_In which we pick up the clue_
THE WAY OUT
THE SCIENCE OF RE-EDUCATION
There is a story of an Irishman at the World's Fair in Chicago.
Although his funds were getting low, he made up his mind that he would
not go home without a ride on a camel. For several minutes he stood
before a sign reading: "First ride 25¢, second ride 15¢, third ride
10¢." Then, scratching his head, he exclaimed, "Faith, and I'll take
the third ride!" Should there by any chance be a reader who, eager to
find the way out without paying the price of knowledge, is tempted to
say to himself "Faith, and I'll begin with Part III," we give him fair
warning that if he does so, he will in all probability end by putting
down the book in a confused and skeptical frame of mind.
It is difficult to find our way out of a maze without some faint idea
of the path by which we got in. He who brings to this chapter the
popular notion that nervousness is the result of worn-out
nerve-cells, can hardly be expected to understand how it can be cured
by a process of mental adjustment. Suggestion to that effect can
scarcely fail to appear to him faddish and unpractical. But once a
person has grasped the idea that "nerves" are merely a slip in the cog
of hidden mental machinery, and has acquired at least a
working-knowledge of "the way the wheels go round," he can scarcely
fail to understand that the only logical cure must consist in some
kind of readjustment of this underground machinery. If "nerves" were
physical, then only physical measures could cure, but as they are
psychic, the only effective measures must be psychic.
=Gross Misconceptions.= Nervousness is caused by a lack of adjustment
to the world as it is; therefore the only possible cure must be some
sort of readjustment between the person's inner forces and the demands
of the social world. As this lack of adjustment is concerned chiefly
with the repressed instinct of reproduction, it is only natural that
there should be people who believe that "the way out" lies in some
form of physical satisfaction of the sex-impulse--in marriage, in
changing or ignoring the social code, in homo-sexual relations or in
the practice of masturbation. But we have only to look about us to see
that this prescription does not cure. Freud naïvely asks whether he
would be likely to take three years to uncover and loosen the psychic
resistances of his patients, if the simple prescription of sex-license
would give relief.
Since there are as many married neurotics as single, it is evident
that even marriage is not a sure preventive of nervousness. License,
on the other hand, can satisfy only a part of the individual's
craving. Freud insists that the sex-instinct has a psychic component
as well as a physical one, and that it is this psychic part which is
most often repressed. He maintains that for complete satisfaction
there must be psychic union between mates, and that gratification of
the physical component of sex when dissociated from psychic
satisfaction, results in an accumulation of tension that reacts badly
on the whole organism.
The psychic tension accumulating in adult sex-relations has its
inception in the mistaken attitude on the part of the wife, who
remains true to her childhood training that any pleasure in sex is
vulgar; or on the part of the man, who reacts to the mood of the wife,
or is held by his own unbroken mother-son complex; or on the part of
both the tension piles up because of society's taboo upon rearing
large families. As the first two factors in this lack of adjustment
grew largely out of some kind of faulty education or from faulty
reaction to early experiences, the only effective way to secure a
better adaptation must be through a re-education which reaches down
to that part of the personality that bears the stamp of the
unfortunate early factors.
=Remaking Ourselves.= As a matter of fact, the science of
psychotherapy or mental treatment is simply the science of
re-education,--a process designed to break up old unhealthy complexes
which disrupt the forces of the individual, and to build up healthy
complexes which adjust him to the social world and enable him to use
his energy in useful ways.
Fortunately, minds can be changed. It is easier to make over an
unhealthy complex than to make over a weak heart, to straighten out a
warped idea than to straighten a bent back. Remarkable indeed have
been some of the transformations in people who are supposed to have
passed the plastic period in life. While it is true that some persons
become "set" in middle life, and almost impervious to new ideas, it is
also true that a person at fifty has more richness of experience upon
which to draw, more appreciation of the value of the good, than has a
person at twenty. If he really wants to change himself, he can do
wonderful things by re-education.
The first step in this re-education is a grasp of the facts. If you
want to pull yourself out of a nervous disorder, first of all learn as
much as you can about the causes of "nerves," about the general laws
of mind and body, and about your own mental quirks. If this is not
sufficient, go to a specialist trained in psychotherapy and let him
help you uncover those trouble-making parts of your personality which
you cannot find for yourself. It is the purpose of this book to
summarize the facts which most need to be known. Let us now consider
those methods which the psychopathologist finds most useful in helping
his patients to self-knowledge and readjustment.
=Various Methods.= As there are a number of schools of medicine, so
there are a number of distinct methods of psychotherapy, each with its
own theories and methods of procedure, and each with its ardent
supporters. These methods may be classified into two groups. The first
group includes those methods, hypnosis and psycho-analysis, which make
a thorough search through the subconscious mind for the buried
complexes causing the trouble, and might, therefore, be called
"re-education with subconscious exploration." The other group,
includes so-called explanation and suggestion, or methods of
"re-education without subconscious exploration," which content
themselves with making a general survey and building up new complexes
without going to the trouble of uncovering the buried past. Although
the theory and the technique vary greatly, the aim of all these
methods is the same,--the readjustment of the individual to life.
