Of course, there is no abrupt division between special and general methods. Yet the different tendency is easily recognized, if we turn only, for instance, from the mere sympathy and encouragement to the method of reasoning with the patient about the origin of his special complaint. Just now the medical profession moves along this line a great deal. Of course, no well-trained psychotherapist will make the blunder of arguing with the insane. To dispute by argument with the paranoiac and to try to convince him would not be only without success, but easily irritating. This does not mean that they are not less amateurish way ought to be taken of accepting his delusions and appearing to be in full agreement with him.
A tactful middle way, preferably a disciplinary ignoring attitude, ought to be taken. But it is entirely different with the mental states of the psych asthenic. The mere statement and objective proof that his obsession is based on an illusion would be ineffective. He knows that himself, but he may take the disturbance as the beginning of a brain disease, as a form of insanity, as a lasting damage which lies entirely beyond his control. Now the physician explains to him how it all came about. He shows to him that the symptoms resulted merely from autosuggestion or are the after-effects of a suggestion from without or of a forgotten emotional experience of the past. That is a new idea to the patient and one which changes the aspect and may have an inhibitory influence.
Of course, the patient does not accept the explanation at once. He feels sure that he is not accessible to suggestion and that he has least of all a tendency to autosuggestions, but the skilful psychotherapist will find somewhere an opening for the entering wedge. He may develop to the patient the modern theories of the origin of neurotic disturbances, all with entire sincerity and yet all shaped in a way which gives to the special case an especially harmless appearance. He may even enter into experimental proof that the patient is really accessible to autosuggestions. A very simple scheme for instance is to put some interesting looking apparatus with a few metal rings on the fingers of the subject and connect it with a battery and electric keys. The key is then pushed down in view of the patient and he is to indicate the time when and the place where he begins to feel the galvanic current. The feeling will come up probably very soon in the one or the other finger, and as soon as he feels sure that the sensation is present, the physician can show him that there was no connection in the wires, that the whole galvanic sensation was the result of suggestion.
Such a method demands patience and good will. The prejudices and deeply-rooted hypochondriac ideas, foolish theories of the patient and pessimistic emotions which have become habitual, must be removed piece by piece until the central symptoms themselves can be undermined and explored. It often takes hours of careful and fatiguing reasoning, in which at any time the patient may suddenly slip back to his old ideas. Yet if the explanatory arguments have once succeeded in making the patient himself believe firmly that his whole trouble resulted from suggestion only, the inhibitory effect of this idea may be an excellent one. The only serious defect of the method is that it often does not work. The credit which neurologists of today give to its effectiveness seems to me much too high. Even slight neurasthenic and psych asthenic disturbances remain too often in complete power when the patient is fully convinced that they originated with an emotional excitement which has long since lost its feeling value or that it resulted from a chance suggestion picked out from indifferent surroundings. The patient knows it and yet goes on suffering from the fruitless fight of his will against the intruder. Where mere reasoning is entirely successful, I am inclined to suspect that an element of suggestion has always been superadded. The authority of the physician has created a state of reinforced suggestibility in which the argument convinces, not by its logic but by its impressiveness.
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