Part 10 (1/2)
The first step in this re-education is a grasp of the facts. If you want to pull yourself out of a nervous disorder, first of all learn as much as you can about the causes of ”nerves,” about the general laws of mind and body, and about your own mental quirks. If this is not sufficient, go to a specialist trained in psychotherapy and let him help you uncover those trouble-making parts of your personality which you cannot find for yourself. It is the purpose of this book to summarize the facts which most need to be known. Let us now consider those methods which the psychopathologist finds most useful in helping his patients to self-knowledge and readjustment.
Various Methods. As there are a number of schools of medicine, so there are a number of distinct methods of psychotherapy, each with its own theories and methods of procedure, and each with its ardent supporters. These methods may be cla.s.sified into two groups. The first group includes those methods, hypnosis and psycho-a.n.a.lysis, which make a thorough search through the subconscious mind for the buried complexes causing the trouble, and might, therefore, be called ”re-education with subconscious exploration.” The other group, includes so-called explanation and suggestion, or methods of ”re-education without subconscious exploration,” which content themselves with making a general survey and building up new complexes without going to the trouble of uncovering the buried past. Although the theory and the technique vary greatly, the aim of all these methods is the same,-the readjustment of the individual to life.
Re-education with Subconscious Exploration
Hypnosis. The method by which most of the important early discoveries were made is hypnosis, or artificial sleep, a method by which the conscious mind is dissociated and the subconscious brought to the fore. It was through hypnosis that Freud, Janet, Prince, and Sidis made their first investigations into the nature of nervousness and worked their first cures. With the conscious mind asleep and its inhibitions out of the way, a hypnotized patient is often able to remember and to disclose to the physician hidden complexes of which he is unaware when awake. Hypnosis may thus be a valuable aid to diagnosis, enabling the physician to determine the cause of troublesome symptoms. He may then begin to make suggestions calculated to break up the old complexes and to build new ones, made up of more healthful ideas, desirable emotions and happy feeling-tones. As we have seen, a hypnotized subject is highly suggestible. His counter-suggestions inactivated, he believes almost anything told him and is extremely susceptible to the doctor's influence.
The dangers of hypnosis have been much exaggerated. Indeed, as an instrument in the hands of a competent physician, it is not to be feared at all. It has, however, its limitations. Many times the very memories which need to be unearthed refuse to come to the surface. Stubborn resistances are more likely to be subconscious than conscious, and may prove too strong to be overcome in this way. Moreover, the road to superficial success is very inviting. It is easy to cure the symptom, leaving the ultimate cause untouched and ready to break out in new manifestations. The drug and drink habits may be broken up without making any attempt to discover the unsatisfied longings which were responsible for the habit. A pain may be cured without finding the mental cause of the pain or initiating any measures to guard against its return, and without giving the patient any insight into the inner forces with which he still has to deal.
Since nervousness is a state of exaggerated suggestibility and abnormal dissociation, many psychologists believe that it is unwise to employ a method which heightens the state of suggestibility and encourages the habit of dissociation. They feel that it is wiser to use less artificial methods which rest on the rational control of the conscious mind and make the patient better acquainted with his own inner forces and more permanently able to cope with new manifestations of those forces. They believe that the character of the patient is strengthened and his morale raised by methods which increase the sovereignty of reason and decrease the role of unreasoning suggestibility.
Psycho-a.n.a.lysis. Freud's contribution has been not only a discovery of the general causes of nervousness, but a special means of locating the cause in any particular case. Abandoning hypnosis, he developed another method which he called psycho-a.n.a.lysis. What chemical a.n.a.lysis is to chemistry, psycho-a.n.a.lysis is to the science of the mind. It splits up the mental content into its component parts, the better to be examined and modified by the conscious mind. Psycho-a.n.a.lysis is merely a technical process for discovering repressed complexes and bringing them into consciousness, where they may be recognized for what they are and altered to meet the demands of real life. It is a device for finding and removing the cause of nervousness,-for bringing to light hidden desires which may be honestly faced and efficiently directed instead of being left to seethe in dangerous insurrection. In order permanently to break up a real neurosis, a man must first know himself and then change himself. He must gain insight into his own mental processes and then systematically set to work to change those processes that unfit him for life.
