e 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.

From sympathy it is only one step to encouragement, which indeed is
effective only where sympathy or at least belief in sympathy exists. He
who builds up a new confidence in a happy future most easily brings to
the patient also that self-control and energy which is the greatest of
helping agencies. The physical and mental efforts of the physician are
alike deprived of their best efficiency if they are checked by worry and
fear that the developments of the disease will be disastrous. As soon as
new faith in life is given, and given even where a sincere prognosis
must be a sad one, a great and not seldom unexpected improvement is
secured. There is no doubt that the routine physician is doing by far
too little in these respects. His instinctive feeling that disease is a
causal process, and that he should therefore keep away from the
purposive attitude, leads him too easily to a dangerous narrowness. He
treats disease as if it were an isolated process and overlooks the
thousandfold connections in which the nervous system stands with the
patient's whole life experience in past and future