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, .

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F irs t E verg reen E d ition 1 962

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,

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 C O N T E NTS

Translator s Preface by’

,
Ralph B . Winn

PART I

THEORE TI CAL PROB LE M S OF

P SYCHO T HE RAP Y

Certain The oretical Questions of Psychotherap y ,

by V N M ias s is chev
. .

S pe ech Th erapy by K I Platonov ,

. .

G en eral M ethodological Problems o f Ps ycho

therapy by M S Lebed ins ky
, . .

On the N eural M echanism of Hypnosis by ,

I I Ko rotki n and M M S us lovo

. . . .

Bio E l e ctrical A cti vity of the Brain in Hypno

-

therapy by M P N evs ky, . .

E ffect of C onditi oned S ti mulation in the Wakin g

and Hypno tic S tate on H um an D igestive
S ecreti on by Y M Levin ,
. .

C oncerning the Physiological F oundati ons of

Psychoth erapy by A K Tros hin ,
. .

Basic M eth odological Qu e stions concernin g

Group Ps ych otherapy in N eur oses b y ,

N V Ivanov
. .
Metho dolo gy o f Sug gesti on in the Wakin g State ,

b y I S Sumbayev
. .

P SYCH OTHE RAPY OF NEU RO SES

Th erapeutic M ethodology in Psych asthenia by ,

E K Yako vleva
. .

Psych o therapy in Phobic S tates ,

by A M Halets ky
. .

Th erapy of C ertain Forms of H yst eria ,

by Z A Kopil Levina
. .
-

C ombinati on of Psych otherapy with M edicinal

S leep by O R C hitaoa
,
. .

The M ethod of Indirect S uggestion as U sed in

Hysteria by Y L S chreiber
,
. .

O n the Psych otherapy of Psychog enic

Impotence by I M Apter ,
. .

Psych otherapy in the M edico Pedagogic Pr a

cti ce -

of a Child Psychi atrist by N O Ves hapelli ,

.

Psych otherapy of Child S tu tterin g ,

b y N A Vlas s ova
. .

PART I I I

P SYCHO T HE RA PY OF P SYCHOSES
The Role of Psychotherapy in th e Treatment of ‘

Psychoses by N V Ka ntorovich, . .

On the Psych otherapy of S chizop hrenia ,

by A N M o lokhoo
. .

The U s e of M edication and Psychotherapy in

Psychiatr ic C linics by A S Poznans ky M I ,
. .
, . .

Z eit lin and I G Tokareva

, . .

Th e R ecord of Psychoth erapeutic Work in

M ental H ospitals by L I Li chtens tein , . .
TREA TM EN T OF A LCOH OLI S M AND S M OKI NG
O n the R ole of S ugg e stion in the Treatment of
A lco h olism by I L Lukoms ky ,
.

U nique F actors in the H ypnotic Treatm ent of

Chr onic Alco h oli sm by T N C ordova and , . .

N K Kovalev
. .

A S tudy of S el e cti ve R apport in Hyp nosis by ,

I O N arbuto vi ch
. . 1 41
Psychotherapy of S moki ng by Y ,
. A Povorins ky
. 1 44

PAR T V
P SYCHO THE RA PY I N SO M A TI C A I L M EN T S
U se of Hypnoth erapy in C as es of Bronchi al
A sthma by I 1 B ull ,
. .

P s y choth erapy in Psychogenic Thyr e oto xicosis ,

by M I Kas hpur . .

The S ignificance of Psyc h oth erapy in O bstetrics

and G ynecology by V I Z dravomys lov ,
.

P sychothe rapy of Hyp ogalactia of N urs ing

M others by A T B elyaeva G I Vino kuro v
,
. .
,
.
,

V I Zd ravomys lo v T M Kravchenko and

. .
, . .
,

N I Kuymova
.

The U s e of H ypnosis and C onditioned R efl ex -

Therapy in Dermatology by M M Z heltak o v ,

. . 1 72
Hypnoth erapy of D ermatoses in Resort Treat
ment by I A Z hukov
, .

GENE RA L P R O B LE M S
Ps y cho therapy of C onvalescence b y ,

I P Kutamin
. .
Psych oth erap eutic F actors in C l inical Practice ,

by A S B orzunova A V Sayfutdinova
. .
, . .
,

Z M Akhmeto va O P K limovi ch and A I

. .
, . .
, . .

S annikova
Psych otherap y in Iatrog enic Illn esses by M A ,
. .

Z hi lins kaya and L G Pervov

. .

Group Ps ych otherapy and th e M ovies by ,

L M
. . Sukharebs ky
Index
 ’

Translator s Pref ace

The coll ection of papers that fo llows w as read at

the las t conference on psychotherapy in the S oviet
U nion ( M oscow ,
There is a mar ked shi ft of
emphasis in research since the precedin g conference
’
of the same ki nd h eld in 194 8 I P Pavlov s infl uence
, . . .

remains true enough as s trong as ever But incre as

, , .

ing attention is b e ing pai d now to the use of s ugges

tion hypnosis and speech th erap y in general ; in
, ,

fact almost all papers contai ned in the book have

,

som ethi ng to say concerning these methods of treat

ment A lcoh oli sm is obvious ly on th e in crease an d
.

c alls for a more vigorous and advanced study Psy cho .

an alysis previously much cri ticized receives hardl y

, ,

an
y ment i on at all .

O n the wh ol e th e di fferences be tween our own

,

meth odology of psychi atri c treatm ent and what we

find in the S ovi e t Union are so striking as to mak e
one wonder wh eth er there is any simil ar ity in the
theoretic al an d practical application of the two tech
niqu e s Th is can be exp lained in part by the fact that
.

psych otherapy is af t er all but a part of ps ychiatry

, ,

and l argely exclud e s th e treatm ent of psych oses and

mental d eficiency But ev e n so it is somewhat s ur
.
,
p ri sin g that we fin d many topics in the coll e ction
dealing with what is h ar dl y di scussed at all in the
A merican ps ychiatric journal s A mong th e papers th at .

ought to arouse much inter e st in our medic al circl e s

“
are Psychotherapy of S moking ( b y Y A Povorin ”

. .

sk ) U s e f H ypnotherapy in C ases of Bro n c hi l

y , o a
A sthm a ( by I I Bull ) Th e S ignificance of Psych o
”

. .
,

therapy in O bstetrics and G ynecology ( by V I ”

. .

“
Zdrav omys lov ) and G roup Psych oth erapy and the
M o vies ( by L M Sukhar ebs ky )
”

. . .

If this book is to b e of value to the Am eric an

readers it must b e approache d in th e spirit of s cien
,

tifi c objectivi ty It contains c e rt ai n attitud e s c ormn on

.

to Russi an sch olars wh ic h we are oft en unwilling to

s h are ; but these attitud e s are clearly customar y am ong
the S ovi et writers N evertheless whatever worthy
.
,

contribu tions th ey have to offer must not be nul lified

b y our antagonism Truth is in the end truth on
.
, ,

both sides of the iron cur tain And wh atever falsity .

exists an ywh ere in th e world will be found out sooner

or later .

RALP H B WIN N .

M onmouth Co llege N I ,
. .
 PS YCH O TH E RAPY

IN

TH E S OVIE T UN ION
 P A R T I

TH E O RE TICAL PR OB LE M S OF
PSY CH O TH E RAPY
 CE RTA I N T HE O RE TI CA L QUES TI ON S OF
P SYCHO THERAPY

by V . N Mi as s is chev
.

( Leningrad )

It is no longer necessary to demonstrate the v al ue

of psych o th erapy Its hi gh prestige is merely a cons e
.

u enc e of successful clinica l experience and e x res ses

q p
the noble human itarian traditions transmitted to us
by outstandin g representatives of our nati onal me di
crne .

The experience of neurological psychiatr ic and

, ,

oth er sp e ci al ized clinics enabl e s us to re g ard psycho

th erapy as an important method or rather as a coll ec
,

tion of meth ods of treating not only mental and ps y

,

cho en i c illnesses but also t h ose of ps y c h osomatic

g ,

causation .

Psych otherapy derives its signifi c ance from the fact

that the causativ e factor in th e development of cer
t ai n diseases is psych ologic al in origin That is why.

neuros e s h appen to form th e most important ar ea in

the d ev elopm ent and application of psychotherap y .

The principal and most urg ent questions of ps y

cho thera
py in our day are : ( 1 ) the form u lation o f
3
theoretical principles in th e field of psych otherapy;
( 2 ) clarifica tion of effective conditions in the use of
psychotherapeutic meth ods ; an d ( 3 ) discov ery of re
liable criteria for the ch oice of psych oth erap eutic
technique for each p articular case .

The method of psychotherapy offers in the last

analysis a way of influencing one human b e ing ( t h e

patient or a group of patients ) by another ( the p h y

s i ci an )
. A s a r e sult the psychotherapeutic method
,

turns out to be uniquely hum an and its appreciation,

and mastery depend upon understandin g of th e per

s onal i t traits of various individuals as social and bio
y
lo gi cal creatures .

M an differs from anim al s in that he is capable

of engaging in sp e ech and abstract thi nking rel evan t
to the processes of work and social relations E ach .

man is not merely an ob ject but al s o a subject con

,

s ci ous l reacting to conditions of hi s sur roundi ngs

y
an d on occasion intentionally transforming them
, ,
.

The evolution and re organization of ps ychother a

-

euti c theory is rooted directly in th e s e psych ological

p
traits of hum an beings and cons e quently it is capable
, ,

of throwing ligh t upon various psychogenic ailm ents

such as personality troubles ; th is th eory emerges from
insi ghts into human personality an d its modes of
r e sponse to immediate re al ity in the form of experi
ences and act ivi t ies .

The problems of psychogenesis as well as psych o

therapy cannot be fully solved apart from materialistic
psychology Th e cont emporary S oviet psych ology has
.

g rown on th e foun dation of t h e general theo ry of dia

l ectical and historic al materialism as w e ll as the p h y

s i ol o i cal d oc trines of I P Pavlov I t has been built
g . . .

4
on the understanding of man in th e ligh t of scientific
and social history .

Whi l e figh ting the faults of idealistic psych ology ,

we must also figh t any on e sid e d approach to human

-

nat ur e wh ich consid ers m er ely th e m e ch anism of

neural activity and thus disregards the underlying
motivating forc e s .

S ch olar s and even rank workers in everyday medi

cal practice ar e confronted with th e job of develop ing
th e l e gacy of Pavlov ; but this task does not consist
merely in automatically r ep e ating Pavlov s words but ’

rath e r in deepening and making more intelligible our

conc eption of man in all h is activities as a union of
, ,

psych ology and p h ysiology .

It is quite cl e ar by th is ti me that all the critical

remarks uttered by Pavlov with r e gard to the ps y
chol o
gy of h is day were d i rected above all against
any exclusively psych ological ( or for th at matter
, ,

exclusiv ely p h ysiological ) int erpretation of experi

ments on animals and also against any type of ide al
,

i s ti c me thodology.

. I P Pavlov put the psycho clinical approach to

.
-

he al th and disease ah ead of the physiological one H e .

r ep e at e dly express e d th e belief that the time has come

for bringing physiolo gy an d psych ology together and
for clarifying th e function of psychology in psych iatry .

H e str e ssed the need for every psychiatrist to be also

a psychologist at least in the empirical sense of th e
,

word .

In the mean time scientific achi evements in the

,

ph ysiology an d path oph ysiology of the h igh er neural

activiti e s supplied physicians with th e kn owledge of
th e laws of no rmal neural activi ty complex interrel a
,

5
ti ons among in di vidual processes an d mechanisms of ,

path ological deviation .

It was th en th at I P Pavlov brough t forwar d his

. .

conc ept of th e secondary sign al syst em existing ex

“
elusiv ely in man Words h e declared can serve as
.
, ,
”

real conditioning stimuli b eyond any quantitative or

qualitativ e comparison with any other sti mulation in
anim al lif e In oth er words the symbols formi n g
.
,

speech ar e uniqu e in significance and for h uman ,

b eings they are subj e ct to c ertain specific laws Um

, .

f ortunately how ever such laws have not y et be en

, ,

reduced to e ither norm al or pathological p h ysiolo gy .

Th ough th e union of psych ology and p hysiology

pres ents a d efinit e research task an d sets a d e sirabl e ,

even nec e ssary goal for scientific progress neither

, ,

psych ology nor p h ysiology e ach by its elf h as so far , ,

b een abl e to solv e the main p robl ems of psych o

g en e sis or psych otherap y Th is b e com e s p articularly .

obvious wh en W e cons i d er the pr evailing views on

p ersonality expe ri ence and h uman relations
, , .

By human r elations w e und erstan d th e proc e ss of

forming s el e ctive ti e s with various as pects of on e s
’

environm ent ; and by on e s personality we m e an a ’

patt ern of such sel e ctive attitud e s The s e concepts .

h av e b ee n s h own to be of gr e at si gnifi can ce from ,

th e Pavlovian standpoint for gaining insigh t into ,

m ental as w ell as neur al activiti e s of man .

This vi e w becomes even mor e signific an t when

examin e d in the ligh t of M ar x L e nin m eth odology in -

g en eral or mor e sp e cifically in application to S oviet

,

p e dagogy the most rem arkable r epr e s entative of

,

I P Pavlov
. .
,
C lin ical E nviro nments ( in Russi an ) ,
1 4 15
, .
ti vi ty, h us underlyi ng and occasionally dir ecting
t
speech though t and b eh avior of man and e stablis h
, ,

in g throug h stimulation close and firm ye t t em ,

orary conn ections

p , .

I ntellectual interest inspiration or p ai nf ul moral

, ,

conflict do affect the enti re hum an org anism Th ese .

factors turn into a sourc e of irresistible impulses ,

unf orgettable experiences and persistent impressions ,

.

It is necess ary to state clearly and emp h atically

that psych ology on th e w h ole di sregards th e fact th at
emotions ar e found in thr e e distinct but oth erwise
clos ely connected variations There are fir st of al l .
, ,

acute emotional reactions with lasting effects ; second ,

there are emotional states during a mental illness , ,

overwh elming th e W h ole man and affe cting all of his

exp eriences ; and thir d th er e ar e changeabl e emotional
,

attitudes wh ich in path ology create prejudicial f e el

, ,

ings or one sid e d or excessive reactions Path ological

-
.

states such as mel an cholia an d psych ogenic dev elop

, ,

ments such as paranoia or delirium of jealousy repre

, ,

sent clinic al forms of emotional manifestation insep

arable from pathologic al c h an ges .

In human beings as distinct from animals th e rol e

of traces of past experience is so great th at reactions
dep end much less on the immediate stimulation th an
on th e relevant experience in th e past ; ind ee d the ,
’

effect of stimulation depends main ly on one s attitude

as d et ermined by th e past Th is can be occasionally .

observ e d in anim als too but in a much less gen eral

, ,

i z ed form than in man Psychogenic disturbances are

.

also connected with acute overwhelming exp eriences ,

whi ch in turn can be account e d for only in t e rms of

, ,

emotional r elations A mer e frigh t or s h ock connecte d

.

wi th these experiences represents reactions the mech

8
ani s m of wh ic h is relatively ind epend ent ; but in all
other cas e s both the path ological r e action and th e
,

path ological stat e ar e connect e d with e motionally

saturat e d r elations of unique significanc e to a p erson .

To ex emplify : unfaith fulness or d e ath of th e b elov e d ,

a p ersonal insult or a s h arp in t ernal conflict form the

,

path ogenic situati ons b e coming the mor e unbearable ,

th e s tronger hav e be e n the t ensions d ev eloped in the

course of one s lif e hi story The loss of a d e ar fri end
’

becomes a h ar d blow only if one f eels a strong emo

tion toward h im say love A n insult produc e s a s h arp
, ,
.

r e action only if it cr e at e s some sort of br e ak with the

past The m e ch anism of the s e s h ocks was well demon
.

s tr ate d by I P Pavlov in his e xp e rim e nts on ani mals

. . .

But th e study of human psych og en e sis must y et s h ow

h ow in th e long run on e s attitud e s ar e formed to
, ,
’

give rise to th e extr em ely strong r e actions we obs erve ,

whi ch lead to br e akdowns of n eural activities and to

pathological m ent al or somati c condi tions .

In th is conn e ction it is important to say a few

,

words conc erning the nature of n e ural activity Her e .

we s h all mention only one h igh ly im portant fact : th at

the typical ch ar act eristics of a p erson dev elop di ffer
ently in di ffer ent systems Th us a p h ysically w e ak typ e
.
,

may d ep ending on h ome upbringing or place of

,

birth becom e ch aract eriz e d by moral strength or sta

,

bil ity or else combine intellectual mobility with depth

of emotions .

From th is w e c an draw the conclusion that it is

m
ins u ci ent to d e scrib e th e first cas e m erely as w e ak
or strong an d th e second cas e as mobil e or inert All .

this do e s not ch ang e Pavlov s postulat e th at the out

’

com e of any emotional strain d epends basic ally on the

correlation b etw e e n th e di i cul ty of th e problem of
9
life
’

and the individual s strength of nerves But in the .

case of man at leas t a furt h er qu alification is in di

,

c ate d as to w h ere hi s typic al tr aits ar e lea di ng in ,

wh at he is w e ak and in wh at strong ; in oth er words ,

the sour ce of his pathology is to be sough t not m er ely

in the type of his personality as a w h ole but also in ,

the weaker links of hi s n e ural make up -

.

In thi s connection th e question a s to the source

,

of pathology must always be properly investigated and

evaluat e d If we happ e n to be d e al ing wi th an ex
.

erimental animal t h e source lies probably in th e

p ,

disturbance conn e cted with the solution of one of its

major problems ; if w e deal with a human being h ow ,

ev er it is more likely to be a person or a group of

,

persons a circumstance or a combination of circum

,

stan ces that becomes unbearabl e In all this it is not .

so much the persons or circumstances themselves that

count but rather one s attitude toward th em ; and it is
’

this attitude rather th an an ything else that r ai s es

’

one s sensitivity to the point of d ang erous strain S uch .

atti tudes are no mere manifestations of specific irri

tabili ty; they have al s o a history that e stablishes or ,

prepar es for the source of patholo gy A more or less

,
.

simple annoying cir cumstance is here replaced by a

more general ized me an in g of th e circumstance Stimu .

lation of this source of pathology may produc e as has ,

b e en cl early shown on animals a badly modifi ed re ac

,

ti on permitti ng us to speak of aspects of the sour ce

,

of patholo gy complicated in more serious cases b y

,

the spreading of it to other neural systems .

If exp erimentation enables us to brin g about th"

‘

formation of path ogenic attitud e s in an im al s clinical ,

studies permit us to account for the origin of some

pa thological states in man by mean s of the s o call ed -

10
subjective an d objective an amnesis The analys is o f .

any giv en path ology in clarifyin g the history of the

,

case helps us considerably to determine the p urposes

,

of treatm ent But in doing so it is necess ar y fir st of

.
, ,

all to consid e r two t es of pathogen e sis In th e first

yp .

typ e th e origin al ly wh ol e some p ersonality forms

,

path ologica l atti t ud e s an d may eventual ly result in a

breakdown if con fronted with di cult condi tions of
" "

lif e ; in th e oth er not only th e atti tudes but also the

,

c h aract er itself ch anges under the infl uence of con

ti nuall y unfavorable con di tions so that the v ery
,

ground of beh avior becom e s path ologic all y al t ered .

A ct ually howev er the dis tin cti on is usu al ly but of

, ,

theoretical value for we find all kin ds of combina

,

tions and modi fications of the two types In a t hera .

euti c si t uation we must concentrate largely on thi s

p ,

complex background its elf without going in to an y

,

furth er s tudy .

It is n e c e ssary moreover to conc e d e that both

, ,

attitudes and the ch aracter as a wh ole are nev e r com

p l e tel
y fixed . E ven t h oug h some attitud e s and tr ai ts
are fai rly stable and consequently di icult to ch an ge "

under concret e conditions of life they prove to be ,

dyn amic all y fl e xible .

Neverthel e ss it is exce e din gly importan t to ao

,

k nowl e dge that even th e most d i icul t stat e s such

”

as th e inward and outward attitudes of conflict and

all kinds of troubl e some e xperience can b e cur e d or ,

r eli eved by psych otherapy It is w ell known to us

.

that the foremost psych oth erap eutic approach con

sists in influ ence of words O n e wonders wher e the
.

word gath ers its massive resour ce s r e qui r ed for the

vital r eh abilitation occurrin g in the sick p erson un der
th e influenc e of psych o th erapy A t th e s ame time we
.
,

11
must also conc e de that whil e in many cases the m e di
,

cal use of words brings about excellent results in ,

oth er cases it r em ain s compl etely h elpl e ss an d futile .

Psych oth erapy as a proc e ss of soci al interaction

,

b etween the p hysician and his pati ent must not be ,

regar ded h owever as merely verbal C ons e qu ently

, , .
,

it would be as wrong to identify psych oth erapy with

speech therapy as to r eplace the conc ept of hi gh er
‘ ’

nervous activity by the narrower conc ept of spe e ch ,

which is but the s e condary signal system E ven in this .

sens e the meaningful expressive and activating ele

, ,

m e nts of psych oth erapy consist not only of spe e ch but ,

also in faci al expressions and gestures in utilizin g end ,

less associative conn ections saturated wi th imagery

and emotional compon ents .

Th e dr y and p e da ntic utteranc e s of a t ired physi

ci an will not cure a single patient But suggestions .

di s t urbing arousing inspiring suggestions— represent

, ,

a compl ex and dynamic syst em of words and mean

ings imagery and mo tions as well as a functional ly
, ,

psych ologi cal and cons e quently p hysiological total ity

, ,

capable of combining a dyn am ic form and a significant

content .

—
Th ere are two basic forms of psych otherapeutic
infl uence suggestion and persuasion ; they differ
mainly in the p ur pose of activating words S ometimes .

they are contrasted as the irration al m e th od and the

rational one In the fir st instance the e ici en cy of the
"

.
,

word is determined by ch an g e s in the r e sponse of the

patient s cortic al c enters in th e state of hypnosis In
’
.

th e second instance the cortical inh ibiti ons an d facili

,

t ati ons typical of hypnosis are absent ; in fact t he ,

process of persuasion is foun d among the hi gh est

12
activities of the secondary sign al s ystem and m ak es .

conscious and critical an al ysis readil y accessible to th e

patient .

Th e question arises as to th e susceptibili ty of the

patient to hypnosis an d his abili ty fully to assimilate
the given suggestions Two factors are usual ly men
.

tio ne d in this conn ection : first the qu alities of his ,

personality such as suggestibility ; an d second re

, ,

s i s tan ce ar ising in th e disin clination to get well or

even in th e a ctual desire to stay sick But the main and .

decisive element in eith er alternative is the patient s

atti t ude toward his physician Patients develop the .

feelings of resp e ct trust and affe ction towar d the p h y

,

s i ci an only gradual ly insofar as he enables the pa

,

tient by a ski lful approach to him to comprehend in

, ,

a sound perspectiv e his life and particul ar ly the com

pl ex obscure and confusing circumstances of hi s p ast
,

and present .

A ll thi s applies to hypno therapy It is well known .

among the professional people that there are two

main forms of h ypnosis O n e is inseparable from an
.

emotion al attitude towar d th e h ypnotist who becomes

the source of overpowering s timulations comparable
to strong sounds or bright ligh ts The other form of .

hypnosis has the opposite effe ct : it pacifi es makes one ,

sleepy In all thi s the hypnotist and hi s words remai n

.
,

the only link between the patient and the outside

world— indeed th e only directive force
,
.

. I P Pavlov used to contend that the nervous s y s

.

tem represents virtual ly a self regulating mechan ism -

,

the near est to perfection From the standpoin t of .

clinical psychopathology a typic al neurosis as dis

,

tinct from psych oses is ch aracterized b y a compara

13
tiv ely correct interpretation of the physical and soci al
re al ity ; but it conspicuously fails in self control and -

self possession
-
.

A nd so in neurasthenia we observe disor g anization

of the ability to concentrate att ention and to man ag e
one s emotions ; in obsession w e cannot disreg ard the
’

continu al s truggl e within th e patient s mind ; an d suf

’

fer er s from hysteria liv e by impulses w hich control

th em rather th an th e other way around .

The psych oth erapist is therefore th e person whose

support and encour ag em ent is badly n e ed e d by th e
patient if the latter is to regain norm al s elf contro l -
.

Unfortunately however the p hysiology of h um an

, ,

r e gulation is not yet s u ici entl y known We are in

"

formed of cours e that it plays some significant role

, ,

in the secondary signal system an d th at more spe ,

cifi c al l it is oft e n abl e to improve t h e mobil i ty of

y
,

v ar ious gen eral m e c h anisms ; but the job of decip her

ing all the m ajor p hysiological d etails in volved in th e
proc e sses sti ll r ema ins to b e don e .

The role of th e psych othera p ist in the life of hi s

pati ents b e com e s fair ly clear as we observ e a v ariety
of pati ents coming to their doctor after they h ave lost
much of the power ov er thems e lv e s and succumbed
to the peculiar p henom ena of the ir sickn ess an d espe ,

ci al l
y aft e r th e y h av e giv e n up h ope in a spont aneous

r e cov ery With out exaggeration it is righ t to decl are

.
,

that to an average pati ent th e p hysician becom es a

t e acher of li f e H e must devot e a great d e al of atten
.

tion to th e re e ducation of the patient and try to do

-

for h im all he can .

m
S om etim e s it is e xc e edingly d i cul t even for an
exp eri enced psychotherapist to d et ermine the precise
14
and even ob ey them When at the end of the hos
.

ti li ti es s h e w as reunited w ith her h usb and an d chil

dren she di scovered that they had changed and
,

wanted reasonable respect This made her feel .

strangely lost for she w as utt erly unable to m ak e

,

adequate concessions to the demands of re ality Then .

she be gan to fight bitterly and s tubbornl y in order to

re g ain her domineering position in the family but ,

h er cries expressed only rage and feelin gs of futili ty .

N evertheless the patient ful ly recovered in the end

,

wh en with h er p hysician s assistance s h e was enabled

,
’

fully to comprehend the cause of h er illn ess and to

reconstruct h er every day attitudes on a more realistic
b as i s
.

Another patient was suffering acutely from fe ar

of death True enough s h e had an enlar gement of the
.
,

h eart and suffered from tachycardia But her mental .

state had little to do with thi s pathology Th e act ual .

cause of it coul d be establis h ed only af ter a car eful

s tudy of her life history It was th en learned th at the
.

fear of death w as actu ally the fear of insecurity and

loss of self respect -
.

It all be g an with a love affair in the cour se of

which she contracted gonorrhea of wh ich s h e w as ,

shortly cured When a few years later s h e w as

.

m ar ried to another man s h e failed to tell him the

,

tr u th particularl y concerni n g th e venere al di seas e

,
.

F or twenty years she lived with her husband per

et ual l worrying about her secret
p y .

A nalysis of this patient s past w as cle arly indicated

’

in the case Sh e grew up in a peasant family in wh ich

.

s exu al morality was stri ctly un con di tion al ly enforced

,
.

Wh en she fell in love with the man in fecting her with

gonorrhea she suffered deeply but remai ned o ther
, ,

16
wise quite normal N evertheless when s he w as event u
.
,

ally married to another man she proved to be frigid

,
.

In th e waking state she never experienced any sexu al

attracti on or sa tisfaction ; but she had from time to
time erotic dreams indicating that her sexual impulses
were merely inhibited It w as clear that with regard
.

to the pain ful question of the broken trust and decep

tion she felt herself as gu ilty as was the man involv e d
in the affair before her m arriage Though the appar ent.

cause of h er il lness was a s e xual tragedy actu ally it ,

was a question of moral conflict and th e danger of

being found out Both her fear of death and pain in
.

the h eart were b ut manifestations of her tormenting

scruples and worries .

I t is worth mentioning that the patient s complaints

of heart di sturb ances increased after a later attack
of an gina ; but neither of these troubles stood in the
way of disapp e arance of her s ymptoms once th e men
t al conflict was resolved H avin g tur ned trustfull y to
.

her p hysician she proceeded actively to cooperate in

,

the clarification of her pathogeni c problems S oon .

afterwards she lost her anxieties completely and he

came norm ally calm and rel axed .

As an addi tion al example we take th e case of a

,

woman whose husb and had been repeatedly unfaith

ful to her A s a result she developed fear of cancer
.
, .

The tr uth was that th e patient regard e d her husband s

’

conduct as a shocking in sult to h erself m aking it ,

completely impossible for her to tr ust h im any lon g er .

This alone cons ti tuted the origina l cause of h er mental

condition .

A ll the se examples of ill ness merely illustrate the

reat v ariety of moral frustrations and confli cts r es on
g p
sible for severe d am age to mind and b ody .

17
 The s o- c alled sexu al traum a repres ents in thes e
cases but an out er app e aran ce capabl e of as suming
a great variety of forms whi ch only conceal entirely ,

di fferent and hi gh ly individual tr aits of p ersonality .

Wh er ever illn e ss arises suddenly and ends with

the recovery of th e affe cted function th er e is no ,

serious re as on to expect its recurrence unless it is ,

complicate d by path ological tra its of character .

A nd fi nally a few things h ave to b e said concerning

the principle of ch oic e in therapy H er e it is necessar y .

to conced e th at different m ethods of tr e atm ent may

l e ad to essentiall y id entic al r e sults In this connection .
,

th e choice of method m us t be left en tir e ly to the

physician .

N everth el e ss th er e are certain objective grounds

,

for th e ch oice A cut e psych ogenic forms of neurosis

.

ar e likely to call for hypno tic sugg e stion In functional .

ill n e sses wh ere the norm al activi ty of the int ern al

organs or skin is affect e d only as th e r e sult of strong
n ervous t ensions with out any marked ch anges in th e
,

p ersonality structure hypnotic sugg e stion ag ain brings

,

th e best and quickest r e sults But there are instances .

of neuros e s of organs conc e al ing much mor e c om”

pl e x psych ogen e sis in which case deep psych oth erapy

,

is d e fini tely in dicated .

The pati ent s attitude of passiv e suff ering tow ard

’

hi s ailm ent mak e s hypnosis pr e ferabl e in the initi al

stag e s of tr e atm ent but it s h ould be follow e d by
,

narco psychotherapy
-
.

