Psychotherapy

by Hugo Münsterberg

On a higher level are objections which come from serious quarters and which are not without sympathy with true science. In recent times this opposition has repeatedly found eloquent expression. It is an objection from the standpoint of morality, belonging therefore entirely to the purposive view of the mind, but we have now reached a point where it is our duty to do justice to this purposive view too. As long as we discussed the problem entirely from the standpoint of the physician, no other view of mental life except the causal one could be in question. As soon as we look at it from the standpoint of the community, it becomes our duty to bring the causal and the purposive view into harmony, and it would be narrow and short-sighted simply to draw the practical consequences of a naturalistic view of the mind without inquiring whether or not serious interests in the purposive sphere are injured. If there is moral criticism against suggestive therapy, it is the duty of the community to consider it. This opposition argues as follows: Hypnotic influence brings the patient under the will control of the hypnotizer and thus destroys his own freedom. Whatever the patient may reach in the altered states is reached without his own effort, while he is the passive receiver of the other man's will. His achievement has therefore no moral value, and if he is really cured of his drunkenness or of his perverse habits, of his misuse of cocaine or of his criminal tendencies, he has lost the right to be counted a moral agent. It would be better if there were more suffering in the world than that the existence of the moral will should be undermined.

No one ought to take such arguments lightly. The spirit which directs them is needed more than anything else in our time of reaching out for superficial goods. No one can insist too earnestly that life is worth living only if it serves moral duties and moral freedom and is not determined by pleasures and absence of pain only. Those who set forth this argument are entirely willing to acknowledge the profound effect which suggestive therapeutics may create. More than this, they have to acknowledge it to gain a basis for their attack. Just because the hypnotizer can entirely change the desires and passions, the habits and perversities of the suffering victim, he seems to them a moral wrongdoer who negates the principle of human freedom. A forcible book of recent days calls the suggestive power of the psychotherapist "The Great Psychological Crime." It says to the hypnotist: "By your own testimony, you stand convicted of applying a process which deprives your subjects of the inalienable right and power of individual self-control. In proportion as you deprive him of the power of self-control, you deprive him of that upon which his individual responsibility and moral status depend. In proportion as you deprive him of the free control and exercise of those powers of the soul upon which his individual responsibility and moral status depend, you thereby rob him of those powers upon which he must depend for the achievement of individual immortality."

But this censure too is entirely mistaken, not because it urges the purposive views against the causal but because it is in error as to the facts. Such critics are fully under the influence of the startling results which are reached; they do not take the trouble to examine the long and difficult way which has had to be traversed with patience and energy. It is quite true that if I hypnotize a man and suggest to him to take up after awaking the book which lies on my table, he follows my suggestion without conflict and in a certain sense without freedom. He feels a simple impulse to go to the table and lift the book and, as no stronger natural desire and no moral objection stand in the way, he carries out that meaningless impulse and perhaps even invents a foolish motive to explain to himself why he wanted to look at that book. But after a long experience, I have my doubts as to whether a man was ever cured in such a way by hypnotism of serious disturbances and of those anomalous actions which the critics want to see overcome by the patient's own moral efforts. On the contrary, every suggestion has to rely on the efforts and struggles of the patient himself and all that the psychotherapists can give him is help in his own moral fight. His own will is presupposition for being hypnotized and for realizing the suggestion. If again and again I hesitate to undertake new cases, it is just because I have to see during the treatment too much of this daily and hourly striving against overpowering impulses. The joy of removing some obstacles from the way of the patients is too much overshadowed by the deep pity and sympathy with their suffering and craving during the whole period of successive treatments. To make a man fight where despair is inevitable, and where the enemy is necessarily stronger than his own powers, can certainly not be the moral demand. Morality postulates that everyone find conditions in which he can be victorious if he puts his strongest efforts to the task.

