PSYCHOLOGY AND PSYCHIATRY BY SHEPHERD IVORY FRANZ 4P. UNIVBBSITY of CALIFORNIA AT LOS ANGELES LIBRARY [Reprinted from THE PSYCHOLOGICAL REVIEW, Vol. 29, No. 4, July, 1922.] PSYCHOLOGY AND PSYCHIATRY 1 BY SHEPHERD IVORY FRANZ St. Elizabeths Hospital, Washington In the past a number of papers have dealt with the topic assigned to me. With their special views and argu- ments I shall not concern myself beyond pointing out some of the difficulties that have arisen either because of them or as provoking them. Psychiatrically, some of the writers, not all in the distant past, have identified psychology with one or more psychologists with whom they have come in contact, sometimes in person but usually through their writings. With the psychological views expressed there was no sympathy, since they were considered to be one-sided, or they were thought to show evidence of gross ignorance, or the wording produced anger and was supercilious or overbearing. The psychologist, on the other hand, has sometimes tried to make the term psychiatry synonymous with the ideas and the behavior of one psychiatrist whose superficiality was recognized by his professional confreres, but whose 'holier than thou' attitude or whose expressions of superiority have incited the psychologist to sarcasm, abuse, denunciation, or pity. In some cases, it is apparent that the physician, jealous or fearing lest some of his licensed prerogatives, or lest some of his assumed functions might be encroached upon, or that others might develop a clientele of potential financial value, has set himself upon a pedestal of supposed knowledge of the whole mental and physical 1 Paper read before the American Psychological Association, December 29, 1921, as part of a Symposium on Psychology in its Social Relations. 241 124915 242 SHEPHERD IVORY FRANZ life and character of the individual. He has charged the psychologist with incompetency in dealing with people, because the latter has not taken the trouble to graduate from a medical college, and because he is not willing to accept uncritically all that the particular psychiatrist be- lieves. The criticizing psychologist, on the other hand, wonders how the physician acquired his supposed superior knowledge of mental phenomena when his medical training of about 4,000 hours comprised instruction in psychology and psychiatry amounting to about 60 hours or less. Similar personal verbal encounters will doubtless recur and with the same result as in the past. Each of the com- batants will have shot at the other without making a hit, and the only difference between such a discussion and a French duel is that after the duel the combatants fall upon each other's neck and kiss. Up to the present time, so far as my knowledge goes, most psychiatrists as such will not kiss a psychologist, nor will most psychologists kiss a psychiatrist as such. The criticism of individual psychiatrists or of individual psychologists may be a necessary and often a commendable performance to prevent an undue exhibition of what the Freudians call a homo-sexual trend, viz., egotism. Such criticisms, unless the individual recognizes and accepts his temporary position as a patient who is being psychoanalyzed, may be amusing for the spectators, but in the words of the comic supplement "it don't mean anything." Further- more, the generalization from one case is a recognized method of unscientific procedure which should have no place in either medical or psychological literature. This is the first point of importance. Let us recognize and remember that there are all degrees of psychiatrists and all degrees of psychologists, that there are differences in specialization as well as in amount of knowledge a man may have, that some of each group are positively ignorant and that others are negatively learned, and that blatancy, obstinacy, intolerance, puerility, and quibbling are neither PSYCHOLOGY AND PSYCHIATRY 243 characteristic nor absent because of the occupation or title or self-advertisement of the individual. Let us, therefore, confine ourselves to the subjects psychology and psychiatry, and to the psychologist and the psychiatrist in general, and exclude the individual. Psychiatry is much more easily defined at the present time than is psychology. The facts or conditions that con- stitute the field of psychiatry are more generally accepted than those of psychology. The psychiatrist is by etymo- logical derivation a mental healer, he is concerned with the cure of those who exhibit 'variations from their usual or normal way of thinking, feeling, and acting.' In practice he also usually deals with feeblemindedness, which is not a deviation from the individual's normal or usual, but a continued or a continuing state. Psychiatry, like other specialized divisions of the practice of medicine or surgery, is an application of facts and principles to certain practical problems dealing with the diagnosis, with the treatment or care of patients, and with the prevention of pathological conditions. It would be presumptuous for me to try to harmonize the conflicting views of the professional psychologists at this time respecting the definition, the scope, and the methods of psychology. It would not be bravery, but unthinking rash- ness, to attempt to decide between the obviously opposing views, to decide which is pure and virtuous and which is improper and evil and corruption. I respect the introspec- tionist's severe individual in the nun's drab habit, I look with pleasure on the ballet dancer of Miss Calkins's 'True Behaviorism,' I see beauty in the Miss Psychology clothed by Warren in the fig-leaf costume, but I also approve what others may call the brazen nakedness of Watson's 'Physio- logical Behaviorism.' I can see, however, that while the garb is of some importance, more to others than to me, the fundamental is the same. Regardless of the outward coverings, psychology is and her beauty or ugliness is de- pendent upon the eye of the beholder. She may be described 2 44 SHEPHERD IVORY FRANZ in terms of brass instruments, or measurements of time and space and energy, as mental science, as behavior, as the study of psychical