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PSYCHOTHERAPY
BY
HUGO MUeNSTERBERG
M.D., PH.D., LITT.D., LL.D.
PROFESSOR OF PSYCHOLOGY IN HARVARD UNIVERSITY
NEW YORK
MOFFAT, YARD AND COMPANY
1909
COPYRIGHT, 1909, BY
MOFFAT, YARD AND COMPANY
_All Rights Reserved_
Published, April, 1909
Second Printing, May, 1909
* * * * *
RECENT BOOKS BY THE SAME AUTHOR
Psychology and Life, Boston, 1899
Grundzuege der Psychologie, Leipzig, 1900
American Traits, Boston, 1902
Die Amerikaner, Berlin, 1904
Principles of Art Education, New York, 1905
The Eternal Life, Boston, 1905
Science and Idealism, Boston, 1906
Philosophie der Werte, Leipzig, 1907
On the Witness Stand, New York, 1908
Aus Deutsch-Amerika, Berlin, 1908
The Eternal Values, Boston, 1909
* * * * *
TO
MY FRIEND AND COLLEAGUE
DR. FRANZ PFAFF
PROFESSOR OF THERAPEUTICS IN
HARVARD UNIVERSITY
* * * * *
PREFACE
This volume on psychotherapy belongs to a series of books which I am
writing to discuss for a wider public the practical applications of
modern psychology. The first book, called "On the Witness Stand,"
studied the relations of scientific psychology to crime and the law
courts. This new book deals with the relations of psychology to
medicine. Others discussing its relations to education, to social
problems, to commerce and industry will follow soon.
For popular treatment I divide applied psychology into such various,
separated books because they naturally address very different audiences.
That which interests the lawyer does not concern the physician, and
again the school-teacher has his own sphere of interests. Moreover the
different subjects demand a different treatment. The problems of
psychology and law were almost entirely neglected. I was anxious to draw
wide attention to this promising field and therefore I chose the form of
loose popular essays without any aim towards systematic presentation of
the subject. As to psychology and medicine almost the opposite situation
prevails. There is perhaps too much talk afloat about psychotherapy, the
widest circles cultivate the discussion, the magazines overflow with
it. The duty of the scientific psychologist is accordingly not to stir
up interest in this topic but to help in bringing this interest from
mere gossip, vague mysticism, and medical amateurishness to a clear
understanding of principles. What is needed in this time of faith cures
of a hundred types is to deal with the whole circle of problems in a
serious, systematic way and to emphasize the aspect of scientific
psychological theory.
Hence the whole first part of this book is an abstract discussion and
its first chapters have not even any direct relation to disease. I am
convinced that both physicians and ministers and all who are in
practical contact with these important questions ought to be brought to
such painstaking and perhaps fatiguing inquiry into principles before
the facts are reached. To those who seek a discussion of life facts
alone, the whole first part will of course appear to be a tedious way
around; they may turn directly to the second and third parts.
One word for my personal right to deal with these questions, as too much
illegitimate psychotherapeutics is heard to-day. For me, the relation
between psychology and medicine is not a chance chapter of my science to
which I have turned simply in following up the various sides of applied
psychology. And still less have I turned to it because it has become the
fashion in recent years. On the contrary, it has been an important
factor in all my work since my student days. I have been through five
years of regular medical studies, three years in Leipzig and two years
in Heidelberg; I have an M.D. degree from the University of Heidelberg.
In my first year as docent in a German university twenty years ago, I
gave throughout the winter semester before several hundred students a
course in hypnotism and its medical application. It was probably the
first university course on hypnotism given anywhere. Since that time I
have never ceased to work psychotherapeutically in the psychological
laboratory. Yet that must not be misunderstood. I have no clinic, and
while by principle I have never hypnotized anyone for mere experiment's
sake but always only for medical purposes, yet I adjust my practical
work entirely to the interests of my scientific study. The limitations
of my time force me to refuse the psychotherapeutic treatment of any
case which has not a certain scientific interest for me, and of the many
hundreds whom I have helped in the laboratory, no one ever had to pay
anything. Thus my practical work has strictly the character of
laboratory research.
The chief aim of this book is twofold. It is a negative one: I want to
counteract the misunderstandings which overflood the whole field,
especially by the careless mixing of mental and moral influence. And a
positive one: I want to strengthen the public feeling that the time has
come when every physician should systematically study psychology, the
normal in the college years and the abnormal in the medical school. This
demand of medical education cannot be postponed any longer. The aim of
the book is not to fight the Emmanuel Church Movement, or even
Christian Science or any other psychotherapeutic tendency outside of the
field of scientific medicine. I see the element of truth in all of them,
but they ought to be symptoms of transition. Scientific medicine should
take hold of psychotherapeutics now or a most deplorable disorganization
will set in, the symptoms of which no one ought to overlook to-day.
HUGO MUeNSTERBERG.
HARVARD UNIVERSITY, March 20, 1909.
CONTENTS
CHAPTER PAGE
I. INTRODUCTION 1
PART I
THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
II. THE AIM OF PSYCHOLOGY 9
III. MIND AND BRAIN 27
IV. PSYCHOLOGY AND MEDICINE 55
V. SUGGESTION AND HYPNOTISM 85
VI. THE PSYCHOLOGY OF THE SUBCONSCIOUS 125
PART II
THE PRACTICAL WORK OF PSYCHOTHERAPY
VII. THE FIELD OF PSYCHOTHERAPY 158
VIII. THE GENERAL METHODS OF PSYCHOTHERAPY 184
IX. THE SPECIAL METHODS OF PSYCHOTHERAPY 212
X. THE MENTAL SYMPTOMS 239
XI. THE BODILY SYMPTOMS 297
PART III
THE PLACE OF PSYCHOTHERAPY
XII. PSYCHOTHERAPY AND THE CHURCH 319
XIII. PSYCHOTHERAPY AND THE PHYSICIAN 347
XIV. PSYCHOTHERAPY AND THE COMMUNITY 370
I
INTRODUCTION
Psychotherapy is the practice of treating the sick by influencing the
mental life. It stands at the side of physicotherapy, which attempts to
cure the sick by influencing the body, perhaps with drugs and medicines,
or with electricity or baths or diet.
Psychotherapy is sharply to be separated from psychiatry, the treatment
of mental diseases. Of course to a certain degree, mental illness too,
is open to mental treatment; but certainly many diseases of the mind lie
entirely beyond the reach of psychotherapy, and on the other hand
psychotherapy may be applied also to diseases which are not mental at
all. That which binds all psychotherapeutic efforts together into unity
is the method of treatment. The psychotherapist must always somehow set
levers of the mind in motion and work through them towards the removal
of the sufferer's ailment; but the disturbances to be treated may show
the greatest possible variety and may belong to mind or body.
Treatment of diseases by influence on the mind is as old as human
history, but it has attained at various times very different degrees of
importance. There is no lack of evidence that we have entered into a
period in which an especial emphasis will be laid on the too long
neglected psychical factor. This new movement is probably only in its
beginning and the loudness with which it presents itself to-day is one
of the many indications of its immaturity. Whether it will be a blessing
or a danger, whether it will really lead forward in a lasting way, or
whether it will soon demand a reaction, will probably depend in the
first place on the soberness and thoroughness of the discussion. If the
movement is carried on under the control of science, it may yield
lasting results. If it keeps the features of dilettanteism and prefers
association with the antiscientific tendencies, it is pre-destined to
have a spasmodic character and ultimately to be harmful.
The chaotic character of psychotherapy in this first decade of the
twentieth century can be easily understood. It results from the fact
that in our period one great wave of civilization is sinking and a new
wave rising, while the one has not entirely disappeared and the other is
still far from its height. The history of civilization has shown at all
times a wavelike alternation between realism and idealism, that is,
between an interest in that which is, and an interest in that which
ought to be. In the realistic periods, the study of facts, especially of
the facts of nature, is prevalent; in idealistic periods, history and
literature appeal to the world. In realistic periods, technique enjoys
its triumphs; in idealistic periods, art and religion prevail. Such a
realistic movement lies behind us. It began with the incomparable
development of physics, chemistry, and biology, in the middle of the
last century, and it brought with it the achievements of modern
engineering and medicine. We are still fully under the influence of this
gigantic movement and its real achievements will never leave us; and yet
this realistic wave is ebbing to-day and a new period of idealism is
rising. If the signs are not deceitful, this new movement may reach its
historical climax a few decades hence, when new leaders may give to the
idealistic view of the world the same classical expression which Darwin
and others gave to the receding naturalistic age. The signs are clear
indeed that the days of idealistic philosophy and of art, and of
religion, are approaching; that the world is tired of merely connecting
facts without asking what their ultimate meaning is. The world dimly
feels again that technical civilization alone cannot make life more
worth living. The aim of the last generation was to explain the world;
the aim of the next generation will be to interpret the world; the one
was seeking laws, the other will seek ideals.
Psychotherapy stands in the service of both; it is the last word of the
passing naturalistic movement, and yet in another way it tries to be the
first word of the coming idealistic movement; and because it is under
the influence of both, it speaks sometimes the language of the one, and
sometimes the language of the other. That brings about a confusion and a
disorder which must be detrimental. To transform this vagueness into
clear, distinct relations is the immediate duty of science.
Indeed it may be said that psychotherapy is the last word of a
naturalistic age, because psychotherapy finds its real stronghold in a
systematic study of the mental laws, and such study of mental laws,
psychology, must indeed be the ultimate outcome of a naturalistic view
of the world. Realism begins with the analysis of lifeless nature,
begins with the study of the stars and the stones, of masses and of
atoms. At a higher level, it turns then to the living organism, studies
plants and animals and even brings the human organism entirely under the
point of view of natural law. When science has thus mastered the whole
physical universe, it finally brings even the mental life of man under
the naturalistic point of view, treats his inner experiences like any
outer objects, tears them in pieces, analyzes them, and studies them as
functions of the nervous system. A scientific psychology is thus reached
which is the climax of realism, because it means that even the ideas and
emotions and volitions of man are treated as natural phenomena, that
their causes are sought and that their effects are determined, that
their laws are found out. To apply this realistic knowledge of the mind
in the interest of therapy is merely to use it in the same way in which
the engineer uses his knowledge of physics, when he wants to harness
outer nature. As that is possible only when theoretical science has
reached a certain height of development, it can indeed be said that
practical psychotherapy on a scientific basis can be considered almost
as the ultimate point of a realistic movement; it cannot set in until
psychology has reached high development, and psychology cannot set in
unless biology has preceded it.
There is no doubt that we are still far from this last phase of the
realistic period. The practical application of scientific psychology is
still a new problem. Experimental psychology began about twenty-five
years ago; at that time there existed one psychological laboratory.
To-day there is no university in the world which does not have a
psychological workshop. But laboratories for applied psychology are only
arising in these present days, and the systematic application of
scientific psychology to education and law and industry and social life
and medicine is almost at its beginning. While the height of the last
realistic wave was in the period of the sixties, seventies, and
eighties, of the last century, its last phase, the practical application
of physiological psychology, including psychotherapy, is only at its
commencement.
But while this last great movement has not yet reached its end, the new
idealistic movement to come has not yet reached a clear self-expression.
A general philosophical interest can be felt, but a great philosophical
synthesis seems still lacking. A new sense of duty can vaguely be felt,
but great new tasks have not yet found common acknowledgment. Above all,
the unshaped emotionalism of the masses has not yet been brought into
any real contact with the new idealism which grows up on the higher
level of scholarly thought. But it is evident, if a new great mood of
idealism is to come, one of its popular forerunners must be the demand
that the spirit is real in a higher sense than matter, that the mind
controls the body, that faith can cure. In such unphilosophic crudeness,
no definite thought is expressed, as everything would depend on the
definition of spirit, of faith, of mind, of reality. Moreover, every
inquiry would prove that the idealistic value of such statements as are
afloat among the masses to-day is reached only by a juggling with words.
That faith can cure appears to point towards the higher world, as the
word faith has there the connotation of the faith in a religious sense;
and yet the faith which really cures a digestive trouble, for instance,
is the faith in the final overcoming of the intestinal disturbance, an
idea which belongs evidently in the region of physiological psychology,
but not in the region of the church. Yet, however clumsy such statements
may be, they are surely controlled by the instinctive desire for a new
idealistic order of our life, and the time will come when their
unreasoning and unreasonable wisdom will be transformed into sound
philosophy without losing its deepest impulse. The realistic conviction
that even the mind is completely controlled by natural laws and the
idealistic inspiration that the mind of man has in its freedom mastery
over the body, are thus most curiously mixed in the popular
psychotherapy of the day, and too few recognize that the real meaning of
mind is an entirely different one in these two propositions.
