James Walsh - Psychotherapy

There is a precious therapeutic secret in this use of deterrent, repugnant, frightful materials which patients use to advantage under certain circumstances. It illustrates the influence of the mind over the body, and emphasizes the fact that such influence can be exerted in the full only when a deep impression is produced upon the patient. Whether this can be imitated without deceit, and without the use of undignified methods, must depend on the physician himself and his personality. There can be no doubt that there is a wonderful power here to be employed. It must be the physician's business to find out in each individual case, according to his own personal equation, just how he may be able to use at least some of it. It is well worth studying and striving for, because nothing is more potent for psychoneurotic conditions, and for neuroses on the borderland of the physical, than which no ailments are more obstinate to treatment.

Though it has seldom been fully realized and has probably never been appreciated as in our time, one of the most important factors in therapeutics, in every period of the history of medicine, has been the personal influence of the physician. Therapeutic fashions have come and gone, new drugs have been introduced, have had their day and then been relegated to the limbo of worn-out ideas. At all times, however, physicians have succeeded in doing good, or at least using, with apparent success, the therapeutic means of their own time, however crude and inadequate these afterwards proved to be. They have succeeded in shortening the progress of disease as well as increasing the patient's resistive vitality and thus enabled him not infrequently to survive where otherwise a fatal termination might have occurred. All unsuspected during most of the time, it was the personal influence of the physician that counted for most in all of the historical vicissitudes of therapeusis. It mattered not that the means he employed might seem absurd to the second succeeding generation, as was so often, indeed almost invariably, the case, his personal influence has at all times overshadowed his available therapeutic auxiliaries. In spite of all our advance in scientific medicine, to a considerable degree this remains true even at the present time, and to fail properly to use this important auxiliary is to cripple medical practice.

Place of Personal Influence.—When the antitoxins and directly curative serums seemed about to make for themselves a place in therapeusis, it looked for a time as though this personal element might be entirely superseded. It seemed that all other therapeutic factors must give way to definitely accurate doses of antitoxic principles, directly opposed to the toxins of disease and capable of conquering it. With the success of diphtheria serum, the prospects for scientific therapeutics from the biological standpoint became very promising. Unfortunately, our further experience with antitoxins and therapeutic sera of various kinds has not been satisfactory, and now the medical world is looking elsewhere for progress in therapeutics.

This throws us back once more on the old-time therapeutics, and we have to learn to use all their elements. One of the most important of these, if not, as we have suggested, absolutely the most important, the one that in all the many variations of therapeusis has maintained itself, is the personal influence of the physician by which he is able to soothe the patient's fears, allay his anxieties, make him face the situation calmly so that he may not use up any of his vital force in useless worry, but on the contrary employ all his available psychic energy in helping nature to overcome whatever disturbance there is within the organism. This personal influence was for several centuries spoken of as personal magnetism, not merely in the figurative sense in which we now employ that term, but in a literal sense. The implication was that some men possessed within themselves a reservoir of superfluous energy, vital in character, but thought to be related to the force exhibited by the magnet, when it attracted bodies to itself, and made metals for a time magnetic like itself, and which actually passed over from the physician to his patient. We have gotten away from the idea of any physical force flowing from physician to patient, but we know very well that certain physicians are much more capable than others of arousing the vital energies of the patient, sometimes to the extent of making him feel, after treatment, that he has more force than before. The patient feels that something must have been added to his natural powers, though he has only been brought into a state of mind where he can better use his own powers.

It is the men whose presence created this impression in patients, an impression that is justified by the fact that somehow he enabled them to vitalize themselves better than before, who have been most successful in the treatment of patients. In all ages the men of reputation for healing have had this. A careful study of their lives shows that this counted for more in many of the experiences of their healing than the drugs and remedies which they employed. The men who have been the most sought by patients have not as a rule left us great therapeutic secrets; on the contrary, they have only employed the conventional remedies of their times with reasonable common-sense and have added to them their own personal influences. On the other hand, the men who have made discoveries in therapeutics, and in medicine, have not always been popular as physicians. They have known too much of their own lack of knowledge to be quite confident in their use of remedies, and this has hurt something of their personal influence over patients.

As a matter of fact, it is easy to comprehend, even from the comparatively scanty details that we have of habits and methods of the great physicians, that their effect upon their patients was always largely a matter of impressive personality. Any one who, from a pharmaceutical standpoint, knows how inefficient were many of the remedies that great physicians depended on, yet how effective they seemed to be to their patients, and even to themselves, will appreciate the factor of personal magnetism that entered into their employment. It is not alone in the olden time that great physicians have been almost worshiped. For their patients they have at all times been men of exalted knowledge, masters of secrets and comforters of the afflicted, just as was the first great physician of whom we have any account, I-em-Hetep, in Egypt nearly six thousand years ago. Such men as Hippocrates, as Galen, as Sydenham and Boerhaave, and Van Swieten, accomplished curative results far beyond the therapeutics of their time. The loving admiration of patients and of their disciples shows how strong were their personalities and gives us, almost better than the writings they have left to us, the secret of their successes as practitioners of medicine.

A Great Modern Physician's Influence.—It is interesting to study in the lives of great physicians the details which illustrate their personal influence, their consciousness of it and how deliberately they used it. A typical example very close to us, whose reputation was still fresh while I was at the University of Paris, was Professor Charcot. He had made great discoveries in nervous pathology. To a great extent he had revolutionized our knowledge of nervous diseases and added many new chapters to this rather obscure department of medicine. Far from making the treatment of nervous diseases easier than before, or giving more assurance to the physician who dealt with them, his discoveries, however, had just the opposite effect. His work emphasized that practically all of the so-called nervous diseases were due to degenerations in the central nervous system, which no medicine could be expected to relieve in any way, and which nothing short of the impossible re-creation of damaged parts could ever cure. His studies included organic degenerations of other organs, and in his treatise on "Diseases of the Old" it is made clear that many of the symptoms of old age are due to organic lesions for which no cure can ever be expected. This would seem to discourage treatment, yet somehow Charcot became a great practicing physician as well as a medical scientist and pathologist.