256 PSYCHIATRY 



those who have the minor symptoms and functional disorders in 

 which the mind is simply needing instruction to a new point of view, 

 or the stimulus of a strong hope which fixes attentions and steadies 

 the whole mental machine. Psychic therapeutics often cure by giving 

 faith and purpose to the weak, wavering, and discouraged. And 

 faith in something is always a sane and most helpful element in a 

 person's character. 



So far as psychiatry is concerned, we can expect little help from 

 the science and art of psychic or hypnotic therapeutics. Its field is 

 narrow and does not take hold of our serious cases. 



So far as internal medicine is concerned, mental influences pro- 

 duce many distressing disorders of function, which may simulate 

 various diseases. The mind is a factor always in modifying the pic- 

 ture of disease, and the physician can never diagnosticate or treat 

 his patient without taking the individual's mental attitude into 

 account. This fact, which psychiatrists learn, can be impressed with 

 advantage on the followers of internal medicine. 



Psychiatry and Neurology and Internal Medicine 



In the past the field of work of the psychiatrist has been perforce 

 much narrowed through the necessities of psychiatric administra- 

 tion. It was long confined to the study of types of mental disorders 

 which had reached their height and shown their hopelessness. It was 

 as though pulmonary tuberculosis had been mainly studied in its 

 third stage, or typhoid fever mainly in its second week, or heart 

 disease after dropsy had set in. For when a psychosis is fully devel- 

 oped and has bloomed into mania, or a dementia, the morbid con- 

 dition has arrived, the god is no longer behind the machine, but on 

 it. It can now be watched and its natural history studied, but in 75% 

 of cases this is all; it cannot be cured. In only a small percentage 

 will it be possible to learn why it came, and psychiatry can only 

 reach a certain stage of progress when its study is limited to the 

 middle and terminal parts of mental disorders. 



The field of psychiatry needs thus to be broadened by securing the 

 help of those branches of internal medicine in which the earliest 

 phases of mental deterioration and disorder show themselves. It was 

 long ago noted that neurasthenia might be called an abortive par- 

 anoia. It is my experience that about a third of the cases of decided 

 melancholia are preceded by attacks of what is called nervous pros- 

 tration; and the same is in a measure true of the early demential 

 psychoses and of paresis. 



In fine it seems to me that a most fruitful practical field just now 

 for clinical study is that of what I term the minor psychoses which 

 includes a vast number of indeterminate mental conditions, classed 



