George W 1856-1940 Jacoby.

Suggestion and psychotherapy online

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of the adherents of Dr. Worcester is different from
that of Mrs. Eddy in that they do not directly re-
nounce medical treatment. They admit that organic


changes of the body cannot be cured by prayer,
and therefore take the precaution to have a correct
diagnosis made for them by professional physicians.
Making a suitable selection of cases in that way,
they leave to the doctors those patients suffering
from organic disease, while those suffering exclu-
sively from functional disorder are subjected to
cure by means of prayer. This movement really
originated in England several years ago, but did
not meet much success. Even here it has not
grown and spread as at first it was expected to.

To recapitulate briefly: We have learned that,
through psychotherapy the perception of pain may ^
be suppressed to a certain extent, appetite and
digestive functions regulated, heart action quick-
ened or retarded. We know that, on account of
the tendency of the organism to complete a process
which is anticipated, hysterical paralyses, as well
as certain idiosyncrasies, may be removed by means
of suggestion. We also know that suggestion may .
be employed with success in all forms of disease
which manifest themselves by functional disorder
and functional symptoms. If, then, it be said it is
immaterial whether these effects are produced
through prayer or through psychotherapy, the reply


must be that, although, objectively considered,
the result may be the same in either case, sub-
jectively the psychotherapist works with creditable
methods, while the faith and prayer curist is the
victim of self-deception in that he attributes to a
miraculous influence the beneficial results attained
by natural means, through the power of the imagi-
nation. What is of the greatest moment, however,
is the sacrifice of many lives through the renuncia-
tion of medical treatment, which is characteristic
of Christian Science — lives which could have been
saved had there been an opportune recognition of
the organic disease which led to their extinction,
and which was quite as unamenable to psycho-
therapy as to religious treatment.

Therein, in my opinion, rests the moral cul-
pability and the criminal responsibility of all faith
and prayer healers. They wilfully exploit a super-
stition, and against such procedure the sick and
the infirm must be protected.

E. The Personality of the Physician

The statement of a well-known clinician that
disease is cured not by the remedy but by the
physician must be accepted cum grano salis. The


kernel of truth which it contains is that the per-
sonahty of the physician exerts an extraordinary
influence on the efficiency of therapeutic procedures.
This is true particularly in psychotherapy, where
use is made of no material remedy but of mere as-
sertion, and where, therefore, signal confidence in
the physician's powers is a prerequisite. Hence,
certain qualities must be possessed by the psycho-
therapist which are not necessary for the practice
of other branches of medicine. Above all, the
practice of psychotherapy requires special prepara-
tion; absolute essentials are a theoretic knowledge
of neurology and psychology, a practical knowl-
edge of the general clinical and anatomical peculi-
arities, and a special knowledge of all the details of
functional disorders and functional symptoms.
Psychotherapy is a sub-division of neurology and
psychiatry. Only the trained neurologist and the
psychiatrist, therefore, are qualified to practise
psychotherapy; but, because of the mutational re-
lations which connect all branches of medicine,
even they can do so w^ith success only if they are
experienced in all other branches of medicine as
well. This is so, if for no other reason, because
the cases most amenable to psychic treatment, the


functional ones, often do not present such pro-
nounced symptoms as would make it possible for
them to be recognized at once. An error in diag-
nosis between organic disease and functional dis-
ease is one to which the inexperienced physician
is easily exposed; and, of course, without correct
diagnosis there can be no proper treatment. Only
that physician who is in constant touch with gen-
eral medicine is qualified for the practice of psycho-
therapy; only he who is able to exclude inappro-
priate cases from psychic treatment will save
himself and his patients from disappointment.

