CONCLUSIONS ON PSYCHOANALYTIC TREATMENT 



No cure or great improvement can be claimed as due mainly 

 to psychoanalysis in these twenty-two cases. To be sure, my 

 purpose was to study rather than treat the patients, but I did 

 try to help six of them, Carhart, Dixon, Lefferts, Nolan, Purdy 

 and Quitner. The old deteriorateds such as Engel, Foster, Gar- 

 land, Irgocz, Jackson and Kimmel were beyond aid from this 

 source. Mathews and Vincent had already recovered from their 

 psychoses. Abrams, Bailey, Halsted. O'Neil and Riegel were 

 too negative and resistant. Tocci was too inattentive in his 

 elations, and inaccessible in his depressions, and the barrier of 

 language separated us. Ulster had too much manic push to listen 

 to anyone. Sabin in his depressed periods was very dull and his 

 psychosis was of long standing. Unless a patient realizes he is 

 sick and wishes to get well, the analyst has little chance to help 

 him. 



Purdy, though often suspicious, had considerable confidence 

 in me and talked freely of his troubles. He got insight into 

 his improper impulses and their projection and improved con- 

 siderably so that I felt much encouraged. Then the old paranoid 

 ideas obtruded and proved too fixed to remove. His remark is 

 illuminating, that he did not want to talk with me for fear I 

 would destroy his belief in his delusions and that he preferred to 

 keep them. But he recovered sufficiently to obtain his freedom. 



Lefferts wished to learn nothing new and would listen to no 

 explanation. He knew all about it already and enjoyed many of 

 his hallucinations. His stubborn conceit was probably an over- 

 compensation for his inferior body and lack of physical courage. 

 During his healthy interlude, coincident with the infection in his 

 hand, I tried very hard to make him understand mental mechan- 

 isms, but his obstinate ignorance was impregnable. He had 

 witnessed supernatural phenomena then, and now he no longer 

 did; this was sufficient explanation for him. Because he had 

 gained no insight whatever, it was easy for him to slip back again 



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