Th e m ethod of distraction too plays an important , ,

rol e in psych otherap y It h as been us e d for a long

.
“

tim e in the tr e atm ent of n e uroses and was sp e cifically ,

r e comm ended by V M Bekh t er e v It does not dir ectly

. . .

affect th e pattern of th e pati e nt s at titud e s nor do e s

’

18
it conspicuously alt er his character ; b ut it does remove
’

the patient s mind from the sources of p ai nful expe

ri en ces and to th at extent is justified both psych o
, ,

logically and p hysiologically In successfully distract

.

ing th e p ati en t s att ention from th e symptom s of his

’

illn e ss the p hysician is able to reviv e h is interest in

,

life and th us enables him to form new as sociations of

ideas This meth od provid e s a ready p hysiological
.

advan tage in that it create s n e w centers of stimula

tion which act by way of n e gative irra di ation to
, ,

we aken the c entr al mec h anisms of the path ological

conditi on .

The m eth od of group therapy wh ether used in a ,

hospital ward or a coll e ctive deserv e s consid erably ,

more att ention Group hypnosis h as already been ex

.

t en s ively employed in th e str uggle again st alco h olism .

But oth erwis e it is now us e d onl y by a few indi vidual

th erapi sts .

The main fault of group psychoth erapy as inter ,

r ete d b y for e i n specialists consists in its depend

p g ,

ence on th e t e achin gs of S Fr eud We have several

. .

other and much more acceptable variations of group

th erapy nam ely ( 1 ) discussion with pati ents of the
,

forms and origins of different psych ogenic ailments ;

( 2 ) discussion of specific cas es ; and ( 3 ) an alysis of
one significant cas e in th e pres e nce of other patients .

Group psych otherapy is not an alternative to in di

vidu al treaunent ; th e two are usually combined But it .

h elps to promote the p hysician s sugge stions and to ’

enh anc e the effe ct of individual treatment .

From all this follows th at psych otherapy is formed

around prot e ctiv e activating and corrective el em ents
, ,

of treatment A s a link in th e ch ain of therapy it can

.
,

b e combined with p hysioth erapy and pharmacother

19
ap
y. But most closely is it connected wit h the th erapy
of work and educati on whi ch normali ze soci al rela
tions and stimulate neuro psychic activity
-
.

The S oviet psychotherap y built on the tradi tions

,

of M arxism L eninism Pavlov s p hysiology and mate

-
,
’

ri ali s ti c psychology has a truly scientifi c foundation ;

,

it is closely related to hygiene and prophylaxis U nder.

conditions of a socialist society it h as every ch ance

,

of extensive growth and fruitful application to

’

protection and restorati on of the workers health .

20
 S P EECH THE RAP Y

by K I Platonov
. .

( Kha r k ov)

In this report we s h al l not spe ak of psychoth erap y

in general but onl y of those narrower problems whi ch
,

involve the use of spe e ch th erapy th at is th e immedi

, ,

ate cur ative infl uence of the p h ysician s words in his

’

deal ings with the pati ent The direct m e dical objective
.

of thi s method is th e patient s m ental activity while

’

the p hysici an s basic tool is h is word The word in its

’

activity upon the secondary signal system of the

cortex goes b eyond it and has an effect also upon the
primary sign al system in separably connected with it
and thus r e ach es th e subcortical regions of the a uto
nomic centers and the seat of un con di ti oned reflexes ,

notably those of ins tincts and emotions In this .

mann er it b e comes possibl e to produce p e rfectly re al

and objectively record e d therap eutic effe cts .

S p e ech therapy thus prov e s to b e a scientifi cally

sound system of th erap e utic influ ences on al l the
bran ches of the patient s high er n ervous activity and
’

indi rectl y upon all th e functi ons of his organism

, ,

in its ment al and somatic aspects .

21
 N umerous physiological studies in dicate th at the
effect of words dep en di ng on th eir content is capabl e
, ,

of bringing about all kinds of p hysiological and bio

chemical changes in the h uman organism It is pos .

sible in this way deliberately to influ enc e the functions

of th e autonomi c n e rvous syst em ev en wh en it con ,

cerns for instance a local in flammation of skin

, , .

Appar ently th er e is not an organ or tissue in th e

human body the condition of wh ic h c annot b e mo di
fi e d in on e mann er or another by means of words ;
that is to say by way of th e cort ex M or e ov er it
, .
,

appears to be p ossible to alter the fun ctions of organs

in sev eral distinct ways— to stimulat e to inhibit , ,

and to modify in some other fas h ion It is w ell kn own .

that the impulses leaving the cort ex ar e able to use ,

“
K M Byk ov s phras e to cause ev ents in the lif e
. .
’

of an organism which are truly extraordi nar y S uch .

”

“
extraordinary events can tak e plac e also through
”

the infl uence of words upon the dynamics of th e

cortex .

O ne form of such interv ention in th e routin e

p hysiological activities as they occur in the h uman
,

organ ism is th e state of hypnosis which may t ak e

,

p lac e in c ertain cases under the influenc e of a singl e

“
bri ef word S l e ep " A s a r e sult ther e may ar is e in , ,

addition to certain cortical inhi bitions also a wh ol e ,

s h ift am ong proc e sses of the autonomic nervous

syst em in the direction of vagotonia .

S omething of the same sort can h ap pen also as a

r e sult of c ertai n emotions naturally formed or sug ,
-

g e st e d for they too ar e capabl e of causing consid er

, , ,

abl e ch ang e s in the activities of th e autonomic system .

O ur inv estigations h av e s h own th at und er the

influ enc e of sugg e st e d emotions it is qui t e possibl e , ,

22
 This possibility to act upon the cortical and even
s ubcorti cal processes by verb al means an d thus to

modify sometimes in a most stri king manner one s

, ,
’

a tti tude toward the extern al and intern al stimul i is

un deniably of great importance .

It has been repeatedly demonstrated in the labora

tory of A G Ivanov S molensky that it is possible to
. .
-

establish condi ti oned reflexes of the hear t blood pres ,

sure an d the pupil of the eye by means of a com

,

mand not b y a hypnotizing p hysician but b y the

, ,

subject himself This finding throws a m o st interest

.

in g light upon the p h ysiological grounds of auto

su g ges ti on .

A t the foundation of all these facts lies the

existence of representation in the cortex of v ar ious
physiological and bio chemical processes occurrin g
-

in the human organism This clearly indicates the .

possibility—nay th e r e ali ty—of a wide range of infl u

,

ence of verbal stimulations on various life processes

in the hum an org an ism many of which ar e quite
,

im portant in th e ps ychotherapeutic approach to

patients .

Prior to the work of I P Pavlov speech therapy . .

,

w as regar de d as tenable onl y in some psychogenic

neuroses A t that ti me we were ignoran t however of
.
, ,

what areas of the cer ebrum it may affect or wh at

physiological mechanisms are involv e d in the elimina
ti on of neurotic states But now we know full well that
.

at the bottom of any dev elopment of psychogenic

ailments lies a functional di srup tion of the hi gh er
neur al processes together with th e lowered tonus of
,

the cortex— disruption of the vigor mobility an d ,

b al ance of its activities S uch are the psycho genic

.

24
neuros e s psychogenic dysfunctions of the internal
,

organs ( the s o call e d neur os e s of organs ) and ps y ch o

-
,

genic psych os e s .

Insofar as verbal stimul ations act upon the cortex ,

speech th erapy must b e r e g arded as a b as ic tr eatment

for all psych og enic dis tur bances th oug h used in a ,

v ari e ty of ways C onsequently it h as sev eral purposes

.
, ,

namely

( 1 ) To d e term ine th e actual causes leading to ,

and callin g forth fun ctional disturb anc e s of th e hi gh er

,

nervous system .

( )
2 To remove t h e operation of the factors wh i ch
functi onally w eaken th e cort ex includin g various ,

forms of negative emotions .

( )
3 To overcome or r e duc e serious fun ctiona l
disturbanc e s of th e higher n ervous activiti e s among
‘

them di sruption of any normal dynamic st ereo typy .

( 4 ) To cr e at e n ew and ad e quat e cortical con ’

necti ons and th us to restor e th e pati e nt s working

ability .

( 5 ) To enable th e patient to g et adjusted to the

condi tions of h is external e nvironm ent th us pr event ,

in g the l ik eli h ood of recurring disturbanc e s in the

fut ure .

All this c an be accomplis h ed by m e ans of

( ) p s uas i o n well ground e d in facts an d reasons

a er ,

conducted during the pati ent s waking h ours and

’

assuming the form of c alm assur anc e s encourag e ,

m ent explan ation an d clarification with active partici

, ,

patiou of the pati ent him self ;

25
 ( b ) strong verb al infl uence assuming the form
of dir e ct or in di r e ct s ugges tion given in the waking
state or sle ep ; and
( c ) motivating sugg e stion conduct e d during an
induced state of dozing or sleep th at is hypnos is
, ,
.

Th e m eth ods of suggestion and hypnosis are today

best un derstood and p hysiologically account e d for .

It is important to point out here th at the use of

sp e ech therapy has greatly in cr e ased in th e rec ent
years and it is now clearly indicated not only in
,

psychog enic di sturbanc e s but also in many oth er

,

illnesses .

Par ticularly wide is its application in psych og enic

neuros e s with visc eral br e akdowns such as br e ak
,

downs in m etabolism the gastro intestinal tract

,
-
,

glands of internal s e cr etion br e athin g ( as in bronch ial

,

"
asthma ) the cardiovascular system ( as in paroxysmal
,

tach icardia ) E ssentially the same can be said of

.

psyc h ogenic disturbances of instinctiv e and emotional

life including th e instinct of s elf pr e servation th e
,
-
,

maternal instinct the sexu al instinct as w ell as of

,

emotional i nstability and various p h obias .

M uch att e ntion is bein g p ai d nowadays to the

precise identification of psych ogenic dysfunctions con
necte d with t h e m alfunction of subcortical endo ,

crinal and visc eral activiti e s insofar as diagnostic

,

errors in th ese cases h ave been quite common lat ely ,

th ough r e adily di sc ernible thr ough speech therapy .

Th ese errors ar e usually notic e d w h en ever a p hy

s i ci an fail s to consid e r th e possibility of psych og e n i c

autonomic dis turbances particul ar ly if the latter as

,
“
sum e the semblanc e of organic faults ( or ps eudo
organic syndromes to us e Dezheri n s term ) A s a
,
’

26
result of thi s disr e gard pati ents are often subjected,

to l engthy tr e atm ents wher e as spe e c h therapy could

,

h av e cured th em with out much d elay .

L et us consider a f e w typical cas es

( )
1 Patient K a sc h ool principal was s ufl ering
.
, ,

from in t e stinal malfunction onc e a month on on e and ,

the same dat e V arious diagnos e s wer e offer e d by

.

diff er ent p hysici an s But ev entually it t urn e d out

.

when th e coincid ence of dat e s was no ticed— th at th e

actual caus e of t he ailment w ent back to a violent
e xcitement produc e d by a fir e in the sch ool Subs e .

qu ently th e m al funct ion occurred r e gularly on th e

,

e xact date of th e fire as a result of the condition e d

r efl ex Th r ee s e ssions of s pee ch therap y und er condi
.
,

tions of sugg e st e d sl eep s u h ce d to r emov e every ,

trac e of path ology .

( )
2 Pati e nt I tw e.nty,
e ig h t y e ars of age w h i le -
,

working in the fi eld saw fir e in h er vil lag e and th ough t

,

of her childr en Frigh t en e d s he ran up the hi ll O n

.
,
.

r e achi ng the top compl etely out of br e ath she

, ,

stopp e d and r e aliz e d th at th e fi re was quite a distance

from her h om e She f ell exh austed But soon after
.
, .

wards ther e app e ar e d attacks of bronch ial asth ma and

th es e recurr e d for five y e ars A t th at tim e it b e c am e .
,

possibl e compl etely to r emove the symptoms mer ely

with six session s of sp ee ch th erapy C atamn e sis for .

thr ee years was positive .

( 3 ) Pati ent S thirty years of ag e began to

.
, ,

d e v elop conspicuous spots of baldn e ss A month long .

-

d erm atological tr eatm ent r e sult e d in no im p rov ement

wh atso ev er Then it becam e known th at the loss of
.

hair in h is cas e b e gan imme di at ely af t er a tragic

, ,

personal exp erience Tw e lv e sessions of suggestion

.

27
followed b y sleep have completely restored normal
hair growth P ositive catamn esis continued for about
.

ten y ears ; there was no recurrence of the s ymptom .

It is definitely establis h ed that speech therap y ,

parti cularly in its hyp no suggestive form may be -

,

effectiv e also in certain non ps ych ogeni c somati c -

,

di seases I t is particularly effective in var ious cases

.

involving acute pains e specially in surgery with out

,

an esthesia bad suffering in th e post operational per

,
-

”
iod d i icult childbirth anguish and agony in ad
, ,

vanced cancer and tab e tic crises G ood hy notizability

p .

is important in these cases .

S peech therapy is also of considerabl e significance

as an auxiliary symptomatic me thod of treatment in
various somatic ailm ents The problem h ere is how
.

to raise th e positive tonus of the cortex a s well as the

organism as a whole S ugg e stion enabl e s us in th ese
.

cases to create calmn e ss r elaxati on an d stability in

, ,

place of emotional stat e s to in sure sle ep to improve

, ,

the proc e ss of food assimilation to restore app etite , ,

and so forth .

S pe e ch therapy has a well e stablis he d role in the

treatm ent of pulmonary t ub erculosis It h as definitely .

a salutary effect upon sl e ep appetite and general , ,

well b e ing ; in some instances it h as b e en k nown to

-

lower temperat ure .

S pe e ch th erapy can be of help also in removing

exc essiv ely high sensitivity of th e organism toward
certain foods and drugs like quinine Th is approach .

has been recommended by A I K art amys hev a . .

,

dermatologist .

It follows from th e prece din g that speech therapy

shoul d be more widely used in every somatic clini c .

28
The us u al ways of reas s urance encour a gement per
, ,

suasion an d explanation so comm onl y us e d in every

, ,

day me di cal practice ar e after all among th e essen

, , ,

tial elements of g en er al psychotherapy In this sense .

,

every p hysician must be a psy chotherapist .

In th e treatm ent of neuroses we employ the com

,

bin ation m ethod of speech therapy It consists in .

conducting an anamnestic talk with the patient or

possibly even a number of such talks It is e asy in .

thi s way to clarify the concrete con di tions an d causes

of th e disease to establis h the desirable rapport wi th
,

the patient and to stimulate in him a trusting attitude

,

toward the physician .

Th ese an amnestic talks natural ly lead to further

steps of therapy namely : ,

( a ) waking spe e ch th erapy in the form of ex

planation p ersuasion and encourag em ent ;
,

( b ) motivat e d suggestion in the hypnotic sle ep ,

the purpose of whic h is to overcom e w h at e ver func

ti on al disturbances of the high er nervous system
may remain ;
( 0 ) special v erbal sugg e stion l eading the patient
to the state of deep r e st in which h e r emains for a
,

d efinit e prescribed tim e W e refer her e emp h aticall y

.

to th e state of d eep r e st because th is kin d of s ugges

tion is capable of bringing about wid er biochemic al
ch anges in the pati ent s organi sm than can possibly
’

happen un der the con di tions of ordi nary rest and

tr anquilli ty .

L et us now say a few words conc erning the sigmi

fi c ance of sp ee c h th erapy in the stat e of sugg e sted
sl e ep A t th e foundation of this m eth od lie two
.

th erapeutically valua ble facts : first that th e inhi bi ,

29
tions of sleep create the most favorable condition for
the restoration of normal cortical activity disrupted
by th e diseas e ; and second th at the functional special
,

i z ati o n of the cortex makes possible both the di rection

and th e specialization of th e influence originatin g at
the p o int of rapport whil e the in h ibitory action at
,

sl e ep keeps the oth er portions of the brain stea di ly

fr e e uninvolved M oreover every center of excitation
, .
,

so aroused becomes strength ened as a result of inhi bi

tion according to th e law of mutual irradiation I t is
, .
,

cons e quently particul arly important to e mploy the

,

correct forms of motivation for v erbal influence th at ,

“
is the s o called formulae of sugg e stion
,
-
.

The us e of hypnosis as a par t of speech therapy

is dir ectly indicat e d in the cas e s requiring the
strength enin g of verbal effe ct namely ,

( a ) Wh e nev er at th e foundation of a neurosis li e s

a psych ic tra uma characterized by an afl ecto genic
low ering of the tonus of the cortex ; for in th ese
instan c e s the state of sugg e sted sle ep is an alogical or
clos ely relate d to the state in wh ich the pathological
condition was originally form e d in the cortical or
subcortical area .

( b ) In th e reaction typ e of neurosis th e origin

-

of which is kn own to the pati ent even th ough he is

,

unabl e to grapple w ith it by hi mself when ever th e ,

distur banc e does not yi eld to spe e ch therapy in a

waking state .

( 0 ) Wh enever it is n e cessary to hel p th e patient

in h is attempts to mak e an adjustm ent to un favorable
but unavoidable ext ernal con di tions especially if the
,

waking sp ee ch therapy is ins u h cient .

( )
d In t h e pres e nce of psychogenic si t uational
 even if it be of lon g duration proves to be but an
,

episode in the patient s l ife O ur findi ngs clearly show

’

that mere duration of such neuro ti c ailments must

not be taken for an obstacle to a quick and complete
cur e
.

E ssentially the same can be said with regard to the

treatment of obtrusive neuroses especially of pho,

bias availing themselves of hysterical mechanis ms

an d continuing for year s P osi tive results of treatm ent
.

in such cases largely depend on combinin g speech

therap y with some extensive an d well motivated -

formula of su ggesti on directed at the disclosure of

causes of the ailment .

L et us next examin e some of the pathological

states in which the use of speech therapy with
suggested sleep has been so far disregarded We refer .

particularly to certa in forms of epilepsy .

The question as to the place of psych ic trauma

“ ”
in the development of the s o called genuine epilepsy
-

is important though lar gely unexplor e d The method .

of hypnotic suggestion is n everth eless indi cated for

som e typ es of patients especially when they are
,

readil y susceptible to it We have indeed observed

.

undeniable positive effects of spe e ch th erapy in those

forms of epilepsy in which the preceding aura shows
defi nite connection w ih a psyc hic trauma Hypno .

suggestive th erapy has been found advantageous also

in the case characterized b y worrisome expectation
of regular seizures .

It may be interes ting to point out th at suitable

combinations of speech therap y have been kn own to
produce m arked effects upon the patients suffering
fr om psychog enic thyr oidism in its various forms
,

32
 ’
in cluding Basedow s di sease The psycho g enic f orm .

of this illness is quite comm on ; yet strangely enoug h , ,

some patients find th emselv e s on the surgical tabl e ,

whil e others are sent to sanatoriums .

A ccor di ng to M I K as hpur twen ty two out of

. .
,
-

s eventy fi ve such patients

-
of his had psych ogenic
etiology S peech th erap y had positive results within
.

two or three weeks In one serious case surgery be

.

cam e unnecessary In the majori ty of th e c as es

.

catam nesis continued for several years A reduced .

basic metabolism in addition to e xtern al signs of

,

improvement objectively demonstrated succ e ss of th e

,

treatment T h ese facts should be taken in to con

.

siderati on by the endocrinologists surg e ons and ,

neur0 athol o i s ts
p g .

G ood results of speech th erapy with suggested

sleep were generally observe d in the toxi coses of
pregnant women wh o as a rule do not react s u ci ently
"

well to pharmacoth erap y O ut of 293 cases of pr e g .

nancy with toxicosis eighty four percent ended in -

normal birth .

S tudi es conduct e d by M Y Mil os l avs ky ( 1951 54 ) . .

-

at th e U kr ainian Insti tute of S cientific Re search for

the Protection of M oth erh ood an d Ch il dhood ( at
Kharkov ) show th at in cas e s of imp ending mis car
,

ri a e
g, sug ge stions during h ypnotic sleep have been
able to reduce excitability of the uterus to qui et ,

down painful cramps and to terminat e bloody dis ,

charges O f 38 7 such cases eighty sev en p ercent

.
,
-

resulted in normal birth .

The m eth od of sp e ech therapy eith er in the waking

or sl e eping state can b e advantag e ously used also
imme di ately after chi ldbir th notably in cases of ,

33
m alf unctionin g mamm ary glands V I Zdr avomyslov . . .

has demons trat e d the effe ctiveness of this meth od in

di stur bances of la ctation .

In obstetrical practice the method of condition,

ing by utilizing indir ect suggestion may be of great

b en efit as a substitut e for anesth e sia Res e ar c h by .

I T Tsvetkov and K V Proni ayeva on 223 observed

. . . .

cas e s has demonstrated that it is not inferior to any .

Quite int er e s ti ng and h ighl y significant are th e

obs ervations of I A Zhukov a dermatolo gi st worki ng
. .
,

at the war m springs at S ochi whi ch s h owed that ,

spe e ch therapy with prolonged sle ep applied to 300

pati ents sufferin g from var ious dermatos e s resulted
in a hi gh ly incr ea s ed percentage of cure .

Patients affected with eczema were when so ,

treated cur e d three times as often as under the

,

traditional typ e s of tr e atment ; those suffering from

neur odermatitis recovered twice as o ften ; and those
"

a i cte d with psoriasis four times , .

What are the essential condi tions of success in

speech th erapy?
The main condition consists simply in a skilful
approach on the p art of the physician to hi s patient
his m anners h is auth ority knowledge and erudi tion
, ,

in th e field of speech th erapy .

If this meth od in its elementary form of explana

tion persuasion and c al mi ng is supposed to b e at
,

the dispos al of every general practitioner then a ,

psychotherapist as a sp e ci al ist bein g als o a psychi a ,

tri st and ps ychoneurolo gis t must feel at h ome in ,

every p hysiologically grounded method of psycho

-

therapy used in a waking state as well as in suggested

sleep .

34
 Wh at are the princip al causes of failure in speech
th erapy ?
Fai lure may som etimes occur as a result of wrong
diagnosis ; but mor e frequently it is a consequ e nce
of an ins u ci ent contact b e tw een th e patient and his
f
r

p hysician so th at th e latter does not t ake into con

,
’

siderati on some relevant circumstances of the patient s

life or e xperi ence for instance unfavorabl e soci al
, ,

relations at home at work e tc L ack of succ e ss in

, , .

the treatm ent of patients with we ak n esses of the

nervous syst e m may sometimes be explained by th e
in ability to cr e ate suitable conditions of lif e for one
self Unsusc eptibility to hypnosis may serve as another
.

serious h andicap to success ful treatm ent O ccasionally .

th e r e al d i iculty li e s in the patient s d esire to pr e

"

t e nd sickn e ss or to remain for some reason sick S till

,
.

another caus e of therapy f ail ure may be found in

the physician s stubbornness to confi ne himself to a
’

singl e meth od of t h erapy and thus to i gnore other

possibilities .

It must b e ackn owled ged that the org anization of

speech therapy in h ospitals often n e eds a considerable
improvement N ow and then speech therapy as s um es
.

mer ely an incidental an d h ap h azard form simply

because many p hysician s h ave never been taught
how properly to avail thems e lves of it Th is indi cates .

th e dire ne e d for puttin g s h ort courses of training

in practical psychoth erapy a t the disposal of g eneral
practitioners and also advanced courses to bring
sp e ci al ists up to dat e in their knowledge
- -
.

M oreover the fundamental facts of psycho therapy

,

and psychopro ph yl axis s h ould be kn own not only to

physicians th emselves but also to th e enti re p ersonn el

,

35
workin g under them in v ar ious insti tutions .

If we are to improve public service in general ,

it is e ssenti al for us to extend the n etwork of

ps ych oneurological clinics It is particul ar ly important
.

to m ake it possible for many patients to avail th em

selves of speech therapy with out int errupting their
work and normal conditions of life .

special psych oth erap e utic o ices

"

I n ad di tion ,

shoul d be organized in every psychiatri c clinic as ,

they were once organized in the clinics of V M . .

Bekhter ev and S S K orsakov

. . .

Psychotherapy must take from now on a promi

nent place in h e field of medical practice
t
.

36
 GENE RAL M E T HODO L OG I CA L PR O B LE M S
OF P SYCHO T HE RAPY

by M S . . L eb e din s ky
( M os cow )

The ques tions of ps ychotherapeutic methods are

i nsep ar able from th eir theoretic al foun d ations and
aims But they could be established in the fi rst plac e
.

onl y after the study of the h igher nervous activity

was su ci ently advanced The ma in task of ps ycho
i .

’
therapy is favorably to influence the patient 8 ps y chol
ogy b y itself or in combination with other medic al
methods ; to regulate the dis turbed dynamics of the
neural processes in his brain and thereb y to restore
th e balance of functions in the whole or gan ism .

A s a branch of medi cin e psychotherapy has at its

,

dispos al specific meth ods of its own But in its b road .

e st meaning i t prop erly applies to the entire area of

medical practice no matter what the fi eld of one s
,
’

specialization may be .

Any accidental or purpos eles s effect of the phy si

’

ci an upon the patient s psyc h ology i s likel y to be

insignificant an d moreover harmful rather than b ene

, ,

fi ci al C onsequently it is v ery important to promote

.
,

37
th e sound knowl e dge of s ci entific facts and psycho
th erapeutic m e thodology in the entir e prof e ssion of
me d icine E ach practising ph ysician s h ould know
.

how to ex ert psych otherap e utic infl u enc e upon h is

p tients not so much durin g sp e cial sessions in h is
a ,

0 i c e as in e v eryday contacts wit h t hem th at is, ,

during m e dical e xami nation daily ro unds wh il e giv

, ,

ing prescriptions e tc ,
.

Psych oth erapy can b e us e d dir e ctly or indir ectly ,

through the entir e organization of m e dical s ervic e

including the v ery environm ent in whic h th e patient
liv e s
.

O ne of the main purpos e s of psych otherap y is to

mobilize the pati ent s own activities so as to attain
’

th e ai ms s et by th e p h ysician in the cours e of

psych o th erapy .

Th e main condition of any succ e ssful ps ycho ther

a
py is t h at t he pati e nt h av e complete trust in t he
p hysician and in the eff e ctiv eness of h is m e th od of
tr e atm ent It is the first task of the p hysician th er e
.
,

fore to d e cid e h ow to prom ot e th e attitud e of trust

,

in ev ery on e of h is patients To b e abl e to do so he

.
,

must car efully study the pati ent h ims elf h is ailment
,

as well as the n eurotic r eactions th at may h av e aris en

as a result .

The story of th e p ersonal experi enc e s as r elated

by the pati ent to his p hysician is oft en quit e frank
and full of d e tails h abitually withh eld from ot her

people ; but th e telling of it is lik ely to d ecr e as e h is

tenseness and improv e h is m ental and p h ysical con
di tion In offering in timat e information concerning
.

himself th e pati ent simult an e ously gets to know h is

,

physician It is quite important consequ ently th at

.
, ,

the pati ent become thoroughly convin ced of the

38
ON THE NEU RAL M ECHAN I S M OF HYP NOS I S

by I I . . K orotki n an d M M Sus l ova

. .

( L eningrad )

The probl em as to h ow the n eural impuls e s con

necte d with h ypnotic suggestion are spreading is in ,

our opinion of considerable significance Particularly

,
.

interesting in this resp e ct are the suggestions leadin g

to the inhibition of c ertain responses .

I t has be en demonstrated by us that hypnotic

suggestion in the a bs ence of any conditioned or
uncon di tioned stimuli results in the inh ibition of
these responses It h as been also shown that this
.

inhibition avails its elf of the m e ch anism of temporary

neural conn ections The stimulation exclud e d by
.
”

this suggestion acquir e s th e qu alities of a condi tioned

inhibiti on
.

A number of rel evant facts p ermit us to ask this

questi on : D o the stimuli r etain their inhibitory effect
in oth er applications th an originally sugge st e d ?
To clarify this qu e stion we conducted obs ervations
on four patients suffering from hysteria thr ee of ,

whom manif e sted somnambulism .

A ll of these pati ents were conditioned to show

40
defense refl exes with regard to sever al different
s ti mul i These conditioned refl exes included one to
.

the sound of a m e tr onome having 120 beats per

minute ( M ) one to an electrical bell ( E ) and one
, ,

to a buzzer ( B ) The specific refl ex w as blink ing in

.

response to M and the closin g of the eyes in respons e

,

to E or B A blast of air applied thrice to the inn er

.

corner of the left eye served as an uncondi tioned

stim ul ation A fter the patients refl exes wer e exami ned
’

. ,

they w ere brought into the state of hypnosis C ert ain .

specific suggestions were given th em in that state .

The effect of these suggestions w as judg e d b y the

appearance of change in the refl exes tak ing place
und er hypnosis as well as in the posth ypnotic state .

To get a convi ncing answer to the above ques tion

several experimental variations were devised in our
study We shall comment upon a few of these
.

variations .

It was suggest e d to a pati ent a little before the

experiment that th e blast of air in the di r e cti on of
the eye would be rather weak following the sound
of the el e ctric b ell ( E ) but much stronger in con
,
e

n e cti o n with M But actually th e int ensity of the

.

blast did not vary at all Prior to th e suggesti on the

.
,

responses wer e quit e cl e ar and e qu al ly s trong wheth er

they were prec e d e d by th e sound of the b ell or that
of the m etronom e But subs e qu ent to the suggestion
.

th e response becam e mark e dly different ; the patient

claim ed that the str e am of air following the sound
of the b ell was weak wh er e as that following the
,

sound of th e metronom e was s trong and corr espond ,

in gly the refl e x b e cam e we ak er in one case and

s tronger in th e other .

“
Then an ad di tional sugg e stion was given : There
41
will be no sound of eith er E or M A ctually the .
,

conditi oned stimuli were present just as befor e but ,

they had no di rect eff e ct whatsoever In th e post .

hypno tic comments the pati ent mentioned th e ah

,

senc e of stimulation It would seem th erefore th at

.
, ,

the uncondition e d stimulus b eing invar iably of on e

,

and the same strength would p roduc e id e ntical r e

s ons e s both wi t h regar d to E or M neit h er of wh ich

p ,
“
w as h eard N everth el e ss the conditioned refl e x was
.
,

strong followin g th e b e ating of th e metronome and

weak following the sound of th e bell The previous .

verbal comments continued an d the pati ent said in ,

response to th e un h e ard metronome that the blast

was s trong and in response to the bell that the blast
,

was w e ak .

S o it seems tha t the con di tion e d responses follow ,

ing the preceding sugg e stion continued to be di f ,

ferenti ate d even though the stimuli wer e no longer

,

he ard .

The second variati on consisted in this th at inst e ad ,

of suggesting a different int ensity of the blast of air

following the application of diff erent condition e d
stimuli it was suggested to th e pati ent that th ere
,

would be no blast of air dir ected into th e eye

following the soun d of the buzzer ( B ) As a r e sult .
,

the response continued as befor e wh en th e hell was

ringing but it b e cam e inh ibit e d in the case of B
, ,

though th e stim ulus was actually appli e d .

