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Know As Neuropsychiatry.2 but Already Before the and Placed In are now moving. The yeast is working, too, in the INSANITY VERSUS MENTAL DISEASES National Conference of Social Work; and just as "charities and correction" has fused and crystallized THE DUTY OF THE GENERAL PRACTITIONER into "social work," so the former committee of that IN PSYCHIATRIC DIAGNOSIS body on "feeblemindedness and insanity" has now into a committee on "mental E. SOUTHARD, M.D. crystallized hygiene." The medical man who does not some year attend a BOSTON meeting of the National Conference of Social Work4 The time has come when the general practitioner will sooner or later wake up to reckon without his must assume responsibilities new to him: he must host-—the social worker. In brief, no sign fails to become as much a psychiatrist as he is specialist in point to an increasing demand for more medical ser¬ other directions.1 But how specialistic, it may be vice, as well as for more service of every technical asked, is the general doctor-man to be? Quien sabe? sort, for the psychopath. And times change. But so much is certain: The But what exactly ought the general practitioner to general doctor-man does not know as much about do for his instruction in modern psychiatry? He psychiatry either as he should know, or as he has com- looks back at a meager training. He was by law a» mand of, let us say, pediatrics, gynecology or derma- a rule excluded for a period of years from whetting tology. Science, C. S. Peirce defined, I believe, as his mind on medicolegal problems of commitment : the range of ignorance. Well, the general practi- the law somehow permitted him to remove an appen¬ tioner's range of ignorance re psychiatry is altogether dix the moment he passed his state board examination, too wide for his own conscience's comfort and disas- but the law required experience and a partner in the trously wide for the good of society. matter of certifying insanity. Again, early in this All this can now be shouted from housetops by rea- century a flood of Teutonic verbiage overflowed the son of what the layman terms "shell shock," a problem field, and the graduate doctor who ventured inside an for medicine no less wide than the whole of clinical asylum hastily beat a retreat when Merkfähigkeit neurology and psychiatry, the field we are coming to raised up its head or Dämmerzustand closed down know as neuropsychiatry.2 But already before the over all. Of course various clearly written books shell shock alarums, the American general practitioner gave the main facts (de Fursac,5 Dercum,6 Diefen- in more than had become responsible these matters for dorf,7 Peterson,8 White,9 et al.) ; but there was little his father had to be. In 1906 the state of Michigan in the medical school memories of most men to tie at Ann had laid down its psychopathic ward Arbor these facts to, except a few curiosa of dismal asylum and control a novel in placed in of it specialist train¬ walks and some medicolegal stories too mature for ing, functions and scope. Now, it is safe to say, no the nonsocialized medical student to grasp in their state can hold up its head in a place of the highest proper relations. Am I this too dark ? honor in painting picture civilization without establishing a psycho¬ Now and then at the apex of a career some The particular pathic hospital. commonwealth of Massachu¬ outstanding man is able to prevail on medical col¬ setts, in 1912, followed the lead of Michigan. Private to him curricular time to do the endowment allowed in leagues give enough 1913 the establishment in Mary¬ topic justice ; but on the whole, even in so-called Class land of another institution in which the scientific point A medical schools, either the of committees, of ignorance view made use of physicians, psychologists and or curricular pressure, or remoteness of clinical mate¬ trained workers the lay for high modern purposes rial, or an overripe professional point of -view, has of mental hygiene. Meantime, societies for mental killed in embryo the medical student's chances of hygiene had been established,3 and doubtless others learning much about psychiatry. I Read before the Section on Nervous and Mental Diseases at the consider and propose that all general practitioners Sixty-Ninth Annual Session of the American Medical Association, who feel at a loss how to use the relics of Chicago, June, 1918. practically Because of lack of space, this article is abbreviated in The Journal. their psychiatric training or the products of their read¬ The complete article appears in the Transactions of the Section and in the author's reprints. ing in such books as the above mentioned should as 1. To show the popular interest in these topics, see any numbers, soon as at least a week in contact especially Current Bibliography, of Mental Hygiene, published quarterly possible spend with by the National Committee for Mental Hygiene, Inc., 50 Union Square, New York City. 4. Proc. National Conference of Charities and Correction, especially 2. See remarks in the Sattuck Lecture for 1918: Southard, E. E.: for 1915, Baltimore; 1916, Indianapolis; 1017, Pittsburgh; 1918. Kansas Shell Shock and After, Boston Med. and Surg. Jour., 1918, 179, 74. City (name now changed to National Conference of Social Work). 