We have discussed both the psychological theory and the practical work
of psychotherapy in a systematic order without any reference to personal
chance experience. After studying the fundamental principles, we have
sketched the whole field of disturbances in which psychotherapeutic
influence might be possible and all the methods available. It seems
natural that our next step should be an illustrating of such work by a
number of typical cases. Here it seems advisable to leave the track of
an objective system and to turn to the record of personal observation.
As this is not a handbook for the physician, dealing with the special
forms of disease, we emphasized before that we avoid even any attempt in
such a direction because it would have to introduce not only the
questions of diagnosis, but above all the highly important questions of
treatment by physical agencies. We saw that for us nothing else can be
desirable, but to show the way in which the various symptoms which
suggest mental treatment occur, and how they yield to the psychical
methods. We had also agreed beforehand that for a first survey we might
separate the mental from the bodily symptoms and group the mental ones
with reference to the predominance of ideational, emotional, and
volitional factors. And finally it may be said that we abstain from
everything which is exceptional or even unusual, and confine ourselves
to the routine observations with which the psychotherapist comes in
contact every day and the simplest country physician surely every week.
Thus I turn from systematic objectivity to my unsystematic reminiscences
of many years. Of course, they abound with eccentric abnormities and
startling phenomena. As I have devoted myself to psychotherapeutics,
always and only from scientific interest, as a part of my laboratory
studies and therefore have refused to spend any time on cases which
offered no special psychological interest to me, the striking and
sensational cases have prevailed in my practice even to an unusual
degree. Yet they are unessential for our purposes here, the more as
their interest lies mostly in the complex structure of the mental state
while the curative features are in the background. Our purpose of
demonstrating practical cases as they occur in every village, and as
they ought to be understood and treated by every doctor, thus rules out
just those experiences which would be prominent in a theoretical study
of abnormal psychology. We want to select only simple commonplace cases.
Only those who have not learned to see are unaware that such cases are
everywhere about them.
As a matter of course, I also leave out everything which refers to
insanity, that is, every mental disturbance which lies essentially
outside of the domain of psychotherapy. The helpful influence which
psychical factors can exert in the asylums for the insane is, as we
emphasized, entirely secondary. The psychotherapeutic methods in the
narrower sense of the word are in the present state of our knowledge
ineffective in the insane asylum. I should also be unable to speak of
laboratory experience with insanity, as I insist on sanitarium treatment
in every such case. The question of how to differentiate the diagnosis
of insanity from that of the other mental abnormities is not our
question at this moment. I select the few illustrations which seem to me
desirable for the purpose of making more concrete our abstract
discussion of methods, essentially from the class of neurasthenics,
psychasthenics, hysterics, and so on.
In all these reports, I shall confine the account to the few points
which are to illustrate the psychical factors, thus abstaining entirely
from the further details which any medical history of the cases would
demand and from all results of further examination and other
particulars. As a matter of course, I exclude the possibility of
identifying the patient. I may start with a typical case of obsessing
ideas of simplest character and with simple routine treatment
illustrating the emphasis on antagonistic ideas.
A man of mature age, well educated, well built and in every respect
in good health, without nervous history and without other nervous
symptoms, suffered vehemently by the persistent recurrence of a
visual image which entirely absorbed his attention. He knew
exactly the development of his trouble. A woman acquaintance of his
had committed suicide by poisoning herself. He knew her slightly
and the emotion of personal loss played hardly any rôle in the
case. But he had met her at a gay dinner a short time before her
death. The news of the suicide came to him when he was overtired
from work. The idea of the contrast between seeing his friend
partaking of the dinner and imagining her drinking the poison gave
him a strong shock. There was hardly any grief mixed in. He
remembers that he shivered at the thought of the contrast, and in
that moment the visual image of the woman raising a glass of poison
to her mouth flashed into his mind and thus became almost a part of
the shock. From that time on, the memory image of this scene
returned more and more frequently. At first it associated itself
with any chance mentioning of death or suicide and to a very slight
degree with the idea of a meal. More and more any element of a meal
and of social life, the word soup or meat, the word gown or dance,
brought up at once the picture of the woman, which had in the
meantime lost every element of personal relation. Any sad thought
of her ending had faded away. It remained merely a troublesome
impression. The man fought against it by trying to suppress the
idea but the more he fought against it, the more insistently it
rushed forward through new and ever new association paths. Any
advertisement in the newspaper referring to food, anything in a
shop window referring to ladies' dresses, any household utensils
related to a meal, and especially the meals themselves, forced the
visual image into the centre and captured the attention to such a
degree that a confusing distraction from the real surroundings
resulted. The struggle against the idea became more and more
exasperating, made life a torture, almost suggested despair, even
faint thoughts of suicide, and especially a growing fear that it
was a symptom of the beginning of insanity.
When he came to me, a number of physical cures, especially bromides
and electricity, had been tried in vain by the physician. Some
weeks in the country had not changed the distress. He came to me
with the direct request as a last resort to try hypnotic treatment.
I found in spite of the fact that he and his physician had
constantly spoken of visual hallucinations that the visual image
had no hallucinatory character at all, that is, he never believed
that he saw the image of that woman as if it were actually present,
he never took the product of his imagination for reality, nor had
it the vividness and character of reality. It was hardly more vivid
than any landscape which he tried to remember, only that it
controlled the interplay of ideas in such a persistent way. I found
that he was a strong visualizer and easily suggestible. I told him
beforehand that I should hypnotize him only to a slight degree,
that he would not lose consciousness, that he would remember
everything which I told him. Then I asked him to lie down and had
him gaze on a crystal only for half a minute, then close the eyes.
I asked him to relax and to think of sleep. With the two blunt
points of a compass, I touched his two cheeks at corresponding
places, then his forehead. And now I told him that I would begin
with the hypnotic influence. I put my hand on his forehead and
spoke to him in a monotonous way, saying that he felt a fatigue in
his shoulders, and in his arms, creeping over his whole body and
assured him that he was now fully hypnotized. To what degree he
really was hypnotized cannot be said as no effort was made to test
it by any experiments, thus avoiding any possible reaction against
the feeling of submission. Expression and breathing indicated a
slight hypnoid state. Then I removed my hand and spoke to him in a
warm and assuring way.
I told him that in future he would give his full attention to his
meal, and not give the slightest attention to any image of his
friend. If he should think of the friend the memory would appear
indifferent, he would not even notice the image and would give his
whole mind to the objects with which he was engaged. In the same
way, when he should be reading newspapers or looking in
shopwindows, his whole attention would belong to that which he
really perceived. Any passing inner image would be ignored. Then I
awoke him from his sleep. He was unwilling to believe that he had
been in hypnosis at all. I told him that the effect would prove it
and in his fully wakeful state I explained to him why there was not
the slightest fear of insanity justified, that it was a
psychasthenic state resulting from fatigue and shock and from a
wrong attitude of his attention during the past months, and then I
asked him to return the next day. Intentionally I had not given the
suggestion that the image would disappear. I could not expect it
would disappear entirely after a first treatment and even a faint
appearance of it would have at once fascinated the attention and
brought about the whole disturbance of the equilibrium which might
become habitual. Instead of it I gave the impulse to the
counter-idea, that is, I reënforced the attention towards that
which he really saw around him and thus withdrew the attention from
the rival image in the mind. The success was complete. He came the
next day in a much happier frame of mind, reporting that he still
had seen the image of the woman every few minutes, especially
strongly at the breakfast table, but it had no longer troubled him.
It was more in the background of consciousness, sometimes it
appeared transparent, it no longer held his attention, and he felt
free to give his full attention to the actual surroundings.
On that basis I hypnotized him the second day and he had hardly
heard me saying that he ought to try to sleep when he was evidently
in a much deeper hypnotic state than the first time. Again I
suggested only the opposite attitude, the positive turning to the
surroundings and the complete neglect and indifference for the
possible memory image. This time the effect was still stronger. On
the third day he reported that he still saw the image but he no
longer minded it, as it was like a veil through which he looked at
real objects and that left him entirely indifferent. His mind was
hardly engaged with it any more. The real spell of the attention
was broken. On the basis of this situation, I took the last step
and suggested that the image of the woman would disappear
altogether and would not trouble him any more. In the next
twenty-four hours, it still returned two or three times, but
colorless and faint. The following day I was able to eliminate it
altogether. Even when the last trace of the inner struggle between
the memory and the perceived surroundings had disappeared, I went
on with two hypnotic sittings to give stability to the new
equilibrium, to insist that the image would not come back and to
settle completely that inner repose with which every fear of
possible disease evaporated. I feel sure that the cure would not
have been reached so quickly, possibly not at all, if the second
suggestion, the disappearance of the image, had been given at the
first step. The improvement was secured because the antagonistic
process itself was used for the suggestion. On the other hand,
there was no doubt that in this case the strong will of the patient
or suggestion in a normal state would not alone have been
sufficient. The hypnotic treatment was indicated by the symptoms
and justified by the results.
