PSYCHOTHERAPY AND THE PHYSICIAN
Every thought of the physician moves in a world the structure of which is determined by the thought forms of cause and effect. He knows the effect which he wants to produce; it is the restitution of the organic equilibrium. He studies the causes which can secure that end. And again the disturbance of the equilibrium itself, the disease, is for him an effect which he seeks to understand by an analysis of the preceding causes. The means which he applies can therefore be valued only in reference to their efficiency; no other point of view belongs to his world. The religiously valuable may be indifferent or even undesirable in the interplay of causes, and the morally indifferent may be most important for the physician’s interests. The religious emotion accordingly has to stand in line with any other mental excitement or with a hundred physical means which the laboratory and the drug store supply. The physician will welcome the methods of treatment without reference to metaphysical systems or to religious beliefs. To him it is an empirical fact that many disturbances of mind and body which interfere with the equilibrium of life can be repaired by influences on certain psychophysical organs. A part of these repairing influences he finds in the sense stimuli, for instance, of spoken or written words which reach the brain and awaken associative and reactive processes. He finds further that these influences can be reënforced in their effectiveness by certain general conditions of the nervous system and again finds that these can be secured partly by sense impressions, and once more especially by words.
It is a matter of course to the physician that application of any sense influence on the brain demands a most subtle analysis of the psychophysical situation. Therefore he gives no less attention to the disentangling of the whole history of the individual brain, to its stored-up energies and to its mental possibilities. If he knows the psychophysical status, and finally if he knows the means of influencing those psychophysical organs which stimulate or inhibit the disturbed central parts, he can foresee the psychophysical effects with a certain definiteness. Thus everything depends upon the sharpest possible, almost microscopic, mental analysis, together with a most thorough examination of the whole nervous system and the most careful calculation of the mental influences applied. The vagueness of the religious appeal transforms itself into an exact calculation and the unity of the soul which seeks spiritual uplift transforms itself into a mental mechanism of bewildering complexity, and yet not more complex than the physical organism, to which for instance, the chemical means of the physician administer. To-day medical science is certainly only in the beginning of this great movement. Especially the analysis of the psychophysical conditions still lacks a sufficient refinement of method. But at least the causal principle is now fully recognized and the scientific man of today no longer doubts that this whole play of psychotherapeutic processes goes on as a causal process in the psychophysical system of the individual without any mysteriousness, without any magnetic influences, without any miraculous interference, without any agencies except those which are working in our ordinary mental life in attention and reaction, in memory and sleep.
It is surprising how late this recognition appeared in the history of human knowledge. It occurred here as in so many places in the history of human civilization that the simple is the late outcome of the complex. Just as in technique the apparatus often began in a complex, cumbersome way and then became steadily simplified, so it is with explanations. The complex machinery of cosmic influences and obsessions by demons and magnetic mysteries was at first necessary until the simple explanation was found that all the results depend upon the working of the mind itself. Yet in technique and explanation alike, such progress to the simpler means always at the same time the making use of much richer knowledge. To explain an obsession or a sleep state by the agencies of evil spirits or magnetic fluids is certainly an unnecessary side conception. But to understand it from the working of the mind presupposes after all the whole modern physiological psychology, and thus had to be the latest step.
The effects themselves were certainly observed in all times. Even the phenomena of hypnotism date probably back some thousands of years, however difficult it may sometimes be to discriminate between the artificial hypnotic states and hysteric or hystero-epileptic occurrences in the past. Certainly it may be acknowledged that the Yogi in India cultivated in the most remote times the methods of autosuggestion which evidently led to hypnotic states, and everywhere around the Mediterranean, antiquity knew the hypnotizing effect of staring on polished metals and crystals. So in Egypt, so in Greece and Rome; and it has often been claimed that the priestesses of Delphi and the sibyls of the Romans were in states of hystero-hypnotic character. As to the therapeutic use, especially the Greek physicians applied hypnotic means. Excited patients were brought to repose by methods of stroking. The efforts to explain scientifically the mysterious powers which men can gain over the mind and will of another begin at the end of the Middle Age and were developed quite naturally from the prevailing astrological doctrines. Astrology worked on the theory that the human fate depends upon the stars. These stars have an effect on the human organism. That proves that an influence can exist between distant bodies. It is, therefore, not more surprising that one organism can also have an influence on another organism. Well known since antiquity were such influences from one object to another, as in the case of the magnet. Thus there may be a kind of magnetic power which creates relations between all objects in the universe.
