Training
One of the most important factors for therapeusis in the sense of the
amelioration of defective motor conditions, the relief of disturbing
sensory affections and the restoration of or compensation for
defective functions of various kinds is training. By this is meant the
training of the power of attention and its concentration in such a way
that defects are overcome. There are many examples of almost marvelous
improvem
but it is well to recall some of them here in order to illustrate the
uses to which this therapeutic mode may be applied. A blind man is
able to read by means of his finger tips, and to recognize raised
letters that seem quite beyond the possibility of tactile recognition
by ordinary individuals gifted with all their senses. The
peculiar skill is simply due to the individual being able by
concentration of attention upon slight variations in touch sensation
to recognize even minute differences readily and so read raised
letters with comparative ease and rapidity.
Over and over again it has been shown that neither the congenitally
blind nor those whose vision has become defective have any better
sense of touch than the average person. With an esthesiometer, their
power to recognize the distance between the points of a calipers is
shown to be no better than that of an ordinarily sensitive individual.
This is illustrated in other ways. Certain blind persons, even those
born blind, are known to be able to distinguish colors more or less
accurately, that is, at least the three primary colors. Their power to
do this is consequent upon a faculty of recognizing differences in
heat absorption. The ordinary seeing person going into a room in the
dark recognizes at once the difference between a pencil and a piece of
metal of the same shape and size by its weight and the greater
tendency of the metal to feel colder. When we are not sure whether a
pillar in a structure is of stone or an imitation, we determine this
by touch, and the fact that stone absorbs heat rapidly while wood and
other imitations of stone do not. It is the same faculty for
distinguishing specific heat that enables certain blind people to
recognize colors. If pieces of cloth of different colors are put over
snow when the sun is shining on them, it will be found that black
absorbs much more heat than the colored cloths, or white, and
consequently that the snow melts faster beneath the black. After black
comes red, then green, then blue. It is this difference in the power
to absorb heat that the blind recognize and thus distinguish colors
after long patient training of themselves.
Obstacle Sense.--An example of the value of training is the so-called
obstacle sense which has been rather carefully studied in recent
years. By means of it blind people are able to avoid larger obstacles
and to know when they are passing an open door or window on a corridor
or a building alongside a street. Blind children have been known to
play in a garden where there were trees and other obstacles and
carefully avoid them even while moving rather rapidly. This sense is
disturbed whenever there is loud noise in the vicinity. It is not very
active and yet it is of considerable value to the blind. Its
disturbance by noise would seem to indicate that it is due to some
sense faculty in the tympanum, or ear drum. It exists in everybody,
but remains quite undeveloped except in those who need it and
therefore learn to make use of it.
Touch and Sight.--The triumph of training is to be seen in the cases
of those who are born blind and deaf and who yet are taught to
understand through lip and throat reading by the tips of the fingers
and taught to talk by being shown patiently the method by which others
accomplish it, though the only avenue to their brain is the dull sense
of touch which means so little for the ordinary individual. The cases
of Laura Bridgeman and of Helen Keller illustrate how a sense that is
usually quite neglected can be made to supply the place of both the
eyes and the ears by patient, persistent training. Lip reading by
sight is, of course, a very interesting example of the same principle
that can be learned by anyone who has good sight in a comparatively
short time. There are compensations of this kind and powers of
development latent in every sense and function of the body that can be
employed to make life interesting and to restore usefulness
after nearly every form of lesion or defect. Practically all of this
compensatory power is mental, hence its place in psychotherapy. We do
not increase the power of the sense but by concentration of attention
the mind is rendered capable of obtaining definite information from
sensory stimuli that are present in every person but that are
ordinarily neglected.
Hearing.--One of the most surprising instances of the value of
training for cases in which favorable results seemed quite out of the
question, is Urbantschitsch's method of training the deaf to hear.
After investigating it personally I reported it in the International
Clinics. [Footnote 24] Patients who could hear but very little,
indeed, only the loudest noises, were trained by means of loud
shouting and the hearing of loud notes gradually to catch sounds more
and more easily until not infrequently they could hear rather well.