I may take another typical case in which also the obsession was brought
about by an idea without emotional value or at least by an idea which
had lost its emotional character; the idea came somewhat nearer to
hallucination, but had its chief elements on tactual ground where the
transition from image to hallucinatory perception is easier. I add this
case to demonstrate that hypnosis is not the only open way of treatment
in such cases and that the variations must always be adjusted to the
special conditions. The case gains importance by the fact that the
patient was himself a physician well trained in mental observation.
The patient is a highly educated physician of middle age. He
reports that he had been neurasthenic all his life with slight
ever-changing symptoms. He has always been troubled by the
"perseveration" of tactual images which had a strong feeling tone
and which were associated with seen or heard reports of the
experiences of others. For instance, when he read in a newspaper
that someone had hurt his hand with a pin, or that someone had cut
his foot on a nail, he immediately felt a not directly painful but
uncomfortable sensation at the particular place in the hand or in
the foot, together with a shrinking of the whole body and such
tactual sensation usually returned during the following days in
fainter and fainter form until it faded away. Most troublesome had
always been the reading of any torture processes in historical
books or in fiction. Yet there had never been a case in which the
sensations really had the vividness of hallucinations and never a
case in which the after effects had not disappeared at least in a
few weeks.
This time the effect had already lasted four months and it became
more and more troublesome. The patient had not the slightest fear
of mental disease and no anxiety, but he felt a very serious
disturbance by the instinctive effort to get rid of the intrusion.
The place of the disturbance was the wrists. The starting point was
a definite experience. On an unusually hot summer day the physician
had listened for a long time to the complaints of a female patient
who suffered vehemently from a nervous fear of scissors and knives
and who was afraid that she would cut her artery at the wrist. He
believes that it was the exhausting heat of the day which weakened
him to a point where the story of his patient affected him very
strongly and made him think of it all the time. Yet there was no
sensation element involved. A few hours later, he sat in a hotel at
his dinner. Just in front of him a butler started to carve a duck
with a long, sharp knife. In that moment he felt as if the knife
passed through the wrists of both arms. He felt for a moment almost
faint; arms and legs were contracted and an almost painful
sensation lingered in the skin, and did not disappear for hours.
From that day at the sight of knives or razors, not only in his
hands or his direct neighborhood, but also in a store and finally
in a picture, stirred up at once the optical image of that carving
knife cutting into the skin of the wrist, only with the difference
that it seldom was found in both arms, usually in the one or the
other. The sensation became a strictly tactual one with optical
overtone, but there was no emotion in it. The pain element had
disappeared. Also the shock, 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 that I wanted him to write to me much
more about that first occurrence. As he was evidently right in
considering that episode as the starting point of his troublesome
associations, I supposed that these associated ideas had not yet
become independent but were still the effect of that first
"complex." Therefore I wanted to bring that to complete discharge.
Accordingly I wrote him to think himself once more into that
happening of years ago, to pass through it with all the power of
his imagination, to describe it to me then in as full a statement
as possible and to express in the letter also his conviction that
there was no reason to avoid the eyes of his superior, that he
might have looked straight into his face. As soon as he got my
reply, he wrote to me on the sixth of February a description of
that first episode, filling nineteen pages, telling me all about
his relations to those various men and every minute detail was
brought clearly to consciousness again. I did not add anything
further, but the expected occurred. On the eighteenth of February,
he writes to me: "In the last week or ten days, the writer has
noted a decided improvement regarding mental condition. The result
is a new interest in life. If you can spare the time, would like to
have you write me a few lines. Gratefully yours." At the end of the
month he writes: "Received your letter about half an hour ago.
Hasten to assure you with a great deal of pleasure that I am
feeling much better. Since sending you the letter regarding the
first case, I have noticed day by day an improvement." On the
eighth of March: "Since writing you last I have noticed a gradual
improvement. It has given me wonderful encouragement." On the tenth
of March: "Just a line to say that I am still improving." On the
twelfth of April: "I desire to say that since the taking up of
treatment with you, life has had a far different appearance to me
than it has had for the last ten years." On the twenty-first of
April: "Since my first letter to you, there has been such an
improvement that I have accepted a position which carries with it
much responsibility."
This case leads over to the large group in which the obsessing idea
involves the relation to a particular person. I find in such cases
autosuggestion more liberating than heterosuggestion if the development
has not gone too far. Of course autosuggestion can never take hypnotic
character, but makes use with profit of the transition state before
normal sleep. The type of these cases which are everywhere about us may
be indicated by the following letter.
The writer is a young woman of twenty-four, whom I did not know
personally. She wrote to me as follows: "I am a writer by
profession and during the last year and a half have been connected
with a leading magazine. In my work, I was constantly associated
with one man, the managing editor. This man exerted a very peculiar
influence over me. With everyone else connected with the magazine,
I was my natural self and at ease, but the minute this man came
into the room, I became an entirely different person, timid,
nervous, and awkward, always placing myself and my work in a bad
light. But under this man's influence, I did a great deal of
literary work, my own and his too. I felt that he willed me to do
it. The effect of this influence was that I suffered constantly
from deep fits of depression almost amounting to melancholia. This
lasted until last fall, when I felt that I should lose my mind if I
stayed under his influence any longer. So I resigned my position
and broke away. Then I felt like a person who, having a drug to
stimulate him to do a certain amount of work, has that drug
suddenly taken away, and without it I am unable to write at
all...." I wrote to the young lady that she could cure herself
without hypnotism and without my personal participation. I urged
her simply to speak to herself early in the morning and especially
in the evening before going to sleep, and to say to herself that
the man had never helped her at her work, but that she did it
entirely of her own power, and that he had never had any influence
on it, and that she can write splendidly since she has left the
place, and much better than before. A few months later, she came to
Cambridge and thanked me for the complete success which the
auto-suggestive treatment had secured. She was completely herself
again and was fully successful in filling a literary position in
which she had to write the editorials, the book reviews, the
dramatic criticisms, and the social news. As a matter of course,
such treatment had removed only the symptom. The over-suggestible
constitution had not been and could not be changed. Thus it was not
surprising that in the meantime, while her full literary strength
had come back, she had developed some entirely different symptoms
of bodily character which I had to remove by hypnotism.
As soon as the obsessing idea of the influence of another person takes
still a stronger hold and develops systems, the suspicion of insanity
always lies near; especially when hallucinations are superadded, the
probability is great that we then have to do with the delusions of a
paranoiac, and thus no case for psychotherapeutic treatment. Yet it is
always wise to keep a psychasthenic interpretation in view as long as
the insanity is not evident. I may mention such an extreme case.
The patient, a man of middle age, highly educated, for years had
heard voices calling his name. A man with whom he had some personal
quarrel, had, as he believed, hypnotized him from a distance and
made him act queerly or do things which he really did not want to
do, by telepathic influence. It is a development which is found
quite frequently. Abnormal organic sensations or abnormal impulses
and inhibitions which the patient cannot account for by his own
motives become connected with some vague ideas which are in the
air, like wireless telegraphy or telepathy or hypnotism from a
distance or electrical influence, or magnetism or telephoning,
these then attached to an acquaintance who stands in a certain
emotional relation. Here, too, some organic sensations evidently
had been the starting point and the idea of the man with whom he
quarreled had been secondarily attached. From this starting point
more and more detail was reached. Every action was brought into
connection with the powerful enemy who controlled more and more
even the normal and reasonable doings of the patient. My first
impression was decidedly that of a paranoiac. Yet in some ways the
case suggested another view. There had remained an insight into the
unreality of the obsession. The patient did not really believe the
theory of the telepathic hypnotic influence. He felt it more as an
idea which he could not get rid of and he did not know clearly
himself whether he requested hypnotic treatment on my part for the
purpose of counteracting the hypnotic power of his enemy or for the
purpose of liberating him from his exasperating fixed idea.
Moreover, I found that his voices had no hallucinatory character,
but were merely sound images. I decided to make the experiment
without great hope of success.
