Ways to Psychic Health: Brief Therapy from the Practice of a Psychiatrist

This edition is published by Muriwai Books – www.pp-publishing.com

To join our mailing list for new titles or for issues with our books – muriwaibooks@gmail.com

Or on Facebook

Text originally published in 1953 under the same title.

© Muriwai Books 2018, all rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted by any means, electrical, mechanical or otherwise without the written permission of the copyright holder.

Publisher’s Note

Although in most cases we have retained the Author’s original spelling and grammar to authentically reproduce the work of the Author and the original intent of such material, some additional notes and clarifications have been added for the modern reader’s benefit.

We have also made every effort to include all maps and illustrations of the original edition the limitations of formatting do not allow of including larger maps, we will upload as many of these maps as possible.

WAYS TO PSYCHIC HEALTH

Brief Therapy from the Practice of a Psychiatrist

BY

A. MAEDER

(ZURICH)

Translated from the German by Theodore Lit

TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 3

DEDICATION 4

FOREWORD 5

ONE—INTRODUCTION 6

TWO—TREATMENT OF PSYCHOGENIC DEPRESSIONS 13

THREE—DISTURBED SLEEP AND INSOMNIA OF PSYCHOGENIC CHARACTER 42

FOUR—CURE OF A DOG PHOBIA IN THE CASE OF A SEVEN-YEAR-OLD BOY (CASE 10) 49

FIVE—DANGEROUS APPENDICITIS OR HYSTERICAL ATTACK? (CASE 11) 52

SIX—DEFIANCE NEUROSIS (TROTZNEUROSE) OF A SEVENTEEN-YEAR-OLD HIGH SCHOOL STUDENT (CASE 12) 54

SEVEN—TREATMENT OF A RECENTLY ACQUIRED OBSESSIONAL NEUROSIS (CASE 13) 64

EIGHT—CURE OF A HYPERTHYROID 75

NINE—PSYCHOTHERAPY AND PASTORAL CARE 88

PART I 88

PART II—The Problem of Guilt and the Attitude of Modern Man 93

PART III—Pastoral Care 100

TEN—REFLECTIONS ON THE HARDSHIPS AND INNER STABILITY OF THE PSYCHIATRIST 106

APPENDIX 115

REQUEST FROM THE PUBLISHER 116

DEDICATION

Dedicated to my dear wife

in gratitude for her understanding

and loyal assistance

FOREWORD

THE original German edition of Ways to Psychic Health appeared in 1944, a sign that our time has need for a brief psychotherapy. It was possible for the author to enter upon this course because he had practised the extended analytic therapy for more than thirty years. The analytic viewpoint is required also in brief psychotherapy where an active-guiding approach of the physician becomes necessary.

The prerequisite for the intervention of the therapist is still familiarity with the self curative tendencies of the mind (self-help of nature). The physician should not seek to influence the patient from the outside, as it were (as did the old, outmoded hortatory therapy), but rather from within outwards by helping the patient to recognize and support his own strivings towards equilibrium and health. Only depth psychology can give one this insight and render this aid.

As can be seen in the following account of treatments, the procedure of the therapist is more an expression of medical art than of a fixed method as in psychoanalysis. Carefully controlled intuition plays the leading role. Not all cases are suited for brief psychotherapy. The compatibility of the two persons involved in the medical relationship has more significance here than in other types of treatment. Of particular importance is the humane sympathetic attitude of the physician which reveals itself mainly in the atmosphere felt in the doctor’s office, in contrast to the matter-of-fact, detached manner of the psychoanalyst.

The original German edition has appeared in French, Swedish, Norwegian and Dutch translations: a Spanish translation is in preparation. May this English edition find its way to the many seeking clarity, for this book was written not only to enlighten but to help.

A. MAEDER

Zurich, October, 1952

ONE—INTRODUCTION

A PSYCHOTHERAPIST reports on the insights gleaned from his practice. This book is based upon medical experience. I have tried to present a true picture of what actually happens during the consultation. It is not so much a question of presenting the typical case material but of seeking to reproduce faithfully what occurs during the fascinating—and often anxious hours of dialogue between physician and patient. These are not case histories of illness, but of treatment! The following reports lack those sensational aspects for which the contemporary public has developed a taste in the area of medical practice. They are as exact as possible but not complete; several details, not absolutely necessary for an understanding of the patient and the treatment were omitted and some facts, for reasons of discretion, were merely hinted at or left unmentioned. Let the reader take this book in hand with a genuine respect for mankind. Thus will all idle curiosity be eliminated. The reader can be certain that he will not be able to identify the actual persons whose lives and sufferings are discussed in these pages. They are simple, unknown persons who came to me from all parts of the country and also from abroad. I have tried to veil certain characteristic details so as to remove every possible clue as to the patient’s identity, and have omitted from this book many cases where I feared that the mere presentation of the facts or the many-sided personal relationships of the patient could have led to his being recognized. The publication of case material is a delicate matter, since personal and intimate details are as a rule confided to the psychiatrist. Some people will ask why such confidences are revealed to the public light. I have done so out of devotion to the cause and a feeling of responsibility towards my colleagues and towards science. Our psychotherapeutic literature is very skimpy in this sphere whereas there is an abundance of purely theoretical publications. By means of this book I should like to help my colleagues to a real understanding of the serious and effective work being done with the emotionally ill.

