DESCRIPTIVE PSYCFOLOGY AND MEDICINE. BY CHARLES L. DANA, M.D., NEW YORK. Professor of Nervous Diseases, Cornell University Medical College. REPRINTED FROK THE MEDICAL RECORD Aug. 28, 1920 WILLIAM WOOD & COMPANY NlllW YORK. DESCRIPTIVE PSYCHOLOGY AND MEDICI'NE. BY CHARLES L. DANA, M.D., NEW YORK. PROFESSOR OF NERVOUS DISE ASES, CORNELL U N I VERSITY MEDICAL COLLEGE. PSYCHOLOGY is a science that has been studied (not without acrimony) from many angles; and in re­ cent times applied in many directions. We have now books on physiological, abnormal, social, voca­ tional and behavioristic psychology and others. Some technical knowledge of psychology is very use­ ful for the understanading and management of the patient and his disease, and in certain lines of prac­ tice such knowledge is imperative; yet I find it rather generally lacking. Perhaps for this reason various psychological cults which appeal to the imagination find easy absorption here. Besides this, a good deal of confusion in descrip­ tion, classification, and interpretation has resulted from the differences among writers in their vocab­ ulary and their standpoint. Hence I make no ex­ cuse for giving a brief account of some of the dif­ ferent fields of psychological work, with their rela­ tive value:; to the physician. I especially wish to present certain elementary facts and definitions in the science. If these are not final or even are not all correct, they at least Copyright. Willia m Wood & Compa ny. 1 rep_resent the situation as fairly and as authori­ tatively as I have found it possible. medical psychology we also apply the terms, meth­ Psy~hology is t?e science of the mind and it is ods, and data obtained by the three group-methods essentially one science. For while there is an ab­ mentioned above. The behaviorists deal with con­ norm~l psycholog:y, a physiological psychology, a duct, and do not call their science psychology. descrip~Ive psychology, etc., these all deal with the Dynamic psychology is a science based on a study mecha~usm~ and laws of mental action. Whether of the forces and their interactions which lead to th~ ~md Is abnormal or diseased or sound, the mental activities and human conduct. Dynamic sci~ntific data of psychology apply just the same psychology attempts to explain the phenomena of It IS all a biological process, to use a word dear!; the mind by finding the causes and establishing loved by _the psychological intelligentsia. The mind the laws of mental action. It cannot yet prove the ~as . a km~ . of . anatomy or structure of its own existence of such forces and laws because they are 2.e. Its activity _Is accompanied with and dependent not in the field of observation. But the laws are on the productwn of certain definite states and conceived to be such as will explain the phenomena, processes, such as. sensation, perception, reasoning, and, being applied, do seem to explain them. Hence etc. W~en the mmd functions it does so through dynamic may also be called a conl!eptual psychol­ the Il!edrum of these states, and in accordance with ogy. (B. Hart.) cert~m la~s. The mind cannot act without the for­ Dynamic psychology gathers data also by obser­ m~tion of Ideas, the development of feelings, etc., or vation, and groups and classifies them. ~ut its in­ withou~ ~h.e processes of association, memory, etc. terpretation of the laws of mental action is obtained !t~ .activities may be modified, however, and even by reasoning processes, and is worked out without mitrated by the conditions of the nervous system reference to physical phenomena or to physiology. and by the play upon it of the physiological processes It does not "mix up brain cells and mental acts." o~ other organs, such as the blood, the internal secre­ Its explanatory laws correspond to certain of our tions, and the nutritive and eliminative organs. conceptions of physical laws such as that of gravi­ We may _speak, therefore, of a descriptive psy­ tation, of the nature of the atom, and of the ether. chology which defines and describes· a dynamic Any given state of mind occurs because of the psyc~olog;y- which tells of forces and' laws; and a methodical working of supposed mental forces, and ph~swlogical psychology which studies the modifi­ in accordance with certain conceived of laws. cati~n and control of mental action through physi­ These underlying working forces have been called ological (and pathological) changes. These are all the "drives," the elan vital, the libido, the instincts, only different methods of attack upon the general etc. As to the nature and unity of this force there problem. is still disagreement. But it seems to be estab­ . The ~ppl~cation of psychology to education and lished that mental activity and human conduct have md?