A Psychiatric Milestone by Various

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The extent to which we can be true to the material foundations and yet
true to a spiritual goal, ultimately measures our health and natural
normality and the value of our morality. _Nature shapes her aims
according to her means._ Would that every man might realize this simple
lesson and maxim--there would be less call for a rank and wanton
hankering for relapses into archaic but evidently not wholly outgrown
tendencies to the assumption of "omnipotence of thought," revived again
from time to time as "New Thought." Psychiatry restores to science and
to the practical mind the right to reinclude rationally and
constructively what a narrower view of science has, for a time at least,
handed over unconditionally to uncritical fancy. But the only way to
make unnecessary astrology and phrenology and playing with mysticism and
with Oliver Lodge's fancies of the revelation of his son Raymond, is to
recognize the true needs and yearnings of man and to show nature's real
ways of granting appetites and satisfactions that are wholesome.

Hereby we have indeed a contribution to biologically sound idealism: a
clearer understanding of how to blend fact and ambition, nature and
ideal--an ability to think scientifically and practically and yet
idealistically of matters of real life.

To come back to more concrete problems again, a wider grasp of what
psychiatry may well furnish us helps toward a new ethical goal in our
social conscience. The nineteenth century brought us the boon and the
bane of industrialism. More and more of the pleasures and satisfactions
of creation and production and of the natural rewards of the daily labor
drifted away from the sight and control of the worker, who now rarely
sees the completed result of his work as the farmer or the artisan used
to do. Few workers have the experience of getting satisfaction from
direct pride in the end result; as soon as the product is available, a
set of traders carries it to the markets and a set of financiers
determines, in fact may already have determined, the reward--just as the
reward of the farmer is often settled for him by astounding
speculations long before the crop is at hand. There is a field for a new
conscience heeding the needs of fundamental satisfactions of man so well
depicted by Carlton Parker, and psychiatric study furnishes much
concrete material for this new conscience in industrial relations--with
a better knowledge of the human needs of all the participants in the
great game of economic life.

Psychiatry gives us also a new appreciation of the religious life and
needs of our race. Man's religion shows in his capacity to feel and
grasp his relations and responsibility toward the largest unit or force
he can conceive, and his capacity for faith and hope in a deeper and
more lasting interdependence of individual and race with the Ruler or
rules of the Universe. Whatever form it may take expresses his capacity
to feel himself in humility and faith, and yet with determination, a
more or less responsible part of the greatest unit he can grasp. The
form this takes is bound to vary individually. As physicians we learn to
respect the religious views of our fellow beings, whatever they may be;
because we are sure that we have the essentials in common; and with this
emphasis on what we have in common, we can help in attaining the
individually highest attainable truth without having to be destructive.
We all recognize relations that go beyond individual existence, lasting
and "more than biological" relations, and it is the realization of these
conceptions intellectually and emotionally true to our individual and
group nature that constitutes our various religions and faiths.
Emphasizing what we have in common, we become tolerant of the idea that
probably the points on which we differ are, after all, another's best
way of expressing truths which our own nature may picture differently
but would not want to miss in, or deny to, the other. One of the
evidences of the great progress of psychiatry is that we have learned to
be more eager to see what is sane and strong and constructively valuable
even in the strange notions of our patients, and less eager to call them
queer and foolish. A delusion may contain another person's attempt at
stating truth. The goal of psychiatry and of sound common sense is truth
free of distortion. Many a strange religious custom and fancy has been
brought nearer our understanding and appreciation since we have learned
to respect the essential truth and individual and group value of fancy
and feeling even in the myths and in the religious conceptions of all
races.

