Psychiatrist

“ Many psychiatrists today will list their special focus there—for example, psychoanalysis, psychoanalytic psychotherapy (brief analysis) , marriage and family therapy, hypnosis, chemical dependency treatment, child and adolescent therapy. If you want to see a psychiatrist and do not find one who indicates the specialized approach you want to try, then you will need to make some calls. ”

“ What end, what freedom, did the patient hope to achieve by the creation of his system?
The scientific thinker of to-day will regard this question as inappropriate. The psychiatrist will certainly smile at it, for he is thoroughly assured of the universal validity of his causalism, he knows the psyche merely as something that is made, descendent, reactive. ”

“ No better illustration could be given, perhaps, of the change in the status of psychiatry in this country and in the world than the contents of the programme of our meeting to-day at which a distinguished investigator from London tells us of the biological significance of mental disorders, an eminent authority from Paris explains the relationship between certain diseases of the nervous system and these disorders, and a leading psychiatrist of this country speaks upon the contributions of psychiatry to the understanding of the problems of life. ”

“ The language of the psychiatrist is unique and formidable. The names he has applied to motives and impulses, to symptoms and syndromes, are foreign to the tongue of the general practitioner who is so awed by them that he withdraws from them and remains humbly reticent in a state of enomatophobia ”

“ No psychiatrist will work without psychological tools when he deals with the exultations of the maniac and the depressions of the melancholic, with the hallucinations of persecution or the erotic insanities of the paranoiac. Still more the whole register of psychology has to be used, when we are to educate the idiot and the imbecile. But the disappearance of the disease or of the chief symptoms through the mental agencies is in all these cases out of the question. ”

“ The internist and the psychiatrist will ever have a common interest in the obscure problems of etiology and pathogenesis of diseases and anomalies that are accompanied by abnormalities of thought, feeling, and behavior. Progress in this direction is bound to be slow for the studies are exceptionally complex and there are many impediments to be removed. Though the problems are deep and difficult, they are doubtless soluble by the mind of man, and they exert an uncommon fascination upon those who visualize them. ”

“ If you wish to call it common sense, human nature, or intuitive, logical thought, any psychiatrist will meet you more than half-way, and you will find that you and the medical profession have an amazing amount in common. ”

“ The cases we hear about are those in which he makes such major slips—as being mistaken as to what his business is, who he is married to, who his friends are, what is going on in the world—that he is forced, against his will, to go to a psychiatrist. ”

“ If early improvement is not observed, a psychiatrist should be consulted and personally, I feel that a joint conduct of the case, particularly the early ones, of obstetrician and psychiatrist will give the most happy results to these unfortunates.—Long Island Medical Journal. ”

“ Psychiatry deals pre-eminently with the variety and differences of human personalities. To correct or supplement a human system apparently enslaved by concern about precedent and baffling rules of evidence inherited from the days of cruel and arbitrary kings, the demand for justice has called for certain remedies. Psychiatry still plays a disgraceful rôle in the so-called expert testimony, largely a prostitution of medical authority in the service of legal methods. Yet, out of it all there has arisen the great usefulness of the psychiatrist in the juvenile and other courts. ”

“ We are entering upon an era in which psychiatry will be recognized as one of the most important specialties in medicine, an era that will demand alliance and close communion among psychiatrists, internists, and the representatives of the various medical and surgical specialties. ”

“ It was a question of compiling a tabulation or list of clinical entities recognized generally by American psychiatrists, subject to such changes and modifications as may be necessary to make it conform to accepted standards. As a matter of fact, no adequate reason for a classification of mental diseases for any other than statistical purposes has even been advanced by the authors of our textbooks on psychiatry. They do not contribute anything of value whatever to our knowledge of symptomatology, diagnosis or treatment. ”

“ Within the field of medicine, psychiatry does, it is true, occupy itself with the description of the observed psychic disorders and with their grouping into clinical symptom-pictures; but in their better hours the psychiatrists themselves doubt whether their purely descriptive account deserves the name of a science. The symptoms which constitute these clinical pictures are known neither in their origin, in their mechanism, nor in their mutual relationship. ”

“ But our psychiatrists do not study psychoanalysis and we psychoanalysts see too few psychiatric cases. A race of psychiatrists that has gone through the school of psychoanalysis as a preparatory science most first grow up. The beginnings of this are now being made in America, where many leading psychiatrists explain the teachings of psychoanalysis to their students, and where many owners of sanatoriums and directors of institutes for the insane take pains to observe their patients in the light of these teachings. ”

“ Any number of young men who will state a preference for general medicine can be interested in this subject about which they know nothing. The solution, therefore, depends upon the commanding officers of these hospitals and upon the psychiatrists on their staffs; depends upon their willingness to detail one or more young men to the psychiatrists, who are interested in the subject. ”

“ Some individuals habitually face the issues of life, whether large or small, and habitually overcome difficulties for themselves and for other people. They are described by the psychiatrists as being grown up, or psychologically evolved. ”

“ One of the chief purposes of psychiatry is to separate fantasy from reality. It is reasonable to expect that future psychiatrists will know more about this borderline than the most learned doctors of today. ”

