Psychotherapy

by Hugo Münsterberg

The "fear of a fear" is indeed a symptom which the psychotherapist has to fight extremely often, but as soon as he has really recognized it and analyzed the whole mental condition, he will hardly have any difficulty in uprooting it. I add a letter of a school-teacher in New York. He writes:

"I am teaching in a high school. I am of a nervous temperament and constitutionally limited in endurance. Often my work is done in a condition of greater or less exhaustion. I find that I blush very easily in purely freakish ways, when there is no occasion for it. I find this blushing connecting itself with certain of the girl pupils of my classes in a conspicuous way. It occurs hardly ever except when my class is facing me and I seem to be powerless to overcome it. I have always tried to live a careful moral life, but my early life was very much secluded. I lacked entirely the free intercourse young people usually have together and I felt awkward with others for a long time. In the matter of the blushing, it sometimes occurs in the case of girls who are especially pleasing to me but also not infrequently in the case of some who are not at all so. The whole thing might be passed over were it not that it has considerable effect in causing constraint toward my students and in some cases affecting them very strongly in an emotional way at the very time of life when such things can do most harm. I regard the matter as being so serious that it brings directly in question my right to teach, but I do not feel at all sure I could find other work that I could do if I give up my present position. The very thought that on a particular occasion it would be extremely awkward to blush makes it almost impossible for me to avoid it."

But we have rather now to consider the therapeutic side, and we may begin again with a routine method of a simple hypnotic treatment.

The patient is a young university professor. His intellectual work is perfect in all directions. There are no nervous symptoms, though there are some slight disturbances of digestion. He suffers as soon as he comes into a crowd of people and as soon as he is on any high place, where he has to look down; the worst when both conditions are combined, as for instance, at a concert or a theatre in a balcony seat. But every meeting of many persons, even at church, produces all the symptoms of nervous excitement. He was easily brought into hypnotic state by verbal suggestions. When he was in hypnosis, I reënforced the conditions for an opposite attitude. I told him that as soon as he was in a crowd of persons he would feel especially comfortable, would enjoy himself, would fully enter into the spirit of the occasion and feel especially secure in their presence. Whenever he should be on a high place, he would enjoy the safety of the ground on which he was standing or the seat on which he was sitting. I assured him that he would neglect entirely whatever he saw and would rely completely on his safe feeling resulting from his tactual impressions. After having hypnotized him three times the disturbance disappeared completely, and even an evening at the theatre in an exposed box on the balcony was enjoyed without any discomfort. After about a year, at a period of fatiguing work, some traces of the anxiety appeared again. This time two hypnotic sittings were sufficient to remove the disturbance of the equilibrium, which as far as I know has not come back. The same hypnotic treatments were used in a secondary way to remove the digestive trouble.

I again quote the case of a teacher, a profession in which the psychasthenics are unusually frequent. It is a case of a young woman from the Middle West.

The young lady wrote me: "I come of a race of strong women and am not hysterical or easily frightened by many things that disturb women. Since my fifteenth year I have been seized by hallucinations of absurd or serious nature which no reasoning could explain away and which have gradually undermined my power of resistance to them. At the age of twenty-two, after a year of unusually hard work, my nervous endurance gave way, and with this breakdown came a sense of fear and a horror of crime that I have been unable to overcome. I have never felt the slightest inclination toward wrongdoing. It is a feeling rather that my shrinking from any mention of evil makes it impossible for me to listen or think rationally when such things are discussed. This feeling has seemed to change my whole attitude toward life and has left me without power to control my facial expression or carriage when it takes possession of me. I have been able to teach more successfully than I could hope, but it is only by cutting myself off from the friendships and pleasures incident to my life that I am able to accomplish my work. I have fought this trouble alone and will still do so if there is no help, but the thought that it is the source of great distress to those dear to me makes it very hard."

A few weeks later the lady insisted on coming to Cambridge. I found that there had never been any hallucinations and that she used the word in her letter only to indicate some insistent memory images which had never taken the vividness of real impressions. In the presence of her friend, I hypnotized her deeply and strengthened through urgent suggestions her consciousness of her having done the morally right thing at every situation in her life and her conviction that she never did and never would commit a crime. Here as always, if possible, I left alone the emotional idea but reënforced the opposite. The effect was an immediate one. She felt freer the next day than she had felt for years. I repeated the treatment a few times and she assured me that the feeling had disappeared entirely.

I take the rather severe case of a woman of fifty.

The highly educated and refined lady had lost her husband by an accident in Switzerland, which had been misrepresented by some of the newspapers as suicide. Two years later she wrote to me: "I feel as if I had received indelible photographs on my brain which have since greatly affected my health and from which I may never recover. This winter the symptoms I have been able to control returned and I have been ill. I unfortunately saw the newspaper headlines with my husband's supposed suicide. Though I exclaimed then, 'how outrageous,' I felt as if I had been struck and since then I can seldom read a paper without dread and apprehension, and the hearing of anyone's suicide fills me with terror. When I hurried to Europe, on the ocean a week from the day of my husband's death, I had a curious and overwhelming shock. On opening a drawer and seeing a pair of scissors, they looked to me like a dagger and suddenly the whole cabin seemed filled with implements of death. The doctors said that I would find it hard to get over such impressions but I told them I would, as I had courage and will. But I have been realizing in these two years that I may be suffering from something that may be beyond the control of will. I often become so nervously sensitive that scissors are unbearable for me to see, or a steel knife or anything that might express death. Our family physicians are still against hypnotism, and if I should go to a neurologist of my own selection, it might be to one who believed still only in nerve foods, baths, or a sanitarium."

The lady came from the South, with her nurse, to Boston and insisted on being hypnotized by me. I cannot say whether a really deep hypnotic state was produced at once as I refrained from testing it. There was certainly no amnesia. Probably it began only with a slight drowsiness but at the fifth treatment I found a relatively deep hypnosis. It was a capricious case in which the improvement was fluctuating but clearly setting in from the first day. I trained her in hearing and seeing words like death and suicide with a reënforced feeling of strength and calmness; I forced her to see and touch scissors with an artificial attitude of strength and indifference. At the same time I reënforced her good mood and her enjoyment in life. When she left for England a few weeks later, she felt herself mentally cured, and throughout the summer her letters testified the wonderful change which the treatment had brought about. Half a year later, as the result of an exhausting physical local treatment, the psychophysiological symptoms came back to a certain degree. She requested me by a letter from England to give her some help by suggestion to suppress again the recurring intrusions. As I had observed her strong suggestibility, I sent her over the ocean a little pencil of mother-of-pearl which she had seen in my hand, and advised her to look at it until she counted twenty slowly and then to close her eyes and simply to sleep. The autosuggestive effect was unusually strong. She writes from London: "When I saw the enclosure of your letter I felt as if it would burn through my hand and the feeling became so overpowering that I locked it away with my jewels, but as the days ran into a week I felt I could not live with it in my apartment any more, and I felt almost ill, until it occurred to me I could seal it and take it to my bankers. I felt as dreamy and absent-minded and paralyzed as if you had just treated me." Nevertheless the effect was on the whole the desired one and she returned to America with a wholesome freedom of mind. I hypnotized her twice again and she writes in her last letter: "I can never repay you for what you have done for me. You have given me back my courage and my love of life in its vividness and interest and color, all that through the last years I had so entirely lost."