Produced by Rick Niles, Ronald Holder and the PG Online Distributed
A PRIMER OF PSYCHOTHERAPY
JOSEPHINE A. JACKSON, M.D.
HELEN M. SALISBURY
THE CENTURY CO.
THE CENTURY CO.
PRINTED IN U.S.A.
MARY PATTERSON MANLY
A LOVER OF TRUTH
"Your trouble is nervous. There is nothing we can cut out and there is
nothing we can give medicine for." With these words a young college
student was dismissed from one of our great diagnostic clinics.
The physician was right. In a nervous disorder there is nothing to cut
out and there is nothing to give medicine for. Nevertheless there is
something to be done, - something which is as definite and scientific
as a prescription or a surgical operation.
Psychotherapy, which is treatment by the mental measures of
psycho-analysis and re-education, is an established procedure in the
scientific world to-day. Nervous disorders are now curable, as has
been proved by the clinical results in scores of cases from civil
life, under treatment by Freud, Janet, Prince, Sidis, DuBois, and
others; and in thousands of cases of war neuroses as reported by Smith
and Pear, Eder, MacCurdy, and other military observers. These army
experts have shown that shell-shock in war is the same as nervousness
in civil life and that both may be cured by psycho-analysis and
For more than a decade, in handling nervous cases, I have made use of
the findings of recognized authorities on psychopathology. Truths have
been applied in a special way, with the features of re-education so
emphasized that my home has been called a psychological
boarding-school. As the alumni have gone back to the game of life
with no haunting memories of usual sanatorium methods, but with the
equipment of a fuller self-knowledge and sense of power, they have
sent back a call for some word that shall extend this helpful message
to a larger circle.
There has come, too, a demand for a book which shall give accurate and
up-to-date information to those physicians who are eager for light on
the subject of nervous disorders, and especially for knowledge of the
significant contributions of Sigmund Freud, but who are too busy to
devote time to highly technical volumes outside their own specialties.
This need for a simple, comprehensive presentation of the Freudian
principles I have attempted to meet in this primer of psychotherapy,
providing enough of biological and psychological background to make
them intelligible, and enough application and illustration to make
them useful to the general practitioner or the average layman.
JOSEPHINE A. JACKSON.
Pasadena, California, 1921.
PART I: THE STRANGE WAYS OF NERVES
In which most of us plead guilty to the charge of "nerves."
NERVOUS FOLK 3
In which we learn what "nerves" are not and get a hint of
what they are.
THE DRAMA OF NERVES 10
PART II: "HOW THE WHEELS GO ROUND"
In which we find a goodly inheritance.
THE STORY OF THE INSTINCTS 33
In which we learn more about ourselves.
THE STORY OF THE INSTINCTS (Continued) 51
In which we look below the surface and discover a veritable
THE SUBCONSCIOUS MIND 77
In which we learn why it pays to be cheerful.
BODY AND MIND 118
In which we go to the root of the matter.
THE REAL TROUBLE 141
PART III: THE MASTERY OF "NERVES"
In which we pick up the clue.
THE WAY OUT 183
In which we discover new stores of energy and relearn the
truth about fatigue.
THAT TIRED FEELING 219
In which the ban is lifted.
DIETARY TABOOS 250
In which we learn an old trick.
THE BUGABOO OF CONSTIPATION 278
In which handicaps are dropped.
A WOMAN'S ILLS 300
In which we lose our dread of night.
THAT INTERESTING INSOMNIA 322
In which we raise our thresholds.
FEELING OUR FEELINGS 333
In which we learn discrimination.
CHOOSING OUR EMOTIONS 359
In which we find new use for our steam.
FINDING VENT IN SUBLIMATION 379
OUTWITTING OUR NERVES
_In Which Most of Us Plead Guilty to the Charge of "Nerves."_
Whenever the subject of "nerves" is mentioned most people begin trying
to prove an alibi. The man who is nervous and knows that he is
nervous, realizes that he needs help, but the man who has as yet felt
no lack of stability in himself is quite likely to be impatient with
that whole class of people who are liable to nervous breakdown. It is
therefore well to remind ourselves at once that the line between the
so-called "normal" and the nervous is an exceedingly fine one.