RE-EDUCATION WITH SUBCONSCIOUS EXPLORATION
=Hypnosis.= The method by which most of the important early
discoveries were made is hypnosis, or artificial sleep, a method by
which the conscious mind is dissociated and the subconscious brought
to the fore. It was through hypnosis that Freud, Janet, Prince, and
Sidis made their first investigations into the nature of nervousness
and worked their first cures. With the conscious mind asleep and its
inhibitions out of the way, a hypnotized patient is often able to
remember and to disclose to the physician hidden complexes of which he
is unaware when awake. Hypnosis may thus be a valuable aid to
diagnosis, enabling the physician to determine the cause of
troublesome symptoms. He may then begin to make suggestions calculated
to break up the old complexes and to build new ones, made up of more
healthful ideas, desirable emotions and happy feeling-tones. As we
have seen, a hypnotized subject is highly suggestible. His
counter-suggestions inactivated, he believes almost anything told him
and is extremely susceptible to the doctor's influence.
The dangers of hypnosis have been much exaggerated. Indeed, as an
instrument in the hands of a competent physician, it is not to be
feared at all. It has, however, its limitations. Many times the very
memories which need to be unearthed refuse to come to the surface.
Stubborn resistances are more likely to be subconscious than
conscious, and may prove too strong to be overcome in this way.
Moreover, the road to superficial success is very inviting. It is easy
to cure the symptom, leaving the ultimate cause untouched and ready to
break out in new manifestations. The drug and drink habits may be
broken up without making any attempt to discover the unsatisfied
longings which were responsible for the habit. A pain may be cured
without finding the mental cause of the pain or initiating any
measures to guard against its return, and without giving the patient
any insight into the inner forces with which he still has to deal.
Since nervousness is a state of exaggerated suggestibility and
abnormal dissociation, many psychologists believe that it is unwise to
employ a method which heightens the state of suggestibility and
encourages the habit of dissociation. They feel that it is wiser to
use less artificial methods which rest on the rational control of the
conscious mind and make the patient better acquainted with his own
inner forces and more permanently able to cope with new manifestations
of those forces. They believe that the character of the patient is
strengthened and his morale raised by methods which increase the
sovereignty of reason and decrease the role of unreasoning
suggestibility.
=Psycho-Analysis.= Freud's contribution has been not only a discovery
of the general causes of nervousness, but a special means of locating
the cause in any particular case. Abandoning hypnosis, he developed
another method which he called psycho-analysis. What chemical analysis
is to chemistry, psycho-analysis is to the science of the mind. It
splits up the mental content into its component parts, the better to
be examined and modified by the conscious mind. Psycho-analysis is
merely a technical process for discovering repressed complexes and
bringing them into consciousness, where they may be recognized for
what they are and altered to meet the demands of real life. It is a
device for finding and removing the cause of nervousness,--for
bringing to light hidden desires which may be honestly faced and
efficiently directed instead of being left to seethe in dangerous
insurrection. In order permanently to break up a real neurosis, a man
must first know himself and then change himself. He must gain insight
into his own mental processes and then systematically set to work to
change those processes that unfit him for life.
We shall later find that a detailed self-discovery through
psycho-analysis is not always necessary, and that a more general
understanding of oneself is sufficient for the milder kinds of
nervousness. But because of the promise which psycho-analysis holds
out to those stubborn cases before which other methods are powerless;
because of the invaluable understanding of human nature which it
places at the disposal of all nervous people, who may profit by its
findings without undergoing an analysis; and because of the flood of
light which it sheds on the motives, conduct, and character of every
human being, no educated person can afford to be without a general
knowledge of psycho-analysis.[41]
[Footnote 41: It is unfortunate that the records of an analysis are
too voluminous for use in so brief an account as this. Since the
report of one case would fill a book, and a condensed summary would
require a chapter, we must refer to some of the volumes which deal
exclusively with the psychoanalytic principles. For a list of these
books, see Bibliography.]
=A Chain of Associations.= Psycho-analysis is not, like hypnosis,
based on dissociation; it is based on the association of ideas. Its
main feature is a process of uncritical thinking called "free
association." To understand it, one must realize how intricately woven
together are the thoughts of a human being and how trivial are the
bonds of association between these ideas. One person reminds us of
another because his hair is the same color or because he handles his
fork in the same way. Two words are associated because they sound
alike. Two ideas are connected because they once occurred to us at the
same time. A subtle odor or a stray breeze serves to remind us of some
old experience. Connections that seem far-fetched to other people may
be quite strong enough to bind together in our minds ideas and
emotions which have once been associated, even unconsciously, in past
experience.
In this way, thoughts in consciousness and in the upper layers of the
subconscious are connected by a series of associations, forming links
in invisible chains that lead to the deepest, most repressed ideas.
