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of view and its indications for action on the part of psychological organizations.
It is easy to agree that medicine and psychology should coöperate for the public good, etc. The essential issue is raised in asking whether such coöperation is to be secured through a new professional class, the psychologists, or through an infiltration of psychology into the medical curriculum. Forecast is made of a person "with biological, educational, social, psychological, and medical background; he need not have the various types of training in obstetrics, surgery, and the other varied fields of the conventional medical course."" Such a person should work as a highly qualified expert in the field of mental adjustments.
To a program like this medicine would accede provided the training were given in a medical school, with enough of general medicine to justify the medical degree, and with the assumption of medical responsibilities. In thinking of background, one should perhaps guard against overloading the informational side of such a program. Most of the informational detail to be insisted on is of a medical character. There is certain information that must be available before any maladjustment case is handled with ordinary safety, and this information is not to be had save through medical training. As medicine sees it, the specialist postulated will have to be a physician.
There is, however, a group of "clinical" psychologists large enough and coherent enough for the development of a definite esprit de corps. Certain conditions affecting a professional class of this kind should not be lost sight of. It belongs with the law and with medicine in dealing with human adjustments, as against engineering, for example, which deals with material things. The practitioners of law and medicine are in great part supported by individuals who seek professional help from the doctor when they are feeling sick, from the lawyer when they are feeling wronged. The value of a profession for private practice upon human beings depends essentially on what it can do to get people out of trouble. If psychology is to develop further as an accom1 Harry L. Hollingworth, PH.D.
plishment of private practice in this sense, it must be able to take care of a certain class of individual troubles better than the lawyer or the physician can take care of them. Before predicating the development of a professional class of consulting psychologists, one must consider carefully how great is the class of troubles that psychology is distinctively qualified to meet. They are not unallied to the type of difficulties that now go to the religious confessor or to systems of healing that have a quasi-religious basis. There are grave difficulties in the way of meeting this type of troubles with the setting of scientific psychology that is now available. This is not out of harmony with the fact that individuals of good personality and exceptional insight have been able to make of themselves a Vaterersatz in the psychoanalytic sense, to guide less stable personalities among life's pitfalls, and earn material reward therefor, all in the name of scientific psychology. Such things are done in the name of medicine or law also, not to mention systems of far less standing. It is on these individual grounds that the few conspicuous successes in private work that psychology records seem best understood. They are not protagonists of a professional class of the same standing that they, as individuals, represent. A professional class of a less pretentious order, the expert in mental measurement, or psychometrist, is already a part of the educational, and to some extent the psychiatric, system. Medical education here seems of rather less relevance than in the case of the dental practitioner. Few psychologists, however, would see in this development a solution of the problem, or consider that it adequately represented the contribution of psychology to medical or educational science.
On the medical side, an approach to the adjustment already suggested is made through a three-year graduate medical course, at the end of which "one might be more or less authoritatively designated as a psychiatrist or neuropsychiatrist" With such training one should come as close as is practicable to the ideal of the "psychobiologist". In considering the substance of psychology's contribution to such a course, it should not be forgotten that practical, if not psy1 Hugh T. Patrick, M.D.
chologically systematic, study of human behavior pervades the whole atmosphere of medical training to an extent approached in no other discipline save perhaps the law.
The program suggested in the above paragraph is clarified by a proposal for "the development of medical education along the lines of extending the responsibilities and correspondingly the educational and practical equipment of the physician. .. The physiologist would have been compelled to undertake certain practical work for mankind had not medicine adopted physiology . . . as a basic science. Now if the medical profession is prepared to take over psychology
either as an independent science or as an extension of physiology, it seems that we have one possible solution of our present practical difficulty.""