"Nervous invalids and well people are indistinguishable both in theory
and in practice," and "after all we are most of us more or less
neurasthenic." The fact is that everybody is a possible neurotic.
[Footnote 1: Putnam: _Human Motives_, p. 117.]
[Footnote 2: DuBois: _Physic Treatment of Nervous Disorders_, p. 172.]
So, as we think about nervous folk and begin to recognize our friends
and relatives in this class, it may be that some of us will
unexpectedly find ourselves looking in the mirror. Some of our
lifelong habits may turn out to be nervous tricks. At any rate, it
behooves us to be careful about throwing stones, for most of us live
in houses that are at least part glass.
=Am I "Like Folks"?= Before we begin to talk about the real sufferer
from "nerves," the nervous invalid, let us look for some of the
earmarks that are often found on the supposedly well person. All of
these signs are deviations from the normal and are sure indications of
nervousness. The test question for each individual is this: "Am I
'like folks'?" To be normal and to be well is to be "like folks." Can
the average man stand this or that? If he can, then you are not normal
if you cannot. Do the people around you eat the thing that upsets you?
If they do, ten chances to one your trouble is not a physical
idiosyncrasy, but a nervous habit. In bodily matters, at least, it is
a good thing to be one of the crowd.
Many people who would resent being called anything but normal - in
general - are not at all loth to be thought "different," when it comes
to particulars. Are there not many of us who are at small pains to
hide the fact that we "didn't sleep a wink last night," or that we
"can't stand" a ticking clock or a crowing rooster? We sometimes
consider it a mark of distinction to have a delicate appetite and to
have to choose our food with care. If we are frank with ourselves,
some of us will have to admit that our own ailments seem interesting,
while the other person's ills are "merely nervous" or imaginary or
abnormal. After all, a good many of us will have to plead guilty to
the charge of nervousness.
We have only to read the endless advertisements of cathartics and
"internal baths," or to check up the quantity of laxatives sold at any
drug store, to realize the wide-spread bondage to that great bugaboo
constipation. He who is constipated can hardly prove an alibi to
"nerves." Then there are the school-teachers and others who are worn
out at the end of each year's work, hardly able to hold on until
vacation; and the people who can't manage their tempers; and those who
are upset over trifles; and those who are dissatisfied with life. To a
certain degree, at least, all of these are nervous persons. The list
=Half-Power Engines.= These people are all supposed to be well. They
keep going - by fits and starts - and as they are used to running on
three cylinders, with frequent stops for repairs, they accept this
rate of living as a matter of course, never realizing that they might
be sixty horse-power engines, instead of their little thirty or forty.
For this large and neglected class of people psychotherapy has a
stimulating message, and for them many of the following pages have
=The Real Sufferers.= These so-called normal people are merely on the
fringe of nervousness, on the border line between normality and
disease. Beyond them there exists a great company of those whose lives
have been literally wrecked by "nerves." Their work interrupted or
given up for good, their minds harassed by doubts and fears, their
bodies incapacitated, they crowd the sanatoria and the health resorts
in a vain search for health. From New England to Florida they seek,
and on to Colorado and California, and perhaps to Hawaii and the
Orient, thinking by rest and change to pull themselves together and
become whole again. There are thousands of these people - lawyers,
preachers, teachers, mothers, social workers, business and
professional folk of all sorts, the kind of persons the world needs
most - laid off for months or years of treatment, on account of some
kind of nervous disorder.
=Various Types of Nervousness.= The psychoneuroses are of many
forms. To some people "nerves" means nervous prostration,
breakdown, fatigue, weakness, insomnia, the blues, upset stomach, or
unsteady heart, - all signs of so-called neurasthenia or
nerve-weakness. To others the word "nerves" calls up memories of
strange, emotional storms that seem to rise out of nowhere, to sweep
the sky clear of everything else, and to pass as they came, leaving
the victim and the family equally mystified as to their meaning. These
strange alterations of personality are but one manifestation of
hysteria, that myriad-faced disorder which is able to mimic so
successfully the symptoms of almost every known disease, from tumors
and fevers to paralysis and blindness.