Sometimes even those who were thought to be absolutely deaf to sound
were found to be able to hear very loud sounds and then it was
invariably discovered that by practice they could be made to hear much
more. The secret of the success consisted not in any increase in the
power to hear, but entirely in training the attention to recognize and
differentiate sounds so that what seemed at first a confused murmur
gradually became intelligible. It is exactly the same process as that
by which a man learns to read with his fingers. He is not able to
differentiate the letters but after a time it is possible to do so
without difficulty.
[Footnote 24: Lippincott & Co., Phila., Vol. IV, 8th series, 1899.]
Equilibrium.--There are typical examples of almost as striking
increase of muscle sensation, or rather of ability to distinguish
minute differences in muscular sensation, noted in those who train
this faculty carefully. Acrobats succeed in developing wonderful
control over muscles and marvelous response to slight disturbance of
equilibrium. The ordinary individual has comparatively small balancing
powers, but the slack-rope performer seems almost to defy the laws of
gravity, because he has learned so to coordinate all muscular action
as to enable him to maintain his balance. He has trained himself to
distinguish every variety of message from his semicircular canals. Of
itself neither of these senses gives us very much information, indeed,
only as much as we ask for from it, but when we pay careful attention
to the minute details of the information that it imparts, we are able
to use it to great advantage.
Muscle Training.--It is this power of training to enable us to
appreciate minute sensations that forms the basis of the Frenkel
treatment of tabes. For the proper guidance of the muscles the
muscular sense is all-important, though ordinarily we are quite
unconscious of the information it conveys. This is seriously disturbed
by the degeneration in tabes. The patient can, however, be taught to
use even the slight amount of it that remains to great advantage or
else to avail himself of some other compensatory sensations which will
enable him to guide his muscles in various motions much better than
before.
This same faculty can probably be employed in many other conditions.
Frenkel has shown that it is applicable in paralysis agitans and
markedly relieves the rigidity that is so annoying a symptom. It gives
these patients something to occupy their minds, too, which means a
great deal for their general condition, for occupation of
attention saves them from neurotic disturbance of themselves.
Sufferers from infantile paralysis can be taught to do many things
with their weakened muscles that seem to be quite impossible to them.
It requires patience to get results, but they mean so much that the
efforts are well worth while. After cerebral incidents, sometimes
actual apoplexies, sometimes injuries, occasionally serious effusions
due to kidney diseases, there may be disturbance of motor functions.
It is surprising how often training will enable the sufferer to use
his muscles much better in these cases than at first seemed possible.
I have seen a man who had lost most of his power for writing after a
cerebral incident regain it as a consequence of being taught to write
from his shoulder, instead of from the forearm as had been his custom.
Heart Training.--In recent years we have learned that training is not
only good for the external muscles and enables them to do more work
without discomfort, but that it is particularly beneficial to the
heart muscle whenever that organ can respond to it favorably. At all
of the heart cures in recent years, exercise of some kind or another
is one of the important features and the failure of physicians
generally to secure as good results while pursuing all the other
methods followed at these cures, seems to show that exercise was
probably the most important factor. Nauheim is the typical heart cure
and there, besides the resisted movements in the bath, there is the
graduated exercise of the walks around the town, all of which, owing
to the situation, lead up hill. Walking up hill, even though it be a
gradual ascent, might seem to be the worst possible exercise for heart
patients, yet it proves eminently beneficial.
Respiratory Training.--Shortness of breath is often a bothersome
symptom, especially for stout people, and prevents them from taking
necessary exercise. When it cannot be traced directly to some
affection of the heart or of the circulatory apparatus, it is usually
due to lack of exercise. Much can be done for it by deliberate
training. In the modern time, with elevators so common, people seldom
have to walk up-stairs, and consequently one of the modes of exercise
that was particularly likely to furnish some training in deep
breathing is absent. Any one who has seen the shallow breathing of
many of the patients who come to Nauheim and how much it has improved
by the gradually increased walks up the hills around the valley, will
appreciate how much training in deep breathing means. This exercise of
the diaphragm will often give benefit besides in making the bowels
more regular, and in getting rid of the accumulation of fat in the
abdomen, which is one of the mechanical causes of the interference
with the diaphragm and consequent shortness of breath.
