Credibilidad de la marca

TUESDAY

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E: (Erickson begins the session by having a new student fill out a data sheet. He then mentions to Christine that he has two granddaughters named “Christine.”)

Christine: That is unusual to have two that have the same name.

E: So, now I am going to change the seating arrangement. (Addresses Rosa.) See how she tries not to look at me. (Speaking directly to Rosa.) Because you’re it.

(Erickson has Rosa move to the green chair. (She has some difficulty speaking English.) You kept avoiding my glance.

Rosa: No, I couldn’t see you very well. I am farsighted. (Pause.)

E: (Erickson puts a toy, a purple octopus made of yarn, on his wheelchair seat just to the left of his body.) When we were very young, we were willing to learn. And the older we grow, the more restrictions we put on ourselves. Now I’m going to give you an example of that. (Erickson leans to his left. Rosa leans closer to Erickson.)

Seven. Ten. One. Five. Two. Four. Six. Three. Eight. Nine. (Erickson addresses group.) What did I just do?

Anna: You counted backwards. Siegfried: You said numbers.

E: I will do it again. Nine. Five. Three. Six. Two. One. Seven. Ten. Eight. (Pause.) How many of you have heard a child count the fingers from one to ten? Four. Seven. Ten. Nine. Eight. Three. Five. Two. One. Seven. (Erickson sequentially points to the fingers on his hands as he says the numbers.) It takes a lot more time to learn to count from one to ten. The child first learns the numbers. He has a concept of counting to ten, but he doesn’t know the right order.

(Addresses Rosa.) Now, how many fingers do you have? Rosa: Twenty. Ten up and ten down.

E: Uncross your legs. Hold your hands on your knees. Does it make any difference if you count from here to there? (Erickson points to her fingers from left to right.)

Rosa: Me?

E: Does it make any difference? Rosa: No.

E: If you count from there to here (Erickson points from right to left) will the answer be the same?

E: If you add the fingers on this hand to the fingers on this hand (Erickson points to her right and her left hand), will you get the correct number?

Rosa: Five plus five?

E: I just asked a question. If you add these fingers to these fingers (he points to his left hand and his right hand), will you get the correct number?

Rosa: You asked me if I add these fingers to these fingers, which would be the correct number? Ten. (She points to her left hand and her right hand.)

E: You sure?

Rosa: I’m not sure, but I think.… That’s what I thought, until now. (Laughs.) E: (Laughs.) And you say you’ve got ten fingers.

Rosa: Yes.

E: I think you’ve got eleven.

Rosa: Eleven. OK, I believe it. (Shakes her head no.) E: You believe it? (Laughter.)

Rosa: Sure. I can see only ten of them. E: Can you move your chair closer?

Rosa: (Moves her chair closer to Erickson.)

E: Now you count them. Rosa: One. Two. Three.…

E: No, I’ll point to them, you count them. (Erickson points.) Rosa: One, two, three, four, five, six, seven, eight, nine, ten.

E: That’s the way you count them. You already agreed that you can count them from this way, or this way. (Erickson points from the left hand to the right hand, and then from the right hand to the left hand.) You already have agreed that these added to these (Erickson points to his left hand and right hand) give you the correct number.

Rosa: Correct number.

E: Now, I’m going to count them. Ten, nine, eight, seven, six (he counts the fingers on her left hand and then points to her right hand), and five is eleven. (Everyone laughs.)

Rosa: That’s right. I can tell my friends I have eleven fingers. E: And now do you know your right hand from your left hand?

Rosa: They told me that this is the right one. (She moves her right hand.) E: And do you believe it?

Rosa: Yes, I did.

E: Put that hand behind you. (She puts her left hand behind her.) Now, which hand is left? (Erickson laughs.)

Rosa: That’s a joke.

E: But, it’s a marvelous technique for working with children. Rosa: It works in English, but in Italian it wouldn’t work. E: Why? Rosa:

Because “left” doesn’t mean two things. It doesn’t mean the one who remains here. You say two different words, so it wouldn’t work in another language. That’s too bad.