processes, or as the science of the facts or content of experience, but in every case there is meant what historically and popularly has been known as mind. With two of the parts or divisions of psychology we must concern ourselves. These are abnormal psychology and pathological psychology or psychopathology. It is these two fields, their relations and dependencies, which give the clue to so many of the disputes of the past, and which if properly understood should bring about a much better under- standing between psychiatrists and psychologists. The field of abnormal psychology can best be understood in terms of the distribution curve. We define the normal as that which is near the average or the medium, and con- versely we define the abnormal as that which deviates greatly from the average or the median. Such a definition can be applied to the individual's sense endowment, to his mental processes, to his behavior in relation to his environment, or to social activities. It carries no teleological meaning. It does not say that the things we speak of should have a cer- tain extensity, or intensity, or speed, or number. It does not define the thing in terms of 'should be/ or 'might be,' or 'ought,' but solely in terms of 'is.' Abnormal psychology, therefore, deals with the extremes, with the hypernormal traits and individuals, as well as with subnormal activities and combinations of function. The distinction has been drawn that pathological psychology and patho-psychology stress the psychological .aspects of the thing under consid- eration, while psycho-pathology stresses the pathological character. All three terms, however they be otherwise differentiated, involve the concept of disease or disorganiza- tion which prevents proper (not the usual or average or the median) function. Normal in contradistinction to patho- logical means the desirable or the necessary. An individual who shows an intelligence quotient of 20 is abnormal, and he may also be pathological. One who passes the Army PSYCHOLOGY AND PSYCHIATRY 245 Alpha with a perfect score of 212 is also abnormal,, but not probably pathological. The man of 80 who retains the intellectual vigor which he showed at 40 is abnormal, but decidedly not pathological. He who at 80 exhibits mental deterioration shows only what more than 90 per cent of individuals of that age show, but he is certainly pathological. Psychiatry, as an art or an application of science looking towards the cure of those who are mentally diseased, bears the same relation to the underlying science of psychology as any other technical application bears to its fundamental science. Psychiatry has relations, however, to many funda- mental sciences and not alone to psychology. It must take from pathology, from physiology, from chemistry, from bacteriology, and from a host of other sciences what it needs to bring about the desired ends, in treatment or cure, and in prevention. It does need the fundamental facts of psychology, those of sensation and perception, those of action and the will, those of feeling and emotion, those of character and personality, and those of the mental life of the child and of the adult. Regardless of the attitude one may take with respect to the value of dissection as giving facts of functional or use value, it is true that one must know the names, colors, and textures of the parts of which a complex machine is composed before one is able to speak of the spatial, temporal, and forceful relations of the parts. And it is in just this direction that psychiatry has taken a peculiar slant. Anatomy, physiology, chemistry, bacteriol- ogy, pathology, are thought to be necessary preliminaries to the understanding of certain bodily functions with which the psychiatrist must deal, but the psychiatrist usually denies the necessity of understanding the methods and the results of psychology in relation to mental things. Because in a technical psychological journal an article appears which his previous education, or rather lack of education, has not fitted him to read with understanding, he considers the modern laboratory psychology to be futile and entirely unpractical. For him and his work it has no meaning. 246 SHEPHERD IFORY FRANZ But, why should it convey a meaning to him? Is it possible to get for one's work the meaning of chemistry or of physics without special training and study? Is it necessary to assume that psychology and its methods should be simplified to the extent that the reading of an intro- ductory text is all sufficient for the understanding of the details of research? To the last question psychiatry has answered vociferously "Yes," but to the former question psychiatrists are forced to answer meekly "No." The difference in attitude is understandable when one knows something of the history of medicine. We need consider only one analogy, that of chemistry. The value of chemistry in medical practice has long been recognized, but the advances in chemistry since the time when it was an almost exclusive medical discipline have been numerous and varied. These advances have been due to the develop- ment of a group of chemical specialists whose interests have not centered on the diagnosis and treatment of the sick, but solely in the discovery of new facts of a chemical order. There have also developed a group of specialized medical chemists the physiological or biological chemists with divided medical and chemical interests, who are the go- betweens or the mediators. They cull from the researches of the silica chemist, from those of the organic chemist, from those of the physical chemist, and from those of other specialized chemists what appears to be applicable to the work and welfare of the body, and they apply this knowledge in their own specialized laboratories. After the intermediary steps have been taken, the results are given to the physician to further apply. A similar division of labor and the steps towards partial application exist between most of the other fundamental medical sciences and the practice of medicine, with the notable exception of psychology. Theoretically, and to a certain extent practically, abnor- mal psychology