Tuesday, December 25, 2007

Psychological treatment

Re-education the faculty of willpower completes the functional, mechanical part of the process of retraining the brain. Patients now have the tools to heal themselves. They know how to modify an abnormal vibration. They can concentrate, and they can exercise their willpower. All they have to do now is create new mental habits by keeping an eye on their level of control. And they can be assured that they will regain their mental equilibrium simply by applying the procedures
they have already learned.

In many simple cases, treatment can be limited to the functional level. In more complicated cases, it is sometimes necessary to compliment functional re-education with a more psychologically oriented training process.
This second part of the training is concerned with ideas, with the way thoughts are conceived, and with the various modifications patients make in their minds which distort ordinary facts, thoughts and feelings.
We are not going to talk about generalities here, but instead maintain a therapeutic point of view, and we must remind the reader of our stated intention to keep this work as simple and practical as possible, so that it can be used by patients as well as doctors. We will therefore limit ourselves to mentioning certain facts, certain anomalies which are useful to know about, since they arise in almost all cases of psychasthenia. These modifications can be easily detected by physicians and patients during the functional treatment stage, by analyzing the various determining causes of recurring symptoms. For example, fear of a certain kind of pain can immediately bring on the pain. Patients can usually understand that the thought precedes and determines the symptom, but are often completely ignorant of the psychological cause of the thought. It is this search for the psychological origin of symptoms that physicians must carefully help patients carry out, since once they become aware of the psychological causes, they can defend themselves and prevent symptoms from developing before they actually appear.

As we have said, the various psychological causes are not difficult to determine. However, therapists must sometimes look to the past, to their patients’ memories, for answers. In the next chapter we’ll be looking at some of these causes in
order to emphasize their importance. Clichés All psychasthenic patients exhibit, at some time or other, certain
symptoms which appear suddenly, under certain conditions, and which seem, at first to be completely inexplicable. The symptom may take the form of general discomfort, fear or anxiety, or be more physical - pain, dizziness, nausea, palpitations, etc. The inexplicable cause of such a symptom is actually an ancient impression, crystallized in the brain so to speak, which always produces the same symptom through an unconscious mechanism. Patients are therefore almost always unaware of this mechanism or, if they do know about it, do not connect it to the symptom. We call this
the “cliché mechanism” because of its persistence. Here are a few examples: 1. Mrs. N... suffered for ten years from a stomach disorder characterized by vomiting at mealtimes. She had no organic illness, and could not find any plausible reason for the symptom herself. After a minute scrutiny of her past, she remembered suffering from a violent
emotional shock ten years before, just as she sat down to a meal. It was this incident, buried in her subconscious, that was causing her nausea: once the cliché was identified, the symptom disappeared.

2. In addition to the usual symptoms associated with psychasthenia, a certain Mr. B... presented the following behavior: after twenty minutes of walking, he would always start sweating profusely, his legs would start trembling, and he would have to sit down and rest or some time before continuing. This had been going on for seven years, and was probably the result of a severe flu he had once contracted, which had kept him in bed for three weeks. The first time he took a walk after recovering, he developed the symptoms, which persisted, although there was no organic reason. However, as soon as he became aware of the cliché, the symptoms ceased.

3. Another case concerns Mr. L... who suffered for a number of years from palpitations, brought on by the slightest effort. We identified the cause as a medical consultation during which the physician told him to be careful about his heart. The palpitations disappeared as soon as Mr. L became aware of their origin.

