Psychotherapy
BY M. DAVID EDER.
44 E won't be happy till he gets it." Here is an illustra- 11- tion of some of the first essentials of mental treat- ment—a proper reading of gesture language and recogni- tion of the cause of distress, with promise of happiness restored when the wish is diagnosed and resolved _or gratified. The psychology pictured is of course simple, as is the treatment ; though even here there is room for cautious inquiry. Will the happiness persist after the wish is granted ? What is there so attractive about the cake of soap ? An answer to the latter question -might also answer the former.
Rarely, even in the nursery, is the psychology so simple or the proper treatment so readily found. Every patient suffering from mental disharmony does indeed know -that he is in distress but does not know what he wants to make him happy. He may fasten on to some- thing in the external world—'some adult substitute for the cake of soap—and believe that, had he but this, all would be well. Perhaps only after many trials and the proving of many errors, does he discover that the diffi- culty is not in the external world but in himself—in his inability to adapt himself to his world.
Friends and physicians alike are commonly at a loss to -read the riddle of the patient's distress—of his illness. The ill-health is due to desires that are, or appear to be, incapable of fulfilment—desires that are left-overs from infancy's and childhood's world of phantasies, and now have become deeply rooted in the mind. Ill- .health has become a substitute for ungratified and possibly ungratifiable desires. Against the nursing of unacted desires the poet-prophet has warned us.
It is no modern discovery that illness can be healed by the influence of the mind ; though for long such treatment was discredited as charlatanry, and the mental healer classed with wizards and fortune-tellers. Respectable practitioners of medicine, confronted with reputed cures, denied the reality of the illness, or that the cure was actual. In the latter part of the nineteenth century the orthodox doctor, having in mind the fate of Mesmer and of Elliotson, wasted little thought on such "trivial matters " as mind cure. He stuck to his surgeon's knife, and to his " blue-flowering borage, very nitrous." But to- day, even if rather grudgingly, it is admitted that Mesmer, however exaggerated his claims and however fanciful his science, did cure many people of their ills ; that Christian Science, whether or no its methods be Christian or scientific, has helped many sufferers ; and that Lourdes has its miraculous cures—for, when the agency is beyond our apprehension, all cures are miracles.
Psychotherapy to-day seeks to understand and to -systematize all methods of healing, based on the influence of mind ; nor is it unduly concerned with hair-splitting distinctions between mind and matter : " What is matter ? Never mind ; What is Mind'? No matter."
The nineteenth-century scientist was as intolerant to mind as is the twentieth-century physicist to matter. The psychotherapist behaves towards the sick person very much as Professor Eddington would have a scientific man behave in passing through a doorway : walk in, he advises, rather than wait till all the difficul- ties involved in a really scientific ingress are resolved.
" Rather than wait," the doctor to-day finds it " more convenient," as Poine,are put it, to treat certain ills—say a broken leg—primarily by _physical methods ; and other ills—say a broken heart—primarily by mental methods. All " functional " diseases are most conveniently treated by psychotherapy. It must; how- ever, be borne in mind that many " nervous " or functional illnesses masquerade in physical guise. Many sufferers from claustrophobia, for instance, who are dis- tressed beyond measure in a church or theatre, ascribe their anxiety to the stuffy air, or to fear of a fire breaking out, themselves as unaware as are their friends and often their doctors that these are pseudo-reasonings, covering some deep mental conflict: - ,-- • .
Wherever there is mental illness there is mental con- flict. So Freud has taught us ; and it is also to Freud that we owe our realization' of the truth that the root of the conflict, its sources, are withheld from the patient's consciousness, though the conflicting forces are dyna- mically active in the unconscious. The symptoms that make up the overt illness which trouble the patient and induce him to seek treatment, represent a compromise between the warring factors. Like most compromises, this usually ends in securing the worst of both worlds, in neither fulfilling nor surmounting the primordial desire.
The conflict is between the wishes, ideas and thoughts that are prevented from emerging into consciousness and the wishes and ideas that prevent their emergence. Put- ting it rather broadly and crudely, the conflict is between the ego and the sex impulses, roughly represented bio- logically by the instinct of self-preservation and the instinct of reproduction. There are two main methods of psychotherapy. The first is treatment by suggestion ; that is the planting of an idea in the patient's mind which he may come to. accept, though there are no adequate grounds for that acceptance, acceptance and non-acceptance both being dependent - on some of the individual's earliest emotional expe- riences. Treatment by suggestion is much practised in every nursery ; and there are numerous variants suitable to all ages and illnesses. Coueism, for instance, is one of the simplest forms of psychotherapy by sug- gestion, whilst hypnotism is a more subtle application of the same method. . The other technique aims at setting the patient free from suggestion—past, present and future. It seeks to effect a cure by displacing the phantasies embedded in the unconscious in favour of reality. This is Freud's psycho-analytic method, of which there are many colourable imitations. It is, indeed, to the genius of Freud that we owe that deep under- standing of human nature on which the modern treat- ment of mental illness is based. Much of his teaching has become so much a part of customary thought that its source often passes unrecognized. Freud's work has given us not only a scientific basis for the psychotherapy of the present, but also an appreciation of the causes of the successes and failures of our predecessors in the art, as well as of those of the many forms of spiritual healing in vogue to-day.
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