I hypnotized the man deeply and suggested that no one can have
power over his actions, that he is the responsible originator of
everything that he does and that no one can influence him and that
from that hour he would feel free from any telepathic intrigue. The
effect of the very insistent and urgently repeated hypnotic
suggestion during the first rather long treatment was such a
surprisingly good one that I decided to continue the
psychotherapeutic cure. I hypnotized him daily for two weeks. The
belief in the real wrong doings of an enemy disappeared entirely
from the first. It was at once apprehended as a mere obsessing idea
in the own mind and this idea itself began to be resolved. It lost
its unity; the absurd impulses were still felt but they became less
and less connected with the idea of another man, and as soon as
they were rightly understood as doings of the own mind, the
opposite motives gained in strength. A stronger and stronger appeal
to his own power made these motives more and more influential.
Slowly the association of the influence of the other man faded away
entirely. I intentionally had not given any attention to the
pseudo-voices, inasmuch as they had not taken any relation to the
ideational delusion. I therefore did not include them in my
suggestions, as I consider it wise to confine hypnotic suggestions
always to as few points as possible. Yet these voices decreased
too. At a certain point in the cure I substituted—to save my own
time—an autosuggestive influence, or rather a mixed one, inasmuch
as I had him read ten times a day a letter of mine which contained
appropriate suggestions. After about six weeks, all the
disturbances for which he had sought my advice had disappeared.
Obsessing ideas of such personal influence involve of course always a
certain amount of emotional excitement and they may lead us to the
unlimited field of disturbances in which the persecuting idea is
surrounded by emotional attitudes. Analysis shows easily that the
emotion is an essential factor and that it persists in the disease while
the ideas to which it clings may change. Central is the emotion of fear;
nearest to it that of worry, but any emotion may give color to the
particular case. Again any number of methods may be applied and a few
illustrations with quite different ways of treatment may indicate more
fully the character of the trouble. There is no doctor in the city and
none in the remotest village who may not find such cases in his near
neighborhood. Of course slight degrees are easily hidden by the
patient's own inhibition of external expression. If such suppression by
the own will secures a real overcoming of the unjustified emotion, this
is surely better than to begin any medical treatment. But as the
suppression usually means simply lack of discharge and thus offers all
the conditions for an unhealthy inner growth of the trouble, the neglect
of such disturbances is most regrettable, and frankness of the patient
must be encouraged. Such situation demands a careful observation of the
whole case and a subtle adjustment of the treatment to the individual
needs. It may perhaps be helpful at first simply to indicate the
varieties of the more frequent disturbances of this kind by quoting from
various letters. Each case belongs to a type which can easily be removed
by psychotherapeutic influence, generally even by a skillfully directed
autosuggestion.
The writer is a young man.
"I have always, as long as I can remember, been very nervous and
sensitive. When about seven years of age, I was attacked by St.
Vitus' Dance. Before that I cannot say whether I was particularly
nervous or not. Afterward it was impressed upon me by the remarks
of relatives that I was nervous, so that I soon took note of this
condition myself. The manner in which this weakness has been
especially troublesome is that it has caused me to be very shy. I
shrank from new acquaintances and disliked being observed. Often in
walking along on the street, I imagined myself closely noticed by
the passerby and I always felt uncomfortable.
"About three years ago I suffered from typhoid fever and after
recovering, a new form of the old trouble showed itself. This time
I imagined that when eating I chewed my food in a manner that was
ridiculous and which made people hardly keep from laughter in
observing me. Often I had to leave the table when half through
because I felt I could not bear having critical eyes upon me any
longer. About three months ago I determined to be troubled no
further by my own foolish fancies and by constantly schooling
myself I have improved very much. Still, however, when I walk alone
along the street, I must fortify myself mentally before passing
each group of people. If once I allow myself to think that they are
looking at me, I feel almost paralyzed, my feet seem too heavy to
lift, my arms do not seem to swing naturally, and in attempting to
look placid and unconcerned, I feel that I am failing utterly. Also
when at table, I must still tell myself before each mouthful that I
have no need for fear, that my manner at table is equal and perhaps
superior to the others beside me. I have gone a certain length in
my self-training, and have relieved myself of a great deal of the
mental distress, but now I believe I can advance no further. What
seems needful now is to do away with the self-consciousness which
brought on my worries, though whether this is possible is hard to
say."
Here the letter of a young woman, the type which fills the army of the
mind healers and faith curists.
"For years I have been seeking, or perhaps to be more accurate I
should say waiting, for a mind to drift toward me; a mind that
would understand my particular case of fear brought on by the
constant bullying and nagging from my earliest childhood by those
in my home. This fear of brutality has greatly depleted my nervous
system and has unfitted me for the strong, useful, forceful life I
should have expressed. If I could only rid my mind of the thought
that I am always displeasing, or rather, going to displease people,
for I hardly do displease them; if I could get rid of the fear of
caring what the attitude of other minds toward me is, I feel that I
should then strike out into a strong life of helpfulness to others.
In other words I have always felt behind me a great force pressing
me out into public work. When I was a child, it was so strong that
I was sat down upon brutally, to so great an extent that I feared
to voice my convictions and that fear still clings to me like a
nemesis. It seems that every individual personality in a public or
private audience rises up to overwhelm me, causing my tongue to
grow heavy and my mind to become a blank. This enervating fear
blends into every thought I have, whether sleeping or waking. I
have fought with all my might to rid myself of it but so far in
vain."
Here an expression of a very frequent variety. The writer is a
middle-aged man.
"I am possessed of a fear that is constantly with me that something
dreadful is going to happen and I do not seem to be able to
overcome it. I am told by physicians that I am bodily sound,
although very nervous, and that the fear is generated entirely by
autosuggestion. When at its worst, it weakens and terrorizes me and
in my better moments I am tormented with a fear of a recurrence of
a bad spell. It is fear of a fear. A year ago at this time I had a
very bad spell but got along fairly well through the summer, but I
am afraid that I will soon again be in a bad condition and lose all
that I may have gained."
The "fear of a fear" is indeed a symptom which the psychotherapist has
to fight extremely often, but as soon as he has really recognized it and
analyzed the whole mental condition, he will hardly have any difficulty
in uprooting it. I add a letter of a school-teacher in New York. He
writes:
"I am teaching in a high school. I am of a nervous temperament and
constitutionally limited in endurance. Often my work is done in a
condition of greater or less exhaustion. I find that I blush very
easily in purely freakish ways, when there is no occasion for it. I
find this blushing connecting itself with certain of the girl
pupils of my classes in a conspicuous way. It occurs hardly ever
except when my class is facing me and I seem to be powerless to
overcome it. I have always tried to live a careful moral life, but
my early life was very much secluded. I lacked entirely the free
intercourse young people usually have together and I felt awkward
with others for a long time. In the matter of the blushing, it
sometimes occurs in the case of girls who are especially pleasing
to me but also not infrequently in the case of some who are not at
all so. The whole thing might be passed over were it not that it
has considerable effect in causing constraint toward my students
and in some cases affecting them very strongly in an emotional way
at the very time of life when such things can do most harm. I
regard the matter as being so serious that it brings directly in
question my right to teach, but I do not feel at all sure I could
find other work that I could do if I give up my present position.
The very thought that on a particular occasion it would be
extremely awkward to blush makes it almost impossible for me to
avoid it."
But we have rather now to consider the therapeutic side, and we may
begin again with a routine method of a simple hypnotic treatment.
The patient is a young university professor. His intellectual work
is perfect in all directions. There are no nervous symptoms, though
there are some slight disturbances of digestion. He suffers as soon
as he comes into a crowd of people and as soon as he is on any high
place, where he has to look down; the worst when both conditions
are combined, as for instance, at a concert or a theatre in a
balcony seat. But every meeting of many persons, even at church,
produces all the symptoms of nervous excitement. He was easily
brought into hypnotic state by verbal suggestions. When he was in
hypnosis, I reënforced the conditions for an opposite attitude. I
told him that as soon as he was in a crowd of persons he would feel
especially comfortable, would enjoy himself, would fully enter into
the spirit of the occasion and feel especially secure in their
presence. Whenever he should be on a high place, he would enjoy the
safety of the ground on which he was standing or the seat on which
he was sitting. I assured him that he would neglect entirely
whatever he saw and would rely completely on his safe feeling
resulting from his tactual impressions. After having hypnotized him
three times the disturbance disappeared completely, and even an
evening at the theatre in an exposed box on the balcony was enjoyed
without any discomfort. After about a year, at a period of
fatiguing work, some traces of the anxiety appeared again. This
time two hypnotic sittings were sufficient to remove the
disturbance of the equilibrium, which as far as I know has not come
back. The same hypnotic treatments were used in a secondary way to
remove the digestive trouble.
I again quote the case of a teacher, a profession in which the
psychasthenics are unusually frequent. It is a case of a young woman
from the Middle West.