Even a dissociated complex has some connection with the rest of the
mind, if we only have the patience to discover it. Therefore, by
adopting a passive attitude, by simply letting his thoughts wander, by
talking out to the physician everything that comes to his mind without
criticizing or calling any thought irrelevant or far-fetched, and
without rejecting any thought because of its painful character, the
patient is helped to trace down and unearth the troublesome complex
which may have been absolutely forgotten for many years. He is helped
to relive the childhood experiences back of the over-strong habits
which lasted into maturity.
=Resisting the Probe.= Naturally, it is not all fair sailing. The
subconscious impulses which repressed the painful complex in the first
place still shrink from uncovering it. In many cases the resistance is
very strong. It, therefore, often happens that after a time the
patient becomes restive; he begins to criticize the doctor and to
ridicule the method. His mind goes blank and no thought will come; or
he refuses to tell what does come. The nearer the probe comes to the
sore spot, the greater the pain of the repressing impulses and the
stronger the resistance. Usually a strange thing happens; the patient,
instead of consciously remembering the forgotten experiences, begins
to relive them with his original emotions transferred on to the
doctor. Depending upon what person of his childhood he identifies with
him, the patient develops either a strong affection or an intense
antagonism to the physician, attitudes called in technical terms
positive and negative transference. If the analyst is skilful, he is
able to circumvent all the subterfuges of the resisting forces and to
uncover and modify the troublesome complexes. Sometimes this can be
accomplished at one sitting, but more often it requires long hours of
conversation. Freud has spent three years on a single difficult case,
and very frequently the analysis drags out through weeks or months.
The amount of mental material is so great, especially in a person who
is no longer young, that every analysis would probably be an
interminable affair if it were not for three valuable ways of finding
the clue and picking up the scent somewhere near the end of the trail.
The first of these clues is nothing else than so despised a phenomenon
as the patient's own night-dreams, which turn out to be not
meaningless jargon, as we have supposed, but significant utterances of
the inner man.
=The Message of the Dream.= When Freud rescued dreams from the mental
scrap-basket and learned how to piece them together so that their
message to man about himself became for the first time intelligible,
he furnished the human race with what will probably be considered its
most valuable key to the hidden mysteries of the mind. Freeing the
dream from the superstition of olden times and from the neglect of
later days, Freud was the first to discover that it is part and parcel
of man's mental life, that it has a purpose and a meaning and that the
meaning may be scientifically deciphered. It then invariably reveals
itself to be not a prophecy for the future but an interpretation of
the present and of the past, an invaluable synopsis of the drama which
is being staged within the personality of the dreamer.
As modern man has swung away from the idea of the dream as a warning
or a prophecy, he has accepted the even more untrue conception of
dreaming as the mere sport of sleep,--the "babble of the mind," the
fantastic and insignificant freak-play of undirected mental processes,
or the result of physical sensations without relation to the rest of
mental life. No wonder, then, that Freud's startling dictum, "A dream
is a disguised fulfilment of a repressed wish," should be met with
astonishment and incredulity. When a person is confronted for the
first time with this statement, he invariably begins to cite dreams in
which he is pursued by wild beasts, or in which his loved ones are
seen lying dead. He then triumphantly asserts that no such dream
could be the fulfilment of a wish.
The trouble is that he has overlooked the word "disguised." Like wit
and some figures of speech, a dream says something different from what
it means. It deals in symbols. Its "manifest content" may be merely a
fantastic and impossible scene without apparent rhyme or reason, but
the "latent content," the hidden meaning, always expresses some urgent
personal problem. Although the dream may seem to be impersonal and
unemotional, it nevertheless deals in every case with some matter of
vital concern to the dreamer himself. It is a condensed and composite
picture of some present problem and of some related childish repressed
wish which the experiences of the preceding day have aroused.
As Frink says, a dream is like a cartoon with the labels
omitted--absolutely unintelligible until its symbols are interpreted.
Although some dreams whose symbolism is that which man has always
used, can be easily understood by a person who knows, many dreams are
meaningless, even to an experienced analyst, until the patient himself
furnishes the labels by telling what each bit of the picture brings to
his mind. The dream, as a rule, merely furnishes the starting-point
for free association.
Each symbol is an arrow pointing the way to forbidden impulses which
are repressed in waking life but which find partial expression during
sleep. The subconscious part of the conscience is still on the job, so
the repressed desires can express themselves only in distorted ways
which will not arouse the censor and disturb sleep. The purpose of the
dream is thus two-fold,--to relieve the tensions of unsatisfied
desire, and to do this in such a subtle way as to keep the dreamer
asleep. Sometimes it fails of its purpose, but when there is danger of
our discovering too much about ourselves, we immediately wake up,
saying that we have had a bad dream.
