Some Unconscious Determinants in Physicians Motivating the Use of Particular Treatment Methods—with Special Reference to Electroconvulsive Treatment

Any treatment method, ideally, is used for realistic and clearly defined scientific reasons. The ideal, unfortunately, is not always attained, for there may be unconscious urges, conflicts and character attitudes in the physician which obstruct his making a realistic appraisal.

The characteristics of a method of treatment can unconsciously evoke responses in the doctor which may be obscure to him and the use or avoidance of the method itself may be motivated, at least in part, by these same obscure responses. For example, gentle massage is very different in its characteristics from a cutting, surgical procedure. Similarly, a tepid bath differs greatly from the application of an electrical current to the brain which produces a spectacular generalized bodily convulsion. In a general way one might say that treatment procedures run the gamut from mild and gentle methods to harsh, rigorous ones, though the ostensible aim in all methods is to obtain a therapeutic effect.

In illnesses such as acute appendicitis wherein the clinical picture is clear cut and circumscribed and the realistically well established method of handling is surgical, the physician's unconscious motivations are restricted. The patient shows great wisdom in developing a clearly denned illness for which the treatment method is well established.

On the other hand, there are those clinical entities which are not so well delined and for which the treatment methods are still in a state of flux, with widespread differences of opinion existing. I would hazard the guess, though the risk is small, that most of these illnesses and treatment methods are in the field of psychiatry. Here, unconscious motivational forces have freer play, and may be a factor, sometimes a decisive one, in the determination to use a particular treatment method.

Choices in psychotherapy are illuminating. Certainly no one special system or mode of psychotherapy can be considered the panacea. Nor is any special commixture of accepted methods