The young lady wrote me: "I come of a race of strong women and am
not hysterical or easily frightened by many things that disturb
women. Since my fifteenth year I have been seized by hallucinations
of absurd or serious nature which no reasoning could explain away
and which have gradually undermined my power of resistance to them.
At the age of twenty-two, after a year of unusually hard work, my
nervous endurance gave way, and with this breakdown came a sense of
fear and a horror of crime that I have been unable to overcome. I
have never felt the slightest inclination toward wrongdoing. It is
a feeling rather that my shrinking from any mention of evil makes
it impossible for me to listen or think rationally when such things
are discussed. This feeling has seemed to change my whole attitude
toward life and has left me without power to control my facial
expression or carriage when it takes possession of me. I have been
able to teach more successfully than I could hope, but it is only
by cutting myself off from the friendships and pleasures incident
to my life that I am able to accomplish my work. I have fought this
trouble alone and will still do so if there is no help, but the
thought that it is the source of great distress to those dear to me
makes it very hard."
A few weeks later the lady insisted on coming to Cambridge. I found
that there had never been any hallucinations and that she used the
word in her letter only to indicate some insistent memory images
which had never taken the vividness of real impressions. In the
presence of her friend, I hypnotized her deeply and strengthened
through urgent suggestions her consciousness of her having done the
morally right thing at every situation in her life and her
conviction that she never did and never would commit a crime. Here
as always, if possible, I left alone the emotional idea but
reënforced the opposite. The effect was an immediate one. She felt
freer the next day than she had felt for years. I repeated the
treatment a few times and she assured me that the feeling had
disappeared entirely.
I take the rather severe case of a woman of fifty.
The highly educated and refined lady had lost her husband by an
accident in Switzerland, which had been misrepresented by some of
the newspapers as suicide. Two years later she wrote to me: "I feel
as if I had received indelible photographs on my brain which have
since greatly affected my health and from which I may never
recover. This winter the symptoms I have been able to control
returned and I have been ill. I unfortunately saw the newspaper
headlines with my husband's supposed suicide. Though I exclaimed
then, 'how outrageous,' I felt as if I had been struck and since
then I can seldom read a paper without dread and apprehension, and
the hearing of anyone's suicide fills me with terror. When I
hurried to Europe, on the ocean a week from the day of my husband's
death, I had a curious and overwhelming shock. On opening a drawer
and seeing a pair of scissors, they looked to me like a dagger and
suddenly the whole cabin seemed filled with implements of death.
The doctors said that I would find it hard to get over such
impressions but I told them I would, as I had courage and will. But
I have been realizing in these two years that I may be suffering
from something that may be beyond the control of will. I often
become so nervously sensitive that scissors are unbearable for me
to see, or a steel knife or anything that might express death. Our
family physicians are still against hypnotism, and if I should go
to a neurologist of my own selection, it might be to one who
believed still only in nerve foods, baths, or a sanitarium."
The lady came from the South, with her nurse, to Boston and
insisted on being hypnotized by me. I cannot say whether a really
deep hypnotic state was produced at once as I refrained from
testing it. There was certainly no amnesia. Probably it began only
with a slight drowsiness but at the fifth treatment I found a
relatively deep hypnosis. It was a capricious case in which the
improvement was fluctuating but clearly setting in from the first
day. I trained her in hearing and seeing words like death and
suicide with a reënforced feeling of strength and calmness; I
forced her to see and touch scissors with an artificial attitude of
strength and indifference. At the same time I reënforced her good
mood and her enjoyment in life. When she left for England a few
weeks later, she felt herself mentally cured, and throughout the
summer her letters testified the wonderful change which the
treatment had brought about. Half a year later, as the result of
an exhausting physical local treatment, the psychophysiological
symptoms came back to a certain degree. She requested me by a
letter from England to give her some help by suggestion to suppress
again the recurring intrusions. As I had observed her strong
suggestibility, I sent her over the ocean a little pencil of
mother-of-pearl which she had seen in my hand, and advised her to
look at it until she counted twenty slowly and then to close her
eyes and simply to sleep. The autosuggestive effect was unusually
strong. She writes from London: "When I saw the enclosure of your
letter I felt as if it would burn through my hand and the feeling
became so overpowering that I locked it away with my jewels, but as
the days ran into a week I felt I could not live with it in my
apartment any more, and I felt almost ill, until it occurred to me
I could seal it and take it to my bankers. I felt as dreamy and
absent-minded and paralyzed as if you had just treated me."
Nevertheless the effect was on the whole the desired one and she
returned to America with a wholesome freedom of mind. I hypnotized
her twice again and she writes in her last letter: "I can never
repay you for what you have done for me. You have given me back my
courage and my love of life in its vividness and interest and
color, all that through the last years I had so entirely lost."
Even in cases where the disease itself is inaccessible to
psychotherapeutic treatment, the superadded grief and worry brought on
by the disease might yield to the mental influence and the whole
situation would to a high degree be transformed for the better by it. I
have often been asked to hypnotize in such cases, where the depression
was wrongly taken as a part of the nervous disease; sometimes I agreed
to do it in spite of feeling sure that the disease itself could not be
removed. I quote an instance.
A young woman afflicted with epilepsy was brought up in the belief
that she had only from time to time fainting attacks from overwork,
and with them secondarily neurasthenic symptoms, especially spells
of depression colored by a constant fear of the next fainting. She
had heard voices all her life and they frightened her in an
intolerable way. I produced a very slight hypnotic state. I
concentrated my effort entirely on suggestions which were to give
her new interest in life, and diminished the emotional character of
the voices without even trying to make them disappear. I proceeded
for several months. The young woman herself believed that the
fainting attacks came less frequently afterwards; yet I am inclined
to think that that is an illusion. But there was no doubt that her
whole personality became almost a different one with the new share
in the world. The epilepsy remained probably unchanged but all the
superadded emotions were annihilated and she felt an entirely new
courage which allowed her to control herself between her regular
attacks. She had been unable to undertake any regular work before
for a long while, but all that improved. More than a year
afterward, she wrote me: "I have really worked most of the time
this past winter and spring and I think I can see a steady though
slow gain. I am reading quite a little and doing it for the most
part easily. To be sure I have, after I have read, hard times with
the voices but their character is usually less determined and
fearful than formerly. Several times I have thought I must come
again to you but each time I have started again to fight it out for
myself, but now, as I am gaining, I can better estimate the great
help your influence was to me at a juncture when everything seemed
so hopeless and helpless."
Even in slight psychasthenic disturbances, the psychotherapeutic
influence is not always successful, especially if there is no time for
full treatment. But it is very interesting to see how even in such cases
the symptom is somehow changing, almost breaking to pieces. It becomes
clear that a protracted effort in the same direction would destroy the
trouble completely. Typical is a case like the following.
An elderly woman has been troubled her life long by a
disproportionate fear of thunderstorms with almost hysterical
symptoms. As she had no other complaint, I hardly found it worth
while to enter into a systematic treatment and could not expect
much of a change from a short treatment, considering that her
hysteric response had lasted through half a century. As she begged
for some treatment, I brought her into a drowsy state and told her
that she would in future enjoy the thunderstorms as noble
expressions of nature. The whole procedure took a few minutes. Yet
after some summer months she wrote me a letter which clearly
indicated this characteristic compromise between the habitual dread
and the reënforced counter idea. "I have the same sick dread at the
sight of thunder clouds that I have always had, but I seem to have
gotten somehow a most desperate determination to control my fear. I
have done this to the extent of keeping my eyes open and looking at
the storm. Is that hypnotism or pride?"
Another thunderstorm case may lead us to other methods of treatment.
Here again in the field of emotional response, we may consider the
methods of going back to primary experience, known or forgotten.
A young married woman of the West had suffered always from
hysterical attacks in response to any sharp sudden impressions,
especially sudden loud noises. The banging of a door, but worst of
all a thunderstorm, could produce hours of weeping and crying and
desperate mental condition with all expressions of excitement. Her
husband wanted me to hypnotize her but I preferred another way. I
tried to get her memory back to the earliest case of which she
could think of this hysterical response. As long as we were in
ordinary conversation, she could not trace it beyond about her
twelfth year. But when I brought her into a drowsy state, her
memory revived older experiences and finally settled at a school
experience in her seventh year of age. She then had an excitable
country school-teacher who relied on whipping the children. Once
her neighbor in the class did something forbidden. Her teacher
mistook her for the culprit and began to whip her most forcibly
before she could explain anything; and while the punishment was
going on and she began to bleed from a wound, she all the time felt
that she wanted to express her innocence and could not speak. After
that, evidently the first attack of hysteric character followed.