[Footnote 3: The technical term for nervousness is
_psycho-neurosis_ - disease of the psyche. There are certain "real
neuroses" such as paralysis and spinal-cord disease, which involve an
organic impairment of nerve-tissue. However, as this book deals only
with psychic disturbance, we shall, throughout, use the term
_neuroses_ and _psycho-neuroses_ indiscriminately, to denote nervous
or functional disorders.]
To still other people nervous trouble means fear, - just terrible fear
without object or meaning or reason (anxiety neuroses); or a definite
fear of some harmless object (phobia); or a strange, persistent,
recurrent idea, quite foreign to the personality and beyond the reach
of reason (obsession); or an insistent desire to perform some absurd
act (compulsion); or perhaps, a deadly and pall-like depression (the
As a matter of fact, the neuroses include all these varieties, and
various shades and combinations of each. There are, however, certain
mental characteristics which recur with surprising regularity in most
of the various phases - dissatisfaction, lack of confidence, a sense of
being alone and shut in to oneself, doubt, anxiety, fear, worry,
self-depreciation, lack of interest in outside affairs, pessimism,
fixed belief in one's powerlessness, along whatever line it may be.
Underneath all these differing forms of nervousness are the same
mechanisms and the same kind of difficulty. To understand one is to
understand all, and to understand normal people as well; for in the
last analysis we are one and all built on the same lines and governed
by the same laws. The only difference is, that, as Jung says, "the
nervous person falls ill of the conflicts with which the well person
Since at least seventy-five per cent. of all the people who apply to
physicians for help are nervous patients; and since these thousands of
patients are not among the mental incompetents, but are as a rule
among the highly organized, conscientious folk who have most to
contribute to the leadership of the world, it is obviously of vital
importance to society that its citizens should be taught how to solve
their inner conflicts and keep well. In this strategic period of
reconstruction, the world that is being remodeled cannot afford to
lose one leader because of an unnecessary breakdown.
There is greater need than ever for people who can keep at their tasks
without long enforced rests; people who can think deeply and
continuously without brain-fag; people who can concentrate all their
powers on the work in hand without wasting time or energy on
unnecessary aches and pains; people whose bodies are kept up to the
top notch of vitality by well-digested food, well-slept sleep,
well-forgotten fatigue, and well-used reserve energy. That such a
state of affairs is no Utopian dream, but is merely a matter of
knowing how, will appear more clearly in later chapters.
_In which we learn what "nerves" are not, and get a hint of what they
THE DRAMA OF NERVES
AN EXPLODED THEORY
="Nerves" not Nerves.= Pick up any newspaper, turn over a few pages,
and you will be sure to come to an advertisement something like this:
Tired man, your nerves are sick!
They need rest and a tonic to restore
their worn-out depleted cells!
No wonder people have believed this kind of thing. It has been dinned
into their ears for many years. They have read it with their breakfast
coffee and gazed at it in the street cars and even heard it from their
family physicians, until it has become part and parcel of their
thinking; yet all the time the fundamental idea has been false, and
now, at last, the theory is exploded.
So far as the modern laboratory can discover, the nerves of the most
confirmed neurotic are perfectly healthy. They are not starved, nor
depleted, nor exhausted; the fat-sheath is not wanting, there is no
inflammation, there is nothing lacking in the cell itself, and there
is no accumulation of fatigue products. Paradoxical as it may sound,
there is nothing the matter with a nervous person's nerves. The
faithful messengers have borne the blame for so long that their name
has gotten itself woven into the very language as symbolic of disease.
When we speak of nervous prostration, neurasthenia, neuroses,
nervousness, and "nerves" we mean that body and mind are behaving
badly because of functional disorder. These terms are good enough as
figures of speech, so long as we are not fooled by them; but accepting
them in their literal sense has been a costly procedure.