We could cite many more examples, since almost all patients have a certain number of cliché symptoms which are more or less pronounced. In addition to symptoms like vomiting, diarrhea etc. a cliché can cause psychological symptoms, particularly fear, depression and anxiety. Identifying a cliché usually happens in the patient’s subconscious memory of the original event, without there being any obvious connection between the event and the symptoms as they continue to arise -at least it is impossible to determine through what process of deduction the brain connects the two. However, in some cases the connection can be identified, as we will see from the following:

One of my patients could not stand seeing or hearing the number

3, which always caused her to experience violent feelings of anxiety. We found the key by accident: a relative, to whom she felt very close, had had a serious accident a number of years before, on the third day of the month. The patient had completely forgotten about the cause, but still exhibited the symptom - a subconscious aversion for the number
three. The cliché symptom will usually disappear as soon as patients become aware that it is only a reaction to a past impression, and has no relation to the present moment. However, in some cases the cliché is so strong that it cannot be gotten rid of so easily. In these cases, patients must make a voluntary effort to remember the event, until the brain is under control. When the cliché is consciously and voluntarily recalled, it does not produce any psychological
or physical symptom. It is therefore important to look for these clichés and make them conscious again, so that patients can modify them be exercising their judgment and willpower.

Abnormal thoughts -abnormal cerebral functions

In this section, we will try to determine what constitutes an abnormal vibration from a psychological point of view, i.e. what peculiarities can be associated with thoughts, sensations and emotions emitted in a non-controlled or passive state. We call these thoughts, sensations and emotions abnormal, in the same sense that we call the functioning of a non-controlled or insufficiently conscious brain abnormal.

There are no thoughts which are uniquely the result of a passive state. Therefore, there is nothing abnormal about a particular thought itself, despite the fact that it is always erroneous in some way. The same goes for sensations and feelings. We should find the same causes here as we do for other abnormal vibrations:

1. Lack of awareness
Thoughts are almost always vague and imprecise, which easily leads to an erroneous mental appreciation.
2. Lack of concentration
This makes thoughts unstable; patients have difficulty thinking hings through, and are always distracted by other thoughts. Consequently, they often achieve exactly the opposite of what they intended. In addition, multiplicity of thoughts leads to mental confusion.

3. Lack of willpower
Thoughts are not tempered by willpower, and therefore tend to be exaggerated, resulting in obsessive behavior.
4. Lack of judgment and rationality
A lack of judgment results in patients finding what would normally be considered absurd and completely unreasonable behavior acceptable.
5. Lack of compassion
In the passive state, patients are usually preoccupied with their own sensations, and don’t give much thought to others. The state brings on a kind of inertia, with thoughts being limited to the past and future (and which therefore do not require any immediate action). The feeling of non-control also creates a sense of inferiority, which distances patients from their peers, so that they separate themselves more and more from the life going on around them, perceiving people
and events through a veil of self-centered anxiety. Everything seems unreal, since they are not in contact with ordinary day to day life. As you can see, the modifications created by the passive state are very numerous.
One abnormal thought process found in many neurasthenics concerns maintaining certain “misgivings” whose origins can be easily

determined. In their subconscious mind, these people never have complete confidence in their thoughts, actions and intentions, and always interpret them to their own disadvantage. For example, a neurasthenic will not admit to making a mistake; instead s/he will form doubts which seem perfectly reasonable, but which are actually an unconscious defense against possible error. The treatment for this problem would consist of showing patients that people with normal cerebral control, i.e. in the active state, do not experience such misgivings. They must accept the fact that having constant doubts is an illness, and therefore wrong, and that the only way to understand this is to exercise cerebral control.

Generally speaking, we can assume that any thought or idea which contains a suggestion that can mislead an individual is abnormal, and becomes what we call a “dominating idea” which, in its extreme form, becomes obsessive. Patients can easily recognize their own obsessive behavior, and usually try to combat it.

However, thoughts or ideas which are dominant, but which have not reached the obsessive stage, often go unnoticed. Patients do not fear such thoughts, since they seem reasonable and even logical. There’s nothing abnormal about the thought itself; what is abnormal is the fact that little by little it, because of its intensity, the thought supplants cerebral control and relegates it to a secondary role. Such dominant thoughts are usually also rather morbid. They flourish because patients are unaware of them, and therefore do nothing to defend themselves against them.
The feeling of guilt or responsibility, for example, can easily become a dominating idea, and can turn someone’s life into a veritable hell.