From that time on any sudden impression released the same group of
reactions. The suppressed emotion had evidently become a
psychophysical "complex." As soon as I had reached this starting
point of her pathological history, I asked her to bring back to
consciousness as many details as possible of that first incident.
She told me all the names and described the classroom and brought
herself vividly into the whole situation. Then I asked her to tell
me the whole story once more and to express strongly her innocence
and the wrongness of the punishment, and when she had completed her
account, brought out with fullest indignation, I had her tell the
whole thing once more and then a third and a fourth time, until she
was quite tired out from it. That was all I did. Very soon after,
the husband reported that there was a great improvement in every
respect, no hysteric attacks, only slight discomfort. Most of the
stimuli which had previously produced strong reactions now passed
without any disturbance and even thunderstorms were experienced
with relative ease. A year later they came once more to Cambridge,
and she simply passed once more through the same process of
discharge which seems now to have removed the symptoms still
further.
By far more reliable, however, is the method of side-tracking the
starting experience into a new associational track.
A gentleman with a decidedly psychasthenic constitution developed a
tendency to hesitate in walking on the street. It was not a
complete stumbling but a disturbing inhibition, which set in when
he was walking alone and his attention was not absorbed by
something on the street. He believed that it came on most strongly
when he looked down at the pavement. He suffered from it vehemently
and avoided going on the street alone. He was unable to connect it
with any starting point. He interpreted it as merely a symptom of
overwork. But going with him through all kinds of experiences which
he had had on the street in previous years, we finally found that
once he was running to catch a street car, when he suddenly saw
almost immediately before him a big hole dug out for laying gas
pipes. He was able to stop himself quickly enough not to fall into
the hole but he got a strong emotional shock from the experience.
He, himself, did not think that his walking troubles set in
immediately after this shock. Yet the hypothesis seemed to me
sufficiently justified that there existed a connection, even though
some weeks lay between that first experience and the first
observation of the abnormal inhibition in walking. On that basis I
tried to train a new associative connection. I made him drowsy and
asked him to think himself once more into the situation of his run
for the car but as soon as he reached the hole to jump over it. He
went through this motor feature on ten successive days with new and
ever new energy and from that time up to the present the trouble on
the street has disappeared entirely.
To mention at least one case of the large group in which suppressed
sexual emotion was the evident source of an anxiety-neurosis, I mention
the case of a woman who showed very strong symptoms of anxiety and
oppression and who was cured by a simple advice.
The woman, aged thirty-two, was a saleswoman in a large store
selling gentlemen's gloves and ties. She suffered from time to time
by attacks of vague anxiety in which her heart showed vehement
palpitation. There were paleness and perspiration and at the height
a nervous trembling together with a feeling of despair. These
attacks were not frequent, separated sometimes by weeks, sometimes
by months, but troubling her exceedingly. She had been assured by a
physician that her heart was normal and that she was probably
overworked. She could find absolutely no source of the disturbance.
After a long conversation, I was also unable to discover any direct
or indirect causes until I worked on the basis of those theories
which we have discussed, the theories which connect hysteric
symptoms with chance intrusions which stand in relations to past
suppressed emotions of sexual character. The patient absolutely
denied any present sexual emotions. She had been engaged about
eight years before and acknowledged that at that time there were
strong sexual feelings connected with her fiancé, who broke the
engagement. Psychoanalytic methods now brought it to full clearness
that she had her first attack after selling a pair of gloves and
fitting them to the hand of a male customer who had a certain
similarity to her fiancé. It was not possible to trace this in the
same way for later cases too, but it seems that bodily contact with
a man by fitting gloves preceded every attack. All this was brought
out partly by questions, partly by free ascending associations
while she, herself, believed that she simply pronounced nonsense
words as they came to her mind, and partly it was secured in a
half-hypnotic state. I came to the conclusion that the suppressed
sexual emotions at the breaking of the engagement were the primary
cause of the disease. The similarity of the first customer together
with the tactual sensations had evidently touched that complex and
brought the suppressed emotion to an explosion which frequently
takes the form of palpitation and similar symptoms. Later the mere
tactual sensation alone produced by the contact with the hand of a
man, possibly with a similar optical impression, perhaps also with
the sound of the voice, brought back the reaction. Instead of
giving treatment, I insisted that she change stores, and become
saleswoman in a house where she would have to do only with women,
and to sell articles which did not bring her into personal contact
with customers. After more than six months of work in her new
place, she reported that the attacks had not come back again.
Of course it may readily be acknowledged that this method does not allow
a sharp demarcation line between its various factors. It cannot be
denied that an element of straight suggestion may be included. The man
whom I train in the forming of a new antagonistic motor response feels
it of course all the time also as a silent suggestion to overcome the
old disturbance. It is thus to a certain degree impossible to say where
the effect of the discharge ends and where that of the hidden suggestion
begins. Yet there certainly cannot be any doubt that this revival of the
first experience and its improved discharge works directly towards the
removal of the troublesome symptom.
Abnormal fear is also the essential factor in most cases of stammering.
The patients usually know it themselves. For instance, a lawyer writes
to me:
"I have been a stammerer the greater part of my life and have
visited every stammering school in the country, but the relief
obtained has been temporary and in most cases I was not benefited
at all. I am convinced that stammering is due wholly to an abnormal
mental condition, which consists of an unreasoning fear that takes
possession of the individual when he attempts to utter certain
sounds. It is simply a lack of confidence inspired by numberless
failures to articulate properly and is not caused by any organic
trouble, because, taking my own case for example, I can at times
talk as fluently and easily as anyone. I am firmly convinced that
stammering can be cured by hypnotic suggestion. If you could get me
in the hypnotic state and suggest to me repeatedly that from
thenceforth I would have easy fluent speech, I feel absolutely
certain that such would be the case."
Or an engineer writes to me:
"At times I stammer very badly. In an ordinary conversation it is
scarcely perceptible, but it is almost impossible for me to make an
explanation or relate an incident or tell an anecdote. I began to
stammer when I was about seven years of age—I am twenty-nine
now—and continued until I was seventeen, when I broke myself of it
by reading aloud. It came back on me about a year ago, at which
time I was laboring under a very severe nervous strain on account
of business matters. I have since tried to break myself of it in
the way that I did at first, reading aloud, but have been unable to
do so. Can it be cured by hypnotic treatment or suggestion? Can any
hypnotist of ordinary ability do it?"
I should affirm this question, which is one of the most frequent put to
the psychotherapist. And yet, if I myself have entirely given up the
cure of stammerers in recent years, it was not only because there was
little chance to learn anything new scientifically from it but also
because it was ultimately disappointing, as the severe cases cannot be
cured entirely. Every hypnotist can quickly secure a strong improvement.
In even new cases I found an almost surprising improvement in the first
two weeks, an improvement which stirs up the most vivid hopes of the
sufferers. Then the improvement becomes slower and finally it stops
before a complete cure is reached. The patient notices it and it easily
works back on his emotion and thus begins again to disturb the speech,
unless a very careful continuous counter-suggestion is given. Slight
disturbances, to be sure, can be removed entirely. The essential point
will always be to suggest to the stammerer the full belief that he is
able to speak every word and that he is able to speak it in every
situation. But where there is a limit for improvement, we must take for
granted that the disturbing fear is only superadded to an organic
trouble. In such cases, probably the inability of certain nervous paths
was primarily irreparable. These inabilities then became the source of
discomfort and of fear and this fear added greatly to the disturbance.
Hypnotism then quickly removes that part of the disturbance which had
been superadded by the mental emotion but it cannot remove that primary
factor, the objective inability, and every cure thus finds its limit
there.
Near the field of emotions stand also the many varieties of sexual
abnormities and perversities. I abstain from discussing any special
cases but it may be said that suggestive treatment is in this region
powerful to an almost surprising degree. Even homosexual tendencies
which go back to the beginnings of the memory of the individual yield,
as my experience shows, in a few weeks, if again the suggestion is not
so much directed towards the suppression as to the creation of the
antagonistic reaction, that means in this case, of the normal sexual
desire.
Both ideas and emotions, of course, lead to actions. Moreover we always
insisted that the resulting action is an essential part of the
psychophysical situation and that every mental experience has to be
characterized as a starting point for action. Yet this factor of
activity and of attitude sometimes stands in the foreground. The
controlling idea is then the idea of an end of action, the predominant
emotion, the emotion anticipated from a certain activity. Typical for
that are those disturbances in which an abnormal impulse or an abnormal
desire awakes perhaps a desire for ruinous drugs like morphine or
cocaine or an impulse to criminal deeds, like stealing. But the
disturbances of the psychomotor factor are not less present when the
central complaint is a lack of energy, the most frequent symptom of the
neurasthenic; and our whole discussion has made it clear that a mere
lack of attention belongs to the same category.