Of course the one or the other of these two elements prevails in the
systematic treatises on the subject; the realistic one in those written
by the psychiatrists, the idealistic one in those written by clergymen
or Christian Scientists. The literature indeed is almost entirely
supplied from these two quarters: and yet it is evident that neither the
one nor the other party can give to the problem its most natural
setting. The student of mental diseases naturally emphasizes the
abnormal features of the situation, and thus brings the
psychotherapeutic process too much into the neighborhood of pathology.
Psychotherapy became in such hands essentially a study of hypnotism,
with especial interest in its relation to hysteria and similar diseases.
The much more essential relation of psychotherapy to the normal mental
life, the relation of suggestion and hypnotism to the normal functions
seemed too often neglected. Whoever wants to influence the mind in the
interest of the patient, must in the first place be in intimate contact
with psychology. On the other hand, the minister's spiritual interest
brings the facts nearer to religion than they really are. That a
suggestion to get rid of toothache, or to sleep the next night, is given
by a minister, does not constitute it as a religious suggestion. If the
belief in religion simply lies alongside of the belief in most trivial
effects, and both are applied in the same way for curing the sick, it is
evident that not the spiritual meaning of religion is responsible for
the cure, but the psychological process of believing. But if that is the
case, it is clear that here again the psychologist, and not the
moralist, will give the correct account of the real process involved.
In short, it is psychology, psychology in its scientific modern form,
which has to furnish the basis for a full understanding of
psychotherapy. From psychology it cannot be difficult to bridge over to
the medical interests, on the one side, to the idealistic ones on the
other side.
Our task here is, therefore, to lay a broad psychological foundation. We
must carefully inquire how the modern psychologist looks on mental life
and how the inner experiences appear from such a psychological
standpoint. The first chapters of this volume may appear like a long,
tiresome way around before we come to our goal, the study of the
psychotherapeutic agencies. And yet it is the only possible way to
overcome the superficiality with which the discussion is too often
carried on; we must understand exactly how the psychological analysis
and explanation of the scientist differ from the popular point of view.
After studying in this spirit the foundation of psychotherapy, we shall
carefully examine the practical work, its methods and its results, its
possibilities and its limitations. We shall inquire finally into the
place which it has to take, looking back upon its history, criticising
the present status and outlining the development which has to set in for
the future, if a haphazard zigzag movement is not to destroy this great
agency for human welfare by transforming it into a source of
superstition and bodily danger.
PART I
THE PSYCHOLOGICAL BASIS OF PSYCHOTHERAPY
II
THE AIM OF PSYCHOLOGY
The only safe basis of psychotherapy is a thorough psychological
knowledge of the human personality. Yet such a claim has no value until
it is entirely clear what is meant by psychological knowledge. We can
know man in many ways. Not every study of man's inner life is psychology
and the careless mixing of different ways of dealing with man's inner
life is largely responsible for the vagueness which characterizes the
popular literature of psychotherapy. It is not enough to say that a
statement is true or not true. It may be true under one aspect and
entirely meaningless under another. For instance, a minister's
discussion of man's energies may be full of deep truth and may be
inspiring; and yet it may not contain the slightest contribution to a
really psychological knowledge of those energies, and would mislead
entirely the physician were he to base his treatment of human energies
on such a religious interpretation.
Can we not look from different standpoints even on any part of the
outer world? I see before me the ocean with its excited waves splashing
against the rocks and shore, I see the boats tossed on the stormy sea
and I am fascinated by the new and ever new impulses of the tumultuous
waves. The whole appears to me like one gigantic energy, like one great
emotional expression, and I feel deeply how I understand this beautiful
scenery in appreciating its unity and its meaning. Yet would I ever
think that it is the only way to understand this turmoil of the waters
before me? I know there is no unity and no emotion in the excited sea;
each wave is composed of hundreds of thousands of single drops of water,
and each drop composed of billions of atoms, and every movement results
from mechanical laws under the influence of the pressing water and air.
There is hydrogen and there is oxygen, and there is chloride of sodium,
and the dark blue color is nothing but the reflection of billions of
ether vibrations. But have I really to choose between two statements
concerning the waves, one of which is valuable and the other not? On the
contrary, both have fundamental value. If I take the attitude of
appreciation, it would be absurd to say that this wave is composed of
chemical elements which I do not see; and if I take the attitude of
physical explanation, it would be equally absurd to deny that such
elements are all of which the wave is made. From the one standpoint, the
ocean is really excited; from the other standpoint, the molecules are
moving according to the laws of hydrodynamics. If I want to understand
the meaning of this scene every reminiscence of physics will lead me
astray; if I want to calculate the movement of my boat, physics alone
can help me.
As long as we deal with outer nature, there is hardly a fear of
confusing the various attitudes; but it becomes by far more complex when
we deal with man and his inner life. We might abstract entirely from
aesthetic appreciation or from moral valuation, we might take man just as
an object of knowledge; and yet what we know about him may be entirely
different in accordance with our special attitude. Each kind of
knowledge may be entirely true, and yet true only from the particular
standpoint. Let us consider two extremes. If I meet a friend and we
enter into a talk, I try to understand his thoughts and to share his
views. I agree or disagree with him; I sympathize with his feelings, I
estimate his purposes. In short, he is for me a center of aims and
intentions which I interpret: he comes in question for me as a self
which has its meaning and has its unity. The more I am interested in his
opinions, the more I feel in every utterance, in every gesture, the
expression of his will and his purposes; their whole reality for me lies
in the fact that they point to something which the speaker intends; his
personality lies in his attitude towards the surroundings, towards the
world. Yet I may take an entirely different relation to the same man. I
may ask myself what processes are going on in his mind, what are the
real contents of his consciousness, that is, what perceptions and memory
pictures and imaginative ideas and feelings and emotions and judgments
and volitions are really present in his consciousness. I watch him to
find out, I observe his mental states, I do not ask whether I agree or
disagree; his will is for me now not something which has a meaning, but
simply something which occurs in his inner experience; his ideas now
have for me no reference to something in the world, but they are simply
contents of his consciousness; his memories now are for me not symbols
of a past to which he refers, but they are present pictures in his mind;
in short, what I now find is not a self which shows itself in its aims
and purposes and attitudes, but a complex content of consciousness which
is composed of numberless elements. I might say in the first place that
my friend was to me a subject whom I tried to understand by interpreting
his meaning, and in the second case, an object which I understand by
describing its structure, its elements, and their connections.
Both ways of looking on man are constantly needed. We might alternate
between them in any experience. In the heat of argument, my friend will
certainly be for me the subject with whose meanings I try to agree or
disagree, whose emotions carry me away, whose ideas open the world to
me. Yet in the next moment, I may notice that his ideas were shaped and
determined by certain earlier experiences; that they linked themselves
in memory according to certain laws of mental flow; that the vividness
of his ideas made him overlook certain impressions of the surroundings;
and that may turn my attention to an entirely different aspect of his
inner life. His feelings and emotions, his volitions and judgments now
have for me simply the character of processes which go on and which are
observed, which coincide and which succeed each other, which fuse and
overlap, and which are composed of smaller parts. My interest is now no
longer in the meaning and intentions of this self, but it belongs to the
structure and the connections in this system of mental facts. At first,
I wanted to understand him by living with him, by participating in his
attitudes, and by feeling with his will; now I want to understand him by
examining all the processes which go on in his consciousness, by
studying their make-up and their behavior, their elements and their
laws. In one case I wanted to interpret the man, and finally to
appreciate him; in the other case I wanted to describe his inner life,
and finally to explain it. The man whose inner life I want to share I
treat as a subject, the man whose inner life I want to describe and
explain I treat as an object.
I might express these two standpoints still otherwise. If my neighbor is
to me a subject, for instance, in the midst of an ordinary conversation,
he comes in question only with reference to his aims and meanings:
whatever he utters has a purpose and end. I understand his inner life by
taking a purposive point of view. On the other hand, the man whose inner
life is to me an object can satisfy my interest only if I understand
every particular happening in his mind from its preceding causes. I
transform his whole life into a chain of causes and effects. My
standpoint is thus a causal one. No doubt in our daily life, our
purposive interest and our causal interest may intertwine at any moment.
I may sympathize with the hopes and fears of my neighbor in a purposive
way, and may yet in the next moment consider from a causal standpoint
how these emotions of his are perhaps affected by his fatigue or by some
glasses of wine, or by a hereditary disposition, or by a suggestion; in
short, at one time I look out for the meaning of the emotion as a part
of the expression of a self, and at another time for the structure and
appearance of the emotion as a part of a causal chain of events. In both
directions I can go on with entire consistency, and there cannot be any
part of inner experience which cannot be fully brought under either
point of view. How far we have a right to mix the two standpoints in
practical life, we shall carefully examine; but it is clear that if we
want to understand the true meaning of the study of inner life, we have
no longer any right carelessly to mix the two standpoints without being
conscious of their fundamental difference. We must understand exactly
what the aim of the one and of the other is, and where each has its
particular value; science certainly has no right to throw together such
different views of life. And now this may be said at once: the causal
view only is the view of psychology; the purposive view lies outside of
psychology.
Such a separation does not at all aim to indicate that the one view is
more important than the other, or that the one has more scientific
dignity than the other; both yield us truth, and both may be carried
from the simplest and most trivial observations of daily life to the
highest elaborations of scholarship. To those who are inclined to give
all value and all credit only to the strictly psychological view, it may
be replied at once that surely our most immediate life experience is
carried on by the non-psychological attitude. If we love our family and
like our friends, and deal with the man of the street, we are certainly
moving in a world of purposive reality. We try to understand each other,
to agree and to disagree, to be in sympathy and antipathy, without
asking how those volitions and feelings and ideas of other people are
built as mental structures, and from what causes they arose; we are
satisfied to understand what they mean. In the same way with ourselves.
We live our lives by hinging them on our aims and purposes and ideas,
and do not ask ourselves what are the causes of our attitudes and of our
thoughts.
This purposive view has in no respect to disappear if we move on from
our personal intercourse to a scholarly study of reality. The historian,
for instance, who tries to understand the will relations of humanity, is
the more the true historian the more he sticks to this purposive view of
man. The truth which he seeks is to interpret the personalities, to
understand them through their attitudes, to make their will living once
more, and to link it by agreement and disagreement, by love and hate,
with the will of friends and enemies, groups and parties, nations and
mankind. It is only a loose popular way of speaking, if this purposive
analysis of a character is often called psychological. In a stricter
sense of the word, it is not psychological. If the historian really were
to take the psychological attitude, he would make of history simply a
social psychology, seeking the laws of the social mind, and treating the
individual, the hero, and the leader, merely as the crossing-point of
psychological law. For such a psychological view the mental life of the
hero would not be more important or more interesting than the mental
life of a scoundrel, and the psychology of the king would not draw his
interest more than the psychology of the beggar. The historian has to
shape all that from an entirely different standpoint: his scientific
interest depends upon the importance of men's attitudes and actions, and
such importance refers to the world of purposes.
In the same way, we have to stick to the non-psychological point of view
whenever man's life, his thoughts and feelings and volitions, are to be
measured with reference to ideals; that is in ethics and aesthetics and
logic, sciences which ask whether the volitions are good or bad, whether
the feelings are valuable or worthless, whether the thoughts are true or
false. The psychologist does not care; just as the botanist is
interested in the weed as much as in the flower, the psychologist is
interested in the causal connections of the most heinous crime not less
than in those of the noblest deed, in the structure of the most absurd
error not less than in that of the maturest wisdom. Truth, beauty, and
morality are thus expressions of the self in its purposive aspect.
We can go one step further. Those who narrowly seek every truth only in
the scientific understanding, ought to be reminded that this seeking for
causal connections is itself, after all, only a life experience which as
such is not of causal but of purposive character. "Life is bigger than
thought." In the immediate reality of our purposive life we aim towards
mastering the world by a causal understanding, and for this end we
create science; but this aim itself is then a purpose and not an object.