N ext a n ew suggestion was given to th e pati ent

,

“
Both E and B will b e discontinued from now on .
”

Immediately after this the pati ent was arous e d from

hypnosis and observations w er e continu e d in th e
,

posth ypnotic state Th e conditioned r efl exes with

.

reg ar d to both s timuli h aving been inhi bited by th e

,

42
suggestion completely disappe ared Yet the uncon
, .

di tione d reflex manif e sted its elf only after the sound
of E It would se em that th e unconditioned response
.

would be well expr essed in both cases in sofar as ,

th e blast of air was applied in both instances even ,

though neither the bell nor the buzzer was he ard .

N everth eless in spit e of the absence of any reaction

,

to eith er E or B the refl ex w as inhibited only with

,

reg ard to the latter .

Thi s variation indicates that in spite of the fact

,
“
that th e excluded conditioned stimuli inhibit the
”

corresponding conditioned r eflexes they continue at ,

th e sam e time corr e ctly to r e act in on e case to the

,

presence of the s timulus and in the oth er to th e

, ,

abs enc e of th e stimulus .

These findin gs throw an interesting light upon

the m e ch anism of various acti vities famili ar to th e
hypnotists as wh en th e subjects in a hypnotic state
,

go around obj e cts inst e ad of bumping into them even ,

though the ir absenc e has been explicitly sugg e sted .

C ould it b e that th e same physiologic al mecha nism

accounts for the fact familiar to ev ery psychotherapis t
th at certain symptoms of diseas e b e come inhibited
when so sugg e sted while others remain unaffected ?
,

C ould it be that in the technique of suggestion we

"

sometimes do not take s u iciently into consideration

th e mul tiforrn activities of path ogenic stimuli ?
It may b e proper al so to conclude in general that
extrem e caution is indi cate d in influencing patients
wi th words wh ich ar e aft er all broad and complex
, ,

sources of stimul ation .

 BI O E LEC TRI CA L AC TI VITY OF TH E
-

B RA I N I N HYP NO THE RAP Y

by M P N evs ky
. .

( Chelyabins k)

Publications on the stu dy of bio el e ctric al a cti vity -

of the human brain in th e state of h ypnosis remain

as yet relatively few .

In our own national literature the first brief men ,

tion of change in th is connecti on in th e action currents

of th e brain is found in th e work of S N S ubbotni k . .

and P I S pielberg
. . wh o pointed out that ,

durin g hypnotic sl e ep the alp h a rhythm is gradually

,

r eplaced by a slow er one Unfortunately h owever.

, ,

th e au thors failed to make any comments upon the

health or sickn ess of th eir subj e cts Th e next work on .

r e cord th at by A I M ar enin a
,
. . was devoted
to the enceph alograp h ic study of hypnotic sl e ep It .

w as conducted on m e ntal patients in a clinic and

showed th at the electric pot ential of the brain was
lowered in th e state of hypnosis .

I n 1 9 54 I h ave arrived at the conclusion that

,

there are four bio electri cal stages arising succ e ssively
-

as a heal thy person goes deeper and deep e r into

44
hypnotic sleep These changin g conditions can be
.

described as the stage of rhyt hm equalization th e ,

stage of alpha spindles the stage of minim al electric ,

activity an d the stage of beta oscilla tions

,
.

Th ese data permit us to conclude t h at the hypnotic

sleep of a normal person is ch aracterized b y a gradu al
decrease of electric activi ty in the brain ( accordin g
to four stages ) which in its elf d epends on the depth
, ,

of hypnotic sleep .

In 1955 a s ymposium was published on the

,

electric activity of the human brain in th e state of

hypnosis The contributors w ere B V Pavlov Y A
. . .
, . .

Povorins ky and V V Bobkov P I S pielberg and

. .
, . .
,

A I M arenina These authors confi rmed the observa

. . .

tion that under hypnosis th e electric activity of the

, ,

brain is lowered in proportion to th e depth of the

s tate .

I n various papers by twelve foreign authors seven ,

( L oomis H arvey and

,
H obar t 1 937 ; Thompson F orbe s , ,

an d Bowles 1 937 ; Lun dholrn and L o ew enbach 1944 ;

, ,

S irna 1945; D ennes 1 947 ; F ord and Inger 1 948 ;

, , ,

Barker and Bergw in 1948 and 1 949 ) contended that

,

hypnosis does not alter the electri c activity of the

brain and that inhi bition does not lie at the found a
tion of the process These authors concluded from
.

this that hypnosis cannot be regarded as a state of

sleep insofar as sleep ch anges conspicuously the
,

action currents of the brain .

The authors of five oth er works detected chan ges

in the electri c potential of the brain under h ypnosis ,

but their findings contr adict e d one ano ther S ome of .

them maintain ed ( Frank 1938 ; Frank and K oopman , ,

1 938 ) that the electric activity of the brain character

is ti cally rises under h ypnosis ; others ( Blake and

45
G erar d 1937 ) found that it f al ls ; and still others
,

( M arinesco Sa ger and Crendley 1937 ) noted that

, ,

the alpha rhyt hm ris e s at first but slows down later ,

or els e ( Frank and Train 1 94 9 ) th at it becomes

,
“
d es yn chr o ni z ed with the app e aranc e of slow waves
”
.

M y own fin di ngs are the result of a s t udy involvin g

tw enty patients with various n euroses ( n e urasthenia ,

psych asth enia and h ysteria ) Th e records of bio

, .

currents of th e brain wer e taken un d e r usual electro

enc ep h alograp hic conditi ons by means of a double
channel cathod e oscil lograp h Hypnosis was induced .

through v erb al fixation The r e cordings of electrical

.

activi ty of the brain were don e before durin g and ,

after each hypn o therap eutic session an d also at th e

-
,

conclusion of th e whole s eries .

Before I d e scribe th e dynamics of bio electric -

activi ty of th e brain ( exclusiv ely among n eurotics )

with p athological fun ctions of the cortex it is n eces ,

s ary to stress th e p e culiarities of electric activity of

the br ai n under hypnosis in normal p e opl e this ,

serving as a norm for the estimate of an y path ological

devia tions .

The r e gul ar modulated al p h a rhythm was marked

on each encephalogram tak en before hypnosis ; the
s am e w as done al s o wi th the n ormal ( in frequency
and intensity ) beta rhythm In the state of initial .

hyp notic drowsiness following th e closing of the eyes

( th e fir st stag e ) the enc ep h alogram show e d l ev eling
,

of the alpha rhyt h m th e lower amplitudes of the

,

alph a waves going up whi le th e higher ones b e come

sligh tly flatt en e d or h ardly ch anged at all Th es e .

early fluctuations in electri c activity of the brain under

hypnosi s consti tute in our termin ology th e stage of
, ,

rhyth m e qualization .

46
call forth the return and strengthening of the alpha
rhythm in this period of hypnotic sleep Wh en the .

suggestions and th e somnambuli stic exp eriences con

nected with th em are removed one can obs e rve within
,

minutes or even seconds th at electric activity of th e

brai n as show n upon the electroencep h alogr am re
, ,

sumes its steady downward trend .

A s soon as the subject is taken out of the hypnotic

state by means of v erb al suggestions the waves ,

promptly di sappear from the electroenc ephalogram

and are replaced by the alpha rhythm and beta
rhyt hm just as before h ypnosis
, .

A ll thi s confirms th e important fact that verbal

suggestion in hypnosis and th e hyp notic sleep as such
leads to complex electro p hysiological and bio chemi
- -

cal changes in th e cort ex .

A s to th e effectiveness of hypnotherapy our ,

patients can be divid e d in three groups Group A .

( ten persons ) consisted of pati ents wh o recovered

fully with all the symptoms of illness gone Group B
,
.

( s ix p ersons ) was composed of those wh ose condi

tion improv e d with some of the symptoms gone To
,
.

Group C ( four persons ) belonged th ose in wh om

no s erious improvem ent could be observ e d .

Th e following ch anges in bio el e ctric activity of

-

the brain were observed in Group A :

1 . The
well expressed alpha rhythm was seen
-

durin g the hypnotherapeuti c sessions to go down ,

together with the weakening of beta wav e s or in -

,

a few cas es with th eir s trength ening ; occasion al ly th e

,

low al p h a rhythm was accompani e d by the appear

ance of slow b eta wav e s S everal patients revealed
-
.

a brief stimulation of the alpha rhythm at th e begin

48
ni n g of h ypnotherapy Th ese chan ges must be con .

s i dere d on the whole as favorable signs with re g ard

to the effectiveness of hypnotherap y in sofar as they ,

indicate the ligh t and dynamic character of functional

dis turbances of the cerebral cortex Indeed the closer .
,

the ch aracter of bio electric c h anges in the hypnotic

-

state of the neuro ti cs to the pictur e of the corre

s ondi n state in normal people the better is the
p g ,

pro gnosis and the greater is the ch an ce of qui ck

recovery .

2 A fter a few ( thr ee to fi ve ) sessions of hypno

.

therap y there were observed ( immediately after the

,

awakening from the state ) certain changes on the

electroencephalo grams characterized b y the transi ,

tion from a weakened and irr egul ar alpha rhythm to a

norm al well modulated al pha rhyt hm ; the slow waves
-

typical of the prehypnoti c conditi on disappeared

'
.

3 At the conclusion of the hypno therapeuti c s e s

.

sions rather well expressed alpha and beta rhythms

-

were noticed in th e electroencephalograms of the

recovered patients ( in s ix out of ten cases ) Two .

patients showed a weakened and somewhat irre gul ar

al pha rhyt hm while two others demonstrated moder
,

ate tachycardia with occasional alp h a waves -

.

L et us cite a couple of cases

Pa tient P thirty s ix year s of age thr ee y ears
.
,
-
,

e ar lier had happened to work in the same 0 ce with i

anoth er woman wh o suffered it w as le arned from , ,

t uberculosis of the lungs A s a result she develop e d .

,

intens e fear of contractin g th e di s e ase S he real ized .

that th e chance of this was small but she c ould not ,

control hers e lf and the id e a persisted In the end

, .
,

s he could no longer overcome the irresistible desir e

49
to wash h er hands repeatedly ; then s h e began to wash
the floors do ors walls tables in her ap artment
, , ,

practically everyt hi ng .

I t was then t ha t she asked for me di c al help B e .

fore th e fir st s e ssion of hypnosis encep h alo grap hy of ,

the righ t h emisp h ere of th e cer ebrum presented the

picture of d epression Th e alp h a rhythm was low
.

and irregular ; t h e b e ta rhythm was slig h tly acc el er

ated D urin g th e session the picture ch anged con

.
,

s i d er abl and remai n ed fairly normal at its conclusion

y .

But two days later another encephalogram show e d

,

hardl y any im provement After five sessions of hyp .

noti c treatment thi ngs began to look better Th e .

pati ent was dis ch arg e d after fift e en sessions C at am .

nes is for two years confi rmed h er compl e t e recov e ry .

Pati ent F thirty tw o years of age suffered for

-
,

about five years from e ryt hrop h obia The electrical .

activity of her brain was characterized by a low

thoug h regul ar alp h a rhythm and a w e ak ened b eta
rhythm A t the conclusion of th e hypnotic series t h e
.

encep h al ogram reveal e d a defini te improvement in

th e al ph a rhythm an d a perfectl y normal b eta rhythm .

The pati ent recovered after sixteen sessions of

hypnotherapy .

Among the patients in th e Group B fe w changes

wer e noticed in th e electrical activity of th e brain
during hypnoth erapy Tachyar hythmi a t emporarily
.

disapp e ared but ther e was al so some weakeni ng of

,

the alp h a rh ythm ; slow beta wav e s of s h ort duration -

wer e observed at tim es .

The pati ents of the Group C manif e st e d an inert

“

stabl e curve of electrical activity of the brain Prior .

to psych oth erapy the encephal o grarns showed no

,

50
al pha rhythm but some t achyarhyt hmi a sometimes
, ,

combined with theta and delta waves .

CO N CLU SION S

1 .Th e dynamics of bio electri cal activity of th e

-

brain in th e h ypno th erapy of n e uroses is ch ar acter

iz e d by : ( a ) decrease of electri c al activi ty of the
brai n durin g hypnotic sessions with an occas ion al
,

acti vi z ati on of th e alp h a r hythm or slow th eta waves ; -

and ( b ) increase of the alpha and b eta rhythms ,

with th e normalization of el e ctri cal activity of th e

brain on completion of each hypn otherapeuti c s e ssion .

2 Th e d e gr e e and type of c h ang e s in bi o el e ctrica l

.
-

activity of th e brain as caused by h ypnotherapy

, ,

h ave si gnifi cant b e aring upon the clini cal int erpr eta
tion of the stat e of th e patient s sickn e ss
’

3 a all c h anges in electr ical activity of th e br ai n

.

dur ing hypno s is t e stif y to the gravity of the n e urot ic

condi tion .

4 The closer th e ch an ges in bio el e ctrical activi tie s

.
-

of th e pati ent s brain during h ypnotherapy to th ose

’

obs erv e d in norm al people under hypnosis the better ,

is th e prognosis .

51
EFFEC T OF COND ITI ONED S TI M U LA TI ON I N
T HE WAKI NG AND HYP NO TI C S TA TE
ON HU M AN D I GES TI VE SEC RE TI ON

by Y M . . L evi n
( N ovos i bi rs k)

pr e sent paper cons titutes a part of a l ar ger

The
research und ertaking by a numb er of authors namely , ,

V G Fuchs V N Panur ova Y M Levin T P

. .
,
. .
,
. .
,
. .

M aximova Y V N ato chin Z G A ndrosova and

,
. .
, . .
,

headed by S S Yudin . . .

F or quite a wh ile the problem of th e psycholo gi

,

c al aspect oi stomach secretion has been arousin g

considerable interest H ornbom g for inst ance con.

, ,

ducted extensive studies on a four year old boy with - -

a fis tula of the stomach H e d emons trated th e exist .

ence of qualitative an d quantitative differences in

secretion during pretended feedin g ( under hypnosis )
w ith meat br e ad and milk I N Sh eftel ( 1929 ) and
, ,
. . .

I N Rybus hkin and I V D anilov ( 1 937 ) studied

. . . .

stomach s e cretions among p atients with fistula They .

confi rmed th e existence of the r eflex aspect of secre

tion and a i n n e d the role of psych ological factors dur
”

in g the in itial stag e s of digestion .

52
 M ost noteworthy ar e the obs ervations on gas tri c
secretion stimulated m er ely by the h ypnotic s ugges
tion of eating as demonstrat e d by V I Zdr avomys lov
,
. . .

Th e resultin g secretory effect clos e ly corr e spond e d to

wha t happ ens normally in consuming say an ordin ary , ,

br e akf ast A ll th ese data tog ether with some addi

.
,

ti o n al new fact s were brough t tog eth er in an ar ticl e

,
“
by S S Yudin ( 1 940 ) e ntitl e d D irect Verification of
. .

the D octrine of I P Pavlov conc erning D igestion

. . .

Quite interestin g also is th e study of th e actu al

relationship betw e en th e cort ex of the brain and the
int ernal organs it inn e rvat e s and of the respective ,

rol e s of the sympathe tic parasympathe tic and , ,

humoral systems In this conn e ction the plan worked

.
,

out by S S Yudin is well worth examining H e

. . .

proposed namely to s tudy surgi cal patients with

, ,

fi s tul ae of the stomach at various stages of th e con

,

struction of an artificial oesop h agus To verify th e .

exact paths of reflex impulses going from the cortex

to the gas tric gl an ds S S Yudin analyzed stomach
,
. .

s e cretion at v arious stag e s of di gestion In addi tion .

to re gular meals he us e d al so meals whi ch wer e

,
“ ”
merely suggested In both ki nds of feedin g th e
.
,

curves of secr etion were ap p roximately alik e Thi s was .

demonstrat e d by m e ans of a special rubber sound

’

introduced into the patient s stomach without causing

any serious discomfort S amples of secretion wer e
.

taken every fifteen minutes and carefull y analyz e d

both quantitatively and qualitativ ely .

The se s tudies were conduct e d in a separat e room

und er conditions of maximum sil e nc e Th e patients .

w ere placed comfortably in b e ds S ome of th e observa .

tions were mad e und er hypnosis oth ers in the waking ,

state Th e fistula op ening of the stomach was in vari

.

53
ab ly hi dden from the patient s eyes b y a special
’

device permitting one to in troduc e food into his

stomach— or to pretend doing it—vvithout attractin g
his attention .

Working with a different group of patients but ,

und er identic al condi tions the experimenter combined

,

th e f e eding with emotion ally indifferent stimulations

by sound Four feedin gs suffi ced to establis h a con
.

d iti on e d r e flex each one prec e ded by remar ks lik e

, ,
“
When you he ar the sound of a metronome food will ,
“
be intr oduced into your stomach or A t th e sound
,
”

of a bell food will be in troduced in to your stoma ch

,
.

Onc e th e con di tionin g was establis hed S S Yu di n

, . .

pass e d to th e n e xt stage of the operation in the

construction of an ar tificial oesop h agus durin g which
,

h e p erformed a s upracardi ac vagotom y .

Th ese studies demonstrate th at it is quite possible ,

even after vagotomy to obtai n th e ris e of gas tric

,

s e cr etion wh eth er in the natur al or hypnotic state .

This seems to s h ow th at t he pn eumogastri c nerv e s

are not th e only ch ann el along which the impulses
can be conduct e d from the brain and produce the
reflex phase of g as tri c secretion .

54
cortex and p articularly of the secondary signal system
on the activity of the lower cent ers of th e brain .

Th e rol e of th e cort e x in the e xp erienc e of pai n

is now well kn own Th e following s t udy on th e effect
.

of words upon pain was un d ertaken according to

the method of motor s ens o gr aphy developed by A K . .

Singayl o .

We first in ves tigat e d th e possibility of producing

analgesia by m e ans of spok e n words as w ell as
hypnotic sugg e stion Then we examined ch ang e s in
.

th e thr e s h olds of tactil e an d p ain stimul ation and ,

in th e thres h olds of e ndurance to pain ; ch anges in

the cortical in hibitions and in th e defensiv e reactions
to pain In one s eries of experiments we studi e d th e se
.

ch ang e s only aft er an expl an atory talk on the safe ty

of such stimul ations and on the possibility of enduring
th em calmly In th e second series of e xp eriments
.

analgesia was sugg e sted under hypnosis Th e anal ysis .

of th e res ults of th e first seri e s s h owed th at in thi r ty

on e out of thirty four cases a sim ple explanation
-

s u i ce d to rais e th e th res h old of pain sensitivity and

"

to increas e th e pow er of enduring it .

In the study conducted wi th M P M alkova on . .

twenty pati ents w e wer e able to demons trate that

it is possibl e to increase the numb er of l e ucocytes in
th e blood A ft er impr e ssing positive emotions upon
.

th e subj e cts minds ( three to five minutes of sug

’

g e stion ) w e were able to s e e that the number of

,

l eucocytes incr e as e d by 1 200 1 500; wh er e as after

-

suggesting negative emotions th eir numb er d e creas ed

by 1 300 1 600 In a f e w instanc e s positiv e emotions
-
.
,

resulted in paradoxical reactions .

56
 B AS I C M E T HODO L OG I CA L Q UES TI ONS
CONCE RN I NG G RO U P THE RA PY I N NEU R OS I S

by N V I vanov
. .

( G o rk i)

Th e p hysici an s psych oth erapeutic work calls for

’

th e promotion of wh ol e some typ es of acti vity in the

pati ent if the latter is to ov ercome hi s n eur otic condi
,

tion Th is can be done in one of two ways : either

.

by strength ening his protective inhibitions or by

enabling him to form n ew centers of inter e st .

Th e m ethod of group psych oth erapy as we use

,

it consists of talks conducted with patients twice or

,

three tim e s a we ek D urin g these talks the p hysician

.

expl ains in a popular languag e wha t we k now about

neuroses an d illustrat e s th e more im port ant facts
with case h istori e s of his form er patients H e tri es .

to convey to them th e basic inform ation conc erni ng

the etiology and path ogenesis of neuroses to analyze ,

in detail th e con di tions preventing possible recov ery ,

an d to s h ow w h at practical measures are likel y to be

helpful in removing neurotic symptoms .

The starting poin t of this kind of tr e atm ent li e s in

getti ng thoroughly acquainted with each individual
57
patient learning about the circumstances of his life
,

and th e reasons for th e fixation of the neurotic s ymp

toms A s a result of this preparatory work the pati ent
.
,

usually assumes a positiv e attitude towar d group

meetings with the physician .

Th e purpose from the p h ysician s point of V iew

,
’

of the first talks with a group of patients is to over

come th eir unsoun d interpretation of their own ill
ness insofar as it creat e s th e mood of depression and
,

prevents the mobilization of available defense m ech

an i s ms A ccordingly the p h ysician tries to di vert their
.
,

attention to oth er things above all to early signs of

,

r e covery To achi eve this he devot e s a couple of

.
,

talks to detail s of tr eatment an d patt e rns of better

mental health .

The s e patterns include : ( a ) a gradual all e viation

of symptoms of th e disease ; ( b ) a wave lik e succession -

of h ealth improvements and d e teriorations in th e

’

patient s condition on the background of a slow

restoration of normal attitudes ; ( c ) a favorable turn
in general condition with the w e ak ening of and ,

occasional ch ange in symptoms ; , disapp earance

of the manife stations of sickness in th e presence of
positiv e emotional experiences ; an d ( e ) th e appear
ance of p eriods characterized by strong att empts to
act contrary to the habitua l fears and worries .

These pr elimin ary talks have usually a good effect

upon th e pati ents They b e come somewhat more
.

observant with regard to signs of improvement and

quite willing or even eager to di scuss them with the
p hysician .

Th e next st ep in thi s course of group psycho

therapy consists in a detailed open discussion with
58
each patient o f the con di tions of hi s lif e unf ortunate ,

infl uences traumatic episodes S ome time is d evoted

, .

al so to a critical examination of vari ous unhappy situ

ati o ns or events of the past and to possible cons ci ous

ch an ges of a ttitu de toward the sour ces of origin al

trauma Thi s is done by offerin g an anal ysis of typical
.

occasions for the formation of neur otic symptoms and

pointing out that most of th em arise as a res ul t of
overs tr ain ing the nervous system The se tal ks arouse .

a great de al of in terest among th e patients and thus

make the subsequent in di vidu al work with them much
e as rer .

A t this stage of group th erap y most patients are ,

anx ious to h ave more contacts with th e physici an and

are quite willing to tell hi m of specific happenings in
their life The success of this form of psychotherapy
.

depends to a certain d e gree on the p h ysician s pres

’

tig e as well as on his attentive interest in each patient .

I t is important for the physician also to touch upon

“
the questions connect e d with various di i culti es of ” ”

life an d to deal factuall y with the experiences of all

the participants By thi s time h e is regarded by the
.

patients as a hum an being wh o h ad an opportunity

to glance into their in ner world This impression goes .

a long way to overcome the belief so co mm on amon g

the neuroti cs that th eir pr e di cament and sufferings
are unique somethi ng that no one e lse has ever ex
,

eri enc e d It is only na t ur al that the p h ysician even

p .

“
,

with out asking any questions is able to guess what ,

”

is worrying his pati ents .

The crucial point at this stage of psych oth erapy

consists in this : that it provides an excellent oppor
tuni ty for h eart to h ear t relati ons with th e patients
- -
.

59
E motional reconstruction is often readily observed at
this tim e It is the job of the p h ysician to encour age
.

and str ength en th e process .

D uring the thi rd and fin al stag e of psychotherapy

th e p hysician s h ould insist on the activ e participation
of all pati ents in th e cons tructive group work thus ,

diverting their attention from th e pr evious mode of

living th at is from the ir n eurotic b eha vior The gen
, , .

eral dir e ction of the physician s comments at this

’

time points toward the unconditional importance of

the pati ent s r e turn to employm ent as t h e best pos
’

sible r em e dy .

The l e ss the pati ent thi nks of himself an d hi s fe el

ings th e mor e succ e ssful b e com e s the tre atm ent The
, .

last talk comp l eting the course of group therapy is

devoted to the prev e ntion of possible di sappointment
among th e patients th at th e talks ar e ending w hile
they still h ave some signs of pathology .

L ong e xp erienc e in the us e of the m e thod de

scrib e d above h as convinc e d us th at group therapy
has many advantag e s ov er individual treatm ent F or .

one thing it permits an imm ens e incr e ase in the e x

,

t ent of m e di cal s ervice It offers exc ellent op portuni

.

ti e s for the p h ysician to establis h good contacts with

his patients with in a short period of time ther eby ,

raising th e chan ces of favorable dev elopm ents E x .

p l an ator
y talks conducted by t h e p h ysician pr o ve to
be v ery convincing and ar e appreciate d by the pa
ti ents as providing serious sci e ntific information rat h er
th an just routine consolation .

In s h ort group psych otherapy makes it incom

,

p ar abl
y e asi e r for th e p h ysician to put at th e d isposal
of h is pati ents various ways and means of counter
acting and all eviating their o w n symptoms .

60
 M E T HODO L OGY OF SUGGES TI ON I N THE
WAKI NG S TA TE

by I S Sumbayev
. .

( Irkut s k )

S ugg e sti on and auto sugg e stion can be achi eved

-
,

as is well kn ow n w ithout resorting to hypnosis that

,
‘

is in the w aki ng state Th e m ethodology of hypnosis

, .

and of suggestion during it h as already been th or

oughly investigated ; but th e methodology of s ugges
tion in th e w aking state has never before been
seriously s tudied A nd yet th ere is no longer any
.

doubt th at it can be of considerable h elp in extendin g

th e ben efits of psychotherapy .

S ome of th e early scholars in the fi eld ( A A . .

Li ebault H B em heim A A Tok arevs ky V M

,
.
, . .
, . .

Bekh terev A F or el etc ) w ere able to show that

,
.
, .

particul ar ly r e sponsive indi viduals und e r the influ ,

enc e of waking suggestion can successfully d emon ,

strat e a number of int erestin g ph enomena such as ,

cat al epsy automatic movements an e s th esia hall uci

, , ,

nations etc — whi ch often aris e und er hyp nosis It was

, . .

al so observed t h at exceptional sensitivi ty to wak i ng

61
s uggestion is found mainly in in d ividuals previously
subjected to hypnosis .

A s to auto suggestion it has been long known

-
,

that it occurs as a rul e in th e wakin g state par ti cu ,

l arly among those sufferin g fr om hysteria where it ,

is responsible for a great variety of neuro psy chi c - .

deviations so typical of th e di sease .

I n th e c onstructi on of the me thodology of waking

suggestion it is desir able to ke ep in mind that hyp
,

nosis as suggested sleep is but one of several pos

, ,

sible techniques of sugg e stion sinc e it can also assume

,

the form of suggested in toxication suggested e cstas y

, ,

suggested depression etc , .

Waking suggestion should fulfil l in our opin ion , ,

two essenti al conditions namely : ,

( 1 ) that it should not result in hyp notic sleep ; and

( 2 ) th at it be capable of effectin g essenti al ly the
sam e ph e nomena which are commonl y observed under
hypnosis .

Af ter considerable pl an ning and experimentati on ,

we have arrived at the foll owing rules and procedures

adequat e ly meeting the scientific p ur poses of wak ing
suggestion .

’
I t is always conducted in an ordin ary physicia n s
o ffice in the daytime and without any special pre
cautions with regar d to ligh ting or noises Th e patient .

is usually sitting completely fr e e to ch oose hi s pose ;

he is even p ermitted to move about if he so wis hes ,
.

N o third p erson is pr e sent though we do not ascribe

,

any particular significanc e to th is fact as long as there

is no interfer ence .

H owever we di d once demons trate waki ng sug

,

62
produce di rectl y some su g g e sted p h enomena worth
investi g ating for inst ance catalepsy amnesia or
, , , ,

hallucination .

Incidentally most of our patients —they are ma inly

,

alcoh oli cs and hyst erics— have never been exposed

to hypnotherapy and some of th em have not pre
vi ous l
y heard of such method of treatm ent .

I n conclusion let us cite a couple of e x amples

,

1 . G tw enty six years of ag e a victim of

P ati ent -
,

traumatic epilepsy H e was placed on a sofa wi th his

.
,

ey es open H e w as repeatedly told th at he w as wide

.

awake and did not want to sleep Ther e were alto .

gether three sessions of waking suggestion separated ,

b y intervals of ten minute duration A t the end of .

each session various questions were ask e d .

F irst s ugg es ti on Th e patient was told that h e

.

hear d music and felt quite sad H is facial expr e ssion .

assumed the exp ression of sorrow and th ere app e ared

tears in his ey es A t th e end of the session h e r elat e d
.

his exp er iences wi th plainly noticeable feeling .

S econd s ugg estion It was suggested to th e patient .

that he just had a sm al l glass of vodka ( actually it

was pl ai n water ) H e downed th e drink wi th an ap
.

ro ri at e facial e x ression L ater on while w a lking

p p p .
, ,

he w as un steady on his feet .

Third s ugges t ion Th e patient was informed th at .

hi s left hand w as rising to touch his for eh ead and no ,

matter how h ar d he tri ed it would remain in that posi ,

tion until he would b e told to remove it Th e sug .

gestion was ob eyed w ithout any di culty 1 .

2 Patient P for ty nine year s of age D iagnosis

. .
,
-
.

chronic alcoh olism H e nev er was subj e cted to hyp

.

nosis but saw a few years before a demons tr ation of

,

64
it in a circus The usual sugg e stion to b e wide awak e
.
-

F irs t su
gg The patient
es ti o n . w as told he w as

falling backward and he di d Th en he was told to

, .

clasp both h ands tog ether and th at h e was unabl e to

,

s eparate h is fing ers no matt er h ow h ard h e tried H e

, .

was unabl e to do anyth ing about it until p ermitted ,

.

S econd s ugges tion Th e pati ent received the sug

.

g e stion to form t he s o call e d catalepti c bridg e be

-

twe en two ch air s He lat er ass ert e d th at he f elt so

.

s trong he could h old up weigh t a grown up -

65
 T HE RA P EU TI C M E T HODO L OGY I N
P SYCHAS THEN I A

by E K Yakovleva . .