We shall later find that a detailed self-discovery through psycho-a.n.a.lysis is not always necessary, and that a more general understanding of oneself is sufficient for the milder kinds of nervousness. But because of the promise which psycho-a.n.a.lysis holds out to those stubborn cases before which other methods are powerless; because of the invaluable understanding of human nature which it places at the disposal of all nervous people, who may profit by its findings without undergoing an a.n.a.lysis; and because of the flood of light which it sheds on the motives, conduct, and character of every human being, no educated person can afford to be without a general knowledge of psycho-a.n.a.lysis. [41]
[41] It is unfortunate that the records of an a.n.a.lysis are too voluminous for use in so brief an account as this. Since the report of one case would fill a book, and a condensed summary would require a chapter, we must refer to some of the volumes which deal exclusively with the psychoa.n.a.lytic principles. For a list of these books, see Bibliography.
A Chain of a.s.sociations. Psycho-a.n.a.lysis is not, like hypnosis, based on dissociation; it is based on the a.s.sociation of ideas. Its main feature is a process of uncritical thinking called ”free a.s.sociation.” To understand it, one must realize how intricately woven together are the thoughts of a human being and how trivial are the bonds of a.s.sociation between these ideas. One person reminds us of another because his hair is the same color or because he handles his fork in the same way. Two words are a.s.sociated because they sound alike. Two ideas are connected because they once occurred to us at the same time. A subtle odor or a stray breeze serves to remind us of some old experience. Connections that seem far-fetched to other people may be quite strong enough to bind together in our minds ideas and emotions which have once been a.s.sociated, even unconsciously, in past experience.
In this way, thoughts in consciousness and in the upper layers of the subconscious are connected by a series of a.s.sociations, forming links in invisible chains that lead to the deepest, most repressed ideas. Even a dissociated complex has some connection with the rest of the mind, if we only have the patience to discover it. Therefore, by adopting a pa.s.sive att.i.tude, by simply letting his thoughts wander, by talking out to the physician everything that comes to his mind without criticizing or calling any thought irrelevant or far-fetched, and without rejecting any thought because of its painful character, the patient is helped to trace down and unearth the troublesome complex which may have been absolutely forgotten for many years. He is helped to relive the childhood experiences back of the over-strong habits which lasted into maturity.
Resisting the Probe. Naturally, it is not all fair sailing. The subconscious impulses which repressed the painful complex in the first place still shrink from uncovering it. In many cases the resistance is very strong. It, therefore, often happens that after a time the patient becomes restive; he begins to criticize the doctor and to ridicule the method. His mind goes blank and no thought will come; or he refuses to tell what does come. The nearer the probe comes to the sore spot, the greater the pain of the repressing impulses and the stronger the resistance. Usually a strange thing happens; the patient, instead of consciously remembering the forgotten experiences, begins to relive them with his original emotions transferred on to the doctor. Depending upon what person of his childhood he identifies with him, the patient develops either a strong affection or an intense antagonism to the physician, att.i.tudes called in technical terms positive and negative transference. If the a.n.a.lyst is skilful, he is able to circ.u.mvent all the subterfuges of the resisting forces and to uncover and modify the troublesome complexes. Sometimes this can be accomplished at one sitting, but more often it requires long hours of conversation. Freud has spent three years on a single difficult case, and very frequently the a.n.a.lysis drags out through weeks or months. The amount of mental material is so great, especially in a person who is no longer young, that every a.n.a.lysis would probably be an interminable affair if it were not for three valuable ways of finding the clue and picking up the scent somewhere near the end of the trail. The first of these clues is nothing else than so despised a phenomenon as the patient's own night-dreams, which turn out to be not meaningless jargon, as we have supposed, but significant utterances of the inner man.
