THE PROBLEM OF PSYCHIATRY IN THE FUNCTIONAL 



PSYCHOSES 



BY EDWARD COWLES 



[Edward Cowles. Professor of Psychiatry, Dartmouth College, since 1886; Clin- 

 ical Instructor in Psychiatry, Harvard University, since 1888; Non-Resident 

 Lecturer in Psychiatry, Clark University, since 1904. b. Ryegate, Vermont, 

 1837. A.B. Dartmouth, 1859; A.M. ibid. 1863; M.D. Dartmouth Medical 

 College, 1863; College of Physicians and Surgeons, New York, 1863; Fellow 

 by Courtesy, Johns Hopkins University; LL.D. Dartmouth College, 1890; 

 Medical Corps, United States Army, 1863-72; Resident Physician and Super- 

 intendent, Boston City Hospital, 1872-79; Medical Superintendent, McLean 

 Hospital, 1879-1903; Consulting Physician, ibid. 1904. Member of the Ameri- 

 can Medico-Psychological Association; American Neurological Association; 

 American Psychological Association; American Association for Advancement 

 of Science; Associ6 Etranger, Socie"te* Me*dico-psychologique, Paris; American 

 Academy of Medicine; Massachusetts Medical Society.] 



IN the study of mental diseases it is important to find their true 

 place in relation to other pathological conditions. Our conceptions 

 of the nature of mental symptoms should be framed in harmony 

 with the true principles of general pathology. These are essential 

 requisites for the progress of psychiatry. I shall try to present 

 some considerations to this end in discussing my subject: "The 

 Problem of Psychiatry in the Functional Psychoses." 



It is essential here, as in all such inquiries, to have a clear un- 

 derstanding of the terms of the problem; words and phrases, and 

 the formulae of principles, should have correct and definite mean- 

 ings. Our ideas may be embodied at first in words which seem to 

 express exactly all that we know; but as our conceptions tend to 

 outgrow their verbal expressions, these may gain the larger import 

 and lose the narrowness of their derivations; or being used in an 

 earlier and more or less restricted sense they hamper thinking in 

 the shackles of authoritative phrases that obstruct reasoning, and 

 single words may perpetuate error and lead to confusion of inter- 

 pretation and discussion. The dicta of general principles accepted 

 as fundamental may sometimes harbor hidden fallacies and prove 

 to be untrue after having long retarded progress. It is a necessary 

 part of this discussion to examine first some definitions and the 

 formulae of certain accepted principles and the doctrines drawn 

 from them. 



The terms in which the present subject is expressed contain no 

 ambiguity as to its meaning to lay down the proposition that the 

 problem of psychiatry is to be found in the functional psychoses, 

 meaning here mental diseases. But something needs to be said 

 defining the true province of psychiatry; and the words "functional 

 psychoses" lead at once into the maze of difficulty surrounding the 