Pomponnazi explained thus at the end of the fifteenth century the therapeutic effects of the human soul by the mutual influence which stars and men have on each other. This theory comes to much more important development in the writings of the physician Paracelsus. One individual by the power of his effort can influence the will of another individual, can fight with it, and suppress it; and all through energies which are analogous to the magnetic power which binds stars and men. In the middle of the seventeenth century, Helmont connects this power of magnetic attraction and repulsion with an ethereal element which penetrates all bodies and keeps them in motion. Through it man, too, can by his mere imagination work on other men. This will can also be effective on drugs which get through it a special therapeutic power. Somewhat different was the theory of a Scotch physician, Maxwell, in the second half of the seventeenth century. The ethereal spirit, which is identical with light, can be artificially cumulated in any organism and that secures its health. As one man can influence this vivifying ether in any other man, he can produce cures even from a great distance. All diseases are merely reductions of this ethereal spirit in the organism.
But the general stream of the explanation continued in the direction of the magnetic doctrine. It was especially Mesmer in the eighteenth century who, in a long life of fantastic mysticism and yet of universal serious study, surely contributed much to the development of the theory. He had started to use, like others, the magnet in his medical practice. But he discovered that the same therapeutic successes could be gained without applying the magnet itself, but by simply using his own hands. The patients became cured when he moved his hands slowly from their heads to their feet. The magnetic power was therefore evidently in man himself. It was an animal magnetism in opposition to the mineral one which belonged to the magnet and to the stars. He believed further that he was able to infuse this magnetic power into any lifeless thing, which would then have curative influence on the nerves. There can be no doubt that, whatever may have been the value of his theories, he cured a large number of patients, evidently producing a state which we would call today a hypnoid state and often simply appealing to the natural suggestibility of the impressionable minds. Among his pupils, usually called mesmerists, was Puysèyur, who discovered, in 1784, the state which was called artificial somnambulism, a kind of sleep in which the ideas and feelings of the magnetized can be guided by the magnetizer. Here evidently was the first recognition of the psychotherapeutic variation which we call today hypnotism. There followed a period in which the scientific interest of the physicians was somewhat sidetracked by an unsound connection of these studies with mystic speculations and with clairvoyance. But especially in Germany animal magnetism in Mesmer’s form and in the form of artificial somnambulism grew in influence through the first decades of the nineteenth century and succeeded in entering the medical schools. The reaction came through popular misuse. At about the third decade of the century, interest ceased everywhere.
The Portuguese Faria insisted in 1819, practically as the first, that all those so-called magnetic influences, including the delusions, the amnesias after awaking, and the actions at a command, did not result from a magnetic power but from the imagination of the subject himself. He believed that the effect depended upon a disposition of the individual which resulted from a special thinness of blood. He abstained therefore from the magnetic manipulations and produced the somnambulic state by making the patients simply fixate his hands and by ordering them to sleep. Thus he is the first who understood these changes as results of mental suggestion. The next great step was due to the English surgeon, Braid, who in the forties studied the magnetic phenomena and like Faria insisted on the merely mental origin of the abnormal state. He proved that a person can bring himself into such an artificial state and that it is therefore entirely independent of energies from without. He examined especially the influence of staring at a shining object, a method which not seldom was called Braidism. He also introduced the word hypnotism. In America mesmerism was generally known under the name of electrobiology; and Grimes in particular came to results similar to those of Braid. Yet the influence of these movements on the medical world remained insignificant until a new great wave of psychotherapeutics by means of suggestion began in France in the sixties.