In our discussion of the mental symptoms I reported as an illustration of the suggestive treatment of the drug passion the case of a morphinist. To make clear this purposive side of the case as against the causal one which alone interested the physician, I may add a few features to the short report as a typical example. When that man left my laboratory for the last time to go out to work and happiness, you might well have believed from his joyful face that it had been an easy and pleasant time in which hypnotic influence smoothly removed from him the dangerous desire for morphine. In truth it was the result of four months of the most noble and courageous suffering and struggling. He had been for years a slave to his passion. To quote from his little autobiography: "When I realized that I was addicted to morphine, I was at first not at all worried as I did not then understand the real horror of the thing, and did not then realize all the future suffering and misery that is coming to anyone who is the user of opium or any of its alkaloids. For the first few months, I found great relief after every injection of morphine, but soon I could not get the same easy feeling and could eat but very little and what sleep I got was in the daytime. I finally went to the sanitarium of a doctor but it was simply a money-making business for him; if he ever cured anyone, I never heard of it. I then tried another one; it was the same kind of a place as the former. When I first went to see the professor in the Harvard Psychological Laboratory, I was using between thirty-two and thirty-eight grains of morphine daily. He put me under his treatment October 6th and that day cut me down by hypnotic treatment to nine grains a day or three doses of three grains a day. I took my hypodermic as directed, but on the following day I lay on the bed too exhausted to get up even to get around the room, and I could not eat and only drank a very little water. The desire for the drug was something terrible. But in about four days I got used to the loss of so much morphine and stayed on this amount for a week, seeing the professor every other day for hypnotic treatment and then returning to my room where I spent twenty-two hours of the twenty-four on the bed, but did not sleep more than two or three hours a day. At the end of the week I was cut off by hypnotic suggestion half a grain and this put me to fighting the desire again. This lasted two or three days and then I began to feel better and began to sleep a little more. But at the end of the week I was cut off another half grain, and the whole fight would have to be begun over. These reductions of the dose were made a week apart and sometimes only two days. The worst time of all was a cut from four injections of a fourth of a grain each to four of one eighth of a grain each, which was about January 10th. At this time I had the worst two days of my life. I tried whiskey, but it gave relief only for about half an hour and then the desire was worse than ever."

In this way every few days I gave the poor fellow under hypnotic influence the suggestion to reduce the dose of morphine in a prescribed way, and with enormous effort he withstood his craving for more, in spite of the fact that he had during all this winter a bottle with a thousand tablets of morphine, prescribed by an unscrupulous physician, in his writing desk. He was thus at every moment during the day and night in full possession of the deadly poison with which he could have fully satisfied his craving. It was a moral victory when he finally reached the point at which he went for several weeks without any desire for morphine and finally presented the remaining tablets to a hospital. And yet there would not have been the least chance for his winning this ethical victory without the outer help of the hypnotist. We do not eliminate the moral will but we remove some unfair obstacles from its path. We have no mystic power by which our will simply takes hold of the other man's will, but we inhibit and suppress by influence on the imagination those abnormal impulses which resist the sound desires. If that were immoral, we should have to make up our minds that all education and training were perverted with such immoral elements. Every sound respect for authority which makes a child willing to accept the advice and maxims of his elders is just such an influence. If it were really a moral demand that the will be left to its own resources and that no outside influence come to strengthen its power or remove its hindrances or smooth its path, then we ought to let the children grow up as nature created them and ought not to try to suppress from without by discipline and training, by love and encouragement, the willful impulses and the ugly habits. Even every good model for imitation is such a suggestive influence from without and every solemn appeal to loyalty and friendship, to patriotism and religion, increases the degree of suggestibility. That is the glory of life that the suggestive power may belong to moral values instead of mere pleasures, but it is not the aim of life to remain untouched by suggestion. And he who by suggestion helps the weak mind to overcome obstacles which the strong mind can overthrow from its inborn resources works for the good of the individual and of the community in the spirit of truest morality.