In view of such considerations, it is not surprising to find argument from the side of psychology for the introduction of psychobiology into medical education as a basic science. It is said of psychology and psychiatry that "one is very obviously a branch of science, the other a particular application of scientific knowledge."" The term psychology is like chemistry in denoting both pure and applied science, but psychology has in psychiatry a term whose etymology denotes application. Actually, also, "clinical" psychology is nonmedical psychiatry. So soon as psychology, the science, is applied to human difficulties, it falls within the definition of psychiatry. The present teaching of psychiatry involves not a little teaching of psychology, whose fragmentary character is somewhat offset by its concreteness. The suggestion is offered that a saving of time when it is of particular value would be effected if the student had a carefully designed course in psychology early in the curriculum, or pre-medically.
The nearest alternative to the gradual incorporation of the medical phases of psychology into medical education is for "the psychologist to continue his present efforts to establish definite standards for psychological work, to lay down high
1 Robert M. Yerkes, PH.D.
2 Robert M. Yerkes, PH.D.
3 A psychologist has recently been appointed psychiatrist to the Bureau of Public Welfare in one of the Southern states.
definitions of what it is to be a psychologist, and to get these on record. ... On the other hand, psychiatry must continue to educate the medical profession to look upon itself as a distinct specialty dealing with mental disease in a strict
The first of these proposals may and should be carried out irrespective of other developments. It happens that the medical phase of psychology where standards can be most objectively formulated is in the field of psychometrics. It should be a matter for official concern that the popular or medical conception of "psychologist" does not come to represent something confined to the psychometric level. While "high definitions" must be less objective, these considerations make them probably as urgent. Any standards now practicable should be formulated with the expectation of making them progressively more exacting. Ultimately they should embody medical requirements.
The physician's disposition to concede the second point does not appear. It is contended that "the whole progress of clinical medicine is toward dealing with minor and relatively insignificant departures from health, where there is opportunity for prevention and early treatment.'” Contemplation of the number and type of problems referred to psychiatry in out-patient services, or in contact with school systems, offers little prospect that this extension of medical activities will be limited by developments within psychology.
The imponderabilia of medical discipline receive from the conference not more than their due weight. No class that does not pass through a comparable discipline should expect to enter into the privileged relationship of the physician toward his patient or the attorney toward his client. The old saying that one should always tell the whole truth to one's doctor, one's lawyer, and oneself, expresses the almost equal privileges of the two relationships. "The doctor has developed, during his medical course and hospital interneship and practice, a protective and responsible relationship towards sick persons that no other profession has. In every civilized country women and children are entrusted in the
1 Harry L. Hollingworth, PH.D.
2 Thomas W. Salmon, M.D.
most confidential relations to physicians with hardly any casualties." In the varied and scattered training, sometimes one of sophistication rather than of experience, that now connotes the psychologist, there is nothing comparable to this medical training.
There is a rather strong feeling among medical men, not unshared in psychology, that the discipline of medical training is a proper prerequisite to certain types of psychological research. These are exemplified as "the mental aspects of the sex life in children, people who are feebleminded, diseased, prevented from exercising a normal choice as to the extent of the investigation or the method."" It is largely felt that matters thus touching on intimate and emotionally charged topics should be studied by medical men or under medical direction. Interest in such studies is by no means a criterion of qualification for them-it may be quite the reverse. Their significance as a sexual Partialtrieb, the rationalization for them derivable from psychoanalysis, with the easy abuse of laboratory license, make it important in medical eyes that such avenues of research should be carefully guarded. That the discipline of the medical course does contribute to a more objective attitude toward such topics is hardly to be questioned. Stress is also laid on the responsible nature of the physician's relationship, now far from established in the case of the psychologist.
It is thought that these points are often passed over too casually. "The training of the medical man is not merely the question of giving him a certain amount of information he is brought into very special and somewhat privileged relation with sick people in regard to very vital issues. This training enables the physician to put aside a great number of conventional prejudices and personal feelings.""
It is argued, and again with reason, that "medical training does not include the whole range of human behavior, nor does it concern itself with all problems of adaptation. There appear to be problems that have a wider significance than those which the medical training so far offered has enabled
1 Thomas W. Salmon, M.D. Thomas W. Salmon, M.D. 3 C. Macfie Campbell, M.D.