The General Principles of Psychotherapy

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C H A P T E R 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 tenden

cies in modern medicine — nam ely, the treatment of

certain functiona l nervous disorders by means of

sug

gestion. Techn ically, 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. W hile psycho

therapy 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 w ith 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 dissocia

tions of consciousness, it was soon perceived that a ra

tional psychic treatment was indicated in purely psychic

disorders. Therefore a ll the diagnostic criteria of

mod

ern neurology and psychiatry were brought to bear upon

260



GENERAL PRINCIPLES OF PSYCHOTHERAPY

261

the study of functional nervous disorders, and the re

sult 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 dis

orders amenable to psychotherapy. I t is rather in the

severe cases which do not yield to ordinary physical

methods and in certain types of pure dissociations of

con

sciousness that psychotherapeutic treatment is indicated.

We cannot reiterate too frequently that a thorough neuro

logical, 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 com

prehension 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. Fo r

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 begin

ning cancer of the stomach. Imm ediate 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 w i ll show

an exactly opposite state of affairs. The patient was a



262 RELIGION AND MEDICINE

young man who for years had been treated for an

organic disease of the stomach, by means of drugs and

special diet. He d id not improve, however, and

finally

a

careful neurological examination revealed that the symp

toms referable to the stomach were not only functional

in nature, but that these symptoms were only a portion

of a severe funct ional nervous disease. I n fact the pa

tien t was a sufferer from hysteria. Care ful 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 em otiona l complex. Suggestions may

be given in the waking,

half-waking,

or hypnotic state;

psychic or motor re-education may be necessary in dis

eases of long dura tion, where habits of though t or of

ac tivity have become distinctly abnormal. Isola tion 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 purpose

ful neglect are sometimes of value in the hysteria of

chil

dren.

The princip le of reserve energy

has opened up

new vistas in psychotherapy. T o a ll of these, of course,

treatment by physical agents is frequently

necessary

—

rest, baths, electricity, massage, die t, drugs. Nor must

1

William James,

The Energies

of

Men, Philosophical Review,

1907. Boris Sidis,

Studies

in

Psychopathology, Boston Medical

and

Surgical Jou rnal, March

14 to

Apri l

1 1 1907.



GENERAL PRINCIPLES OF PSYCHOTHERAPY 263

we forget one factor of the highest importance, — the in

dividuality 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 compre

hension by the lay reader, but all presuppose a thorough

medical

examination.

A rationa l psychotherapy can only

be developed on the basis of a rational psychopathology.

The nature and value of hypnosis have already been

discussed.

I n many cases, however, hypnosis is unneces

sary; in fact, it is only used when other lines of treat

ment fail. Frequently in the psychoneuroses, a ra tional

explanation and analysis of the patient's condition

w il l go far toward re lieving many distressing symptoms,

especially if the patient, as is too frequently the case,

has been the victim of some popular medical misconcep

tion 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. Fo r 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 gratify-

1

Morton Prince and Isador Coriat, The Educational Treatment of

the Psycho-Neuroses, Journal Abnormal Psychology, vo l. i i , N o. 4 ,

October-November,

1907.

Isador H . Coriat, Some Further Studies

on Nocturnal Paralysis, Boston Medical and Surgical Journal, De

cember 5,

1907.



264 RELIGION AND MEDICINE

ing considering that the cases were of years' duration and

had resisted a ll 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 dis

orders. O f course, in some of these cases psychic treat

ment was combined with physiological hygiene, but the

general principles of treatment were carried along the

line of the correction of faulty habits of thought, instruc

tion of the patient into the nature of his disease, and the

suppression of individual symptoms by various suggest

ive 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 fau lty m otor education. Iso lation methods

have been of great value, particu lar ly in hysteria or neuras

thenia, and recently Dubois of Berne has written a pop

ular 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 ner

vous 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 J ournal 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.

The General Principles of Psychotherapy

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