Of course this development from astrology to magnetism and from magnetism to hypnotism represented only one side of psychotherapy. Parallel to it goes the progress in the treatment of the insane. In the first half of the eighteenth century, they are still on the whole thrown together with the criminals but the more the disease character of the disturbance is acknowledged, and the more special hospitals for the insane are created, and finally the more the humane treatment in them supersedes the brutal, the more psychotherapy enters into the work. England showed the way. Especially Arnold, Crichton, and Perfect became influential; and soon Pinel and Esquirol followed in France; and Reil and Langermann in Germany. Reil recognized clearly at the threshold of the nineteenth century that "Both psychical and physical diseases may be cured by psychical means, but at the same time psychical diseases may also be cured by physical means." And in his "Rhapsodies," rhapsodies on the application of psychical methods in the treatment of mental disturbances, he declared, "that the medical Faculties will soon be obliged to add to the two existing medical degrees still a third, namely, the doctorate in psychotherapy." This stream became broader and broader and every new development of psychiatry in the last hundred years did new justice to the influence of psychological means in the treatment of mental diseases; to be sure, without allowing up to the present day the hope that mental factors as such can cure the grave forms of insanity. The borderland cases and the incipient mild forms alone allow the hope of a cure. Outside of them the work of psychotherapy in the insane asylum meant essentially improvement and relief only. Again, in another direction, the general dietetic influence of sound mental life may be called a part of psychotherapy and this engaged not a few of the leading medical thinkers in all countries during the last century, especially the nerve physicians who gave serious attention to the wholesome engagements of the mind. Finally, might not much be attributed to psychotherapy, which offically belongs to the doctrines of homeopathy?
But we may return to the new heralds of suggestion. Liébeault’s book on the artificial sleep in 1866 became the starting point of the new great movement. Yet at first it remained unnoticed. It is claimed that for a long time only one copy was sold. But he continued to make his hypnotic experiments on the poor population of Nancy and they finally attracted the attention of some of the leading medical men there. Bernheim became convinced and Dumont, the physiologist Beaunis joined the movement, and in the eighties we find Nancy the center of hypnotic interest to which medical men from everywhere made their pilgrimage. This latter phase was paralleled by Charcot’s studies in Paris, who brought hypnotism into nearest neighborhood with hysteria. And also the later development of the Paris school by Richer, and especially the brilliant work of Janet, kept hysteria in the foreground of the therapeutic interest. Liébeault’s experiment had brought the psychology of suggestion entirely into the center of this whole circle of phenomena and this view controlled the development of the last few decades, which was essentially an elaboration of the special treatment of diseases. Forel in Switzerland, Moll and Vogt in Germany, Wetterstrand in Sweden became the chief exponents of therapy by hypnotism. Others, like Dubois, in Switzerland, emphasized more the suggestive treatment through persuasion. In England at first Carpenter, later Hack-Tuke gave serious attention to hypnotism, in Russia Bechterew, and in the last few years the literature on therapy by suggestion became developed in practically all countries. In America Beard, Hammond, and others belong to the older school; Osgood, Prince, Peterson, Putnam, Sidis, and others to the most recent years. At the same time, under the leadership of Kraepelin, Ziehen, Sommer, and others, the methods of the psychological laboratory, especially the reaction and association methods, were made useful for the purposes of psychopathology.
But interest in suggestion does not represent to-day the last step of psychotherapy. The latest movement, which is entirely in its beginning, the development of which no one can foresee, but which promises wide perspectives, is connected with the name of Freud in Vienna. The entirely new turn of psychotherapy is given by the fact that his aim is not to overcome a symptom by suggestion but to make it disappear by removing the ultimate mental cause. He found that large groups of mental disturbances result from a psychical trauma, a disagreeable idea which, inhibited in the mind, becomes the source of mischief and produces phobias and obsessions and hysterical motions. The cure of the symptoms demands the recognition of this first mental accident, which may lie back for years and which may no longer be in the memory of the patient. As soon as this earlier experience is brought to consciousness again, it needs only a natural discharge and a normal expression and the symptoms which it brought about will disappear. Thus the cure itself needs no hypnotism and no persuasion or suggestion but the reawakening of forgotten situations, and only in the service of this effort hypnotism may be used to reënforce the memory. Yet this represents only the first period of Freud’s activity, in which he collaborated with Breuer, a phase which is represented by their book on hysteria, in 1895. But there followed a further development which is still more essential. The hysterical disturbance may indeed have started with such an accidental traumatic impression but that does not explain why just this impression had such a strong effect. Other impressions of equal strength and emotional vividness may have passed without leaving any damaging result. And therefore there must be some prior cause in the subject which makes just this particular impression so injurious; and here is the point of Freud’s fundamental discovery, which for the layman appears on the surface to have little probability but which has proved of greatest consequence for clinical work. It was found that only those situations become injurious and become starting points for hysterical symptoms which touch on repressed and artificially inhibited ideas of the sexual sphere.
