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Read books online » Psychology » Psychotherapy by Hugo Münsterberg (e novels to read online .TXT) 📖

Book online «Psychotherapy by Hugo Münsterberg (e novels to read online .TXT) 📖». Author Hugo Münsterberg



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which still recurred in the first days slowly disappeared. The longer the symptom lasted, the more the optical factor faded away, and the tactual factor came into the foreground after three or four weeks. Perhaps seeing a razor in a store window or a pocket knife open no longer stirred up the image of cutting the wrist, but simply a strong tactual sensation, as if the skin of the wrist was scratched and pinched. Finally, after about two months, the association character disappeared to a high degree and the scratching and cutting sensation in the skin became independent and automatic. The patient awoke in the morning with a vivid tactual hallucination of being cut without associating with it any picture of a knife. Throughout the day, in the midst of work and in the midst of conversation, sometimes one and sometimes the other wrist became the center of the exasperating sensation, easily bringing with it involuntary reactions as if to withdraw the arm. This became more and more frequent and more and more vivid.

The doctor, fully aware of the borderland character of this experience, felt sure that his inner fight against the disturbance would get control of it. The usual tonics did not show any influence. On the other hand, there were no other nervous symptoms and, with his most acute analysis, he did not find the slightest trace of emotion any longer. When the symptoms reached a point at which they seriously interfered with his comfort, he asked me for psychotherapeutic treatment, under the condition that I was not to apply hypnotism. He was absolutely averse to the use of hypnotism in his own case because he was afraid that to be hypnotized would mean for him a certain disposition to fall into hypnotic sleep by auto-suggestion, as he knew the vividness of his imaginative sensations. He wanted to avoid that the more as his own professional work might sometimes demand hypnotizing in his own practice. In any case he had an aversion to it and asked for other means.

Under these circumstances, it seemed to me the most logical conclusion that the counter idea with its antagonistic reactions might be reënforced by direct perception. The abnormal tactual sensation forced on consciousness the idea of the cutting of the wrist. The necessary counter action would be to force to consciousness the idea of the uninjured wrist and the corresponding reactions. As the wrist can be easily made accessible to sight and as I anticipated that the visual sensations would be more forceful than the tactual ones, I told him to look straight at his own wrists for ten minutes three times a day after waking, after luncheon, and before going to bed. He had to hold his two forearms close in front of his eyes and stare at them, giving his full attention to the visual impression of the smooth, uninjured skin of the wrist. If during this process, the tactual counter-sensations were vivid, he had to go on with the staring at both arms, both held near together until the perception had crowded out the rival touch sensation. When this performance had been carried out six times, he did not notice the coming up of the tactual sensation with vividness any longer. From the third day it had disappeared entirely. I told him to go on with the process still every morning for some weeks. The physician himself considered the cure as complete.

Our first case dealt with hypnosis, our second case removed the intruding idea by a perception in a waking state. To point at once to the variety of methods which we sketched, we may turn again to a case of emotionless idea removed by the method of switching off and side-tracking the originating and physiological "complex."

The patient is a school-teacher in the Middle West, a nervous, thin-looking woman of about twenty-five. Her only complaint is a persistent idea that she may at any time get a child. She has had this idea "as long as she can remember," according to her first expression. She never had any intimate acquaintance with any man, she was never engaged, she hated bitterly every thought of immorality, she knows and has assured herself by much reading that it is entirely impossible that she might get a child without sexual contact. Yet this thought recurs to her all the time, even when she is talking with other people. It embarrasses her in school, in spite of her teaching only girls in a private institution. This thought keeps her away from company and the effect of its embarrassing occurrence depresses her, but she is sure that the thought itself does not include any emotion. It is a mere thinking of it with a full consciousness that it is absurd, and yet she cannot suppress it.

I began at once to try to find the origin of her queer obsession. After some efforts to pierce into her memories, we came to an experience of her youth. When she was about thirteen years of age, a young girl whom she had admired much for her beauty, living in the neighborhood of her parents, suddenly got a child which died after a few days. At that time no thought of immorality seems to have entered into that news. It was evidently mere sadness about the quick death of the child which gave to the experience its emotional tone. She was at that time completely naïve. She received an intense shock in the thought that an unmarried girl may suddenly get a child which would then quickly die. She cannot tell whether the thought that she herself would get a child had ever entered her mind before this occurrence in her neighborhood, nor can she say that it occurred immediately or very soon after it. She now knows only that she has always had that thought, but whether that means more than ten years, she does not know.

