Psychotherapy (Paperback)

OXFORD MEDICAL PUBLICATIONS PSYCHOTHERAPY ITS USES AND LIMITATIONS BY D. RHODES ALLISON M. D., M. R. C. P. AND R. G. GORDON M. D., D. Sc. f F. R. C. P. GEOFFREY CUMBERLEGE OXFORD UNIVERSITY PRESS LONDON NEW YORK TORONTO 1948 PREFACE IN recent years the art of Psychotherapy has grown up. From small beginnings when it was the object of suspicion if not derision it has developed to the stage when the public expect much of it and even the most conservative of medical practitioners accept it as an essential part ef therapeutic procedure. So rapid, however, has been its growth that even its experienced practitioners are not quite sure of the extent of its present province and what may be expected of it in the future. As to the lay public it is confused by old claims some of which have had to be abandoned and by new adven tures into what is now familiarly, but rather vaguely, referred to as psychosomatic medicine. Meanwhile the rank and file of the medical profession are hard put to it to know what can be done by psychotherapy and what cannot. They are apt to assume that it can or ought to be able to cure all sorts of mental illness, while the expert knows that it cannot. On the other hand, when the expert suggests that the treatment of many conditions hitherto supposed to be entirely within the field of the general physician or surgeon, would be much better referred to the psychotherapist the ordinary medical man feels bewildered. The medical student acutely conscious of the importance of the mental side of medicine finds it difficult to obtain definite directions. With the end of the second world war the authors thought that the time was ripe to examine the whole field and try to assess theproper r61e of psychotherapy in modern medicine and to do something to define its legitimate scope and its undoubted limitations. They have made no attempt to describe the different methods of psychotherapy, there is literature enough and to spare on the subject. They have sought merely to indicate to the student and the practitioner the sort of case in which they may expect help from the specialist in this form of treatment and where he is unlikely to be of any assistance. They have tried to point out how without special knowledge the physician and the family VI PREFACE doctor may often help the patient to conquer his disease by maintaining his courage and morale and have urged the necessity, if medicine is to progress, that an end should be made to suspicions and rivalries and that all branches of medicine should combine to fight disease in a team which can deal with both psyche and soma with individual and environment, all of which indeed are indivisible. D. R. A. September, 1947. R. G. G. CONTENTS PREFACE ...... v I. THE DEVELOPMENT OF PSYCHOTHERAPY . 1 II. PSYCHOTHERAPY IN THE TREATMENT OF THE PSYOHONEUROSES . . . .12 III. TEMPERAMENTAL INSTABILITY . . .24 IV. PSYCHOSOMATIC CONDITIONS . . .29 V. THE VISCERAL NEUROSIS . . . .44 VI. THE RELATION OF RHEUMATISM TO MENTAL ILLNESS ...... 55 VII. THE ENDOCRINE BACKGROUND . . .59 VIII. THE PSYCHOLOGICAL ASPECT OF ORGANIC DISEASE . . . . . .73 IX. PSYCHOTHERAPY IN THE TREATMENT OF THE PSYCHOSES . . . . .93 X. PSYCHOTHERAPY IN THE TREATMENT OF MENTAL DEFICIENCY . . . . .101 XI. PSYCHOTHERAPY IN THE TREATMENT OF PSYCHO PATHIC PERSONALITIES . . .110 XII. THE PATIENTS REACTION TO BODILY DISEASE . 124 XIII. THE ORGANIZATION OF PSYCHOTHERAPY, 135XIV. THE COMBINED APPROACH .... 148 INDEX ....... 157 vii CHAPTER I THE DEVELOPMENT OF PSYCHOTHERAPY SINCE the time of Hippocrates and before, all doctors and healers have practised Psychotherapy. Before the rise of scientific medicine successes in treatment and undoubted successes there were must have been due in very large measure to the personality of the physician and his uncon scious psychotherapy...