In an address delivered before the Paddington Medical Society, Ernest Jones shows how psycho-analysis can be compared to the functioning of modern clinical medicine, the importance of the dynamic striving impulses of the mind being particularly emphasized. In considering the contact made between psycho-analysis and general clinical medicine, the following three impulses are dealt with: the assistance psycho-analysis gives in dealing with a hitherto obscure field of clinical medicine; the light it throws on the interaction of mind and body in cases of organic disease; and the extent to which it is widening the field of medical practice.
Experienced practitioners have estimated neurotic disorders as varying between 60 and 90 per cent., irrespective of whether organic disease is present or not. Even if the body is one half of the organic personality and the mind the other half, then the understanding of disease can be divided equally between general medicine and clinical psychology. One common attitude is to deny the significance of these facts; other well-known methods of evasion are then commented on.
An analogy is drawn between bodily and mental pain, and it is pointed out that the mind is far more ingenious than the body in masking pain. Apart from the obvious acute pain of agitated melancholia most mental pain is overlooked and not 5 per cent. of it is appreciated at its true value. All neuroticsymptoms are a method of escape from mental pain, and in this connection the conversion hysterias are exemplified. Mental dis-ease is often masked by its opposite, pseudo-happiness. The suicide frequently gives the impression of being 'in the best of spirits'.
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Particular attention is paid to instincts and conflicts. The instinctive mental processes lie nearest to both the psychological and the biological way of thinking. The physical correlative of the instincts would be found in biochemistry. Instincts that matter most are concerned with either a positive or negative attitude towards our fellow-beings. The moral group is a combination of the two. Examples given are sexuality, hate, fear and morality. These instincts whether positive or negative in kind work in one of two opposite ways, sthenic or asthenic. Sthenic effects are bracing and asthenic effects enervating. If the instinct acts as an expression of the personality approved by the self, we call it ego syntonic, or if in opposition to important constituents of the personality, ego dystonic. Physiological emotional accompaniments, such as sweating and tachycardia occur mainly with ego dystonic manifestations. The importance of early mental development is now emphasized, and it is stated that the child has to accomplish the transition from animal to civilized man in his first five years of life, an achievement which has taken mankind anything from 50, 000 to 500, 000 years to accomplish. The essential content of repressed impulses summed up as incest and murder are now lucidly explained. The circuitous nature of symptom formation is mentioned, stress being laid on privation or thwarting in its relation to guilt.
In discussing the relation of psycho-analysis to bodily disease, several interesting points are raised under the three headings of Deprivation, Fear, and Opportunity for Suffering. Deprivation manifested in restriction of strength or movement is unconsciously a punishment for guilty impulses which may become conscious in the unsophisticated in the form of sacrificial ceremonies. Compensatory phantasies serve to deny the guilt or defy the punishment. The neuroticsymptoms occurring as a result of this conflict, commonly express themselves clinically in the form of exaggerated physical symptoms. The result is intensified pain, etc.
Some degree of unconsciousfear is inevitable. The word 'heal' means to make 'whole'. The significance of mutilation and castration is explained in this connection.
Under the heading 'Opportunity for Suffering', the deep need for self-punishment is explained and it is pointed out that this need may be expressed physically in avoidable accidents or in the commoner methods of self-thwarting in life which neutralize the unconscious guilt. The libidinizing of suffering or punishment found in masochism may express itself in a desire to undergo a surgical operation which may coincide with repressed sadism in the surgeon.
Finally, a more general application of psycho-analysis to social problems is mentioned, marital unhappiness receiving special attention. In the future the medical psychologist will play a far more important part than hitherto in the body politic and in legislation. The article ends with
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a significant statement that the medical profession is signally unaware of and unresponsive to its present opportunities in this field.
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Riggall, R.M. (1934). General. Int. J. Psycho-Anal., 15:305-307