From a long experience I have to confess that I have seen that
this unsentimental remedy is the safest and most important prescription
in the prescription book of the psychotherapist.
There is one more feature of general treatment which seems almost a
matter of course, and yet which is perhaps the most difficult to apply
because it cannot simply be prescribed: the sympathy of the
psychotherapist. The feelings with which an operation is performed or
drugs given do not determine success, but when we build up a mental
life, the feelings are a decisive factor. To be sure, we must not forget
that we have to deal here with a causal and not with a purposive point
of view. Our sympathy is therefore not in question in its moral value
but only as a cause of a desired effect. It is therefore not really our
sympathy which counts but the appearance of sympathy, the impression
which secures the belief of the patient that sympathy for him exists.
The physician who, although full of real sympathy, does not understand
how to express it and make it felt will thus be less successful than his
colleague who may at heart remain entirely indifferent but has a
skillful routine of going through the symptoms of sympathy. The
sympathetic vibration of the voice and skillful words and suggestive
movements may be all that is needed, but without some power of awakening
this feeling of personal relation, almost of intimacy, the wisest
psychotherapeutic treatment may remain ineffective. That reaches its
extreme in those frequent cases in which social conditions have brought
about an emotional isolation of the patient and have filled him with an
instinctive longing to break his mental loneliness, or in the still more
frequent cases where the patient's psychical sufferings are
misunderstood or ridiculed as mere fancies or misjudged as merely
imaginary evils. Again everything depends upon the experience and tact
of the physician. His sympathy may easily overdo the intention and
further reenforce the patient's feeling of misery or make him an
hypochondriac. It ought to be sympathy with authority and sympathy which
always at the same time shows the way to discipline. Under special
conditions it is even advisable to group patients with similar diseases
together and to give them strength through the natural mutual sympathy;
yet this too can be in question only where this community becomes a
starting point for common action and common effort, not for mere common
depression. In this way a certain psychical value must be acknowledged
for the social classes of tuberculosis as they have recently been
instituted.
Public-domain text, read in full here on John Shaqi.
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