Of course, the abnormal impulse is psychophysically not different,
whether it leads to a legally important result like the impulse to kill
or leads to an indifferent result. The subjective suffering may be the
same in both cases. The starting point of the impulse may be any chance
experience. The psychasthenic may pick up such impulses from any model
for imitation or from any haphazard report. It may be entirely freakish
and yet beyond conscious control.
A physician had read in a well-known book on hysteria about a case
in which a girl was troubled by a constant effort to move the big
toe in her shoes. This idea worked on him as a suggestion for
several months. At my advice he fought it by auto-suggestion. He
brought himself into a slightly drowsy state by staring into a
crystal ball and assuring himself by spoken sentences with
monotonous repetition for a long while that he has perfectly the
power to hold the toe at rest. From the second day only a slight
kinæsthetic sensation remained; the movement itself disappeared.
Or a more unusual case.
A young lady once noticed in a man a different color in the two
eyes. It gave her an uncanny feeling, together with the natural
impulse to compare the two eyes. Accordingly she shifted her own
eyes from one eyeball to the other in the man's face. The accent
which this shifting impulse had received by the disagreeable
feeling evidently forced her to repeat this movement with everyone.
At first it became half a play, but soon a disturbing habit and
finally an intolerable impulse. Whenever she talked with anyone,
she lost control of her eyes and was obliged to enter into a kind
of pendulum movement from eye to eye. The situation became so
unendurable that the thought of suicide began to occur to her. I
hypnotized her four times, suggesting to her complete indifference
as to the face of those with whom she spoke and at the same time
certain new habits of fixation. The impulse lost its hold and when
I saw her last, it had completely disappeared.
By far more frequent than such neutral impulses are the desires, for
instance, of the alcoholist. On the whole it may be said that
psychotherapy can gain its easiest triumphs in the field of alcoholism
and a wide propagation of psychotherapeutic methods and of a thorough
understanding of psychotherapy would be fully justified, even if no
other field were accessible but that of the desire for alcoholic
intemperance. The moral disaster and economic ruin resulting from
alcoholic intemperance, the physical harm to the drinker and to his
offspring is so enormous, and the temporary cure of the victim is so
probable that the movement certainly deserves most serious interest. Yet
I speak of temporary cure and I refer here especially to the restriction
with which I introduced the psychotherapeutic methods in general. They
do not deal with diseases but with symptoms; and they certainly do not
deal with constitutions, but with results of the coöperation of
constitution and circumstances. That the given constitution may be
brought anew under conditions which again stir up similar symptoms is
always possible, and just with alcoholism the danger lies near unless
beneficial influences remain in power. Certainly no one has a right to
neglect such psychotherapeutic aid simply because relapses are possible.
Even a temporary relief can be a great blessing. Moreover, the temporary
relief is the safest basis to work towards the prevention of a
recurrence of the evil. Only in two directions is further restriction
needed. Psychotherapeutic methods are in my opinion of very small avail
in cases of periodic drinkers. Such periodic attacks of patients who
have not even a desire for alcohol in intervals between the attacks,
intervals which may last a quarter of a year, are related to epilepsy.
It seems that constant hypnotic influence during the interval has a
certain power to reduce the periodic impulse. I personally have not
seen any special improvement from it. The second restriction would be
that the drinker has to be under constant supervision during the first
days of hypnotic treatment. No patient, not even the morphinist, is so
skillful in deceiving his friends and even the physician. Even the most
emphatic gestures of sincerity ought to be distrusted.
Only a short time ago I dealt with a young man whom his parents and
a chauffeur had accompanied to Boston, exclusively for the purpose
of watching him constantly while I was to attempt to cure him from
excessive whiskey drinking. The chauffeur accompanied him from his
room in the Boston hotel to the threshold of my laboratory. All
through the day he was with his parents, and at the hotel the
management had given the strictest orders not to sell any drink to
the young spendthrift. He was an earlier student of mine and had
attached himself to me with such an apparent sincerity as removed
every possible doubt of his pledge. Intentionally I had not even
asked him for a pledge not to drink but only for a pledge to
confess to me the next day if he ever should take any alcohol. In a
tentative way I suggested to him in a half hypnotic state on the
first day that he would feel disgust for whiskey. I did not expect
much of an improvement before at least three or four treatments. I
was therefore most surprised when he most solemnly assured me the
next day that he awoke in the morning with an assured feeling that
he should never touch whiskey again and that he had not the
slightest desire for it. Instead of a systematic development of
suggestions, I confined myself therefore to a mere repetition of
the treatment of the first day and as every morning the same
assurance came forth, there seemed to be no need for any
variation. It was not before the fifth day that I discovered that
he had taken from the start a pint of whiskey every day. When he
first arrived he had bribed a laundress of the hotel to bring to
his room every day the whiskey hidden in the laundry and he drank
it during the night. Then I declined any further participation.
The danger of deceit is of course less imminent when not the family but
the patient himself takes the initiative. Yet even here distrust is
wise. The patient has sometimes the most sincere intention to be cured,
but under pressure of his craving he admits compromises which he hides
from the physician. Having reduced the large quantity of alcohol to
which he was accustomed, he hides the fact that he yet takes a few
drinks, which he thinks cannot prevent the cure. Yet inasmuch as a
complete cure has to rely on psychical factors, this consciousness of
deceiving even with small transgressions interferes badly with progress
and, inasmuch as the cunningness of the patient is itself a symptom of
the disturbance, the strongest possible precaution is advisable at the
beginning. For that reason it is also not best to begin at once with
complete prohibition, but to lead to a total abstinence in about one
week. But certainly in the case of every drunkard, total abstinence is
the only desirable goal. A pronounced drinker ought never to be
transformed simply into a moderate one. The return to intemperance would
result rapidly. On the other hand it would be unfair to deny that
psychotherapy has cured the symptom if the desire really once
disappeared completely, even if, after years, new temptations develop a
new desire. I myself had diphtheria three times in my life; my
constitution is thus probably especially favorable to that disease but I
do not estimate less the fact that I was perfectly cured the second
time, in spite of the fact that I caught it a few years later a third
time. To be sure, such experiences of relapse cannot be spared any
psychotherapist. I may give a typical instance.
A well-known professional man of fifty years, through a long
bachelorhood, was accustomed to close his work at four o'clock and
then to sit comfortably in his study with a book and an unlimited
supply of brandy. He took one cognac after another and every
evening he was completely intoxicated. He married a young wife and
felt the need of changing his habits, the more as he himself saw
symptoms of his excess which alarmed him. When he came to me, I saw
that he was seriously wishing to give up, and he understood himself
that there was only the one way, namely, complete abstinence. He
felt that he could not reach it by his own will power alone and
sought my aid. I hypnotized him six times, suggesting at first a
reduction to four drinks, then to two, then to one and then to pure
mineral water. I concentrated my effort on stirring up the
antagonistic attitude, the dislike of the smell of brandy and the
aversion to its taste. The effect was excellent. After the fifth
time the mental torture which he had felt in the first afternoons
had completely disappeared. I considered further hypnotizing
superfluous and felt sure after the sixth time that the man was
cured. For about a year he remained abstinent, but in the meantime
his professional life brought severe disappointments, and with cool
consideration he decided that he might have at least some pleasure
from life and forget its miseries. Accordingly after a year he
determined again to take some brandy in his study, and of course,
that led rapidly to an increase of the dose and today he is
probably at the old point. And yet it may be said with correctness
that psychotherapy had done its duty. If at the right moment before
he took the first step again, even the slightest counter-suggestion
had been applied, the disastrous second development could have been
easily avoided.
My experience indicates the best results where the suggestions are from
the start directed as much against the unfavorable social conditions,
with their temptations and impulses to imitation, as against the
alcoholic beverages themselves. On the whole it is easier to break the
vicious drinking habits of the social drinker than those of the lonely
drinker, a point which ought to be well considered in settling the
complex problem of prohibition versus the temperance movement.