The first act is thus for us, the thinkers, not a part of the causal
events, but a purposive intention towards an ideal. Therefore, our
purposes have the first right; they represent the fundamental reality;
the value of causal connections and thus of all scientific and
psychological explanation, depends on the value of the purpose. Causal
truth can be only the second word; the first word remains to purposive
truth. From this point of view we may understand why there is no
conflict between the most consistent causal explanation of mental life
on the one side, and an idealistic view of life on the other side; yes,
we can see that the fullest emphasis on a scientific psychology--which
is necessarily realistic and, to a certain degree, materialistic--is
fully embedded in an idealistic philosophy of life, and that without
conflict. And we shall see how this consistency in sharply separating
the psychological view from the non-psychological, secures much greater
safety for true idealism than the inconsistent popular mixing of the
two principles, where scientific psychology is constantly encroached
upon by demands of faith and religion, and where faith and religion seem
constantly in danger of being overturned by new discoveries in
physiological psychology. We may, indeed, remove from the start the
mistaken fear that a consistent causal aspect of life leads to injustice
to the higher aims and ideal purposes of mankind. If we want to have
psychology,--and that means if we want to consider the mental life in a
system of causes and effects,--we must proceed without prejudices, and
without side-thoughts.
From a psychological standpoint our own mental life and that of our
neighbor, that of the man and that of the child, that of the normal and
that of the insane, that of the human being and that of the animal, are
to be considered as a series of mental objects. They are to be analyzed,
and to be described, and to be classified and to be explained, just as
we deal with the physical objects in the outer world. How are these
objects of the psychologist different from the objects of the physicist,
from the pebbles on the way and the stars in the sky? There is only one
fundamental difference and all other differences result from it. Those
outer objects which we call physical, are objects for everybody. The
star which I see is conceived as the same star which you see, the table
which I touch is the table which you may grasp, too. But every psychical
object is an object for one particular person only. My visual impression
of the star, that is, my optical perception, is a content of my own
consciousness only, and your impression of the star can be a content of
your consciousness only. We both may mean the same by our ideas, but I
can never have your perception and you can never have my perception. My
ideas are enclosed in my mind. I may awaken in your mind ideas which
have the same purpose and meaning, but they are new copies in your mind.
We both may be angry, but your anger can never be my anger, and your
volitions can never enter my mind. Every possible psychical fact thus
exists in one consciousness only, while every physical fact exists for
every possible consciousness.
The psychologist's final task is to explain the appearance and
disappearance, the connections and sequences of these mental objects,
the contents of consciousness. But before he can start on explanation of
the facts, he has to describe them, and describing means analyzing them
into their elements and fixating those elements and their combinations
for an exact report. Such descriptive work is in a way preparatory for
the further task of real explanation; yet it is in itself important,
complicated, and difficult. Of course, it may be easy to separate the
complex content into some big groups of facts, to point out that this is
a memory idea and this an imaginative idea and the other an abstract
idea, and this a perception and that a feeling, this an emotion and that
a volition. But such clumsy first discrimination does not go further,
perhaps, than does the naturalist's, who tells us that this is a
mountain and that a tree, this a pond and that a bird. The real
description would demand, of course, an exact measurement of the height
of the mountain and the geological analysis of its structure, or an
exact classification of the tree and the bird, with a complete
description of their organs, and in each organ the various tissues have
to be described, and in each tissue the various cells, and the
microscopist goes further and describes the structure of the cell.
Certainly in the same way the psychologist has to go on to resolve every
one of those complex structures; he has to examine the mental tissues
and the mental cells of which a volition or a memory idea or a
perception are composed. And while he cannot use a microscope for these
mental elements, yet his studies may cause elements to appear which the
naive observation remains entirely unaware of.
Perhaps he finds in his consciousness the perception of the table before
him which lingers for a little while in his mind. He finds no difficulty
in analyzing it into color sensations and tactual sensations; and yet he
is aware of so much more in it. The table, for instance, has form for
him and he may find that these form perceptions involve the sensations
of the eye movements which he makes from one corner of the table to the
other; he may find that if the idea lasts in him, he becomes aware of
the time by sensations of tension; he finds that in his perception of
the table lies an idea of its use, and he discovers that that is made up
of elements which are partly memory reproductions of earlier
impressions, partly sensations of movement impulses; he also finds that
the table feels smooth, and he discovers by his analysis that this
impression of smoothness results from a special combination of tactual
sensations and movement sensations; and again those movement sensations
he analyzes further into sensations of muscle contraction and sensations
of pressure in the joints and sensations of tension in the tendons.
Before a zooelogist has completed his description of a bird in the
landscape, he has given account of hundreds of thousands of things; but
before the psychologist would complete the enumeration of the mental
elements which enter into the seeing of the table, he would have to give
account of by far more psychical elements. Every point in the surface of
the table has its own light value, perhaps different in its quality and
intensity and saturation, in its hue and tint and shade from the next
one, and at whatever point of the table's edge our attention is
directed, each one involves numberless shades in the vividness of all
the other points and numberless mental relations of space perception
among the various parts of the table. In the thorough analysis of the
describing psychologist, every single idea, and in the same way, every
single emotion or feeling or judgment becomes complex like a living
organism, an aggregate of thousands of mental tissues, and yet made up
from "the stuff that dreams are made of."
But there is one particular difficulty which makes the psychological
description so much harder than that of the physicist, and which gives
rise to many disagreements and discussions in psychological literature.
The psychologist has not only to tear the complex into pieces and thus
to seek the elements, but he has to fixate those elements for the
purpose of communication, as, of course, a scientific description
demands that he be able to give account to others of what he
experiences. The physicist has no difficulty whatever in that line
because, as we saw, the world of physical things is the world which all
men are sharing together. Every element which I find in it, I can show
to every other person, and if I cannot show that particular thing,
because I cannot yet carry the mountain to another place, then I can at
least measure it, as we share those standards of space. Thus natural
science has in its objective measurements the possibility of describing
every part of the physical world. The psychical world, on the other
hand, is as we saw, the world which is private property. Every effort at
description is thus entirely in vain as long as our mental facts cannot
somehow be linked with physical happenings. If I say that I have in my
mind sweetness or sourness, or bitterness or saltness, I cannot carry
any understanding to anyone else and therefore cannot give any
description until I have agreed that I mean by sweetness the sensation
which sugar gives me, and by saltness the sensation of salt. The sugar
and salt I can point out to my neighbor and only in that way I
understand what he means if he says that he tastes salt and sweet;
otherwise I should have no means whatever to discriminate whether that
which he calls a sweet taste sensation is not just what I call headache.
Where no such direct relation for a physical thing is known, description
of the mental element would remain impossible. Of course, every
perception of the outer world, all our seeing and hearing, and touching
and tasting, offers us at once such definite connection between the
inner experience and a piece of the physical universe. Our own organism
is also such a piece of physical nature: just as I describe my tasting
or touching, I may describe the perception of my arms and legs or my
inner organs. Thus everything which is material of perception gives us a
handle for a real psychological description. Psychology usually calls
the elements of these perceptions sensations. Whatever is composed of
sensations is thus describable.
On the other hand, no other way of description is open. If there were
mental states which are composed of other elements than sensations, they
would necessarily remain indescribable; we could not grasp them because
they would not have any definite relation to the common physical world.
We might say, for instance, that our mental content is made up of
sensations and feelings, but if such feelings were really entirely
different from sensations, they would have to remain for all time
mysterious and unknown. We could not compare notes. The feeling which I
call joy may feel just like the one which you call despair. The
consistent development of modern psychology and its emancipation from
vagueness and superficial analysis became possible only through the fact
that such recourse to indescribable elements has become unnecessary.
Modern psychology has been able to demonstrate more and more that the
same elements which constitute our perceptions are also the elements of
the other contents of consciousness. In other words modern psychology
has recognized that the volitions and emotions and feelings and
judgments, and the whole stream of inner life, are made up of
sensations. Millions of sensations in all degrees of vividness and
clearness, of intensity and fusion, in endless manifoldness of rhythms
and relations constitute their whole content. It is a discovery quite
similar to the one which chemistry made when it found that the same
elements which are part of the inorganic substances are also the only
possible elements of the organic world.
From a strictly psychological standpoint, the ideas and the not-ideas
contain thus nothing but sensations. Their grouping, their shading,
their combination, their succession decide whether we have before us a
perception or an imagination, a volition or an emotion. What are we
ourselves then for the psychologist? Evidently we ourselves belong also
to the inner experiences which we know; and psychology has succeeded in
analyzing this idea of our own self just in the same way as it analyzes
our idea of the moon. In this analysis, psychology finds its idea of the
self as a content of consciousness crystallized about the sensations
from the body. Every one of our bodily activities is represented in our
consciousness by movement sensations, and these sensations form the core
of the complex aggregate which develops into the idea of ourselves.
Organic sensations from our inner organs, pain sensations and pleasure
sensations fuse with the movement sensations, and the whole complex
shapes itself slowly into the idea of the personality of the self in
contrast to the idea of other personalities. We ourselves are for
ourselves a complex combination of sensations; and yet all our feelings
and emotions and volitions are only a part of it. Psychology thus
necessarily considers those experiences of feeling and will and
character simply as changes in the midst of that central experience of
personality which is itself made up of bodily sensations. Each bit of
will and emotion must be decomposed into its finest elements. There is
no passing mood, and no floating half-thought in our mind, no dream and
no intuition, no slightest change of attention, no instinct and desire
which cannot be analyzed thus into its sensation elements or rather
which must not be analyzed, if we are to describe it at all, and that
means if we are to give a psychological account. Psychology is endlessly
far from this ideal to-day. It has been claimed, not without justice,
that psychology has reached to-day only the level which physics attained
in the seventeenth century; but psychology must insist that its ideal
lies in this direction. No one takes a real psychological view of the
human mind who does not understand this endless complexity of the
material, and who does not see that even the simplest mental state
practically presents a most complex problem to scientific analysis. The
physician who really aims towards scientifically exact influence on the
human mind has reached the first step of his preparation as soon as he
understands that the content of consciousness is composed of hundreds
of thousands of elements. To treat the mind as if there were only a few
large pieces, one thing called memory and one thing called will and one
called emotion and so on, is as if a surgeon were to perform an
operation, knowing that there are arms and legs, but not knowing the
ramifications of the nerves and blood-vessels which his knife may
injure. Yet the description of these complex facts is only the beginning
of psychology. We saw that the real aim is their explanation.
III
MIND AND BRAIN
The central aim of the psychologist must be to explain the mental facts.
It is not sufficient to describe the procession of mental experiences in
us, we must understand the causes which determine that now this and now
that appears and disappears, and appears just in this combination of
elements. The astronomer is not satisfied with describing the stars, he
wants to explain their movements and to determine which movements are to
be expected. The psychologist, like the naturalist, aims towards
explanation, and it is this demand which forces him to look from the
psychical facts to the physical ones, from the mind to the brain. He is
under an illusion if he fancies that he can explain mental facts by
themselves. The purposive mind has its connection in itself, the causal
psychological mind demands for its connection the body. To understand
this necessity is the first step towards understanding the relation of
mind and brain.
The psychologist's problem of explanation is in one way entirely
different from that of the physicist. The physicist finds a world of an
unlimited number of atoms which are ultimately conceived as all alike,
but each one in a different place, and all the changes in the universe,
the movements of the stars, the waves of the ocean, are to be explained
by the causal connections of the movements of these atoms. The
psychologist, on the other hand, finds an endless manifoldness of
elements which are not in space, and which have no space form whatever.
My will is neither triangular nor oval; my emotion is neither shorter
than five feet nor longer; my memory image of a melody has no thickness
and no tallness; my contents of consciousness are as such not in space;
their elements cannot pass through any space movements like the atoms of
the physicist. Instead of it, the psychical atoms, the sensations, have
different qualities, are blue and green, and cold and warm, and sweet
and sour, and toothache and headache. The changes which go on in such a
system are thus not changes of position and movements, but changes in
kind and strength and vividness and fusion; and exactly such changes are
the processes which the psychologist wants to explain. He wants to make
us understand why this idea grows up and the other fades away, why this
impression stands out with clearness as an attended object while the
other lacks vividness and disappears, why this volition grows out of
that emotion, why this feeling leads to this imaginative thought.
