“Psychiatry Ltd.”

Extract

I am satisfied one of the results, if not the objective, of medical education is for doctors to judge their success, or the state of progress of any branch of medicine, against a pathological rather than a sociological criterion. This is the inevitable effect of the amount of time and attention given to pathology in the medical curriculum, and is further reinforced by what is asked in examinations.

Traditionally, the problem for the doctor is to try to determine the pathological lesion, using this term at best in a wide sense, and to control this if he can; and the pathological criterion of disease he has in mind is an objective physical criterion, demonstrable in life or after death.

As we all know, no pathological lesion in this traditional sense is demonstrable in a large number of patients who go, or are brought, to see doctors. All physical examinations and investigations prove negative. Medicine is therefore faced with the dilemma in these cases of either (a) coming to the conclusion that there is nothing wrong, which is often clearly untenable, or (b) of expanding its scope almost indefinitely to cover every type of maladjustment.