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Psychotherapy And The Individual Patient

The most important element in Psychotherapy is the individual patient.
Old Dr. Parry of Bath said a century ago, "It is much more important
to know what sort of a patient has a disease, than what sort of a
disease a patient has." Mental influence is not of the slightest avail
against pneumonia or typhoid fever, nor constipation nor rheumatism as
such; mental influence may be, and often is, of the greatest possible
help to the patient suffering from any of these diseases.

We recognize frankly now that for most diseases we can do nothing to
counteract the disease directly or to cure it specifically. The idea
of specifics in medicine has to a large extent disappeared. Two or
three of them possibly we have, but even with regard to these, there
are certain doubts as to the essential modes of their activity. We
have learned, however, to help the patient to overcome disease. We
know how to conserve his forces, to increase his vital reaction, to
maintain his nutrition without disturbing his general condition, and
to secure elimination in such a way as to prevent nature from being
interfered with in her curative purposes. To this, psychotherapy would
enable us to add such encouragement of the patient as would tap new
sources of energy in him according to the law of reserve energy, and
would prevent discouragement and the inhibition of favorable nerve
impulses that so often follow. The outcome of any disease depends on
two factors. One is the condition of the patient at the time the
infection was acquired, the other is the virulence of the infection.
We can do nothing to modify this latter element, once the disease
manifests itself. We can, however, do much to enable the patient to
throw off the disease and, above all, by securing a favorable attitude
of mind, we can enable him to use his forces to the best advantage.

Anyone who has noted the difference between the patient's state just
before and just after his physician has called, though absolutely no
physical remedy has been employed, is able to realize very well how
much psychotherapy is able to accomplish. One who did not know, would
be sure to assume that some potent remedy had been administered--and
there has been. This potent remedy is psychotherapy. Whether the
personal magnetism necessary to produce therapeutic effects of this
kind can be learned or not depends on the individuality of the
physician. Undoubtedly, however, everyone can add to whatever of
personal influence he has by definitely recognizing its place, by
making every effort to employ it, and then by regular systematic
effort in securing as much personal information as possible with
regard to the patient. This personal relationship of physician and
patient makes instruction easier and suggestion more effective.

The securing of personal information is of the utmost importance in
determining the affections that psychotherapy will relieve, because
very often details of life and habits are discovered that can be so
modified by instruction as to bring about a disappearance of
unfavorable physical influences. It is indeed surprising to find how
many unreasonable things people do from habit, from unfortunate
persuasion, or from lack of knowledge. In many of the minor chronic
ailments that are the source of so much mental discomfort to patients,
the physician finds that a change in the patients' habits, not
necessarily of marked degree, may make all the difference between
cheerful health and rather despondent low-spirited feeling. Now that
epidemic disease has become rarer, a physician's practice, especially
among the better classes, is much more taken up with these minor
ailments than with the typical classical diseases.

The ordinary history of their ailments, as patients commonly present
them, especially when there are neurotic elements, is likely to be
meager in what is objective, but consists mostly of the subjective.
Such patients have much to say of their sensations, their feelings,
their dreads, their surmises, their conclusions as to their particular
condition, and especially the hereditary elements in it, but
comparatively little of the objective realities of their ills and of
their environment. What the physician needs to know about them is
their habits of life, their daily routine of existence, just as
minutely as it is possible to obtain the information. There is just
one way to get the latter details, and that is to inquire particularly
with regard to actual happenings. In chronic conditions of many kinds,
it is so helpful that it will always be worth the physician's while to
get at these details, especially in supposedly puzzling cases for
which various forms of treatment have been already tried.

In spite of every precaution in this matter, the physician sometimes
finds, after a series of consultations, that some point which when
brought to light he considers to be of great importance, has been
thought so trivial by the patient that it was never mentioned, in
spite of the most careful questioning. In all medical practice the
rule is that mistakes of diagnosis are much more due to neglect in
eliciting necessary information than either to lack of expertness in
diagnosis, or lack of knowledge of the significance of symptoms.

In the affections that can be relieved by psychotherapeutics, the most
important element for diagnosis, besides a minute knowledge of the
patient's habits, is just as detailed information as possible with
regard to his ways and modes of thought as to his ills. Practically
every motive, as well as every action of the day, must be scrutinized,
and often it will be found that little things mean much for the
individual. "Trifles make perfection, but perfection is no trifle," as
said by Michelangelo, might well be changed for the physician to,
"Trifles make all the difference between health and discomfort, though
health is no trifle."

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