The first step towards such explanation is, of course, in psychology, as
in all other sciences, the careful observation of regularities. It
quickly leads us to formulate some general laws. Psychology has known,
for instance, for two thousand years, that if we have perceived two
things together, and later we see the one again, the new perception
brings us a memory image of the other thing. If we saw a man's face and
heard at the same time his name, seeing his face may later awaken in us
the memory of his name, or the hearing of his name may later awaken in
us a reproduced memory image of his face. On such a basis, for instance,
we formulate some general laws of association of ideas, and as soon as
we have such laws laid down, we consider the appearance of such a memory
image by association as sufficiently explained. We feel that it gives us
sufficient basis to predict that in the future this idea will stir up in
us the other idea. Psychology has formulated plenty of such general
statements, and they serve well for a first orientation.
Yet can this ever be considered as a last word of scientific explanation
of psychical facts? Can psychology really in this way reach an ideal
similar to that of scientific astronomy or chemistry? Would the
scientist of nature ever be satisfied with this kind of explanation,
which is nothing but generalization of certain sequences? Does not the
explanation of the naturalist contain an entirely different element? He
does not merely want to say that this effect has sometimes been observed
and that there is thus probability that it will come again, when similar
causes are given. No, the physicist wants to understand those
connections of cause and effect as necessary ones. He tries to find
sequences which cannot be otherwise because they cannot be thought in
any other way. Therefore he is not satisfied with complex regularities,
but analyzes them until he can bring them down to simple physical
connections, and these physical connections finally to mechanical
processes, which realize for us logical necessities. That matter lasts
and cannot disappear is such a presupposition, which comes to us with
the necessity of logical thinking. We simply cannot think it otherwise.
And the whole idea of natural science is to conceive the physical
universe in such a way that all changes in the outer world can be
understood as the movements of its parts in accordance with such
necessary physical axioms. If we knew all the atoms of the present
status of the universe, and we knew every present movement of every
atom, we should be able to foresee the position of every atom in the
next moment and in the following moment and in all following moments,
and all that by the necessary continuation of the substance and its
energies. That alone is the background of all special physical inquiry,
and we rely on the special laws of physics and chemistry, because we
trust that this universe, as a whole, could be ultimately understood as
such a system of necessary changes in the positions of the lasting
atoms.
For the psychologist there is no hope of finding such necessity in the
mental processes. The point is not that psychology is to-day too far
removed from the fulfillment of such an ideal, the point is rather that
such an ideal would be meaningless for the psychologist. His materials,
the psychical contents of consciousness, are by their nature unfit to
enter into such necessary connections; they cannot do it because they
cannot last. The physical object, we saw, is the object which is common
property, which we all feel in common, which must thus exist for all
time. The things in nature may burn down or decay, but no atom of them
can ever disappear from the universe, each must enter into new and ever
new combinations and last through all changes. The psychical thing, on
the other hand, can exist only for the one immediate experience. Every
sensation which enters into my ideas or volitions or emotions is a new
creation of the instant which cannot last; each one flashes up and is
lost with the moment's experience. My will to-day may have the same aim
as my will of yesterday, but as psychical object, my will to-day is a
new will, is a new creation in every pulse beat of my life. I must will
it again, I cannot store it up. And my joy of to-day can never be as
psychical fact the same joy which I may have to-morrow. Mental objects
as such, as psychological material, are not destined to last. It has no
meaning whatever to think of their being kept over until another time.
It is a coarse materialism to conceive the mental contents like pebbles
which may remain on the road from one day to another. Our ideas and
feelings are mental appearances which have their existence in the act of
the one experience; each new experience must be an entirely new
creation.
If I remember my last year's perception, I do not dig it out from an
under-mind, in which it was stored up and buried, but I create an
entirely new memory picture, just as I may make to-day a speech which
says the same thing which I said last year, and yet my action of
speaking is not last year's speech movement. It is a new action, and the
movement did not lie over somewhere during the interval. Mental life is
produced anew in every moment. When the first experience is gone and the
second comes, nothing of the stuff from which the first was made still
has existence in the content of consciousness. By this fact it becomes
entirely impossible ever to conceive necessary connections in the sense
of physical necessity in the world of consciousness. The one idea may
bring to me another idea by association, but as long as I consider both
strictly as mental facts, I can never understand why this association
happens, I can never grasp the real mechanism of the connection, I can
never see necessity between the disappearance of the one and the
appearance of the other. It remains a mystery which does not justify any
expectation that the same sequence will result again. Whatever belongs
to the psychical world can never be linked by a real insight into
necessity. Causality there remains an empty name without promise of a
real explanation.
Only when we have recognized this fundamental difficulty in the efforts
for psychological explanation, can we understand the way which modern
psychology has taken most successfully. The end of this way is simply
this: every psychical fact is to be thought of as an accompaniment of a
physical process and the necessary connections of these physical
processes determine, then, the connections of the mental facts. Indeed
this has become the method of modern psychology. It has brought about
the intimate relation between psychology and the physiology of the
brain, and has given us, as foundation, the theory of psychophysical
parallelism; the theory that there is no psychical process without a
parallel brain process. But the real center of the theory lies indeed in
the fact which we discussed; it lies in the fact that we cannot have any
explanation of mental states as such at all, if we do not link them with
physical processes.
Is it necessary to express again the assurance that such statements of a
parallelism between mind and brain in no way interfere with an
idealistic view of inner life? Have we not seen clearly enough that
these mental facts which are conceived parallel to physiological brain
processes do not represent the immediate reality of our inner life, that
our life reality is purposive and as such outside of all causal
explanation, and that we have to take a special, almost artificial,
point of view to consider inner life at all as objects, as contents of
consciousness, and thus as psychological material? But since we have
seen that for certain purposes such a point of view is necessary, as
soon as we have taken it we must be consistent. Our inner life in its
purposive reality has therefore nothing to do with brain processes, but
if we are on the psychological track and consider man as a system of
psychological phenomena, then to be sure, we must see that our only
possible interest lies in the finding of necessary causal connections.
But these cannot be found otherwise than by linking the mental facts
with the physical ones, the psychological material with the processes of
the brain.
Of course, that mental experience stands in intimate relations to the
body is a knowledge which does not wait for such philosophical
arguments. That mind and body come in contact is a conviction which goes
with every single sense perception. I see and hear because light and
sound stimulate my sense organs, and the sense organs stimulate my
brain. The explanation of perception through causes in the physical
system seems the more natural as it is evident that in such cases there
are no psychical causes which might have brought forward the perception.
If I suddenly hear bells ringing, there was on the mental side nothing
preceding which could be responsible for my sound perception. And the
same holds true if the physical source lies in my own body, if perhaps
my tooth begins to ache, although no expectation preceded it.
In the same way it seems a matter of course that mind and body are
connected wherever an action is performed. I have the will to grasp for
the book before me, and obediently my arm performs the movement; the
muscles contract themselves, the whole physical apparatus comes into
motion through the preceding mental fact. The same holds true where no
special will act arouses the muscles. If a thought is in my mind and it
discharges itself in appropriate words, those words are after all as
physical facts the movements of lips and tongue and vocal cords and
chest; in short, a whole system of physical responses has set in through
a mental experience. But the same thought may be the starting-point for
many other bodily changes; it may make me blush, and that means that
large groups of blood-vessels become dilated; or I may get pale, the
blood-vessels are contracted. Or I may cry, the lachrymal gland is
working; or it may spoil my appetite, the membranes of my stomach cease
to produce; or my muscles may tremble, or my skin may perspire; in
short, my whole organism may resound with mental excitement which some
words may set up.
But it is not only the impression of outer stimuli and the expression of
inner thoughts in which mind and body come together. Daily life teaches
us, for instance, how our mental states are dependent upon most various
bodily influences. If the temperature of the blood is raised in fever,
the mental processes may go over into far-reaching confusion; if hashish
is smoked, the mind wanders to paradise, and a few glasses of wine may
give a new mental optimism and exuberance; a cup of tea may make us
sociable, a dose of bromide may annihilate the irritation of our mind,
and when we inhale ether, the whole content of consciousness fades away.
In every one of these cases, the body received the chemical substance,
the blood absorbed and carried it to the brain, and the change in the
brain was accompanied by a change in the mental behavior. Even ordinary
sleep at night presents itself surely as a bodily state--the fatigued
brain cells demand their rest, and yet at the same time the whole mental
life becomes entirely changed. It is not difficult to carry over such
observations of daily life to the more exact studies of the
psychological laboratory and to examine with the subtle means of the
psychological experiment the mental variations which occur with changes
of physical conditions. We might feel, without instruments, that our
ideas pass on more easily after a few cups of strong coffee, but the
laboratory may measure that with its exact methods and study in
thousandth parts of a second, the quickening or retarding in the flow of
ideas. Every subjective illusion is then excluded, our electrical
clocks, which measure the rapidity of mental action and of thought
association, will show then beyond doubt how every change in the
organism influences the processes of the mind. Bodily fatigue and
indigestion, physical health and blood circulation, everything,
influence our mental make-up. In the same way it is the laboratory
experiment which shows by the subtlest means that every mental state
produces bodily effects where we ordinarily ignore them. As soon as we
apply the equipment of the psychological workshop, it is easy to show
that even the slightest feeling may have its influence on the pulse and
the respiration, on the blood circulation and on the glands; or, that
our thoughts give impulse to our muscles and move our organs when we
ourselves are entirely unaware of it.
Again we may turn in another direction. Pathology shows us how every
physical disablement of the brain is accompanied by mental processes.
If the blood supply to the brain is cut off, we faint; a blow on the
head may wipe out the memory of the preceding hours, and a hemorrhage in
the brain, the bursting of a blood vessel which destroys groups of brain
cells, produces serious defects in the mental content. A tumor in the
brain may completely change the personality; the bodily disease of
certain convolutions in the brain brings with it the loss of the power
of speech; paralysis of the brain dissolves the whole mental
personality. Physical inhibition in the growth of the brain involves, on
the mental side, feeble-mindedness and idiocy. Of course, all this is
not sufficient to bring out a definite parallelism between special
mental functions and special physical processes, as the phenomena are
extremely complex. If a patient who has suffered from a mental
disturbance dies, and his brain is examined, there is no simple
correlation before us. It may be difficult to diagnose exactly the
mental symptoms. If we have heard that the man was unable to read, we do
not know from that what really happened in his brain. He may not have
read because he did not see the words, or because the letters were
confusing, or because he had lost memory for the meaning, or because he
had lost the impulse to speak the words, or because he felt unable to
turn his attention, or because the impulse to read aloud was not carried
out by his organism, or because an inner voice told him that it is a sin
to read, or for many similar reasons; and yet each one represents
psychologically an entirely different situation. On the other hand, on
the physical side, the destruction is probably not confined to one
particular spot. Complications have crept over to other places or the
disturbance in one part works as inhibitory influence on other brain
parts, or a tumor may press on a far-removed part, or the disturbance
may be one which cannot be examined with our present microscopic means.
In short, we have always a complex mental situation and a complex
physical one, and to find definite correlations may be possible only by
the comparison of very many cases.
Other methods, however, may supplement the pathological one. The
comparative anatomist shows us that the development of the central
nervous system in the kingdom of animals goes parallel to the
development of the mental functions, and that it is not only a question
of progress along all lines. Any special function of the mind may have
in certain animal groups an especially high development, and we see
certain parts correspondingly developed. The dog has certainly a keener
sense of smell than the man--the part of the brain which is in direct
connection with the olfactory nerve is correspondingly much bulkier in
the dog's brain than in the human organism. Here too, of course,
research may be carried to the subtlest details and the microscope has
to tell the full story. Not the differences in the big structure, but
the microscopical differences in the brain cells of special parts are to
be held responsible. But comparison may not be confined to the various
species of animals; it may refer not less to the various stages of man.
The genetic psychologist knows how the child's mind develops in a
regular rhythm, one mental function after another, how the first days
and first weeks and first months in the infant's life have their
characteristic mental possibilities, and no mental function can be
anticipated there. The new-born child can taste milk, but cannot hear
music. The anatomist shows us that correspondingly only certain nervous
tracts have the anatomical equipment by which they become ready for
functioning. Most of the tracts at first lack the so-called medullar
sheath, and from month to month new paths are provided with this
physical equipment.