E: You mean the English have a right hand that’s left. Rosa: What?

E: You mean the English have a right hand that can be a left hand. (Laughter.) Rosa: Yes.

E: (Shakes his head and smiles.) These national differences are astonishing.

All right, yesterday I emphasized the importance of understanding the patient’s words and really understanding them. You don’t interpret your patient’s words in your language. And she just demonstrated

that the right hand in English can be the left hand. But it can’t be the left hand in Italian.

Now, every word in any language has usually a lot of different meanings. Now, the word “run” has about 142 meanings.

Siegfried: Run?

E: Yes, “run.” The government can run. A run of luck in cards. The girl can run. A run of fish. A run in a lady’s stocking. A road runs uphill and downhill, and still stands still. A hundred and forty-two meanings for one word.

In German you say, “Machen Sie das Pferd los.” Is that right? (Addresses Siegfried and Christine. Both indicate it is correct.) In English, you say, “Untie the horse.” The Germans put their verbs one way, the English use their verbs a different way. And so, you ought to be acquainted with the linguistic patterns of your patients. And we all have our own linguistic patterns, our own personal understandings.

I was invited to speak to the Medical Society in St. Louis. The president and his wife were to be my hosts, and the president’s wife said, “Dr. Erickson, I would like to prepare a very nice dinner for you and I would like to prepare your favorite foods.” And I told her, “I’m a meat and potatoes man. Any kind of meat, any kind of potatoes. And you can boil the potatoes. But if you want to give me a special treat, I would like some milk gravy.”

(To the group) You all know what milk gravy is? (Everybody says, “no.”) Flour mixed with milk and boiled. Milk gravy is very tasty.

And when I said, “If you want to give me a treat, give me milk gravy,” her husband collapsed on the couch and roared with laughter. And the wife stood transfixed as if frozen, her face very, very red. Her

husband kept on roaring with laughter. Finally, he got control of his laughter and said, “For 25 years I’ve been asking my wife, begging her, to make milk gravy and she has always told me, ‘Milk gravy is for poor, white trash.’ And tonight I’m going to have milk gravy.” (Group laughter.)

Her husband had lived on a farm and so had I. We both knew how good milk gravy was. She was a city girl, and that was only for poor white trash.

Now your patients come to you and tell you their problems. But do they tell you their problems or do they tell you what they think are problems? And are they problems only because they think that the things are problems?

Now, a mother brought her 11-year-old daughter in to see me. As soon as I heard the word “bedwetting,” I sent the mother out of the room and took the history from the little girl — a tall blond, a very pretty girl.

Her story was that within a month of her birth she had developed a bladder infection. That infection had been treated by urologists. She had been cystoscoped, day after day, week after week, month after month, year after year. Finally the pelvis and each kidney were examined with a Lucite lamp inserted through the bladder and up into the pelvis and the kidney. The focus of the infection was found in one kidney so she was operated on and was freed of the infection. But she had been cystoscoped… I hope you all know that word. Do you? (To Rosa.) Do you know what a cystoscope is? …so many times that her bladder sphincter was so dilated that as soon as she relaxed in sleep she wet the bed. While she could forcibly control her urination in the waking state, it was an all-day job. And as soon as she laughed at something, bodily relaxation would cause her to wet her pants.

Since she was now 11, had been free of the infection for several years, her parents were impatient. She ought to learn to control herself and not have a wet bed every night. She had three younger sisters who ridiculed her and called her bad names. All of the neighbors knew that she wet the bed and wet her pants. All of the two or three thousand children at school knew that she was a bedwetter, and took pleasure in making her laugh so that she would wet her pants. And life was not very pleasant for her. I asked her if she had been to see any other doctor and she said that she had seen a lot of them and swallowed a barrel full of pills and barrels full of medicine. Nothing helped. And finally her mother brought her to me for me to help her.

Now, how would you treat that case? (Erickson looks at Rosa.)