“ Great advances have also been made in the methods of examining the minds of the patients and of determining the mental factors in their disorders and the means of restoring their capacity for adjustment to healthy thinking and acting. Psychiatry has been furnished with a body of well-arranged facts, and with a technic which is not inferior in system and precision to that of many other branches of medicine. In the study and management of the minds of the patients the physician is thus enabled to apply himself to the task as he does to any other medical problem. ”

“ You doctors, all of you, constantly practice psychotherapy, even when you do not know it, or do not intend it, but it has one disadvantage, you leave entirely to the patient the psychic factor of your influence. ”

“ General practitioners of medicine and medical specialists—at least the more enlightened of them—welcome the developing science of psychiatry, are eager to hasten its progress, and will gladly share in applying its discoveries to the early diagnosis, the cure, and the prevention of disease. ”

“ To some physicians a patient will present only conventional symptoms, while a follow practitioner will discover the elements of an interesting case. Above all, the painstaking physician, interested in psychology, will find mental and other personal manifestations in his patient that distinctly modify the course of the disease. We must know all that is possible about the patient's attitude of mind toward his malady, and all the ideas that he has acquired with regard to it, either from previous relations with physicians or from what he may have read or heard from others. ”

“ They are frequently introduced into treatment in a not very commendable fashion, simply because reliance is placed upon their suggestive effect. But it is in his soul that the patient is really sick; in those most complicated and lofty functions which we scarcely dare to include in the province of medicine. The doctor must needs, in such a case, be a psychologist, must needs understand the human soul. He cannot evade the urgent demand upon him. So he naturally turns for help to psychology, since his psychiatry text-books have nothing to offer him. ”

“ Likewise I am informed that this or that colleague has made appointments with a patient for psychic treatment, whereas I am certain that he does not know the technique of such a treatment. He must, therefore, expect that the patient will bring him her secrets, or he seeks salvation in some kind of a confession or confidence. I should not wonder if the patient thus treated would rather be harmed than benefited. The mental instrument is really not at all easy to play. ”

“ The hygiene of childhood, in which line great advances are made, is still not adequately represented in most of our medical colleges, and the study of psychiatry and nervous disturbances in general is not sufficiently lifted from the realm of quackery. "Not only," says a correspondent, "should psychiatry be taught in every medical school, but it should be taught from a clinical standpoint. Every city in which there are medical schools should have a psychopathic hospital for the reception of all cases of alleged insanity and for their study, treatment and cure. ”

“ I do not think it at all impossible that with the proper changes in the procedure it will be possible to disregard this contraindication, and thus claim a psychotherapy for the psychoses.
3. The age of the patient also plays a part in the selection for the psychoanalytic treatment. Persons near or over the age of fifty lack, on the one hand, the plasticity of the psychic processes upon which the therapy depends—old people are no longer educable—and on the other hand, the material which has to be elaborated, and the duration of the treatment is immensely increased. ”

“ In treating a psychiatric case, such as a neurosis, a physician uses words almost entirely. He asks questions. He listens to the patient’s answers. Each answer takes the physician nearer and nearer to a diagnosis. By and by the physician knows what most of the difficulty is. Then he must present his knowledge slowly to the patient, gradually guiding the patient to understanding. It is a psychological truth that telling a man in ten [Pg 192] minutes what is wrong with him does not cure him. ”

“ 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. ”

“ The medical study and treatment of the mind is no longer so exclusively confined within the walls of institutions nor to the type or degree of disorder which necessitates compulsory seclusion. Psychiatry is extending out from the institutions into the communities by means of out-patient clinics and social workers, through newly created organized agencies, through informed individuals, physicians, nurses, and lay workers, and through the general spread of psychiatric knowledge. ”

“ Certainly the inactivity of many years has been followed by an awakening which has placed modern psychiatry on a dignified plane and its progress will now compare favorably with the accomplishments of any other branch of medicine. The statement is, I think, justified, that psychiatry has been established on a thoroughly scientific basis as the result of the work of comparatively few years. ”

“ The patient understands every suggestion, he concentrates on the problems that the treatment requires him to solve, reminiscences and ideas flood his mind. The physician is surprised by the certainty and depth of these interpretations and notices with satisfaction how willingly the sick man receives the new psychological facts which are so hotly contested by the healthy persons in the world outside. An objective improvement in the condition of the patient, universally admitted, goes hand in hand with this harmonious relation of the physician to the patient under analysis. ”

“ The mental symptoms of disease now receive attention in hospitals and in private practice and at a much earlier stage than formerly. Even the courts, the prisons, and the reformatories are awakening to the importance of scientific psychiatry; before long penology may be brought more into accord with our newer and juster conceptions of the nature and origin of crime, dependency, and delinquency. That schools of hygiene and the public health services must soon fall into line and consider mental hygiene seriously is obvious. ”

“ Not ours is the task of analyzing special methods of neurological and mental differential diagnosis such as are used in the psychiatric clinic and in the office of the nerve specialist. There the family history with reference to nervous and other diseases, the history of the patient himself, the infectious diseases which he has passed through, his habits and anomalies, his use of alcohol and of drugs, his experiences in social life, the demands of his profession, his recent troubles and their first origin are to be recorded carefully. ”