The Message of the Dream. When Freud rescued dreams from the mental sc.r.a.p-basket and learned how to piece them together so that their message to man about himself became for the first time intelligible, he furnished the human race with what will probably be considered its most valuable key to the hidden mysteries of the mind. Freeing the dream from the superst.i.tion of olden times and from the neglect of later days, Freud was the first to discover that it is part and parcel of man's mental life, that it has a purpose and a meaning and that the meaning may be scientifically deciphered. It then invariably reveals itself to be not a prophecy for the future but an interpretation of the present and of the past, an invaluable synopsis of the drama which is being staged within the personality of the dreamer.
As modern man has swung away from the idea of the dream as a warning or a prophecy, he has accepted the even more untrue conception of dreaming as the mere sport of sleep,-the ”babble of the mind,” the fantastic and insignificant freak-play of undirected mental processes, or the result of physical sensations without relation to the rest of mental life. No wonder, then, that Freud's startling dictum, ”A dream is a disguised fulfilment of a repressed wish,” should be met with astonishment and incredulity. When a person is confronted for the first time with this statement, he invariably begins to cite dreams in which he is pursued by wild beasts, or in which his loved ones are seen lying dead. He then triumphantly a.s.serts that no such dream could be the fulfilment of a wish.
The trouble is that he has overlooked the word ”disguised.” Like wit and some figures of speech, a dream says something different from what it means. It deals in symbols. Its ”manifest content” may be merely a fantastic and impossible scene without apparent rhyme or reason, but the ”latent content,” the hidden meaning, always expresses some urgent personal problem. Although the dream may seem to be impersonal and unemotional, it nevertheless deals in every case with some matter of vital concern to the dreamer himself. It is a condensed and composite picture of some present problem and of some related childish repressed wish which the experiences of the preceding day have aroused.
As Frink says, a dream is like a cartoon with the labels omitted-absolutely unintelligible until its symbols are interpreted. Although some dreams whose symbolism is that which man has always used, can be easily understood by a person who knows, many dreams are meaningless, even to an experienced a.n.a.lyst, until the patient himself furnishes the labels by telling what each bit of the picture brings to his mind. The dream, as a rule, merely furnishes the starting-point for free a.s.sociation.
Each symbol is an arrow pointing the way to forbidden impulses which are repressed in waking life but which find partial expression during sleep. The subconscious part of the conscience is still on the job, so the repressed desires can express themselves only in distorted ways which will not arouse the censor and disturb sleep. The purpose of the dream is thus two-fold,-to relieve the tensions of unsatisfied desire, and to do this in such a subtle way as to keep the dreamer asleep. Sometimes it fails of its purpose, but when there is danger of our discovering too much about ourselves, we immediately wake up, saying that we have had a bad dream.
It is at first difficult to believe that we are capable of this elaborate mental work while we are fast asleep. However, a little investigation shows us to be more clever than we realize. The subconscious mind, in its effort to satisfy both the repressing and the repressed impulses, carries on very complicated processes, disguises material by allowing one person to stand for another, two persons to stand for one, or one person to stand for two; it s.h.i.+fts emotion from important to trivial matters, dramatizes, condenses, and elaborates, with a skill that is amazing. We are all of us very clever playwrights and makers of allegories-in our sleep. Also, we are all very clever at getting what we want, and the dream secures for us, in a way, something which we want very much indeed and which the world of social restraint or our own warped childish notion denies us.
Not every one can become an interpreter of dreams. It takes a skilled and patient specialist thoroughly to understand the process. But it is fortunate indeed that we possess such a valuable means of diagnosis when extraordinary conditions make it necessary to explore the subconscious in the search for trouble-making complexes. [42]
[42] For f urther study of the dream, see Freud: Interpretation of Dreams; and General Introduction to Psycho-a.n.a.lysis.