~t:Ial hfe takes us into the fields of practical several different "driving" forces. At one time the activities and human conduct. In abnormal and sexual instinct, i.e. the instinct for the preserva­ tion of the race, was assumed to be the main driver; 2 3 then there has been added the instinct of self-asser­ tions complexes, conflicts, and rep1·essions. It is tion and advancement; then that of self-preserva­ belie~ed that the minds shows resistances and has tion; that for herding together (the group in­ a kind of censorship. There is an activity of the stinct ) ; that for religious observance ; and that for mind called projection by which it is assumed that social betterment. the individual's complex is passed on to another Associated with these and forming their effective ' person. Symbolism, phantasy, day-dreaming, and sides, there are described the emotions, of love, de­ -~ subconscious wishes, defenses, and attempts at re­ sire, vanity, and self-distrust; of anger and fear, adjustment are f urther agenci_es in the psy~ho l og ­ and of religious exaltation and devotion. There ical mechanism. The concept10ns of the w1 sh, of may be also something in the nature of a "pull" dissociation, and of conflict are very important in which incites to mental action and human conduct. explaining normal and abnormal phenomena. The This is shown in the influence of an ideal towards existence of a well-organized subconsciousness that which one strives. acts on the conscious is assumed, or perhaps demon- These instinctive forces work both consciously strated. and unconsciously and one may be quite conscious The definitions and details belonging to this phase of the emotion or of a driving force and not quite of psychological science must be sought in the aware of the kind of compelling instinct that works of Freud, Jung, Adler, Trotter, and other in­ arouses it. terpreters. It is to secure the proper interpretation of these This conceptual psychology is plainly a sound forces that there have developed the methods of method of scientific attack. It has worked out psychological analysis. And efforts have been made various hypothetical laws which may be wholly and to explain in a mechanistic way those morbid men­ are certainly partly true. In fact to a large extent, tal states called the psychoses and psychoneuroses. this psychology tells us in sicentific or technical lan­ Some explain these on the basis of disturbances in guage what students of human nature and ordinary the "driving" force of the sexual instinct ; others psychology already know. Since the beginning of on the basis of a compelling sense of inferiority ; neurology at least, we have known for example that others on the dominance of fear, and on disturb­ a woman's headaches and hysteria were her methods ances of and antagonisms to the herding instinct. of defense and self-exploitation. Its essential merit All these "drives" may be modified by abnormali­ has been to show most emphatically the high or­ ties in mental make-up and development, as for ex­ ganization, influence, and importance of the sub­ ample when the adult life continues to be a juvenile conscious activities. one. These various instinctive urges, when However, the laws of a conceptual psychology do thwarted or deviated, are assumed to lead to emo­ not work in the production of mental phenomena, tional perturbations and psychoses. There have without some correlated activity of the brain and been conceived various laws or mechanisms of men­ body. One can not explain morbid mental phenom­ tal action which go under the names of dissocia- ena by conceptual phychology alone. There is al- 4 5 ways some defect of structure or function. Healthy . b interpreting to the patient the m~s- brains have no delusions or obsessions, no morbid be reh eve~h ymind the misuse of its resources, lts fears, abulias, or melancholias. No matter how deeds of de r epre~ s i o n s and conflicts, but the fact deeply fixed is the subconscious disturbance, the misfits, a~ t ·n the body is often more fundamen­ dehaions of g~neral paresis in a man w~th a luetic that a de ec le of badly worked machinery of the t Uy the caus . d t d encephalitis are not due to activities and forces al­ a. d is quite absolutely estabhshe o- ay. together psychological. When a person has an in­ mln ' t1"on with the study of the psychology jury of his angular gyrus or parietal lobe and has In connect he presentation of t h e re1 a t.lons h.lp be- alexia, or agnosia, this psychical state is not due to of trau:n ~ r ies to the central nervous system and complexes or repressions or any purely conceptually tween mf:tes has been discussed by me in an ar­ conceived mental law.