The psychological work of the physician does not begin with his curative
efforts. Therapy is always only the last step. Diagnosis and observation
have to precede, and an inquiry into the causes of the disease is
essential, and in every one of these steps psychology may play its role.
The means of psychodiagnostic are not less manifold than those of
psychotherapy. Moreover there the technique may be more complex and
subtle. The whole equipment of the modern laboratory ought to be put at
its disposal. Perceptions and associations, reactions and expressions
ought to be examined with the same carefulness with which the
conscientious physician examines the blood and the urine.
A particular difficulty of the task more or less foreign to every other
medical inquiry is the intentional or unintentional effort of the
patient to hide the sources of the trouble and to mislead as to their
true character. Too often he is entirely unconscious of the sources of
trouble or else he has social reasons to deceive the world and himself,
and ultimately the physician. And yet no psychical treatment can start
successfully so long as the patient is brooding on secret thoughts at
the bottom of his mind. The desire to hide them may often be itself a
part of the disease. It is surprising how often unsuspected vistas of
thoughts and impulses and emotions are opened by an inquiring analysis
where the direct report of the patient does not awaken the least
suspicion. In the field of insanity, naturally the physician at once
goes to an examination on his own account, but in the borderland regions
of the psychasthenics and hysterics and neurasthenics, the intellectual
clearness of the patient too easily tempts one into trusting the
sincerity of his story; and yet the most important ideas clustering
perhaps about love or ambition, about vice or crime, about business
failure or family secrets, about inherited or acquired diseases may be
cunningly withheld and may frustrate every psychotherapeutic influence.
Where suspicion is awake and mere confidential talk and persuasion seem
insufficient, the physician may feel justified in the interest of his
patient in drawing the thoughts out of their hiding-place by artificial
means. Skill, tact, and experience are needed there.
Public-domain text, read in full here on John Shaqi.
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