Much more justified than such ethical objections are the fears which move entirely in the causal sphere. It must be acknowledged that a method which has such powerful influence over the mind that it can secure ideas and emotions and impulses which the own will of the patient cannot produce, ought to be allowed only to those who are prepared for its skillful use. To hypnotize or to perform any persistent psychotherapeutic treatment may thus be dangerous, if it is done by the unfit. We have discussed before the injuries which might result from the administration of such powerful psychotherapeutic effects through the best meaning minister, but we can extend this fear to anyone who has not systematically studied medicine and to a certain degree normal and abnormal psychology. The possibilities of overlooking symptoms which ought to suggest an entirely different treatment, or of adjusting the treatment badly to the special physical conditions, or of ignoring the desirable physical supplement by drugs, or of creating unintentionally by suggestion injurious effects, are always open when medical amateurs undertake such work. Certainly there is no physician who is not liable to make mistakes, and a physician who has never given any attention to psychology and psychiatry would also be a rather poor agent of psychotherapeutic methods, but the probability is that such a physician would simply abstain by principle from all psychotherapeutic methods; his mistake only begins if from his lack of acquaintance with the subject he draws the conclusion that the method itself is undesirable. That his real preparation ought to include psychological studies we have pointed out before, and the time seems ripe for the community to urge such a reform of the studies.

All that involves the conviction that even the experimental psychologist as such is not prepared to enter into medical treatment; and a "Psychological Clinic," managed by a psychologist who is not a doctor of medicine, is certainly not better than a church clinic. I cannot even acknowledge the right of psychologists to make hypnotic experiments merely for the psychological experiment's sake. Nobody ought to be brought into a hypnotic or otherwise abnormal state of mind if it is not suggested by the interests of the subject himself. Science has the right to make hypnotic experiments, or experiments with abnormal mental states, only under the one condition that a physician has hypnotized the subject in the interests of his health and that the patient has agreed beforehand to allow in the presence of witnesses certain psychological studies. Needless to say that any hypnotization for mere amusement and as a parlor trick ought to be considered as criminal.

On some other objections which interest the community as such we had to touch before, and there is no need of returning to them with any fullness of argument. We spoke of the danger which the mental cures carry with them when they are based on any particular creed, and especially when they are tied up with a semi-religious arbitrary metaphysics. What is gained if some nervous disorders are helped by belief, if the belief itself devastates our intellectual culture and brings the masses down again to a view of the world which has all the earmarks of barbarism? That is indeed one of the central dangers of all non-medical suggestive cures, that while any belief may cure through the mere emotional power of the act of believing, the content of the belief gains an undeserved appearance of truth. Any absurd superstition can become accredited because its curative value may be equal to a truly valuable suggestion. The intellectual life of the community would have to suffer greatly if the way to be freed from bodily suffering had to be the belief in the metaphysical doctrines of Mrs. Eddy's "Science and Health." From a cultural viewpoint, too, suggestive therapeutics must stand the higher, the more sharply it is separated from special philosophical or religious doctrines. No theory of the world and of God ought to gain authority over the mind from such an external motive as a belief in its curative effects. Freest from such implications is certainly the hypnotic method of the physician who does not need the strong religious reënforcement of the suggestion because he reënforces instead the suggestibility of the patient by slight influences on his senses.

Even where sound religion without superstition and without pseudophilosophy stands behind the therapeutic work, the community will not give up the question whether the church does not necessarily neglect by it the interests which are superior. The community becomes more and more strongly aware that too many factors of our modern society urge the church to undertake non-religious work. Social aid and charity work ought to be filled with religious spirit, but to perform it is not itself religion. Still more that is true of the healing of the sick. Whether or not such expansion of church activity in different directions saps the vital strength of religion itself is indeed a problem for the whole community. The fear suggests itself that the spiritual achievement may become hampered, that in the competition of the church with the other agencies of social life the particular church task may be pushed to the background, and that thus the church in imitating that which others can do just as well or better loses the power to do that which the church alone can do. The final outcome is therefore practically in every way the same. From whatever starting point we may come, we are led to the conviction that the physician alone is called to administer psychotherapeutic work, but that he needs a thorough psychological training besides his medical one.

But the interest of the community is not only a negative one. Society does not only ask where psychical treatment can be dangerous, but asks with not less right whether the scheme and the method might not be fructified for other social ends besides the mere healing of the sick. If psychotherapy demonstrates that for instance hypnotism makes possible the reshaping of a pathological mind, it is a natural thought to use the same power for remodeling perhaps the lazy or the intemperate, the careless or the inattentive, the dishonest or the criminal mind. Both educators and criminologists have indeed often raised such questions, and social reformers have not seldom seen there wide perspectives for social movements in future times.