Psychotherapy

by Hugo Münsterberg

But is not perhaps just this compromise dangerous in another direction, inasmuch as it awakens a feeling of safety in those who feel in sympathy with scientific medicine? They have passed the hand of the physician and believe accordingly that because their illness is recognized as functional, the minister can really perform all that ought to be done. Is this belief justified? At the threshold, it occurs to every one that such a diagnosis by physicians may be erroneous and that the chances for such error are under the conditions of the church clinic much greater than under the conditions of a regular medical treatment. The diagnostician who treats the patient himself has ever new chances to remodel his diagnosis and to correct it under the influence of therapeutic effects. The danger is great that under the proposed conditions, the activity of the physician will be superficial, because he is deprived of his chief means, the constant observation. But we may abstract from this possibility of error. Does the fact that the disease is one the symptoms of which may yield to psychical treatment really make it advisable that the further treatment be handed over to the clergyman? To begin at the beginning, the usefulness of psychical treatment does not at all exclude the strong desirability of physical treatment at the same time. The emphasis which is laid on religious persuasion and inspiration, on prayer and spiritual uplift practically excludes the use of baths and douches, of massage and electricity, of tonics and sedatives. And yet it is not caprice or sham when every well-schooled medical specialist applies such means in the treatment of these so-called functional diseases of the nervous system. The minister applies and can apply only one of many possible methods for cure and yet, if we really want to make use of the resources of modern knowledge, we have to adapt most carefully all possible means to the individual case. If we take the strictly religious standpoint the situation is of course different, but if we speak of psychophysiological effects, we may acknowledge the healing influence of prayer and yet rely in the special case still more on bromide or strychnine. Yet the religious psychotherapists not only neglect the physical help but usually emphasize the antagonism. Some of the strongest supporters proclaim it as a non-drug healing, thus deciding adversely about a medical method regarding which they have no means at all to judge.

Parallel to this neglect of physical theory goes, of course, the neglect of the physical factors in the disease. The physician may have justly diagnosed that the case is "merely" neurasthenia or hysteria and not a brain tumor or paralysis of the brain. Yet that does not mean in the least that a real treatment which remains in harmony with the progress of modern medicine ought to ignore the hundred physical elements which enter daily into the disease. There are the most complex digestive problems involved which demand a thorough understanding of chemical metabolism, there are still more complex problems of the sexual organs which the minister certainly ought not to discuss with his female parishioners, there are bacteriological questions, there are questions of the peripheral nervous system and sense organs; in short, questions which belong to a world into which the minister as minister has never looked. Even if he believes he might gather in an amateurish way some information as to those questions which lie so far from his experience as student of divinity, how can his half-baked knowledge compare with the experienced study of the regular physician? Such physical questions cannot be settled by the preparatory examination of the physician; they come up every day during the treatment and what the spiritual diet which the minister offers may help, may at the same time be ruined by the physical diet about which the minister without chemistry cannot judge.

But let us abstract from the bodily aspect. Is the situation really very different for the mental one? The appeal to the religious emotion, the reënforcement of religious faith is from the religious point of view certainly the one central effort from which everything has to irradiate. The unity of this controlling thought is the glory of such inspiration. But as soon as we handle this thought as a psychotherapeutic remedy, destined to restitute the disturbed psychological equilibrium, it becomes evident that the very uniformity of it makes it a clumsy, inadjustable pattern. If there is anything which impresses the careful student of psychology, it is the over-rich manifoldness, the complexity of mental life. Even the simplest content of consciousness is a tissue woven from millions of threads and any stereotyped influence means crudeness and destruction. The minister's attitude towards inner life is there directly opposite to that of the psychologist. He cannot enter into those endless interplays of associations and memories, or inhibitions and sensations and impulses, he cannot examine from which remote psychological sources those ideas have arisen, how the feelings become disturbed and the judgments sidetracked. He should not analyze even if he could, because his whole aim is to synthesize. He asks for the meaning and not for the structure, for the aims and not for the elements. His therapeutic effort is therefore not even directed towards a careful rebuilding of the injured parts of the mind, but it is nothing more than a general stimulation to the mind to help itself. By touching on one of the deepest emotional layers of the mind, the layer of religious ideas, the minister gives to the soul an intense shock and expects that in the resulting perturbation, everything will be shaken and may then settle itself by its own energies in a healthful way. It is a fact that that can sometimes happen and under certain conditions the chances for it are even favorable. Under many other conditions the chances are unfavorable and the result does not happen at all.

