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Fairbairn, W.R. (1940). Clinical: Jules H. Masserman and Hugh T. Carmichael. 'Diagnosis and Prognosis in Psychiatry.' Journal of Mental Science, 1938, Vol. LXXXIV, pp. 893–946.. Int. J. Psycho-Anal., 21:346-348.
Psychoanalytic Electronic Publishing: Clinical: Jules H. Masserman and Hugh T. Carmichael. 'Diagnosis and Prognosis in Psychiatry.' Journal of Mental Science, 1938, Vol. LXXXIV, pp. 893–946.

(1940). International Journal of Psycho-Analysis, 21:346-348

Clinical: Jules H. Masserman and Hugh T. Carmichael. 'Diagnosis and Prognosis in Psychiatry.' Journal of Mental Science, 1938, Vol. LXXXIV, pp. 893–946.

W. R.D. Fairbairn

Long in the 'mystical state' (Comte) of the evolution of a science, psychiatry rapidly entered into its taxonomic phase once its rightful claims became recognized. Almost simultaneously, premature efforts to expedite its evolution led to a burial of the facts in rigid classificatory systems. Recent years have witnessed a salutary tendency among psychiatrists to review their data and re-examine the pragmatic and heuristic value of accepted formulations. In this connection the researches of the psycho-analytical school in ætiology and psychopathology deserve special mention. The present paper is offered as a contribution towards the fundamental reorganization of psychiatry. One hundred patients were intensively studied and treated in the Psychiatric Division of the University of Chicago Clinics and were re-examined a year or more after discharge for the evaluation of (a) the validity of the diagnoses made during their hospitalization, (b) the results of the various forms of treatment employed. Among the results of a detailed and statistical analysis of the data were the following. The patients had a mean age of 29 and were mostly unmarried; three-quarters were female. The percentage of Jewish patients was excessive, especially in the schizophrenic group. The period of hospitalization

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averaged 24 days. A history of abnormal behaviour in childhood was commonest in patients diagnosed 'psychopathic personality', and rarest in the control group of organic cases. It was also commoner in schizophrenics than psychoneurotics. In less than 50 per cent. of cases could the personalities of the schizophrenics and manic-depressives be described respectively as 'schizoid' and 'cyclothymic'. All groups included individuals of a personality designated 'puerile'. Although passive and dependent, such individuals were not 'infantile'; nor were they either 'psychopathic' or 'neurotic' characters (in Alexander's sense), since their reactions were both alloplastic and autoplastic. Psycho-sexually the women were demanding, insecure and frigid, the men impotent, jealous and promiscuous. The mixed character of most neurotic and psychotic reactions was shown by the irregular distribution of symptoms in the various diagnostic categories. Predominant emotional tones were only found in manic and depressive cases. Depression was the commonest affect—its frequency being notable in patients with early schizophrenic syndromes (the group with the highest incidence of suicidal tendencies). The affect next in frequency was anxiety. Distortions of thought and feeling appeared in all groups and formed an almost continuous series from hypochondriacal preoccupations and obsessions to phobias, feelings of unreality and delusions. Obsessions and compulsions appeared in all diagnostic groups (and notably the schizophrenic). Maladjustments were but rarely confined to any single sphere. Sexual maladjustments were commonest among schizophrenics and conversion hysterics. In cases of 'psychopathic personality' external sexual adjustments were better, social and occupational adjustments proportionately worse. The psychoneurotic reactions of most married patients were judged to have been aggravated by connubial incompatibilities. Under a régime which included all indicated forms of medical treatment and superficial psycho-therapy, definite improvement occurred during hospitalization in 65 per cent. of 'psychoneurotics', 55 per cent. of 'manic-depressives' and 30 per cent. of 'schizophrenics'; but the obsessions and compulsions, like the hallucinations and delusions, remained uninfluenced. Out-patient treatment followed discharge in half the cases; and environmental readjustments were generally recommended. Psycho-analytical treatment was recommended in 4 cases; but the results are not yet available. A year after discharge the general level of recovery was found to have been fairly well maintained, even in the absence of such a reorganization of the personality as psycho-analysis might have effected. The figures conformed closely to the revised figures of the Chicago Psycho-Analytic Institute. It was found that in individual cases the prognosis could not be closely related to the diagnosis assigned. Since, in 41 cases, careful observation during the year following discharge revealed developments necessitating a major

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revision of the original nosological classification, it must be inferred that, unless the original diagnoses were unreliable, the nosological concepts used were of little prognostic, therapeutic or heuristic value.

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Article Citation

Fairbairn, W.R. (1940). Clinical. Int. J. Psycho-Anal., 21:346-348

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