The situation of alcoholism repeats itself in still more ruinous forms
with morphinism and cocainism, vices which grow in this country to an
alarming degree. The psychotherapeutic treatment of such drug habits
demands much patience and much skillful adjustment to the psychological
conditions. Its general difference from the treatment of alcoholism is
given by the circumstance that any too rapid withdrawing of the drug is
certainly dangerous, if the organism is adjusted to a relatively strong
dose. On the other hand, I may say that I have not seen a single case
in which a really patient and insistent treatment of morphinism has not
been successful, even if the destructive dose of forty grains a day had
become habitual. The condition is only that the patient himself have the
best will, a will which yet is not strong enough to win the fight
without psychotherapeutic help. But no one ought to expect that the
psychotherapist can secure miracles like some of the pill cures which
treat the drug fiend in three days. Moreover neither physician nor
patient ought to believe that the worst is to come at the beginning. On
the contrary, it is the end which is hardest, the reduction of the small
dose to nothing. As illustration, I give an extreme case.
A man who was formerly station master on a railroad had been
operated on in a hospital after an accident, and as some pain in
the hip remained which disturbed his sleep, the physician of the
hospital gave him some morphine and provided him with the material
for morphine injection after leaving the hospital. Then began the
usual story. He became more and more dependent upon his injection,
the dose was steadily increased, he found unscrupulous physicians
who yielded to his demand for morphine prescriptions; he lost his
position with the railway by the growing effects of the morphine
poisoning, he became divorced, sank lower and lower, his daily dose
fluctuating between thirty-five and forty grains a day, and when he
came to me, he presented a picture of the lowest type of hopeless
manhood. He spent practically the whole day in bed and was only
able to totter slowly along with a cane. He assured me that life
was hell for him. He could not sleep, he could not eat, he could
not think, he had made up his mind to commit suicide if I could not
help him. I foresaw that it would in the best case demand months of
insistent energy to make a man out of that unfortunate wreck. He
had gone through three different morphine cures in three
sanitariums and none had helped him, and every physician whom he
had consulted had declared his case as beyond any physical cure. I
decided to make the somewhat disproportionate sacrifice of time in
order to study whether even such an extreme case of morphinism is
accessible to psychotherapeutic treatment. Four months later, he
left my laboratory looking like an athlete, strong and vigorous,
joyful and energetic. For three weeks he had not received any
morphine, had good appetite, slept well, and had happily married.
As his wife was a trained nurse, she will take good care that no
new slip shall ever occur.
There was nothing remarkable in those four months of treatment. He
was easily hypnotized, and I hypnotized him at first every day,
then every second day, then every week. It was without difficulty
that I reduced the forty grains to about six grains a day. Then the
struggle began. To test the case as a strictly psychological
problem I left the effort entirely to his own will, that is, I did
not deprive him of the morphine supply but left the regulation in
his own hands. During that whole winter he had a bottle with a
thousand morphine tablets standing on his desk. Thus he would have
been entirely able to satisfy any craving, but by his own will he
followed my suggestions and never took more than I permitted. It
meant a terrible struggle. The tortures which he had to pass
through were perhaps worse than those which he had experienced at
the time of his lowest downfall. They came to a focus when he tried
to go from five grains to three grains a day and then again when
he approached half a grain. From there he had to move to a fourth
of a grain, then to an eighth, and even that had still to be
divided into four different doses which were then reduced to three,
to two, and finally to one dose and ultimately to injections of
warm water. A rapid increase in general strength and a return of
appetite for food began when he had reached the five grain limit. I
did not allow on any occasion the introduction of a substitute. On
the other hand, I added every day suggestions covering the various
secondary symptoms, especially the pains in the stomach and the
feelings of faintness and the emotional depression.
There, is no doubt that under favorable conditions, especially if the
dose of morphine is not too strong, autosuggestion can bring about a
similar effect. A reduction of ten per cent every week can be carried
through, if a pledge is given to one's self in a drowsy state. The great
value of autosuggestion showed itself not seldom in the fact that
morphinists who had applied to me by mail for a cure in the mistaken
belief that I do work in a professional way for payment and who got from
me a written reply that I could not receive them, but that they can help
themselves, wrote to me that my letter gave them strength to reduce
their dose considerably.
Quite similar is the situation with cocainism or with the combination of
morphine and cocaine which is so frequent nowadays with young
physicians. I have repeatedly seen cures where the case already gave the
impression of insanity. Again I give a rather extreme case.
A physician had acquired the habit of using and misusing cocaine
for the treatment of a disease of his nose. The habit grew to a
craving for cocaine while the cocaine itself poisoned the brain.
Acoustical hallucinations began; he heard voices from every corner
of the room, and on the street the voices took persecutory
character. He connected them with his brother living in Europe,
heard his voice in the denunciations, and developed a pathological
system of ideas around the central thought that his brother had a
telepathic influence on him. His reason succumbed, he lost all
consciousness of delusion, and believed himself really to be under
the control of the absent brother. When he came to me he had been
without sleep and without food for several days, and he was not
seeking my help to get rid of the mental disturbance but to
overcome the power of his older brother. He did not connect the
fear at all with his misuse of cocaine. When I discovered the rôle
which the cocaine played, I determined to try the suggestive
influence, the more as I found that he was in a half-hypnotic state
as soon as he had entered my room. I suggested to him to sleep and
to take food and to reduce the cocaine dose by a fourth. The next
day he was an entirely different man by the effect of ten hours'
sleep and a large breakfast. Now I concentrated my efforts on the
reduction of the cocaine. After ten days of hypnotic treatment he
gave up cocaine entirely, after three weeks the voices disappeared
and slowly the other symptoms faded away. The pathological idea of
the telepathic influence lasted a while after the voices had gone
until this idea, too, yielded to suggestion. It still took six
weeks before he himself felt that he was entirely normal.
The way in which the average physician nowadays neglects the simple tool
of suggestive treatment, when it can be used for the protection of
society, is perhaps nowhere so reckless as in the case of the morphinist
and cocainist. To give a typical case of this neglect I may mention that
of a highly intelligent young man who had been in the habit of using
both cocaine and morphine for ten years when at his own request he was
sent to a New York hospital. He had been taking alternately morphine for
a year or two, then cocaine for a year or two, and had sometimes
alternated and sometimes combined both in an irregular way. When he
entered the hospital in May, 1908, he was in a cocaine period and was
taking the enormous dose of one hundred and eighty grains of cocaine
every day. In the hospital they withdrew the drug altogether. During the
first weeks, he was entirely sleepless. They energetically refused him
any substitutes and after six weeks he began to feel comfortable. He
gained steadily in weight and after three months, when he left, he had
gained fifty pounds, felt entirely comfortable, and seemed in all
respects normal again. Before twelve hours had passed after leaving the
hospital, he had again taken thirty grains of cocaine and ten grains of
morphine, and this dose rapidly grew until after a few weeks it again
reached a hundred grains of cocaine and up to sixty grains of morphine a
day. Then came the complete breakdown. If that man in the last two or
three weeks of the hospital treatment, when he felt entirely comfortable
and normal and had gained his normal weight, had received even a slight
suggestive treatment suppressing any desire for cocaine or morphine, he
would easily have been saved. To let such a man after a drug career of
ten years go out again to the places of his old associations, where the
desire had to be stirred up, is inexcusable at a time when
psychotherapeutics has won its triumphs in this field. It might have
been sufficient to give him preventive treatment at least for the first
three days of his freedom. And such a case is typical of hundreds.
The overstrong impulse and overstrong desire finds its counterpart in
the abnormal lack of energy and lack of attention. The patient—and it
is especially the neurasthenic patient—has lost his usual strength, he
shrinks from every undertaking, he cannot decide upon any action, he
needs a disproportionate effort for the smallest task, and cannot
concentrate his attention in spite of his best will. The varieties of
this lack of power and inertia are familiar to every physician. They
certainly often need much more than merely psychotherapeutic treatment,
although on the physical side no schematic method is admissible. The
laziness of the anæmic needs a different treatment from the laziness of
the exhausted but in every case psychological factors can be of decisive
influence, whatever the physical and chemical treatment besides them may
be. A few letters may again illustrate the varieties. Here again there
is no sharp demarcation line between the normal and the abnormal.
Letters like the two following, for instance, are hardly letters of
patients. They show a variation which is still entirely within normal
limits and yet a source of suffering; it is a disturbance which usually
can be removed by psychotherapeutic means.
"I do almost everything with effort, nothing spontaneously. I have
been writing for five years but am a mood writer of the worst type.
The mood comes at such uncertain times that I seem to be absolutely
at the mercy of caprice. This might not in itself be a misfortune
but writing is my only calling and I suffer the proverbial torments
of lost spirits when I am idle. The necessity of driving myself to
every piece of work, aggravated by the fact that my parents allowed
my constitutional inertness to have full play, has hitherto
prevented me from forming any regular habit of labor. I am now
thirty-eight. Would you suppose that if I kept my nose to the
grindstone for one, two or three years, I might yet hope to work
with some ease and regularity? That is, if I compelled myself to
write a certain number of hours every day as a discipline,
regardless of the quality of matter I produce, is there any
probability that I might ultimately overcome the fearful paralysis
that so often grips my faculties? Can constitutional indolence be
overcome by determination? I put in a little time on a couch every
day. When worried I get neurasthenia and all kinds of phobias. Just
now I am afraid to look at the newspapers on account of the cholera
in St. Petersburg, and I have seen the time when I found it
difficult to drink water after I had boiled it myself."
