline
of thought and imagination, emotion and will. If
by that means nothing else is achieved than safe-
guarding the young from those dangers to which
they are exposed through sexual aberrations and
alcoholic excesses, much will have been accom-
plished.

But if, in addition, love for work and aversion
to idleness can be stimulated, the fountain-head of
neurasthenic and other nervous states will be
blocked. The sole difficulty consists in so select-
ing and apportioning activity that it will become
a pleasure and concord with the desires and capa-
bilities of the individual. Wherever that purpose



THE MOST IMPORTANT METHODS 311

is not accomplished, work becomes a source of
emotional depression and nervous disorder. Much
criticism has been made of strain in school as a
cause of neurasthenia among children. In general
it is my opinion that the exactions of an education
which keeps pace with the progress of the times
must grow. Although I freely admit that, through
too much learning by rote, the memory is exces-
sively burdened, I do not consider the demands
made by the school excessive for a normal brain.
That, however, does not apply to children who are
mentally deficient, who, without exactly being ab-
normal, still have brains of lesser capabilities and
therefore are overtaxed by the demands made on
them. For them psycho-prophylaxis must endorse
the establishment of special schools, a prc^Apn
which is steadily growing. The instruction given
in schools organized for children of average capa-
bilities must become a source of neurasthenia for
those who are mentally deficient. Moreover, the
emotional depression caused by inability to com-
pete with their comrades, together with the ridicule
they are obliged to endure as a result, may and
often has become a psychic detriment of grave nat-
ure. Wherever such mental deficiency is not de-



312 PSYCHOTHERAPY

pendent on bodily abnormalities, eye-strain, ade-
noids or other causes easily removable, stress must
be laid, in its psycho-prophylactic treatment, on
relaxation and not on activity.

To impress the youthful brain with noble and
beautiful thoughts is but one function of educa-
tional training. It is quite as important to regu-
late by means of habit the flow of ideas, the impulses
of the will, and their dependent actions, so that, as
an integral possession, they will fortify the per-
sonality for its battle of life. It is true the ideal, a
healthy mind in a healthy body, can but rarely be
fully realized, but it is better to have a healthy and
efficient brain in a crippled body than a crippled
mind in a normal body.

Child-training, however, is not the sole task of
psycho-prophylactic treatment. Adults, too, re-
quire training — frequently more so than children.
Consider, for example, those drones of wealth
whose entire lives are filled with outward form and
trivialities, whose lack of serious purpose makes
them easy victims to the unbridled play of their
imaginations. Constituting, as they do, so large a
proportion of sufferers from neurasthenia and other
psycho-neuroses, they teach us particularly that in-



THE MOST IMPORTANT METHODS 313

ordinate relaxation leads to imaginary disorder,
ideational diseases, quite as much as does over-
taxation through work.

Let us here emphasize the principle that health
cannot, as Hoffmann expresses it, be absorbed in
comfortable repose with the aid of a drug, but
must be acquired and maintained through useful
work. When races or individuals, enervated through
luxurious living, unwilling to accept further cares
or obligations, tend toward "race-suicide" through
their need for repose, and, worshipping a morbid
feminism, look on hard work as a disgrace, they
represent the dead twigs of humanity, which have
fallen and must be replaced by fresh shoots; they
have become useless and must give place to those
who, through earnest work, have remained young,
strong, and active.

May these few allusions suflSce to indicate the
unlimited field open to psycho-prophylaxis. These
times of relentless, brutal competition in all fields
of culture require, above all, combative characters,
men of action with wills of force and purpose.
Psychotherapy will have an important influence in
the production of such characters, in counteracting
excessive effeminateness and sensitiveness, since



314 PSYCHOTHERAPY

the positive ideas which it arouses exert not only
a curative, but also an inherent preventive action.
Imagination kept within proper bounds by trained
habit enables us to protect ourselves more or less
against detrimental influences; it not only guards
us from that fear which increases actual suffering
or even produces disease, but it also augments our
capacity for the enjoyment of all that is good and
beautiful. This occurs in conformity with natural
laws. Observation of them keeps us strong bodily
and mentally; neglect of them inevitably leads to
degeneration of the race. This degeneration,
manifesting itself in an alarming increase in nerv-
ous troubles, as well as in other ways, can be com-
bated only by training the brain to adapt itself to
the conditions of life furnished by the intensity of
work and progressive culture.

Cui bono? Why put ourselves to all this trouble ?
Who can be helped by such means ? If such ques-
tions can still be asked, the nature of psychotherapy
has not been grasped. Psychotherapy must stand
or fall together with the right of existence of the
entire science of medicine.



PRACTICAL EXAMPLES 315

B. Practical Examples

Before illustrating the action and uses of psycho-
therapy by means of practical examples, it will be
well once more briefly to remind the reader that
suggestion acts directly as well as indirectly, and
that he must keep in mind the distinction between
the influence exerted by suggestion when employed
alone and the influence it exerts as part of some
other therapeutic procedure. In practice direct
suggestion and the exclusive employment of psycho-
therapy are usually associated, while indirect sug-
gestion is linked with other therapeutic measures.

