Psychiatry

“ Psychiatry, which engages in the exploration of the mind, stands ever at the door seeking in vain to weigh and measure as in the other departments of science. We have long known that we have to do with a definite organ, the brain; but only beyond the brain, beyond the morphological basis do we reach what is important for us—the mind; as indefinable as it ever was, still eluding any explanation, no matter how ingenious. Former ages, endowing the mind with substance, and personifying every incomprehensible occurrence in nature, regarded mental disorder as the work of evil spirits ”

“ To-day we feel that modern psychiatry has found itself—through the discovery that, after all, the uncritical common-sense view of mind and soul is not so far remote from a critical common-sense view of the individual and its life activity, freed from the forbidding and confusing assumptions through which the concept of mind and soul has been held in bewildering awe. ”

“ 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. ”

“ 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. ”

“ Through the rise of specialism, it is true, psychiatry itself has arisen and the psychiatrist, like the skilled integrating internist, is interested in the synthesis of the findings in all domains, for only through such synthetic studies, such integration of the functional activities of the whole organism, is it possible to gain a global view of the patient as a person, to make a complete somatic, psychic, and social diagnosis, and to plan a regimen for him that will ensure the best adjustment possible of his internal and external relationships. ”

“ Special reference should be made to the important contributions to the literature of psychiatry of such well-known American writers as Meyer, Hoch, Kirby, White, Barrett, Campbell, Southard, Peterson, Diefendorf, Jelliffe, Paton, Salmon, Russell, Buckley, Rosanoff, Orton, Singer and many others. The work of Kraepelin, Bleuler, Nissl, Alzheimer, Freud, Jung, Stekel, Janet and others abroad has exercised an influence on the psychiatry of the day which must be recognized. ”

“ 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. ”

“ Psychiatry, like each of the other branches of medicine, has come to be recognized as one of the subdivisions of the great science of biology, free to make use of the scientific method, in duty bound to diffuse the knowledge that it gains, and privileged to contribute abundantly to the lessening of human suffering and the enhancement of human joys. ”

“ 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. ”

“ The internist shares with the psychiatrist the desire that knowledge of the facts regarding care, cure, and prevention of mental disorders may become widely disseminated among medical men and at least to some extent among the laity. Experts in psychiatry firmly believe that at least half of the mental disturbances now prevalent could have been prevented, if, during the childhood and adolescence of those afflicted, the facts and principles of existing knowledge and the practical resources now available could have been applied. ”

“ The modern trend in psychiatry is distinctly in the opposite direction. We no longer today insist upon material changes in cells and tissues for every psychotic phenomenon, but rather endeavor to investigate mental life, be it normal or abnormal, from the biologic point of view. We are being constantly confronted with the undeniable fact that whatever may be the physical substratum of mental disorder, it does not aid us in understanding the peculiar expression which a given psychosis chooses to assume. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The knowledge already gained, and still more that which will become accessible when those at present fully occupied with the needs of the moment have leisure to record their experience, will be of the utmost importance to the future of psychiatry. ”

“ 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. ”

“ Psychology, taken in the widest way, ought to study every sort of mental activity, the useless and harmful sorts as well as that which is 'adapted.' But the study of the harmful in mental life has been made the subject of a special branch called 'Psychiatry'—the science of insanity—and{5} the study of the useless is made over to 'Æsthetics.' Æsthetics and Psychiatry will receive no special notice in this book. ”

“ Deplorable as it may seem that such important elements in the education of the individual have been overlooked, it is not nearly so surprising as the fact that no instruction of any consequence is given in psychiatry in the great majority of our medical schools. ”

“ In order to understand man, especially abnormal man, we must study him in a longitudinal section; we must note his mode of reaction to experiences in everyday life, under all manner of conditions and circumstances; we must investigate the motives and desires which prompt his conduct; we must find out how effectually he adapts himself to the environment in which he happens to be placed and in how far he is able to modify the world about him so as to make it subservient to his needs and wants. The same problems which confront criminology today, psychiatry had to face some years ago. ”

“ The borderline between normal and morbid psychic conditions is, in a way, a conventional one, and, in another way, in such a state of flux that probably every one of us oversteps it many times in the course of a day. On the other hand, psychiatry would do wrong to wish to limit itself continually to the study of those serious and cloudy illnesses which arise from rude disturbances of the delicate psychic apparatus. ”

“ Psychiatric treatment in general is no doubt an important contribution to medicine, but we must believe it is still a growing rather than a perfected science. As Bahá’u’lláh has urged us to avail ourselves of the help of good physicians Bahá’ís are certainly not only free to turn to psychiatry for assistance but should, when available, do so. ”

“ As an internist who values highly the gifts that modern psychology and psychiatry have been making to medicine, I have given some thought to the conditions and causes that may be responsible for these professional delinquencies that you deplore. ”

“ Much good would undoubtedly be accomplished by the application of the methods of modern clinical psychiatry to the study of the sources of the prejudices and various forms of intellectual intolerance which have resulted in the painfully slow progress of the human race. In the examination of patients in the clinic, a careful study of their powers of sense-perception is conducted before proceeding to an estimation of the capacity for originating and associating ideas, or for forming intellectual judgments. ”

“ 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. ”

“ A discussion of the part played by paranoia, or the paranoid conditions however characterized, in the psychiatry of the present day, is essentially a review of the final chapter in the history of a psychiatric conception which is several centuries old. ”

“ There is, furthermore, a dearth of concise, authoritative, well-written text-books on psychiatry, and the general medical journals rarely print psychiatric papers designed to interest the average practitioner. The most widely diffused psychiatric reports of our time are the sensational news items of the daily press. ”

“ If group practice is to grow and be successful in this country, as I think likely, groups must see to it that psychiatry, as well as the other medical and surgical specialties, is properly represented in their make-up. ”

“ 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. ”

“ Based on their official reports an analysis has been made of over seventy thousand consecutive first admissions.
There is no disposition on the part of the writer to overestimate the value of statistical studies. Our conclusions should, however, be based as fully as possible on facts rather than on abstract theories or individual observations alone. The social, economic and clinical aspects of mental diseases must all be given adequate consideration if psychiatry is to fulfill its obligation to the community and assume a dignified rôle in the advancement of modern medicine. ”

“ One became especially convinced of the potency of mental factors in the production of mental disease from the observation and study of the psychoses of criminals. Here the conflicts which lead an individual to seek in mental disorder a satisfactory compromise are so concrete as to leave no doubt concerning cause and effect. ”

“ At the outset we shall endeavor to draw a distinction between the class of individuals we have just discussed, and that which we are about to consider now. We have seen that the former is made up of individuals who in most instances have come in conflict with the law for the first time, and that the mental disorder which they develop stands in the closest relation with some definite experience in their life. ”

“ By calling attention to certain symptom-complexes, which are especially characteristic of certain mental disorders, he gave us the means by which we are able at the present time to predict with a fair degree of certainty what the future life of a given patient will be. We can now tell without great fear of contradiction which of our patients are going to spend the rest of their lives in institutions. ”

“ Mental life, after all, expresses itself in a series of reactions destined to result in a proper adaptation to environmental conditions, and the causes which determine a given reaction may be psychic as well as physical in nature. Indeed, in the realm of psychopathology we see indubitable evidence of the predominance of psychic causes of mental disorder over physical ones, and the subject under discussion here further emphasizes this. ”