The Psychological Approach to Medicine

A DISCUSSION of psychological medicine before a medical but non-psychiatric audience best starts with a differentiation of methods and aims of psychological medicine from those of general medicine and surgery. If one speaks of a diagnosis in general medicine, one means a certain pathological or etiological entity, i.e. in speaking of diabetes mellitus one has a fair idea of the pathology and physiology of the disease even if one cannot decide if it is due to arterio-sclerosis, degenerative changes, or if an infection is the basis of the condition. Even in psychological medicine, or rather on the borderline of psychological medicine, we know conditions which we can diagnose with the same precision, and on the same principles. Take the case of G.P.I. In speaking of G.P.I., we may have a particular psychological picture in our minds, but we think in the first place of the pathological and etiological entity. As a psychological diagnosis it is a matter of the past, and anybody basing his diagnosis of G.P;I. on the psychological picture alone would make a grave mistake. It is a neurological and infective condition, which almost accidentally has psychological symptoms. G.P.I. may or may not be an isolated case of an illness that has grown out of the limits of psychological medicine. Perhaps it is only the forerunner of other conditions which we shall one day understand in terms of physical pathology. To-day there are fundamental differences between psychological and physical diagnoses. Adolf Meyer, of Johns Hopkins University, taught us to approach psychoses, and for this matter also psycho-neuroses, from an angle which is unknown in physical medicine. He encouraged us ta look upon psychological illnesses not so much as illnesses, but as the reaction of an individual to his physical, biological, and social surroundings. He suggested that one should cease to talk about certain psychological illnesses, and suggested calling them reaction types. These types exist as much among the psychologically normal as among the psychologically sick. Under pathological exaggeration certain groups or types have become prominent. In so far as the psychoses are concerned, you, of course, know that I am referring to the two vast groups, the schizophrenic and manic-depressive reaction-types. An enormous amount of research has been done in biochemistry and pathology of patients of both of these types, but with remarkably little results. I do not say that there are no results at all. Not long ago Gjessing carried out promising research on the protein metabolism in catatonia, but it is too early to appreciate the real significance of these findings. If you ask me why a certain person belongs to one reaction type and not to the other, I am afraid I cannot give you a satisfactory answer. I know how unsatisfactory it is to speak of "constitution," and we all hope that constitution will one day be defined in chemical and physical terms. At present we are still far away from this aim. It was the clinical acumen of Kretschmer,l which spotted a curious correlation of bodily build and certain psychological reaction-types. Kretschmer