Since, therefore, it is certain that not every phy-
sician, no matter how efficient he may be in his
own branch, will be a good psychotherapist, it must
follow that certain attributes are required for the
practice of' psychic treatment which need not be
possessed by the surgeon, the general practitioner
or the specialist in any particular branch of practise.
This brings us to a consideration of the most char-
acteristic difference between the practice of psycho-
therapy and that of the other specialties in medicine.
For the recognition of all diseases presenting dis-
tinct objective manifestations, whether these be
elicited by means of percussion or auscultation, or


by microscopical, chemical, radiographic, or elec-
trical examination, no understanding between phy^
sician and patient actually is necessary. The fact
that a patient is unconscious, or is a deaf mute, or
speaks a language unknown to the physician need
not preclude the possibility of arriving at a cor-
rect diagnosis or instituting the proper treatment.
Without having to ask a single question, the
physician can recognize a pneumonia, an organic
disease of the heart or the kidneys, diphtheria,
fractures, dislocations, etc.

In psychotherapy, on the other hand, everything,
including diagnosis and treatment, depends on a
proper understanding between physician and pa-
tient. The physician must be able to follow the
train of thought and the emotions of children and
adults, of the cultured and the uncultured, of the
rich and the poor. If their ways of thinking and
feeling be strange to him, how can he gain the con-
fidence of his patients, or elicit the frequently ab-
struse history of their disease, or give them proper
instructions? In psychotherapy, even when com-
bined with other forms of treatment, it is the word
which counts. To secure the acceptance of this
word, to effect receptive adoption of his suggestions


by patients of the most varied degrees of education
and refinement, the psychotherapist, more than
other physicians, must possess a high degree of
knowledge of human character and vast experience
of life. Stress must be laid, too, on the ethical
qualification of the physician. Not only must he
understand the patient, but he must feel with him.
Golden words are these of Delboeuf :

"When I am with a patient, deep compassion
for his sickness overcomes me. When he suffers
I partake of his pains, and when he weeps it moves
me to tears. Between him and me there exists a
common tie. Is it not this sympathy which makes
it seem, when I talk to him, as though I were talk-
ing to myself, and is it not this same sympathy
which makes him believe when I am talking, that
he hears himself talking? Is not this compassion
the secret of those who are successful comforters in
sufferings which resemble their own ? ''

Cold, heartless, and emotionless egotists can
neither comfort nor suggest successfully. Only
forceful, sensitive, impressionable natures, them-
selves easily influenced by the sufferings of others,
are able to exert a psychotherapeutic influence.
Delboeuf's view that psychotherapy presupposes


the existence of a special sort of sensibility in the
physician, and that it is the patient who first acts
psychically on the physician, is perfectly correct.
It is a fact that the manner in which the patient
acts toward the physician is quite as important a
factor in successful psychic treatment as is the
demeanor of the physician himself. Where there
is no psychic contact, the enthusiasm, the joy in
one's work, becomes toned down. Hence it is this
psychic contact which plays the determining role
in psychotherapy. Without it medicines may be
administered and surgical operations performed
effectively, but successful suggestions cannot be
implanted. No matter how calmly the physician
may listen to the exaggerated complaints of hys-
terical patients, he knows the exaggeration is not
simulation, and the patients actually suffer even if
the existence of any disorder cannot be demon-
strated objectively. In his therapeutic dispensa-
tion there can be but one governing law for the
physician, and that is that when a patient believes
himself to be suffering, and asks for help, he actually
is suffering, and needs that help.

Wherever this psychic contact evolved from sym-
pathy, which we have designated as the most im-


portant factor in suggestive treatment, is present,
it will not be difficult for the physician to extend
that measure of tranquility and patience which the
nature of psychotherapy demands. This very de-
mand, in fact, makes the practice of suggestive
therapeutics impossible for many physicians. Time
and patience are factors of the greatest importance.
To listen to the never-ending complaints of many
neurasthenic and hysterical patients is always a tax
on both time and patience, but he who tries to
hurry his patient, he who receives these complaints
restlessly, without interest, or even with a hint the
complaints are foolish or imaginary, will never
achieve the slightest success in this form of treat-

Nervous, excitable persons are particularly un-
adapted as psychotherapists, for the ability to con-
centrate his thoughts is necessary not only for the
patient who is to be influenced, but also for the
physician who desires his suggestion to be adopted.
Similarly, on the other hand, the phlegmatic per-
son will have but slight propensity for so arduous
a task as suggestive or hypnotic treatment, for his
words will lack that force w^hich is necessary to im-
press the truth of his assertions on the patient.