Entirely new perspectives have been opened by these studies. Above all, now for the first time there is in sight a psychotherapy which not only aims to remove symptoms but which really uproots the disease itself. That earlier method of bringing the trauma to consciousness and making it discharge, the so-called cathartic method, removes only the particular group of disturbances but the patient remains a hysteric, and if ever new accidents should happen which would touch again those inmost repressed ideas, new hysterical symptoms would develop. But if we can go back to that starting point, if we can discover those first suppressions of desired gratifications which often most indirectly are related to the sexual sphere, and if we can liberate the mind from those primary strangulated affections, then the patient is really cured. Freud himself practically abstained from the help which hypnotism can give for the reawakening of forgotten experiences, while some of his pupils still prefer this short way to the forgotten memories. His way is, on the whole, to let the imagination bring up any chance material of associated ideas and then to study their connections and follow the hints they give. He calls it the psychoanalytic method. Others prefer the methods of association tests, again others tap the lower layers by automatic writing, but the chief problem remains always to discover those repressed desires and to understand through them the injurious effects of accidental experiences. The whole field of hysteria, and perhaps still more that of the anxiety neurosis, has come into new perspective through this pioneer work which men like Bleuler, Jung, and Stekel have developed in various directions.
Thus in recent decades the thorough work of scientific physicians has developed a psychotherapy of considerable extent and of indubitable usefulness, far removed from the simultaneous efforts of the churches and of the popular mental healing cures. A number of eminent men in all countries have tested the methods and have published the results. But the curious side of it is that all this is essentially a movement of leaders while the masses of the profession hesitate to follow. It is a set of officers without an army. Every large city has one or another specialist who applies suggestive therapy, one or another nerve specialist who hypnotizes, but the average physician moves on without any serious effort to utilize psychotherapy. It is as if the prescription of the modern chemical drugs were confined to some leading scholars in the country, while the thousands abstained from it in their office work and in their family practice. In reality psychotherapy ought to be used by every physician, as it fits perfectly the needs of the whole suffering community. Its almost exceptional use in the hands of a few scholarly leaders deprives it of its true importance. It is the village doctor who needs psychotherapy much more than he needs the knife and the electric current.
Why does the medical profession on the whole show this shyness in the face of such surprising results? In other fields they do not show any reluctance in taking up the newer developments of method. Even the Roentgen ray apparatus has quickly won its way, and psychotherapy is less expensive. To be sure, the most important reason is probably one which is most honorable. The physicians do not like to touch a tool which has been misused so badly. Psychotherapy has come too much into the neighborhood of superstition and humbug. Where miracles are performed, the man of science prefers to leave the field. The less one knows about those groups of problems, the less one is able to see the sharp demarcation line between true scientific studies, for instance, in hypnotism, and the pseudo-scientific fancies of psychical research. Experiments in suggestibility are then easily mixed with experiments in telepathy, and those go over by gradual degrees to clairvoyance and premonitory apparitions, and from there the way is not far to the reappearance of the dead and the routine performances of the spiritists. It seems to many as if there is no point where they have a reason to stop. If they begin with such abnormal phenomena at all, it seems as if they are necessarily carried over to all the mysteries of supernatural energies. Even the competition with Christian Science, and other mental healers whose judgment is not hampered by any previous study of medicine, might seem rather unattractive to the serious physician.
Further not a few have the impression that such suggestive treatment directly demands from them that they also begin to humbug their patients or to throw out suggestions which they themselves do not believe, in short, that they be brought down to the level of the miracle performer. Yet, however much all that speaks in favor of the conscientious instinct in the physician, it is ultimately based upon a misinterpretation. The line between real science and its counterfeit is here as everywhere a distinct one, and the true man of science ought not to hesitate in doing his duty from fear that he might not be discriminated from the charlatan. A well-conducted psychotherapeutic treatment as a scientific physician ought to carry it out, is entirely different in meaning and appearance, from the first step of diagnosis to the last treatment of after-effects, from every unscientific faith cure. It is also in no way necessary that the psychotherapist ever leave the path of complete sincerity. There is no reason at all for promising that the patient will be entirely cured if the physician believes that a real cure through suggestion is impossible. The more the true physicians undertake psychotherapeutic work, the more it will carry with it that dignity which is now too often lost by the predominance of those who treat without diagnosis and cure by mere appeal to superstition.