and psychopathology intervene between psychology and psychiatry, but as intermediate kinds of technology with groups of workers they do not exist. A PSYCHOLOGY AND PSYCHIATRY 247 few are engaged in the fields bordering upon both psychology and psychiatry. Without laboratory training some psychia- trists consider themselves psychopathologists, and there are few psychologists who have adequate training in first-hand acquaintance with the different kinds of abnormalities in the mental diseases. A psychiatric criticism of psychology that has had vogue is that the psychologist as an analyst has dissected the mind, and metaphorically cut, mounted, and examined it through the microscope, but that he has devoted little or no attention to the interrelations and importances of the things the psychiatrist has seen and described. Because of this psy- chology is said to have no value in psychiatry. I am quite willing to grant the validity of the conclusion, but I object to the argument. I am quite willing to admit at the same time and in the same sense that anatomy, histology, physi- ology, chemistry, physics, and bacteriology have no value in psychiatry. The analyses made in these scientific pur- suits have only indirect values. The workers have not, and are not expected to have, direct interest in the advancement of psychiatry. It is the right of the psychiatrist to take what he will, or to have it adapted to his own use by an- other. But even though all of the facts may not be of equal value, and even though we may admit that the ana- tomical facts of a psychological kind are not equally valuable in the care of the mentally diseased, it is true that some of them must be known and understood. While the analogy is not to be followed out completely it may be said that the psychiatric attitude towards analytic psychology is much the same as that of many drivers of automobiles towards their machines. A few obvious gross details are all they are willing to admit to be necessary for the running of a machine. The places where the feet must be placed, the hands and water and gas, are apparently all that are needed for the operation of the machine in health. It is when the car will not work that its behavior is then described in terms of depression, dissociation, repression, egocentric reac- 248 SHEPHERD IVORY FRANZ tions, regression, and the like. So far, so good, but more anatomical knowledge is needed before the car can be placed in running order. Its anatomy, as well as its physiology, must be partly understood. The reason for some of the common disabilities, such as flat tires and the like, may be learned from a casual anatomical examination, but in those cases in which the driver does not know the difference between the vacuum tank and the magneto, his ability to care for the machine is greatly reduced. When the engine coughs, spits, and stops, the symptoms point to inadequate food supply. But they may also be due to other physiological dissociations. If the psychiatric driver does not know more than that the machine has a kind of catatonic reaction he may spend hours on a lonely road trying to locate and remedy the trouble. Conversely, the psychologist who knows the weights, the sizes, the shapes, the colors, and the intimate composi- tions of the parts of a machine will not infrequently find, after the pieces have been laid out and measured, that putting them together again is a task of a different order. He may discover many apparently superfluous parts. Psychology is, however, becoming more and more dy- namic, even in the psychiatric sense. More effort is being made to understand interrelations and dependencies, just as in present-day anatomy it is no longer deemed sufficient to describe and classify but to use the facts to illustrate functional relations. But even though psychology become entirely functional or dynamic, there is no reason to assume that the facts or explanations can be carried over bodily into psychiatry. There must be, in the same way as between anatomy and medical practice, close connecting links. It is here that, in different senses, abnormal psychology and psychopathology belong. They are psychological-psychia- tric intermediaries. In psychology the deviations are of interest because exaggerations and diminutions frequently point out relations that are not obvious in the normal. From the standpoint PSYCHOLOGY AND PSYCHIATRY 249 of psychology it makes no difference whether or not the abnormality be associated with a pathology. In psychiatry the important thing is the combination of phenomena point- ing to disease types, or giving indications of prognosis or treatment. Because in both psychology and psychiatry a knowledge of abnormalities and of pathological conditions are of value, more and more investigations must be made if advances are to be expected. It is here that abnormal psychology and psychopathology find their work. They will serve to benefit both psychology and psychiatry. Extreme enthusiasm for a cause and an excessive damna- tion of what is believed to be opposing that cause are charac- teristic of the fanatic and the reformer. During the past few years there has been an exaggeration of one aspect of psychopathology psychoanalysis which in certain quar- ters of psychiatry has produced a reaction against psychology and which in certain psychological quarters has produced a reaction against psychiatry. But this is the history of many scientific advances. To counteract the many forces advo- cating cults it is important that both psychologists and psychiatrists study and keep in mind the mental epidemics, and recognizing their virulence and their usually short .dura- tion, take scientific hygienic measures to preserve their own mental health and stability. This will best be accomplished when there are more psychological psychiatrists and more psychiatric psychologists, as well as more real abnormal psychologists and more real psychopathologists. 124915 This book is DUE on the last date stamped below 14 1930 MAR ^ 4 1933 10 193* DEC 2 1935 JUL 22 SEP 8 I960 Form L-9-35m-8,'28 ANGSLJBS " ... 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