Rosa: How would I? (Erickson nods.) I would have seen the entire family together, the father, the mother and the sisters. I would have seen the family.

E: Family therapy. (Looks at Carol directly opposite from him.) How would you. (Pause.) In fact, how would all of you … and don’t shout all at once.

Anna: I would have checked the physiological things first. See if there were damage on a physiological level. And once I had information, I would have gone along with family therapy and individual therapy and what’s her investment in not controlling.

E: How long would you expect to treat her?

Anna: How long? Probably once I had dealt with the whole family and seen what was going on, I could tell.… It might be more the family than her.

Carol: I’d try hypnosis.

E: And what would you tell her?

Carol: Well, maybe I would try working with her around her laughing and consciously letting go, then trying to gain control, and approach it that way.

E: What do you think she has been doing for the last four years?

Dan: How about getting her back to the age when she was originally trained and retraining her. I haven’t used hypnosis myself, but my first thought was I would send her to you. (Laughter.)

Jane: (Jane is a therapist from New York.) Finding out if the sphincter muscle could be tightened up. E: How would you do that?

Jane: I would ask a physician who knew about muscles and I would ask him if it were possible. Maybe I could teach her through exercises or send her to a physiotherapist who could teach her to retrain that muscle.

E: How long would you anticipate treating her?

Jane: I don’t know how long it takes a muscle to get back into shape.

Christine: I can think of one other approach which may be similar to hers. Maybe in hypnosis to get her motivated and teach her to um…

E: (Interrupts.) Don’t you think being called a bedwetter for 11 years would motivate her enough?

Christine: OK. I should start differently then. To have her practice before she empties her bladder to contract and not allow herself to empty the bladder completely which would train her to increase the muscle tone.

E: How long would it take you?

Christine: I think without hypnosis it would take a long time. But I think with hypnotic training, with hypnotic suggestions, it would be rather fast that the child would be able to do it. And she would be able to understand better what you were trying to tell her, also.

E: All right.

Christine: (Continuing over Erickson.) I think you did mention that there was some damage to the muscle. E: Yes.

Christine: And she needs to have some retraining about strengthening the sphincter muscles.

E: Don’t you think that she has been trying to exercise those muscles in 11 years? Christine: I’m sure that she has, but I’m not sure that she knows how to do it.

E: How would you explain to her how to do it?

Christine: To try to hold her urine as much as she can before going to the bathroom voluntarily. To try to do that off and on.

E: All right. Now all of you know the answer, but you don’t know that you know the answer. I told her, “I’m like all other doctors. I can’t help you either. But there is something that you know, but you don’t know that you know it. As soon as you find out what it is that you already know, but don’t know you know, you can begin having dry beds.” Now what did she already know, but didn’t know she knew?

Christine: She could hold her urine during the day voluntarily most of the time.

E: By “most of the time” you mean she could hold it some of the time but not all of the time. That isn’t very helpful knowing that you can’t hold it some of the time.

Now all of us grow up and we learn that when we empty the bladder we empty it completely. We have grown up with that knowledge. We take it for granted, and practice that knowledge every day.

So I told the girl, “Look at the paperweight on my desk,” not to move, not to talk, “Just keep your eyes open and look at the paperweight.” I would remind her of the time that she first went to school to learn to write the letters of the alphabet, how hard it was — all those different shapes and forms — and printed letters and written letters and capital letters and small letters. But eventually she had formed a visual- mental image, located somewhere in her brain and located there permanently. Even though she didn’t know that she had a mental image, it was there permanently.

And then I told her, “Now keep looking at that paperweight, so don’t move, don’t talk, your heart rate is changed, your respiration is changed, your blood pressure is changed, your motor tone and muscle tone are changed, and your reflexes have changed. Now that is not an important thing — I’m just telling you that.

“And now, I am going to ask you a very simple question and I want a very simple answer. Suppose you were in the bathroom, sitting down and urinating and a strange man pokes his head in the doorway. What would you do?”

She said, “I’d freeze.”