All that does not mean that other motives do not hold the physician back. Not seldom he is afraid of unfavorable consequences. He does not feel sure that, for instance, a deep hypnosis is without dangerous results or that he will be able to produce it in the technically correct way. But all these objections mean nothing but insufficient acquaintance with the facts. Of course every technique needs its period of preparation for the task, but it is now sufficiently demonstrated that hypnotism carried through in a scientific spirit will never have any injurious consequences. The morphine injection and the Roentgen rays are by far more dangerous. Those who think that for hypnotizing especially inborn power is needed stand, of course, outside of a serious discussion. They do not even know the elements of the modern theories. Every physician has in himself the necessary means for a psychotherapeutic treatment in every form.
More scientific insight belongs to the argument that most of these psychotherapeutic schemes are essentially for treatment of symptoms. We have acknowledged that throughout. The possibility of a relapse or of a new obsession is thus to a high degree open, and that is certainly a discouraging feature. Yet we have seen sufficiently that as soon as the symptoms are removed, there is no lack of means, also by psychotherapy, to prevent the recurrence. Moreover, to remove the present symptoms is in any case a great gain and in many cases a decisive gain. And whatever can be secured by such methods is of such a character that hardly any other method could have been substituted. It can be said with certainty that hundreds of thousands leave the offices of their doctors every year without relief where relief could be secured by psychotherapeutic means.
To be sure, one reply of the physicians is not infrequent and carries some weight. Psychotherapeutic methods demand much time and patience and skill. To relieve a cocainist of his desire by mere suggestion may demand an assiduity which the average physician simply cannot afford; and nothing requires more time than a real use of Freud’s psychoanalytic method. Hours and hours of conversation about the most trivial occurrences have to be spent to relieve the repressed ideas and to give them a chance for a free ascension. It cannot be denied that most of the really illuminating work in all these fields has been done by scholars who combine a strong theoretical interest with their effort to cure the patients, and who therefore examine and treat the individual case primarily from the wish to get new insight into the laws of nature. The average physician whose time is his income may be the less willing to enter into such time-devouring schemes, as the patients too easily may think that the physician did not do much for them when he simply was sitting down and gossiping with them.
Yet after all, behind all of it stands one motive which has held back the development of psychotherapy in the medical profession more than anything else. The physician feels instinctively that a real success can be reached in every one of these fields, only if he possesses a reasonable amount of knowledge of psychology. He feels that wherever he touches the patient’s body, examines his lungs or his heart or his reflexes, that a large background of anatomical knowledge and of general pathology gives meaning to every single observation. But in the field of mental abnormities, in the whole world of ideas and emotions and volitions, he simply lacks that background. Everything seems to him without reference to real knowledge. He feels as amateurish as if he were to operate on the abdomen without knowing its anatomy. He is instinctively aware that even the simplest mental life represents a bewildering complexity and that to stimulate ideas or feelings or to suppress emotions, to inhibit volitions, must demand always a most subtle disentanglement of the most widely different components. He abstains from approaching that ground at all rather than to blunder by his ignorance of psychology. And after all, he is right. But is he right in allowing that ignorance? Can the medical profession afford to send into the world every year thousands of young doctors who are unable to use some of the most effective tools of modern medicine, and tools which do not belong to the specialist but just to the average practitioner, simply because they have not learned any psychology?
Indeed the times seem ripe for a systematic introduction of psychological studies into every regular medical course. It is not a question of mental research in the psychological laboratory where advanced work is carried on, but a solid foundation in empirical psychology can be demanded of everyone. He ought to have as much psychology as he has physiology. Moreover the psychological study ought not to be confined to the normal mental life. Again we do not speak of psychiatry. What is needed is abnormal psychology, entirely independent of the therapeutic interests of the alienist. The mental variations within the limits of normal life and the borderland cases ought to be studied there as well as the complete derangements. The ideal demand would be that the future physician should spend at least a year of his undergraduate time on empirical psychology, especially on experimental and physiological psychology. He would take perhaps half a year’s lecture course on the whole field of psychology as covered in the English language by the well-known text-books of James, Wundt, Titchener, Judd, Royce, Calkins, Angell, Baldwin, Kuelpe, Ebbinghaus, Thorndike, Stout, Ziehen, Ladd, and so on. In the second half-year the course ought to be either advanced psychology entering into the more complex phenomena or a practical training course in elementary laboratory psychology as indicated for instance by Titchener’s "Experimental Psychology. A Manual of Laboratory Practice." If the undergraduate can possibly afford the time in his college course, he ought to add courses which either lead him towards the philosophical problems of psychology or towards the comparative aspect of psychology. If he can find time for a year of post-graduate work between college and medical school, he could hardly spend it more profitably than by a year of research in a well-conducted psychological laboratory to become really acquainted with an independent analysis of mental states. On the other hand in the medical school, room must be found for a course in abnormal psychology, which of course presupposes a thorough knowledge of normal psychology and, if possible, follows the courses on nervous diseases and precedes the course on psychiatry.
