402
JOHN H. GAGNON
full
belief by the physician that it was efficacious and in the belief
by the patient that the physician knew what he was doing. Nor is
surgery excluded from the power of faith, for, as Henry Beecher of
Harvard reports, a surgical technique is more effective when used
by surgeons who believe in its efficacy than when used by surgeons
who regard it as debatable or experimental.
It
was Freud who made a primary break in the course of treat-
ment of mental disorder by directing his attention to matters that had
not been of interest for more than one hundred fifty years. There
was, as a result of his work, a shift from what has been called the
directive-organic technique, the accepted method in the early part of
the nineteenth century, to the analytic-psychological. Today this split
between the two approaches still exists, and there is a constant strain-
ing in traditional medical circles to return,
if
not to organic theories
of mental illness, at least to organic techniques of treatment. In most
directive-organic treatment the physician remains close to the practice
of physical medicine, and the problems of the patient are felt to be
treatable through the ingestion of chemicals, the application of
certain bodily shocks (electric or otherwise), the treatment of specific
lesions in the nervous system or, at its most psychological, the giving
of good advice. This ever-present division has led to serious difficulties
for patients in cases in which psychological treatment has been given
for specific organic problems, and, on the other hand, for patients
whose lesions have been treated and were assumed to be cured even
though the lesions have produced psychological difficulties. Thus
many physicians, to take a simple example, tend to treat only the
damaged liver of the alcoholic and ignore the problems that led him
to drink, while many therapists often pay no attention to the debil–
itated state of the physical organism that
is
not responding to psycho–
logical treatment.
Freud disposed of irrationality and possession by pointing to
the psychic causes of mental suffering. In the atmosphere of nine–
teenth-century empiricism, though it was possible to conceive of men
lying to one another, it was not possible to believe that they them–
selves did not know what their own motives were or what the truth
was. It is out of this econometric view of man that an attempt, like
Bentham's, at a rational calculus of choices was possible. The devils
of the Middle Ages had been routed by positivistic philosophy.