Thanks to the investigations of physiologist and psychologist, usually
combined in the person of a physician, "nervousness" has been found to
be not an organic disease but a functional one. This is a very
important distinction, for an organic disease implies impairment of
the tissues of the organ, while a functional disorder means only a
disturbance of its action. In a purely nervous disorder there seems to
be no trouble with what the nerves and organs are, but only with what
they do; it is behavior and not tissue that is at fault. Of course, in
real life, things are seldom as clear-cut as they are in books, and
so it happens that often there is a combination of organic and
functional disease that is puzzling even to a skilled diagnostician.
The first essential is a diagnosis as to whether it be an organic
disease, with accompanying nervous symptoms, or a functional
disturbance complicated by some minor organic trouble. If the main
cause is organic, only physical means can cure it, but if the trouble
is functional, no amount of medicine or surgery, diet or rest, will
touch it; yet the symptoms are so similar and the dividing line is so
elusive, that great skill is sometimes required to determine whether a
given symptom points to a disturbance of physical tissue or only to
If the physician is sometimes fooled, how much more the sufferer
himself! Nausea from a healthy stomach is just as sickening as nausea
from a diseased one. A fainting-spell is equally uncomfortable,
whether it come from an impaired heart or simply from one that is
behaving badly for the moment. It must be remembered that in
functional nervousness the trouble is very real. The organs are really
"acting up." Sometimes it is the brain that misbehaves instead of the
stomach or heart. In that case it often reports all kinds of pains
that have no origin outside of the brain. Pain, of course, is
perceived only by the brain. Cut the telegraph wire, the nerve, and no
amount of injury to the finger can cause pain. It is equally true that
a misbehaving brain can report sensations that have no external
cause, that have not come in through the regular channel along the
nerve. The pain feels just the same, is every bit as uncomfortable as
though its cause were external.
Sometimes, instead of reporting false pains, the brain misbehaves in
other ways. It seems to lose its power to decide, to concentrate, or
to remember. Then the patient is almost sure to fancy himself going
insane. But insanity is a physical disease, implying changes or toxins
in the brain cells. Functional disorders tell another story. Their
cause is different, even though the picture they present is often a
close copy of an organic disease.
=Distorted Pictures.= It should not be thought, however, that the
symptoms of functional and organic troubles are identical. Hysteria
and neurasthenia closely simulate every imaginable physical disease,
but they do not exactly parallel any one of them. It may take a
skilled eye to discover the differences, but differences there are.
Functional troubles usually show a near-picture of organic disease,
with just enough contradictory or inconsistent features to furnish a
clue as to their real nature. For this reason it is important that the
treatment of the disease be solely the province of the physician; for
only the carefully trained in all the requirements of diagnosis can
differentiate the pseudo from the real, the innocuous from the
False or nervous neuritis may feel like real neuritis (the result of
poisons in the blood), but it gives itself away when it localizes
itself in parts of the body where there is no nerve trunk. The
exhaustion of neurasthenia sometimes seems extreme enough to be the
result of a dangerous physical condition; but when this exhaustion
disappears as if by magic under the proper kind of treatment, we know
that the trouble cannot be in the body. Let it be said, then, with all
the emphasis we can command, "nerves" are not physical. Laboratory
investigation, contradictory symptoms, and response to treatment all
bear witness to this fact. Whatever symptoms of disturbance there may
be in pure nervousness, the nerves and organs can in no way be shown
to be diseased.
THE POSITIVE SIDE
="Nerves" not Imaginary.= "But," some one says, "how can healthy
organs misbehave in this way? Something must be wrong. There must be
some cause. If 'nerves' are not physical, what are they? They surely
can't be imaginary." Most emphatically, they are real; nothing could
be more maddening than to have some one suggest that our troubles are
"mere imagination." No wonder such theories have been more popular
with the patient's family than with the patient himself. Many years
ago a physician put the whole truth into a few words: "The patient
says, 'I cannot'; his friends say, 'He will not'; the doctor says, 'He
cannot will.'" He tries, but in the circumstances he really cannot.
