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Page 15
(5) The overemphasis of psychogenetic factors to the apparent neglect of
important somatogenic factors by some psychiatrists has tended to arouse
suspicion regarding the soundness of the opinions and methods of
psychiatric workers in the minds of men thoroughly imbued with
mechanistic conceptions and impressed with the results of medical
researches based upon them. The ardor of the psychoanalysts, also,
though in part doubtless justified by experience, has, it is to be
feared, excited a certain amount of antipathy among the uninitiated.
(6) The fears of insanity prevalent among the laity and the repugnance
of patients to any idea that they may be "psychotic" or "psychoneurotic"
(words that, in their opinion, refer to "imaginary symptoms," or to
symptoms that they could abolish if they would but "buck up" and exert
their "wills") undoubtedly exert a reflex influence upon practitioners
who put the "soft pedal" on the psychobiological reactions and "pull out
the stop" that amplifies the significance of any abnormal physical
findings.
(7) Psychotherapy, to the mind of the average medical practitioner, is
(or has been) something mysterious or occult. He uses much psychotherapy
himself but it is nearly always applied unconsciously and indirectly
through some form of physical or chemical therapy that he believes will
cure. He is usually quite devoid of insight into the effect of his own
expressed beliefs and bodily attitudes upon the adjusting mechanisms of
his patients. Conscious and direct psychotherapy is left by the average
practitioner to New Thoughters, Christian Scientists, quacks, and
charlatans. If he were to use psychotherapy consciously and were to
receive a professional fee for it he would feel that he was being paid
for a value that the patient had not received. A highly respected
colleague once privately criticised a paper of mine (read before the
Association of American Physicians) on the importance of psychotherapy.
"What you said is true," he remarked; "we all use psychotherapy but we
are a little ashamed of it; and it is better not to talk about it." Even
he did not realize that every psychotherapy is also a physical therapy.
(8) The rise of specialism, through division of labor and
intensification of interests restricted to limited fields, in practical
medicine, the necessary result and to a large extent also a cause of the
rapid growth of knowledge and technic has brought with it many
advantages, but also some special difficulties, among them (a) the
impossibility any longer of any single practitioner, unaided, to study
and treat a patient as well as he can be studied and treated by a
co-ordinated group whose special analytical studies in single domains
are adequately synthesized by a competent integrator, and (b) in the
absence of such group work, the tendency to one-sided study, partial
diagnosis, and incomplete and unsatisfactory therapy. 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.[7]
Working in a diagnostic group myself as an integrating internist, I have
been much helped by the reports of personality studies made by skilful
psychiatrists; these are linked with the special reports on the several
bodily domains (cardiovascular, respiratory, h�mic, dental, digestive,
urogenital, locomotor, neural, metabolic, and endocrine) in order
finally to arrive at an adequately co-ordinated and (subordinated) total
diagnosis from which the clues for an appropriate therapeutic regimen
can safely be drawn. 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.[8] From now on, too, general practitioners
should, as Southard emphasized, be urged to be at least as familiar
with the general principles and methods of the psychiatrist as they are
with those of the gynecologist, the dermatologist, and the
p�diatrist.[9] Well organized group-diagnosis and general will then help
to counteract the inhibiting influence of earlier isolated specialism
upon the appreciation of psychiatry.
This enumeration of some of the causes of the ignorance and apathy
(existent hitherto) in the general profession regarding psychiatry may
perhaps suffice as explanation. These causes are, fortunately, rapidly
being removed. 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.
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