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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