Finally we have the experiment of the physiologist. His vivisectional
experiments, for instance, demonstrate that the electrical stimulation
of a definite spot on the surface of a dog's brain produces movements
which we should ordinarily take as expressions of mental states,
movements of the front legs or of the tail, movements of barking or
whining. On the other hand, the dog becomes unable to fulfill the mental
impulses if certain definite parts of his brain are destroyed. The
physiologist may show from the monkey down to the pigeon, to the frog,
to the ant, to the worm, how the behavior of animals is changed as soon
as certain groups of nervous elements are extirpated. It is the mental
emotional character of the pigeon which is changed when the physiologist
cuts off parts of his brain. In short, stimulation and destruction
demonstrate, by experiments which supplement each other, that mental
functions correspond to brain functions.
There is thus no lack of demonstration from all quarters that mental
facts and brain processes belong together; and yet, however much we may
cumulate such popular and scientific observations, they would never by
themselves admit of the sweeping generalization that there cannot be any
mental state which is not accompanied by a process in the central
nervous system. Someone might say, to be sure, the perceptions and
memory images, the volitions and instincts and impulses, have their
physiological basis, but there remain after all acts of attention, or
decisions, or subtle feelings, or flights of imagination, which are
independent of any brain action. Here, indeed, observation cannot settle
such a general principle. Its real hold lies in the fact with which we
started: there is no causal connection in the mental states as such. If
we want to understand mental facts as such in a chain, of causal events,
we have first to conceive them as parallel to physical events. The
principle of psychophysical parallelism, that is, the principle that
every psychical process accompanies a physiological change is thus not a
mere result of observation. It is simply a postulate. Every science
begins with postulates and only that which fulfills such postulates has
the dignity of truth in the midst of that scientific realm. The
astronomer cannot find by observation that there is no star the
movements of which are not the effects of foregoing causes. He knows it
beforehand, he demands it, he does not recognize any movement as
understood until he has found the causes, he presupposes that such
causes exist, that no star moves simply by a magic power, and that
nowhere in the astronomical universe is the chain of causality broken.
He postulates it, and where he does not discover the causes, he is sure
that he has not solved the real problem.
In the same way the psychologist who aims towards explanation of mental
facts must postulate that there cannot be any mental state which is not
an accompaniment of a physical brain process, and is as such connected
through physical means with the preceding and the following events in
the psychophysical system. Only when such a general framework of theory
is built up by a logical postulate, is the way open to make use of all
those observations of the laboratory and of the clinic, of the zooelogist
and of the anatomist. It is the theory which has to give the right
setting to those scattered observations. However far we may be from
being able to point to the special brain process which lies at the
bottom of the higher mental state, we know beforehand that there is no
shadow of an idea, no fringe of a feeling, no suggestion of a desire
which does not correspond to definite processes in the brain. The
details may and must be material for diverging theories, but the
conflict of such hypothetical opinions has nothing to do with the
certainty of the underlying conviction that if we knew the whole truth,
we should recognize every single mental happening as parallel to
physical processes in the nervous system. To explain mental facts means
to think them as parallel to the brain processes which have their own
causal connections in the physical world.
We started, for instance, from the old observation that two impressions
which come to our mind at the same time have a tendency to reawaken one
another; and we saw that psychology was well able to formulate these
facts in general statements of the association of ideas. But we realized
that that in itself is not really explanation. If the odor which we
smell awakes in us the name of a chemical substance, and if we now bring
this under the general heading of association of ideas, an explanation
is not really given by it. That smell sensation itself is not really
understood as a cause of those sound sensations of the word. We have no
insight into the connection of those two happenings. But the situation
is entirely changed, if we consider the smell effect from the point of
view of the parallelistic theory. Now the association of facts would
indicate that we got the first two impressions together, because two
brain processes were going on at the same time. My nose brought me the
smell stimulus, my ear gave me the sound stimulus, each going on in a
particular center, or, to express it in a simplified schematic way, each
reaching particular brain cells, and the excitement of these brain cells
being accompanied by the particular sensations. The physiologist has
many possibilities of conceiving the further stages of the process, in
order to satisfy the demand of explanation. He may say the excitement of
each of these two brain cells, the one in the olfactory center, the
other in the auditory center, irradiates in all directions through the
fine branches of the brain fibers. Each cell has relations to every
other cell in the brain; thus there is also one connecting path between
those two cells which were stimulated at once. Now if the two ends of an
anatomical path are excited at the same time, the path itself becomes
changed. The connecting way becomes a path of least resistance, and that
means that if, in future, one of the two brain cells becomes excited
again, the overflow of the nervous excitement will not now go on easily
in all directions, but only just along that one channel which leads to
that other brain cell. A theory like this explains in real explanatory
terms, in ways which physics and chemistry can demonstrate as necessary,
that any excitement of the odor cell runs over into the sound cell and
vice versa. In short, the psychological association of ideas, which we
should simply have to accept as inexplainable fact, is thus transformed
into a connection which we understand as necessary; and the fact is
really explained.
This simple scheme of the physiology of association for a hundred years
has given a most decided impulse to the progress of psychology. As the
association process can so easily be expressed in physiological terms,
the aim was prevalent to understand the interplay of mental life more
and more as the result of association. The underlying thought of this
whole association psychology was thus a conviction that whenever two
mental experiences occur together, either of them keeps the tendency to
reawaken the other at a later time. Through the endless combination
which life's impressions awaken in the mind from the first hour after
birth, the whole stream of memory images and thoughts and aims and
imaginations is thus to be explained.
The whole theory of physiological associationism works evidently with
two factors. First, there are millions of brain cells of which each one
may have its particular quality of sensation, and second, each brain
cell may work with any degree of energy, to which the intensity of the
sensation would correspond. If I distinguish ten thousand different
pitches of tone, they would be located in ten thousand different cell
groups, each one connected through a special fiber with a special string
in the ear. And each of these tones may be loud or faint, corresponding
to the amount of excitement in the particular cell group. Every other
variation must then result from the millionfold connections between
these brain cells. Indeed, the brain furnishes all possibilities for
such a theory. We know how every brain cell resolves itself into
tree-like branch systems which can take up excitements from all sides,
and how it can carry its own excitement through long connecting fibers
to distant places, and how the endings of these fibers clasp into the
branches of the next cell, allowing the propagation of excitement from
cell to cell. We know further how large spheres of the brain are
confined to cells of particular function, that for instance cells which
serve visual sensations are in the rear part of the brain hemispheres,
and so on. Finally we know how millions of connecting fibers represent
paths in all directions, allowing very well a cooeperation by association
between the most distant parts of the brain. The theories found their
richest development, when it was recognized that large spheres of our
brain centers evidently do not serve at all merely sensory states, but
that their cells have as their function only the intermediating between
different sensory centers. Such so-called association centers are thus
like complex switchboards between the various mental centers. Their own
activity is not accompanied by any mental content, but has only the
function of regulating transmission of the excitement from the one to
the other. Above all their operation would make it possible that through
associative processes, the wonderful complexity of our trains of thought
may be reached.
Yet even the highest development of the association theories did not
seem to do justice to the whole richness of the inner life. We may well
understand through those association processes that a rich supply of
memory pictures is at our disposal, that ideas stream plentifully to our
minds and enter into new and ever new combinations. But that alone is
not an account of our inner experience. If there is anything essential
for inner life, it is the attention which gives emphasis to certain
states and neglects others. And that means that certain mental contents
are growing not only in strength but in vividness and clearness, and
that others are losing their vividness, are inhibited and suppressed.
Here were always the real difficulties of the association theories; they
seemed so entirely unable to explain from their own means why certain
states become foremost in our minds and others fade away, why some have
the power to grow and others are neglected. These facts of attention and
vividness, inhibition and fading, worked almost as a temptation to give
up the physiological explanation altogether and to rely on some mystical
power, some mental influence which could pull and push the ideas without
any interference and help from the side of the brain. Yet since we have
seen that the truth of psychophysical parallelism has the meaning of a
postulate which we cannot escape unless we want to give up explanation
altogether, it is evident that such falling back into un-physiological
agencies would be just as inconsistent as if the naturalist should posit
miracles in the midst of chemistry or astronomy. If the facts which
cluster about attention cannot be understood by the simple scheme of
associationism, the demand must be for a better physiological theory.
The development of physiological psychology in recent years has indeed
shown the way to such a wider theory, which furnishes the physiological
accompaniment also for those experiences of attention and vividness
which form the weakness of associationism. This new development has come
up with the growing insight that the brain's mental functions are
related not only to the sensory impressions, but at the same time to the
motor expressions. The older view, still prevalent to-day in popular
writings, made the brain the reservoir of physical stimuli, which come
from the sense organs to the cortex of the brain hemispheres. There the
perceptions arose and through associative interplay the memory pictures
and the ideas of action and the feelings arose, and the whole inner life
was thus bound up with the processes in these sensorial spheres. When
the mind had done its work, finally an impulse was sent to some motor
apparatus in the brain which then sent off the impulse to some acting
muscles. That whole motor part was thus a kind of appendix to the brain
process. The psychical life had nothing to do with it but to give the
command for its action. The process in the motor part thus began when
the mental proceeding was completed. But it became clear that this view
was only the outgrowth of the strong interest which physiology took in
the sense processes. If a neutral fair account of the brain actions is
attempted, there can hardly be doubt that this whole sensorial view of
the brain is only half of the story and that the motor half has exactly
the same right to consideration. The cortex of the brain, the functions
of which are accompanied by mental processes, is always and everywhere
not only the recipient of sensory stimuli but at the same time the
starting point of motor impulses. That which is centripetal, leading to
the cortex, is therefore not more important for the central process than
that which is centrifugal, leading from the cortex. The cortex is the
apparatus of transmission between the incoming and the outgoing
currents, between the excitements which run to the brain and the
discharges which go from the brain, and the mental accompaniments are
thus accompaniments of these transmission processes. If the channels of
discharge are closed and the transmission is thus impossible, a blockade
must result at the central station and the accompanying mental processes
must be entirely different from those which happen there when the
channels of discharge are wide open. Here too all the special theories
are still in the midst of tumultuous discord. Yet this new emphasis on
the motor side of the psychical process seems to influence modern
psychology more and more.
Nobody can deny that first of all this is the necessary outcome of a
biological view of the brain. What else can be the brain's function in
the midst of nature than the transforming of impressions into
expressions, stimuli into actions? It is the great apparatus by which
the organism steadily adjusts itself to the surroundings. There would be
no use whatever biologically in a brain which had connections with the
sense organs, but which had no connections with the muscular system, and
on the other hand, a brain which had motor nerves and muscular
adjustment would be entirely useless if it had not sensory nerves and
sense organs connected with it. In the one case the world would be
experienced, but no response would be possible; in the other case, the
means for response would be given, but no adjustment could set in
because no experience of the surroundings would be possible. Adjustment
every moment demands the relation of the brain in both directions.
Through the sensory nerves the brain receives; through the motor nerves
the brain directs, and this whole arc from the sense organs through the
sensory nerves, through the brain, through the motor nerves and finally
to the muscles, is one unified apparatus of which no part can be thought
away. The brain in itself would be just as useless for the organism as
the heart would be without the arteries and veins.
We must keep this intimate and necessary relation between the sensory
and motor parts constantly in view, and must understand that there
cannot be any sensory process which does not go over into motor
response. Then only the ways are open to develop physiological views
which give a physical basis to the processes of attention and vividness
and inhibition, just as well as to the processes of memory and
association. Such motor theories take many forms. Perhaps we shall most
quickly bring the most essential factors together, if we say that full
vividness belongs only to those sensations for which the channels of
motor discharge are open, while those are inhibited for which the
channels of discharge are closed; and any channel of discharge is
closed, if action is proceeding in the opposite channel. If I open my
hand, the motor paths which lead to closing my fist are blocked; and if
I close my fist, the channels which lead to the opening of the hand are
closed. Now if only those ideas are vivid which find the channels open,
it is clear that all the ideas which would lead to the opposite action
have no chance for development; they remain inhibited, and just this
relation between the vividness of certain ideas and inhibition for those
ideas which lead to the opposite action is the characteristic of the
process of attention.