( L eni n
grad )

M uc h has be en said and written concerning

psych asthenia ; but th is literatur e expr e sses all kinds
of vi ews on its psych og en e sis a nd offers many distinct
m ethods of treatm ent of which most impressiv e so
,

far is psych otherapy In disregarding wh at we beli ev e

.

to be wrong th eori e s of th e psychoth erapy of neuro

s e s we wis h to state that psych otherapy as rooted in
, ,

Pavlov s doctrin e of th e high er nervous activity h as

’

rec e ived its sci entific foundation only r e c ently .

Th e complexi ty of th e path ogenesis of ps ychas

theni a calls for th e use of fa irly complicated tech
niqu e s of tr e atm ent A par t from nutritional and tonic
.

m e dication psych otherapy is the principal approach

,

to th is condition and its main purpose is to clarify

,

the circumstanc e s of lif e und erlying th e d evelopm ent

of the disease .

The meth od of psych oth erapy used by us h as be en

built around the g enetic understanding of n euros e s as ,

d ev elop e d by V N M i as s is chev It consists primaril y

. . .

69
in th e study of th e patient s previous experience in so
’

far as it has bear ing upon the development of his

“
n eurotic condition M an s experience says V N
.
’ ”

,
. .

M i as s is chev rs determin e d by h is attitud e s toward

,

r e ality ; th ey are form e d in th e process of growt h and

maturation an d play an important role in h is s ubs e
quent actions and reactions to life .

Th is appr o ach to p sych otherapy und erlies our

treatment of psychasthenia ; but in certain cases ,

d ep e nding on the form of the neurosis and its dura

tion it m ay b e advantageous to t urn to such supple
,

mentar y methods as suggestion and hypnosis Th eir .

use may be indicated for instance in th e presence

, ,

of hi gh excitability or negativi sm as s h own by E A , . .

Popov .

A ph ysician employing psychotherapy buil t on the

,

genetic interpr etation of n euroses examin e s first of all ,

the pati ent s case h istory an d clarifies with in his own

’

mind th e peculiarities of the pati ent s ch ar act er in his ’

r e actions to various circumstances of life and especially

to the h app enings s erving as precipitating causes of
th e sickness This information is suppli e d largely by
.

the pa ti ent hims elf but may be sup p lemented by hi s

,

relatives Nev erth eless such informati on does not

.
,

quite s u ce to d et ermin e the cause of the pati ent s

i
’

disease C onsequently the gath ering of an amn estic

.
,

data must not be merely formal ; nor can it be limited

to simple comments r ef erring to certain ev ents in
th e pati ent s life M or e important is th e clar ification
’
.

of h is atti tud e toward e ach event r el evant to his

di i culties ; and it is not so much th e event itself
th at matt ers as the patient s interpretation of it ’

Indeed it is th is incorrect evaluation of events that

,

70
that the patient h ims elf would be abl e to appr e ciate
it and r e c eiv e it in the righ t spirit .

Th ere is an oth er way of saying this E ach process .

of psych oth erapy has another side that of a gradual ,

r e e ducation of the pati e nt l e ading h im to t h e recon

-
,

s truction of his emotionally dis turbed relations with -

the world into more wh olesome and more satisfactory

on e s Th is proc e ss of r e construction of alterin g the
.
,

patient s h abi tual r e actions c an oft en b e emin ently

’

succ e ssful but n ev er e asy

, .

R e e ducation as a form of psyc h oth erapy built

-

“
around the patient s practic e of life was advocated
’

as early as P B G annus hki n But it was V M

. . . . .

“
B ekh t erev wh o gav e this meth od th e nam e of tr eat
m ent by re e ducation K I Platonov d eveloped it a
-
. . .

step farth er by pointing out th at it calls for precise

recogni tion of th e causes and conditions of th e dev el
oping neurosis .

O f gr e at importan ce in this process of re educati on -

is self education that is to say learning h ow to dis

-
, ,

ci l i n e ones e lf to be cri t i cal of ones e lf to r e ulate

p ,
g ,

on e s own conduct Thi s was cl early and explicitly

’

stated for th e first time by I P Pavlov w ho found . .

th at such s elf und erstan ding and self control giv e th e

- -

pati ent both a motive an d opport unity to g et adjusted

to his s urroundings .

Th e soundness of the se vi ews was fr e quently con

firm e d by our pati ents th ems elv es after th eir r e cov ery .

“
One of th em sai d for instance A ll my life I was
, ,

l iving by feelin gs and only now I h av e le arn e d to

“
r e ason Another one wrote I am no longer a slav e
.
,

to my w e akness e s I am my own master an d I se e

.

ev eryth ing in an entirely di fferent ligh t .

72
 P SYCH OTHE RA P Y I N P HO BI C S TA TES

b y A M H al ets ky
. .

( As trakha n)

Th e stu dy of p h obias brin gs out clearly th e path o

“
g enic role of isolated sore points O nce th e state of .
”

fear is formed under certain environmental condi tions ,

the r e sponse is readily fixated in th e form of pathol o gi

cal con di tioning Th is fact was oft en mentioned in
.

the works of I P Pavlov M K Petrova A G

. .
,
. .
, . .

Ivanov S molensky B N Birman E A Popov N P

-
,
. .
, . .
, . .

Tatar enko and others

,
.

S ome ph obia s ar e qui te sim p l e in th eir etiology .

To th is cat e gory b elong the p h obias of actors l e c ,

t ur er s and musicians wh o h av e to fac e a d is criminat

ing audi enc e This form of p h obia usually originates
.

in som e fai lur e of m emorization causing the feeling

“
of p ani c stoppage of th ough ts as well as exc e ssiv e
,

p erspiration an d pallor S ubs e qu ently on sim ilar c c

.
,

casions there arises fe ar th at the failure may repeat

,

its elf Th is exp e ct e d reaction unless ov ercom e be

.
, ,

com e s h abitual and increas e s with th e approach of

the mom ent of responsibility A s a result desir ed .
,

actions become inhi bited m emory fails ,

.

73
 The followin g cas e will illustr ate the problem .

Patient Y born in 1 929 a rh apsodist I n 1 9 49 he

.
, , .
,

was chided by a teach er in the sch ool of music for

a mistake in playin g an d told to restudy th e assi gned
piece But the next tim e the error occurred in the
.

s ame p lace The t e acher becam e angry declared that

.
,

the s tudent was doing this deliberately and thr e at ,

ened to fail him unl ess th e mistake was corrected .

But the mistake occurred again and again always in ,

the same pla ce even while the stu dent was practi sin g
,

at home There appeared also sudden relax ations of

.

fi ngers .

Psychotherap y resulted in a considerable improve

ment Th e patient w as able to play perfe ctly w ell by
.

hi mself an d before a fam iliar audience ; he even

p articipated in a group performance at a club But he .

was never able to play the p i ece solo .

The task of elim inating such p h obic in h ibitions is

by no me ans simple Th e patients in turni ng to a .
,

p h ysician for help us uall y are aware of the origin

,

of the phobic s ymptom but tend to minimize the ,

p ath ogenic role of the original experience whi ch any ,

way h as in the meantim e lost its signific ance

,
.

E xercis e s along th e same lines are not advisable ,

for th ey retain the same path ogenic power to cause

e xcitement and inhibition The pati ents must be told .

that attempts at vigorous self control c an be of no -

avail A ny pra ctice s h ould be preceded b y systematic

.

reduction of mental ten s ion It i s w ell to recall in .

this connection K S Stanis l avs ky s advic e found

. .
’

in h is M y Life in Art A ll muscul ar tension h e said .

, ,

must be eliminated by an actor about to come out on ’

the stag e Th is isn t easy E ven a sligh t muscular

.
’
.

tension interferes with fre e dom of moti on with ade ,

74
quate gestures K S S tani slavsky jus tly urged elimina
. . .

“
t ion of clamps on the nerves .

Th e common fault of many actors lectur ers mus i , ,

ci ans— of everybody suffering from the fe ar of memory

fail ur e or proper tim ing—cons ists in thi s th at all ,

exercises worrisome expectations s tr enuous efforts to

, ,

overcome the unhappy s ym ptoms m erely r ais e the

state of tension which in its tur n negativ ely s timu
, ,

lat e s cortical ac tiviti e s an d in terferes wi th normal

automatis ms To e liminate such stubborn di icul ti es
"

on e s h ould resort to exercis e s under relaxed domes tic

conditions This is done in the followi ng m ann er
. .

Th e pati e nt sits down in a ch ai r making h ims elf ,

comfortable H is mov em ents s h ould be slow e d down

.
,

while the muscles of hi s arms legs and neck are ,

permitt e d to relax Th ough ts in h is h ead s h ould al so

.

assum e an even un h urri e d ch aract er A s to emo

,
.

tions and volitions th ey too s h ould enter the state

, , ,

of r elativ e eas e and p assivity To forestal l any possible .

di sturban ces as in playing a musical instrum e nt the

, ,

atti tude of calm ness must b e gradually d eveloped .

N o effort of will to m eet an accid ental di h culty or

interferenc e is permitted E ach acti vity suc h as play.
,

ing an ins tr ument r ehe arsal for a p lay or r e citing

, ,

a po em is cons e qu ently done only after a consid erabl e

,

prep aration along the lines in di cat e d above O ne s

’

att ention must b e entir ely absorb e d in li ving a rol e ,

in the sounds of a m elody If an actor h app ens to b e .

forced by f e ar to abandon acting on the stage he ,

must go through all the st eps of actin g in front of

hi s friends and acquaintanc e s c hildr en audi enc e s or ,

app e aring in sm al l clubs befor e he permits him s elf ,

to r e turn to th e stag e Prior to e ach ap p e ar anc e h e

.
,

s h oul d ag ai n go through every m e ans of freein g him

75
 self from worry or tension and r e duc e th e vigor of hi s
g e stur es and oth er motions A lectur er is also urg e d
.

to pay attention only to a few basic points of hi s

spe e ch and to talk c almly slowly avoiding loudness
, ,
.

I n talks with patients th e psych oth erapist tri e s

,

to explain th e significance of psych as th enic reactions

in the origin of p h obia and s h ows the ways of
str ength ening on e s will an d self confi den ce by utiliz
’
-

ing examples taken from the pati ent s own life The ’

p hysician comm ents also upon the formati on of path o

logical conditi on e d links and upon th e mech anism of
in ert irradiation To be effective he must always h ave
.
,

a s u ci ent supply of convincing exampl e s and

f
i

arguments .

Psych otherap eutic action is somewh at more com

pl ex in p h obias originating in inner confli cts which
in th eir turn are caused by a clas h of stimulating and
inh ibiting processes within th e pati ent s personality
’

Unfortunately th is probl em h as n ev er b een s u ci ently

,
r

studied p erh aps b e cause it r e adily r eminds us of the

,

psych oanalytic the ory of repression .

S impl e m eth ods of psych otherapy are even less

lik e ly to succ e ed in p h obias of hypoch ondriacal typ e .

S uch pati ents may be afraid to go out after dark

b e caus e of occasional giddin e ss attacks of tachycar di a
, ,

or b e caus e th ey suffer from nyctophobia .

A c ar eful study of the ailm ent may s h ow in s uch ,

‘

cas e s a chr onic infection leading to various auto

,

nomic dis turbances R ep eat e d temp eratur e m e asure

.

m ents may s how a sligh t fev er Th e pati ents may .

com p lain of chills exc e ssive p erspiration p erio di c

, ,

w e akn e ss loss of weigh t r e curr ent colds insomnia

, , ,
.

Quit e oft en th e sourc e of such troubl e s lies in chronic

tons illitis .

76
 Any psychotherapeutic measures mus t go in these
cases tog e th er with antibiotic or an tiallergic medica
ti on The idea s h ould be giv e n up tha t every com
.

pl ai nt of a neurotic is nec e ssarily psych ogeni c in

origin Th e possibility of a somatic background of
.

certain neuroses among them of p h obias is often

, ,

overlook e d by th e psychiatri sts A s a matt er of fact

.
,

th e pati ents s h ould som e times be told of th e possible

in te rrelati ons h ip betw e en somatic illness and psych o
g enic symptoms for th ere are now and th en or g anic
,

reason s for excessiv e f e ar s an d unre alistic expecta

tions Th is h elps the patient anyway to trust his
.
, ,

doctor a little more and enables him to underst and

the purpose of the treatm ent .

The patient with psychogenic somatic disturban ces

is particularly s ensitiv e toward what his physician
do e s or pr e scrib es He r e s ents th e advice of a doctor
.

“
sayin g not to worry about in ternal sensations or ”

to stop thinking about his h e alth for all this is ,

pr e sumably nothing but nervous ness H e someti mes .

leav e s th e physician wi th the fe elin g that his experi

en ces an d feelings wer e di sregarded .

Psych oth erapy can never be limited to several

unifo rm patterns of treatm ent such as persuas ion sug
, ,

gestion hypnosis and th e like F orms of n e uros e s

, , .

are rich in vari e ty E qually rich should be th e

.

availabl e methods of p s ych otherapy and th eir

combin ations .
THERA PY OF CE RTA I N F ORM S OF HYS TE RIA
by Z A Kop il —L evina
. .

( N ovos i birs k)

Therapeutic problems in certai n functi onal di s

orders of sensations and speech have never been
su ci entl investi gated A s a matter of fact th e re
y .
,

still ar e a few old fashion e d physicians retaining the

-

unwarranted a t titude toward such patients as peculi ar

an d unsociable c h aract ers .

We have had an opportuni ty to study quite a

numb er of these patients some with di sturbances of
,

long duration wh o have not yielded to ordinary

,

methods of psychotherapy O ur observations have

.

b e en conduct e d on 37 7 clini c al cas e s an d ninety s even

-

exp erim ental cases A s lat e as D ecemb er 1 94 1 we

.
, ,

propos e d that the g en eral disturbance of ski n s ens r

ti vi ty around the d efective sense organ be regarded as
a definite di agnostic si gn of functional di s turbance .

Thus in full de afness of both e ars one often observes

,

the anesthe tic condi ti on of the conch ae ; in partial

deafn e ss hyp e sthesia may accomp any it In cases of
.

on e sided d e afn e ss anesth esia or h ypesthesia are

-

lik ely to be confined to th e correspon di n g ear .

78
transition from pronouncing separate sounds to pro
nouncin
g sylla bles
,
words and p h r ases O,
ur met h od .

replaces this procedure with one conducted in the

state of hypnoti c sle ep ; or else following th e way of ,

B em heim and Bekh ter e v the patient is placed in a

,

lying position wi th closed eyes and in d ar kn ess A s a .

result the full restoration of speech is usually ach iev e d

,

in one or tw o sessions In cases of mutism accompan i e d

.

by th e di sruption of the entire speech mech anis m in

th e form of adynamia ( ins u i ci ent movement of th e ’

tongue and mouth muscles tog ether wi h analg e sia )

, ,

we seldom succe e d in bringing about pronunciation

of sounds or syllabi through a s rmpl e verb al com
mand But we do att ain this p urpose by op ening th e
.

patient s mouth and askin g h im to utter the fir st

’

vowel sound by tak ing a deep br e ath and exh aling ,

and by s haping th e lips in a proper way Th is addi .

tion of tacti le an d motor compon ents to sounds results

usually in quick r e storati on of sp e ech .

In cases of th e d e af and dum b we first restore

- -
,

hearing and then speech Th e s ame ord er of succession

.

is followed also in dysp h onia and stuttering com

bin e d with deafness .

In every instance of disturbance of h earing th e ,

m eth od of stimulation as d e scri bed above proved to

, ,

be b eneficial in the fi rst session R eturn of spe e ch in .

mutism an d dysph onia required one or two sessions ;

and correction of stuttering called for as many as
thr ee or four s e ssions .

This method has been found effectiv e also in the

work of other specialists— psychiatrists n europatho lm ,

gists otolaryngologists op h thalm ologists among th em

, , ,

A S C his tovi ch and O I Shers hevs k aya

. . . . .

Let us consider th e follow in g case .

80
 Patient G twelve ye ar s of age had poor vision
.
, ,

for s ev eral years H e was given eyeglasses and had

.

to sit in th e first row at sch ool In 1949 he d evelop e d .

inflam mation of th e ey elids ; as a result he became ,

practically blind H e no longer could read write or

.
, ,

even recognize objects ; h e h ad to grope to move

about Wh en transferr e d from a N ovosibirsk hospital
.

to our clinic the boy und erw ent a c ar eful examin a

,

tion We di scov ered analg e sia e xactly correspondin g

.

in form to th e glasses N o organ rc damage to eith er

.

the organs of vision or th e nervous system could b e

d et e ct e d Th e diagnosis w a s : hysterical blindn ess
. .

The boy s eyesight was fully regained wh en th e

’

analg e sic region was r e stor e d to sensi tivity by s tim u

lation C atamnesis for sev eral y e ars remained positiv e

. .

CON CLU SIO N S

1 A nesthesia i n th e peripher al region of sensory

.

organ s when it follows th e loss of th eir fun ction

, ,

ap pe ars to b e a d efi nite diagnostic sign of a functi onal

an d consequently correctible di sturbanc e usually aris

ing as a r e sult of inerti a of prot e ctive inhi bitions .

2 In functional disord ers of th e sensory or g ans

.
,

spe e ch paralyses an d contractur e s of limbs we c an

, ,

r e comm end th e meth od of functional restoration of

th e affe ct e d sense organ s by m e ans of arousing th e
s ensitivi ty of th eir p erip h eral p arts .

81
 C O M BI NA TI ON OF P SYCHO T HERAP Y WI T H
M E DI C I NA L S LEE P

by O . R . Chi tava
( Tbilisi )

In di vidu al ps ycho therapy as the basic method in ,

the treatment of neuroses must be built around thr ee ,

factors : qualities of the patient s personali ty the ’

form of his ill ness an d its causes , .

The specific feature of hum an neur oses accordi n g ,

to I P Pavlov is the involvement of th e secondary

. .
,

si gnal system It plays a major role in the origin and

.

pro gress of the disease in some cases retar di n g its ,

development in others acceleratin g it

, .

K I Pl atonov s experiments have demonstr ated

. .
’

that verbal suggestion may alter the metabolic proc

esses an d activities of the internal organ s S p eech .

therapy ( A G I vanov S molensky ) is the outgrowth

. .
-

of these id e as .

S tartin g from the principle of combinati on trea t

m ent of n euroses and avai ling ourselves of A D . .

Zur abas hvil i s suggestion w e subj e cted t w en ty pati ents

’

to psych otherapy combined w ith ext end e d ni ght sleep .

The patients in this group suffered from neuroses of

82
the followin g types : hy steria psychas thenia phob i as , , ,

hypochondriac syndromes and compulsions The dura ,

.

ti on of their sickness ran ged from one month to two

Af tera careful clinical examin ation an in di vidual ,

regimen w as prescribed to each patient A ss uming .

that every neur otic condi tion h as both ps ychogeni c

and s omatic components medication treatment ( glu
,

cose vitamines s try chni ne etc ) was prescribed in

, , , .

all c as es to s tren g then the or g anism On the first day .

of treatment the physician conducted an explan atory

,

tal k on varieties of nervous sickness its causes and ,

Ps y chotherap y
b e g an only after a full contact ,

i ncludin g mutual trust w as established between the

,

physician and hi s patient Th e ch oice of tr eatment.

depended on the natur e of the di sease patient s age ,

and his intellec tual and cul tur al char acteristics To .

prolong night sleep barbiturates were used The

, .

length of night sleep varied from ten to twelve hours .

Th e wh ole treatment continued from two to three

weeks .

The followin g variations of treatment wi th ex

tended sleep were used :

1 . M e di cinal
sleep for sever al day s followed by ,

psych otherapy This var iation was employed when

.

ever the element of inhibition w as conspicuous in

th e cli nical picture ( for instanc e in p h obias an d ,

hyp ochondriasis
2 M e di cinal sleep preceded by a few sessions of
.

psychotherapy to weaken neurotic sym ptoms and to

quiet th e patient down This sort of treatment was
.

used in hysteria and gen eral excitabili ty .

83
 3 . The tw omethods of treatment conducted s imul
t an eo us ly to the end .

The combination meth od of tr e atment on the ba ck

ground of extend e d nig ht sleep prov e d to be most
successful in psychasth enia co mpulsions hypo chon
, ,

dri as is and some forms of p h obia In cas e s of hysteri a

‘

.
, ,

when the pati e nt s activities were at a low level

’

m e di cin al sleep was alternated with waki ng suggestion

or hypnosis .

The treatm ent had a m ar k e d positive effe ct in

fourteen cases N oticeable improvement w as obs erved
.

in a f e w in stanc e s after tw o or thr ee days .

The succ e ss of psych oth erapy combined with ex

t en sive nigh t sl e ep can be exp l ain e d in this way
Under the influence of sl e ep th ere is strengthening of
,

the protective forces of the org anism leading to a ,

better tonus of th e nervous syst em The s e ch ang e s

.

cr e ate favorable opportuniti e s for psych otherapy R el e .

vant suggestion under such conditions mak e s it

, ,

possible to stimulate certain areas of th e cort ex ; thi s

s e ems to precipitate n e gativ e ir ra diation thus h elping
to weaken the pathogenic centers of excitability .
 THE M E T HOD OF I ND I REC T SUGGES TI O N
AS USED I N HYS TE RIA

by Y . L . S chreiber
( Leningrad )

We use a form of indi rect suggestion ps ychother

a
py to remove t h e fixated sym ptoms of hysteria ot h er ,

wise unyielding to ordinary metho ds .

A week b efore treatm ent starts th e pati ent is ,

informed at consid erable length that his illness is

functional in ch aracter di stinguis h ed b y conversion
,

p h enom ena Th e pati ent is assur ed however that h e

.
, ,

is to be treate d in a manner th at will be of consider

abl e h elp After spendi ng several days in exp e ctation
.

“
of th e medication in t ended to remove the s ymptoms
”

of h is ailment th e patient is conducted to th e tr eat

,

ment room and invit e d to li e down on a couch H e is .

“
then informed that th e medicine will be poured
slowly on a special mask and assimilated by his
organism by m e ans of br e athing in the evaporating
drug He is fur th ermore assur e d th at th e substanc e
.

brings no unpleasant reactions wh atsoev er such as ,

nausea or headache Thes e r emarks help consid erably

.

to avoid any possible complications arising in auto

85
suggestion The patient is then told in a m anner
.
,

w el l adjusted to the level of his education that he ,

will feel much better that the symptoms of his di seas e

,

ar e a product of corti c al inhibition and th at the dr ug ,

b ein g a powerful stim ulating subst ance is intended to ,

remove the inhibition It is explained for instance

.
, ,

that th e pati ent s hyperkin esis is determined by excita

’

tion of brain cells and that the drug by calm ing the
, ,

nervous system puts them back into a normal state

,
.

Imm e di ately after this a regist ered nurse begins

,

to pour drop by dr op some aromatic liqui d such as

, , ,

m enthol di ssolved in a lco h ol on the mask already ,

on the patient s face The whole proc e dur e of treat

’

ment takes no more than ten minutes In th e mean .

ti me, a di scussion is conducted with some other

physician concerning th e effectiveness of the treat
ment with whic h th e latt er concur s Th ey poin t out
,
.

that th e drug has an excell ent effect upon the nervous

system and is capable of r emovi ng many pathological
mani festations N o remarks ar e addressed di rectly to
.

the patient ; from the very beginn ing of th e treatment

he remains a passive lis ten er to th e conversation con
duct e d only b e tw een th e two p hysicians : the conversa
tion is a ctually a ques ti on of in di r e ct suggestion .

Thi s m ethod of tr e atm ent h as b e en used by us for

a great v ariety of symp toms inclu di ng h yst eric al con
,

tract ur e hyp erkin e sis parti al paralysis astasia abasia

, , ,
-
,

mutism an d persistent vomiting

,
.

Wh er e as in oth er forms of psych otherapy th e

authority of th e physician is of great importan ce if ,

s e en in the totality of relati ons betw een hi ms elf and

his patient in th e meth od of indir ect sugg estion
,

there are addi tional el em ents of autosugg e stion— the

“
patient s faith in th e effective ch aracter of the medi
’

86
 M ost patients , on completion of th e treatment ,

react strongly to the restoration of the lost function ;

some of th em become even euphoric as the emotion al
background of experience enters the stage of recon
str uction In some instances patients fal l asl e ep for
.
,

several hour s almost immediately aft er removal of the

mask apparentl y und er the infl uence of the exhaustive
,

emotional experience an d protective inhibiti ons Th is .

sleep seems to norm al ize basic n eural processes and

to raise the functional power of cortical cells .

In quite a few cases of cured hyst erical par alys i s

or astasia abasia the patients d evelop moderate p ain s
-
,

in th e e xtr e miti e s on completion of treatment ; but ,

consid ering the previous condi tion of a long dur ation ,

this s e ems to be rather natural These pain sensations

.

usually last for on e to t e n days th eir durati on being

,

roughl y proport ional to the duration of the pathol o gi

cal state To prev ent this complication we employ
.
,

massage of th e limbs prior to the treatm ent .

A n important qu e stion of principl e must not be

disregarded in connection with this meth od of indirect
suggestion th erapy To wh at extent is me di cal ethics
.

compatible with the us e of an indifferent substance

while it is supposed to be a valuabl e me di cati on ?
I n each concrete case the physician must d ecide
,

for hims elf as to th e m e thod of treatm ent In in di rect

.

suggestion therapy th e p hysician s words are of great

,
’

and real ben e fit to th e pa tient Is it righ t to abst ai n

.

from uttering th em ? Is it righ t to leave the p ati ent

sick wh en he can be cured ? M oreover if the gravely
,

sick individuals must b e told nothing but tru th they ,

are needlessly burd ened with iatrog eny .

88
 ON THE P SYCHO T HE RAPY OF
P SYCHOGEN I C I M P O TENCE

by I M Apter . .

( Kha rkov)

By psych ogenic impotence w e und erstand v ar ious

functional disturban ces of th e activity of th e m al e
sexu al organs expressing themselves in the loss
, ,

weak ening or some oth er deviation from th e normal

refl ex process e s contr olling er e ction and ejacula tion .

Th ere were altog e th er 220 patients of thi s kind

under our obs e rvation The gr e at majority of them
.

were in the age group betwe en twenty and

forty M ore th an h alf of them ( 1 26 ) were married
.
,

th e r e st ( 94 ) were not .

Th e total clinical picture wh en broken down by ,

symptoms may be represented as fol lows :

,

F u nct ion a l d is tur ban ce

Lo ss o r w eak ness o f t h e refl ex o f er ec ti o n

Inh ibi ted erec tio n and ej acul atio p raecox

N o rm al erec t io n an d e acul a ti o
j p raeco x
Lo s s o f er ec t i o n an d l
sex ua i n d i ff er ence
P sych i c as p ermatis m
89
 Q uite a few o f the pa ti ents developed disturbance
of sexual activi ty clear ly on a g eneral n eurotic basis .

A number of them enjoyed a period of satisfactory

sexu al relations in the past ; three men were married
happily for a number of y ears compl aini ng of no ,

previous impotence But on the whole every one of

.
, ,

th e patients acknowledged some inadequacies of his

sexual experience .

M ost patients had but a sin gle s ymptom of sexual

inadequacy In the common background of neur osis
.

there was much mas turba tion in adolescence and

youth extensive and recur rent fe ars of ven ereal
,

disease contin ual practice of coit us interruptus during

,

the marria ge period Several patients had to s h ar e

.

their room with married couples an d apparently did

not feel sexuall y at ease .

L et us now briefly consider the problem of medi cal

treatment The prin cipal m eth od of h andling cas e s of
.

psychogenic impotence is of cour s e psych otherapy , ,

.

M ore specifically exp lanation and persuasion must

,

be used extens ively ; in cases of p ersistent worries ,

some technique of distraction may be advisabl e .

But the choice of tr e atment is never e as y M any .

factors hav e to be considered : the characteristics of

impotence etiology individu al peculi ar ities of the
, ,

patient s organi sm the state of h is h ealth In some

’

,
.

cases the measures am ount only to protectiv e ther

,

a y; in oth er cases they aim at s timulation

p ,
.

In this connection our own patients were exten

,

s ivel e
y p x osed to waki ng suggestion ; in some inst ances

the state of drowsiness was preferred The method of .

hypnosis was employed but seldom S ome physi other .

a
py and pharrna co therapy w as used concurren tly .

90
to abstai n from s e xual r elations for about two or three
month s N o s timulants wh atsoever were permitte d
.

durin g the period .

We employed waking suggestion th erapy in cases

where s exual approac h was accompan i e d by fears and
worries an d tri e d to instill self c onfi dence in the
,
-

pati ent If it was known th at som e h ighly irritating

.

factor was responsible for impotenc e in the fir st place ,

we a rranged for a psych otherapeutic t al k to expl ai n

to the patient the p hysiological m e ch anism of his
weakness an d to r e commend proper coun ter m e asures -
.

If th e cause of impotence h app en e d to be con

n ect e d with a chang e in t h e habits of cohabitation ,

it was recomm end e d t emporarily to change the en

viro nm ent for in stanc e to take a trip
, ,
.

Quite often it was found useful to arr ange a t alk

with the patient s wi fe in h is pr e senc e during which
’

th e p hysician might comm ent upon th e temporary

cha racter of all psych og enic ailm ents an exc ellent ,

c h ance of recov ery and also upon th e V ital role of

,

the wife s conduct in the progress of recovery

’

O n the wh ol e th e process of tr e atment of patients

,

with psych ogenic im pot enc e may be analytic al ly

separated into s everal stag e s namely ,

1 . The first meeting : a frank talk between the

p h ysician and h is pati ent to calm th e latt e r d ow n ;
sugg e sti on of confidence in th e lik ely recovery .

2 R emoval of th e emotion of f e ar in an approach

.

to a woman .

3 Prot e ctiv e psychotherapy stimulating therapy

“

.
, ,

or di s tr a cting th erapy .

4 A vailing h im s elf of a convenient moment the

.
,
'
p hysici an finds an opportunity to t e st th e results of
92
the treatmen t,
’
as seen in the light of the patient s
condition and surrounding environment .

Psychotherapy of psychog enic impotence demands

much effort from th e p hysician examin ation of minute
,

details in th e case history; it calls also for much

patience and persistence on the part of both the
p hysician and the patient .

P ositive results are not expected in all instances .

I n the group obs erved by us there was complete

,

r e covery in fi fty six percent of the cas e s and a definite

-

improvement in t wenty thre e percent

-
.
 P SYC HO THERA PY I N TH E
M ED I CO P EDAGOG I C PRAC TI CE
-
OF
A CH I LD P SYCHIA TRI S T

by N G Ves hapelli
. .