I said, “That’s right, you would freeze and stop urinating. And as soon as that strange man went away you could start all over again. Now all you need to do is practice starting and stopping, starting and stopping. You don’t need a strange man to look at you. You can start and stop all by yourself. Some days you will forget to practice. That’s all right. Your body will be good to you, and always give you more

opportunities to practice. And some days you may forget to practice. That’s all right. Your body will be good to you.

And now, to get the first dry bed it may take you two weeks. That’s all right. You need to practice starting and stopping. To get two dry beds in succession, that’s much harder. To get three dry beds in succession, that’s still harder. To get four in succession, that’s still harder. After that it becomes easier. And the fifth, the sixth and the seventh will give you a whole week of dry beds. After you have had one week of dry beds, you get another week of dry beds.

“Now, it would surprise me very much if you had a permanent dry bed within three months. It also would surprise me very much if you didn’t have a permanent dry bed in six months.”

And six months later she was staying overnight with friends, going to slumber parties. All she needed to know was that she could stop, at any time, her urination, with the right stimulus. And all of you know this truth. And that’s what we all overlook.

We grow up thinking that we have got to finish. That isn’t true. And so… Anna: We all overlook what?

E: That we must continue until we are finished. That isn’t true. We can always interrupt ourselves given the proper stimulus. And all of you know what happens when you are sitting on the toilet urinating and a strange man or woman looks in on you. You stop. (Erickson laughs.) So, since she was only a little girl, 11 year old, I spent a whole hour and a half… and that was all.

As for treating the family, well, I figured it would be a task for the father and the mother to get used to a dry bed. (Laughter.) I thought it would be the hard luck of the sister to get used to her big sister having

a dry bed. I thought it would be the hard luck of the school children to lose a very valuable way of teasing. I thought the patient was the only one who needed treatment.

And so, about 10 days later she brought me this toy to symbolize the first time in her life that she ever gave a present to anybody knowing that she had a dry bed. (Erickson laughs and shows the group a purple yarn octopus that the girl had made for him.) And the first dry bed occurred within two weeks.

Why should I bother to see her a second time? Would there be any purpose for seeing her again?

Why are you hiding back there? (Erickson turns and addresses a woman who comes into the waiting room from the office behind Erickson. She did not attend the session yesterday. She is obviously late for today’s meeting. She is an attractive tall blond wearing jeans and a blouse that loosely covers a tube top. She has completed all her Ph.D. requirements in psychology except for her dissertation.)

Sally: I was waiting for a good time to interrupt. Let’s see if I can find a seat. E: I can pick up at any point, so come in and find a seat.

Sally: Is there a seat back there?

E: ( Speaking to Rosa in the green chair.) Can’t that seat be shoved over. You can put another chair right here. (Points to a space directly to his left.) Hand her a chair. (A man sets up a folding chair just to the left of Erickson. Sally sits down next to Erickson and crosses her legs toward him.)

E: You don’t need to cross your legs.

Sally: (Laughs.) I thought you might comment on that. OK. (She uncrosses her legs.)

E: Our foreign visitors may not know, “A dillar, a dollar, a ten o’clock scholar,” but you know that rhyme, don’t you?

Sally: No.

E: (Incredulous.) You never learned about a dillar, a dollar, a ten o’clock scholar? Sally: I don’t know the rest of it.

E: Frankly, I don’t either. (She laughs.) Are you feeling comfortable? Sally: No. Actually, I walked in in the middle of things and I’m … I ah.… E: And I never met you before.

Sally: Mmm… I did see you one time last summer. I came with a group. E: Did you go into a trance?

Sally: I believe so, yeah. (Nods head.)

E: You don’t know? Sally: I believe so. (Nods head.) E: Just a belief?

Sally: Um-hum.

E: A belief and not a reality? Sally: It’s sort of the same.

E: (Incredulous.) A belief is a reality? Sally: Sometimes.

E: Sometimes. Is this belief of yours that you went into a trance a reality or a belief? (Sally laughs and clears her throat. She seems embarrassed and self-conscious.)