From such a point of view, the total mental life can be brought into the
psychophysical scheme. We now have not two variable factors, but three,
namely, the qualities of the elements, the intensities of the elements,
and, as a third, the vividness of the elements. The quality corresponds,
as we saw in the association theory, to the local position and
connection of the brain cells; the intensity corresponds to the energy
of the excitement; and the vividness, we may add now, corresponds to the
relation to motor channels. The whole mental life thus becomes the
accompaniment of a steady process of transmitting impressions and
memories into reactions. That every experience involves millions of such
elements we saw when we spoke of the description of mental life. The
effort to explain mental life shows us now that this millionfold
manifoldness belongs to a system of reactions of which all parts are in
steady correlation: a moving equilibrium of unlimited complexity. Surely
no one can reduce this wonderful manifoldness to those clumsy concepts
with which popular psychology is reporting the story of the mind and its
relations to the brain.
It may seem that such a psychological view of inner life annihilates
that which we feel as the most essential characteristic of our inner
experience, its unity and its freedom. In one sense that is certainly
true. In the real life which we live and fight through, where our duties
and our happiness lie, we know a unity and freedom of our personality
which psychology must destroy. Of course that does not mean that
psychology denies the truth of that freedom and unity. Moreover it would
condemn itself if it were to deny that which gives meaning to the
endeavors of our life and thus also to every search for truth.
Psychology claims only that we must abstract from it, when we take the
psychological standpoint towards life. Freedom of our real life means
that we must know ourselves in the midst of our life work as guided by
aims and obligations, and that in this purposive existence of ourselves
we do not feel ourselves as determined by causes. I will the fulfillment
of my ideals only because I will them. That this will itself may be the
effect of foregoing causes is an aspect which does not belong to my
naive experience. Our freedom means that in our real life our will is
not related to causes, that the point of view of causality is thus
meaningless for the value of our achievements. And the other man's will
too comes in question for us as something to be interpreted and to be
appreciated, but not to be explained by connection with causes. As long
as we move in this sphere of purposive interest, we are free and deal
with free selves; but if in the midst of these free aims, the will
arises to consider the actions of others and of ourselves from the
standpoint of causality, then we have ourselves decided to enter a new
sphere in which it would be meaningless to seek for any will which is
not determined by causes. As soon as we have chosen the psychological
standpoint and are in the midst of the work of causal reconstruction,
any will which is not understood as determined by causes is simply an
unsolved problem. In the midst of a causal construction, absence of
causes would never mean real freedom.
In that purposive world of immediate life experience, we also are
unities inasmuch as we ourselves know us as the same in every new will
of ours. We remain identical with ourselves because every purpose is
posited in the midst of, and bound up with, the general purpose of
ourselves. And in this internal unity of meaning, nothing breaks
ourselves into pieces, and the whole manifold of experience is thus
expressed by a personality which knows itself in its purposive unity.
But this unity again is denied by our own intention as soon as we decide
to take the causal view of inner life. The purposive unity must now
transform itself into an endless complexity, and our own self becomes a
composite of hundreds of thousands of elements.
On the other hand, all this does not mean that psychology cannot have
its own consistent conception of the mind's unity and freedom. Our
psychological mind is a unity because its manifold is a system in which
all parts hang together. A change in any one part involves changes in
the whole system. The interrelation, to be sure, is not a strictly
psychical one, for we have seen that the causal connection as such
appears at the physical side. But, inasmuch as there is no psychical
process which does not belong to a physiological one, the
interconnection of the mental facts is complete and involves the
totality of neural processes of which after all a small part only has
its psychological record. We might compare those hundreds of millions of
neurons in each brain with the hundreds of millions of individuals who
make up the population of the nations, and the psychical accompaniment
we might compare with the written historical record of mankind. The
written records themselves have no direct interconnection, they are only
accompaniments of what happens in these millions of men. And again only
the higher layer of the neurons in the population sees its doings
recorded in the annals of history; and yet whatever those leaders of
action and thought and emotion may achieve is dependent upon and working
on the actions of those millions of subcortical population neurons. The
historical record has its unity through the interrelation of all parts
of historical mankind.
But after all the psychologist has no less a right to speak of freedom.
Of course his freedom cannot mean exemption from causality. Whatever
happens in the psychological system must be perfectly determined by the
foregoing causes. But the psychologist has good reason to discriminate
between those actions which result from the normal psychophysical
factors and such actions as result from broken machinery. If the brain
is poisoned by alcohol or in fever, if an infectious disease has
destroyed the brain cells, action is no longer the outcome of the
normal cooeperation of the organs, and even those clusters of neural
activities which are accompanied by the consciousness of the own
personality lose their control of the motor outcome. The man in delirium
or paralysis acts without causal connection with his past; the action
is, therefore, not the product of his whole personality, and the
psychologist is justified in calling the man unfree. But, whenever the
motor response results from the undisturbed cooeperation of the normal
brain parts, then the inherited equipment and the whole experience and
the whole training, the acquired habits and the acquired inhibitions
will count in bringing about the reaction. This is the psychological
freedom of man. The unity of an interconnected composite and the freedom
of causal determination through normal cooeperation of all its parts
characterize the only personality which the psychologist has to
recognize.
IV
PSYCHOLOGY AND MEDICINE
We are now ready to take the first step towards an examination of the
problem of curing suffering mankind. So far we have spoken only of the
meaning of psychology, of its principles and of its fundamental theories
as to mind and brain. We have moved in an entirely theoretical sphere.
Now we approach a field in which everything is controlled by a practical
aim, the treatment of the sick. Yet our discussion of psychology should
have brought us much nearer to the point where we can enter this realm
of medicine. Everything depends on the right point of entrance. That an
influence on the inner life of man may be beneficial for his health is a
commonplace truth to-day for everybody. Every serious discussion of the
question has to consider which influences are appropriate, and in which
cases of illness the influence on inner life is advisable. The popular
treatises usually start this chapter by speaking of the "mental and
moral" factors; and this coupling of mental influences and moral
influences characterizes large parts of the discussions of the Christian
Scientists and the Christian half-scientists. Yet we must insist that
the right entrance to psychotherapy is missed if the difference between
morality and mentality is not clearly recognized from the beginning. The
confusion of the two harms every statement. To avoid such a fundamental
mistake, we had to take the long way around and to examine carefully
what psychology really means and what it does not mean.
We know now that inner life can be looked on from two entirely different
standpoints: a purposive one and a causal one, and we have seen that
these two ways of looking on inner life bring about entirely different
aspects of man's inner experience, serve different aims, and stand in
different relations to the immediate needs of our real life. We know
that the one, the causal aspect, belongs to psychology, while the
non-psychological, the purposive aspect, belongs to our immediate mutual
understanding in the walks of life. If the physician is to make use of
inner experience in the interests of overcoming sickness, he must first
decide whether to take the causal or the purposive point of view in
dealing with the patient's mind. This problem is too carelessly ignored
and through that neglect arises much of the popular confusion. Of course
just this carelessness becomes in some ways the ground for apparent
strength for many a superstition and prejudice. If the doors of the
causal mind and of the purposive mind are both open, and the spectator
does not notice that there are two, any trick on thought and reason can
easily be played. Whatever cannot pass through the causal door slips in
through the other, and whatever does not go in through the door of
purpose marches through the entrance of causality. With such methods
anything can be proved, and the most unscrupulous doctrines can be
nicely demonstrated. If we are to avoid such logical smuggling, we must
see clearly which attitude towards mental life belongs properly to the
domain of psychotherapy.
But what we have discussed now leaves little doubt as to the necessary
decision. The physician is interested in the mental life with the aim of
producing a certain effect, namely, that of health. Thus the mental life
of the whole personality comes in question for him as belonging to a
chain of causes and effects; whichever levers he may move, everything is
to be a cause which, in accordance with causal laws, is to produce a
certain change. Inner life is thus, in the interests of medical
treatment, necessarily a part of a causal system. This means the
standpoint of scientific psychology is the only adequate one. The
purposive view of inner life ought not to be in question when the
patient enters the doctor's office.
To characterize the difference, it may be said at once that it is a
purposive view which belongs to the minister. If the minister says to
his despairing parishioner, "Be courageous, my friend, and be faithful,"
nothing but a strictly purposive view gives meaning to the situation.
The word friend indicates it, that one subject of will approaches
another subject of will, with the intention of sympathy and
understanding of the attitude of the other; and the advice to be
courageous and faithful means an appeal which has its whole meaning in
the relation to aims and ends. The speaker and the hearer are both
moving in a sphere of will relations, purposes and ideals, sin and
virtue, hope and belief. To take the other extreme: if the neurasthenic
in his state of depression and in his feeling of inability seeks relief
from the nerve specialist, he too may say: "My friend, be courageous and
faithful," yet his words have an entirely different purpose. They are
not appeals to a common interest of belief; they are subtle tools with
which to touch and to change certain psychophysical processes, certain
states in mind and brain; there each word is a sound which awakens
certain mental associations, and these associations are expected to be
causes of certain effects and these effects are to inhibit those
disturbing states of emotional depression. If a few grains of sodium
bromide were to produce the same effect, they would be just as welcome.
The whole consideration moves in a sphere in which only physiological
and psychological processes are happening. Thus the physician may work
with the ideas of religious belief, but those ideas are then no longer
religious values but natural psychophysical material, which is to be
applied whenever it appears as the right means to secure a certain
effect.
On the other hand the minister also knows, of course, that every word
which he speaks has its psychological effect, but he abstracts from that
entirely, as his belief should appeal directly to the struggling will of
the man. As minister, he is thus not a psychologist. He works with
moral means; the physician, with causal means. The view which the doctor
has to take of the man before him is therefore thoroughly psychological;
whereas that of the religious friend is thoroughly unpsychological, or
better, apsychological. Indeed it is misleading, or at least demands a
special kind of definition, if people say that the minister has to be a
good psychologist. It is just as misleading as the claim, which we hear
so often, that for instance Shakespeare was a great psychologist. No,
the poet deals with human beings from the purposive standpoint of life
and the mere resolving of complex purposes into parts of purposes is not
psychology in the technical sense of the term. The poet makes us
understand the inner life, but he does not describe or explain it; he
makes us feel with other people, but he does not make those feelings
causally understood. The realistic novelists sometimes undertake this
psychological task, but they are then on the borderland of literature,
the analysis of their heroes becomes then a psychological one.
Shakespeare understood human beings better than anyone and therefore the
men and women whom his imagination created are so fully lifelike that
the psychologist may feel justified in using them as material for his
psychological analysis, but Shakespeare himself did not enter into that
psychological dissection; he kept the purposive point of view. In the
same way certainly the minister--the same holds true for the lawyer or
the tradesman or anyone who enters into practical dealings with his
neighbor--may resolve complex attitudes of will into their components,
but each part still remains a will attitude which has to be understood
and to be interpreted and to be appreciated, while the psychologist
would take every one of those parts as a conscious content to be
described and to be explained. But here we abstract from the purposive
relations. Our attention belongs now to the doctor's dealing with man;
for him cause and effect are the only vehicles of connection. Thus he
has to exclude the purposive interpretation of inner life and has to
understand every factor involved from a psychological point of view: his
psychotherapy must be thoroughly applied psychology.
The day of applied psychology is only dawning. The situation is indeed
surprising. The last three or four decades have given to the world at
last a really scientific study of psychology, a study not unworthy of
being compared with that of physics or chemistry or biology. In the
center of the whole movement stood the psychological laboratory with its
equipment for the most subtle analysis and explanatory investigation of
mental phenomena. The first psychological laboratory was created in
Leipzig, Germany, in 1878. It became the parent institution for
laboratories in all countries. At present, America alone has more than
fifty psychological laboratories, many of them large institutions
equipped with precious instruments for the study of ideas and emotions,
memories and feelings, sensations and actions. Still more rapid than
this external growth of the laboratory psychology was the inner growth
of the experimental method. It began with simple experiments on
sensations and impulses, and it seemed as if it would remain impossible
to attack with the experimental scheme the higher and more complex
psychical structures. But just as in physics and chemistry the triumphal
march of the experimental method could not be stopped, one part of the
psychological field after another was conquered. Attention and memory,
association and inhibition, emotion and volition, judgment and feeling
all became subjected to the scientific scheme of experiment. And that
was all supplemented by the progress of physiological psychology,
pathological psychology, child psychology, animal psychology. In this
way the last decades created a science which of course was by principle
a continuation of the old psychology, but yet which had good reason to
designate itself as a "new" psychology.
