America's ablest neurologists and psychiatrists now boldly assert that the greatest triumph of neurology is its successful employment of measures aimed to modify the mental mechanism underlying the symptomatic manifestations presented in that class of nervous diseases designated as the psychoneuroses, which embrace hysteria, psychasthenia, and the large "heap" of neurotic disturbances included in the so-called neurasthenia.

This sentiment is well voiced by Dr. J. J. Putnam, professor of nervous and mental diseases in the Harvard Medical School, in these well-chosen words:1

"The neurologists of the present day tend less and less to treat the nervous invalids intrusted to their care in accordance with the principles of a narrow 'militarism' or as subjects for cajoling, and more and more as reasonable beings, possessed of consciences and independent wills, and capable of intelligent co-operation. In proportion as our knowledge of mental life has become deeper and more accurate, there has been a growing tendency to seek further and further for the causes of distressing symptoms - whether these causes lie in the environment of the patient, or in habits, instincts, and experiences dating back to the years of childhood, or expressed in inherited physical traits."

The interest in this special branch of applied psychotherapeutic technic has arisen from the investigations of Freud, Bleuler, Breuer, Babinski, Jung, Prince, Sidis, Meyer, and others, and has resulted in the employment of a method of diagnosis and treatment of the Psychoneuroses by laying bare and remedying the pathological mechanisms underlying the symptomatic manifestations presented in the individual case, and the technic of the procedure is known as psychoanalysis.

1 Psychotherapy, by Morton Prince and others, consisting of the papers presented before the American Therapeutic Society, May, 1909. Published by Richard G. Badger, Boston.

It is more especially through the work of Freud, of Vienna, that the psychoanalytic form of psychotherapy has been given to the medical profession. That the method, and the theory upon which it is based, represents one of the most important steps in the evolution of psychotherapy, particularly as applied to the treatment of the psychoneuroses, and is destined to become more and more useful, just in proportion as the theory and technic of its application is simplified and rendered more rational, as the result of further development, is beyond question to the fair-minded investigator. That the ability to successfully apply the psychoanalytic form of psychotherapy must be limited to those having a special adaptability for comprehending, appreciating, and employing the simpler methods of psychotherapeutic technic must be equally certain. The efficacy of any therapeutic or surgical procedure will, in most cases, depend upon the development of the personal capacity of the individual employing it. The truth of this assertion can not be denied. The same rule holds good with the employment of the psychoanalytic method of treatment as applies to other departments of medical practice.

Professional skill is the result of work, study, and painstaking development.

In many respects, Freud's psychology harmonizes with my own theoretical explanations for the results obtained from other methods of employing suggestion in all classes of medical and surgical practice. The essential difference in his technic lies in his method of employing suggestion as a means of detecting and remedying the effects of previous harmful suggestions - or "psychic traumas," as he calls them - due to experiences occurring in early childhood and other processes of experience. The essential difference in his theory is in his conviction that the dissociated functionating complexes which are within the domain of the subconscious, conserving the painful ideas which are the most productive factors in the etiology of neurotic symptoms, are, in the ultimate analysis, those consisting of wishes or impulses related in some way to the sexual instinct, representing the pathological fulfillment of a repressed wish, and having its origin in the sexual incidents of infancy and early childhood, producing the traumas which are the psychogenetic factors responsible for the neurosis developed in later life.

I will discuss these two points of technic and theory in which Freud's methods are so radically different from my own after showing the points of similarity, or harmony, existing between his views and those set forth by me in the present and previous editions of this book. In doing so I hope to set a correct valuation on Freud's contribution to the psychology of the psychoneuroses, as well as to illustrate the small value of his methods of psychotherapeutic application.

The ipse dixit of some recent writers, purporting to describe Freud's methods, denies that suggestion plays any part in the method of employing psychoanalysis, or that it is to its efficacy that the cure is effected. On this point I was an agnostic until reading a description of his technic by Freud himself, showing that he uses suggestion from the start to the finish of his psychoanalytic procedure, with the special intent of eliciting the autosuggestions of the patient, so that the mature judgment of the individual patient can react to the evidence evoked through recalling effectively to his memory the influence of experiences of the forgotten past, which have been responsible for his neurotic symptoms. In this he is conforming to a well-known principle known by every one making successful employment of any method of applied suggestion - i. e., that every suggestion, to be effective, must be presented in such a manner as to be accepted and assimilated as an autosuggestion. No suggestion can be effective if not presented to the patient in such a manner as to appeal to the reason, to the voluntary desire, to the intelligent will of the patient, unless it be by forcibly attempting to dominate, coerce, or intimidate the patient, a method which is as unreasonable as the attempt to hold up a victim at the point of a pistol, and is unjustifiable under any circumstances.