From the Case-Book of a Medical Psychologist

An Address given to the Ulster Medical Society IT is unusual for a paper to a Medical Society to deal with a special branch of medical practice as a whole, instead of focussing upon a part. I have, however, decided to deal with the whole field of the practice of psychological medicine, in a general manner, by describing cases illustrating the different types of problem with which one is called on to deal. I do this because, while those dealing with general medicine know much of every other speciality, as a rule they know little of psychological medicine, not because they are not interested in it, nor because they do not often come in contact with cases which would benefit by it, but because their pre-graduate training has been so inadequate in regard to it. The medical student is taught about insanity, but, at least until very recently, nothilng about the neuroses,, nothing about mental deficiency, nor about child guidance. He will not be long in practice, however, before he has a case which calls for knowledge of one of these things. This lack of training in psychological medicine is all the more to be deplored, because, since every novelist has a smattering of the Freudian theories, the general public now talks largely, but without understanding, of complexes and repressions, etc., and demands some knowledge of psychology from medical men; and these, if they do not study it after graduation, are too apt to take refuge in dismissing it as nonsense, with the result that the sufferer, having been told that there is nothing the matter with him, and not being directed to a medical psychologist, seeks help from some correspondence college which promises him command of his personality, or goes to some layman who is dabbling in psychology. Such cases often reach us too late for treatment. I frequently get cases who have suffered from mental abnormalities for ten to twenty years before getting in touch with anyone with knowledge of their problems. I do not know of any other speciality in medicine where the general practitioner so seldom calls in expert advice. Of course I recognise that one difficulty is that those of us who practise psychological medicine are commonly associated with mental hospitals, and that is apt to be alarming, but we are not likely to advise admission unless it is absolutely necessary for treatment. Our object …