Any thought, word or action, even the most innocent, can become an incessant cause of anxiety through a specious reasoning process which patients do not realize is absurd, since it is based on what they perceive as a real or possible fact. For example, a patient drops a banana peel on the sidewalk one afternoon, and at night is still thinking about it, feeling responsible for all the possible accidents it may have caused. Next morning, the guilt is still there, as the patient is sure s/he was the author of all sorts of broken bones, concussions, and even deaths. A few days later, the patient remembers seeing a piece of crumpled paper in the street, and is convinced s/he should have picked it up, that in so doing s/he could have prevented all kinds of fantastic, and disastrous consequences.

These unfortunate people spend their lives worrying about hypothetical disasters that they caused. But they never actually go back and pick up the banana peel or the piece of paper, or whatever the cause of their anxiety happens to be.
In the same way sensations, like ideas, can become abnormal. They are just as bizarre and just as ill defined as abnormal thoughts; like thoughts, they become increasingly exaggerated and persist for no reason, in widely varied forms.
Dominant feelings are even less predictable; they may become very intense, but usually don’t last very long; in most cases they become obscured and forgotten, since patients are indifferent towards anything that doesn’t directly concern them. A mother suddenly stops loving her children, a lover wakes up one morning having lost all feelings of love for his partner; even religious beliefs, which are the most important thing neurasthenics have to hold on to, disappear.
However, we must hasten to add that all these can be regained as a patient’s illness is cured.

Abnormal cerebral function

Thoughts are rarely sustained and carried through to their logical conclusion; instead, patients get caught up in any thought that arises; these supplant the original thought, and are in turn supplanted by new distractions, and so on. The original thought or idea is completely forgotten, or recalled with difficulty. Normal persons can easily follow the progression of their thoughts. In the non-controlled state, a part of the mind is usually unconscious, and patients draw conclusions which are opposite to what they intended. I am not exaggerating when I say that a neurasthenic patient can come up with a statement like, “I am in perfect health, therefore I’m sick!” and this with the total assurance of being
logical and correct. All we have to do to understand what they mean is to add the patient’s unconscious deductions. “I am in perfect health, but I may get sick” may be what they mean. Or “What if I get sick...” or “I’m afraid of getting sick...” or simply “I am sick...” Patients only recall that in their minds they followed a plausible progression of ideas, so their conclusion must be correct. It would be impossible to explain how patients manage to produce certain symptoms if this fact were not taken into account. Another abnormal cerebral function is the constant analysis patients perform in their minds. Every thought is dissected, scrutinized and weighed to the point where patients invariably become lost in a labyrinth of deductions and doubts. They cannot reach any satisfactory conclusions which would be capable of dispelling their doubts and calming their minds,

nor can they accept any proof that a given idea is valid. They end up doubting everything, including their own sensations and feelings, as well as their thoughts. You can understand the extent of the mental torture such persons
undergo. Unfortunately, the intervention of another person only seems to aggravate things.
Patients think it is their superior intelligence which eables them to analyze their thoughts and feelings so extensively, and cannot accept things any other way. They do not realize that this involuntary, unconscious analysis deprives their mind of being able to perceive any valid sensations or emotions, which they immediately distort instead of accepting as they are. They do not see that what they take for reason and judgment are really faculties which are not controlled by their “superior self” and that the doubts they entertain are only proof of their own blindness. A succession of non-controlled ideas, which is the result of abnormal cerebral function, also leads to characteristic states of morbidiy
and depression. It begins with a sensation that may be normal and not exaggerated. Then a painful memory, or some kind of fear or sad thought - in fact almost anything - becomes a pretext for developing this form of harmful thinking. The state is characterized by the following behavior: the painful memory (or whatever the pretext is) spreads progressively
and indefinitely to everything the patient remembers, instead of remaining limited to the specific event which caused it in the first place.

Mr. X is a typical example: One day, during a discussion with one of his friends, something was said that hurt him. There’s nothing unusual about that. However this friend happened to be wearing a blue jacket, and since that time all blue jackets produced the same sensation of hurt, until eventually the color blue became enough to trigger the unpleasant reaction. And that’s not all: the discussion took place on a Friday, and that day became etched in Mr. X’s mind as a fateful day, on which he refused to travel, or undertake any kind of activity. The Friday in question also happened to be the ninth day of the month, so the number nine was also to be avoided at all cost. He would not get on a bus that had the number nine, and was very careful never to place nine objects on his dressing table. This uncontrolled association of ideas persisted and all but ruined Mr. X’s life, since he spent all his time trying to avoid anything that might remind him of the original unpleasant experience.

