PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 269 



largest sense, and not within the narrow limits of any specialism 

 which may seem to include the sphere of mental activities. He 

 has to deal with the physical effects upon the individual of all the 

 influences that act upon him in his environment, and that enter 

 into him from without, or are engendered within, which make for 

 the maintenance or impairment of his vital processes. Such phys- 

 ical influences contributing to conscious experience have their 

 mental effects; the psychiatrist must not only seek to understand 

 the physical changes and effects but he must deal with the patient's 

 consciousness of them; and the more subtle influences that affect 

 the subconscious mental life. The physician must study not alone 

 the influence upon the mind of the body in health and disease, 

 but also the external physical, social, and moral conditions of the 

 environment unfavorable to mental health and growth. It is in 

 association with this broader view of general medicine that, with 

 respect to mental disorder, he must seek explanation on the phys- 

 ical side of the organism, and turn to expert research for such aid 

 as can be given him by the contributing sciences. 



The field of the medical sciences is as wide as that of biology, 

 which comprehends all the interdependent phenomena of mental 

 and physical life; the abnormal must be referred to the normal. 

 The first recourse of the psychiatrist is to physiology, whose do- 

 main is the study of the forces or functions of living matter. There 

 are no symptoms until there are deviations from normal func- 

 tion; without functional activity disease is impossible. 1 On the 

 side of normal life, living substance necessarily presents the con- 

 ditions of structure, form, and function; these conditions are pri- 

 mary and disease is not necessary to the existence of living sub- 

 stance. Here the general physician finds himself involved in the 

 contention between the sciences of physiology and pathology; the 

 psychiatrist needs first a normal standard in his knowledge of 

 general physiology, and all that he can learn of mental physiology 

 and its relations to its mechanism, structure, and form. Psycho- 

 logy lays open to intimate study the facts of the mental life; on 

 the anatomical side we can know little, and that little explains 

 nothing of the relations between mind and body. It is at this point 

 that the physician must choose his point of view and form his con- 

 ceptions of fundamental principles. If these are true, they should 

 fit all discovered facts, whether of function or structure, and will 

 lead to advancement of his knowledge; if not true, they lead to 

 conflict and confusion, and obstruct progress. It is necessary to 



1 Cf. Orth, J., Relation of Pathology to Other Sciences, Am. Medicine, vol. ix, 

 1905. "When there is no functional activity and thus no deviation from nor- 

 mal function there can be no disease." Published while this paper was in manu- 

 script. 