It is at first difficult to believe that we are capable of this
elaborate mental work while we are fast asleep. However, a little
investigation shows us to be more clever than we realize. The
subconscious mind, in its effort to satisfy both the repressing and
the repressed impulses, carries on very complicated processes,
disguises material by allowing one person to stand for another, two
persons to stand for one, or one person to stand for two; it shifts
emotion from important to trivial matters, dramatizes, condenses, and
elaborates, with a skill that is amazing. We are all of us very clever
playwrights and makers of allegories--in our sleep. Also, we are all
very clever at getting what we want, and the dream secures for us, in
a way, something which we want very much indeed and which the world
of social restraint or our own warped childish notion denies us.
Not every one can become an interpreter of dreams. It takes a skilled
and patient specialist thoroughly to understand the process. But it is
fortunate indeed that we possess such a valuable means of diagnosis
when extraordinary conditions make it necessary to explore the
subconscious in the search for trouble-making complexes.[42]
[Footnote 42: For further study of the dream, see Freud:
_Interpretation of Dreams_; and _General Introduction to
Psycho-Analysis_.]
=The Word-Test.= Although dreams furnish the main clues to buried
complexes, they are by no means the only instrument of the
psycho-analyst. Another device, called the association word-test, has
been developed by Dr. Carl Jung of Switzerland. The analyst prepares a
list of perhaps one hundred words, which he reads one by one to the
patient, hoping in this way to strike some of the emotional reactions
of which the patient himself is unaware. The latter responds with the
first word that comes into his mind, no matter how absurd it may seem.
The responses themselves are often significant, but the time that
elapses is even more so. It usually happens that it takes very much
longer for some responses than for others. If a patient's average time
is one or two seconds, some responses may take five or ten or twenty
seconds. Sometimes no word comes at all and the patient says that his
mind is a blank. He coughs or blushes, grows pale or trembles, showing
all the signs of emotion even when he himself has no notion of the
cause. The significant word has hit upon a subconscious association
with some emotional complex. The blocking of the mind is an effort of
the resistance to keep the painful ideas out of consciousness. The
telltale word then furnishes a starting point for further
associations.
One of my patients blocked on the word "long." Instead of saying
"short" or "pencil" or "road" or "day" or any other word which might
naturally be associated with "long," she laughed and said that no word
would come. Finally an emotional memory came to light. It seems that
this woman had been courted by a man whom she unconsciously loved, but
whom she had "turned down" because she was ambitious for a career.
After the man had moved to another town, my patient heard that he was
engaged to another girl. She then realized that she loved him and
began to long for him with her whole heart. The meaningful word "long"
thus led us to one of the emotional memories for which we were
seeking.
="Chance" Signs.= There are other clues to hidden inner processes,
other sign-posts pointing to the cause of a neurosis. Not only through
dreams and through emotional reactions to certain words does the
subconscious reveal its desires, but also through the little slips of
the tongue and of the pen, the "chance" acts and unconscious
mannerisms which are usually ignored as entirely insignificant. When
we "make a break" and say what we secretly mean but wish to hide from
ourselves or others; when we forget an appointment which part of us
really wishes to avoid, or forget a name with which we are perfectly
familiar; when we lose the pen so that we cannot write or the desk key
so that we cannot work; when we blunder and drop things and do what we
did not mean to do; then we may know--the normal as well as the
nervous person--that our subconscious minds with their repressed
desires are trying to get the reins and are partially succeeding.
An example from my own life may illustrate the point. In building a
number of houses, I had occasion often to use the word studding, but
on every occasion, I forgot the word and always had to end lamely by
saying "those pieces of timber that go up and down." Each time the
builder supplied the word, but the next time it was no more
accessible. Finally, the reason came to me. One day when I was a
little child I looked out of the window and cried, "Oh, see that great
big beautiful horse." My grandmother exclaimed, "Sh! sh! that is a
stud horse." Over-reaction to that impression repressed the word stud
so successfully that as a grown woman I could not recall another word
which happened to contain the same syllable.
During an analysis a patient of mine who had a mother-in-law situation
on her hands told me a dream of the night before. "I dreamed that my
mother-in-law, who has really been very ill, was taken with a
sinking-spell. I rushed to the telephone to call the doctor, but found
to my terror that I could not remember his number." "What is his
number?" I asked, knowing that she ought to know it perfectly.
"Two-eight-nine-six," she answered at once. The number really was
2876. Asleep and awake, her repressed desire for release from the
mother-in-law's querulous presence was attempting to have its way. In
the dream, she avoided calling the doctor by forgetting his number
entirely. Awake, she evaded the issue by remembering a wrong number.
In the dream she thinly disguised her desire by displacing the anxious
emotion from the sense of her own guilty wishes to the idea of the
mother-in-law's death. When confronted with this interpretation, the
woman readily acknowledged its truth.
Even stammering, which has always been considered a physical disorder,
has been proved, by psycho-analysis, to be the sign of an emotional
disturbance. H. Addington Bruce reports the case of one of Dr. Brill's
patients, a young man who had been stammering for several years.
