264 PSYCHIATRY 



The Position of Psychiatry as shown by Current Teachings 



The point of view of this inquiry is that of general medicine for 

 one who, without predilection and looking for light on all sides, 

 approaches the field of psychiatry and tries to understand its pro- 

 blems. In seeking the true place of mental diseases in relation to 

 other pathological conditions, and in order to harmonize his con- 

 ceptions with the true principles of general pathology, it is found 

 at the outset that the functional psychoses are to be regarded as 

 being in contrast with the psychoses proper associated with as- 

 sumed structural changes and "disease-processes," or with definite 

 organic diseases of the brain. Here as in general medicine this dis- 

 tinction of functional and organic disease appears to be an expres- 

 sion of the dominance of morphological conceptions in medical 

 knowledge. Diseases due to obvious structural changes can be 

 understood and subjected to treatment as in surgery; but the bodily 

 diseases called functional for which there is no pathological ana- 

 tomy constitute a very large group. 



Although there is a greater reason for this being true also of func- 

 tional mental diseases, the inquirer finds in the psychiatry of the 

 time small interest in them. It is a very old idea that the different 

 forms of insanity may be explained by the study of the brain and 

 its degenerations. The history of modern psychiatry shows that 

 it has given great emphasis to these morphological conceptions 

 by its precise methods and achievements in histological investi- 

 gations of the brain. In recent years the German schools have 

 been the centres of interest. The environment of their origin had 

 preeminently the morphological stamp. Thus the effort to deter- 

 mine definite "disease-forms" and "disease-processes" has been 

 a distinctive characteristic of modern teachings in the search for 

 anatomical correlations and explanations. The application of the 

 scientific method in clinical study has been most fruitful of ad- 

 mirable results. The "disease-process" assumption has been stimu- 

 lating and helpful as a spur to morphological investigation, which 

 all agree should be carried to the utmost. But with the inherit- 

 ance of such conceptions the modern movement has been char- 

 acterized also by the continuance of the quest for mature forms 

 and types and for their systematic classification. The patholog- 

 ical principles being embodied in the designations "disease-form" 

 and "entity," and "disease-process," the consistent use of these 

 has implied that every such pathological process should have its 

 cause, course, and outcome. A psychosis thus constituted is held 

 to present the attributes of scientific truth, although some actual 

 morphological characters that furnish complete and proper proof 

 may yet be wanting. 



