Page:The International Journal of Psycho-Analysis II 1921 3-4.djvu/108

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362 AUGUST STARCKE

gnosis, to a group of cases with a definite aetiology or a definite anatomical basis, or with a definite prognosis and where possible a definite therapy. In psychiatry this rule applies only to the in- fective diseases and grosser lesions of the brain, which comprise a relatively small percentage of the cases. In by far the greater number of cases the diagnosis gives no indication of the causes, no anatomy or useful prognosis (fifty per cent of errors in one of the best clinics), and no therapy. The therapeutic measures in vogue are based more on sympathy than science and the results are nothing to be proud of. Under these circumstances the relation of psycho-analysis to psychiatry seems to be summed up in the statement that its relation to psychiatry is the same as to any other psychic formation of doubtful utility; psycho-analysis has to interpret the formation and endeavour to remove it in order to replace it by something useful. If we were to adopt this view, however, we should commit a triple injustice.

First, we should underestimate the results that psychiatry has to show, not as regards the understanding of the psychoses but In sundry matters of secondary importance. Jt may even be admitted that the finer anatomy and physiology of the central nervous system, of the sense organs and endocrine glands, is building a very promising foundation; and a bridge can be carried from this foundation to Freud's theories if the building is not prematurely wrecked on the same obstacle at which clinical psychiatry has made a halt and turned aside, namely, sexuality.

These methods of study, however, are not psychiatry, but its auxiliary sciences, which in other respects are independent and fully adequate in themselves. Psychiatry can signify nothing other than the science of the medical treatment of the mind.

A second and historically important fact, which we must not overlook, is that psychiatry has not always proceeded in such a helpless and fluctuating manner as in the last thirty or forty years. It had been on the best road to discover the fixation of the libido as the cause of the failure of adaptation. The word hysteria — which formerly comprised all kinds of cases that now are included in other psychotic types — bears witness to this. The oldest theories asserted that the wanderings of the uterus throughout the body were the cause of hysteria. When Galen proved that these wanderings were impossible, the blame was attributed to retention of semen or blood in the uterus, since tlie humours could