The psychoneuroses and their treatment by psychotherapy / Translated by Smith Ely Jelliffe.

  • Dejerine, J. (Jules), 1849-1917.
Date:
1913
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Licence: In copyright

Credit: The psychoneuroses and their treatment by psychotherapy / Translated by Smith Ely Jelliffe. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    turbances, however Rabelaisian they may sometimes be. One must look upon them as exceedingly serious, and often very grave conditions, because the very life of the patient may depend upon their persistence or their disappearance. In the treatment of a false genital fixation it is very essential, how- ever material may be the nature of the phenomena that are met with, not to make fun of them. If in a theoretical description one may be justified in using circumlocution, with the patient one must use the right word, the physiological or anatomical term. He must be made to understand that the sexual functions, for a physician at least, are noth- ing to be ashamed of, or nothing to joke about. And if it sometimes happens that the patient jokes about his own symptoms, do not follow him in this line. He laughs perhaps because he thinks that it is manly to laugh, while all the time he is much more inclined to weep. C. Gynaecological Pseudo-manifestations do not offer any special therapeutic indications. The physician's chief work consists in stating to the patient, after a sufficiently thorough examination, that she is perfectly healthy, in reassuring her concerning each of the special manifestations which she presents, in getting her to turn her attention away from her genital organs, and in insisting that she give up all treatment and stop watching herself. This is very simple theoretically, but it often runs up against a most firmly established systematization which has been encouraged and developed by a long-drawn-out local therapy. It is not a rare thing, under these conditions, for the neurologist to be obliged to call in the help of a gynaecologist, who in his turn tells the patient that her fears are foolish and there is no necessity for treatment. The successive convictions which one thus tries to implant in the mind are not only added to one another but become multiplied, giving the patient a feeling of perfect security, which per- mits her to do, what is the one thing that one is trying to accomplish, —namely, to forget the functional manifestations with which she has been afflicted and the phobias which have deceived her. To speak frankly, these manifestations require a certain therapy, but this therapy is prophylactic, and to be addressed to physicians and not to patients. It is not that we wish to deny the value of certain conservative practices in gynaecology. But for a certain number of cases where pessaries, tampons, glycerin, ichthyol, etc., are found to be of value, how many others are there where the physician knows perfectly well that his patient is in good health, nevertheless believes it to be right, in order to satisfy her, to make her undergo a more or less lengthy treatment. He thinks that it will calm her, but he only ex- asperates her. She was merely nervous, but she becomes a neuropath, with fixed obsessions concerning her genital organs. The physician is responsible if he has been weak enough to look at things from the patient's point of view, and has not had sufficient energy positively to