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.

As a matter of course, in the overwhelming mass of cases the frankness
and the good will of the patient himself will support the physician and
accordingly his examination is not obliged to trap the patient but
simply to guide him to important points. But then begins the most
essential study of diagnostical differentiation. With all the means not
only of psychology but of neurology and internal medicine, he has to
separate the particular case from similar ones and to examine whether
he deals with, for instance, a hysteric or with a paranoiac, with a
neurasthenic or with a case of dementia praecox; and he will not forget
that there exist almost no symptoms of serious diseases which the
nervous system of the hysteric may not imitate for a time. Not ours is
the task of analyzing special methods of neurological and mental
differential diagnosis such as are used in the psychiatric clinic and in
the office of the nerve specialist. There the family history with
reference to nervous and other diseases, the history of the patient
himself, the infectious diseases which he has passed through, his habits
and anomalies, his use of alcohol and of drugs, his experiences in
social life, the demands of his profession, his recent troubles and
their first origin are to be recorded carefully. Then begins the
physical examination, the study of his sense organs and his nerves, of
the motor inabilities, the pains, the local anaesthesias and
paraesthesias, the disturbances of the reflexes, of the spasms, tremors,
convulsions, and incooerdinations, of the vasomotor and trophic
disorders, and so on. In a similar way the psychical examination tests
the hallucinations and illusions, the variations and defects of memory
and attention, of judgment and reasoning, of orientation an