Among the most interesting formulations and potential contributions of
psychiatry are those reaching out toward jurisprudence. Psychiatry deals
pre-eminently with the variety and differences of human personalities.
To correct or supplement a human system apparently enslaved by concern
about precedent and baffling rules of evidence inherited from the days
of cruel and arbitrary kings, the demand for justice has called for
certain remedies. Psychiatry still plays a disgraceful role in the
so-called expert testimony, largely a prostitution of medical authority
in the service of legal methods. Yet, out of it all there has arisen the
great usefulness of the psychiatrist in the juvenile and other courts.
There it is shown that if psychiatry is to help, it should be taken for
granted that the person indicted on a charge should thereby become
subject to a complete and unreserved study of all the facts, subject to
cross-examination, to be sure, but before all accessible to complete and
unreserved study. This would mean a substantial participation of law in
the promotion of knowledge of facts and constructive activity, and a
conception of indeterminate sentence not merely in the service of
leniency but in the service of the best protection of the public, and,
if necessary, lasting detention of those who cannot be reformed, before
they have had to do their worst. Whoever is clearly indicted for
breaking the laws of social compatibility should not merely invite a
spirit of revenge, but should, through the indictment, surrender
automatically to legalized authority endowed with the right and duty of
an unlimited investigation of the facts as they are.

Looking back then, you can see how the history of the human thought
about what we call mind and psyche displayed some strange reactions of
the practical man, the scientist, the philosopher, and theologian toward
one of the most important and practical problems. It is difficult to
realize what it means to arrive at ever-more-workable formulations and
methods of approach. We do not have to be mind-shy _or_ body-shy any
longer. To-day we can attack the facts as we find them, without that
disturbing obsession of having to translate them first into something
artificial before we can really study them and work with them. Since we
have reached a sane pluralism with a justifiable conviction of the
fundamental consistency of it all, a satisfaction with what we modestly
call formulation rather than definition and with an appreciation of
relativity, we have at last an orderly and natural field and method from
which nobody need shy.

The century that has passed since the inspiration of a few men of the
Society of the New York Hospital to provide for the mentally sick has
cleared the atmosphere a great deal. We can start the second century
freer and unhampered in many ways. Much has been added, and more than
ever do we appreciate the position of just such a hospital as that of
Bloomingdale as a centre of healing and as a leader of public opinion
and as a contributor to progress.

The Bloomingdale Hospital has a remarkable function. It is a more or
less privileged forerunner in standards and policies. Without having to
carry the burdens of the whole State with its sweeping and sometimes
distant power and its forced economy, a semiprivate hospital like
Bloomingdale aims to minister to a slightly select group, especially
those who are in the difficult position of greater sensitiveness but
moderate means in days of sickness. It serves the part of our community
which more than any other sets the pace of the civilization about
us--the intelligent aspiring workers who may not have reached the goal
of absolute financial independence. It creates the standard of which we
may dream that it might become the standard of the whole State.

When we review the roster of Superintendents--from John Neilson to Pliny
Earle and from Charles Nichols, Tilden Brown, and Samuel Lyon down to
the present head, our highly esteemed friend and coworker William L.
Russell--and the names of the members of the staff, many of whom have
reached the highest places in the profession, and last, but not least,
the names of the Governors of The Society of the New York Hospital, we
cannot help being impressed by the forceful representation of both the
profession and the public, and we recognize the wide range of influence.

Instead of depending on frequently changing policies regulated from the
outside under the influence of the greater and lesser lights and
exigencies of State and municipal organization, the New York Hospital
has its self-perpetuating body of Governors chosen from the most
public-spirited and thoughtful representatives of our people.
Bloomingdale thus has always had a remarkable Board of Governors, who,
from contact with the General Hospital and with this special division,
are in an unusual position to see the practical aspects of the great
change that is now taking place. You see how the division of psychiatry
has developed from practically a detention-house to an asylum, and
finally to a hospital with all the medical equipment and laboratories of
the General Hospital. And you begin to see psychiatry, with its methods
of study and management of life problems as well as of specific brain
diseases, infections, and gastrointestinal and endocrine conditions,
become more and more helpful, even a necessity, in the wards and
dispensary of the General Hospital on 16th Street. The layman cannot,
perhaps, delve profitably into the details of such a highly and broadly
specialized type of work. But he can readily take a share in the best
appreciation of the general philosophy and policy of it all.