All such anomalies must be sought out in the course of psychological treatment. We have to open patients’ eyes and make them understand how these mental defects work, and teach them to accord little or no importance to all passive thoughts or sensations. Patients who become aware of the process can correct it. It is only ignorance that gives passive thoughts and sensations their power. A whole range of thoughts and feelings can be called intrinsically passive or non-controlled, although they are not abnormal per se. Fear, envy, hate, jealousy etc. are all non-controlled; other feelings, like remorse can be either controlled or non-controlled, active or passive. In active remorse, a person recognizes his or her fault and tries to correct it; passive remorse, on the other hand, can destroy a person as s/he cannot forgive the error, nor struggle to correct it. Passive sadness is a blend of egoism and indifference, while active sadness can be healthy and beneficial.

The difference between the two is of enormous importance, both from a moral and psychological point of view. A host of destructive consequences could be avoided by an awareness of this distinction. Any passive thought is a sign of trouble, of a psychological or even physical disorder, which acts as a real toxin on the organism. We could mention many other ways in which patients develop false attitudes towards life, how they refuse to accept obvious facts would go beyond the scope of the present work. What we have to do is teach patients to be on their guard against exterior impressions. Such incidents are not caused by abnormal cerebral function, but rather by a reduction, or even total absence, of
the brain’s reactive faculties.

Reduction of reactive facultiesIn normal persons, the brain is constructed in a way that allows it to react against any exterior influences that may disturb its functioning. Psychasthenic persons, on the other hand, are exaggeratedly impressionable. This condition is, relatively speaking, more pronounced when dealing with minor external influences than with major ones. We have, in fact, observed that these people seem able to bear the brunt of an intense psychological trauma, while becoming completely unbalanced by some minor incident. This can be explained by
the fact that an intense disturbance is strong enough to awaken their reactive faculties, while a minor one is not, and therefore leaves them defenseless.

All the little incidents that occur during the course of a normal day, including changes in the weather and atmospheric pressure, be they hot, cold, wet or dry (each patients has his or her specialty) has a detrimental effect on both the mind and body. A slight problem assumes tragic proportions, a minor setback becomes a disaster. This seems absurd to persons who react with normal cerebral control; their brain tends to automatically get rid any harmful influences,
like a rubber ball that bounces back to its original form after absorbing the shock of a disturbance. In patients with insufficient control, the opposite occurs - even a minor disturbance results in a very strong impression that tends to remain fixed in the brain. How can this exaggerated impressionability be modified and a normal reactive faculty re-established? That is what patients must learn to do.

First of all, they must be conditioned to accept the following axiom:

“No exterior influence has an absolute effect on the brain.” This mean that although we naturally perceive outside influences, both strong and weak, we must always consider ourselves capable of controlling our reactions and overcoming them. It would be useless to talk about control if this were not true. And as absolute as this axiom may seem to patients, they must use it as a basis for defending themselves. This is the only way they can awaken their normal reactive faculties, increase their resistance and self confidence, and cease being a slave of all and any exterior impressions. If patients refuse to accept this truth, they will be sure to suffer a relapse. They will never be able to defend themselves, since they believe that the sensations and symptoms they experience, although

caused by exterior influences, are logical and cannot be combated They would be true if exterior influences affected normal persons in the same way, but their error lies in the fact that it doesn’t - it has no effect unless a person’s brain is passive, and therefore incapable of reacting properly.

We ask patients to verify for themselves what we are proposing, through numerous experiments. When their attitude has been modified in a positive sense, they will be convinced that we are right. In most cases, exterior influences cannot produce harmful effects unless the brain is in a passive state. In its active state, the brain is always capable of reacting. If warned in time, and if they possess the ability to modify brain activity from previous training, patients soon learn to defend themselves. Relapses are insidious, usually stemming from a patient’s inability to differentiate between normal and nervous reactions.