Observation revealed the fact that his chief difficulty was with
words beginning with K and although at first he firmly denied any
significance to the letter, he later confessed that his sweetheart
whose name began with K had eloped with his best friend and that he
had vowed never to mention her name again. Upon Dr. Brill's suggestion
he tried to think of the unfaithful lover as Miss W., but soon
returned, saying that he was stammering worse than ever. Investigation
showed that the additional unpronounceable words contained the letter
W. When he was induced to renounce his oath never to call the girl's
name again, he found that he had no more difficulty with his
speech.[43]
[Footnote 43: H. Addington Bruce; "Stammering and Its Cure,"
_McClure's_, February, 1913.]
Thus we see that even the halting tongue of a stammerer may point the
way to the buried complex for which search is being made.
Since there is no accident in mental life, and since there is behind
every action a force or group of forces, no smallest action is
insignificant to the person trained to understand.
If this at first seems disturbing, it is only because we do not
realize that there is nothing within of which we need be ashamed.
People are very much alike, especially in the deeper layers of their
being. What belongs to the whole human race does not need to be
hidden away in darkness. There is nothing to lose and everything to
gain by an increasing understanding of the chance signals which reveal
the forces at work within the depths of the mind. To the analyst every
little unconscious act is a valuable clue pointing toward the end of
his quest.[44]
[Footnote 44: For further discussion of this subject, see Freud's
_Psycho-pathology of Everyday Life_, translated by A.A. Brill.]
=The Aim of Psycho-Analysis.= As we have seen, the object of all this
technique is the discovery and the removal of the resistances which
have been keeping the emotional conflicts in the dark. It is a long
step just to learn that there are resistances; and by reliving, bit by
bit, the earlier experiences responsible for unfortunate habits, we
find that the habits themselves lose much of their old power. They can
be seen for what they are, and changed to suit present conditions. A
wish is incomparably stronger when unconscious than when conscious;
and the old stereotyped, automatic reactions tend to cease when once
they have been seen for what they are. They become assimilated with
the rest of the personality and modified by the mature attitudes of
the conscious mind. The person then re-educates himself by the very
act of discovering himself. In other cases, the uncovering is merely
the first step in the process of re-education. The analyst then
assumes the rôle of educator, cutting away old shackles, breaking down
false standards, building up new complexes, showing the patient the
naturalness of his desires, inducing him to look at them as biologic
facts, and showing him how to sublimate those which may not find
direct expression; in fact, leading him out into the self-expression
of a free, unhampered life.[45]
[Footnote 45: "It will be readily understood that in the
reconstruction of the shattered purposes, the frustrated hopes and the
outraged instincts which are found to lie at the source of those human
woes we call 'nervous disorders,' there takes place a gradual
transposition of values, a total recasting of ideas, and that through
the whole process, education in the deepest meaning of the word,
enters at last into its full sovereign rights."--Trigant Burrow.]
Among my patients at one time was a woman subject to terrible fits of
despondency. She was happily married and enjoyed the marriage
relationship, but could not free herself from a terrible sense of
guilt and degradation, a sense which was so acute that she wanted to
end her life. Although she was an active member of a church, she was
starving for the real message of the church, continually bound by a
feeling of aloofness which made her a stranger in the midst of
friends. Psycho-analysis revealed an experience of her childhood which
she had kept a secret all these years. It seems that when she was
seven years of age an old minister had driven her into town and had
made some sort of sex-approach on the way. Although ignorant of its
significance, the child was badly frightened and overcome with a sense
of guilt. She had already inferred that such subjects were not to be
mentioned and she hesitated long before telling even her mother.
Smoldering within her through the years had been this emotional
complex about the sex-life and about people connected with a church,
so that even as a grown woman the relationships of her mature years
were completely ruined by her old childish reaction. With insight as
to the cause of her trouble, she was able to modify her attitudes and
to live a free and happy life.
Several years ago there came to me a man of exceptional intellectual
ability, who for years had been totally incapacitated because of blind
resistances built up in childhood. Although married to a woman whom he
thoroughly liked and admired, he was absolutely miserable in his
married life. He had, in fact, a deep-rooted complex against marriage,
and had only allowed himself to be captured because the woman, with
whom he had been good friends, had cried when he refused to marry her.
During analysis it transpired that as a little boy of four he had
often seen his silly young mother cry because she could not have a new
dress. He had taken her side and bitterly felt that she was abused by
his father. Later, at six, he had heard some coarse stories about sex
to which he had over-reacted. Still later he had heard the workmen on
the farm say that they could not go to the gold-fields because they
had wives and were held back by marriage. "There are no idle words
where children are," and this little boy had built up such a strong
complex against marriage that he could not possibly be happy as a
grown man. He was as much crippled by the old scar as is an arm which
is bent and stunted from a deep scar in the flesh. After the analysis
had broken up the adhesions, he found himself free, able to give
mature expression to his repressed and dissatisfied love-instincts.
Psycho-analysis is not a process of addition, but one of subtraction.