But in this whole development, until yesterday, the curious fact
remained that it was going on without any narrow contact with practical
life; it was a science for the scientist and measured by its practical
achievements in daily life, it seemed barren and unproductive.
Psychology was studied as palaeontology and Sanscrit were studied,
without any direct relation to the life which surrounds us. And yet
after all it deals with the mental facts which have to enter into every
one of our practical deeds, if we are to consider mental life from a
psychological point of view. The psychologists were certainly not to be
blamed for sticking to their theoretical interests. More than that,
they were certainly justified in their reluctance, as everything was in
the making, and incomplete theories can easily do more harm than good.
But slowly a certain consolidation has set in; large sets of facts have
been secured, and psychology seems better prepared to become serviceable
to the practical tasks. On the other hand, it has been noticeable for
some time that not a few of the psychological results have gone over
into unprofessional hands and have been thrown on the market places and
have been brought into many a home where no one knew how to deal with
them rightly. Thus the need seems urgent that the psychologists give up
their over-reserved attitude and recognize it as their duty to serve the
needs of the community.
It is not sufficient for that end, simply to take odds and ends of
psychology and to hand them over to anyone who can see some use for
them. We must have a systematic scientific work done for the special
purpose of adjusting psychological knowledge to the definite practical
tasks and of examining the psychological facts with that practical end
in view. A science must be developed which is related to psychology as
engineering is related to physics and chemistry. Just as the
technological laboratories of the engineer bring out many new problems
which the physicist would never have approached, in the same way we may
expect that special institutions for applied psychology will shape the
psychological inquiry in a new way.
Such a new science of applied psychology of course has before it a
field just as large and manifold as the field of technology, where
physical engineering, chemical engineering, mechanical engineering, and
electrical engineering and so on are separated. Such a future
psychological technology would deal, for instance, with
psychopedagogical problems. There belongs everything which refers to the
psychology of memory or attention, of discipline, of fatigue, of habit,
of imitation or effort; in short, all those mental factors which have to
be considered whenever the schoolchild is looked on from a causal point
of view. Further there is the psycholegal field where the memory and the
perceptions, the suggestibility and the emotions of the witness are to
be studied, where the psychological conditions which lead to crime, the
means to tap the hidden thoughts of the criminal, the inhibitions for
the prevention of crime, the mental effects of punishment and similar
causal processes must be determined. There are the psychoscientific
problems referring to psychological influences on the observations and
judgments and discriminations of the scholar who watches the stars or
who translates an inscription. There are the psychoaesthetic problems
where the task is to examine causally the factors which lead to the
agreeable effects of beautiful surroundings, and from the height of the
psychology of aesthetics in painting and sculpture, the inquiry may go to
the psychology of the pleasant effects in dress-making or cooking. There
are the large groups of psychotechnical problems where the effort refers
to the application of psychology in securing the best conditions for
labor and industry and commerce. It leads from the mental effects of
signals or the mental fatigue in mills to the secrets of advertisements
and salesmanship. There are especially important psychodiagnostical
studies where the aim is to determine the individual differences of man
by experimental methods and to make use of them for the selection of the
right man for the right place. There are psychosocial problems where we
examine the psychological factors which have to enter into public
movements, into social reforms, into legislation and into politics. In
this way new and ever new groups may be added; every time the central
thought is: how far can causal psychological knowledge help us to reach
a certain end? Together with these forms of applied psychology, we find
the psychomedical problems; here belongs everything which allows the
application of causal psychology in the interests of health.
It might be answered that this demand for a strictly causal point of
view can hardly be fulfilled, because, if I am acting,--it may be in the
interest of education or law or technique or medicine,--I must always
have an end in view and to select such an end belongs after all to my
system of purposes. If I am a teacher and have to deal with children,
then it may be said that after all, my knowledge of causal psychology
cannot help me if I am uncertain for which ideals I want to educate
these children. Psychology can tell me that I need these means, if I
want to reach certain effects, but I cannot find out by psychology which
effects are desirable. Psychology may tell me how to make a good
business man or a good scholar or a good soldier out of my boy, but
whether I want him to become a soldier or a merchant I must decide for
myself with reference to general aims, and that leads me back to the
purposive view of life. Such argument is entirely correct. Yes, it is
evident that it is in full harmony with our whole understanding of the
purpose of psychology. We saw that psychology with its causal treatment
of man's mind does not express the immediate reality, but is a certain
reconstruction which allows a calculation of certain effects. Thus it is
itself a system existing for a subject who has certain ends in view. The
whole causal view of man is thus a tool in the service of the purposive
man. This is the reason why it is indeed utterly absurd to think that
psychology can ever help us to determine which end we ought to reach.
In education, for instance, very many different ends might be reached;
psychology cannot decide anything. The decision as to the aims of
education must be made by ethics, which indeed takes not a causal but a
purposive attitude. Only after ethics has selected the aim, psychology
can teach us how to reach it. Of course this principle must hold for the
physician too. All his causal dealing with the mind presupposes that he
has selected a certain end in harmony with his purpose. The only
difference is that, in the case of the physician, there can be no
possible doubt as to the desirable end; what he aims at is a matter of
course, namely, the health of the patient. To desire the health of the
sufferer is thus itself a function which belongs entirely to the
purposive view of the world, and only in the interest of this purpose
does the physician apply his knowledge of psychology or of the causal
sciences of physics, physiology, and chemistry. Indeed only with this
limitation have we the right to say that the psychotherapist takes the
causal,--and that means the psychological,--view of his patient. As far
as he decides to take care of the health of his patient, this decision
itself belongs to the purposive world and to his moral system. The
physician is thus ultimately just like the minister and just like anyone
who deals with his neighbor, a purposive worker; but while the minister,
for instance, remains on this purposive track, the physician puts a
causal system into the service of his purpose. He knows the end, and his
whole aim is to apply his causal knowledge of the physical and psychical
world to the one accepted end of restoring the health of the patient. He
has to ask thus in general: what has psychology to-day to offer which
can be applied in the interests of medicine?
It would be an inexcusable narrowness to confine that chapter of applied
psychology which is to deal with the psychomedical problems to the work
of psychotherapy. Medicine involves diagnosis of illness as well as
therapeutics. Between the recognition and the treatment of the illness
lies the observation of its development and all this is preceded by
steps towards the prevention of illness. In every one of these regions,
psychology may be serviceable. Psychotherapy is thus only one special
part of psychomedicine. But the situation becomes still more complex by
the fact that the illness to be treated or the disturbance to be removed
may stand in different relations to the psychophysical processes. The
illness may be a disturbance in the psychophysical brain parts, or it
may belong to other brain parts which are only in an indirect way under
the influence of mental states or which are themselves indirectly
producing changes in the mental life. And finally the disturbance may
exist outside of the brain in any part of the body, and yet again
through the medium of brain and nervous system it may produce effects in
the mind or be open to the influence of the mind. Thus we have entirely
different groups of medical interests and it would be superficial to
ignore the differences.
Both psychodiagnostic and psychotherapeutic studies must be devoted to
cases in which the mind itself is abnormal, further to cases in which
the normal minds registers the abnormalities in other parts of the body,
and finally to cases in which the normal mind influences abnormal
processes in the body. These latter two cases have to be subdivided into
those where the bodily disturbance still lies in the brain parts and
those where it lies outside of the brain. But the situation becomes
still more complex by the mutual relations of those various processes.
The impulse to take morphine injections may have reached the character
of a mental obsession and thus represent an abnormality of the mind, but
yielding to it produces at the same time disturbances in the whole body
which thus become again external sources for abnormal experiences in
otherwise normal layers of the mind.
Of course the interest of the psychologist as such remains always
related to the psychological factor, but the relation of the
psychological factor itself to the total disturbance may be of most
different character. If I diagnose or treat the fixed idea of a
psychasthenic, the psychological factor itself represents the
disturbance. On the other hand, if I study the pain sensations of a
patient who suffers from a disease of the spinal cord, then the
sensations themselves, the only psychological factor in the case, are
only indications of a disease which belongs to an entirely different
physical region; the mind itself is normal. Or, on the other hand, if I
try to educate a sufferer from locomotor ataxia to develop his walking
by building up in his mind new motor ideas to regulate his cooerdinated
movements, the mind again is entirely normal but the physician needs his
psychology on account of the influence which the mind has on the bodily
system. Again, we must insist that psychomedicine covers this whole
ground. Wherever a psychical factor enters into the calculations of the
physician either by reason of its own abnormality or by its relation as
effect or as cause to a diseased part of the body in the brain or
without, there we have a psychomedical task, and as far as it is
therapeutic, we have psychotherapy.
The psychodiagnostic research lies outside of the compass of our book,
but we cannot emphasize sufficiently the great importance which belongs
to that work. Moreover, just in the field of psychodiagnostics, the
methods of the modern experimental psychological laboratory are most
promising and successful. Let us not forget that we deal with such
psychological factors even when we test the functions of eye and ear and
skin and nose by examining the sensations and perceptions. The oculist
who analyzes the color sensations of a patient and the aurist who finds
defects in the hearing of the musical scale and discovers that certain
pitches cannot be discriminated, is certainly dealing, for diagnostic
purposes, with the material that the psychological laboratory has sifted
and studied. Even that sensation symptom which enters into so many
diseases, the sensation of pain, belongs certainly within the compass of
the psychologist and it is only to be regretted that the systematic
study of the pain sensations, mostly for evident practical reasons, has
been much neglected in the psychological laboratory.
The psychologists have been at work all the more eagerly in the fields
of association and memory, attention and emotion, habit and volition,
distraction and fatigue. Here subtle methods have been elaborated,
methods which surely common sense cannot supply, and which showed
differences of mental behavior with the exactitude with which the
microscope reveals the hidden differences of form. If physicians are
slow in accepting the help which the psychological laboratory can
furnish, it may be in good harmony with the desirable conservative
policy in medicine, but finally the time must come when this
instinctive resistance against new methods will be overcome. The recent
attachment of psychological laboratories to certain leading psychiatric
clinics is a most promising symptom. Yet the diagnostic studies with the
means of the psychological laboratory cannot be confined to the cases of
mental disease. The mild abnormalities of the mind, and especially the
nervous disturbances which exist outside the field of insanity, demand
this support of psychology much more. And even the normal personality
will be more safely protected from disease and from social dangers for
its mental constitution if the resources of experimental psychology are
employed. The more we know of the psychological constitution of the
individual, the more we can foresee the development which is to be hoped
for or feared and which may be encouraged or retarded.
The psychologist may determine, for instance, the degree of attention
with its resistance against distracting stimuli, the power of memory
under various conditions and on various material, the mental
excitability and power of discrimination, the quickness and correctness
of perception, the chains of associations, the rapidity of the
associative process for various groups, the types of reaction, the
forming of habits and their persistence, the conditions of fatigue and
of exhaustion, the emotional expressions and the emotional stability,
the time needed for recreation and the resistance against drugs, the
degree of suggestibility and the power of inhibition: and every result
in any of these lines may contribute to the diagnosis and prognosis of
cases. The chronoscope here measures the reaction times and association
times in thousandths of a second; the kymograph, by the help of the
sphygmograph, writes the record of the pulse and its changes in
emotional states, while the pneumograph records the variations of
breathing, and the plethysmograph shows the changes in the filling of
blood vessels in the limbs which is immediately related to the blood
supply of the brain. Here belongs also the ergograph, which gives the
exact record of muscular work with all the influences of will and
attention and fatigue, the automatograph which writes the involuntary
movements, especially also the galvanoscope which may register the
influence of ideas and emotions on the glands of the skin, and thus lead
to an analysis of repressed mental states, and hundreds of other
instruments which are used in the psychological laboratory.