Also the next man is familiar to all of us.
"Plainly we are told every man is born into the world to fill some
purpose, or at least be of some benefit to himself or his
fellowmen. For some reason I do not make friends among men. I have
not the zeal or ambition to carry or even begin a conversation
that will interest the individual man. I worry a great deal. I have
never been able to concentrate my mind to study and figure out
problems. I can read them zealously but apparently do not get to
the bottom and cannot retain what I do read. If I could just get
hold of the power of thinking and dig out that tangible something
that holds me back, I could go forward and make myself what I know
I should be. But I feel that so far I am a total failure. If I only
had that one great gift, the power of concentration and will power,
I would make what I so much desire, a success of myself."
A similar effect and yet psychologically a different condition exists
where the lack of energy results from the suggestive power of the
opposite, producing a constant indecision.
"I am thirty years old and nearly all my life since childhood I
have been fearfully troubled with the habit of indecision and
regretting whatever I do. It has grown into a habit so fixed that
at times I am fearful of losing my mind. I feel anxious to do
something and decide to do it, then as soon as it is done, I nearly
go wild with regrets until I have to undo it, if possible, and then
only to regret that. I am this way about the most trifling things
and about the most serious. I can't perform any duty well. In
business and in social affairs, it is always with me. It has me in
its clutches, a horrible monster dragging me down. My friends
misinterpret me and wonder what I mean by doing so when all the
time I want to do what is for the best and cannot for this tyrant
who is ever present with me. I will plod for hours and hours at a
time, and at every turn I am handicapped. I am intelligent
naturally and appear a perfect fool."
From the report of such chronic cases we may turn to the acute ones.
Here a characteristic letter of, a typical neurasthenic young modern
poet.
"These are my plans but I hardly think that I can carry them
through, although perhaps you can help me by suggestion. I have the
feeling that through the whole of last year my development did not
go forward but backward. It is as if by a mental or physical
overstrain, my whole personality has entered into a transition. I
have no joy in life, no sensation in love, no satisfaction in
labor. My will has become weak where it was strong. I am lazy, up
to an absolute dislike of everything, while I have been energy
itself. Often I have only the one desire, to end my life from mere
fatigue. If there had been any external reason for ending my life,
I should perhaps have done it long ago. I am so apathetic that I no
longer take myself seriously. My successes do not please me; the
idea of writing anything gives me anxiety. I have become less
resisting, more sweet, more soft, I should almost like to say, more
feminine. I became infatuated with a girl, simply because I knew
that she hates all men. The inaccessible is still the only thing
which can stimulate me somewhat. I have even written a poem on her,
but nothing can satisfy me in love. I consider my state a disease
of the will as a result of nervous exhaustion. I must find some one
who, with kindly power, reënforces my will system. I need a strong
mind—it may be a man or a woman. It would even be possible in the
latter case that I might marry her.
"Even the writing of this letter has fatigued me so much that I
should like best to sleep. In moments like the present I should
like best to throw myself down on the street or ... quickly ...
sink ... into the ocean. (I regret having made the little points.
They look as if my expressions are a pose.) Yet there are moods in
which I am entirely normal and no one fancies what I am passing
through. I have even become superstitious lately. Are there perhaps
beings which can absorb our energy? Perhaps another being has drunk
up my energy."
Authors run easily into such states. Here is another.
"I am a neurasthenic, and I am beginning to believe, a professional
one. My object in writing is to ask concerning the advisability of
my visiting you for treatment. I am ready to take the next train if
you say the word, if you believe you can help me. It seems that the
regular practitioner, who is very irregular, cannot. If there is
one good doctor I have not consulted, I would like to know his
name. I was doing editorial work in X and broke down. Still the
doctor said that if I liked my work, I should go back to it and
pitch in. I did. It lasted a few days and then I had to give up
altogether, couldn't grind out another word. Then to another
doctor——also the best in the city. He told me to give up all
work, which I did, and then I went on a farm for six months. That
did not help me either. Later I went west and spent some time in
the mountains. I felt no better there. Then I went to Arizona and
lived in a tent out on the desert; that did not help me. There was
always a sensation of exhaustion and any physical exertion put me
on my back, even when it was light and pleasant exercise. Then I
went to California; it did me little good. It is a perfect paradise
for anyone who has not got neurasthenia. I still have not got
myself in hand. I cannot do or say or write just what I wish, and
cannot concentrate my thoughts. To try to read a book is punishment
because I forget as fast as I read." And so on.
I answered him certainly not to come but tried to induce some
autosuggestions. A few weeks later, he wrote me: "Ever since you
wrote me, I am now feeling somewhat improved." Yet I cannot judge
how far the improvement belonged to the psychical factor only,
inasmuch as I had advised him also to take some bromides. The
really effective treatment would have been heterosuggestion and I
had no time to enter into the case.
Where direct suggestion is used, the effect is often surprising.
A young lawyer after a period of overwork had come to a state of
complete lack of energy. He could not find strength to write a
letter and he came to me at a day when he did not see any way but
suicide open for himself. He complained that, as soon as he began
to grasp a thought, it was evaporating. He stared absently about
the room and felt sure that he would never again achieve anything.
He had not even the energy to read the newspaper. I hypnotized him
three times, each time waking in him the pleasure in a definite
piece of work, at first simply in a novel which he was to read,
then in some letters which he was to write, and then in his
professional work. There was always an interval of three days. The
fourth time he declared himself that the hypnotic influence was
unnecessary, as he felt that he was again in the midst of his work.
As a rule the effect is a much slower one, but if all personal factors
are well considered and especially physical disturbances are excluded,
the result is usually satisfactory.
Very different from such neurasthenics, of course, is the lack of
attention in the feeble-minded, and suggestion of the ordinary type is
hardly advisable, but it is surprising how much can be reached by a
systematic psychical régime. I give one typical instance, representative
of many.
A boy of twelve years when he was brought to me showed the mental
powers of a stupid child of four. In a silly way he repeated every
question which he heard without answering it; he talked steadily to
himself in a nonsensical manner, mostly repeating nursery rhymes
without end, never holding his attention to anything in the room,
giving the impression that there was no attention whatever. The boy
was a child of rich parents; he had his own teachers, but was for a
large part of the year under the influence of the parents only, who
very naturally yielded to every desire of the unfortunate child. I
insisted on a complete change of the education. It was my effort to
build up the mind by a rigorous training and by development of the
power of inhibition. I absolutely forbade any meaningless material
like the nursery rhymes, insisted that the child should never be
allowed to talk to himself, and whenever he began to speak to
himself he was to be addressed sharply, and if he yet went on, to
be slapped on his hands. In the same way he was not allowed to
repeat a question, but the question was repeated until he answered
it, the question always formulated in simple words. He was forced
to go through simple reading and writing without being allowed to
make his silly diversions. His whole life was brought under strict
discipline and no parental indulgence was permitted. Six months
later the child was completely changed. It seemed as if he had gone
through an improvement of three years. I regulated the whole of
his elementary studies in accordance with the successful principle.
The training of inhibition stood in the foreground and every
haphazard reaction was severely rebuked. The summer vacations spent
with the parents in the fashionable surroundings, to be sure, had
always a retarding influence, but the main part of the year in
which it was possible to carry through the strict discipline showed
such steady and inspiring progress that the boy, while of course
feeble-minded for life, can yet live externally a harmonious life.
A systematic training of the power of inhibition is indeed the
fundamental factor in all psychotherapeutic treatment when the
disturbance is in the volitional sphere, but the inhibition is secured
most safely by reënforcement of the antagonistic attitude. From these
volitional variations on the one side, from the ideational disturbances
on the other, only a few steps lead to those dissociations of the
personality which are characteristic of many graver cases of hysteria.
But to give to them any adequate analysis, it would be insufficient to
refer in this brief way to particular cases. Psychopathological
literature possesses some excellent analyses of such complex
disturbances. As I said before, I abstain entirely here from such
complex phenomena, as they enter too seldom into the sphere of the
practitioner and as the bewildering manifoldness of their symptoms does
not allow us so easily to recognize the fundamental principles which
alone were to be illustrated by our short survey of practical cases.