For the average future physician, it would be wiser to omit even the psychiatry studies than those in abnormal psychology. The latter ought to lead him far enough to discriminate early between a mere neurasthenia, for instance, and a beginning of insanity. As soon as the discrimination is perfected and insanity is found, he has to give the case out of his care anyhow and hand it over to the specialist and to the asylum. The knowledge of psychiatric treatment is, therefore, not essential for the average practitioner. But no one can relieve him from the responsibility for those borderland cases, for the hysterias and psychasthenias and neurasthenias, and he can never master them without normal and abnormal psychology. Moreover it must not be forgotten that mental factors may enter into every disease. The psychology of pain, for instance, and of comfort feeling, the psychology of hunger and thirst, of nausea and dizziness, the psychology of the sexual feelings, the psychology of hope and fear, of confidence and discouragement, of laziness and energy, of sincerity and cunningness play their rôle in almost every sick room. And if the physician haughtily declares that he does not care for the methods of suggestion, it might justly be asked whether he can be a physician at all if he does not apply some suggestions; yes, if his very entrance into the sick room does not suggest relief and improvement from the start. The introduction of a serious study of psychology is the most immediate need of the medical curriculum. Instructorships in abnormal psychology must be created in every medical school; institutes for psychotherapy should soon follow. But in all this, there is nowhere to appear any artificial antithesis between mind and body, any more than between organic and functional diseases; we have discussed all that with full detail. Only the physician who has a thorough psychological preparation can fulfill the manifold demands which modern life must raise; he alone is prepared to coöperate with the other factors of the community in the development of a sound and healthful nation, to work towards the hygiene of the nervous system and of the mental life; and to correct the injuries which the perversities of our civilization inflict.
In all that he will not avoid the comradeship of the clergyman. He will, of course, not forget the fundamental difference of attitude between them, he will not forget that the minister seeks for the meaning and values of inner life while he, the physician, has to consider that same inner life from a causal point of view and thus has to work with it as with natural material for the normal functioning of the organism. But the interrelation between them can be intimate in spite of the difference of their standpoints. The minister, to be sure, ought not to consider health as such as the greatest good, but he will not forget that a wholesome devotion to ideals cannot be carried through when the attention is absorbed by the sufferings of the body and the mental powers are debilitated. Only in a sound mind the full ideal meanings of life can be realized. The minister must therefore seek the health of his congregation not because health is the ideal of life but because the true ideals cannot be appreciated by the mental cripple. On the other hand, the physician from his standpoint should in no way feel it his duty to play the amateur minister and to put emphasis on the spiritual uplifting of his patients. But he knows well that not a few of the suggestive influences which are needed for the relief from disease are most effective when an emotional emphasis can be given to the suggestions and that this emphasis is for large numbers most powerfully supplied by the religious emotion. Thus the minister will be a very important assistant to him and the church will most successfully do for many patients what for other patients perhaps travel or music or the theatre, sport or social life, may do.
Just in the relation to the church, the physician will need subtlest discrimination, and he will not forget that while even a strong religious emotion may be without damage for a normal man, it may well be injurious to the unstable brain. But if the physician uses tact and wisdom, he will be surprised to find how often the religious stimulation can indeed be helpful for his purposes and the division of labor demands that this be supplied not by himself but by the minister. He will advise the consulting sufferer to seek the influence of a godly man who awakens in him upbuilding wholesome emotions and volitions. The minister may in this way very well become the assistant of the physician. But whether this coöperation is looked on from the one or from the other point of view, in every case it needs absolute clearness. Nothing is gained and too much is lost if the two functions are carelessly mixed together. It is never the task of the minister to heal a mind and never the task of a physician to uplift a mind. One moves in the purposive sphere, the other in the causal sphere. Their friendship can seriously endure only as long as they remain conscious of the fact that they have two entirely different functions in the service of mankind.