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Page 16
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. Causes may be internal or external, and are often a
combination of both. The tracing of the direct and indirect
relationships between these causes and the abnormal cerebral functioning
upon which the disturbances of psychobiological adjustment seem to
depend is the task of pathogenesis. The internist who has studied the
infantile cerebropathies with their resulting imbecilities, syphilis
followed by general paresis, typhoid fever and its toxic delirium,
chronic alcoholism with its characteristic psychoses, cerebral
thrombosis with its aphasias, agnosias, and apraxias, thalmic syndromes
due to vascular lesions with their unilateral pathological feeling-tone,
frontal-lobe tumors with joke-making, uncus tumors with hallucinations
of taste and smell, lethargic encephalitis with its disturbance of the
general consciousness and its psychoneurotic sequel� (lesions in the
globus pallidus and their motor consequences), pulmonary tuberculosis
with its euphoria, and endocrinopathies like myxoedema and exophthalmic
goitre with their pathological mental states, is encouraged to proceed
with his clinical-pathological-etiological studies in full assurance
that they will steadily contribute to advances in psychiatry. The
eclectic psychiatrist who is examining mental symptoms and
symptom-complexes ever more critically, who is seeking for parallel
disturbances in physiological processes and who considers both
psychogenesis and somatogenesis in attempting to account for
psychobiological maladjustments will welcome, we can feel sure, any help
that internal medicine and general and special pathology can yield.
These studies in pathogenesis and etiology are fundamentally necessary
for the development of a rational therapy and prophylaxis. Already much
that is of applicable value in practice has been achieved. 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.
We have recently had an excellent illustration of the benefits of
applied psychiatry in the remarkable results achieved during the great
war through the activities of the head of the neuropsychiatric division
of the Surgeon General's office and his staff[10] and those of the
senior consultant in neuropsychiatry and his divisional associates in
the American Expeditionary Force. In no other body of recruits and in no
other army than the American was a comparable success arrived at, and
the credit for this is due to American applied psychiatry and its wisely
chosen official representatives.
The active campaign for the preservation of the mental health of our
people and for a better understanding and care of persons presenting
abnormal mental symptoms carried on during the past decade by the
National Committee for Mental Hygiene marks a new epoch in preventive
medicine.[11]
The prevention of at least a large proportion of abnormal mental states
through the timely application of the principles of mental hygiene is
now recognized as a practically realizable ideal. Many important reforms
are now in process throughout the United States, no small part of them
directly attributable to the active efforts of our leading psychiatrists
and to our National Committee's [Transcriber's note: original reads
'Committe's'] work. The old "asylums" are being changed into
"hospitals." Psychiatric clinics are becoming attached to teaching
hospitals and psychiatric instruction in the medical schools is being
vastly improved. 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.
The objection sometimes made that the practical problems are too vague,
not sufficiently concrete, to justify attack by public health officials
is no longer valid. In no direction, probably, could money and energy be
more profitably spent during the period just ahead than in the support
of a widely organized campaign for Mental Hygiene.[12] Psychiatrists
can count upon internists and general practitioners to aid them in
educating the public regarding the nature and desirability of this
campaign.
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