The shaping of the policy of a semiprivate hospital is not quite as
simple as shaping that of a State Hospital with its well-defined
districts and geographically marked zones of responsibility.
Bloomingdale has its sphere of influence marked by qualitative selection
rather than by a formal consideration. It does not pose as an invidious
contrast to the State Hospital, and yet it is intended to solve in a
somewhat freer and more privileged manner the problem of providing for
the mentally sick of a more or less specific hospital constituency, the
constituency of the New York Hospital; and since it reaches the most
discriminating and thinking part of our population, it has the most
wonderful opportunity to shape public opinion. Like all psychiatrical
institutions, it has to live down the traditional notions of the
half-informed public; it has to make conspicuous the change of spirit
and the better light in which we see our field and responsibilities.
This organization can show that it is not mere insanity but the working
out of life problems that such a hospital as this is concerned with. The
conditions for which it cares are many. Some of them are all that which
tradition and law stamp as insanity. But see what a change.
Seventy-five per cent of the patients are voluntary admissions; and more
and more will be able to use the helps when they begin to feel the need,
not merely when it becomes an enforced necessity.

By creating for this Hospital a liberal foundation, by completing its
equipment so as to make possible a free exchange of patients and of
workers from the Hospital in the city and this place in the country,
much has been done and more will be done to set a living example of the
very spirit of modern psychopathology and psychiatry. We know now that
from 10 to 40 per cent of the patients of the gynecologist, the
gastroenterologist, and the internist generally would be better treated
if a study of the life problems were added to that of the special organs
and functions. To meet this need it should be possible to have enough
workers in this branch of the Hospital to take their share of the
consulting and co-operation work in the wards and dispensary of the
General Hospital, and perhaps even in the schools provided for the same
type of people from which you draw your patients. The grouping of the
patients can be such that the old prejudices need not reach far into the
second century of the life of the Hospital. With a man of the vision and
practical experience of Dr. Russell, there is no need for an outsider to
conjure up a picture of special practical achievements as I have done
of the more general principles to-day.

An institution is more than a human life. Many ambitions combine and
become part of a group spirit permeating the organization and reaching
their fulfilment in the succession of leaders. The life and growth and
happy self-realization of an institution is not the bricks and
mortar--it is a living and elastic entity--never too stable, never too
finished, a growing and plastic plant--to use a metaphor that has
slipped in perhaps without arousing all the implications the term plant
might carry and does carry.

Some years ago my wife celebrated her birthday and told her colored cook
jocosely: "Geneva, I am a hundred years old to-day." The cook's jaw
dropped and then she suddenly remarked: "Lord! you don't look dat ole."
That is the way I feel about Bloomingdale Hospital as we see it to-day
pulsating with ever-fresh life and ever-fresh problems! How different
from a simple human being, after all! The heart and wisdom of many a man
and woman has gone into the perpetuation of what a few thoughtful men
started in 1821 and the result is that it is ever renewing its youth.

Many a dream has been realized and many a dream has given way to
another. Here and there the past may make itself felt too much. But the
spirit and its growth show in recruiting ever-new lives to meet the
present day and the days to come, and this all the more so if we can
show the younger generation that every effort is likely to have its
reasonable direct support. We all want a man like Dr. William L. Russell
to have the fullest opportunity to bring to its best expression the rich
and well-tried wisdom of over twenty-five years of devoted work in the
field. This is no doubt a time of stress when many personal and general
sacrifices may be needed to bring about the fruition and culmination of
the labors of the present generation. Yet is it not a clear opportunity
and duty, so that those who are growing up in the ranks to-day may
really be encouraged to get a solid training, always animated by the
conviction that one can be sure of the practical reward for toiling
through the many years of preparation in a psychiatric career, whether
it be as a physician or as a nurse or as an administrator?