3. Connecticut, 1908; national, 1909; Illinois, 1909; New York, 1910; 5. De Fursac: Psychiatry, translated by Rosanoff, latest edition. Massachusetts, 1913; Maryland, 1913; Pennsylvania, 1913; North Car- 6. Dercum: A Clinical Manual of Mental Diseases, 1917. olina, 1913; Dayton, Ohio, 1914; District of Columbia, 1915; Alabama, 7. Diefendorf: Clinical Psychiatry: A Textbook for Students and 1915; Louisiana, 1915; California, 1915; Rhode Island, 1916; Ohio, Physicians. 1916; Tennessee, 1916; Missouri, 1916; Indiana, 1916; Iowa, 1917; 8. Peterson, in Church and Peterson: Nervous and Mental Diseases. Virginia, 1917. 9. White, W. A.: Outlines of Psychiatry. Downloaded From: http://jama.jamanetwork.com/ by a University of Manitoba User on 06/08/2015 the clinical material of some institution like the Ann ophthalmology and otology. Up to recent times, we Arbor Psychopathic Ward, the Boston Psychopathic have not demanded from the general practitioner a Hospital, or the Henry Phipps Psychiatric Clinic at knowledge of so much about mental diseases as we Baltimore. I specify these institutions, not because have often been able to demand for diseases of Ihe the state institution men are unable to give in some skin, the ear or the eye. The time has come when instances even more valuable instruction, but because the general practitioner must assume responsibility in the specified institutions have contact with the acute, this direction. Even at the expense of postgraduate curable, incipient and dubious cases that most resemble work on the topic, the general practitioner is going to the most important psychiatric material of general fail who does not proceed to acquire a grasp on the practice. I have not thè slightest doubt that the main conceptions of psychiatry. authorities of the specified institutions would not only I have recently, for the purpose of discussion with tolerate but actually welcome the arrival of the general specialistic colleagues, gone over the textbooks and the practitioners for such study purposes. I am sure that main classifications used in institutions for the insane the general practitioner who comes for a week will want to stay a month and will certainly come back TABLE 2.—MENTAL DISEASE GROUPS (ORDERS) more. 1. Syphilitic .Sypbilopsychoses for 2. Feebleminded .Hypophrenoses 3. Epileptic .Epileptoses WHAT THE GENERAL PRACTITIONER SHOULD 4. Alcoholic, drug, poison.Pharmacopsychoses 5. Focal brain ("organic," artcriosclerotic).Encepbalopsychoses KNOW OF PSYCHIATRY 6. Bodily disease ("symptomatic").Somatopsychoses 7. Senescent, senile.Geriopsychoses I want now to sketch the main features of the 8. Dementia praecox, paraphrenic.Schizophrenoses 9. Manic-depressive, cyclothymic.Cyclothymoses psychiatric landscape as I think it should be com¬ 10. Hysteric, psychasthenic, neurasthenic.Psycboneuroses manded by the general practitioner. 11. Psychopathic, paranoiac, et al.Psychopathoses First, the to become general practitioner ought and the attention to Ameri¬ something of a psychiatrist and not in the first instance psychopathic, confining my can views.11 I find an on try to become an alienist. I am here making a some¬ extraordinary unanimity what unfamiliar distinction. In Table 1 I summarize the part of these colleagues on the subject-matter of Those of the who in parallel columns the line of distinction as I think psychiatry. general practitioners it well be drawn. occasionally dip into the specialistic literature of might mental an I recently discussed somewhat fully the intricacies and nervous disease strike into atmosphere of the column.10 The here of what must seem the most lively controversy. But foregoing parallel point in of fact the battles are localized—I rather is to ask how much of the field of mental dis¬ point greatly mean the battles the actual concerning facts. There is a ease, medically considered, general practitioner deal of nomenclatural difference still to have in his range. I suppose there can be good preserved ought in textbooks. I have been to some no doubt that the to know sundry trying put general practitioner ought order into this matter and offer in Table 2 a list of as much about as he does about relatively psychiatry the groups of mental disease which I think will the sixteen or seventeen other main of major groups topics be found the vast of that we denominate A approved by majority special¬ practical specialties. general ists.12 In fact, I do not know a who must be in that he has single specialist practitioner general actually would not that in some sense each of the sub¬ more command of all the than one of agree specialties any exists.
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