Adventurings in the Psychical Part 16

To accomplish this, Doctor Donley resorted to the method of subst.i.tution, suggesting to the patient, while still under hypnotic influence, that he was quite mistaken in supposing that the street-car had seriously injured the little girl; that, on the contrary, it had scarcely touched her.

The result, after only eight days' treatment, was effectually to replace the painful memory image with one free from distressing a.s.sociations. As by magic, the young man shook off his absurd phobia. No longer, when he had to take a car, did he stand on street corners, sometimes for an hour at a time, waiting anxiously for a car with an even number to appear.[40]

[40] This case and several others similarly ill.u.s.trative of the disease-creating power of emotional disturbances are discussed by Doctor Donley in "Psychotherapeutics," a book of composite authors.h.i.+p.

Bizarre as these cases must seem, they are actually typical of a widespread malady that causes an amount of suffering only appreciable by the sufferers themselves. In every land there are thousands of men and women afflicted with obsessions equally strange and equally distressing, yet amenable to treatment by the methods of psychopathology.

Often, in order to effect a cure, it is not necessary to make use of the roundabout device just described. Direct suggestion--a strongly negative command imposed in the hypnotic state--is frequently sufficient.

Often, besides, it is not necessary to use hypnotism at all, a cure resulting if only the psychopathologist can dig down to the root of the trouble, and, by recalling to conscious recollection the lost memory image, rea.s.sociate it with the rest of the contents of the upper consciousness.

Particularly interesting in this connection, as being ill.u.s.trative also of an ingenious method of "mind tunnelling" nowadays frequently employed to get at forgotten memories, is a case reported by Doctor A. A. Brill, a New York psychopathologist. His patient was a young woman who applied to be treated for extreme nervousness. She had been perfectly well until three months before, when, she said, she had begun to suffer from a complication of disorders, including insomnia, loss of appet.i.te, constant headache, irritability, and stomach trouble. No physical cause for her condition could be detected, and Doctor Brill suspected that it was due to some secret anxiety, but the patient earnestly a.s.sured him that she "had nothing on her mind."

To get at the facts which he suspected she was consciously or unconsciously concealing from him, Doctor Brill decided to make use of what is known as the "a.s.sociation-reaction method of mental diagnosis,"

a c.u.mbersome and formidable term for a really simple process.

Everybody knows that if a man is suddenly asked a question bearing on matters which personally concern him and which he is anxious to keep entirely to himself, he is apt to "react" to the question in a way that will betray the true state of affairs. He may blush or stammer before replying, may reply evasively, may find it impossible to reply at all.

If he is a man of uncommon self-control, and not to be taken off his guard, the reply may come smoothly enough, and to all appearance without hesitation. Nevertheless, experiment has shown that, even in such cases, there is an appreciable difference in the time, if not in the character, of the replies he makes to emotion-arousing questions, as compared with the time it takes him to reply to questions that have no special significance to him. The same holds good in the case of questions evoking within him memories--albeit perhaps wholly subconscious memories--of happenings that may be no longer, but once were, of keen emotional import to him.

Out of the discovery of this fact the a.s.sociation-reaction method has been evolved. The specialist using it reads slowly to his patient a list of one hundred words or more, and requests him, as he hears each, to respond with the first word that comes into his mind. Seemingly the list of stimulus words is chosen at random; actually it is so constructed that some of the words are likely to stir into activity the subconscious memories of which the physician is in search. If they do this the fact will be disclosed in the time of his reaction-words--the words he utters in reply--as measured by a chronoscope or stop-watch; or in their character, as noted down by the specialist.

Of course, it is necessary for the physician to select words having, or likely to have, emotional significance to the particular patient; and as a guide in the selection, strange though it may seem, nothing is more useful than the patient's dreams. For it has been definitely established that dreams are far from being the haphazard products of imagination they are generally supposed to be; that on the contrary, no matter how trivial or nonsensical they seem, they always have an emotional foundation corresponding with some present or past reality; and that usually they mask matters of distinct significance to the dreamer.

As a preliminary, then, in the treatment of his nervous patient, Doctor Brill asked her to write out her dreams and bring them to him.

"But," she said, "I never dream, except when I am troubled by indigestion, and then my dreams are so absurd that they are not worth telling."

"Never mind," was his reply. "Whenever you do happen to have a dream, report it to me."

Laughingly she promised to comply, and one day brought him the following:

"I dreamed that I was in a lonely country place and was anxious to reach my home, but could not get there. Every time I made a move there was a wall in the way--it looked like a street full of walls. My legs were as heavy as lead; I could only walk very slowly as if I were very weak or very old. Then there was a flock of chickens, but that seemed to be in a crowded city street, and they--the chickens--ran after me, and the biggest of all said something like: 'Come with me into the dark.'"

"There," she said, "that is my dream, and if you can make head or tail of it, it is more than I can. It is so ridiculous that I am ashamed to tell it."

But Doctor Brill was already at work drawing up a test list, with the more striking words of the dream sprinkled through it. Twice he read the list to her, noting not only the time of her responses, but also their character.

He was immediately impressed by the fact that certain of the dream words--such as "chicken," "street," and "dark" had caused a noticeable time variation; and that she had also given in her responses words that would not ordinarily be a.s.sociated with the test words. Especially peculiar was the a.s.sociation of "mystery" and "marriage" with the word "dark." The suspicion formed in his mind that a disappointment in love might be at the bottom of all her disease symptoms. But he did not at once give voice to this idea; instead, he sought to obtain corroboration from her own lips without her appreciating his purpose, by means of another method of "mind tunnelling" known as the method of free a.s.sociation.

"I want you," he said to her, "to concentrate your attention on the word 'chicken,' and state the thoughts that come to you in connection with it."