I cannot help feeling as I stand here that I am in a way representing
not only my own sentiments and convictions but those of our dear old
friend Hoch. We all wish that he might be with us to express himself the
warm feelings toward the Bloomingdale Hospital and its active
representatives, from the managers to the humblest workers. Hoch in his
modesty could probably not have been brought to state fully and frankly
his own share in the achievements of this Hospital. But I know how much
he would have liked to be here to express especially the warmth of
appreciation we all entertain of what our friend William L. Russell
means to us and has meant to us all through the nearly twenty-five years
of our friendship and of working together. We delight in seeing him
bring to further fruition the admirable work he did at Willard, and
later for all the State hospitals; and that which we see him do at all
times for sanity in the progress of practical psychiatry, and now
especially in the guidance of this institution. We delight in seeing his
master mind given more and more of a master's chance for the practical
expression of his ideals and convictions concerning the duties and
opportunities of such a hospital as Bloomingdale.

Our thanks and best wishes to those who invited us to stand here to-day
at the cradle of a second century of Bloomingdale Hospital! It is a
noteworthy gathering that joins here in good wishes to those who have
shaped this ever-new Bloomingdale. With a tribute to our thoughtful and
enthusiastic friend in internal medicine, Lewellys F. Barker, to our
English coworker, Richard G. Rows, to the illustrious champion of French
psychopathology, Pierre Janet, to our friend and leader in practical
psychiatry, William L. Russell, to our friends and coworkers of the
Bloomingdale staff, and especially also to the Board of Governors who
shape the policy and control the finances, and exercise the leadership
of public opinion, I herewith express my sincerest thanks and best
wishes.

FOOTNOTES:

[Footnote 2: A Guide to the Descriptive Study of the Personality, with
Special Reference to the Taking of Anamneses of Cases with Psychoses, by
Dr. August Hoch and Dr. George S. Amsden.]

[Footnote 3: See, for instance, Moebius, The Hopelessness of All
Psychology, reviewed in the Psychological Bulletin, vol. IV, 1907, pp.
170-179.]

ADDRESS BY
DR. LEWELLYS F. BARKER

_The Chairman_:--The Johns Hopkins Medical School lends us also to-day
Dr. Lewellys F. Barker, its Professor of Clinical Medicine. Dr. Barker
has done so much to define and settle the contradictions of mind and
matter, and has clarified so much, and in fields so varied, as teacher,
research worker, and practitioner, that we welcome this opportunity of
listening to his discussion of "THE IMPORTANCE OF PSYCHIATRY IN GENERAL
MEDICAL PRACTICE."

DR. BARKER

We have met to-day to celebrate the hundredth anniversary of the
founding of a hospital that, in its simpler beginnings and in its
evolution to the complex and highly organized activities of the present,
has served an eminently practical purpose and has played an important
role in the development of the science and art of psychiatry in America.
I desire, as a representative of general medicine, and, especially, of
internal medicine, to add, on this occasion, my congratulations to those
of the spokesmen of other groups, and, at the same time to express the
hope that this institution, historically so significant for the century
just past, may maintain its relative influence and reputation in the
centuries to come.