( Tbilis i)

It must be regretq y admitted that the role of

psych oth erap y is not suffi cientl y appreciated in the
field of the medico peda gogi c activity of the physi
-

ci an s workin g aroun d the sch ools and t rying to pre

vent or tr e at neur otic ailments I t ought to b e .

rememb ered in this conn e cti on that the peculi ar ities

, ,

of the cortical n eur odyn amics of a growing or ganism

make th e chil dren s nervous system highly sens itive
’

to endogenous traumata aris ing in fami ly tr oubles ,

errors of upbringing over ex ertion and the like

,
-
,
.

O ur p hysiologists have demonstrat e d a close rela

ti ons hi p be tween functions of the nervous system an d
th ose of in ternal organs and this is p ar ti cularly oh
,

vion s durin g c hildhood C onsequently various somatic

.
,

gri evanc e s such as infections and toxic conditions

, ,

h ave intim ate bearing upon functional chan ges in the

nervous syst em of ch ildr en .

Childr en wh o h ad the misfortune of sufferin g at an

94
 betw een the chil d s org an ism and dem ands of his
’

ti e
surroun din gs someh ow break dow n The lowered .

responsiveness of the child as thenizati on of his organ

,

ism as a res ul t of a series of il lnesses or organ ically ,

det ermined fun ctional inadequacy of the nervous sys

tem lead to reduced adjustability of his organism to
ordin ary requirements of everyday environment .

Wrong con di tions of h ome educati on un usual pr e s ,

sure imposed upon hi s leisure tim o —as when the L

p arents insist that the child in additi on to routine ,

sch ool s tudies s h ould also go to a school of music

, ,

even thoug h he m anifests no inclination for i t— int er

fere w ith his peac e of mi nd Al l this is likely to .

und ermine the pattern of his habits r e duce e ciency ,

n
,

create fear of failing in examinations loss of s elf ,

confid ence and emo tional tensions Th ere may arise

, .

in th is way malfunction of hi s br ai n centers and

even tual ly a neur otic con di tion .

That is wh y ch il d psych iatrists as well as teachers

may play a v e ry im portant rol e in the timely reco gni
tion of early symptoms of a neurosis serving as sig ,
’

n al s of an un sati sfactory state of the child s mental

heal th .

E very child overwhelmed by impressions of the

,

day should sleep a suffi cient numb e r of hours every

,

nigh t so as to provide the cortex of his brai n wi th

a normal amount of rest F or sl eep as a source of
.
,

protective inhi bition is of very special si gni ficance in

,

supplying prophylactic measures to combat neurotic

dangers .

A rational order of the daily routine indi vidual ly ,

adjust e d and differentiated improv em ent in family

,

conditions of lif e normali zation of corti cal processes

, ,

an d balancing of organic he al th an d envir onm ental

96
stimuli and reactions— all these li e at the foun dation
of the medico prophylactic activity of the child
-

ps ych otherapist .

Th e main purpose of psych otherapy consists as ,

correctl y pointed out by V A G uili arovs ky V N . .

,
. .

M i as s i s chev G E S ukharev and T N S impson not

, . .
,
. .
,

so much in getting rid of n e urotic symptoms th em

selves as in re education with gradual elimination
-
,

of traits conducive to the formation of neuroses A t .

the same time we want consid erable improvement in

the conditions of study mode of life an d bo dil y
, ,

ex ercl s e .

It follows in general that an effi cient organiza

, ,

tion of psychotherapeuti c h elp to school chi ldren

must be made everywher e a p ar t of practical work of
al l medico proph ylactic and pedagogical i nsti tutions
-
.
 ''
P SYCHO THERA P Y OF CH I LD STU I I E RIN G
’

by N A . . Vl as s ova
( M os cow)

There are many different vi ews on the natur e of

stutt ering and the prop er methods of its treatm ent .

Neverth el e ss h owever di fferent be the interpretations

, ,

most auth ors agree that stutt ering stems bas ical ly
from a neurosis E ven the authors w ho used to reg ar d
.

it as a loc al cr am p treat it in their later works as

neur otic in origin Practically all psychi atrists t ak e
.

th e same position .

It is necess ary to a ckn owledge that in every

available m ethod of treatment of stuttering with ,

the possible exception of sur g ery one in v ar iably finds

,

elem ents of psych oth erapy They are foun d even .

am ong th e proponents of the didactic method wh o ,

support th eir en dl ess breathing and voice exerci ses

“
with talks and recorded advices exemplifi ed by Be
c al m bold and wakeful
, .
”

S tuttering has been regarded as a neur osis for

the last th irty y e ars and its treatment cons ists over
,

w helmingly in psych oth erapeutic talks .

“
V A Gui li arovs k y contends that psychotherap y
. .

98
was discussed ; but most s urprisingly Irene di d not
, ,

appear to mind it at all Instead of objecting to visits

.

to th e clinic she eag erly awaited them Withi n a

,
“

week she wh ispered to one of the supervisors th at

she would like to be praised by t he group H aving .

been told th at every praise must be deserv e d the ,

girl changed h er conduct even at h om e H er b eh avior .

toward the mother improv e d r emarkably and s h e was ,

finally lauded by the group At th e same ti me her

.

sp e ech b e gan rapidly to improve In the course of .

tim e Irene gr aduat e d from the sch ool an d eventuall y

, , ,

fromth e Institute of Architecture S he never stutt ered

.

again .

S ym pathetic talks within a group go a long way

to ov ercome both s tutt ering and the fears that und er
li e it A n o p portunity to speak with out s tuttering to
.
, ,

other chi ldr en during gam e s is so attractive to a

n eurotic ch ild th at vis i ts to th e sup ervised group
b e come more and mor e desir able ; and for that reason , ,

the effectiven e ss of this treatm ent increas e s .

Another psychoth erapeutic acti vi ty which makes

speech e asi er for the child consists in musical rhythmi
cal exercises known as l o gorhythmic and introduced
,

by V A G uil i arovs ly D uring these exercises spe e ch

. . .

is combined with music and motions A ch ild in lis .

,

tening to music together with oth er children does not ,

pay much att ention to speech and is thus enabl e d

to utt er words without self consciousness -
.

L et us make one more remark in conclusion The .

psychotherapeutic activities wi th chil dr en suffering

from stutt ering consist not only in special talks wh ich ,

may be som ewh at di h cult for pr e sch ool childr en to

understand but al so in v arious positive influ ences of
,

th e entire group of children in th e re education of

,
-

100
chil dr en through a mentally s ui table envir onment ,

and in th e professional organization of the entire

medico pedagogic process of speech recons truction
-
.

If every p hysician has to be a psych o therapist of

a sort so has every specialist in speech who en
,

counters s tuttering children It is well known indeed

.
, ,

th at a clumsily worded qu e stion a careless remark

, ,

or a th oughtless answer may do considerable damage

to the s ensitive psychology of th e sick .

Th us we come to see that psychotherapy when

us e d with childr en suffering from s tutt erin g is much
mor e than a mere verbal t e chnique : I t is a whole
system of measures design e d to achieve health and
person al ity improvement among ch ildr en with a real

10 1
 T HE ROLE OF P SYCHO THE RAPY I N TH E
TR EA T M EN T OF P SYCHOSES

by N V K antorovich
. .

( Frunze)

In spite of the fact that the psychi atrists have been

taki ng a very active part in th e study of theoretic al
and practic al problems of psych otherapy the main ,

ar eas of its app li cation have been so far neuroses ,

alco h olisms narcom ania psych oprop h ylaxis of child

, ,

birth certain somati c ailm ents etc A s to psychoses

, , .

in the narrower sense of th e word th e psychiatris ts

,

do not use much psych oth erapy or any special psycho

therapeutic methodologi e s in th e tr eatm ent of their
pati ents though th ey do at tribute considerable s i gnif
,

i can ce to the psyc h o th erap e utic effect of th e regimen

of mental hospitals their surroundin gs and personn el
, ,

relations with the patients .

In the study of p erio di c dis turbances of such

patients it has been definit ely established that among
,

the immedi ate caus e s of any excitement and the

general det erioration of the patient mor ale words ,

uttered by the personn el and inmat e s play an appre

ci abl e an d sometimes un ha pp y role It follows that
.
,

1 05
if improper verbal in fluence can cause d et erioration in
th e condition of mental pati ents or evoke the appear
an ce of new symptoms then proper speech th erap y
,

may cert ainly be of curative value .

The principal method in the psychoth erapy of

psychoses is that of persuasion an d explanation But .

we should not confuse persuas ion with waking sug

g es ti on in this conn e ction Though p ersu as ion cannot
.

possibly exclude ev ery element of suggestion th ere is ,

a substan ti al difference between th e two metho ds .

I n wakin g suggestion as well as in hypnosis the ,

physici an employs categorical or imperativ e patterns

of speech wh ereas in persuasion he discuss e s with
,

the pati ent what is of interest to the latter and uses

ration al arguments lo gic scienti fic facts and the like
, , ,
.

All this becomes quite obvious wh en one encoun ters

patients who are open to p ersuasion without being
in the least suggestible or the oth er way around A s
,
.

to the treatm ent by suggestion it is on the whol e ,

preferable to use hypnotic suggestion th an waki ng

one for the latter is much weaker by comp arison and
,

has few advantages of its own U nfortunately how .

,

ever quite a few ps y chotic patients c ann ot be hypno

,

ti z ed at al l because of th eir low sugg e stibility .

Neverth eless hypnoth erapy has bee n successfully ap

,

pl ied in psychiatric practice for inst an ce in the , ,

removal of hallucin ations The principle is simple

.

enough : if it is possible to produc e h allucinations in

norm al persons by me an s of hypnosis then surely it ,

must be possibl e to remove them in the sick by the

s am e means .

L et us consi der the foll owin g c ase

P atient A nin eteen years of ag e D iagn osis : hash

.

is h ad di ction . From 1952 to 1955 the patient smoked

10 6
 The thi r d d
most important stage of persuasion
an

psycho therapy de al s with altering the conduct and

experiences of the patient M uch depends h er e on .

the patient A ccordi ng to our observations in some

.
,

cases thr ee or four tal ks will s u i ce wh ereas in ,

other cases as many as twenty talk s wi ll be requir ed .

They can be conducted daily every s e cond day or , ,

with l ar ger intervals E ach talk should last anywh ere.

from ten to forty minutes .

We do not believe to be sur e that it is possible , ,

to cur e psych oses merely b y psychotherapy But we .

do find th at ev en wh en used by itself it may lead

, ,

to considerabl e improv ement in the patient s s ymp ’

toms response to treatment an d genera l coop era

, ,

ti ven es s M oreover in combination with insulin s h ock

.
, ,

electro shock treatment or sleep therapy psych o

-
, ,

therapy may substan ti al ly in creas e the effectiveness of

these types of therap y .

To make this clear let us cite a case ,

Patient F twenty three y e ars of age Diagnosis

.
,
-
.

traum atic psych osis Th e il nes s d evelop e d quickl y on

’

S eptember 1 0th 1 955 im medi ately aft e r an automo

, ,

bile accident without any visible bodily injury When .

the pati ent regained consciousn e ss he s h owed antero ,

rade am nesia emotional instability tend e ncy towar d

g , ,

inner conflicts H e acted rudely demanded imm ediate

.
,

disch ar ge A mong other s ymptoms were : poor orienta

.

tion suspiciousness eup h oria confabulation

, , , .

Tr e atment : p rolong e d sleep injections of magne ,

sium sulp hid e The pati ent reacted readi ly to persu a

.
=

sion ; aware of his illness he conceded the faults of ,

his conduct and dev e loped an at titude of confidence

108
towar d the me di cal personnel There were alto gether .

eig h t psychotherapeutic talks .

Th e patient was di sch ar ged after seventeen day s

in the hospit al without any signs of psychosis .

It is tru e of course th at acute traumatic psychoses

, ,

may occasionall y disappear by th emselves with out ,

an
y psyc h ot h erapy w it h in t
,
his period But it is irn .

portant to point out tha t the patient r e acted positi vely

to psych otherapy from th e v ery b e ginnin g and b e
cause of this mad e easi er his relations with the
personn el th us e nabling th em to introduce s ym ptoma
tic medic al treatment .

The fourth and fin al stage of psychoth erap y in ,

these cases consists in consolidation of th e a ttain e d

,

therapeutic remission as well a s in prep aration of the

pati e nt s attitudes for th e post psych otic period This
’
-
.

stage implies r e sumption of employm ent restoration ,

of temporar ily lost interests r e al life contacts etc To

, , .

this stage too w e ascribe considerable importance

, , .

F or it is well kn own that many patients h aving re ,

cover e d from psychotic symptoms find themselves ,

overw hehn ed with passivity desolation fe ars an d

, , ,

asthenia A s long as these pati ents are free from any

.

organic injury they often react quite well to psycho

,

therapeutic persuas ion provided it is conducted cau

,

tiousl y and patiently .

L et us examin e ano ther clini cal case

Patient G tw enty years of age D iagnosis : a

.
, .

simpl e form of sch izophrenia second commitment , .

D uring the five months of hi s commitment he w as

treated with prolonged sleep medica tion ( c affeine , ,

henamin e glutamin e acid ) and a combinat i on of

p , ,

109
ins ul in shocks and electro shock treatments ( twenty
-

seven of the former and thr ee of the latter ) A t the .

end of this period the pati ent was sti ll in different

, ,
'
taciturn lack ing in initi ative in active A ll ques nons
, , .

were ans wered correctly but briefly H e was spending .

hours without doin g anythi n g All work readin g and .

,
“
playing were decli ned with the remark I t does not ,
”
interest me .

S essions of ps ychotherap y were intr oduced at that

time The talks emphasized this lin e of argument
.

durin g the course of treatment the patient got ao

customed to inactivi ty and gradually lost typical inter
ests of a normal man of good h ealth ; to change this
trend it is n e cessary to re activate contacts wi th the
,
-

outside world to resum e work an d readi ng however

, ,
”
d cul t it may be at fir st ; whe n this is done old
’

habitual ties wil l revive Thi s form of p ersuas ion

.

prov e d to be quite successful The patient turne d .

som ewh at r eluctantly to readin g ches spl ay an d con , ,

versation wi th other pati ents H e spontaneously con .

fess e d one day that talk s w ith the p hysician were

helpful The sp h ere of his interests and activities
.

gradually enl arged and he w as soon dischar ged

,

cons iderably improved .

Among the tasks of the las t sta ge of psychotherapy

’
is either a critical anal ysis o f the patient s state of
health or an inti mate discussion of hi s pathological
experiences durin g the sickn ess Thi s can be done .
,

to be s ur e only when th ere is no amnesia of the

,

acut e period of the psychosis The significance of .

such discussions has be en well exp r e ssed by one pa

“
tient with recurrent schizophrenia : I t is not the first
tim e that I ha v e been sick but it is the fir st time th at
, ,

at the time of discharge I have understood what has

,

1 10
to achieve by itself any cure of psychosis it shoul d
,

be conduct e d in combination with p hysiotherapy an d

medications It is particul ar ly significant in conn e ction
.

with insulin s h ock treatment ; at th at tim e the pa

-
,

ti ents become more acc e ssible th e ir pathological e x

,

eri ences b e come stabili zed ; th eir nervous syst ems ;

p
too show a t endency toward normali zation Psych o
,
.
"

th erapy administer e d during th at state is able to

strengthen and consolidate what ev er improvements
h ave result e d O ur observations s h ow howev er th at
.
, ,
“
when such treatm ent is conducted mech anic al ly ”

when the p hysici an watche s only the pa tient s somatic ’

condition the success of the treatment is stati s t ic al ly

,

low er th an when psych otherapy is applied intelli

g ently and with int er e st .

It must be conceded of course th at psychoth erapy

, ,

does not always produce positive r e sults But we .

c an say ,
though as y et with out e xact figur e s that ,

positive results are achi eved in the majority of cases .

1 12
 ON T HE P SYCHO THE R AP Y OF
SCH I ZO P H REN I A

by A N M ol okhov
. .

( Kis hi n ev)

P sych otherapy is h ar dl y us e d at all in the treatm ent

of schizop hreni a Th e r e ason for that li e s probably
.

in the tra ditional attit ud e of s h ocked passivity toward

this mental dis e ase M any unsuccessful a ttempts to
.

apply activ e psych oth erapy to acute stat e s of schizo

p hr eni a may h ave aggravat e d the situati on s till
fur th er But the main obs tacle to th e us e of psych o
.

therap y in sch izoph r enic cas e s h as lain since th e

begin ning of the c entury in the psych o an alytic ap
proach to the und erstan di ng of path ology of th e min d .

M uc h us e l e ss t erminology h as b een coin e d an d much

unscientifi c work has been done in efforts to remove
“
r epr e ssions and thus to restor e th e p ati ent s contact
” ’

with reality
'
.

S uch misconcep tions arise from in s u i cient com

prehension of acute or chronic forms of schizop hr enia .

It is al so often forgotten th at if psych ological trau

,

mata someti m es contri but e to the schi zop hr enic proc

1 13
ess , it does not nec essarily follow that psychotherap y
can readil y reverse this pathologic al process .

S chizophr enia causes in its development consider

able qualitative changes in h um an psych ology un d er ,

mines the basic rules of on e s logic and modi fi es

’

one s social atti tudes to such an extent as to make a

’

person virtually unrecognizable Th at is why it takes .

considerable knowledg e and skill to deal effectively

with a pati ent suffering from this di sease .

S ome authors consid er it possible however to re , ,

tard or even to stop the dev elopment of schizophr enia

by means of active psych oth erapy at least in its early ,

stages This is essentially th e contention of S I

. . .

K ons torum for instance But though th e sym ptoms of

,
.
,

schi zophrenia are in a sens e functional their removal ,

requires p h ysiological m e asur e s ; psych otherapy is use

ful only to supplement them .

N evertheless it is tru e e v en an acute form of the

,

di sease demands that th e p hysician av ai l h imself of

some ps ychotherapeuti c approach to the condition
from the very beginning for this may h elp consider
,

ably to set back the entir e growing and broadening

sym ptomatolo gy It is particula rly important to com
.

“
bat the factors wh ich settl e down as a quite super
fl uou s but oth erwis e burd ensome load on the weak
, ,

cortical cells in the e xpr e ssion of I P Pavlov

”

,
. . .

E very basic form of psych othe rapy is applicable

to various states of sch iz ophr enia though not neces ,

s ari l with equa l success namely : ( 1 ) cal ming down

y , ,

explanation removal of psych ogenic symptoms and

,

unnecessary excit em ent ; ( 2 ) suggesti on and dis trac

tion ; ( 3 ) stimulation of cortical activities ; and 4 ) in
s truction in adjustment .

The choice of one or another of these techni ques

1 14
lies in mod erating autis tic unrealistic thinld ng feel
, ,

in gs of estrangement or worthlessness and at the ,

same tim e in raising psychological tonus The physi .

ci an at this stage of treatment s h ould avail himself

, ,

of ev ery suitable opportunity to promote the patient s ’

adjustment It may b e observe d ind ee d that a few

.
, ,

patients manifest the tendency to r e gain whol e som e

motives by themselves ; these must be found an d
dev e lop e d O ther pati ents happen to retain kn owledge
.

and ski lls acquired in the sch ool or at work ; thes e

must b e revived and encouraged The physician in.
,

trying to stim ul ate the pati ent s inclinations to work

’

to enjo y entertainment sav e s him from degradation

,

of inactivity and from path ologica l personality

changes .

11 6
 THE USE OF M ED I CA TI ON AND
P SYCHO THE RAPY I N P SYCH IA TRI C C LI N I CS

b y A S Po znan s ky M I Ze itlin
. .
,
. .
,

and I G Tokareva
. .

( G orki)

Th e combinati on m e thod of treatm ent in wh ich ,

path ological symptoms ar e attacked from sev eral sid e s

simultan e ously som etimes proves to b e most effe ctiv e
,
.

M edication and p hysioth erapy ar e widely em p loy e d

tog eth er or succ e ssively A s to the combination of
.

m e dication and psych otherapy it h as b e en us ed until

,

r e cently only by a few clin ici an s alth ough it h as b een

,

kn own for quit e a wh il e th at the effe ct of almost

every dr ug and m e dicinal ingr e di ent d epends not
only on th e p ro perti e s of th e p h armacological agent ,

but also on th e psych ological mood of th e pati ent .

The m eth od of combinin g me di cation and p sych o

therap y has b een so far consid er e d in psych iatry
m ainly in the tr e atm ent of n euroses and alcoh olism .

S yst ematic p sych otherapy h as b e en appli e d to th e

tr e atm ent of psych os e s but s eldom .

O ur own experi enc e with the treatm ent of n euros e s

and c ertain psych os e s by m e ans of medication and
1 17
psychotherapy has demonstrated the existence of
var ious advantages of this m e thod Hypnoth erapy for .
,

i nstan c e w a s conduct e d in combination with a num

,

b er of p h armac euti cal preparations Dep en di ng on the .

natur e of the dis e as e and the pati ent s state of h ealth ’

we us ed in som e cas e s s oporifi c drugs in others ,

ms i t m in sti ll others novocaine etc , .

We have obs erved a marked positive effect of

combining hyp noth erapy with hypoglycemic doses of
in sulin in the case of pati ent C tw enty fi ve y e ars of .
,
-

age wh o developed th e s o call e d parting pains irn

,
-

m e di ate ly after a surgic al operation on stom ach ulc er .

E arli er tr e atm ents including tissue therapy brought

, ,

no r eli ef Th e pati ent h ad lost almost twenty pounds

.

and r emain e d un employ e d for mor e th an on e y e ar .

But th e combination of insulin and hyp nosis ( tw elve

sessions ) made it possibl e to di sch arg e him com
p l etel
y he alt h y withi n a coupl e of w ee ks .

K M Bykov an d I T K urts in poin t out that

. . . .

par ting p ain s ar e path ologi cal i mpuls ati ons arising
‘ ’

in the ailing tissu e or org an and l e ading to th e forma

tion of r e gional in ertn e ss of th e cort ex Th is explains .
,

in the abov e m entioned cas e the in eff e ctiv eness of the

-
,

local tr e atm ent of the stomach But the combination .

of tr e atm ents actin g on both the cortical and th e

V isc e r al syst em could b e cl e ar ly mor e effe ctiv e .

In an other cas e th at of r e gister e d nur se

,

four ye ars of ag e w e obs erv e d a typical pictur e of

,

canc ero ph obia Her ailm ent b egan aft er s he was

.

s ent to h av e an x r ay p ictur e tak en in connecti on with

-

the stomach ache s s he h ad complain e d of The .

ro entg enologist ask e d her s ev eral qu e stions among ,

“
them W er e ther e any cases of c an c er in your fam
“ ”

ily ? an d H ave you any di iculty in swallowing ?

” ”

11 8
friend about four month s before admission to the
,

h ospital But th e examination of the patient includin g

.
,

cardiograp h y exclud e d the possibility of an organic

,

heart trouble .

O n account of an incr e asing restles s n e ss of th e

patient he h ad to b e transferred to th e p sych iatr ic
,

ward Th ere after a car eful examination the pati ent

.
, ,

was subject e d to hypnotherapy A t th e end of the fifth .

session h e calmed down considerably but continu ed

, ,

to complain It was then decid e d to add novocaine

.

blockade to th e tr e atment A s a r e sult of this com .

bination meth od th e patient s condition noticeably ,

’

improv e d and h e b e gan rapidly to recover A ltog ether .

th ere w er e four blockad e s and ten hypnotic sessions .

The patient was disch arged as cured aft e r two months

of treatment A ccording to the r e cord of catamnesis
.

for about four years he has h ad no heart attacks ,

and s till feels perfectly w ell .

The mechanism of combination therapy must by

no means be int e rpr et e d as mere arithmetic al summa
tion of th e eff e cts of p h armacological prep ar ations an d
psych oth er ap eutic action This ha s been amply con .

firm e d by medical exp erience with tr e atm ent of

s e veral cas e s of sch izop hr e nia exemplified by the fol ,

lowing one .

Patient K tw enty fi v e years of age D iagnosis

.
,
-
.

schizop hrenia He was suffering from it for ab out a

.

year O n admission to the hos p ital he complain ed

.

of severe headaches ; th er e w ere hallucinations in th e

“
form of voic e s and unp leasant odors Th e patient .

began increasingly to worry about losing h is mind:

A t the s am e tim e he b e cam e in active and emotionally
in different Ins ulino ther apy was prescribed to which
.

hypnotherapy was subsequently adde d Hypnotic .

1 20
sleep often reached th e stage of somn ambulism In .

that state th e pati ent quit e r e a di ly r esponded to sug

ges tion A ll posthypnotic suggestions too wer e ao
.
, ,

c e te d and
p ,
if nec e ss ar y promptly e nact e d But th e
, .

hypnotic exp erienc e s w ere in variably affe ct e d by

amnesia A t the sam e time s tran g ely enough the
.
, ,

arteri al blood pressur e would go down and th e puls e

would be reduced to fifte e n to twenty fi ve beats per -

minute .

A t the end of the combination treatment consist

in g altogether of nin ete e n hyp oglyc emic states and
tw elve h ypnotic sessions th e patient was di sch arged
,
r
s r i ci entl improved and able to go to work
y .

Al l th e se experim ental and clinical d ata permit

us to conclude that the practice of hyp nosis in mental
disease notably in schi zophr enia h as in addition to
, , ,

th e help it renders an intimate effect upon the auto

,

nomic and metabolic proc e ss e s .

There are a number of fai rly ur gent problems ,

howev er which r emain to be inves tigat e d and pos

,

s ibl
y solv e d by p e rsons e ngaged in r e s e arc h if the ,

combination m eth od of tr e atm ent is to b e come

widely successful Th e se problems include above all
.
, ,

th e qu e stions of prop er selection of words in sug

gestion and the exact activity of ch osen drugs in th eir
total as well a s specific effect upon the organism .

12 1
 THE R ECO RD OF P SYCHO THE RAP EU TI C
W O RK I N M EN TA L HOS PITA L S

by L . I . L ichtenstein
( M os cow )

Tr e atm ent was conduct e d in a ward for sligh tly

disturb e d wom en at a h ospital in K azakh
Ther e w er e altog ether thirty f em al e patients under
obs e rvation The followin g meth od of ext end e d sl e ep
.

was used for tre atm ent : all th e patients wer e hypn o
ti z e d simultan e ously at bed tim e to sl eep for about ,

elev en to fourt een h ours th at is approxi mat ely up to

, ,

lunch ti m e Wh en not under tr e atment the patients

.
,

w ere engag e d in work of som e sort .

Th e ch oic e of ward pati ents w a s d et ermin e d not

so much by diagnosis as by syndromes of sickness
indicating th e pres enc e of protectiv e in hibition ; t hat
is to say they w er e e xclusiv ely asthenics as then o
, ,

d epr e ssiv e s or pati ents suffering from exh austion en t er

,

som e activ e tre atm ent Ther e was on e addition al

.

r ul e : all V iol ent an d di sori ente d p ati ents w ere invari

ably exclud e d from the group so as to assur e con d i
ti ons of tranquilli ty cl e anlin e ss and courte ous con
, ,

duct in th e war d S ui table measur es were taken to

.

122
 S uggestion durin g sleep w as employed only when
it was definit ely indicat e d After a g en eral t al k indi
.
,

vidu al suggestions ( spok en in wh isp er ) were used

with som e of the pa ti ents Toward th e end of th e
.

s e cond h our the hypnotic sl eep usually ch anged into

natural sl e ep The pati ents continu e d to sl eep natur
.

ally th oug h influ enc e d by posth yp notic suggestions

, ,

with out any int erf er enc e up to th e lunch time almost ,

invariably r etain ing their position .

C onsid ering the aft ernoon rest the patients total

,
’

sl e ep ing time was thus l engthened to t w elve to

fourt een h ours per day Th e number of sessions was
.

diff er ent for e ach patient and varied from sever al

to as many as forty or ev en fifty O n completion of
.

e ach hyp notic s e ssion a vigorous waking stat e durin g

,

the day was g en erally sugg e st e d .

Certain exp lanatory comm ents must now b e made

con c ern ing the natur e an d effe ct of our work Aft er .

a c ertain numb er of s e ssions of p rolonged sle ep our ,

pati ents manife st d e sir e for activity and this d e sire

,

must b e encourag e d and satisfi e d It h appens quite

.

oft en in ordin ar y m ental h os p itals th at pati ents re

m ai n inactiv e for month s and ev en years O ur att itud e .

is different : w e b eli ev e th at when ev er a pati ent

begins to s h ow si gns of recovery it is of vital im por
,

tanc e to organize a plan of activiti es for him to ,

giv e h im an opportunity to do som e thing W ork .

therapy in its broad e st sens e includ e s hous ek e epin g ,

assistance to th e hospital p ersonn el s awing cultural

, ,

activities games exercise ; whatever it be it can

, , ,

s erv e as a therapeutic factor su pp l em enting prot e ctive

tr e atm ent M any of our pati ents d e clar e th at when
.

they work they forg e t about their troubl e s and f eel

much b ett er In activ e and abulic pati ents ar e sug
.

1 24
g ested under hypnosis : You will put the room in
“ “
order You will saw or You are a good worker
”

, , ,

don t just sit and do nothing Th us almost all of

’

.
”

our patients are busy and by th e end of the ir stay ,

at the h ospital they are workin g quit e h ard thus ,

pr eparing themselves for norm al condi tions of the

outside world .

All this can b e illustrated more sp e cifi call y b y

the following case h istory :
Patient N D iagnosis : schizophrenia Wh en ad
. .

mitt e d to the hospital she was restive unwillin g to , ,

eat She suffer e d from a d elusion of persecution an d

.

wan t e d to go away A t tim e s s he was s h owing signs of

.

waxy fl exibility Th inki ng t hat h er children w er e in

.

the adjac ent ward ( for s h e he ard young voices th ere ) ,

s he would ent er it and mistake a boy for h er son .

A fter insulin therapy s he somewh at improved .

De lirious utt eranc e s b e cam e f ew But lacking s elf .

confid enc e s he expr e ss e d her r eluctance to l e av e th e

,

h os p ital and said : If the ch il dr en can r emain h ere ,

I s h all stay her e .

”

She was then tr ansferr e d to the ward for sl e ep

th erapy Sh e slept a gr e at deal at fir st but improved
.
,

only slightly It was cons e quently suggested to her in

.

sl e ep th at it is im p ortan t to work and not to be afr ai d

of di h culti es of life Fin ally s h e expressed a d e sire .
,

to join the h ousek eeping branch The work was h ard .

there to star t with but s he gradually got accustomed ,

to it and felt fine Wh en disch ar g e d from the h ospital

.
,

s he look e d well and s h owed no psycho tic symptoms

wh atsoever .