Her reply, given after a few moments of silent meditation, was:

"I remember now that I could see only the biggest chicken; all the others seemed blurred; it was unusually big and had a very long neck and it spoke to me. The street in which I saw it recalls where I used to go to school--the block was always crowded with school children."

She paused, and began to blush and laugh.

"Go on," said Doctor Brill encouragingly. "What next?"

"Why, it recalls the happy school days when I was young and had no worries. I even had a beau, a boy who attended the same school. We used to meet after school hours and walk home together. He was lanky and thin, and the girls used to tease me about him. Whenever they saw him coming, they said: 'Belle, here comes your chicken.' That was his nickname among the boys."

Stopping suddenly, she exclaimed:

"Doctor Brill, it couldn't be possible that the chicken with the long neck, that I saw in my dream, was my old beau!"

"It begins to look very much like it," he smiled. "Have you seen him lately?"

"Not for months."

"And before then?"

Little by little the whole story came out. They had kept up their acquaintance after the school days were long gone. Three times he had asked her to marry him, but each time she had refused, because although she "liked" him she was not at all sure that she "loved" him. At last she had decided that the next time he proposed she would accept. But he had not proposed again. And shortly before she became ill she had heard that he was paying attentions to another young lady.

"I take it," interposed Doctor Brill, "that he is not so well off as he might be, and that this had something to do with your refusing to marry him."

"What makes you say that?"

"In your dream I note that you state: 'Every time I made a move there was a wall in the way; it looked like a street full of walls.' A street full of walls might easily signify Wall Street--hence money. That has been the real obstacle, has it not?"

She confessed that he was right.

He then explained that the one great cause of her ills was her insistent, if subconscious, brooding over the disappointment she had experienced, and that her cure depended upon her ability to overcome this mental att.i.tude. Realizing for the first time, as a result of the dream a.n.a.lysis, that she was really in love with the man she had three times declined to wed, she soon solved the problem. Only a hint was needed to transform him into a suitor once more, and within a very few months they were happily married.[41]

[41] Doctor Brill has reported and discussed this case in his recently published "Psychoa.n.a.lysis," pp. 48-54.

Sometimes direct questioning is sufficient to enable the physician to get at the underlying mental cause of trouble. Take, for example, another case successfully treated by Doctor Donley.

The patient was a woman of thirty-five who was troubled by a constant and involuntary hacking, which sounded as though she were trying to clear her throat. Drugs, local applications, and electricity had been tried at intervals during more than four years, but to no purpose. On inquiry, it was found that the trouble had set in about five years before, when the patient, who was a mill hand, had suffered from a sore throat. The physician whom she then consulted told her that she had a bad case of tonsilitis, and that her tonsils would have to be burned out.

Greatly frightened, she had hurried home, refusing to submit to the operation. In a few days the tonsilar symptoms disappeared, and she returned to work. But she was attacked a second time three weeks later, and visited another doctor, to be informed that her tonsils were so badly diseased that it would be well to have them removed by cutting.

Again she refused to submit to an operation, but the fear of cutting, added to her previous fear, now revived, of burning out her tonsils, threw her into a highly nervous state. She then began to experience an unpleasant stinging, tickling feeling in her throat, which she tried to remove by hacking. As the tickling continued, the hacking became more and more frequent, and by the time she came under Doctor Donley's observation had taken on the character of a "tic," or uncontrollable muscular movement.

These facts in the early history of the case, the patient herself remembered only vaguely. But she confessed that she was still tormented by a haunting fear of a possible future burning or cutting of her tonsils. Finding her exceedingly suggestible, Doctor Donley made no attempt to hypnotize her. He merely requested her to close her eyes, remain perfectly pa.s.sive, and listen attentively to him.

"She was then told, with much emphasis," he says, in describing the treatment, "that her tonsils were perfectly healthy, that no cutting or burning ever was or ever would be required; that the tickling sensation in her throat arose from the constant fixation of attention upon this part; that she would feel no more desire to hack because her supposed reason for hacking had ceased to exist, and finally, that when she should open her eyes she would feel better than she had in a good many years.

"Much emphasis was placed upon this feeling of health, because it was desired to leave her on the crest of a pleasurable emotion, which of itself has a very great suggestive value. What had been predicted in her regard actually occurred. When she sat up, her tic had disappeared, and she expressed herself as feeling quite grateful and happy. The treatment lasted an hour, and except for two slight recurrences easily removed by waking suggestion, this patient has had no further difficulty."[42]

[42] Quoted from "Psychotherapeutics: A Symposium," p. 152.

Unfortunately, such an easy solution of problems like this is comparatively rare, particularly when, as in this instance, a physical trouble is superadded to the mental. Often--a fact which cannot be emphasized too strongly--it happens that, in dissociational cases, physical symptoms so far predominate as to lead to totally wrong diagnosis, even by experienced physicians. This results, as was hinted above, from the power inherent in subconscious "fixed ideas" of producing an endless variety of disturbances simulating true organic diseases, it may be diseases remediable only through surgical operations.

As a consequence, innumerable operations have been performed on patients who should have been given, not surgical but psychopathological treatment. I have in mind as I write a case of this kind that was called to my attention by a friend who partic.i.p.ated in the lamentable affair.

A middle-aged woman entered one of the Boston hospitals and complained of severe abdominal pains, which she attributed to cancer of the stomach or intestines. She was obviously greatly frightened, and suffering intense agony. A diagnosis of appendicitis was made, and an immediate operation deemed imperative.

But, to the surprise of the surgeons, the appendix was found to be in a normal condition. At once they directed their attention to the other abdominal organs, examining them one by one. None showed any sign of disease. Finally, with a rueful smile, one of the surgeons straightened up, and, touching a finger to his head, said: