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

improvement of function brought about in this way that are familiar,

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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