125
 ON THE R O L E OF SUGGES TI ON I N T HE
TREA TM EN T OF A L COHO LI S M

by I . L . Luk omsky
( Arkhangel sk)

The question of suggestive th erapy as applied to

the tr e atm ent of al co h olis m is by no me ans new ,
.

Unfortunat ely how ever we have fail e d so far to

, ,

attain unanimity in th is connection The results of .

inv e stigations publis h ed by various auth ors as to t he

effe ctiv en e ss of availabl e th erap e utic m e th ods do not
agr ee ; mor e over ther e ar e substantial differenc e s ev en
,

with r e gard to th e formulation of the p roblems to b e

solv e d The s e disagr eem ents aris e as a r e sult of differ
.

ent the or etical pr emis e s and consequ en tly of di scord

, ,

ant crit eria for defining the conc ept of al co h o l ism

its elf
.

Thus S S K orsakov and F E Rybakov r e gard

. . . .

anybody as an alcoh olic who manifests symptoms of

organic disturbance caused by frequent consumption
of intoxicating beverages E Kra ep elin and K Bon
. . .

h afer interpr e t th e con cep t more narrowly as con ,

fin e d to th ose who intr oduce new amounts of alco h ol

into th e blood b efore it is complet ely free from th e
1 29
p revious d oses S G Z h
.i s l in i nsists that there is no
. .

alcoholis m ap ar t from the syndrome of hangover ,

whil e I V Stri elchuk s tresses irresis tible ath acti on

. .

to al cohol N P Tatarenko on th e other hand re

. . .
, ,

g ards attr action to alco hol mer ely as a secondary

phenomenon—a result of e xtensive organic ch anges ,

in cludin g those in the high er nervous system an d

metabolism themselves caused by rep eated consump
,

ti on of al cohol .

A ccordingly N P Tatarenko takes a definite posi

, . .

tion with regar d to the r ange and succession of

research tasks culminating in acceptable treatment .

The fir st thing to do is in h is opinion to free the , ,

or gan ism from all effects of alcohol ; second to raise ,

the tonus of th e basic processes in the cortex ; third ,

to remove attracti on to alcoh ol ; and fourth to re ,

i nforce the results al r e ady attained and to r e educate -

the patient In this set up m eth ods of psych oth erapy

.
-
,

( in cluding suggestion ) receive a comparati vely mod

est place .

.Y A Povorinsky interprets the problems of alco

.

holis m in an entirely different way A ccording to him .

,

the whole process of treatm ent must be di vid e d into

three consecutive stages : prot e ctive reconstructive , ,

and stimulative Am ong th e most important tasks of

.

the fi rst stage are : to establis h an adequate contact

with the patient and to apply measures of persuasion
aiming to arouse desire for cur e in him The second .

stage is devoted to sp ee ch th erapy seeking to pro

duce in the patient a n e gativ e at titude toward al coh ol ,

to the reconstr uction of hi s relations with other p e ople ,

and to the formation of wholesome social attitud es .

Of parti cular im portance here is hypnotherapy The .

1 30
both in the psychi atric clinic of the Arkhang elsk
M edical Insti tute an d in th e loca l h ospital d emon —
strat e s th at c ertain basic conditions of treatment ought
to b e invariably fulfill e d insofar as they raise appre
,

ci abl
y t he e f
f e ctiv e n e ss and perman e nc e of t h e results

attain e d by suggesti v e and combination tr eatment

of alco h olism .

The most important condition practically guar an

te eing systematic and consequently mor e eff e ctive us e
of m e dical measur e s consists in obs erving th e princi
ples of stag e s in tr e atm ent O ur exp erience confirms
.

the valu e of th e above m ention e d division ( by Y A

-
. .

Pov orin s k y ) of tr e atm e nt of alco h olism into thr ee

stag e s The c entral probl em of the fi rst stag e li e s in
.

removing th e symptoms wh ich subj e ctively impos e

, ,

s erious h ards h ips on the pati ent : disturbance of sl eep

and app etit e fluctuation of moods loss of str ength
, , ,

etc .

A dmi nistration of a corr e ct combination of seda

tiv es an d tonics goes a long way to win th e pati e nt s
’

confid enc e and to establis h in h im the b eli ef in th e

ultimat e succ e ss of the tr e atm ent A ll th is s erv e s as
.

extr em ely valuabl e pr ep aration for the following sug

gestion therapy .

S ugg e s tion therapy plays a vital rol e in the second

stage of tr e atm ent ; its p rincip al p urp os e i s to w e ak en
pathological patt erns of the pati ent s personality and
’

conduct and to establis h n ew an d wh ol e som e patt erns .

Hyp noth erap y is particular ly us eful in overcoming

th e pati ent s longing for alco h ol
’

O n e of th e most important conditions of effe ctiv e

hypnoth erapy among alco h olics consists in its differ
ential application . In other words it is n e c e ss ar y to
,

take into consideration not only the clinical pictur e of

1 32
the case of ad di ction but also its original causes
,
.

S ome pati ents tur n to alco h ol in d e c eptiv e h op e of

r ai sin g their e ici ency in work or h um an r e lations ;
"

other pati ents attempt to nar cotize pains or to dull

som e p articularly unh ap py exp eri ences ; som e b e gin
drin king und er th e infl uenc e of their social s e t ; etc .

E qu al l y vari e d are the impulses comp elling alco

hol i cs to s e ek m e dical h elp S ome patients ar e eager
.

to restore th e ir social status or reputati on ; other

pati ents want to r e aliz e th eir much pos tponed plans
of lif e ; still others become worried about their failing
he alth ; and ther e ar e al s o those wh o h ope to im prov e
disrupt e d family relations .

E ach on e of such various yet uniqu e causes of

alcoh olism as w e ll as of desir e to b e cur e d must be
tak en into consid eration as an el ement of psycho
therapy ; and th is can b e don e only on th e condi tion
of a strictly individualized approach to th e cas e A s .

a r e sult in spite of certain advantag es of group

, .

hypnotic s e ssions— including higher suggestibility and

imitativeness—so me lim its must b e impos e d on such
sessions in ord er to avoid excessive standardization
t endin g to lower the effectiveness of th is treatment ;
for th e s o call e d uniform groups of specially s el e cted
-

pati ents are nev er really uniform C onsequ ently in di

.
,

vidual sessions are d efin itely to be pr ef erred even ,

th ough they lead to consid erable incr e as e in th e total

amoun t of work But even so there is dang er of a
.

standar di z e d approach to th e pati ents .

O n th e wh ol e a preliminary car eful study of the

,

pati ent may not be avoided This m eans th at much

.

att ention s h ould be given to h is m e dical and g en e ral

an amnesis Th is means also th at a somewh at different
.

variation of hypnoth erap y must b e applied to e ach

1 33
 patient To attain such individualized approach to
.

th erapy it b e com e s nec ess ar y to combine clinical ex

,

amination with a pr eliminary talk with every patient ;

and such a talk p rovid e s valuable ori e ntation for th e
pati ent as well as for h is p hysician Th is talk aims
.
,

first of all to explain to th e patient th e e ss ence of th e

, .

int ended tr e atment to disp el h is unfounded fears

,

as w ell as exagg erated e xp e ctations and th us to e stab

,

lis h a reasonably corr e ct lin e of conduct during hypno

therapy A nd second th e p hysician may utiliz e th e
.
,

talk as an opportunity to determin e th e degree of

the pati ent s suggestibility th e extent of hi s informa
’

tion an d the composition of hi s vocabul ary Th is latter .

finding is of importanc e for the choic e of v erbal forms

in hypnotic and p osthyp notic sugg e stion .

In the content of suggestion its elf it is advisable

to avoid all g en eral schemes an d standards ; rath er it ,

is pr eferabl e to us e the v ery plans which th e pati ent

hims elf builds for his future and th us to make th e
conqu e st of alcoh olism th e main condition for th eir
realization .

In many instanc e s it is d e sirabl e to modify the

,

ways of tr e atment so as to enh an ce th e effe ct of

psyc h otherapy Th us sugg e stion m eth ods may be com
.

bin e d or alt ernat e d wi th medication or p h ysiotherapy .

But e very such modification must be refl e ct e d also

in the content of th e posthypnotic sugg e stion and
th us to su pp ort the conviction in th e pati ent s min d
’

th at the wh ole course of tr e atment is conducte d in

strict agr eem ent with th e originally dev eloped plan .

Unl e ss this is don e the pati ent may start susp e cting
,

th at ev ery new ch ang e mean s that th e ph ysician is

not quite sure of th e succ e ss of the c h os en treatment .

Among th e combination m ethods of tr e ati ng alco

1 34
 UN IQ UE FAC T O R S I N THE HYP NO TI C
TR E A TM EN T OF CH RON I C A L COHO LI S M

by T N C ordova and N K K ovalev

. . . .

( Kurs k)

Th e us e of apomorp hine to e stablish th e vomi ting

r efl ex in r e sponse to consumption of alco h ol h as
b e com e quit e wid e spr e ad in th e tr e atm ent of alco h ol
ism In co m bination with h ypnosis it produce s e xcel
.
,

lent results according to I V Stri el chuk and V E

, . . . .

Rozhnov Th er e is on e not eworthy obj e ctio n to the

.

drug h owev er In the cardiac and vascular ailm ents

, .
,

stomach ulcers and liver diseas e s it is d efinitely

,

co u n terin d i c ate d But it so h app ens that alco h olics

.

ar e exc ep tionally oft en affe cted with the se troubl e s ;

there aris e s cons e qu ently a s erious di culty for th e
, ,
i

p hysicians in the ch oic e of tr e atm ent for such pati ents .

This was the reason for our d e cision to investigate

the possibility of dev elopin g a suitable m eth odology
of hypnotic treatm ent for t hese cases We h ad 1 50 .

pati ents und er our obs ervation all ch ronic alcoh oli cs;
,

Tw enty eigh t of them w er e treate d by means of

-

hyp nosis ; in sixty two cases th e combination of hyp

-

nosis an d apomorph in e was us e d ; and sixty pati ents

1 36
had only apomorp h ine In th e first of these groups
.

th e use of apomorp h ine was d efinit ely counter

indicated b e cause they suffer e d from hyp ertoni a
,

ulc ers or gastritis and he art ailm ents

A bout h alf the pati ents ( s eventy two ) were be tw e en
-

thirty one and forty years of age

-
.

The distribution of a ges at which the abuse of

alco h ol b e gan h ow ever presents an entirely di ffer ent
, ,

pict ure The following table makes it cl e ar

.

N um ber

The se fi gures in di cate the obvious importance of

educati on in hygi ene and prop h ylactic measur e s
among th e adol e sc ents and young people .

The h ypnotic s e ssions were conducted in gr oups of

four or fiv e p ersons twic e a w e ek for th irty min ut e s ;
,

altog e th er the re w e re from five to t w e lve suc h ses

sions There were individual talks b efor e each tr e at

.

m ent during wh ich th e effec t of alco h ol upon th e

,

human organism was explain e d and detailed ins truc

tions giv en with r e gard to conduct during the coming
s e ssion The s e ssions thems elv e s wer e conducted in a
.

sp e ci al room sligh tly dark ened The .

m eth odology of hypnosis consisted in verbal sug

g e stion of sle ep accompani e d with stimulation by
,

rhythm ic sounds ( clock ticking ) .

Wh en th e p ati ents wer e all und e r h ypnosis it ,

was sugg e st e d that the sigh t sm ell and taste of

,

alcohol will cause nausea and vomiti ng A fter two or .

1 37
 thr ee sessions each patient received specific s ugges
tions to h ave h allucin atory experi ences conn e cted with
episodes of drinkin g resulting in fe elin gs of disgust
toward anythi ng contai ning alcoh ol F or inst ance a .
,

patient would b e told th at he was in a bar with

a glas s of vodka in front of him ; and that the taste
and smell of it made him vomit D uring this s ugges
.

tion the pati ent s face would plainly express di s gust

’

and initial vomiting movements would be observed .

This eff e ct was p ar ticularly well achi eved in the

somnambulistic stage of hypnosis Wh en the intended .

result was not obs e rved the sugg e sti on was supported
,

by a wad of vodk a so aked cott on placed in front of

-

th e pa ti ent s nos e D urin g the next session vomiting

’

.
,

was observed at mere m ention of passin g n e ar a bar .

The treatment with apomorp hin e ( sixty two -

patients ) began with a minimal dosage which was

gradually increas e d until the vo miting rea cti on was
pro duce d L ater on the doses h ad to be somewh at
.

increased for th er e is a certain tend ency to becom e

,

habituated to the drug .

S ugg e stion enabled us to effect the vomiting refl ex

also with smaller doses of apomorp hin e The patient .

was told under hypnosis tha t each n ew injection of

apomorp h ine would cause strong er vomiting though ,

th e dosage r emained th e same Par ticularly good re

.

s ul ts of thi s kind wer e obtained from the pat ients

readil y reaching the somnam bulistic stage .

The eff e ct of thi s treatment was subsequently

verified through catamnesis am ong 1 1 0 patients It .

s h owed th at hypnotherapy ( with or without apomor e

p h ine ) was mor e succ e ssful than th e tr e atm e nt r ely

ing on apomorp h ine alone This is cl e arly in di cated
.

in the following table

1 38
 4 Th e therapeuti c effect in cas e s of alcoh olism is
.
, ,

incr eas e d in proportion to th e dept h of th e hypnotic

state attain e d from which follows the advantage of
,

inducing wh enever possible the somnambulistic state

, ,
.

5 In the tr e atment of persons a i cte d with c h ronic

.

alco h olism th e d e gree of hypnotizability s h ould be

,

tak en into consid eration for th e highl y hypnotizabl e

,

persons can be treated with out resorting to the inj ec

tion of apomorp hine especially when there are
,

c o un terin d i c atio n s to it .

6 In d e aling with pati ents insu i ci en tly susc ept

.

ible to hyp nosis it may be wise to combin e its us e

,

with th at of apomorphine ; and suggestion s h ould

its elf b e then d ir e ct e d toward the increase of vomiting
r e actions and cons e qu ently to d e creasing th e amount
, ,

of r e quir e d apomorp hin e .

7 Whe n dealing with persons d i i cul t to hypn o

f
.

ti z e it is advisabl e to pr e c e d e the tr e a tm ent with an

,

explanatory talk .

8 It is recommend e d th at an averag e course of

.

hypnotic tr eatm ent consist of nin e to t w elv e sessions .

In alco h olism of long duration it may b e necess ary

,

to e xt end the number of sessions up to fift een .

140
 A S T UDY OF SE LEC TI VE RA PP O RT
I N HYP NOS I S

by I O N arbutovi ch
. .

( S talingrad )

The study of clinical p h enom ena an d physiologi cal

m e ch an isms of h ypnosis as an im portant meth od of
,

psychotherapy h as both the ore ti cal and practic al

,

signifi cance M uch att en tion has al r eady been devoted

.

to th e p robl ems connected with it in this country

and els ewher e .

O n e of the p e culiarities of hypnotic sle ep lies in

th e existence of rapport or to use I P Pavlov s ex
’

. .
,

pression of the guardi ng point

, .

It is g en erally b eli ev e d that rapport is s trictly

s electiv e th at it is limit e d to th e hypno ti zing p erson
,

alone an d that to tr an sfer rap p ort to som ebody else

, , ,

it is n e c e ssary to utt er a sp e cial sugg e stion to th is

effe ct To verify this contention we conduct e d an
.

exp erim ent with el e ven men and two wo men all ,

suff ering from chronic alcoh olism .

O ur fin dings s h ow th at full s el e ctivi ty does not

exist ev en in th e somnambulistic stag e of hypnosis ,

wh en inh ibition is at its hi ghe st The s e fin di ngs are

.

in complete accord with th ose of V E R ozhn ov . . .

14 1
 Ther e arises therefor e the qu e stion as to the
reasons for the above m ention e d b eli ef concerning th e
-

stri ct s el ecti vity of rapport in hypnos i s O ur observa .

ti ons d emonstrate that such s el e ctivity is by no m e ans

automati c ; rath er it is ar tificially in duc e d by means
,

of a sp e cial suggestion amounting to direct or indir e ct

instruction to disr e gard the voice of any person exc ept
“
th e hypnotist h ims e lf Th e latter may d e clare : You
.

do not he ar anythi ng but my voic e ; you list en to no

one but mys elf O r els e it may amount to th e simpl e
.

order : From now on you will h ear only my voic e .

It must be add e d in this conn e ction that the

hypnoti z e d person is lik ely to be s ensitive to s ugges
tions of any degree or s h ade H ere is a good illustra .

tion of this
Pati ent P thirty s ev en y ear s of a ge ; suffers from
.
,
-

chronic alco h olism The p hysician conducting the

.

hyp notic s e ssion lifts the patient s l eft arm and utters ’

the following sugg e stion : Your arm will remain in

thi s position unti l I mak e it fr ee A t th at mom ent .
”

“
another p hysician says : I s h all count one two thr ee , , ,

and at th e count th r ee the muscl e s of your l eft ar m

‘ ’

will r elax and it will drop He then counts but the .

,

arm do e s not drop A ft er th is th e p h ysici an hypnotist

.
-

continu e s with the therapeutic sugg e sti ons at th e ,

conclusion of wh ich he lifts th e pati ent s right

’

“
and sugg e sts Y our arm w ill r emain in th is posi tion
until it is fre e d Wher eupon the other p hysician
.

rep eats h is form er r em ar ks A t the count of thre e ‘ ’

the arm dr ops .

Th is exam pl e d emonstrates th at if the hypnotist

“
would us e in the first suggestion the p hrase until it
“
is fre e d instead of until I make it fr e e th e r e sult
”

of interference by another p erson mi gh t be quit e

142
 P SYCH OTHE RAPY OF S M OKI NG

by Y A . . Povorins ky
( L eningrad )

The problem of h ow to combat the ad di ction to

sm oking d e s erves s erious consid eration P e ople wh o .

do not smoke cannot un d erstand the psych ology of

smok ers A nd the m en and wom e n wh o h ave suc
.

ce e d e d in overcoming th e h abit by t hemselv e s do not

quite appr e ciate the typical smok er s n ee d for help ’

Neverth el e ss the probl e m is by no m e ans simpl e It

, .

is not e asy ind ee d to quit smokin g Th ere ar e many

, , .

peopl e wh o th ough knowing full w ell th e obvious

,

h ar m of smoking and e ag er to abandon the p ersist ent

h abit simply cannot do it with out outside help
, .

I V Stri el chuk not e s corr e ctly th at treatm ent of

'
. .

“
smoking is one of the most d i cult tasks in the fi eld
of narcom ani a When smok ers ar e d eprived of tobacco
.
,

they may manif e st the attitude comparabl e to th at

of an abstaining morphin ist The r e action to abstain
.

ing from tobacco is som ewh at di ffer ent to be sure ,

to som e it is quite e asy to oth ers very d i cult

”

.
,

The smoki ng of tobacco is th e most widespr e ad

form of n arcomania In spite of the fact that smok in g
.

144
is harmful and must b e forbidd en in som e illnesses ,

literatur e on its tr e atm ent is so far scarc e .

I V Stri el chuk is in favor of medicinal th erapy

. .
,

but h e also poin ts out th at psych oth erapy plays an

im p ortant rol e in the treatm ent of smok ers ; h e re
marks moreover th at psych oth erap y when us e d sys
, , ,

t em ati c al ly may be of considerable benefit A M

,
. . .

R ap oport advocat e s the use of pilocarpin e in the tr e at

m ent of smok ers A t a conference of th e M oscow N ar
.

cotic S ociety some ti m e ago ( in it w as pointed

out that individual treatment of smokers is wasteful of
tim e and contrary to good s ens e ; accor di n gly a mo
tion was pass e d to abandon such tr e atment Instead .

of it group therap y was recomm end e d

, .

We do not d eny the prophylactic significance of

the group m eth od ; at the sam e tim e we feel th at ,

in di vidual psych o therap y is t he only acceptabl e

meth od Wh en ev er a w e ll establis h ed h abit must b e
-

ov ercom e S moking is an e asily acquir ed addiction

.

and consequently it is us ually associat e d w ith all

, ,

kinds of p henomena of everyday life M y own expe .

ri en c e with a larg e number of cured smok ers s e ems

to indicate th at a more consci enti ous and c ar eful

sel e ction of the th erap eutic measures is indicat e d in
each case .

L et m e enum erat e the principal m e thods of treat

ing smok ers in contemporary m e dicine :

1 . Treatment w ith m ed i c at ion This

. includes gar
gling and sm e aring of the in n er surfac e of the mou th
with a w e ak solution of argenti nitri ci or protar gol ,

which caus e s a p r e sumably unpl e asa nt tast e during

smoking A d di tion of rad ix H eleniae to tobacco also
.

res ul ts in objectionable s ensations Thi s m eth od is

.

1 45
 rarely successful accordin g to our obervations be
, ,

c ause it usually leads to pla in resen tment or ev e n

to deception .

2 Treatment wi th hypnos i s involving prohi bition

.

to smok e Beginning with th e first visit by th e patient

.
,

it is suggest e d dur ing hypnosis th at the taste of

cigarettes is dis gusting to him th at h e does not wis h ,

to smoke at all etc Th e effect of this me thod c annot

, .

be called v ery satisfactory for the suggestion di s ,

r e gards many experiences in timately connect e d with

smoki ng ; it h as b e en known to e stablis h various com
plex conflicts within th e patient s mind ’

“
Two episodes will s u ce to illustrat e th e probl em .

A p hysician made a suggestion to his patient a ,

woman that cig arett e smoking will produce vomiting ;

,

but he did not think of m e ntioning the loss of desire

to smoke A s a result s he felt e xc e edin gly uncom
.
,

fort abl e for e very att empt to smok e l e d to vomiting

,
.

Fin al ly s h e return e d to the doctor demandi ng th at

the sugg e stion be r e vok ed sinc e in th e meantime s h e
,

had lost all desire to abandon smoki ng .

A no th er patient was giv e n t he sugg e stion to be

p h ysically unable to smok e at all Th is cas e also ended .

in failur e When h e cam e h ome h e was ind ee d una ble

.
,

to smok e though d e sire to do so was very strong

,
.

S everal h ours later h e became extrem ely i rritable and

,

excit e d L ate in the evening he c al led h is p hysician

.

by tel ephone asking for h elp Wh en p ermission was .

granted he assert e d h e was still unable to smoke

, ,

even th ough a pack of cigarettes was lyin g in front

of h im Th is pati ent ev ent ually r e s um ed smoking toe
.
, ,

an d r e fused to abandon the h abit .

3 Treatm ent by pers uas i on This meth od offers a

. .

possibility of emotion al influence upon the smoker ;

146
patient b een smoking ? ( 2 ) U nd er wh at circum stanc e s
di d he b e gin to smok e ? ( 3 ) D id he ev e r tr y to quit
smoking ? ( 4 ) What h as ar oused h is pr e s ent d esir e to
quit smoking ? ( 5 ) O n wh at occasions do e s he par
ti cul arly want to smok e ? ( 6 ) W h at atti t ud e do e s he
m anif e st in smoking ? D o es he pay an y att ention to
hi s s ensations or do e s h e smok e m e ch an ically as it
w er e ? ( 7 ) H ow many cigar e tte s on the av erag e do e s
h e s mok e p er day ?
S uch an int e rvi e w dwell s particularly on the data
which will b e of par ticular signific an c e during tr e at
m ent It s h ould not h owev er m er ely coll e ct the
.
, ,

r el evant data Among its m any p urp os e s ar e a lso

.

und erstanding of the pati en t s p ersonality and the ’

d ev elopment of an attit ud e of mutu al trust b etw een

the pati ent and the physician The form er s h ould .

h av e every o p portunity to expr e ss hi ms elf for ev en ,

the most insign ificant d e tails mi gh t p rov e to b e of

con sid erabl e valu e in the subs e qu en t tr e atm ent In .

the s e cas e s just as in any c as e of n eurosis it is d e

, ,

sirabl e to conduct an unh urri e d conv ersation through

which the p h ysician familiar iz e s hims elf with the
pati ent s personality social conn e ctions an d the cir
’

, ,

cum s t an c e s of h is lif e during its e ntir e duration up

to the mom ent .

M ost im p ortan t ar e of cours e the id e as the

, ,

smok er h as about h is ow n smoking— its caus e s satis ,

factions annoyan c e s and e sp ecially the worri e s mak

, ,

ing hi m s eek the physician s help A s far as the ’

succ e ss of tr e atm ent and p ro gnosis ar e con c ern e d ,

much d epends on the clarification of the p ati ent s

’

d e sir e to sto p smoki n g If the conflict und erlyin g it

.

can b e r e solv e d the ch anc e of succ e ss is gr e atly in :

,

cr ea s e d ; otherwis e th e outcom e is doubtful

,
.

148
 The compl exity of th e problem becomes clear
when we consider th e following case .

Pati ent K a woman h as b een smok ing for a long

.
, ,

time But rec entl y s he was inform e d th at s h e s uffered

.

from tub erculosis of th e lungs Th e m otive to quit .

smoking seems to b e obvious : s he wan ts to get well .

But actually th e h ar m of smoking does not worry

her very much Th e talk reveals that the patient is
.

enga ged to be marri e d to a man wh o does not smoke .

N aturally enough s he is thi nkin g about h er relations

,

with the future husband Sh e is worrying about such

.

things as tobacco smell from h er mouth color of skin , ,

and the lik e Wh en the true reason for the d e sir e to

.

qui t smokin g b e comes clear the success of tr eatm e nt

,

becomes almost assured .

S trong motivation is of considerable h elp of ,

course in re con di tioning the pati ent s attitude towar d

,
-
’

smoking W e rem emb er a case wher e a smoker w as

.

cur e d from his h abit almost instantaneously He .

d ev eloped an acut e catarrh of th e thr oat an d cam e

to consult a la ryn gologist wh o aft er examining h im , ,

declared th at unl e ss he quit smoking h e was bound

, ,

to develop tuberculosis of th e thr oat Th e patient .

form e d his decision to stop smoki ng righ t there and

nev er smoked again .

Unfortun at ely h owever th e gr e at majority of

, ,

patients approaching a p hysician with r e qu e st for

help in this conn e ction are by no m e ans e asy cases .

There ar e too many links in the ch ain of their desir e s

and h esitations h opes and doubts fears and worri e s
, ,

to se e the situation cl e arly to evaluat e it correctly

, ,

and to state it pr e cis ely A s a r e sult they are s eldom

.
,

abl e to inform the p h ysician as to th e exact cause of

th eir di fi culti es We often deal her e wi th hidden
.
,

1 49
introv ertive mo tives or to use A G Ivanov S molen
, . .
-

sky s expression with th e patho dyn ami c structure of

’

hum an p ersonality Th e pati ent s beli ef th at he ought

.
’

to quit smo king r emains cold as it w er e as long as it

is abs tracted from the mass of confus e d emotions .

Th e best th at a p hysician can do in such cas e s is to

encourag e the smok er s vagu e scruple s and dis
’

satisfactions with h imself .

A ft er a car eful exam ination of th e pati ent s lif e ’

exp eri enc e s and attitud e s w e must turn to th e s e cond

,
“
stag e of tr e atm ent which may b e call e d registr ation
”

of d etail e d facts in exp erim ental ch ang e s in th e

patient s h abit of smoking This s h ould by no m e ans
’

he don e in a m e ch ani cal m an n er Wh en th e pati ent .

is instruct e d to cut dow n the num b er of cigar e ttes

p er day h e is bound to think of th e next cigar ett e
,

and in addition to suffer from the effort he is making

,
.

This is lik ely to end v ery simply : th e pati e nt r e turns

to his old h abit of smoking .

W hen a p hysician i n his conv ersation with the

,

pati ents t urns to the qu estion of regulating smoking

, ,

an d th e pati e nts learn wha t is expe ct e d of t he m a ,

high p erc entage r efus e at onc e to follow the instr u o

tion E v en among the smok ers expr e ssing willingn ess
.

to r e gulat e the ext e nt of their smoking there ar e ,

many wh o would not ob ey the physician s ord ers ’

S ome wh o would migh t b e n e glig ent about recording

,

th e exact numb er of cigar ett e s they smok e .

To r e gulat e the smokin g mor e e fi ciently the ,

p ati e nt is ask e d to start

,
with n ot to smok e for on e
,

wh ol e day ; or if thi s is b eyond his pow er for a s

, ,

long as he can D ur ing thi s period he must dir e ct

.

all h is att ention toward the s en sations r e sulting from

abst ention Th e n ext day h owev er he is p ermitte d
.
, ,

1 50
 of working abili ty and other effe cts of di sturbance in
,

the h abit ual balance of bodily activities E xperiments .

with an imals demonstrate th at nicotin e introduc e d

into their organism serve s first as a s timulant and
lat er as a d epr e ssant of the n e rvous system But it .

must be conc e ded th at th e p hysiological effects of

abst ention am ong h uman b eings di ffer in intensity
from person to person .

Hypnotic sugges tion itself which culminates th e

,

progress of treatm ent is not necessarily the most

,

important part of it We turn to it only when th e

.

pati ent has b een th oroughly pr epared for it Putting .

the pati ent in to th e hypnotic state aim s only at

creating th e most favorable conditions for cons ol id at
ing t h e results of treatm ent A nd th e stat e of h ypnosis
.

is undoubt e dly th e b e st state in whi ch to r ece1ve sug

gestion We do not se e k h ow ev er de ep sleep for
.
, ,

sugg e stion E xperienc e s h ows as a matter of fact

.
, ,

th at suggestion as w ell as p ersuasion ana lysis as ,

well as synthesis of id e as ar e more e ci ent in the ’

n

li gh t er forms of hypnosis th an in th e deep er ones wi th ,

amn e sia that often follows th em .

In most instances c e ssation of smoking takes place

,

af t e r the first s e ssion But it is always desirable to

.

h ave an oth er session th e following day and again tw o

days lat er It h appens occasionally that th e patient
.

returns to smoking usually aft er som e un pleasant

,

experience when s elf control has been weakened But

,
-
.

such failures are easily corrected .

1 52
P A R T

S O M ATI C
o thers d ev eloped and enrich ed our understand
,

in g of bronc h ial asthma and t h us e stablis he d the

co rti c ovi s cer al the ory of its e tiology and pathogenesis .

Th ere ar e now s ev eral hyp oth eses attempti ng to

explain th e m e ch anism of asthmatic attacks O n e of .

them claims that the main factor lies in the spasm

of the smoo th muscl e s of the bronchia ; anoth er at
tributes i t to the incr e ased s e cretion of mucus ; th e
th ird finds it in the enlarg ement of vessels and th e
mucus membran e of the bronch i In our ow n inter .

retati o n all t h es e facts ar e tru e but th e main factor

p , ,

is inde e d the bronch ial spasm .

