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one to handle well." This returns to the vital part of the issue. Granted that there is such a lack in medical training, is it to be supplied through psychology or through psychologists? Is the question that of a professional class seeking to establish a standing as such, or is the contention for the place of a certain discipline in that system of training which is historically responsible for the organism's well-being?
Medicine should not be expected to look with favor upon the management of an ailment independently of medical authority. It is said that some people will go to a psychologist before they will to a physician, nor can the psychologist, without sacrifice of the patient's interest, at once send them to a physician. The physician replies that such cases are insignificant in number. It must not be lost sight of that very similar considerations would apply to persons who have first recourse to various systems of faith healing. The point is made that one does not fulfill one's duty to the patient without the best practicable control of objective factors with which the physician alone is trained to deal. Recognition of this is not lacking in psychological quarters. "There would be no hesitation on the part of all psychologists to feel that medical examination was desirable and essential, even if the findings were negative. The question of sequence will arise. Which examination is to precede the other?""
To some extent this question answers itself in terms of the type of examination to which the individual first comes. As to synthesis, undoubtedly there are cases in which psychology provides a better synthesis than does medicine in its ordinary sense. Also, there are psychologists who can synthesize such cases better than the average physician. The best equipment for synthesis now available seems to be a genius for certain aspects of psychology plus a medical education.
A physician states the ethics of the situation to the effect that "in the community where there is a well-trained body of medical men who have spent years in studying these disorders, it would be the natural thing, the desirable thing, for the psychologist to refer these cases to these individuals. In a community where such people are not available, then it might · 1 David Mitchell, PH.D.
2 Francis N. Maxfield, PH.D.
be proper for the psychologist to deal with the cases in the light of his special training. The psychiatrist living in other communities would not resent this. One would like to have in every community the possibility of the individual getting help of a rather advanced nature.""
Attention is directed to complications that may arise in the cross-reference between psychologist and physician. "Suppose the patient originally goes to the psychologist, who refers him to a physician, who finds him physically all right.
There is no assurance that the patient will remain that sort of patient. The question of diagnosis cannot be disposed of once and for all. . . . If the psychologist is not familiar with psychoses, he is not in a position to decide either at the beginning or at any other stage when the individual needs medical help.""
It will probably be approved by all physicians, and by many psychologists, "that the terms 'clinic' and especially 'clinical' be eliminated from the psychologist's technical vocabulary. The introduction of these terms has, to be sure, been innocent enough, but it now proves to have been unfortunate. Clinical psychology as it exists to-day is something entirely different."" The most forcible objection is the implication of a medical setting where none exists. The clinical psychologist also finds a large part of his work in educational rather than in pathological fields. As indicative of something the psychologist does not do, and not indicative of what he does, there is no term whose tabu at the hands of the psychologist is more advisable. A prominent medical school lists a course in "clinical physiology". In such a setting, it is not impossible for clinical psychology, as that portion of clinical practice concerned with the mental processes of the patient, to find a more descriptive application.
However extensive its boundaries, it is surely clear that the explored territory of psychology and the degree of organization within it do not constitute it a discipline coördinate to medicine or law or religion. Psychology is one of those sciences that have particularly to do with human health
1 C. Macfie Campbell, M.D.
2 Hugh T. Patrick, M.D.
3 Communication from Robert S. Woodworth, PH.D.
through human adjustment. The other sciences of this character have developed naturally as medical sciences. Distinguished names attest that the early days of psychology did not lack points of contact with medicine. Overlapping has been more recent.
Neither anatomy nor pathology nor physiology nor psychology is so constituted as to carry the whole weight of a human-adjustment problem. Psychology is the latest of these to bring forward knowledge of particular value in such problems. As such, it has a similar, but not greater, place as an autonomous profession than belongs to other medical sciences or to different branches of the law. All of psychology, indeed, is not a medical science, any more than is all of chemistry, from which medicine takes over its biological aspect. The "mental age" of psychology is that of chemistry fifty years ago, yet to take over psychology might be a larger order than could profitably be disposed of. If medicine does attempt to take over psychology, it is right to ask the taking over of not less than is relevant to medical problems in the broad sense in which medicine now conceives them. In one field of psychology-namely, psychoanalysis-principles and methods were both developed by physicians.1 To this should be added the simpler, but more objective field of psychometrics, while granting that much routine work in this field requires no more psychological than medical background. Psychometrics should be covered up to the point where the cases in hand cease to be medical problems, wherever this line be drawn. The general course in psychology should be based on genetic study of the personality, giving more attention to affective and instinctive life than does psychometrics, but having a more objective foundation than psychoanalysis. If medicine is to dominate the field of human-adjustment problems, it should incorporate as much of psychology, as of other science, as is relevant thereto. This seems to be the best solution both for medicine and for psychology. Should one expect the standing of non-medical psychologists to be unfavorably affected by such a development? While medical education will un
1 It cannot be too clearly realized that psychoanalysis is not a medical application of principles discovered by others, but grows out of principles and methods developed for strictly medical purposes by men with that type of training.
doubtedly become a more and more frequent and advantageous part of the consulting psychologist's equipment, this need not prejudice the standing of the consulting psychologist with competence already established on grounds of research, teaching, and personality. Persons being trained to-day in psychology have an advantage over their fellows of twenty years ago not incomparable with the advantage that medical education offers to the psychologists of the future. How seriously has this affected the standing of those who made this better training possible?
The psychology of to-day is a species of myriapod with feet in the camps not only of medicine, but of religion, law, education, sociology, and industry. In these relationships it occupies a distinctive position and one with unusual possibilities. As Peter the Great labored in foreign shipyards for the advancement of his undeveloped country, psychology should not hesitate to incorporate itself with better organized disciplines, in which its own progress is the sole limit to its influence, and some of which it may in time come to dominate. Law and education have perhaps not fewer natural affiliations with psychology than has medicine, but these disciplines are less markedly under scientific influence, and there is in them no hierarchy of sciences capable of assimilating the subject matter of psychology.
It is hardly to be claimed that one can acquire sound training in medicine and psychology within the space of four years. A graduate course in psychiatry, such as that before mentioned, would have to carry the greater part of such psychological training as was given. This would be that part of psychology which could be made a graduate medical subject, assuming certain fundamentals pre-medically and in the medical course.
The American Psychological Association recently conducted an inquiry as to what psychological subjects were considered of greatest importance from the standpoint of faulty mental adjustments. A composite of ratings by 81 persons professionally concerned with this class of work rated various course titles as follows, a maximum score for practical purposes being 486:
Subjects of medical bearing rank somewhat conspicuously
The main conclusions that seem to emerge are that psycho-