But whether or not a cure results, in any case it is certainly not an effort which can be said to be in harmony with modern science. The idea of science is always to understand the complex from its elements and to restore the disturbed complex object by recognizing the disturbances in the elements and by bringing those disturbed elements into right shape again. Certainly the psychologist, too, in examining carefully the injured mental mechanism may discover emotional injuries which might be cured by the introduction of religious ideas, but he will not give to them a value different from the introduction of any other ideas and emotions, for instance, those of art and music and poetry, those of social company or civic interest, of travel or sport or politics. Each may have its particular value and to cure every mind with religious emotion would be from a psychological point of view as one-sided as it would be to cure every disturbed stomach by milk alone. Moreover in very frequent cases, for instance, of neurasthenia or hysteria or psychasthenia, such wholesale remedies can form only the background of the treatment, but all the details have to be furnished with reference to a most subtle analysis of the special symptoms, and a particular organic symptom or a particular memory idea or a special inhibition by a well-selected counter-idea will do much more than any great emotional revival.

Stereotyped religious appeal is not only insufficient in an abundance of cases—it must never be forgotten that those who nowadays go to the minister for their health are already selected cases more open to religious suggestion than the average—but can easily be decidedly harmful. Of course that holds true for every physical remedy too, and the judgment of the exact limit is one of the chief duties of the physician. It holds also for the other mental factors like sympathy. A certain amount of sympathy may save a neurasthenic from despair, and only a little more may make his disease much worse and may develop in him a consciousness of misery which makes him a complete invalid. Still more is it true for the religious emotion, from the standpoint of nervous physiology the strongest next to the sexual emotion, that it can be the healing drug or the destructive poison. Everything depends upon the degree of the intrusion and upon the resistance of the psychophysical system. From a purposive point of view there cannot be faith enough, from a causal point of view there can easily be too much of the faith emotion. Religious fervor has at all times helped to create hysteria and to develop psychasthenias. It cannot be otherwise. A group of ideas which has such tremendous power over man must easily be able to produce inhibitions and exertions which become dangerous to a nervous system the constitution of which is pathological. To leave such a dangerous and powerful remedy entirely in the hands of men who by their profession must aim towards a maximum dose of religious influence can certainly not be in the interests of the patients or of the community.

Even the whole technique of this movement awakens the fear of possible harmful consequences. On the one hand we have the movement itself as a popular suggestion for the suggestible masses. The patient who seeks the help of a scientific neurologist hardly becomes a center of psychical contagion, but the church services for the sick offer favorable conditions for an epidemic development of hysterical symptoms. But more important are the influences on the individual patient. The whole purpose of the treatment demands the highest possible degree of suggestibility brought about by the ministerial persuasion. But it is evident that this degree of suggestibility means at the same time the most fertile soil for every chance suggestion and for influences which are perhaps entirely unintended. The physician and the psychologist, considering the mental state with reference to its elements, will make most careful use of those accessory influences. The minister, who necessarily has his spiritual aim in mind, cannot even become aware of all the involuntary influences which reach the mind in its most suggestible state. There can be no doubt that it would often need psychological art to avoid the creation of new pathological symptoms in such half-hypnotized patients. Yet the minister even goes so far as to make use of the sleeping mind without any consideration of the possible damage which may be done to his subject. He goes to the bedside of a sleeping girl and whispers his suggestions and is satisfied when they show their effects the next day. It does not lie in his horizon to consider the grave consequences which such suggestions during sleep may produce during future years in the brain the sleep of which has been transformed into such half-somnambulic relations. Hysterias may be created by such methods. No one can blame the minister for his remoteness from such doubts and problems, but the physician is to be blamed if he encourages the belief that all this still belongs to the proper sphere of the ministerial worker in abnormal psychology.

Those engaged in such work were not long in finding out that the mere emotional inspiration is often no sufficient remedy, and the development went along the same lines in which it has gone everywhere for some thousands of years. Not to disappoint the sufferers, the religion had to become in very many cases simply an inactive side issue and the real cure was performed by the same methods with which any worldly neuropathologist would go to work. If the woman who cannot sleep is cured from her insomnia by being made to listen to the beats of a metronome, it may sometimes be effective, however crude, but it is certainly no longer religion, even though the metronome stands in a minister's room. The more the movement spreads to those who have no psychological training and knowledge, the more it must be necessary for them to import the whole claptrap of the quack hypnotist and soon the minister may discover that in certain cases physical means and drugs help still better. Thus he simply enters into competition with the regular physician, only with the difference that he has never studied medicine. The chances are great that in his hands even such remedies and drugs may do harm and finally, even if they were effective, is not the question justified: will not religion suffer?