Many prejudices still exist in this area, due in part to lack of information, for which we psychotherapists are largely responsible because we have not tried hard enough to make ourselves understandable. One learns from life itself, not merely from abstract theorizing and from schematically presented case material. The manner of presentation should, however, not only be true to the facts but should also as much as possible take into consideration the interests of the patient and thus serve as testimony to the ideals which animate our professional work.

This book is mainly addressed to psychotherapists-in-training and practising psychotherapists (psychiatrists intra and extra muros). However, the material has been presented in such a manner that any physician could understand it immediately without any special training. General practitioners as well as medical specialists in their practice come across neurotics and psychotics; many symptoms of all kinds of diseases upon closer examination reveal themselves as a condition resulting from developments brought about by both mental and physical factors.

This book is also intended for the growing number of (non-medically trained) practising psychologists and psychological technicians who may gain an insight into the workings of the unconscious and the procedures of the physician in his workshop.

A special characteristic of this book is its portrayal of the interaction in vivo between medical psychotherapy and pastoral care and the illustration of their combined application. There is no doubt that a new era has begun in which an exchange of ideas is taking place between medical psychiatry and pastoral care which, it is hoped, will lead to a fruitful collaboration or co-operation. My own point of view towards this problem is developed in a special chapter which follows the earlier sections wherein a practical illustration of this type of activity is presented. Thus, this book is also meant for ministers. They often encounter amongst those coming to them for help persons obviously mentally ill with whom they probably cannot cope. It may be of help to them to be able to recognize the confines of their own sphere of activity and to have confidence in the work being done by their colleagues in the field of medical psycho-therapy. Furthermore, others, educated and open-minded persons, may, on the basis of the following presentations of the treatment of the emotionally disturbed, regain the necessary confidence and understanding for psychotherapy which they had lost because of unfavourable experiences, mere rumours or biased reports.

Since the author is reporting from his office, his book cannot be rigidly systematic. The choice of case histories was determined essentially by considerations of simplicity of presentation. A pedagogical intention is easily discernible, leading to a certain broadness in the description which presents an opportunity for observations and suggestions of a general nature. Should the reader as a consequence be aroused to critical analysis, one of the main purposes of the book will have been achieved. The author sought particularly to present the life, the mistakes and sufferings, and the self-discovery of the individual in such a manner as to awaken in the reader a genuine understanding of the nature of illness and cure and of the co-operative efforts of the patient and physician. The dialogue between these two occupies the centre of the stage; the entire action during the cure takes place between these two poles. In his presentation, the author has at times sought to elucidate general principles concerning the structure of psycho-neurosis (psychogenic disease), the course and meaning of the cure and the function of the physician. In connection with the description of the course of treatment for hyperthyroid condition (Chapter VIII), the author has sought to present his views on these main problems in as concise a manner as possible.

The author has imposed upon himself a special kind of limitation; under discussion in this book are examples only of short and of brief psychotherapy. By short psychotherapy (kleine Psychotherapie) is meant a treatment of quite short duration (up to two or three sessions), dealing with disturbances of a mild or limited (localized) nature, as in the case history of Mark; whereas the brief therapy (kurze Therapie)—involving two to ten sessions—concerns itself with illnesses of a deeper and more generalized character and penetrates further into the roots of the disorder (Martha, Max, Arnold).{1} The material brought to light concerning the previous history of the patient and the course of the treatment itself lend themselves well to review and presentation. These brief case histories are particularly suitable in view of our special pedagogic purpose. Many of the case studies presented here were used in connection with a training course for psychiatrists given at the Institute for Psychotherapy in Switzerland. Experience has shown that such presentations achieve their purpose. The discussion periods following the lectures were stimulating and enriching for all participants, including the author, and encouraged him to present his views to a wider circle of readers.

There has been very little discussion in the technical literature up to the present on brief therapy. It is hoped that this book may serve to fill this gap. Perhaps this brief type of treatment is not frequently practised. Although the author has practised psychotherapy for the past thirty-five years, it is only within the past ten years that this brief therapy has developed. It is based upon long, painstaking experience in major psychotherapy in which, as is known, dream analysis plays an important role and affords a deep insight into the psyche and the life of the unconscious. The author is well aware of the fact that without his theoretical and practical background he would not have ventured to apply the active and radical therapy herein presented, for the brief treatments are in part clearly a form of mental surgery (if one may use this figure of speech) and impose a great responsibility on the practitioner. It may well be that future developments will bring with them a simplification and shortening of classical major psychotherapy. These brief treatments may promote this process. The scientific training of the physician has instilled in him a need for completeness and theoretic systematization. Actual medical practice, however, is an art (not merely knowledge). By medical art is meant judicious limitation and the voluntary omission of everything not essential to cure and further development. The physician must be able to restrain his thirst for knowledge in the interest of the patient and for the sake of the actual therapy. Consideration for the individual and service to him take precedence over thirst for knowledge. In general, dream analysis is omitted in brief psychotherapy in order to avoid arbitrary activation of the unconscious. However, the mere recounting by the patient of a dream (without further discussion) is, of course, a valuable source of information of which the physician makes use.