Naturally psychotherapy primarily shows its
effectiveness in that class of pure neuroses or psycho-
neuroses which are dependent exclusively on ideas
and imagination. That class is made up in great
part of neurasthenia (psychasthenia) in its varied
forms, sexual neuroses, fright neuroses, and hysteria,
with its manifold ramifications. To those must
be added numerous nerv'ous symptoms which also
may be psychically induced, such as sleeplessness,
loss of appetite, habitual headaches, nervous dys-
pepsia, imperative thoughts and acts (obsessions),
hypochondriacal depression, and muscular spasms



316 ' PSYCHOTHERAPY

of an epileptoid or choreoid character. In all such
conditions the assurance that the affection will
pass away, given by the physician and willingly
accepted by the patient, usually suffices to effect a
cure. But such exclusive employment of psycho-
therapy cannot be successful against those affec-
tions which are a combination of organic disease
and functional symptoms enhanced by the fantasy
and the imagination. True, the psychic symptoms
of disease in such composite affections may be
cured, or at least ameliorated by direct and exclu-
sive psychic influence, but the symptoms dependent
on organic disease can be influenced only indirectly
by psychic means, the extent of such influence being
dependent on the degree to which the force of ideas
may apparently mitigate an existing malady and
at the same time augment one's confidence in the
beneficial action of any other therapeutic measure
which is being concomitantly employed.

A just estimate of the following illustrative cases
can be obtained only if these differences in the
various modes of psychotherapeutic procedure be
kept in mind. Moreover, let us not fail to con-
sider that in psychotherapy, as, in fact, in thera-
peutics in general, the removal of the cause of a



PRACTICAL EXAMPLES 317

disorder by the employment of any specific treat-
ment is an ideal which is but rarely attained. All
specific treatment premises knowledge not only of
the causes of the disease against which it is directed,
but also of all the changes which such disease has
produced in the nerve cells; and, needless to say,
this knowledge still is very incomplete. The art
of medicine, however, cannot sit helplessly by
awaiting the time when the science of medicine
will have given us complete cognition of the proc-
esses which take place during the causation and
the subversion of disease. The physician must
act; hence he is obliged in most diseases to confine
himself to symptomatic treatment. The task of
symptomatic treatment is to eliminate from the
numerous conditions which in the individual case
determine the course of a disease those symptoms
which stand in the foreground of the picture.
While the fulfilment of this task does not strike at
the root of the trouble, it does attain distinct suc-
cesses through the palliation and repose which it
brings about. This is particularly true in psycho-
therapy, which intrinsically can treat only symp-
toms. Phobias and obsessions of neurasthenia or
the emotional outbreaks of hysteria, with their



318 PSYCHOTHERAPY

physical associates, may be removed, and relief
may be brought about which will react favorably
upon the disease itself, but no one can maintain
that the neurasthenia or the hysteria has thereby
been cured. Still, the treatment of symptoms re-
quires constant attention to the entire disease as
well as to the entire personality of the patient. Each
symptom to be treated must be recognized as merely
a part in the object of attack.

Take the case, for instance, of a patient who is
unable to obtain rest by night or day on account of
persistent pain. He does not sleep, takes no food,
and, as a result of malnutrition, is in danger of
dying through exhaustion. Morphine or some
other pain-relieving remedy is then prescribed by
a physician. Although, of course, the cause of
the disease is not removed thereby, sleep is restored
with the cessation of pain, the appetite returns and
tissue waste is prevented. All of which represents
a therapeutic gain. Or, let us take the case of
another patient suffering from urinary retention in
consequence of local obstruction. The physician
causes the bladder to be evacuated regularly by
means of catheterization. Thus, again, only a
symptom and not the cause of the disease is re-



PRACTICAL EXAIMPLES 319

moved, and yet it is certain this symptomatic treat-
ment means much to the patient and favorably
influences the course of the disease which afflicts
him. When all has been said, every disease, clin-
ically considered, is but an agglomeration of symp-
toms. Therefore, if in any disease we have no
therapy which will remove the cause of the disease,
but are able to cause its symptoms to pass away
one by one, we certainly have brought about one
of the objects of all treatment, namely the subjective
feeling of well-being of the patient. Then, too,
psychotherapy often must seek its end by this same
indirect means of symptomatic treatment. If the
neurosis itself cannot be made to disappear, then
the removal of obsessions and other disturbing
symptoms will constitute the task allotted to
psychotherapy.

Understanding this, we may classify functional
diseases, as Dejerine and Gauckler have done, ac-
cording to the dominating symptoms; i. e., into
affections of the digestive, urinary, sexual, respira-
tory, circulatory and sensory organs, affections of
the nerves and muscles, and psycho-neuroses in a
more restricted sense. With no intention of cover-



320 PSYCHOTHERAPY

ing this entire field or of taking up these varied
symptoms seriatim, let us begin with those func-
tional disorders which manifest themselves in
digestive disturbance.

A drastic example of this nature is furnished by
the case of a man of middle age, with no hereditary
taint and who never had been sick, who arranged
for a trip to Europe to obtain a much-needed vaca-
tion, and who about a week before the time set for
sailing, was taken with nausea and vomiting. His
malady increased from day to day and could not be
controlled by treatment. The most careful physical
examination failed to reveal any cause for the
trouble. Finally, when no food of any kind could
be retained, the trip had to be given up as the
patient was too ill to leave home. The distressing
state persisted until the steamer had left without
him, and then all symptoms of illness disappeared
at once. The abrupt change, together with other
facts, led me to believe the patient was suffering


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Online LibraryGeorge W 1856-1940 JacobySuggestion and psychotherapy → online text (page 16 of 18)