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CHAPTER X I I I

THE GENERAL PRINCIPLES OF PSYCHOTHERAPY


T h e chief object of this volume is to present to the
reader an epitome of one of the most important tendencies in modern medicine namely, the treatment of
certain functional nervous disorders by means of suggestion. Technically, this is known as psychotherapy.
As a great deal on the subject had been scattered through
the chapters of this book, it seemed desirable to unify
the various statements and to present a short account
of the general principles of psychotherapy. While psychotherapy is by no means a new method of treatment, but
has been employed by physicians in one form or another
from the earliest dawn of medicine, yet its scientific and
rational application has been the work of only recent
years. Formerly much empiricism prevailed in this
field, at least so long as psychology was looked upon as
one of the occult sciences and a branch of a more or
less unpractical metaphysics. But with the advent of
physiological psychology, of sound experiment instead of
hazy generalizations, with the modern advances in the
study of hysteria and the various aspects of the dissociations of consciousness, it was soon perceived that a rational psychic treatment was indicated in purely psychic
disorders. Therefore all the diagnostic criteria of modern neurology and psychiatry were brought to bear upon
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the study of functional nervous disorders, and the result has been not only new and sound conceptions, but
rational psychologic indications for treatment.
In order to free the reader's mind from any a priori
misconceptions, it will be well to state in the beginning,
that while psychotherapy in some form or another is the
rational treatment for functional nervous disorders, yet
it is not indicated in all, neither are all functional disorders amenable to psychotherapy. It is rather in the
severe cases which do not yield to ordinary physical
methods and in certain types of pure dissociations of consciousness that psychotherapeutic treatment is indicated.
We cannot reiterate too frequently that a thorough neurological, psychiatric, or general medical examination is
absolutely necessary before the institution of any form of
psychic treatment, not only to rule out any organic disease
or distinctly organic complications of a seemingly pure
functional disorder, but also to obtain an intelligent comprehension of the case. Only in this way can grave errors
be averted and the patient saved much unnecessary loss
of time if other lines of treatment are indicated. For
instance, in one case of a middle-aged man, there was a
complaint of some vague gastric disorder in association
with ill-defined neurasthenic symptoms. A chemical
examination of the stomach contents revealed a beginning cancer of the stomach. Immediate operation was
advised, and while it is yet too early to ascertain a definite
outcome, yet the chances of cure are much greater than if
the patient's valuable time had been wasted by a wholly
ineffectual psychic treatment. Another case will show
an exactly opposite state of affairs. The patient was a

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young man who for years had been treated for an


organic disease of the stomach, by means of drugs and
special diet. He did not improve, however, and finally a
careful neurological examination revealed that the symptoms referable to the stomach were not only functional
in nature, but that these symptoms were only a portion
of a severe functional nervous disease. I n fact the patient was a sufferer from hysteria. Careful psychic
treatment directed towards hysteria brought about a
disappearance of the gastric symptoms and finally a cure.
The above are merely two cases out of many that could
be cited.
Pyschotherapeutic methods vary, the object of some
is purely therapeutic, of others distinctly analytical, to
penetrate into the origin of certain disturbances and lay
bare the essential emotional complex. Suggestions may
be given in the waking, half-waking, or hypnotic state;
psychic or motor re-education may be necessary in diseases of long duration, where habits of thought or of
activity have become distinctly abnormal. Isolation is
indicated in certain hysterical states, while persuasion or
a rational, sincere explanation will often appeal to the
more intelligent class of patients. Ignoring and purposeful neglect are sometimes of value in the hysteria of children. The principle of reserve energy * has opened up
new vistas in psychotherapy. To all of these, of course,
treatment by physical agents is frequently necessary
rest, baths, electricity, massage, diet, drugs. Nor must
1 William James, " The Energies of Men," Philosophical Review,
1907. Boris Sidis, " Studies in Psychopathology," Boston Medical and
Surgical Journal, March 14 to April 11, 1907.

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we forget one factor of the highest importance, the individuality of the physician.
It would exceed the scope and purpose of this book to
discuss the above methods in detail, as most of these are
not only far too technical to admit of intelligent comprehension by the lay reader, but all presuppose a thorough
medical examination. A rational psychotherapy can only
be developed on the basis of a rational psychopathology.
The nature and value of hypnosis have already been
discussed. In many cases, however, hypnosis is unnecessary; in fact, it is only used when other lines of treatment fail. Frequently in the psychoneuroses, a rational
explanation and analysis of the patient's condition
will go far toward relieving many distressing symptoms,
especially if the patient, as is too frequently the case,
has been the victim of some popular medical misconception or superstition. Recently the application of these
pyschotherapeutic conversations in the management and
treatment of certain paranoic states, or in limited types
of delusion formation, has attracted considerable notice.
Of course, for a sound, psychotherapeutic treatment, the
psychogenesis of these states must be carefully analyzed,
and this presupposes a knowledge of mental diseases
that is not possessed by any of the pseudo-scientific
cults of mental healing. For the principles of psychic
re-education, the reader is referred to two papers by Prince
and Coriat.1 The results in this series were most gratify1 Morton Prince and Isador Coriat, " The Educational Treatment of
the Psycho-Neuroses," Journal Abnormal Psychology, vol. i i , No. 4,
October-November, 1907. Isador H . Coriat, "Some Further Studies
on Nocturnal Paralysis," Boston Medical and Surgical Journal, December 5, 1907.

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ing considering that the cases were of years' duration and


had resisted all other methods of treatment. Here were
treated and cured convulsive attacks of purely functional
origin, the peculiar types of nocturnal paralysis, nocturnal
enuresis, psychasthenic states, and functional gastric disorders. Of course, in some of these cases psychic treatment was combined with physiological hygiene, but the
general principles of treatment were carried along the
line of the correction of faulty habits of thought, instruction of the patient into the nature of his disease, and the
suppression of individual symptoms by various suggestive measures.
Motor re-education has been of value in the various
tics and habit spasms of adult life and childhood. These
conditions are sometimes mistaken for chorea, but are
really functional motor disturbances, in many cases the
result of a faulty motor education. Isolation methods
have been of great value, particularly in hysteria or neurasthenia, and recently Dubois of Berne has written a popular book on the purely psychic treatment of certain
psychoneuroses.1
A question of great importance now arises what
particular form of psychic treatment shall be used ? To
this we reply that the method of treatment is absolutely
dependent on the results of the medical examination,
particularly, the origin and nature of the particular nervous disease. Also, it is frequently the case, that even in
1 L. F. Barker, " Some Experience with the Simpler Methods of
Psychotherapy and Re-education," American Journal oj the Medical
Sciences, October, 1906. J. Camus and P. Pagniez, Isolement el
Psychothfra-pie, Paris, 1904. Paul Dubois, The Psychic Treatment
0} Nervous Disorders, 1905.

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purely functional disorders, medical treatment is necessary in combination with psychotherapy, and sometimes,
in a functional disorder, physical therapy alone is indicated. The outline of the treatment, like the diagnosis
of the condition, should be in the hands of a competent
physician.