Like a surgical operation, it undoes the results of old injuries,
removes foreign material, and gives nature a chance to develop freely
in her own satisfactory way.
RE-EDUCATION WITHOUT SUBCONSCIOUS EXPLORATION
=Simple Explanation.= So far, "the way out" sounds rather involved. It
seems to require a special kind of doctor and a complicated, lengthy
process before the exact trouble can be determined. But, fortunately
for the average nervous patient, this lengthy process of analysis is
by no means always necessary. People with troublesome nervous
symptoms, and even those who have had a serious breakdown, are
constantly being cured by a kind of re-education which breaks up
subconscious complexes without trying to bring them to the surface. If
the dead past can be let alone, so much the better. Sometimes a
bullet buried in the flesh sends up a constant stream of discomfort
until it is dug out and removed; but if it has carried in no infection
and the body can adjust itself, it is usually considered better to let
it remain.
The subconscious makes its own deductions. If resistances are not too
strong it is often possible to introduce healthy ideas by way of the
conscious reason, to break up old habits, and make over the mentality
without going to the trouble of uncovering some of the reactions which
are responsible for the difficulty.
=Moral Hygiene.= Because this is true, there has grown up a kind of
psychotherapy which is known as simple explanation, or persuasion. As
usually practised, this kind of re-education pays very little
attention to the ultimate cause of "nerves." It has little to say
about repressed instincts or the real reasons for fearful emotions and
physical symptoms. Instead, it attacks the symptom itself, contenting
itself with teaching the patient that his trouble is psychic in
origin; that it is based on exaggerated suggestibility and
uncontrolled emotionalism; that it is made out of false ideas about
the body, illogical conclusions, and unhealthy feeling-tones; and that
it may be cured by a kind of moral hygiene, which breaks up these old
habits and replaces them with new and better ones. It tries to
inculcate the cheerful attitude of mind; to give the patient the
conviction of power; to correct his false ideas about his stomach, his
heart, or his head; to train him out of his emotionalism; to lead him
into a state of mind more largely controlled by reason; and to make
him find some useful and absorbing work.
This kind of mental and moral treatment has been sufficient to cure
many neuroses of long standing. In cases that are helped by this
method, the patient's love-force, robbed of the material out of which
it has woven its disguise, and trained out of its bad habits by
re-education, automatically makes its own readjustments and forces new
channels for itself out into more useful activities. Very many nervous
persons seem to need nothing more than this simple kind of help.
=When Simple Explanation Does not Explain.= For very many cases,
however, this procedure, good as it is, does not go deep enough.
Although it gives a sound objective education about the facts of one's
body, it furnishes only the most superficial subjective knowledge of
one's inner life. If the inner struggle be bitter, the competing
forces will hold on to their poor refuge in the symptom, despite any
number of explanations that the symptom can have no physical cause.
Sometimes it is enough for a person to be shown that he is too
suggestible, but often it is far more helpful for him to get an
inkling as to why he likes unhealthy suggestions, and to understand
something of his starved instincts which he may learn to satisfy in
better ways.
PSYCHOLOGICAL EXPLANATION
Between the two extremes of the cases which need a real analysis and
those which are cured by simple explanation, I have found the great
bulk of nervous cases. To simple explanation with its highly useful
information, I therefore add what might be called psychological
explanation, a re-education which makes use of all that illuminating
material unearthed by the explorations of hypnosis and especially of
psycho-analysis. Along with correct ideas about such matters as
digestion, sleep, and fatigue, I give, so far as the patient is able
to understand, a comprehension of the rights of the denied instincts,
the ways of the subconscious, the fettering hold of unfortunate
childish habits, the various mental mechanisms by which we fool
ourselves, and the ways by which we may make better adaptations.
=According to the Patient.= The treatment varies according to the
nature of the trouble, and is somewhat dependent on the mentality of
the patient. There are many people who would only be confused by being
forced into a study of mental phenomena. Not being students, they
would be more bewildered than helped by the details of their inner
mechanisms. Others, of studious habits and inquiring minds, are
encouraged to browse at will in a library of psychotherapy and to
learn all that they can from the best authorities.
In any case, I give the patients as much as they are able to take of
my own understanding of the subject. There are no secrets in this
method. The patient is treated as a rational human being who has
nothing to lose and everything to gain by the fullest knowledge that
he is able to acquire. Without forcing him to plunge in over his
depth, I encourage him to understand himself to the fullest possible
extent. Besides individual private conferences, we have twice a day an
informal gathering of all the patients in my household--"the family"
as we like to call ourselves--for a reading or talk on the various
ways of the body and the mind, which need to be understood for normal
living and for the cure of nerves. Very often people of only average
education, long without the opportunity of study, gain in a
surprisingly short time enough insight to make new adaptations and
cure themselves. For this, a college education is not nearly so
important as an open mind. It is because of the success of this method
that I have been encouraged to reach a larger number of people by
means of a book, based on the same plan of re-education.
