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The Clinical Study of Mental Disorders

The Presidential Address at the 85th Annual Meeting of the Royal Medico-Psychological Association, held in London, July 13–16, 1926

Published online by Cambridge University Press:  19 February 2018

J. R. Lord
J. R. Lord*
Affiliation:
National Council for Mental Hygiene
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Extract

Now that our Association, by a gracious act of our Sovereign, has been granted a Royal Charter—a signal recognition of its achievements and of the humane principles and aspirations of which it is an expression; a change, too, which is emblematic of the growth of its activities and influence—it is not inappropriate that I should address you on some aspects of the practice of psychiatry, especially in regard to possibilities and lines of progress in the future, and as to how the Association might better assist their materialization. The aspect I wish particularly to dwell upon is that which is the title of my address.

Type
Research Article
Information
Journal of Mental Science , Volume 72 , Issue S298 , August 1926 , pp. 1 - 79
Copyright
Copyright © Royal College of Psychiatrists, 1926 

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References

(1) Delivered in the Great Hall of the House of the British Medical Association London, W.C. 1, July 13, 1926.Google Scholar
(1) Reference to the minutes of the proceedings at the meeting in July, 1841, which inaugurated the Association, declares the objects of the Association to be the improvement in the management of the hospitals for the insane, the treatment of the insane, and the acquirement of a more extensive and more correct knowledge of insanity.Google Scholar
(1) This reminds one of a passage from William Cullen's First Lines of the Practice of Physic, 1784, quoted by J.B.Spence, British Medical Journal, January 20, 1900: “Cullen also recommends the use of the surprise bath, which, he says, consists ‘in throwing the madman into the cold water by surprise, by retaining him in it for some length of time, and pouring water frequently upon the head, while the whole of the body except the head is immersed in water, and thus managing the whole process, so that, with the assistance of some fear, a refrigerant effect may be produced.’” Google Scholar
Cullen rejected humoral notions in the pathology of insanity and insisted upon careful pathological and anatomical investigations of the brain.Google Scholar
(2) The reference to tertian and quartan agues is interesting, having regard to the modern use of these diseases for the cure of general paralysis. Hippocrates was acquainted with the methods of curing mental disorders by inducing febrile diseases, and Galen actually records a case of melancholia cured by intermittent quartan fever.Google Scholar
(3) It is well to be clear as to Pinel's share in this noble work. Priority must be given to M. Daquin, a physician of Chambery, who published in 1791 a book On the Philosophy of Madness, in which it is proved that this Malady ought to be treated by Moral rather than by Physical Means. Daquin did in fact actually liberate many of the insane from their chains and found that extraordinary improvement followed. Pinel was first appointed to Bicétre in 1792, and also to Salpètrière in 1794, and his reforms commenced immediately. From the inscription under a painting by Robert Fleury it is gathered that Pinel's non-restraint treatment commenced in 1795 at the Bicétre.Google Scholar
(1) The term “sociology” was first introduced by Auguste Comte in his Positiv Philosophy , 1839.Google Scholar
(1) “Experience expresses both physical and mental aspects.” “Science is the systematization of experience under forms of ideal construction.” “Physical facts are mental facts expressed in objective terms, and mental facts are physical facts expressed in subjective terms.”—Lewis, G. H., Annual Automatism, para. 6.Google Scholar
(2) The term “biology” was first used in 1802 by Treviranus in Germany and Lamarck in France, and was not adopted in this country until much later.Google Scholar
(1) With regard to the relation existing between mind and brain two views are contended for—one that the brain originates, the other that it is only the instrument of thought. The discussion is metaphysical rather than physiological, because the phenomena observed in both cases are the same, and these depend upon the structure and quality of the organ itself. In this respect the brain is exactly similar to a nerve or muscle. It possesses properties and functions which it is our duty to study. Why it does so we are ignorant, and are content to regard them as ultimate facts in our science. In the same way, therefore, that contractility is a property of muscle, sensibility of nerve, growth of tissue, and secretion of gland, so we regard thought as a property of brain. But to avoid metaphysical subtleties, we are quite willing to say that it furnishes the conditions necessary for the manifestation of mind. (Bennett, Hughes Prof., “Lectures on Physiology, Pathology and Therapeutics,” Lancet, April 25, 1863.)Google Scholar
(1) In cosmology, monism is either materialistic or idealistic (spiritualistic or intellectualistic). Descartes introduced dualism into modern psychology in 1650. He taught that there were two separate substances—the thinking substance and the material substance. Spinoza, who succeeded him, was the father of modern materialistic monism, and assumed that there was one substance which showed itself from two sides—mind and nature. This monism later divided into spiritualism (Fichle's absolute “ego”) and John Lock's realistic materialism. This was followed by Bishop Berkeley's doctrine of ideas as the objects of both perception and of knowledge and by Hume's denial of substantial souls. Realism views both mind and body as substances. Reid Stewart and Hamilton were realists; Comte, Haeckel, Spencer, Huxley and Tyndall were materialists; Kant, Leibnitz, Lotze and Hegel were idealists.Google Scholar
