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Page 9
What a difference between the history of a patient reported and studied
and advised by the well-trained psychiatrist of to-day and the account
drawn up by the statistically minded researcher or the physician who
wants to see nothing but infections or chemistry and hypotheses of
internal secretion. What a different chance for the patient in his
treatment, in contrast to what the venerable Galt of Virginia reports as
the conception of treatment recommended by a great leader of a hundred
years ago: "Mania in the first stage, if caused by study, requires
separation from books. Low diet and a few gentle doses of purging
physic; if pulse tense, ten or twelve ounces of blood [not to be given
but to be taken!]. In the high grade, catch the patient's eye and look
him out of countenance. Be always dignified. Never laugh at or with
them. Be truthful. Meet them with respect. Act kindly toward them in
their presence. If these measures fail, coercion if necessary.
Tranquillizing chair. Strait waistcoat. Pour cold water down their
sleeves. The shower bath for fifteen or twenty minutes. Threaten them
with death. Chains seldom and the whip never required. Twenty to forty
ounces of blood, unless fainting occurs previously; ... etc."
To-day an understanding of the life history, of the patient's somatic
and functional assets and problems, likes and dislikes, the problem
presented by the family, etc.!
So much for the change within and for psychiatry. How about psychiatry's
contribution beyond its own narrower sphere? It has led us on in
philosophy, it has brought about changes in our attitude to ethics, to
social study, to religion, to law, and to life in general. Psychiatric
work has undoubtedly intensified the hunger for a more objective and yet
melioristic and really idealistic philosophical conception of reality,
such as has been formulated in the modern concept of integration.
Philosophical tradition, logic, and epistemology alike had all conspired
to make as great a puzzle as possible of the nature of mental life, of
life itself, and of all the fundamental principles, so much so that as
a result anything resembling or suggesting philosophy going beyond the
ordinary traditions has got into poor repute in our colleges and
universities and among those of practical intelligence. The consequence
is that the student and the physician are apt to be hopeless and
indifferent concerning any effort at orderly thinking on these
problems.[3]
Most of us grew up with the attitude of a fatalistic intellectual
hopelessness. How could we ever be clear on the relation of mind and
body? How could mind and soul ever arise out of matter? How can we
harmonize strict science with what we try to do in our treatment of
patients? How can we, with our mechanistic science, speak of effort, and
of will to do better? How can we meet the invectives against the facts
of matter on the part of the opposing idealistic philosophies and their
uncritical exploitations in "New Thought"--_i.e._, really the revival of
archaic thought? It is not merely medical usefulness that forced these
broad issues on many a thinking physician, but having to face the facts
all the time in dealing with a living human world. The psychopathologist
had to learn to do more than the so-called "elementalist" who always
goes back to the elements and smallest units and then is apt to shirk
the responsibility of making an attempt to solve the concrete problems
of greater complexity. The psychiatrist has to study individuals and
groups as wholes, as complex units, as the "you" or "he" or "she" or
"they" we have to work with. We recognize that throughout nature we have
to face the general principle of unit-formation, and the fact that the
new units need not be like a mere sum of the component parts but can be
an actually new entity not wholly predictable from the component parts
and known only through actual experience with the specific product.
Hydrogen and oxygen, it is true, can form simple mixtures, but when they
make an actual chemical integration we get a new specific type of
substance, water, behaving and dividing according to its own laws and
properties in a way not wholly predictable from just what we know of
hydrogen and oxygen as such. Analogy prompts us to see in plants and
animals products of physics and chemistry and organization, although the
peculiarity of the product makes us recognize certain specificities of
life not contained in the theory of mere physics and chemistry. All the
facts of experience prompt us to see in mentation a biological function,
and we are no longer surprised to find this product of integration so
different from the nature and functions of all the component parts. All
the apparent discontinuities in the intrinsic harmony of facts, on the
one hand, and the apparent impossibility of accounting for new features
and peculiarities of the new units, are shown to be a general feature of
nature and of facts: integration is not mere summation, but a creation
of ever-new types and units, with superficial discontinuities and with
their own new denominators of special peculiarities; hence there is no
reason to think of an insurmountable and unique feature in the origin of
life, nor even of mentally integrated life; no need of special mystical
sparks of life, of a mysterious spirit, etc.; but--and this is the
important point--also no need of denying the existence of all the
evidence there may be of facts which we imply when we use the deeply
felt concepts of mind and soul. In other words, we do not have to be
mind-shy nor body-shy any longer.
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