In brief psychotherapy, the question is not only one of methodology and medical procedure. The patients themselves must be suitable. There are some who are not adapted to this type of treatment, namely those who are severely and chronically ill, suffer from an obvious hereditary defect, or live under very complicated external circumstances. To a certain extent we must also include in this category those patients who live in over-protected and secure circumstances, who have never felt the rough winds of reality and as a consequence have never really learned to defend themselves or to fight for a full, fruitful life. In fact, most of the patients described in this book were simple, uncomplicated people who, in the struggle of life, have held their own to a certain degree. The age of the patient is a factor as are also the ability to develop confidence and a genuine readiness to be helped, without too many advance guarantees and stipulations. No doubt the reader will be struck by the amount of hard work put forth by the patient during this type of cure. This takes quite a bit of doing, and unfortunately not everyone is equally successful.

All the treatments included in this compilation took a positive course and led to a successful cure. They may serve as an illustration of the Ways to Psychic Health. Unfortunately, not all the treatments are as successful as these. The patient’s will to recovery, his positive attitude and energetic co-operation constitute the prerequisite for the success of the treatment.

It is also important that the treatment be undertaken at the right moment. Consequently, the physician would best avoid trying in any way to talk the patient into undergoing psychotherapy. It should occur only when the patient can freely make the decision for himself. Putting pressure on him can lead to undesirable consequences; the resistance blocks all roads and as a result the situation becomes all the more impenetrable. Sometimes the patient is able to work through for himself his impression of the first meeting with the physician and to fight his way to a free decision. If he says I have been sent here, but I didn’t feel like coming, then the physician does well to do nothing in the matter and to postpone treatment until the patient himself requests it. Naturally, this approach applies only to ambulatory psychotherapy and not to a patient who is very ill or psychotic. In such a situation an entirely different procedure may be necessary, including possible commitment to a mental institution. The matter should, in such a case, be discussed with the family before arriving at any decision.

Naturally, not every physician is suited to every type of patient, since there are certain limits to the physician’s capacity for insight and for appropriate procedure. Both should consider the question, should we undertake this or not? A case that looks hopeless here and now may be successfully handled at another time and place. In turning down a case, the physician should never leave the patient with the impression that any other physician would find the situation equally hopeless.

Unfortunately, there are mental disturbances which the art of medicine cannot cure. But the case may not be hopeless. Life is richer in possibilities than we human beings realize. The person with faith may still hope where the mere realist gives up in despair. Paracelsus says in Volumen Paramirum: ...Let God take care of those whom he would heal; be it wondrously through saints, through self-cure, through doctors, or through old women. You Christians should note that God should be the Archdoctor...but you should implore Him. He will send you the healer, be it through a saint, or a doctor or yourself.

Every era has its own psychotherapy. In the last quarter of the nineteenth century the discussion over hypnosis, suggestion, and the splitting of the personality held the centre of the stage; French physicians—Charcot, Bernheim, Janet—were preeminent. A Swiss physician, Paul Dubois (Bern), marked off a whole group of illnesses—the psychoneuroses—from the sphere of internal medicine and sought to bring them into the realm of psychological treatment (traitement moral par la persuasion). At the turn of the century, Freud’s psychoanalysis emerged—the beginning of the exploration and influencing of the human being through depth psychology—which up to the present has remained dominant in psychotherapy. There then occurs what is so characteristic in the history of ideas—the birth of several tendencies and schools of thought which struggle against each other (Freud, Steckel and Adler in Vienna; Jung and his followers in Switzerland) until it is recognized that they all have made a positive contribution to the common research. A new insight is won which in turn leads to a deeper understanding of the psychic processes. The physician himself must undergo analysis before he may apply the new method to his patients. The physician can bring his patients only so far as he himself has come. This signifies nothing less than that the physician as a person is drawn into the treatment of the patient; he does not merely observe the case, but engages in the dialogue with the patient as a human being. A new approach which introduces a profound transformation in the field of medicine! The dividing gap between physician and patient is overcome and replaced by a truly human relationship. The factor of the physician’s personality has always played a larger role in psychotherapy than in any other branch of medicine and has become especially marked since the turning point described above. It occurs, however, under conditions of analytically-sharpened self-discipline which is indispensable.

By personality is meant—aside from the purely individual and