Above all, the physician must be imbued with the
truth of his own statements, for then self-confidence
and surety of demeanor must follow.

He who wavers and doubts his own capabilities,
he who does not himself believe in the effectiveness
of psychic treatment, will never gain the confidence
of his patients. I cannot agree with Struempell in
his contention that the psychotherapist, and es-
pecially the hypnotist, must possess dramatic talent
to produce a more marked impression and to conceal
his own misgivings. There should be no want of
confidence, no doubt in one's self, which may need
covering. Of course, it is an advantage to the
physician to have a voice which is tender and agree-
able. Delboeuf mentions the favorable impression
which the pleasant, convincing tone of Liebault's
voice made on him. But, after all, the means of
expression which the physician uses, whether these
be words or gestures, must harmonize with his
innermost conviction. Where that harmony is
wanting, the successful practice of psychic thera-
peutics is impossible. It would almost seem the
true psychotherapist is born, not made, and yet it
cannot be denied that practice and experience are
essential for the development of this natural dis-


position, and for the fixation of that confidence
in one's powers on which success depends. The
psychotherapist who is the fortunate possessor of
natural and acquired quaHfications cannot fail to
cull the fruits of conscientious endeavor.

F. The Personality of the Patient

Emphasis has been laid repeatedly on the fact
that it is in the field of functional disorder that the
most brilliant successes of psychotherapy are
achieved. All affections which have been pro-
duced by psychic influence, the force of idea or
imagination, may also be set aside by psychic
means. The main occupation of the psychother-
apist, therefore, will be the treatment of neuras-
thenics and hysterics. Of these, according to the
opinion of the majority of writers, those most
easily influenced are children and other persons
who are not given to independent thought and
action, or, to put it in another way, who are accus-
tomed to obey orders promptly, and who have great
respect for authority.

Still, intelligence, will power, and strength of
character also constitute important factors in sug-
gestive susceptibility. Sceptics, persons in whom


the spirit of contradiction is strong, materialists, and
those who are inclined to be sarcastic, are not in-
fluenced easily. They are insistent upon explica-
tion, and they criticize or oppose any method of
treatment if they do not at once appreciate its
efficacy. In their cases, hypnosis is the only method
worthy of trial, for this sleep-like state excludes, or
at any rate curtails, the force of counteracting ob-
jections. On the other hand, idealists, enthusiasts,
people who are emotional and impressionable, are
most easily influenced by psychic means. This is
probably the reason why, according to Obersteiner,
Moll, and other authors, people who are strongly
affected and emotionally excited by music are good
hypnotic subjects.

Real insanities, as we have seen, cannot be bene-
ficially influenced by means of psychic treatment.
A priori it would seem that precisely that want of
critical acumen which forms so great a contrast
between the thoughts and feelings of the paranoiac,
the paretic, etc., and those of a healthy mind would
be markedly propitious for psychotherapic action.
But if we remember that this lack of discrimina-
tion, dependent as it is on actual disease of the
brain, cannot be corrected so long as the tissue


changes or circulatory conditions which are present
render an orderly association of ideas impossible,
this apparent contradiction, that insanity and psy-
chotherapy are incompatible, can no longer astonish
even the mind of the layman. Ideas of grandeur,
hallucinations, etc., when once fixed in the brain,
are more powerful than the word of the psycho-
therapist, and the critical indiscrimination which
arises through an unordered association of ideas
cannot be corrected through a discrimination which
is dependent on an orderly association of those
same ideas.