Training the Appetite.--Just as training may be used for the sensory
and motor systems that are external, so it may also be used for many
internal functions analogous to these. There are a great many people
who eat too little. They are the nervous, irritable persons with no
fund of reserve energy to draw on when anything happens, and who are
in their years before middle life likely to be the victims of
infectious disease. They suffer much from lack of proper covering in
the winter time and from a certain protection that is afforded to the
nervous system generally by being up to weight. Often their
under-weight is a life-story, and occasionally it is a family matter.
When they suffer from neurotic symptoms a gain in weight nearly
always does them good. They complain that when they increase their
diet they have uncomfortable feelings. This is only what is to be
expected, since the muscularis of their stomach--much more important
than its secretory function--has not been accustomed to as much
exercise as is now being demanded of it.
On the other hand, for those who are over-weight, training in eating
less is the one important therapeutic factor. If their diet is cut
down suddenly, they soon become discouraged. If there is a gradual
reduction of food quantities, variety being allowed, so that they may
eat practically everything they have been eating before, the system
gradually accommodates itself to less and less food. This is the only
sensible way of bringing about reduction in weight. It requires
constant attention over a long period, but it can be done with
excellent success.
In the same way the bowels may be trained to perform their work
regularly. Habit means probably more with them than any other factor.
Our digestive tract, however, is largely dependent on habit. We get
hungry three times a day or twice a day, according to the custom that
we have established. Countries differ radically in the matter, and
nearly always, when a man goes from one country to another in early
years, he changes to the habits of the new country, though if he comes
after middle age he usually clings to those that he is used to.
Training to Stand Pain.--There are many painful conditions, especially
involving the muscles in the neighborhood of joints, that are worse on
rainy days and are spoken of as rheumatism, that can be very much
improved by training in the use of muscles. As men grow older and gain
in weight, the lack of exercise in their sedentary lives incapacitates
their muscles for activities of many kinds. The consequence is that
where most strain is put upon them, in the neighborhood of joints,
they readily become tender and painful. It is this class of cases
particularly that is benefited by irregular practitioners of all
kinds. Mental healing, osteopathy, Eddyism, the many liniments,
rubbings and manipulations prove beneficial. What is needed is
training in the use of muscles so as to enable them to do the work
that is required of them without discomforting reaction. This is
particularly true for the leg and foot muscles. Exercises that
strengthen the muscles of the calf and of the thigh, and particularly
such as require free movement of the foot, are almost sure to relieve
these patients of many annoying symptoms. Pains around the ankles and
in the knee and hip, worse in rainy weather, disappear as a
consequence of such gradually increased use of these muscles as gives
them increased nutrition and power. This subject is discussed more
fully under Foot Troubles and Painful Conditions of the Knee.
There may be a training in bearing discomfort which is of great value
to over-sensitive patients. Some nervous patients seem to suffer
merely from their ordinary physiological functions. These are the
patients who abuse the drugs that are supposed to bring relief. There
is just one mode of treatment that is successful with them: they must
be told to bear their discomfort for a while without seeking drug
relief, but always securing freedom from discomfort by means of
attention to other things, until gradually they have succeeded in
diverting their minds from the concentration of attention on their
functions which is causing their disturbance. The whole programme
need not be outlined to them or they will perhaps have a
revulsion of feeling against it that will make its accomplishment
impossible. They can, however, be made to stand their discomforts for
a time with the promise that it is for the best, since there will be
eventually an improvement.
Intellectual Faculties.--Nearly every one of our faculties can be
trained to do much better work than we have any idea of if we only are
willing to take the trouble and give the attention. I have often shown
people who came complaining of loss of memory that if they wanted to
train themselves to remember they could do so. The memory probably
cannot be bettered any more than can the sense of touch in the blind
man, but by attention to minute details, in the concentration of the
mind on certain subjects, it can accomplish results that seemed quite
impossible before. All systems of improving the memory are founded on
this method of concentrating attention on what one wishes to remember
and connecting it with other things that we know by experience are
readily remembered.
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