The Word-Test. Although dreams furnish the main clues to buried complexes, they are by no means the only instrument of the psycho-a.n.a.lyst. Another device, called the a.s.sociation word-test, has been developed by Dr. Carl Jung of Switzerland. The a.n.a.lyst prepares a list of perhaps one hundred words, which he reads one by one to the patient, hoping in this way to strike some of the emotional reactions of which the patient himself is unaware. The latter responds with the first word that comes into his mind, no matter how absurd it may seem. The responses themselves are often significant, but the time that elapses is even more so. It usually happens that it takes very much longer for some responses than for others. If a patient's average time is one or two seconds, some responses may take five or ten or twenty seconds. Sometimes no word comes at all and the patient says that his mind is a blank. He coughs or blushes, grows pale or trembles, showing all the signs of emotion even when he himself has no notion of the cause. The significant word has. .h.i.t upon a subconscious a.s.sociation with some emotional complex. The blocking of the mind is an effort of the resistance to keep the painful ideas out of consciousness. The telltale word then furnishes a starting point for further a.s.sociations.
One of my patients blocked on the word ”long.” Instead of saying ”short” or ”pencil” or ”road” or ”day” or any other word which might naturally be a.s.sociated with ”long,” she laughed and said that no word would come. Finally an emotional memory came to light. It seems that this woman had been courted by a man whom she unconsciously loved, but whom she had ”turned down” because she was ambitious for a career. After the man had moved to another town, my patient heard that he was engaged to another girl. She then realized that she loved him and began to long for him with her whole heart. The meaningful word ”long” thus led us to one of the emotional memories for which we were seeking.
”Chance” Signs. There are other clues to hidden inner processes, other sign-posts pointing to the cause of a neurosis. Not only through dreams and through emotional reactions to certain words does the subconscious reveal its desires, but also through the little slips of the tongue and of the pen, the ”chance” acts and unconscious mannerisms which are usually ignored as entirely insignificant. When we ”make a break” and say what we secretly mean but wish to hide from ourselves or others; when we forget an appointment which part of us really wishes to avoid, or forget a name with which we are perfectly familiar; when we lose the pen so that we cannot write or the desk key so that we cannot work; when we blunder and drop things and do what we did not mean to do; then we may know-the normal as well as the nervous person-that our subconscious minds with their repressed desires are trying to get the reins and are partially succeeding.
An example from my own life may ill.u.s.trate the point. In building a number of houses, I had occasion often to use the word studding, but on every occasion, I forgot the word and always had to end lamely by saying ”those pieces of timber that go up and down.” Each time the builder supplied the word, but the next time it was no more accessible. Finally, the reason came to me. One day when I was a little child I looked out of the window and cried, ”Oh, see that great big beautiful horse.” My grandmother exclaimed, ”s.h.!.+ s.h.!.+ that is a stud horse.” Over-reaction to that impression repressed the word stud so successfully that as a grown woman I could not recall another word which happened to contain the same syllable.
During an a.n.a.lysis a patient of mine who had a mother-in-law situation on her hands told me a dream of the night before. ”I dreamed that my mother-in-law, who has really been very ill, was taken with a sinking-spell. I rushed to the telephone to call the doctor, but found to my terror that I could not remember his number.” ”What is his number?” I asked, knowing that she ought to know it perfectly. ”Two-eight-nine-six,” she answered at once. The number really was 2876. Asleep and awake, her repressed desire for release from the mother-in-law's querulous presence was attempting to have its way. In the dream, she avoided calling the doctor by forgetting his number entirely. Awake, she evaded the issue by remembering a wrong number. In the dream she thinly disguised her desire by displacing the anxious emotion from the sense of her own guilty wishes to the idea of the mother-in-law's death. When confronted with this interpretation, the woman readily acknowledged its truth.
Even stammering, which has always been considered a physical disorder, has been proved, by psycho-a.n.a.lysis, to be the sign of an emotional disturbance. H. Addington Bruce reports the case of one of Dr. Brill's patients, a young man who had been stammering for several years. Observation revealed the fact that his chief difficulty was with words beginning with K and although at first he firmly denied any significance to the letter, he later confessed that his sweetheart whose name began with K had eloped with his best friend and that he had vowed never to mention her name again. Upon Dr. Brill's suggestion he tried to think of the unfaithful lover as Miss W., but soon returned, saying that he was stammering worse than ever. Investigation showed that the additional unp.r.o.nounceable words contained the letter W. When he was induced to renounce his oath never to call the girl's name again, he found that he had no more difficulty with his speech. [43]