PSYCHOLOGY AND MEDICINE

We know now that inner life can be looked on from two entirely different
standpoints: a purposive one and a causal one, and we have seen that
these two ways of looking on inner life bring about entirely different
aspects of man's inner experience, serve different aims, and stand in
different relations to the immediate needs of our real life. We know
that the one, the causal aspect, belongs to psychology, while the
non-psychological, the purposive aspect, belongs to our immediate mutual
understanding in the walks of life. If the physician is to make use of
inner experience in the interests of overcoming sickness, he must first
decide whether to take the causal or the purposive point of view in
dealing with the patient's mind. This problem is too carelessly ignored
and through that neglect arises much of the popular confusion. Of course
just this carelessness becomes in some ways the ground for apparent
strength for many a superstition and prejudice. If the doors of the
causal mind and of the purposive mind are both open, and the spectator
does not notice that there are two, any trick on thought and reason can
easily be played. Whatever cannot pass through the causal door slips in
through the other, and whatever does not go in through the door of
purpose marches through the entrance of causality. With such methods
anything can be proved, and the most unscrupulous doctrines can be
nicely demonstrated. If we are to avoid such logical smuggling, we must
see clearly which attitude towards mental life belongs properly to the
domain of psychotherapy.

But what we have discussed now leaves little doubt as to the necessary

decision. The physician is interested in the mental life with the aim of

producing a certain effect, namely, that of health. Thus the mental life

of the whole personality comes in question for him as belonging to a

chain of causes and effects; whichever levers he may move, everything is

to be a cause which, in accordance with causal laws, is to produce a

certain change. Inner life is thus, in the interests of medical

treatment, necessarily a part of a causal system. This means the

standpoint of scientific psychology is the only adequate one. The

purposive view of inner life ought not to be in question when the

patient enters the doctor's office.

To characterize the difference, it may be said at once that it is a

purposive view which belongs to the minister. If the minister says to

his despairing parishioner, "Be courageous, my friend, and be faithful,"

nothing but a strictly purposive view gives meaning to the situation.

The word friend indicates it, that one subject of will approaches

another subject of will, with the intention of sympathy and

understanding of the attitude of the other; and the advice to be

courageous and faithful means an appeal which has its whole meaning in

the relation to aims and ends. The speaker and the hearer are both

moving in a sphere of will relations, purposes and ideals, sin and

virtue, hope and belief. To take the other extreme: if the neurasthenic

in his state of depression and in his feeling of inability seeks relief

from the nerve specialist, he too may say: "My friend, be courageous and

faithful," yet his words have an entirely different purpose. They are

not appeals to a common interest of belief; they are subtle tools with

which to touch and to change certain psychophysical processes, certain

states in mind and brain; there each word is a sound which awakens

certain mental associations, and these associations are expected to be

causes of certain effects and these effects are to inhibit those

disturbing states of emotional depression. If a few grains of sodium

bromide were to produce the same effect, they would be just as welcome.

The whole consideration moves in a sphere in which only physiological

and psychological processes are happening. Thus the physician may work

with the ideas of religious belief, but those ideas are then no longer

religious values but natural psychophysical material, which is to be

applied whenever it appears as the right means to secure a certain

effect.

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