Yet it would be misleading to think only of complex apparatus when
experimental psychology is in question. An experiment is given whenever
the observation is made under conditions which are artificially
introduced for the purpose of the observation. Thus there is no need of
the physical instrument. If I bring a spoonful of soup to my mouth at
dinner and I become interested in the combination of warmth sensation
and touch sensation and taste sensation and smell sensation, then I have
performed an experiment if I take one more spoonful of soup just for the
purpose of the observation. The physician too may carry out important
psychological experiments, without needing the outfit of a real
laboratory. Association experiments, for instance, promise to become of
steadily growing importance. To make them serviceable to the problems of
his office, nothing but a subtle psychological understanding is needed,
inasmuch as any routine work schematically applied to every case alike
would be utterly useless. Give your man perhaps a hundred words and let
him speak the very first word which comes to his mind when he hears the
given ones. You call rose, and he may say red or flower or lily or
thorn; you call frog and he may answer pond or turtle or green or jump,
and if you choose your hundred words with psychological insight, his
hundred answers will allow a full view of his mental make-up. This is an
experiment which does not require any instruments at all but a man's
subtle analysis of the replies. That is not seldom sufficient to secure
the diagnosis of complex mental variations. The method yields still more
if the time for such a reply is measured, but there again not the costly
chronoscope of the laboratory is indispensable; a simple stop watch
which gives the fifths of a second would be fully sufficient for all
practical purposes. From such simple facts of the mental inventory the
association experiments may lead to complex questions which slowly may
disentangle the confused ideas, for instance, of a dementia praecox, and
thus lead to subtle differential diagnosis.
The psychological laboratory alone can also elaborate the methods of
studying, for instance, the feeble-minded with all the individual
variations. New and ever new methods have been tried; the memory was
tested by reading and repeating figures or letters, or colored papers
were shown or cardboards of different forms or nonsense syllables, and
the powers of remembering were studied. Or the accuracy of arm movements
was examined, or the quickness of understanding associated words, or the
success in planning a complex movement like throwing a ball at a target,
or the tapping of a key in the rhythm of a metronome, or the
discrimination and recognition of the pieces in the game of dominoes and
many another scheme. The laboratory has to analyze the conditions for
such methods and the psychologist has to prepare the means for the use
of the physician, just as the chemist has to prepare the sleeping
powders. In a similar way the laboratory may furnish means to analyze
the mental disturbances by a comparison with the experimental results of
artificial influences, for instance, of over-fatigue or half-sleep, of
drugs or alcohol, of poisons and emotional excitements. The
psychological resolving of the mental symptoms may of course, in the
same way, furnish the diagnosis where the mental variation is only a
distant effect of a bodily ailment. The changes in the emotions, for
instance, may lead to the recognition of a heart disease; lack of
attention may be a hint of the overgrowth of the adenoids; irritability
or apathy or delirious character of the mental behavior may indicate
whether uraemic acid is in the system or an infectious disease: anaemia
and undernutrition may be diagnosed and the psychology of fever demands
too a much closer analysis with the means of the psychological
laboratory than it has received so far.
We have not spoken as yet about those psychological methods which
themselves introduce abnormal mental states like hypnotism, and which
also not seldom are only means for diagnostic purposes. The hypnotic
state may bring to memory forgotten experiences of which the
physiological effects may have lasted in the brain and which may have
brought injury to the psychophysical system. Hypnotic inquiry can thus
lead to the recognition of the first causes in many hysterical states
and where hypnotism is not the best adjusted tool, a certain dreamlike
staring may be more effective. We have to return to much of that later
in full detail because just for instance in hysteria, the clear
recognition of the sources and of the character of the disease may at
the same time prove to be in itself the right starting point for
curative treatment.
We have spoken so far only about the relations of psychology and
medicine from the point of view of diagnosis; the relations from the
point of view of therapy will make up the second part of this book. We
shall describe the methods and the results, the possibilities and the
limitations with manifold detail. That is the chief topic of this
volume. All that is needed to prepare for this principal problem is on
the one side a preparatory clearing up of some fundamental conceptions,
especially of those two which have played the chief role in the whole
discussion, namely the subconscious and suggestion. And on the other
side, we may consider at first some fundamental discriminations which
steadily influence the inquiries and controversies in the field. I think
of the difference between normal and abnormal mental states, between
psychical and physical facts in psychotherapy, between functional and
organic diseases, and to return to our starting point, between mental
and moral influences.
Every curative effort presupposes that the normal state of health has
been lost and that a diseased state has set in. Yet the mental analysis
suggests still less than the bodily inquiry, just where the normal
functioning is really lost. It would be easy to draw a demarcation line
if the pathology of the mind introduced any mental features which are
unknown in our normal existence, but the opposite is true. No mental
disease introduces elements which do not occur in the sphere of health.
A degenerated brain cell looks differently under the microscope from a
normal one, but the ideas of a paranoiac, the emotion of a maniac, the
volition of a hysteric, the memory idea of a paralytic is each in its
own structure not different from such elements in any one of us. The
total change lies thus only in the proportion; there is too much or too
little of it. The pathological mental life is like a caricature of a
face--each feature is contained, as in the ordinary portrait, but the
proportion is distorted, there is too much or too little of chin or of
nose. But who can indicate exactly the point where the distortion of the
features constitutes a caricature? Every grotesque change in the
relations ruins the healthy state: what makes us sure that the harmony
of health is spoiled?
Certainly we cannot settle it by mere statistics. The norm never means
merely a majority. Even if the overwhelmingly larger part of mankind
suffered from phthisis, the few who were free from it would be
recognized as well and all the others would be considered ill. In mental
life still more, no one ought to propose that the exceptional function
is the symptom of disease. The few persons who never had a dream in
their lives differ much in their mental experience from the large
majority and yet their peculiarity is certainly not a symptom which
needs curative treatment. The only real test of health is the
serviceableness to the needs of life. We have an unhealthy state of the
personality before us wherever the equilibrium of the human functions is
disturbed in a way which diminishes the chances of existence, and the
seriousness of the ailment depends upon the degree of this diminishing
power. Seen from a strictly psychological point of view, we must expect
thus a broad borderland region between the entirely normal well-balanced
mental life and that unbalanced disorder of functions which really
interferes with the chance for self-protection and effectiveness. That
the melancholic who declines to take any nourishment, or the paranoiac
who misjudges his surroundings, is unable to secure by his own energies
the safety of his life cannot be doubted. The balance is completely
destroyed and the will and the intellect of the physician and of the
nurse must be substituted for his own mental powers, if his life is to
be prolonged at all. But the misjudgment and the depression of the
insane are only an exaggeration of that which may occur in any man.
There are therefore thousands of steps which lead from the normal error
or regret to the destructive disturbance. Everyone knows persons whose
pessimistic temperament makes them inclined to an over-frequent
depression, or others whose silly disposition brings out constantly
those emotional tendencies which the maniac shows in an exaggerated
degree. The stupid mind shows those lacks of association and connection
which reach their maximum degree in the mind of the idiot. We know from
daily life the timid, undecided man who cannot come to a will impulse;
the hasty man who rushes towards decisions; the inattentive man who can
never focus his consciousness; and the overattentive man who can never
dismiss any subject; the indifferent man on whom nothing produces
evident impression and feeling; the over-sensitive man who reacts on
slight impressions with exaggerated emotion; and yet every one of such
and a thousand similar variations, needs only the projection on a larger
scale to demonstrate a mental life which is self-destructive. The silly
girl and the stupid boy, the man who has the blues and the reckless
creature, are certainly worse equipped for the struggles of existence
than those who are intellectually and emotionally and volitionally
well-balanced. They will take wrong steps in life, they may be
unsuccessful, their stupidity may lead them to the poorhouse, their
recklessness may lead them to the penitentiary. And yet we do not speak
of them as patients because their disproportionate mental features may
be sufficiently corrected by other mental states which are perhaps more
strongly developed.
Further, inasmuch as human life just in its mental functions is related
to its social surroundings, much must depend on the external conditions,
whether the disproportion and abnormality has to be treated as
pathological. The mind which may find perhaps its way under the most
simple rural conditions would be unable to protect life under the
complex conditions of a great city. The man who in certain surroundings
may appear a crank has to be treated as a patient in a different set of
life conditions. Wherever psychotherapeutic work is in question, perhaps
nothing is more important than to keep steadily in mind this continuity
between normal and abnormal mental features. The mental disturbance must
constantly be looked upon as a change of proportions between functions
which, as such, belong to every normal life. We have to train and to
develop, and thus to reenforce, that which is too weak, and we have to
drain off and to suppress and to inhibit that which is too strong.
Yet just this functional view of disease must remind us strongly from
the beginning that it would be utterly in vain to draw any demarcation
line between psychical disturbances and physical ones. We have seen from
the start that from the point of view of physiological psychology,
there can be no psychical process without an accompanying physiological
process in the brain. Every disturbance in mental actions is thus at the
same time a disturbance in the equilibrium of nervous functions. Yet
that alone would not exclude the possibility of considering some
diseases, for instance, exclusively from the mental side, and we should
be justified in doing so if those parts of the brain which are the seat
of the mental processes could remain in the diseased state without
influence on other parts of the nervous system and of the whole body. In
such a case it would indeed be sufficient to consider the psychophysical
disturbance from the psychological point of view only, that is, to speak
of the disease as a disorder of intellect, of emotion or will, without
thinking of changes in the brain cells. But such isolation does not
exist in nature. Not only the bodily factors like nutrition and
circulation and sexual functions have a thousandfold influence on the
psychophysical processes, and these in turn change the vegetative
functions of the body, but especially the other parts of the brain and
nervous system can be affected in most different ways. If we want to
consider whether a certain variation of the personality demands curative
treatment, we certainly cannot confine ourselves to the mental
variations. They are after all only parts of the whole group of changes
in the organism and are thus symptoms of a disease which has to be
studied in its totality. The mental symptoms alone may be relatively
slight variations, which in themselves might be sufficiently balanced
not to disturb the equilibrium of life, and yet they may be symptoms of
a brain disturbance which as a whole must interfere with the safety of
life. On the other hand, mental life may appear like a chaos and yet the
disturbance may be the symptom of merely a slight brain affection and
the treatment of the mental symptoms in their apparent severity would be
a useless effort. The mental disturbance, for instance, of the
intoxicated or the hashish smoker, even the delirium of the feverish,
does not suggest a fight against the mental symptoms during the attack.
On the whole, there is a far-reaching independence between the apparent
mental variations and the seriousness of the brain affection. Light
hysteric states may produce a strong absenting of the mind while severe
epileptic conditions of the brain may be accompanied by very slight
mental changes. Every neurasthenic state may play havoc with mental
life, while grave brain destructions may only shade slightly the
character or the intellect. To deal with the mental changes as if they
belonged to a sphere by itself, to the soul which is well or ill through
its own independent alterations without steadily relating the changes to
the total organism, leads therefore necessarily to failure. The mind
reflects only symptoms of the disease; the disease itself belongs always
to the organism. Psychotherapy has suffered too much from the belief
that the removal of mental symptoms is a cure of disease.
Certainly the psychophysical symptoms may often stand in the foreground
of the disease, and in that case it may be left to the special needs
whether we deal with them as psychical or as physical changes. Even the
patient may be made to see them in one or the other way in accordance
with his special needs. To tell him that his brain cells are in disorder
and that they can be cured will be the right thing for him who takes
only the introspective view of his suffering and is in despair because
his own will seems powerless to overcome those mental changes. For the
next patient, the opposite may be wiser. The belief that his brain is
ill may have induced him to give up effort of the will instead of
helping along by steady self-suggestion. He will be helped more if he
understands that his mind is working wrongly. But the full truth is that
both mind and body are in disorder; the function of the disturbed brain
cells accompanies the ineffective will, and to reenforce the will means
to bring into equilibrium again the disturbed brain cells. For the
psychotherapist the temptation of giving the attention to the mental
symptoms only is strong. The more firmly the physician sticks to the
standpoint of psychophysiology, the better he will see ailment and cure
in their right proportion.
This demand for the consideration of the whole personality, mind and
body, ought not to be influenced by the popular separation between
organic and functional diseases. If we call organic diseases of the mind
those in which the mental disturbance is the accompaniment of a brain
disturbance, and functional those in which no brain disturbance exists,
we leave entirely the ground of modern psychology. As soon as we
believe that the mind can be disturbed without a change in the functions
of the brain, we give away all that which has brought scientific order
into the study of psychological existence. Every mental disturbance
corresponds to a disorder in the brain's functions. But there cannot be
a change in the functions of the brain without a change in its
structure. Thus we must claim that all those so-called functional
disturbances like neurasthenia and hysteria, fixed ideas and obsessions,
phobias and dissociations of the personality, as well as the typical
insane states of the maniac or paranoiac have their basis in a
pathological change of the anatomical structure of the brain. This
postulate cannot be influenced by the fact that the microscope has been
unable to detect the character of most of these changes.