Psychotherapy addresses itself to personalities.
The personality of the patient represents an entity
which cannot be divided into parts. When a pa-
tient seeks medical aid he is not able to analyze his
disordered sensations to such an extent as to make
him willing to have only those symptoms which
are of functional origin removed by psychotherapy.
What he asks of the psychotherapist is freedom
from all his troubles, even those which grow out of
organic changes. We have seen that, although
psychic treatment cannot directly influence organic
disease, a therapeutic effect may be produced by
psychic reinforcement of a patient's confidence in


the potency of medicinal or other remedies. In a
way, therefore, the patient's hope for rehef is not
unwarranted, for it cannot be denied that, together
with the disappearance of certain symptoms which
to a large degree react perniciously on the nervous
system, the general condition becomes markedly
improved. He who has learned that no better
remedy exists for stimulating the digestion, for regu-
lating the movements of the bowels, for inciting
the appetite, for influencing the heart's action, than
the power of suggestion supported by the authority
of the physician, is bound to come to the conclusion
this power must be of potent advantage to the entire
personality of the patient, and that by means of
the combined method of treatment associating the
employment of psychotherapy and medicinal or
mechanical remedies, the patient will at one and
the same time receive both specific and general

True, it is not always evident, then, which has
been the active factor — suggestion alone, or the en-
hanced belief in the potency of the other treat-
ment. This, however, cannot be of great signifi-
cance so long as it is recognized that therapeutic
suggestion is of itself capable of prolonging an al-


teration in a person's physical condition. The
physician's supreme law must be his patient's weal;
how the good is accomplished is of secondary im-
portance and it can be of no consequence whether
the patient himself can or cannot distinguish the
benefits derived through therapeutic suggestion
from those produced by other means. Even should
those material remedies which support the action
of psychotherapy be inactive of themselves, they
are nevertheless worthy of employment because of
their opportuneness. It is a foible of human nature
which assures the acceptance of concrete things
with greater readiness than of mere assertions, and
this trait must not be disregarded by the physician
in his employment of the combined method of
treatment. Even a person of strong character will
be more inclined to look forward to the occurrence
of certain changes in his condition if the assertion
of the physician be reinforced by the simultaneous
use of remedies which have a material influence on
the patient. The physician cannot dissect the
personality of a patient in such a way as to in-
fluence the mind to combat functional disorders
and symptoms and at the same time to ignore the
treatment of organic changes which may exist.,


In the one case as well as in the other, whether
directly or indirectly, the state of mind of the pa-
tient exerts an influence upon the cure. The per-
sonality of the patient, in fact, is the most important
basis for the individualization of psychotherapy.

The routine practice of medicine is always to be
condemned because in various persons special con-
ditions will cause the same disease to take different
courses and, therefore, will demand different treat-
ment. But in the exercise of psychotherapy, a
consideration of the individual characteristics of a
patient is of decisive importance. It should be
remembered above all else that personality or char-
acter is by no means a fixed entity. People whose
characters ate unchanging and unalterable under
all conditions and in all phases of their develop-
ment certainly are exceptional. It may safely be
maintained that the characters of most persons are
subject to many fluctuations as a result of stress
and other external conditions, and that pain and
suffering seem to alter entirely the personality of an

In his most excellent dissertation on the "Re-
lation of Character Formation to Psychotherapy,"
Putnam says:


"A person's character is not always just the
same — each phase of a multiple personality has
its own character, and these phases reappear as
quasi normal moods. The severe test of illness
sometimes develops forms of character that might
otherwise have remained undeveloped. Within the
orbit of the invalid selfishness sometimes reigns,
and narrow egotism, together with sentimentality,
ignorance, and weakness of will, and these ten-
dencies may remain active long enough to make
themselves felt through modifications of the char-
acter. But, — what is more important for our pur-
poses, — unselfishness, devotion, willing sacrifice of
ambitions and desires, thoughtfulness, persistent
effort, loyalty, the sense of service, may likewise be
manifested here in their best form. The invalid
may make excursions into certain realms which are
rarely open to the well and the strong.''