I considered it a justifiable hypothesis that this strong emotional experience early in life had become the starting point for that secondary absurd thought. I considered that primary experience as cause for a deep physiological brain excitement which had irradiated towards the ideas of her personality. It had stirred up there associations which kept their psychological character while the primary disturbance had long lost its psychical accompaniment. It worked its mischief in a physiological sphere but was probably still the starting point for the persistent obsession. My aim was to remove this cause. It would have brought little improvement simply to suppress the freak idea as long as that physiological source was active. On the other hand I should not have the means to stop the physiological after-effects of that real experience: I had to sidetrack it and to secure thus a reduction. I decided therefore to work on the basis of that hypothesis, to accept that physiological complex as existing, but to switch it off by linking it with appropriate associations, thus setting it right in the whole system of her thoughts.

For that purpose I brought her into a hypnoid state, bending her head backwards and speaking to her with slow voice until I saw that a slight drowsy state was reached. In this state I asked her to think back as vividly as she could of that experience of her youth, to fancy herself meeting that pretty girl, her neighbor, once more. She is to imagine that she speaks with her. Now I make her talk with me and she assures me that she sees the scene distinctly. She believes she sees the girl on the street. I ask her to tell the girl how indignant she feels over her behavior; she is to tell her that she understands now all which she did not understand in her childhood, that she knows now that she must have lived an immoral life; that she must have had a friend and that a pure girl like herself could never under any circumstances come into such a situation, that no pure girl could suddenly have a child. She is to express to the other girl her deepest disapproval of such conduct and her own feeling of happiness that anything like that could never happen to her. In accordance with my demands, she worked herself entirely into the scene: without using audible voice, she internally spoke with great vividness to her neighbor. When I awoke her from her drowsy state, she was quite exhausted from the excitement. I repeated that scene with her four times. She assured me that she felt it every time more dramatically. The power of the obsession weakened from the first day. After the fourth time, it had disappeared. The subcortical complex had evidently found its normal channels of discharge.

In discussing this method of side-tracking the complex, we mentioned that in other cases the result is reached by bringing the memory of that first experience to a vivid motor discharge, without substituting any other ideas. For that purpose no direct personal influence is necessary. Treatment might just as well be performed "by correspondence," provided that the right starting point is discovered and that right suggestions are given. As an illustration, I may choose a case which shows at least the maximum distance treatment by mail, from Boston to Seattle. This particular case presented no difficulty in getting hold of the starting point as my correspondent, whom I have never seen, himself at once pointed to the original source of his obsessing idea.

The patient who lived with his family in Seattle wrote to me the following: "——I shall undertake to describe in a few words a condition which the writer has fought against for about eight years and which has subjected him to untold mental anguish.——I was backward in a social way but altogether happy. After working in a bank about a year, was discovered one evening by the cashier smoking a cigar in the basement, was unable to look him in the face at the time. Went home that night and thought very little about it, but on the following morning during the regular course of business, I stepped up to him to ask some question, and as usual, unconsciously looked him in the face. His glance was questioning and suspicious, and that was the beginning of a life of anguish for me. At first I could not look him in the eyes, then when looking at some other person, I happened to think of it and so on, until in two or three days it was impossible to look at anyone who came to my window. The cashier did everything he could for me. No use: I quit my position, lost most of my friends, had to leave a happy home and came to Seattle to work for an old school friend. In the first year, owing to new environments, I managed to conceal my mental condition to a certain degree. All of a sudden, I was again plunged into the depths of black despair. It took me about two years to (partially) forget it, when the same thing occurred again, and I lost my grip. The last time about eighteen months ago was almost more than I could stand. These three or four instances I speak of were cases of extreme despondency, but my usual mental condition is extremely unhappy. If occasions arise where I have to sit and talk to anyone for ten minutes, controlling myself is such an effort that it leaves me with a case of the blues.... I shall come and see you as the relief would give me a new lease on life."

This letter was written on the twenty-third of January, 1908. I replied to him at once that he certainly ought not to come from the Pacific to the Atlantic, but

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