=Explanation vs. Suggestion.= Re-education through this kind of
explanation is simply a matter of learning the truth and acting upon
it. It is a process of real enlightenment, and is very different from
suggestion which trades upon the patient's credulity, increasing his
already exaggerated suggestibility.
Freud illustrates the difference between suggestion and
psycho-analysis by saying that suggestion is like painting and
psycho-analysis like sculpture. Painting adds something from the
outside, plastering over the canvas with extraneous matter, while
sculpture cuts away the unnecessary material and reveals the angel in
the marble. So suggestion covers over the real trouble by crying,
"Peace, peace, when there is no peace." Without attempting to remove
the cause, it says to the patient: "You have no pain. You are not
tired. You will sleep to-night. You will be cheerful." Sometimes the
suggestion works and sometimes it does not, but at best the relief is
likely to be a mere temporary makeshift. The symptom may be relieved,
but the character is not changed and therefore no permanent relief is
assured. It is far better for a nervous person to say to himself,
"There is something wrong and I am going to find it," than to keep
repeating over and over, "There is nothing wrong," and so on through a
list of half-believed autosuggestions.
On the other hand, psycho-analysis, and this kind of re-education
based on psycho-analytic principles, do not pay a great deal of
attention to the individual symptom. Instead of adding from without
they try to take away whatever has proved a hindrance to normal
growth and development, and to remove unnecessary resistances which
are responsible for the symptom, and which have been holding the
patient back from the fullest self-expression.
=Incantation vs. Knowledge.= There came to me one day a well-known
public woman who had suffered from nervous indigestion for many years.
As she was able to be with me for only one night, we had time for just
one conversation, but in that time she discovered what she was doing
and lost her indigestion. In the course of the conversation she turned
to me, saying: "Doctor, I know what a force suggestion is. I believe
in its power. Will you tell me why I have not been able to cure myself
of this trouble? Every night after I go to bed I repeat over and over
these Bible verses," naming a number of passages relating to God's
goodness and care for His children. My answer was something like this:
"You are too intelligent a woman to be cured by an incantation. When
you feel surging up within you the sense of God's goodness, or when
you actually want to realize His loving kindness, then by all means
repeat the verses. But don't prostitute those wonderful words by
making them into a charm and then expect them to cure your
indigestion. It is a desecration of the words and a denial of your own
intelligence. Autosuggestion is a powerful force, but real
psychotherapy is based not on the mechanical repetition of any set of
words, but on a knowledge of the truth."
=The "Bullying Method."= Sometimes, to be sure, explanation is not
enough. The brain paths between the associated ideas are so deeply
worn that no amount of persuasion avails. It is easy for the doubter
to say: "Well, that sounds very well, but my case is different. I have
tried over and over again and I know." With people of this sort, an
ounce of demonstration is worth a pound of argument.
By way of illustration we might mention the man who couldn't eat eggs.
To be sure, he had tried many times but always had suffered the most
intense cramps in his stomach, and no amount of talk could make him
believe that an egg was not poison to him. I took the straight road of
simply proving to him that he was mistaken, and had him eat an egg.
After a time of apprehension and retching, he vomited the egg,
thinking, of course, that he had proved his point. To his
astonishment, I said, "Now, let's go and eat another." With great
consternation, he finally complied, evidently expecting to die on the
spot; but as I immediately prescribed a game of tennis, he scarcely
had time to think of the pain, which in fact failed to appear.
However, as he thereafter insisted on eating four eggs a day,--with
eggs at top-notch price I decided that the joke was on the doctor!
=Enjoying the Right Things.= In substituting healthful complexes for
unhealthful ones, psychotherapy not only changes ideas and emotions,
but alters the feelings of pleasure or pain that are bound up with the
ideas. Dr. Tom A. Williams writes: "The essence of psychotherapy and
education is to associate useful activities with agreeable
feeling-tones and to dissociate from injurious acts the agreeable
feeling-tones that may have been acquired." Right character consists
not so much in enjoying things as in enjoying the right things.
Some people enjoy being martyrs. They love to tell about the terrible
strain they have been under, the amount of work they have done, or the
number of times they have collapsed. One of my patients gave every
evidence of satisfaction as he told about his various breakdowns. "The
last time I was ill," or "That time when I was in the sanatorium,"
were frequent phrases on his lips. Finally, after I had asked him if
he would boast about the number of times he had awkwardly fallen down
in the street, and had shown him that a neurosis is not really a
matter to be proud of, he saw the point and stopped taking pleasure in
his mistakes.
Such signs of pleasure in the wrong things are evidence of suppressed
wishes which we do not acknowledge but try to gratify in indirect
ways.[46] The pleasure which ought to be associated with the idea of
good work well done has somehow been switched over to the idea of
being an invalid. The satisfaction which ought to go with a sense of
power and ability to do things has attached itself to the idea of
weakness and inability. The pleasurable feeling-tone which normally
belongs to ministering to others, regresses in the nervous invalid to
the infantile satisfaction of being ministered unto.