This emotional variation, these fluctuations of
character and personality, may be of little signifi-
cance for medicotherapy or surgical intervention.
But, for the psychotherapist, who must exert an
influence mainly by words, if not through words
alone, due consideration of the mentality, of the psy-
chic constitution of his patient, and of the appro-


priate manner and ways in which his suggestions
are to be imparted, are of the greatest importance.
No physician of discrimination will speak to a pa-
tient who is extremely depressed in the same man-
ner as he would to one who is capricious and
obstinate. Such individualization is called for par-
ticularly in those patients who at different times
manifest the crass contradictions which are con-
comitant with dissociated consciousness and alter-
nating personality.

The chapter on " Peculiarities of Mental Activity'*
has show^n the differences which exist in the minds
of the child and the adult, of man and of woman,
etc. If, then, the abrupt fluctuations of character
and emotions of each individual are problems which
make serious demands on the tact and the wisdom
of the psychotherapist, how much greater will
these demands be when the problem confronting
him is the effective adaptation of his procedure to
the understanding of different personalities! His
capability for considering individual peculiarities,
for weighing conscientiously the methods of action
under certain given conditions, and for the adoption
of a proper method, will be the surest demonstra-
tion of his efficiencv. Bernheim's statement that


he never has been able to exert any psychothera-
peutic influence on children whose reasoning
powers have not yet been developed, must be un-
qualifiedly endorsed. All suggestion must be
adapted to the intellect, to the powers of compre-
hension of an individual. Hence, suggestion for
the very young and for people of but little culture
must be conveyed in the most simple words. On
the other hand, an intellect which is mature, or a
personality of strong and independent judgment,
will not be swayed so easily by mere commands,
unaccompanied by explanations of the reasons
and the expediency of a procedure. Thus ample
scope is given to the physician for demonstration
of his powers of individualization.

Liebault states that his mere assertion that such
would be the case, caused certain peasants who
were mentally healthy, but thoroughly unsophisti-
cated, to behold the Virgin Mother. Had he been
dealing with more sceptical personalities this surely
would have been an impossibility. A patient who,
because of his poverty drank only water, received
from Liebault the suggestion that for two days at
Easter all water would be converted at meals into
red wine, and the concentration of expectation


developed by this ignorant person actually caused
him to believe this miracle had taken place. Lie-
bault tells of another peasant who often heard it
said that any person going into a meadow by a
certain specified path would be unable to leave it.
The peasant one day went into this field, but no
sooner had he done so than he conceived the idea
he was using the bewitched path, and so dominated
was he by the delusion of his inability to get out
of the meadow that he had to be removed by force.

Charcot says he has sent patients suffering from
hysterical palsy or contracture, whom he had been
unable to relieve through suggestion, to places of
pilgrimage, and on their return he was able to
verify the fact of their cure.

Effects which can be attained without difficulty
in persons of deep religious nature, cannot of course
be brought about through similar means in those
who are agnostically or atheistically inclined. In
order that similar results may be derived from
similar causes, as, for example, the removal of
hysterical paralysis in different individuals by
means of suggestion, the conditions for cure must
be the same. In psychotherapy these conditions
are not made up, as in medicinal therapy, of chem-


ical affinities, or, as in surgery, of antisepsis and
asepsis, but are formed essentially by the person-
ality of the patient and by the sphere of ideas
which control him. These facts enable us to de-
duce the very important principle that the decisive
indication for psychotherapeutic influence is given
not by the perceptional powers of the physician,
but by those of the patient. That physician who
would undertake to counteract similar functional
disorders in different patients by suggestions of a
similar kind, without regard for the thoughts, the
character, and the emotions of the patient, would

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Online LibraryGeorge W 1856-1940 JacobySuggestion and psychotherapy → online text (page 14 of 18)