(1) “A rational pathology must ever be based upon the basis of physiology. The physiological principle upon which we have to build a system of cerebral pathology is that mental health is dependent upon the due nutrition, stimulation and repose of the brain. How any combination of cells can be attended by processes of thought is, to us, inconceivable, but it is not more inconceivable than that similar combinations should result in the phenomena of life or that a combination of atoms should result in the movements of the solar system.” (Bucknill, J. C., Journ. of Ment. Sci., iii, 1857, p. 287.)Google Scholar
“At the present time it is simply an impertinence—etymologically speaking—in anyone who has not made himself acquainted with the physiology of the nervous system, to vex a heavy-laden world with vague and vain psychological speculations.” (Henry Maudsley, Journ. Ment. Sci., lii, 1865, p. 550.)Google Scholar
“The psychologist who has not prepared himself by a study of the organism has no more right to be heard on the genesis of the psychical states, or of the relations between body and mind, than one of the laity has a right to be heard on a question of medical treatment.” (G. H. Lewis, The Nature of Life, para. 2.)Google Scholar
“ Where physical phenomena appear abnormal there is mental disorder, which has its root in the mind, so far as this is manifested through the sensual organs; and has its root in the body, so far as this is the organ of the mind. To search after the phenomena in which these relations are revealed with the unprejudiced eye of experience, to investigate them scientifically in every point, that is of importance to the physician; and to collect them into one whole is the province of medical psychology.” (Feuchtersleiben [1806–49], Medical Psychology, translated by the Sydenham Society, 1847, iv, p. 344.)Google Scholar
“In the clinical study of mental diseases, however, both sides of the question must be examined; the psychological equally with the medical and practical, and both simultaneously and in an equal degree.” (Griesinger, Journ. Ment. Sci., ix, 1863, p. 531.)Google Scholar
(1) Some of these were alluded to by Prof. Sherrington when he said that “The shaping of the animal body, the conspiring of its structural units to compass later functional ends, the predetermination of specific growth from egg to adult, the predetermined natural term of existence—these, and their ultimate mechanisms, we are, it seems to me, still at a loss to understand.” (Presidential Address, British Association, 1922.)Google Scholar
(1) Haller (1708–1777) referring to mental diseases, said: “When, in some rare instances we can discover no disease of these parts (the brain), we may conclude either that it is seated in their very elementary particles or has not been sought for with sufficient patience and attention.” (Elements of Physiology.) Google Scholar
(2) I am conscious of the fact that in making this assertion I am disobeying both empirical and ideal canons of scientific causality. The latter is absolutely inapplicable, and, as regards the former, it is conceivable that “hereditary influences” might be the origin of both the psychological and physiological phenomena. I know of no other common factor, let alone its nature, and since the view I have taken is useful, in accordance with common sense and not opposed to practical experience, no other course appears open to me.Google Scholar
(1) Jacobi and his adherents in the German somatic school taught that mental disorder had no existence. Insanity was an associate of bodily disease. This view should not be confused with that of the physiogenic school of England and France.Google Scholar
(1) The clinical method of investigating mental disorders yielded katatonia (Kahlbaum), hebephrenia (Hecker), adolescent insanity (Clouston), amentia (Meynert), circular insanity (Falret), progressive delusional insanity (Regis), manic-depressive insanity and dementia præcox (Pick and Kraepelin), anergic stupor (Newington), etc. Google Scholar
(2) “In view of the facts that no system of classification has yet been found which will, without forcing, account for all the cases which present themselves, and that the founders of systems the most widely adopted in their time, admit that in a fourth to a third of their cases an absolutely certain diagnosis is impossible, it is evidence that a sufficiently extensive field still remains unconquered.” (Farrar, , Amer. Journ. of Insanity, 1905, p. 448.)Google Scholar
(1) Copies may be seen on application to the Medical Superintendent of Horton Mental Hospital, Epsom, Surrey.Google Scholar
(1) “I am sure of this: that as the justly successful members of our profession grow older and probably wiser, they more and more guide themselves by the study of their patients' constitution, learning more of family histories, and detecting constitutional diseases more skilfully in signs which to others seem trivial.” Paget. Google Scholar
(1) One of the first to draw particular attention to the important part played by the sympathetic nervous system in emotional disorders was William Murray, M.D.Lond., in a book named A Treatise on Emotional Disorders of the Sympathetic Nervous System of Nerves, Churchill & Sons, 1866, p. 118. He was adversely reviewed in the Journal of Mental Science. Google Scholar
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