I t is our beli e f th at th e use of hyp nosis will

greatly facilitat e the study of the problem .

S ci entific lit eratur e contains a f ew references to the

us e of hypnosis in cas e s of bronch ial asthma namely , ,

by O We tterstrand V M Belous A M arx D A

.
, . .
, .
, . .

Vi gdorovi ch A N B e rnst e in and V E R ozhnov

,
. .
, . . .

A ll the se auth ors tr e at e d bronch ial asthm a wi th

hypnosis and obtain e d good r e sults .

W e obs erv ed on e h undr e d such cases between

1 95 1 and 1 9 55 in the L eningrad M e dical Institute of
I P Pavlov A ll the p ati ents und erwent a course of
. . .

hypnoth erapy and w er e und er obs ervation from tw o

to thre e year s aft er th at Th ere were altogether
.

s even ty eigh t wom e n and tw enty tw o men By age

- -
.

th eir distribution was as follows

A ccording to the duration of the di sease ,

the cases
were distribut e d as follows :
1 56
 Less th an a ye ar 3
l 1 0 years 53
ll 20 29
The patients were divided into thr ee groups , ao

cordi ng to th e gravity of th e a i lm ent fr e quency of the ,

atta cks and he art and lungs compli cations Those

, .

with a few attacks p er y e ars and without complica

tions ( 8 ) wer e classified as light cas es .

Th e pati ents with several attacks per month

wh o al so suffered from the ini tial form of chronic
emphys ema of th e lungs comp ri s e d the second group
,
.

The pat ients with several attacks per day

wi th both lung and heart complications in most cases ,

formed the third group .

In ninety cases th e disease was pr e ced e d by in

fecti on of the organs of br e athing— pneumoni a gripp e , ,

chronic bronchitis etc In fifty on e cas e s the fir st

,
.
-

attack of asthma followed an aggravation of the infec

tion In forty nine cases the decisive factor consist e d
.
-

in psychologic al traumatic exp eri enc e or l as hn g nega

’

tive emoti ons .

Among the patients there wer e some wh o in addi ,

tion to asthma su ffer e d from oth er dis e as e s as well

,
.

Five h ad hypertonia ; three gastric ulc ers ; five , ,

chronic choli cys ti tis Fifty pati ents were kn own to

.

suffer from neuros e s ( tw enty four from neurasthenia ; -

,

six t e en from psych asthenia ; and ten from h ysteria )

, ,
.

All di agnoses w er e mad e by specialists .

In the course of treatm ent certain indicati ons in

favor of hypnotherapy w ere found among th em : ,

1 A bsence of acute infe ctions in the org an s of

.

brea thing .

1 57
 2 . Sn lsuggestibility of the patient or his
ci ent

d e sire to be tr e ated by h ypnosis .

3 C onnection of asthmatic attacks with some

.

mental trauma or negative emotions .

4 Pr e sence of obvious m e c h anisms of condition e d

.

reflexes in connection with r e current attacks ( dep end

ing on smells tim e of th e day or nigh t specific
, ,

environment ,

5 C oincid e ntal di agnosis of mental ailments

.
,

nam ely neurasth enia psyc h asth enia hyst eria

, , , .

Individu al s essions of hypnotherapy continued for

about th irty minutes every second day Th e wh ole
, .

cours e of tr e atment consisted of ten to thirty sessions ,

depending on the need Thi rt y patients were hypno

.

ti z e d at first individually an d then with thei r con ,

s ent th ey form e d a group

, .

Hypnosis was conducted by m e ans of verb al

sugg e stion of somn ol e scence and strength ened de ,

p endi ng on individual requirements by visual aud , ,

i t ory or tactil e stimulation .

Thre e degr ee s of th e depth of h ypnosis w ere dis

tin gui s he d : ligh t me di um an d d e ep Th e fir st w as
,
.

typical of fift e en pati ents ; th e second of forty eigh t; ,

-

th e thi rd of twenty s even And ten persons could not

,
-
.

b e hypnotiz e d at all .

Th e therapeutic suggestions w ere on the whole , ,

organized on the basis of the pati ents complaints

’

an d the progr e ss of h ealt h conditions We tri e d to .

k eep up th eir moral e and improv e their disposition .

In cas e s of insomnia it was sugg e sted to sleep well

,

and soundly as b efor e illn e ss A ll the possible effects

,
.

of weath er ch ange an d odors upon th e attacks as

also of worr ies and oth er emotional disturb an ces were
158
proves the lun g capacity increases the art eri al pres
, ,

sure u ses .

3 Treatment b y hyp nosis has be en statisti c all y

.

justified Forty tw o patients ( out of 100 ) s h owed

.
-

much im provement and had no attacks for the dura

tion of s ix months to thr ee years Twenty eig ht patients
.
-

were well improved ; the attacks were conspicuously

milder and r arer Th e rest showed no signific ant
.

chan g e .

160
 P SYCHO T HE RAP Y IN
P SYCHOGEN I C T HYREO TO"I COS I S

b y M K as hpur
.

( Kharkov)

Th e pr e sent report d e als with sp e ech therapy ap

pli e d to thyr eotoxic os es used whenever ther e ar e
,

psych ogenic factors in th e case history .

There is nothing n e w in the belief th at this disease

may be caused by psych ologic al trauma Th ere is .

much evidence to th e effect that symptoms of this

di sease may appear as a result of som e fun ction al
di s turbanc e of the acti vi ti es of th e thyroid glan d
unbalanced by negative experi ences in th e patient s
’

lif e A number of authors r eferred to thi s in th e past

. .

S P Botkin wrote th at symptoms of thyreotoxicosis

. .

may app e ar withi n h ours after a s trong emotional

“
exp eri enc e D ubois in h is tim e r emar k e d th at in
.
, ,

som e instanc e s Basedow s dis e ase ar ises in an acute

’

form as a result of a strong moral s h ock .

R e c e ntly publis he d mat erial s h ows that psych o

g enic sources of thi s illn ess are quite common Th us.

Andres and Vilk om irs k y p oin t out th at th ir ty fi ve -

percent of 228 cas e s of thyr e otoxicosis they treated

1 61
were psych oge nic in origin M ore r e cently .

M A K opel ovi ch and N M Dra z nin compil e d mat e

. . . .

rial on 547 cas e s of this ill ness of which w ere ,

found to be psychog enic in origin .

It ha s b een k nown for som e time al ready that the

treatment of Basedow s dis e ase by m e an s of psycho
’

th erapy is lik ely to bring about positiv e r e s ul ts We .

ourselves had an opportunity to observ e s ev enty fi v e -

cases with Bas e dow s syndrome O n e group con ’

sisted of p e ople wh o had suffer e d from th e ailm ent

for a long tim e ( from sev en to twelv e year s ) ; the
o ther was composed of comp aratively rec ent cases
( from on e to two y e ars ) In for ty e ig h t cas es th e .
-

dis e as e w as cl e arly psych ogeni c in origin E v ery one .

of th em h ad typical symptoms of thyreotoxicosis such ,

as protrusion of the eyeb alls high rate of m etabolism , ,

enl arg em e nt of the thyroid tachycar di a E veryone ,

.

of them complain e d of p alpitation of th e he ar t ,

trembling of fingers exc e ssive p erspiration di arrhe a

, , ,

loss of w e ight insomn ia f eelings of w e akness We

, ,
.

were able to observe hi gh excitability as well as low

Spirits S ome of the patients r eported pers iste nt f ear s
.

and psych og enic h al lucinations .

Tw enty tw o of thes e pati ents were subjected to

-

sp e ech th erapy with positive results in each instance .

A f ew case h istories will illus trate the probl em tr e at ,

ment and outcome .

1Patient A twenty two year s of a ge D eveloped

. .
,
-
.

sickn e ss after a frigh t caused by an attempt by a

n eighbor to rape h er From that tim e on she mani .

fes ted n e urotic symptoms Withi n s everal we eks th ere .

,

appeared enl argem ent of the neck h eart p al pitations , ,

fr e quent p anting Sh e w as forc e d to abandon her

.

1 62
eyes A t that time s h e d ev eloped progressiv e Bas e
.

dow s dis e ase and was finally op erat e d on for goiter

’

But r ec ently s h e h ad h ad the misfortun e of losing her

onl y ch ild and h ad d evelop e d the abov e m ention e d -

symptoms .

Thi s tim e the pati ent w as subj e cted to ps ycho ther e

a
py wit h de e p sl ee p ( eig h t sessions ) Sh e.recover e d ,

g ai n e d in w eigh t and was abl e to go to work .

O ur int erpr etation of the Basedow s syndrome as a

’

local psych og e nic d isturban c e of th e regulatory work

of the cort ex is bas e d on the doctrin e s of I P Pavlov . .

and the exp erim ental work by K M Bykov . . .

In all our tr eatm ents w e us e sp e ech therapy After .

investigatin g the caus e s an d conditions of th e pati ent s

’

sickn ess w e b e gin with explan atory and calming

,

sugg e stions in the waking state Thi s is follow e d by

.

hyp noti c sl eep Th e p ati ent r emain s asl eep for tw o

.

h ours e ach tim e and is giv e n sugg e stions of d eep rest

an d r e storation of str ength A dditional sugg e stions
.

ar e d et ermin e d by t he pati ent s cas e hi story and

’

sym ptoms .

Ther e ar e altog ether from four to t en such s e s

sions d epending on the patient s condi tion and th e
’

rat e of improvem ent .

1 64
 THE S I GN I FI CANCE OF P SYCHO T HE RA P Y
I N O B S TE TRI CS AND GYNECO L OGY

by V I Zdravomys l ov
. .

( S tavropol)

In obst e trics th e rol e of word as an anaesthetic

,
‘ ’

factor is extrem ely great .

Ch ildbirt h is the only p hysiologic al act which as a

rule tak e s plac e painfully even th oug h all the tissues
,

of the organ ism have been pr epar e d for the event

( by slowly b e co m ing more elastic ) dur ing nine
months .

Th e pains of ch ildb irth ar e of two kinds : natural

an d sugg e st e d
. The sugg e st e d p ai ns d e v elop as a
r e sult of widespr e ad conviction that they are in evit
able Th is conviction h as b een cul tivated from g enera
.

tion to generation and rm e d and r e a h rme d by

relativ e s and fri ends and also by reli gious circles

, ,

m e dicin e and lit eratur e And this suggest e d aspect

.

of birth pains is by far th e mor e signi fican t .

“
Th e m ark e d incr e as e of th e cortical th r e shold of
s ensitivity to th e impulses of p ain during childbirth
”

can be consid erably lower e d how ev er ; sometimes it

,

can be compl etely overcome But even m ore can be .

165
 ‘

done by mere words to r emove sugg est e d pai ns

’

In fact no oth er known meth od offers b e tt er res ul ts

,

th an anaesthe sia of c hildbir th by means of sugg e s tion .

We ar e able to report on the r e s ul ts of sugg e sted

painless birth in on e th ousand cas e s Seven h un dr e d .

of them h ad prop hylactic pr eparation whi l e thr ee

hundred underwent suggestion of p ai nl e ssn e ss only
during the proc e ss of ch ildbirth In eigh ty perc ent .

of all cases th ere was marked positiv e effect and in ,

forty perc ent there was no pain wh atsoever .

C o unteri n di cati on s to c hildbirth ana e sthesia by

medi cation ar e practically synonymous with the eu
“
tire s o call e d obst e trical path ology It include s
-
.

dis e ases of th e h eart liv er kidn eys an d oth er org ans

, , , .

But suggestive anaesthe sia h as no co un teri ndi cati on s

at all.

It is p ermitt e d to use sugg e stion for painless birth

“
dur ing deliv ery ( therapy of pain an d in prepar a
“
tion for it ( prop hylaxis of chi ldbirth pains
It is v ery important to giv e wom en th orough
acquaintanc e with the p hysiology and p roc e ss e s of
birth as w ell as with the activiti e s at any moment
of birth labors S ugg e stive pr eparation s h ould pr ef er
.

ably begin e arly during con sultations This c an b e .

followed by sugg e stions of p ainless bir th D uring .

th ese s e ssions all n e gati v e emotions conn e cted with

pre gnancy and childbirth s h ould be r emoved and
replaced by positiv e e motions A nd incid entally ad di .
,

ti on al sugg e stions may be giv e n with r e gard to proper

sl eep bow el movem ents moods etc O n th e av erag e
, , ,
.
,

a woman n ee ds up to s ix s e ssions th ough the s u 0 1eI1 t

,
1

effect may b e attained even in one .

Th ese sugg e stions can be conducted individually

or coll e ctively F or th e latter purpose groups of thirty
.

1 66
 P SYCH OT HE RA PY OF H YP OGALACTIA OF
NU RS I NG M O THE R S

by A T Belyaeva G I Vinokurov
. .
, . .
,

V I Zdravomys l ov T M Kravchenk o
. .
, . .
,

and N I Kuym ova . .

( S tavropo l)

complete absence of milk ( agalactia ) happens

only in acutely pathological changes in the breas t
glands such as their atrophy inborn abnormality and
, , ,

seri ous injuries to th em In th e absence of such .

pathological changes practically every woman has the

,

ability at the time of chil db irth to nurse her b ab y

, , .

U F Dombrovs k aya observed agalactia onl y in one

. .

percent of the cases M S M as lov in four percent

, . .
,

and other auth ors between t w o and ten percent Much .

"

more frequently one finds merely insu ici ent amount

of milk or hypogalactia A ccordi ng to M S M as lov
,
. . .
,

hypogal act ia is found among anywhere betw een fif

t e en and t w enty fi ve percent of the nur sing mothers
-
.

I Y Polyak Bragin s k aya observed the phenomenon

. .
-

in thi rty seven percent -

.

169
 Unfortrm ately hypogalactia compels many mothers
,

to transfer childr en to arti fi cial f ee di ng too e arly ,

som etim es from th e very fir st days of the ir life In .

m any instances this predisposes them to various ill

,

ness es connected with disturbanc e s of nutrition To .

avoid this a vari ety of di e te tic p h armaceutical and

, , ,

other measures hav e been d evised But the most .

effici e nt approach to the probl em in M S M as l ov s

’

. .
,

opini on lies in psychoth erapy

, .

The first physician to in troduce sugg e s tion th erapy

in thi s conn ection was V I Zdr av omys l ov. .

H rs fi ndings showed at that tim e positiv e r e sults in

eigh ty nine perc ent of the cas e s S ome year s later
-
.
,

suggestion th erapy w as organized under his l e ad er ,

s hip in the First Chi ld Polyclini c in S tavropol to

,

tr e at hypogalactia and r elat e d nutr iti onal d i culties .

In ad di ti on to hyp ogalactia and ag al acti a p sych o ,

therapy w as appli e d al so to cas e s of h yp ergalactia and

defects of the nip p l e s .

There were al tog eth er sev enty nursing mothers

und er obs e rvation The number of s e ssions v ari ed
.

from one to sixt e en accordin g to need

, .

Increase in the quantity of milk in the br e asts was

consider e d as an obj e ctive evid enc e of succ e ss of the
treatm ent Th e success was regard e d as full w h en th e
.

mo ther was abl e on the conclusion of th e therapy

, ,

to nur s e th e baby exclusiv ely by breast wh ile the ,

baby w as gaining in w eigh t By partial success we.

understood th e situation in wh ich the supp ly of

mother s milk ap pr e ciably incr e as e d but ins u ciently
’

,
f
r

so to provide the baby wi th a d equate nutriti on .

Th e whol e pict ure of results of this treatm ent can

b e seen in th e follow ing table
1 70
 THE USE OF HYP NOS I S AND
COND ITI ONED REFL E " T HE RAP Y
-

I N DE RMA T O L OGY

by M M Zhel tak ov
. .

( M os co w )

M uch research work h as been done in our countr y

an d abroad on th e ap lication of hy nosis to vario us
p p
areas of m e di cine includin g th at of dermatology
,
.

M ost authors ref er to th e high effe ctiven e ss of hypno

sugg e stiv e therapy Nev erth el e ss this m e thod h ad so
.
,

far a rath er limit e d use in g eneral me di cal practice

or specific al ly in dermatology .

But the time h as arri ved to put the fin din gs

tog e th er an d to dr aw proper conclusions from the
total experi ence of our psych oth erapists and also to ,

list the in di cations and c ounterin di cati ons for hypno tic
treatment of various ai lments .

We definitely recommend a much wider use of

hypn os ugges ti ve th erapy but insist on th e import anc e
,

of in dividu al ization in both m etho ds of tr e atment and

the contents of sugg e s tion .

The probl em of making hypnotic sugg e stion indi

vi duali z e d whe never th is type of treatment is cl e arly
,

1 72
in di cated is d i i cul t and complex for it is d et ermined
, ,

not only by the natur e of the dis e as e but also by ,

th e functional state of th e pati e nt s nervous syst em ’

a t th e time of contraction of sickness an d th e begin

ning of treatm ent N or s h ould th e typ e of th e h ig h er

.

n ervous activity be di sr e gard e d .

It h app ens som e tim e s th at the p hysician using

hypnosis for the pu rpos es of tr e atm ent do e s not
consider the pati ent s personality and what can be
’

done with it und er th e circumstanc e s Th is is lik ely .

to result in a lower effe ctiv en e ss of hyp notherapy and

may ev e n discredit the meth od in th e ey e s of o th er
physicians and pati ents .

Hypnosis is no panac e a but only one of th e most ,

effe ctiv e meth ods of ac tin g upon the pati ent s organ ’

ism through th e hig h er c ent ers of hi s nervous system

— h is cortex Ph ysicians of di ff erent s pe cializations
.

sometimes vagu ely refer to th eir pati ents as h aving

some n eurotic t enden ci e s A ctually the pati ent may
.

be suffering from say an ulc er or hypertonia eczema

, , ,

or psoriasis Sh ould the pati ent be treated by hyp

.

nosis ? D efinit ely so But it does not follow at all from

.

th e se considerations th at th is pati ent s h ould b e tr e ated

onl in t h is way H e may n ee d a ls o ot he r forms of
y .

treatm ent such a s di et or medi cation U nl e ss the se

, .

facts are tak en into consid eration the failur e of ,

tr e atm ent cannot b e attribut e d to h ypnosis alone .

It is v ery important to remember th at in the ,

development of various dis e as e s th e n eural and men ,

tal traumatic conditions the overstimulation of th e

,

nervous system and di i cult p ersonal exp eriences may

,

play a tr em endous role ; such things quit e ofte n l e ad

to neuroses Th is is p arti cularly tru e of pati e nts
.

suffering from skin diseases som e of wh ich are ,

1 73
di cult to cure such as ecz ema neuro derrnato s is
1
, ,
-
,

psorias is etc A n e urosis of such pati ents may h av e

,
.

many differ e nt caus e s O n the on e h and th e skin

.
,

disease may contribute to th e aggravation of th e

pr eviously exi sti ng n eurosis ; and on th e oth er th e ,

neurotic con d ition its elf may h av e originat e d as a

result of a s erious and prolong e d sk in dis e ase In .

either cas e n eurosis is lik ely to add to the un

,

pleasantn e ss of the situ ation .

C linical obs ervations d emonstrate that neurotic

con di tions are signific an tly common among pati ents
sufferin g from the s e di seas e s Th e e xplanation is sim
.

pl e enough M any skin ai lm ents for instanc e ecz ema

.
, , ,

neuro dermatosis h on eycomb t ett er psoriasis or nettl e

-
, , ,

ras h ar e usually accom p ani e d by itch ing som e tim e s ,

qui t e intense an d p ersist ent Itchi ng is lik ely to .

caus e som e distur banc e s in the n ervous syst em m er ely ,

b e caus e the p ati e nts with the s e troubl e s ar e excitabl e

and irritabl e They may suffer from insomnia too and
.
, ,

ther e may b e som e cons e qu enc e s of autonomic origin .

It is rath er unfortunat e th at in skin dis ea s e s the , ,

pati ent h as an o pp ortunity almost at all tim e s to

obs erv e the manifestations of h is dis e ase E v en a .

slight e st d et erioration in the p ictur e of h is malady

affe cts h is p sych olo gy and l e ads to unf avorabl e d e
v e l o m en ts T h is is particularly so w he n t he disease
p .

is localiz e d on the o pen and r e adily visibl e portions

of the skin e s pe cially on th e fac e or h ands ; function al
,

disturbanc e s of the n ervous syst em ar e quit e common

in the s e cas e s S uch disturb an ces occur even when
.

the troubl e h appens to b e minor a m er e cosmetic ,

d efe ct Neverthe l e ss the p sych ological stat e of the s e

.
,

pe opl e may b e s eriously affe ct e d Wh en in addi tion .

,

fri ends and n eigh bors manif e st th e atti tude of

1 74
 ( 1 ) correct in dicati ons for its use
( 2 ) suitabl e m e th odology ;
( 3 ) th e natur e and s erious n ess of th e sickness ;
( )
4 th e abili ty of t he p h ysici an to employ h yp n o

therapy wi th ski ll ; an d
( 5 ) th e pati ent hi m s elf th e typ e of h is n ervous
,

acti vity an d h is faith in the m ethod of tr e atm ent

,
.

In thi s comm uni cation we confin e ours elv e s to the

stat em ent of g en eral p ri nciples conc erning m etho d ol
ogy in us e of hyp notherapy .

Indications toward the us e of hypnotherapy in skin

dis e as e s may b e di vid e d into two larg e s e ctions ;
fir st broad indications when hyp notherapy is em
,

ploy e d m er ely as an auxiliary m eth od ; and s e cond ,

mor e specific indications when hypno therap y is em

ploy e d as the main an d basic t e ch niqu e .

To the s e ction of broad indications b elong n e uroti c

conditions in g en eral ; insomnia accomp anying many
d ermatos e s ; various man if estations of n e rvousn e ss ,

such as f e ar of b eing incurably ill worry about one s

’

he alth A ll such instanc e s of un balanc e of th e n erv e s

.

a ffe ct unfavorably the cours e of the skin ailm ent .

The s e pati ents ar e cl e arly b en efit e d by hypn os ugges

tive th erap y but only as an aux iliary m e th od
,
.

When the treatm ent calls for sugg estion or hypno

sis as the basic m e th od o f tr e atm ent indications ar e
,
“
call e d s pe cific or limit e d A mong the d ermatos e s
.

falling into th is cate gory ar e th os e alr e ady enum erate d

and many others for instanc e or di nary warts
, , .

It is advisabl e for b e st r esults to combin e hypno

, ,

sis with condition e d refl ex action of s el e ct e d drugs

-
.

This is b en efici al even when th e pa ti ents ar e hi ghly

,

sugg e sti bl e mai nly because th e therapeutic effect of

,

1 76
 sugges tion does not last long enough S o it occur s that .

th e symptoms of the di sease become re e stablis h ed -

after a whil e sometimes even withi n s ev eral hours

,
.

A s it is impracticable to employ hyp nosis too often ,

the patient is conditioned to th e dr ug and tak e s it at

intervals between hypnotic s e ssions This meth od as .

sur es th e contin uity of th e tr e atm ent and thi s is ,

p ar ticul arly advantageous in d e aling wi th chronic

illn ess e s wh ic h yield to treatm ent but slowly H igh .

sugg e stibil ity and hi g h condition ing usually go to

gether an d thus produc e the b e st r e sults .

In most cas e s th e formation of a conditioned

,

reflex r e quires rep e at e d suggestion If th e patient i s

.

highly sugg e stible it may b e don e in two or thr e e

,

hypnotic s e ssions F or this therap y it is p ossibl e to

.
,

use either medication wi th d efi nit e p h armacological

prop erti e s ( such as lumi nal for insomnia or d imedr ol
for itch ing ) an d also 1n different drugs Wh en a d
’

mi nister e d to pati e nts of low sugg e stibility th e ,

latt e r may be with out effe ct for lack of s u cient

"

conditioning .

Th e condi tion e d refl ex therapy is particularly use

-

ful in th e following cas e s : to eliminat e itch ing and

pain to e stablish conditioned sleep to reduce or
, ,

ov ercom e n eurotic symptoms dev eloping in some skin

ailm ents to count eract various und e sirable emo
,

ti on al e xperienc e s .

Se ssions of hypnosis and condition e d sleep work

b e st wh en conducted in bed at th e usual sle ep ti m e
, ,

whe n th e patient may r emain hypnotiz e d Hypnosis .

gr adually passes then into natural sl e ep .

177
 HYP N OT HE RA P Y OF DE RM A TO S E S IN
RESO R T TREA TM EN T

b y I A Zh ukov
. .

( Khos ta)

O ur s tudy was confined to the role of hypnos ug

es tive therapy under r e sort co n ditions ( in S oc h i and
g
M ats e sta C aucaus us ) wh ere d e rmatoses are ex
, ,

tremely common among patients .

The s ul p h ur baths at M ats e sta as well as sea and

sun bath ing constitut e the main attractions of the
region Th e fame b e auty an d exc ell ent climate of
.
, ,

this r e sort environment produce by themselves a

favorabl e influ ence upon th e patients But the use.

of psych oth erapy on the back ground of these bene

fi ci al factors en abl e s us to attain even quicker and
mor e enduring improv ement in th e pati ents h ealth ’

A ll our hypnoti c tr e atments were conducted by

means of th e s o call e d fascination t e ch nique ( involv
-

ing st aring at som e brigh t obj e ct ) the spok en word

,

conv eying the requir e d sugg e stion E v ening h o urs

.

wer e chos en for the h ypnotic sessions in sofar as ,

th is tim e was most compatible with th e r e sort regim en

1 78
 Ther ewer e altog ether on e hun dr e d and sixty s ix -

p ersons suffering from varl ous form s of neur o d erma -

titis h al f of them in the exp erimental group and the

,

other h alf in the control group .

The comparison of the results achieved in each

group is given in th e followi ng tabl e :

T abl e II (N E UR O D E R M AT IT IS)
-

R es u l ts o f T r ea t m en t C o n tr o l G r o up E xper i men ta l G r o up
C o m p l e te R eco ver y
M ark e d I mp ro vemen t
Sl i gh t I m p ro vem en t
N o ch ange
D e teri o r ati o n

The group suff ering from psoriasis consist e d of on e

h undr e d an d forty—four persons h alf of them in the ,

exp erim ental group and an equal numb er in the con

trol grou p The p ati en ts in t he form er group wer e
.

from twen ty to sixty y e ars old ; the dur ation of the ir

d is e as e was from on e to tw en ty fi ve y ears In most -
.

cases the illn e ss was quit e ext ensiv e an d aff e ct e d th e

he ad the tru nk and the l e gs an d f eet
, ,
.

Th e results can b e s ee n in the following tabl e

comparing the outcom e of treatm en t in both groups
of pati ents .

T ab l e I II (P S O R IAS I S)

R es u l ts o f T r ea t m e n t C o n tr o l G r o up E x per i m en ta l G r o up
C o m p l e te R e co ver y
M ark e d I m p r o v em en t
Sl i g h t I m p o vem en t
r

N o ch an ge
D e teri o r ati o n
 Th erewas a follow up of this s tudy of eczem a
-
,

neur o dermatitis and psorias is Practicall y all the pa

-
, .

of th e control group were co ntacted by me an s of a

ques tionnaire and 229 answer s were received The
, .

permanent
of improvements .

18 1
 P SYCH OT H E RA P Y OF CONVALESCENCE

by I P Kutanin
. .

( S aratov)

I n the light of I P Pavlov s fin dings every word

. .
’

uttered by a physici an plays a significan t role in his

patient s treatment Th e p hysici an must kn ow what
’
.

h e is saying an d wh at effect his words ar e producin g .

But it is equ al ly true that the physician should k now

and understand hi s patient A nd in psychotherap y . ,

the patient must be s tudied for he r epresents a ,

compl ex and s ensitive psychosomati c uni ty I n the .

development of various ill nesses the patient s mental ,

state particularly hi s emotions cons titute an impor

, ,

t ant in gredient Th at is why it is so essenti al to

.

an al yze it .

The mai n representatives of Russi an medical

thought—M Y M udrov G A Zakharyin N I
. .
,
. .
, . .

Pirogov N A O s troumov and others—assign ed to

, . .
,

the psych ogenic fact or an importan t place in the

etiology and path ogenes is of disease V A M anas s eyin . . .
,

in commenting upon the role of mental s h ocks clearly ,

“
asserted that they may not only cause various forms
1 85
o f troubl e in the organs of the b o dy b ut al so dis turb ,

genera l nutrition of the organi sm .

”

G A Zakh aryi n often pointed out that most

. .

seriously ill patients by virtue of their sickn e ss find , ,

thems elves in a gloomy mood and look worri edl y

tow ard the future Th e p hysici an to be successful .
,

in the treatm ent must encourage the pati ent give , ,

him hope of recovery or at least a ch an ce of

improvem e nt .

A nd indeed many such patients manifest th ese

,

attitudes according to the degr e e of their pains f e ars , ,

and other negativ e experiences In addition to he ad .

aches and in somn ia they are li kely to have hypo ,

ch ondria d epr e ssion astheni a apathy abulia an d

, , , , ,

other n euro t ic r e actions .

P atients in sanatoriums display capricious be

h avior minor dec eptions and lack of discipline To
, ,
.

control this kind of conduct it is v ery important to ,

understand th e pati ent s temperament ch aracter pre ’

, ,

vi ous illnesses e tc ,
.

A ny patient prior to his arrival to th e sanatorium

, ,

h ad probably much to do with other p hysici ans ,

made inquiries received much discord an t information

,
.

Th e physician at th e s an atorium must be aware of all

this mak e his own diagnosis
,
and be s ur e of hi s ,

findings Th is d emands of him a great d e al of medi cal

.

knowl e dg e as well as of und erstan ding of human

ps y chology .

Unfortunately however it cannot b e s ai d that in

, ,

typical sanatorium practice much attention is being

’

paid to patients psychological states .

O ne of the most important tasks for a p hysici an

is to c al m the pati ent to reduce his worries and ,

t ensions O r to put this differently am ong the many

.
, ,

186
 P sychotherapy sho ul d be interpreted here in its
broadest mean ing It may include such activities as :
.

( a ) reading of books and magazin es ; ( b ) movies

from tim e to time ; ( 0 ) occas ional music ; selected
p hysical work ; and ( e ) various cultur al acti vities .

