After studying in each patient all the non-mental disorders such as infections, intoxications, and the like, we can now also attack the problems of life which can be understood only in terms of plain and intelligible human relations and activities, and thus we have learned to meet on concrete ground the real essence of mind and soul—the plain and intelligible human activities and relations to self and others. There are in the life records of our patients certain ever-returning tendencies and situations which a psychiatry of exclusive brain speculation, auto-intoxications, focal infections, and internal secretions could never have discovered.
Much is gained by the frank recognition that man is fundamentally a social being. There are reactions in us which only contacts and relations with other human beings can bring out. We must study men as mutual reagents in personal affections and aversions and their conflicts; in the desires and satisfactions of the simpler appetites for food and personal necessities; in the natural interplay of anticipation and fulfilment of desires and their occasional frustration; in the selection of companionship which works helpfully or otherwise—for the moment or more lastingly throughout the many vicissitudes of life. All through we find situations which create a more or less personal bias and chances for success or failure, such as simpler types of existence do not produce. They create new problems, and produce some individuals of great sensitiveness and others with immunity—and in this great field nothing will replace a simple study of the life factors and the social and personal life problems and their working—the study of the real mind and the real soul—i.e., human life itself. Looking back then this practical turn has changed greatly the general view as to what should be the chief concern of psychology. One only need take up a book on psychology to see what a strong desire there always was to contrast a pure psychology and an applied psychology, and to base a new science directly on the new acquisitions of the primary sciences such as anatomy and histology of the nervous system. There was a quest for the elements of mind and their immediate correlation with the latest discoveries in the structure of the brain. The centre theory and the cell and neurone theory seemed obligatory starting-points. To-day we have become shy of such postulates of one-sided not sufficiently functional materialism. We now call for an interest in psychobiological facts in terms of critical common sense and in their own right—largely a product of psychiatry. There always is a place for elements, but there certainly is also a place for the large momentous facts of human life just as we find and live it.
Thus psychiatry has opened to us new conceptions and understandings of the relation of child and mother, child and father, the child as a reagent to the relations between mother and father, brothers and sisters, companions and community—in the competitions of real concrete life. It has furnished a concrete setting for the interplay of emotions and their effects.
It has led us from a cold dogma of blind heredity and a wholesale fatalistic asylum scheme, to an understanding of individual, familiar, and social adjustments, and a grasp on the factors which we can consider individually and socially modifiable. We have passed from giving mere wholesale advice to a conscientious study of the problems of each unit, and at the same time we have developed a new and sensible approach to mental hygiene and prevention, as expressed in the comprehensive surveys of State and community work and even more clearly in the development of helps to individuals in finding themselves, and in the work in schools to reach those who need a special adaptation of aims and means. To the terrible emergency of the war it was possible to bring experienced men and women as physicians and nurses, and how much was done, only those can appreciate who have seen the liberality with which all the hospitals, and Bloomingdale among the first, contributed more than their quota of help, and all the assistance that could possibly be offered to returning victims for their readjustment.
It is natural enough that psychiatry should have erred in some respects. We had forced upon us the herding together of larger numbers of patients than can possibly be handled by one human working unit or working group. The consequence was that there arose a narrowing routine and wholesale classifications and a loss of contact with the concrete needs of the individual case; that very often progress had to come from one-sided enthusiasts or even outsiders, who lost the sense of proportion and magnified points of relative importance until they were supposed to explain everything and to be cure-alls. We are all inclined to sacrifice at the altar of excessive simplicity, especially when it suits us; we become "single-taxers" and favor wholesale legislation and exclusive State care when our sense for democratic methods has gone astray. Human society has dealt with the great needs of psychiatry about as it has dealt with the objects of charity, only in some ways more stingily, with a shrewd system and unfortunately often with a certain dread of the workers themselves and of their enthusiasm and demands. Law and prejudice surrounded a great share of the work with notions of stigma and hopelessness and weirdness—while to those who see the facts in terms of life problems there can be but few more inspiring tasks than watching the unfolding of the problematic personality, seeking and finding its proper settings, and preventing the clashes and gropings in maladjustments and flounderings of fancy and the faulty use and nutrition of the brain and of the entire organism.
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.