Indeed we have so far considered the question from one side only. We have confined ourselves to the question of how far such a movement is sound for the interests of the patient; but can we be blind to the other side and overlook the not less important problem of whether it lies in the interests of religion and of the church to amalgamate its spiritual work with a medical one? We are not thinking of those widespread, unfair arguments to the effect that this whole movement is undignified because it is instituted by the desire to fill the empty pews or to make competition with the success of Christian Science. That is utterly unjust. But there are intrinsic factors in the movement which interfere with the true aims of religion. First of all it cheapens religion by putting the accent in the meaning of life on personal comfort and absence of pain. The originators of the Emmanuel Movement stand well above such error, but their national congregations do not. Certainly the longing for pleasure and a well feeling and the abhorrence of pain and illness pervades our practical life and keeps in motion all our utilitarian efforts. But if there is one power in our life which ought to develop in us a conviction that pleasure is not the highest goal and that pain is not the worst evil, then it ought to be philosophy and religion. It is only the surface appearance if it seems as if the religious therapeutics minimizes the importance of pain; in truth it does the opposite. It tries to abolish pain, but not because it thinks little of pain; on the contrary, because it thinks so much of pain that it is willing even to put the whole of religion into the service of this strife for bodily comfort. The longing for freedom from pain becomes the one aim for which we are to be religious. In a time which denies all absolute ideals, which seeks the meaning of truth only in a pragmatic usefulness, it may be quite consistent to seek the meaning of religion in its service for removal of pain, and personal enjoyment. But in that case the ideal of both religion and truth is lost. It is finally not less undignified for religion to seek support for the religious belief in effects which it shares and knows that it shares with any superstitious belief on earth. Granted that the church can cure: the shaman of Siberia can cure too, and the amulets of Thibet not less. The psychologizing church knows, therefore, that it is not the value of the religion which restores the unbalanced nervous system; and yet it wants to provide for the spreading of true belief by the miraculous cures which it exhibits.

This situation naturally produces the desire of the church to substitute a religious explanation for a psychological one. It is claimed that after all it is not the mental effect of the prayer, but the prayer itself, not the psychophysical emotion of religion, but the value of religion which determines the cure. Yet in that moment the whole movement in its modern shape comes into a still more precarious position. If the cure results from the inner value of the religion how can we confine it to the so-called functional diseases and abstain from any hope in organic diseases? Luther, from his religious point of view, still had the right to separate the two groups because only those functional diseases were effects of the devil, obsessions which could be banished by the minister and by prayer, while the other diseases did not result from the devil, but merely from natural causes. Such a definition does not fit into the modern system. To-day from a really religious point of view, both groups of diseases must be acknowledged to be natural or with Mrs. Eddy, as the work of the unholy spirit. Christian Science is indeed by far more consistent. If the cure results through the meaning and value of religion, there is no reason whatever why cancer and diphtheria and paralysis should not be cured as well as psychasthenia. And if, on the other hand, organic diseases cannot be cured because the psychophysical process of the religious emotion has no influence over diphtheria bacilli, then the whole process is removed to the causal sphere and it is acknowledged that the purposive meaning of religion is not in question at all. The whole system of such religious psychotherapeutics is therefore in its inner structure contradictory. It contains causal and purposive elements without any possibility of unifying them. They are loosely mixed, and the power of prayer means on one page something entirely different from what it means on another. In these respects Christian Science is by far more unified and in harmony with itself; its therapeutics is really anchored in a system.

From a scientific point of view, its dangerousness is of course much greater inasmuch as it extends its methods over every organic disease and thus applies merely psychical treatment where from a standpoint of scientific medicine, physical treatment would be absolutely necessary. Moreover its philosophy is after all only a pseudophilosophy; its tempting equations of disease and error and sin and unreality are ultimately a mere playing with conceptions. If we were to point to the root of the misunderstanding in Christian Science, we should say that everything depends on the philosophical commonplace that the objects with which we deal in our life are ideas and that our whole experience is mind. "Christian Science reveals incontrovertibly that Mind is All-in-All, that the only realities are the divine mind and idea." But now silently this mental character of the real world is identified with the mental experience which stands in contrast to the physical experience. There results the impression that physical experience therefore, does not belong to the world of reality. It is evident, however, that mental in contrast to physical means something entirely different from mental in the philosophical sense. In the latter meaning of the word, we all agree that the world is mental; the word mental indicates there that the world has reality not in itself but only as experience of subjects. In the second sense, mental or psychical means that it is experience for one particular subject only and not for every possible subject. The physical thing, for instance this table, is indeed different from my mental memory idea of a table, inasmuch as every possible subject can experience this table while my mental memory image belongs to me alone. The physical table and the mental memory image of it are both equally mental in the philosophical sense, inasmuch as the physical which is object for every possible subject and in this sense not mental is therefore not less given to subjects. Every physical body with its disease is thus in one sense taken as something not mental while in another sense as mental; if we use the same word in two entirely different meanings, it indeed cannot be difficult to demonstrate any metaphysical consequences.