The following case history is a clear example:

Mr. C left the treatment center fully confident that he was cured. On the trip home, he caught a slight cold. His doctor, who considered him to have a weak constitution, advised him to be careful and stay in bed for awhile. The patient gradually became depressed. He developed a persistent headache, and feelings of fatigue and lassitude grew until any activity became difficult, and all the symptoms of his neurasthenia reappeared. The patient placed all the blame on the fact that he’d caught a cold, and it didn’t even occur to him to react. He wrote me a month later and asked for my advice. As soon as I wrote back and explained his error, all his symptoms disappeared.

We could cite a host of similar relapses, some due to even more absurd causes like a bout of anger or some extremely minor, everyday incident like breaking a pair of glasses. We always find the same error - the patient does not react, thinking that any attempt to do so would be futile.

Causes of relapseThe preceding section called attention to the kind of errors we should look for as being the main causes of relapse, based on what we have observed in our patients. We are not referring to relapses which occur in patients who are not completely cured, since these are not real relapses, but only to those which occur in patients who have re-established normal control. The disappearance of symptoms may be temporary, and cannot be considered as absolute proof of recovery. We can see how, in cases of intermittent psychasthenia, the brain remains overexcited to a degree,
despite the appearance of health.

Patients may suffer a relapse for two main reasons:
1. The mechanism of concentration is not well established.
2. Psychological causes.

Faulty mechanism

Most patients who come back to us have not fully recovered because they have not fully integrated the laws of control into their lives. Treatment usually stops when symptoms have disappeared, or when patients feel able to control them. But this is not enough for a complete cure. Awareness, concentration and the exercise of willpower must become habitual. This does not always happen during the few weeks of therapy. Patients must therefore remain attentive and con

tinue the work on their own, until such time as normal control is fully established. Usually, concentration and willpower are fairly easy to maintain, while awareness of reactions breaks down. In such cases, it is usually enough to resume simple “conscious action” exercises to attain a definitive cure.

In less frequent cases, a “cliché” which has not been fully eliminated takes hold of the patient once again. This type of relapse is also not serious, and can be quickly overcome by doing some more work on eliminating the clichéd response pattern.

Psychological causes

Intense emotional shocks are not as often a cause of relapse as might be expected. Generally speaking, patients react well to such situations. Although they may become sad or depressed, they do notfall back into their old defeatist state. However, post operative shock due to narcosis can easily lead to a relapse which, however, usually doesn’t last very long.
A more common cause is lassitude: patients who have constantly to struggle against various kinds of problems may give up the fight, and sometimes voluntarily decide to suffer a relapse, since all they want is rest, hoping to escape the burden of life’s vicissitudes. We must understand these people, and try to help them. In all forms of relapse, previous treatment still has an effect, so that improvement occurs rapidly, however weak the patient’s motivation may be. Nevertheless, some motivation is necessary - patients must want to get better. We sometimes observe patients who, at the
last moment, step back and do not dare take the step that will free them from their illness.

Why does this happen? The possible causes are numerous, and patients rarely acknowledge them. It may be a real fear of resuming a normal life and the responsibilities that go along with it; in other cases, patients might want to stop suffering, but are unwilling to give up their negative habits; still others get some kind of absurd pleasure
from complaining, and wish to continue doing so. Unfortunately, such cases are not unusual, even among patients
who seem to want to get better, since it must be realized that deep down they may be afraid of being cured. Although very frustrating for treating physicians, these people should not be abandoned, for the simple reason that they are still sick.

This brings to an end our study of the re-education of cerebral control. We have dealt with those areas which we consider most useful to patients, and which will give practitioners an insight into our methods.
The section on psychology has been condensed a minimum, since our treatment in this area does not differ from traditional psychotherapeutic methods, which have already been amply described by authors more qualified than ourselves. The following sections will deal with insomnia, and the specifics of the treatment we use.

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