=The Man behind the Body.= The trouble is real; the organs do "act
up"; the nerves do carry the wrong messages. But the nerves are merely
telegraph wires. They are not responsible for the messages that are
given them to carry. Behind the wires is the operator, the man higher
up, and upon him the responsibility falls. In functional troubles the
body is working in a perfectly normal way, considering the perverted
conditions. It is doing its work well, doing just what it is told,
obeying its master. The troubles are not with the bodily machine but
with the master. The man behind the body is in trouble and he really
has no way of showing his pain except through his body. The trouble in
nervous disorders is in the personality, the soul, the realm of ideas,
and that is not your body, but _you_. Loss of appetite may mean either
that the powers of the physical organism are busily engaged in
combating some poison circulating in the blood, or that the ego is "up
against" conditions for which it has "no stomach." Paralysis may be
due to a hemorrhage into the brain tissues from a diseased blood
vessel, or it may symbolize a sense of inadequacy and defeat.
Exaggerated exhaustion, halting feet, stammering tongue, may give
evidence of a disturbed ego rather than of a diseased brain.
=All Body and no Mind.= At last we have begun to realize what we ought
to have known all along, - that the body is not the whole man. The
medical world for a long time has been in danger of forgetting or
ignoring psychic suffering, while it has devoted itself to the
treatment of physical disease.
By way of condoning this fault it must be recognized that the five
years of medical school have been all too short to learn what is
needed of physiology and anatomy, histology, bacteriology, and the
various other physical sciences. But at last the medical schools are
realizing that they have been sending their graduates out only
half-prepared - conversant with only one half of a patient, leaving
them to fend for themselves in discovering the ways of the other half.
Many an M.D. has gone a long way in this exploration. Native common
sense, intuition, and careful study have enabled him to go beyond what
he had learned in his text-books. But in the best universities the
present-day student of medicine is now being given an insight into the
ways of man as a whole - mind as well as body. The movement can hardly
proceed too rapidly, and when it has had time to reach its goal, the
day of the long-term sentence to nervousness will be past.
In the meanwhile most physicians, lacking such knowledge and with the
eye fixed largely on the body, have been pumping out the stomach,
prescribing lengthy rest-cures, trying massage, diet, electricity, and
surgical operations, in a vain attempt to cure a disease of the
personality. Physical measures have been given a good trial, but few
would contend that they have succeeded. Sometimes the patient has
recovered - in time - but often, apparently, despite the treatment
rather than because of it. Sometimes, in the hands of a man like Dr.
S. Weir Mitchell, results seem good, until we realize that the same
measures are ineffective when tried by other men, and that, after all,
what has counted most has been the personality of the physician rather
than his physical treatment.
No wonder that most doctors have disliked nervous cases. To a man
trained in all the exactness of the physical sciences, the apparent
lawlessness and irresponsibility of the psychic side of the
personality is especially repugnant. He is impatient of what he fails
=All Mind and no Body.= This unsympathetic attitude, often only half
conscious on the part of the regular practitioners, has led many
thousands of people to follow will-o'-the-wisp cults, which pay no
attention to the findings of science, but which emphasize a
realization of man's spiritual nature. Many of these cults, founded
largely on untruth or half-falsehood, have succeeded in cases where
careful science has failed. Despite fearful blunders and execrable
lack of discrimination in attempting to cure all the ills that flesh
is heir to by methods that apply only to functional troubles, ignorant
enthusiasts and quacks have sometimes cured nervous troubles where the
conscientious medical man has had to acknowledge defeat.
=The Whole Man.= But thinking people are not willing to desert science
for cults that ignore the existence of these physical bodies. If they
have found it unsatisfactory to be treated as if they were all body,
they have also been unwilling to be treated as if they were all mind.
They have been in a dilemma between two half-truths, even if they have
not realized the dilemma. It has remained for modern psychotherapy to
strike the balance - to treat the whole man. Solidly planted on the
rock of the physical sciences, with its laboratories, physiological
and psychological, and with a long record of investigation and
treatment of pathological cases, it resembles the mind cure of earlier