A good book may calm and di stract the pa ti ent ,

redir e ct his though ts ; it may contribute to the rec o n

struction of his personali ty But it may als o be harm
.

ful A ll literature available to patients shoul d b e

.

chosen with a clear purpose Ea ch san atorium mus t .

be e quipped with a librar y desi gned spec i ally for its

kind of patients S ome pati ents say : Wh at cur ed me
.
“

“
was books or This book is b etter th an any
medicine .

C in ema too plays a great therapeutic role in

, ,

resort life Th e films s h own to the patients shoul d

.

be carefully an d wisely sel ected for th e purpose of ,

treatment rather th an for m e re e ntertainment They .

s h ould b e ch e erful and bright in content rather th an

sad or oppressive ; their effec t s h ould be to c al m an d
r e lax .

A certain place must be assigned in therapy also

to music especiall y among th e neur otics M usic makes
,
.

it possible to al ter or rais e th e patients mood or to ,

redir e ct their thoughts E verybody knows in fact

.
, ,

wh at favorable effect a successful concert or an

’

e vening of pleas an t activity may have on one s di spo

sitiou The positive influence of music had already
.

been observe d at th e time of V M Bekhterev O ur . . .

own e x pe rienc e with the psychiatri c clinics and oh

s ervati ons on the effe ct of symp h onic conc erts at —

S och i an d Kislovodsk confirm the beneficial results of

good musical entertainment .

A s to the work th erapy lon g rec omm ended in ,

1 88
psych o neur otic h ospitals it is advisable only in plac e s
-
,

wh ere patients r emain for a considerabl e l ength of

ti me as in sanatoriums for tubercular cas e s But such
,
.

therapy must b e made attractiv e and as v ar i e d as

possible It may be conduct e d indoors as w ell as
.

outdoors C arpentry work in the garden or kitche n

.
,

gard e n sawin g and pai nting exemplify th e activiti e s

, ,

th at can be org aniz e d d ep ending on the kind of

patients one d e als with and on local opportuni ties .

It is regrettable that many p hysicians manifest only

a pas sive attitude toward more cultural a ctivities in
th e sanatoriums Th ey usually leave this job to experts
.

in cultural e ducation Nev er theless it happens to be

.
,

very true that games sports excursions literary dis , , ,

eussio n s and the lik e e stablis h most favorable condi

,

tions for treatm e nt .

Th e organization of leisure time activities is in

separabl e from th e general r e gimen of a sanatorium .

I t s h ould involve th e e ntir e staff as w el l as th e

pati ents The appear ance of strict ord er an d punctual
.

i ty h as in suc h institutions a most desir abl e effe ct upon

the p ati ents morale ’

Th e wh ol e atm osp here of the sanatorium must

not be dom inated h ow ever by a great vari e ty of
, ,

activiti e s It is abov e all a place of rest and p e ace

.
, ,

of mind The wh ol e staff must s ee to it that every

.

w ard is ch aract erized by the desir e to assur e the

pati ents comfort and r ela xati on
’

It is to b e exp e cted th at in a s anatorium the

patients s h ould gain in s tr ength in cr e ase w e igh t feel , ,

b e tt er and in addition acquir e us eful h abits so es sen

, ,

tial to th eir lat er lif e and work Psych ohygiene is .

,

after all a par t of gen eral hygiene

, .

18 9
 PSYCH OTHERA P E U TI C FA CT ORS IN
C LI N I CA L PRAC TI C E

by A S . . B orzun ov a ,
A V
. . Sayfutdi nova Z M
,
. .

Akhmetova , O P
. . K limcvi ch ,
and A I . . S annikova
( Ufa and L eningrad )

Thi s report contains the results of treatment of

29 3 neuroti c patients observed b y us during 19 50
1 954 We us e d rati onal psyc h o therapy an d wak ing
.

suggestion b efore which each pati ent an d hi s cas e

,

history were car efully studied .

T he psyc h o therap eutic sessions b egan only wi th

each patient s approval after the pur pose of the tr e at
’

m ent was explain ed to him S uggestion was con .

duct e d in the following manner Th e patient was .

tak en to a comfortable but somewh at d arkened room ,

put on a soft couch in a conveni ent pose fr e ed from ,

an
y ti g h t garm e nts an d asked to close his eyes Und er
,
.

th e se condi tions th e nervous system becomes rela

,

tively fre e from strong visual stimuli capable of

d iv ertin g his att e ntion or arousing ir relevant though ts .

M or e over as long as the patient is relaxed in a lying

,

position h e does not h ave to maintain bal ance

, ,

chan g e his position make gestur e s etc All this has

, ,
.

19 0
therap y w as applied to thirty nine In many instances -
.
,

medication and physiotherapy were comb ined with

hypnosis .

To classify by sex : male patients were 199 ; female ,

94 Out of the total number sixte en were children

.
,
.

The results of the treatment classifi ed by disease , ,

were as follows :

Type o f Dis eas e

C hro nic al co h o lis m
N euroses
M o r ph i n ism
H yp o ch o n d r i a
So m at i c ill n ess ( h yp er to nia ,

g as tric ul cer, tub ercu o l

s is , e tc.
)
C ycl o th ymi a
R eact i o n t yp e cas es
-

M anic d epressive
-

psychos is
Invo l utio n ar y mel anch o l i a
P s ycho p ath ic p erso nal i ty

us briefly exami ne a few case histories

Le t
Patient Z manifested on arrival symptoms of
.

repressibl e vomiting extreme emaciation and a para

, ,

lytic condition of th e limbs Prior to this she had .

been tr eated repeate dl y ; there wer e in di cati ons of in ‘

r

ternal cancer In the psychiatric clinic after a careful

.
,

examination the diagnosis was h ysteria Treatment

, .

beg an with rational therapy was ch ang e d to h ypnos i s ,

and modified to prolonged sleep conduct e d sim ul

taneo us ly with anoth er pati ent for ten days The dura .

ti on of each session was twenty two hours per day -

.

A t the end of the period there w as noticeable im

1 92
provem ent The treatment continued for a while but
.
,

soon the pati ent r e turned to work .

Pati ent K forty fi ve ye ar s of age was a victim

.
,
-
,

of severe war injuries with th e eventual am putation

,

of the righ t arm A s a result th er e developed p h an

.
,

tom sensations including pains in th e non exist ent -

fing ers of th e amputat e d arm Several surgical opera .

t ions w ere of no avail A series of h ypnotic tr ea t ments

.

end e d with th e elimination of dis turbing p ain s as well

as in the restoration of normal attitudes tow ar d h is

crippl e d stat e Two years lat er th e symptoms r e curred

.
,

in conn ection with th e death of his son ; but sev eral

hypnotic s e ssions su fic e d to cure th e patient
f
.

Pa tient " h ad suffer e d from hypoch ondr ia for

.

“
t w o years A ccord ing to him
. he w as sick all over , ,

with all internal organs compl e t ely inactive Und er .

the influ enc e of a f ew sessions of prolonged hypnoti c

sl eep the p atient w as abl e to r e turn to work
,
.

Patient P a case of pulmonary tub erculosis w as

.
, ,

abl e when subj e ct e d to waking sugg estion to get

, ,

rid of f eelings of discouragement and also to gain

w eigh t and overcom e asthmatic br e athing In the end .
,

she cons ented to be transferred to a country insti tution

for the tuberculars .

It is now feasibl e to conclud e th at psych otherapy

is indicated not only in many cases of neurosis and
some cas e s of psych osis but al so in c ertain somatic
,

ill ness e s.

O ur exp erience demonstrates in g eneral th at psy , ,

cho thera euti c methods should b e us e d as follows

p

1 In persistent neuro tic conditions hyp och ondria

.
, ,

and psych os e s with the h ypoch ondriac syndrome : wak

ing sugg e stion in a lying posi tion with clos e d eyes .

19 3
 2 In somatic ailm ents : prolonged hypnotic sleep
. .

3 In h yst e ria n arcom an ia and al co h olism : h yp

.
, ,

nosis d ep ending on the nat ure of th e cas e ; it may b e

given differ ent forms including group hypnosis and
,

prolonged sleep .

4 I n depression of v arious forms

. su
gges

ti on followed by
di agnosis of a somatic di sease with out ad e quate
grounds tentativ ely as it w er e Then in th e cours e
, .
,

of th e subs e qu ent tr e atment th e patient forms c er

,

t ain appar ent— not necessarily real— patholo gi ca

sym ptoms .

Pati ent E for inst ance h ad a serious menta

.
, ,

shoc k : s h e lost her moth er from canc er of the

stomach O n the backgroun d of a weaken e d n ervou
.

syst em s h e began to compl ai n of stomach pains an c

,

visited a p hysician Th e usual many sided inv e stiga

.

tion of the cas e only confirmed in th e pati ent the

possibility of cancer th e mor e s o th at th e phys i ci ar
openly consider e d i t A ll thi s does not mean 0
.
,

cour se that various proph ylactic st eps should not be

,

taken ; neverth el e ss it is most important to consid er

,

the patient s personality e xp eri ences an d the state

’

, ,

of h er nervous system F ortun at ely enough a rather

.
,

long psych oth erap eutic tr e atm ent of th e pati ent w as

successful in ov ercoming th e p h obic syn drom e .

It happens also th at a pati ent s p hysici an discusse s

’

hi s case h istory with som e body els e in hi s pr e s enc e

without considering th e p ossibl e im p ressions Sucl .

situations do commonly occur in the examination oi

pati ents or during daily rounds in h os p itals or clinics
A s a result th e pati ent may recall the remarks con
,

c erni ng h is he alth or illn ess and try to comprehenc

the strange words he h eard The result may b e th a1
.

th e existing neuroti c condition is unnecessarily

aggravated .

Practically all of our pat ients with iatrog enic s ymp

toms b el ong e d to the w e ak type of the n ervous sys
tem D uring th eir ex amination by m e ans of clinica
.

or p h ysiological meth ods th e sam e weakn e ss was ob

served ; functions of th e autono mic system w er e con
19 6
s i der abl m od i fi ed indi cating some di sruption of the
y
corti cal and s ubcorti cal control .

L et us cons ider a c ase history .

Patient M forty years of age D iagnosis : neur as

.
, .

th eni a with a phobic syndrome H is n e rvous system is .

of the w e ak typ e E xcessive worry of h is parents con

.

cerning hi s h ealth since early chi ldhood contributed

heavily to th e development of the fe eling that his
health was below par E very time he met a di i cul t
"

si tuation in life he felt sick The patient entered a .

hospital complaining of pains in th e region of the

heart and fe ar of death H e became particula rly sick.

when a p hysician after examining hi m decid e d that

,

it mig ht be dang erous for him to go to a resort inso ,

far as he suffered from hypertonia and myocar di ac

dystrop h y O n hi s retum home th e pati ent b eg an to
.
,

f ee l pains in the heart again Th e polyclinic physi .

ci an ord e r e d h im to stay in b e d but another p hysi ,

oian making rounds c h ang e d the order Th e patient .

w a s demor al iz e d mor e t h an ev e r F urther examina .

tion e xclud e d the possibili ty of a heart ai lment how ,

ever and the patient was tr an sferr e d to a psychoth era

,

peuti e ward A fter sever al psych otherapeutic talks and

.

suggestion regular w al ks for exercise an d the us e

, ,

of bromid e s in smal l cl oses ( with c afl ein ) the pati ent ,

gradually recover e d D uring two years of observation

.

he showed no signs of the former ailment .

Our fin di ngs s h ow that th e victi ms of iatrogeni c

neuros e s ar e mainly persons wi th n e rve we akn es s .

The central task of tr eatm ent consists in rais ing the

tonus of the hi gh er nervous system and in r emovin g
al l noticeable dominant pathological ideas by means

of psychotherapy and wh atever other mean s may be

av ailab le .

19 7
tages wh en it is com bin ed wi t h the in d ivi d u al metho d
of treahn ent .

The avai lable evidence testifi es to the effect that

each of the methods h as its unique features an d ,

someti mes it has to be also combined wi th oth er typ e s

of therapy such as medi cation and p hysiotherapy The
, .

m ai n thing is to approach each case with proper dis

crimination .

H alf a cen tury of experience with s h owing motion

pictures to all ki nds of au di ences includi ng sick peo ,

ple in dicates th at films have a many sided influ enc e

,
-

upon human psychology They are or may be more

.
, ,

th an ent ertai nment only I S Sumbayev h as demon

. . .

s tr ate d th at in psych otherapy words affect p e opl e

, ,

not only as co ld me an ings but also as rhyth m and

,

tone conve ying feelings H e points out that sounds

.

coming from the screen can a ssum e the form of color

“
ful vocal g e stures They can be pronounced quietly
.
”

or in whisper ; or else th ey can come to an end in a

beautiful and long rem emb er e d song S ounds can be
-
.

enh anc e d by m e ans of acc ents paus e s and musical , ,

effects of all kinds .

The music of films can be hi ghl y b en eficial to th e

pati ent ; it is abl e to pr od uce a calming effect upon
the pati ent to provid e him with positi ve emotions
,
.

The probl em of th e value of music in the tr e atm ent ”

of pati ents has been attractin g the ph ysicians atten

’

ti on for a long time V M Bekh terev was active in

. . .

th e fi eld and spoke of the therap eutic r e sults of

m usical experi e nce .

A n int er e sting and import ant mo tion picture ,

Once and For ever was produced a few years ago ; it

d e alt with th e treatm ent of alcoh olics by hypnosis .

Th ere w ere thr ee parts to it Th e first part h ad to do

.

with al coholism as a social evil affecting th e family ,

200
every d ay lif e an d in d ustry Th e content was not
, .

merely educational ; it al so served as a war ning or emo

tional preparation Th e second part of the film por
.

t rayed a hypnotic session with a medical purpose .

Th e public saw a group of in di viduals on the scre en ,

all sufferin g from alcoholi sm in various stages and

forms ; they al so had an opportuni ty to see Pr ofessor

Y V K an nabih putting the patients to sleep The
. . .

third part constituted an attempt to hypnotize th e liv

in g audience It aimed at mas s hypnosis conducted di
.

r ectl from the scr e en A ll the stages of s cho ther a

y .
p y
peutie infl uence were organicall y brough t together
thus in creasing th e influence of sugges tion E xamin a .

tion of the r e sults s h owed a hi gh psychotherapeutic

effectiveness of the picture .

Unfortunately th e number of films of thi s calib er

,

is stil l com parati vely small But for th e purpos e s of

.

psychoprop hylaxis even ordin ary films of hig h qu al i ty

may be v ery useful An d ind ee d obs e rvations in the
.
,

First M oscow M edical Institut e have demonstrated

that certain films have a considerable psychothera
peutie effect .

It has been fr e quently observed that when pa

ti ents obs e ss e d by un h appy memories or though ts
have an opportunity to s e e a gay and stimulating mo
tion pictur e the y seem to leave the h abi t ual mental
,

stat e s b ehind at least for a whi le

, .

E xcell ent influence upon patients was actually

“
produc e d by such musical comedy films as A nton
” “
Ivanovich is Angry or A ir C oachman Wh en .
”

adapted for demonstrati on in ordinary wards they ,

offered a valuabl e form of rel axation .

S om e hi gh quality films are definitely recom

mended for audi enc e s of sick chil dr en D emonstration .

“
of a picture lik e Doctor O uch does much good to
”

201
such children It is w ell known that our youn gsters
.

are sometim es afr ai d of the p hysici an s resist me di cal ,

examination interfere wi th temp erature taking and

, ,
“
refuse to swallow me di cine But the films lik e D octor .

“
O uch or Limpopo quite often ch ange the chil dr en s
” ” ’

attitude toward medical proc edur es drugs and phy , ,

s rcrans .

We have act ually seen that when a worried chil d

is reminded of the good D oct or O uch he often con ,

sents to take medicine or have his temperature meas

ure d The role of film s as a psychotherapeutic fa ctor
.

must not be un derestim ated .

In all psychoneurological centers high quality ,

films ar e now s h own regular ly an d as a matter of

course But the responsibility for th e job is often l eft
.

in the hands of the entertainment staff while the ,

p hysicians keep their h ands off and are not even con
s ul te d .

Yet whenever films of emotion al intensity and

,

str uggl e a re s h own to the patients the results may ,

consist in the d eterioration of their he al th S ome of .

them afte r watch ing a moti on picture of thi s sort

, ,
'
h ave d culty in fall ing asle ep It follows that the
"

c h oice of films for sick people must be made more

c au fi ous l prefera bly after consultation wi th a phy
y ,

s rcran .

It is des irable furthermore that the demonstra

, ,
’

t ion of films be preced e d by a physician s address to

the patients ( no longer th an ten or fifteen min utes ) ,

in whi ch they are informed concerning the content

an d typ e of the film The purp ose of the talk is of
.
,

course psychotherapeutic I n some cas e s the s h ow

,
.
,

ing of the motion picture may be also followed by a

tal k or dis cus sion .

202
C l i ni cs , 3 , 1 90 194 -
g
F r i i d i ty, 16 -1 7
C o l i er , O . R .
, 1 19 F r o l ov, Y . P 1 55
Co mp ul sio n , 83 F uchs, V . G .
, 52
C o nd i tio ned r efl ex es , 4 1 -4 3
C o nd i t i o n e d -
refl ex t h erap y
1 72 1 77
-

Co nval escence , 1 85 1 8 9 -
G an n us hk in, P B . 72
Cr e n d l ey, 4 6 G erar d , 46
G ers h un i, G V . 79
G o ld berg , E . I ,
. 1 35
G o l u bov ,
N . F .
, 1 55
D an i l ov I V 52 , . G or d ova, T . N 1 36 140 -

D en n es 4 5 , G ro up th erap y , 1 9 5 7 60
,
-

D er m ato ses 1 72 1 8 1 ,
-
G u il iaro vs ky V , . A 79 9 7
, ,

D ezh er i n , 26 1 00
D i ges tive s ecretio n , 52 54-

D is tracti o n 1 7 1 8 ,
-

D o m br ovs k aya, U . F 16 9
Do n d ys h, L . M .
, 1 35 H al e ts k y, A . M 73 77 -

Drazn in, N . M .
, 1 62 H all uci n ati o n , 1 06 1 07-

D u bo is ,
16 1 H arv ey, 45
H o bar t, 4 5
H o r n bor ng, 52
H yp no s i s , 1 3 , 22, 30 3 1, 4 0 5 1 , - -

E czema 1 79 , 5 5 56
-
,
1 06 10 7 , -
122-123.
E mo ti o ns 7 23 , , 1 3 1 1 33
-
, 1 36 - 1 4 3 , 14 6 , 152 .

E n ceph al ogr ap hy 44 50 ,
-
1 56 , 1 58 - 16 0, 1 6 3 16 4 , -
16 8 ,
Ep i l ep s y 32 , 1 72 1 8 1
-
, 1 8 7, 1 9 1 -1 94
E uph o ri a 8 8 , H ypno t ari u m , 1 37
E x tend ed s l eep 8 3 84 122 ,
-
,
- 125 Hy p och o n d ri as is 8 3 1 19 , , , 1 93
H yp o gal acti a 16 9 17 1 ,
-

H ys t er i a , 1 4 16 -
, 3 1 32, 40 4 3
- -
,

78 8 1
-
, 8 3- 8 8
F eed i n g , su gges ted , H ys ter i cal p ar al ysis , 88
F o r bes, 4 5
F ord, 45
F o r el , A .
, 61
F r a n k , 4 5, 4 6 Iatro geny 1 95 1 9 8 ,
-

F r eu d , S .
, 1 9 , 39 Imp o t en ce ps ych ogenic , , 89 93 -
Ind irect s ugg estio n 8 5 88 ,
-
L oo mis , 45
In g er 4 5
, L uk o ms ky, I L . 129 -1 35, 1 99
In h i b i tio n 40 56 57 , ,
-
L und h o l m , 45
Ivan ov N V 57 60 , . .
,
-

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T HE C ONF I DENCE MAN H r m M l e an e vrlle

T HE VERSE I N ENGL I SH OF R I CHARD CRASHA W $ 9 5 1

C OUN T D OR EL R y m d d t $ 7 5
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I MMOR T A LIT Y A h l y M t g u s e on a

JA P ANESE LIT ERAT URE D ld K ona eene

L ITT LE NOVE L S OF S I C I LY G i i V rg $ 1 75 ovann e a

MOLLOY S mu l B k tt $ 5 a e ec e 2 2
T HE I NSUL T ED AND I NJUR D F y d r D t k y E o o os oevs

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T HE P OEMS OF CAT UL L US H r G r g ry t o ace e o , r .

T HREE EXEM PL ARY NOVELS M g l d mu l ue e Una no

DEMOCRACY AND D I C T A T ORSH IP Z d B r b u $ 9 5 eve e l a 2
W A ITI NG FOR GODO T S mu l B k tt $ a e ec e 1 45
LI S T EN I NG WIT H T HE T H I RD EAR T h d r R k eo o el

T HE AN TI C MUSE R P l k d $ 1 5 Fa , e 9
MALONE D I ES S mu l B k t $ 7 5 a e ec et 1
T HE B I OSOC I AL NA T URE OF MAN A h l y M t g u $ 7 s e on a 1 5
T HE PIT A S t r y f C h i g F r k N
: o o ca o an orrl s

T HREE P ENNY NOVEL B r l t B r h t $ 9 5 e to ec 2

W H IT E JACKE T H r m M l ll $ 9 e an e vl e 1 5
T HE MA I DS d DEAT H W AT CH J G t
an ean e ne

RE B EL WIT HOU T A CAUSE R b r t L d $ 95 o e l n ner 1

T HE FORGO TT EN L ANGUAGE E h F r mm $ 75 rl c o 1
T H E HOUSE OF T HE DEAD Fy d r D t k y o o os oevs

CA PT A I N DREYFUS h H l $ 95 Nl c o las a as z 1
P ROUS T S mu l B k tt a e ec e

T HE AN T ARC TI C CHALLENGED L rd M t $ 45 o oun evans 1

P ARA B LES FOR T HE T HEA T RE B r t l t Br h t $ 1 95 e o ec

P OE T I N NE W YORK F d G L r $ 9 5 e erl co arcra o ca 1

PI RRE OR T HE AM B I GU ITI ES H r m M l
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SELEC T ED P OEMS L wr D urr l l $ 7 5 a e nce e 1

A LONDON LI FE H ry J m $ 1 9 5 en a es

B LACK ANGER Wul f S h ac s

ON AC T ORS AND T HE AR T OF AC TI NG G r g H L w $ 9 5 eo e . e es 1
T HE NO PL AYS OF JA P AN A r h ur W l y 95 t ae

REASON AND ENERGY M i h l H mb ur g r c ae a e

P SYCHOANA L YS I S EVOLU TI ON AND DEVE L O P MEN T M ul l hy Th mp

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T HE GUARE FE L LO W B r d B h $ 95 en an e an 1
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SE L EC T ED P OEMS H D . .

NE W L I GH T ON T HE MOS T ANC I EN T EAS T V G rd Ch Id . o on l e

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A S T UDY OF I N T ER P ERSONA L RE L ATI ONS P k M ul l hy d $ 2 at u o a , e 95

C O L LEC T ED P OEMS 1 92 9 1 Edwm M : 1 -1 5 uu
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SELEC T ED W R ITI NGS OF JU L ES LAFORGUE W l mJ y S m h d $ 2 l na

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T HE CREATI VE EX P ER I MEN T C M B wr $ 95 . o a 1
T EN CEN T UR I ES OF S P AN I SH P OE T RY E l r L Tur b ul l d $ 95 eano . n , e 2
 E8 4 T HE WAY AND IT S P O W ER A rth ur W l y ae

ES S T EN SECONDS FROM NO W K y C ll $ 1 4 5 a i ce is

EBS T HE D I SCOVERY AND CONOU S OF MEX I CO B r l D d l C t il l E T e na l az e as o

E8 7 EDUCATI ON AND HUMAN RELATI ONS A h l y M t g u s e on a

E8 9 A W EEK I N TUR NEVO AND O T HER ST OR I ES A l i T l t y $ 9 5

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E9 0 T HREE P LAYS U B tt i go e

E9 1 S P EC I AL I ZED T ECHN I QUES I N P SYCHO T HERA P Y G u t B y h w k i d s av c o s , e .

$2 45
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EQS CALL ME I SHMAE L Ch l Ol ar es s on

E9 6 E NDGAME S mu l B k tt $ 1 25 a e ec e .

E9 7 T H E ENDUR I NG AR T OF JA P AN L g d W r r $ 195 an on a ne .

EQS O PI UM Th D i ry f C ur J C t u $ 1 95
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E1 00 T H E B L I ND O W L S d gh H d y t a e e a a

E1 01 FOUR P LAYS E u g I ene ones co

E1 04 MUR P HY S mu l B k tt $ 1 9 5 a e ec e

E1 05 T HE SC I ENC E OF CUL T URE L l i A W h i t es e . e

E1 06 W HO ARE T HE GU I LT Y ? D i d A b r h m M D av a a s en, . .

E1 0 7 T HE SEARCH WIT H I N T h d r R ik eo o e

E1 08 A WALKER I N T HE C IT Y A l f r d K m e az

E1 1 0 T HE B RU T E AND O T HER FARC E S A t C h k h n on e ov

E1 12 M ONKEY Wu C h g $ 2 45
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E1 1 4 SELEC T ED W R ITI NGS J u R m J i m an a on enez

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E1 1 7 T HE UNNAMA BL E S mu l B k tt a e ec e

E1 1 8 A H I S T ORY OF CH I NESE L IT ERA T URE H r b rt A G i l e e es

E1 1 9 AMEDEE T HE NE W T ENAN T V I C TI MS OF DU T Y E u g I
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E122 YUAN M E I 1 8 th C tur y P t A rth ur W l y

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E124 T HE LOVES OF KR I SHNA W G A r h r . . c e

E1 2 5 T HE JAZZ MAKERS N t H t ff N t S h p ir d a en o a a o, e s .

E1 26 G I RL B ENEAT H T HE L I ON A dr P y d M d g n e i e re e an i ar ues

E1 2 7 T HE T HEAT ER AND IT S DOU B LE A t i A rt ud n on n a

E1 28 LORCA T HE P OE T AND H I S P EO P LE A rtur B r
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E1 3 0 T HE B ALCONY J G t ean ene

E1 3 4 T HE MODERN P SYCHOLOG I CAL NOVEL L E d l eon e

E1 3 5 OF LOVE AND LUS T T h d r R ik eo o e

E1 36 T HE SOL IT ARY S I NGER G y Wi l A l l a s on en

E1 3 7 FOR T UNAT E S T RANGERS C r l iu B k k mp I MD o ne s eu en a , r .
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E1 44 FADE OU T D u g l W l f o as oo

E1 45 T HE W ONDER T HA T W AS I ND I A A L B h m $ 4 95 . . as a
E1 4 6 GU I DE T O W ES T ERN ARCH IT EC T URE J h G l g o n oa

E14 7 T ALES OF HOFFMANN C h ri t ph r L r d s o e aza e, e .

E14 8 VANDOVER AND T H E B RU T E F r k N rri $ 2 9 5 an o s

E1 4 9 P EDRO P ARAMO J u R l an u fo
E1 5 1 T HE HOS T AGE B r d B h en an e an

E1 52 W A TT S m l B k tt a ue ec e

E1 53 T HE T EN T H MUSE E y i C r i ti i m H r b rt R d
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T HE P R I VA T E MEMO I RS AND CONFESS I ONS OF A JUS TI F I ED S I NNER J m H gg a es o

T HE P OEMS OF S T J OHN OF T HE CROSS J h F N i m t

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A T AS T E OF HONEY S h l gh D l y $ 4 5 e a e ane 1
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FREUD I AN I SM AND T HE L IT ERARY M I ND F r d ri J H ffm e e c . o an

P ROJEC TI VE P SYCHOLOGY L wr E Abt B l l k d $ 2 95 a ence . e a , e s .

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ONE T HOUSAND SOULS A l i P m ky exe is e s

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MARK T O B EY C l tt R b rt
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MEX I CO C ITY B LU ES J k K r u ac e o ac

P A TT ERNS OF P SYCHOSEXUAL I NFAN TI L I SM Wil h l mSt k l e e e

SELEC T ED P OEMS OF B ER T OLT B RECH T $ 1 95

T HE K I LLER AND O T HER P LAYS E u g I $ 95 ene ones co 1
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ROO T S OF C ON T EM P ORARY AMER I CAN ARCH IT EC T URE L w i M u mf rd d e s o , e .

T HE AU T OMO B I LE GRAVEYARD d T HE TW O EXECU TI ONERS A rr b l an a a

S T UAR T DAV I S R ud i Bl h es

SCHOOL OF NE W YORK B H Fri d m d e an, e

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L I V I NG ZEN R b rt L i
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R I VERS I N T H E DESER T N l G lu k e s on ec

A H I S T ORY OF ENG L AND A dr M ur i n e a 0 s

T HE B LACKS A C L O W N SHO W J G t
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T H E BOOK OF SONGS A rth ur W l y t ae , r .

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SECRE T TIB E T F M os co arai ni

MY T H AND R IT UAL I N CHR I S TI AN IT Y A l W W tt $ 2 4 5 an . a s

L I ES L I KE T RU T H H r ld C lur m a o an

T HE W ORLD OF P R I M ITI VE MAN P u l R di $ 2 25 a a n

T HE HAUN TI NG ME L ODY T h d r R i k $ 45 eo o e 2
AN T HO L OGY OF JA P ANESE L IT ERA T URE D ld K d ona ee ne , e .

T HREE JA P ANESE PL AYS f r m th Tr d i i l T h tr E rl E r t d $ 95

o e a t ona ea e a e nes , e . 1
DRUGS AND T HE M I ND R b rt S d R pp $ 9 5 o e . e o 2
T HE S PI R IT OF ZEN A l W W tt an . a s

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T HE CARE T AKER d T HE DUM B W A IT ER H r ld Pi t r

an a o ne
T RANSAC TI ONAL ANA L YS I S I N P SYCHO T HERA P Y E ri B r M D c e ne, . .

MODERN L IT E RARY CR ITI C I SM l mg H w d $ 2 9 5 rv o e, e

SONS AND COMRADES K i mi r B r d y $ 75az e z an s 1

C OUN T ERFE IT SEX E d mu d B r g l r M D $ 2 95
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T HE W AY T O C O L ONOS C ll
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P RO B L EMS OF H I S T OR I CAL P SYCHO L OGY Z d B r b u eve ei a

A S T RANGE SOL IT UDE P h i l i pp S l l r $ 9 5 e o e s 1

PSCHOSOMATIC RESEARCH R y R G ri k r M D
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T HE B I R T HDAY P AR T Y d T HE ROOM H r ld Pi t r
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