The interest taken in psychiatry by the general practitioner and by the
consulting internist has been growing rapidly of late. Some of the
reasons for this growth of interest and heightening of appreciation I
have drawn attention to on an earlier occasion.[4] Psychiatry as a whole
was for a long time as widely separated from general medicine as
penology is to-day, and for similar reasons. It was a long time before
persons that manifested extraordinary abnormalities of thought, feeling,
and behavior were regarded as deserving medical study and care, and even
when a humanitarian movement led to their transfer from
straight-jackets, chains, and prison cells to "asylums for the insane,"
these institutions were, for practical reasons, so divorced from the
homes of the people and from general hospitals that psychiatry had, and
could at the time have, but little intercourse with general medicine or
with general society. Mental disorders were moral and legal problems
rather than biological, social, and medical problems. Their genesis was
wholly misunderstood, and legal, medical, social, religious, and
philosophic prejudices went far toward preventing any rational
scientific mode of approach to the questions involved or any formulation
of investigative procedures that promised to be fruitful. Even to-day
the same prejudices are all too inhibitory; but thanks to the
unprecedented development of the natural sciences during the period
since this hospital was founded, we are witnessing, in our time, a rapid
transformation of thought and opinion concerning both the normal and the
disordered mind, a transformation that is reaching all circles of human
beings, bidding fair to compel the strongholds of tradition and
prejudice to relax, and inviting the whole-hearted co-operation of
workers in all fields in a common task of overcoming some of the
greatest difficulties by which civilization and human progress are
confronted. And though the brunt of this task is borne and must be borne
by the shoulders of medical men, physicians assume the burden
cheerfully, now that they know that they can count upon the intelligent
support and the cordial sympathy of an ever-enlarging extra-medical
aggregate. No better illustration could be given, perhaps, of the change
in the status of psychiatry in this country and in the world than the
contents of the programme of our meeting to-day at which a distinguished
investigator from London tells us of the biological significance of
mental disorders, an eminent authority from Paris explains the
relationship between certain diseases of the nervous system and these
disorders, and a leading psychiatrist of this country speaks upon the
contributions of psychiatry to the understanding of the problems of
life. Psychiatry, like each of the other branches of medicine, has come
to be recognized as one of the subdivisions of the great science of
biology, free to make use of the scientific method, in duty bound to
diffuse the knowledge that it gains, and privileged to contribute
abundantly to the lessening of human suffering and the enhancement of
human joys. General practitioners of medicine and medical
specialists--at least the more enlightened of them--welcome the
developing science of psychiatry, are eager to hasten its progress, and
will gladly share in applying its discoveries to the early diagnosis,
the cure, and the prevention of disease.

That the majority of medical and surgical specialists and even most of
the widely experienced general practitioners, though constantly coming
in contact with major and minor psychic disturbances, are, however,
still far from realizing the full meaning and value of the principles
and technic of modern psychology and of the newer psychiatry must, I
fear, be frankly admitted.[5] But dare we blame these practitioners for
their ignorance of, apathy regarding, and even antipathy to, the psychic
and especially the psychotic manifestations of their patients? Ought we
not rather to try to understand the reasons for this ignorance, this
apathy, and this aversion, all three of which seem astonishing to many
of our well-trained psychologists and psychopathologists? Are there not
definite conditions that explain and at least partially excuse the
defects in knowledge and interest and the errors in attitude manifested
by those whom we would be glad to see cognizant and enthusiastically
participant? Psychiatrists, who have taught us to understand and rescue
various types of "sinners" and "social offenders" will, I feel sure,
avoid any moralistic attitude when discussing the shortcomings of their
brethren in the general medical profession, and will, instead, seek to
discover and to remove their causes.

As an internist who values highly the gifts that modern psychology and
psychiatry have been making to medicine, I have given some thought to
the conditions and causes that may be responsible for these professional
delinquencies that you deplore. Though this is not the time nor the
place fully to discuss them, the mere mention of some of the causes and
conditions will, perhaps, contribute to comprehension and pardon, and
may serve to stimulate us all to livelier corrective activity. Let me
enumerate some of them:

(1) A social stigma still attaches, despite all our efforts to abolish
it, to mental disorders and has, to a certain extent, been transferred
to those that study and treat patients manifesting these disorders.

(2) The organization of our general education is very defective since it
fails to make clear to each student man's place in the universe and any
orderly view of the world and man; it fails adequately to enlighten the
student regarding the processes of life as adaptations of organisms to
their environment, man, himself, being such an organism reacting
physically and psychically to his surroundings in ways either favorable
or unfavorable to his own preservation and that of his species; it fails
to teach the student that the human organism represents a bundle of
instincts each with its knowing, its feeling, and its striving
component, that what we call "knowledge" and what we call "character"
are gradual developments in each person, and that if we know how they
have developed in a particular person we possess clues to the way that
person will react under a given stimulus, that is to say, what he will
think, how he will feel, and how he will act; and it fails, again,
properly to instruct students regarding the interrelationships of
members of different social groups (familial, civic, economic,
occupational, ethical, national, racial, etc.); in other words, our
general educational organization is as yet far from successful in
inculcating philosophical, biological, psychological, and sociological
conceptions that are adequate symbols of reality.

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