[Footnote 46: For a further elaboration of this theme, see Holt: _The
Freudian Wish_.]
But these things are only a habit. A good look in the mirror soon
makes one right about face and start in the other direction. Once
started, a good habit is built up with surprising ease. It is really
much more satisfying to cook a good dinner for the family's comfort
than to think about one's ills; much pleasanter to enjoy a good meal
than to insist on hot water and toast. Once we have satisfied our
suppressed longings in more desirable ways, or by a process of
self-training have initiated a new set of habits, we feel again the
old zest in normal affairs, the old interest and pleasure in
activities which add to the joy of life. Thus does re-education fit a
man to take his place in the world's work as a socially useful being,
no longer a burden, but a contributor to the sum total of human
happiness.
SUMMARY
=Knowing and Doing.= Having set out to learn how to outwit our
nerves, we are now ready to sum up conclusions and in the following
chapters to apply them to the more common nervous symptoms. It has
been shown that a nervous person is in great need of change,--not,
indeed, a change in climate or in scene, in work or in diet, but a
change in the hidden recesses of his own being. Outwitting nerves
means first and foremost changing one's mind, an inner and spiritual
process very different from the kind of change which used to be
prescribed for the nervous invalid.
As Putnam says, the slogan of the suggestion-school of psychotherapy
has always been, "You can do better if you try"; while that of the
psycho-analytic school is, "You can do better when you know." Refuting
the old adage, "Where ignorance is bliss 'tis folly to be wise," the
best methods of psychotherapy insist that the first step in any
thorough-going attempt to change oneself must be the great step of
self-knowledge. As the conflicts which result in "nerves" are always
far beyond those mental regions which are open to scrutiny, a real
self-knowledge requires an examination of the half-conscious or wholly
unconscious longings which are usually ignored. A real understanding
of self comes only when one is willing, to analyze his motives until
he sees the connection between them and his nervous symptoms, which
are but the symbolic gratification of desires he dares not
acknowledge.
Although these deeply buried complexes are the real force behind a
nervous illness, the material out of which the symptoms are
manufactured is taken largely from superficial misconceptions
concerning the bodily functions. It is therefore a great help, also,
to possess a fund of information,--not technical nor detailed but
accurate as far as it goes,--about the more important workings of the
bodily machinery. A little knowledge about the actual chemistry of
fatigue and the way it is automatically cared for by the body is
likely to do away with the idea of nervous exhaustion as resulting
from accumulation of fatigue. A simple understanding of the biological
and physiological facts concerning the assimilation of food and the
elimination of waste material leaves the intelligent person less ready
to convert his psychic discomfort into indigestion and constipation.
Chapters IX to XIII in this book, which at first glance may seem to
belong to a work on physiology rather than on psychology are designed
to give just such needed insight.
But knowing the truth is only the first half of the way out. Every
neurosis is a deliberate choice by a part of the personality.
Self-discovery is helpful only when it leads to better ways of
self-expression. The final aim of psychotherapy is the happy
adjustment of the individual to the demands of society and the
establishment of useful outlets for his energy. This phase of the
subject will be discussed more fully in Chapter XVI.
=The Future Hope.= Much has been said about the cure of a neurosis.
There are enough people already in the maze of nervousness to warrant
the setting up of numerous signs reading, "This way out." But after
all, is not a blocking of the way in of vastly more importance? As it
is always easier to prevent than to cure, so it is easier to train
than to reform. If re-education is the cure, why is not education the
ounce of prevention which shall settle the problem for all time?
If the general public understood what "nerves" are, it is hardly
conceivable that there could be so many breakdowns as there are at
present. If a man's family and friends, to say nothing of himself,
understood what he is doing when he suddenly collapses and has to quit
work, it is not likely that he would choose that way out of his
difficulties.
Most important of all, when parents know that the foundation of
nervousness is laid in childhood, they will see to it that their
children are started right on the road to health. When fathers and
mothers realize that an over-strong bond between parents and children
is responsible for a large proportion of nervous troubles, most of
them will make sure that such exaggeration is not allowed to develop.
And, finally, when parents are freed from their "conspiracy of
silence" by a reverent attitude toward the whole of life, their very
saneness will impart to their children a wholesome respect for the
reproductive instinct. There will then be found in the next generation
fewer half-starved men and women carrying the burden of unnecessary
repressions and the pain of unsatisfied yearnings.
Not that such a day will usher in the millennium. We are not
suggesting a panacea for all the social ills. There is an inevitable
conflict between the instinctive urge of the life-force and the
demands of society, a conflict which makes men and women either finer
or baser, according to the way they handle it. What is claimed is that
the right kind of education--using the word in its largest, deepest
sense--will remove the most fruitful cause of nervousness by taking
away the extra burden of misconception and making it easier for people
to be "content with being moral."[47]
[Footnote 47: Frink: _Morbid Fears and Compulsions._]