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Page 14
That the majority of medical and surgical specialists and even most of
the widely experienced general practitioners, though constantly coming
in contact with major and minor psychic disturbances, are, however,
still far from realizing the full meaning and value of the principles
and technic of modern psychology and of the newer psychiatry must, I
fear, be frankly admitted.[5] But dare we blame these practitioners for
their ignorance of, apathy regarding, and even antipathy to, the psychic
and especially the psychotic manifestations of their patients? Ought we
not rather to try to understand the reasons for this ignorance, this
apathy, and this aversion, all three of which seem astonishing to many
of our well-trained psychologists and psychopathologists? Are there not
definite conditions that explain and at least partially excuse the
defects in knowledge and interest and the errors in attitude manifested
by those whom we would be glad to see cognizant and enthusiastically
participant? Psychiatrists, who have taught us to understand and rescue
various types of "sinners" and "social offenders" will, I feel sure,
avoid any moralistic attitude when discussing the shortcomings of their
brethren in the general medical profession, and will, instead, seek to
discover and to remove their causes.
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. Though this is not the time nor the
place fully to discuss them, the mere mention of some of the causes and
conditions will, perhaps, contribute to comprehension and pardon, and
may serve to stimulate us all to livelier corrective activity. Let me
enumerate some of them:
(1) A social stigma still attaches, despite all our efforts to abolish
it, to mental disorders and has, to a certain extent, been transferred
to those that study and treat patients manifesting these disorders.
(2) The organization of our general education is very defective since it
fails to make clear to each student man's place in the universe and any
orderly view of the world and man; it fails adequately to enlighten the
student regarding the processes of life as adaptations of organisms to
their environment, man, himself, being such an organism reacting
physically and psychically to his surroundings in ways either favorable
or unfavorable to his own preservation and that of his species; it fails
to teach the student that the human organism represents a bundle of
instincts each with its knowing, its feeling, and its striving
component, that what we call "knowledge" and what we call "character"
are gradual developments in each person, and that if we know how they
have developed in a particular person we possess clues to the way that
person will react under a given stimulus, that is to say, what he will
think, how he will feel, and how he will act; and it fails, again,
properly to instruct students regarding the interrelationships of
members of different social groups (familial, civic, economic,
occupational, ethical, national, racial, etc.); in other words, our
general educational organization is as yet far from successful in
inculcating philosophical, biological, psychological, and sociological
conceptions that are adequate symbols of reality.
(3) Though our medical schools have made phenomenal advances in the
organization and equipment of their institutes and in provision for
teaching and research in a large number of preclinical and clinical
sciences, they have up to now almost wholly ignored normal psychology,
psychiatry, and mental hygiene. The majority of the professors in these
schools are so absorbed by the morphological, physical, and chemical
aspects of their subjects, that students rarely get from them any
inkling of the psychobiological aspect, any adequate knowledge of human
motives, or any satisfactory data regarding human behavior, normal or
abnormal.[6] It is only recently and only in a few schools that
psychiatric clinics have been established as parts of the teaching
hospitals, that medical students have been able to come into direct
contact over an appreciable period of time with the objects of
psychiatric study, that the psychic manifestations of patients have
received any direct and particular attention in the general medical and
surgical wards, and that there has been any free and constant reciprocal
exchange of thought and opinion between students of the somatic on the
one hand and students of the psychic on the other.
(4) 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; or, if he be more tough-minded, he may be amused by,
or contemptuous of, what he refers to as "psychiatric jargon" or
"pseudoscientific gibberish." 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.
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