Remarks on THE PRESENT POSITION OF THE PROBLEM OF PSYCHIATRIC PATHOLOGY
Authors: W. F. Menzies
Journal: BMJ (1929)

THE miettal case is too ofteci an uinwielcome addition to the 1anxieties of tlce busy practitioner.Apart from nursing difficulties tIie whole pirocess of ingravescent mental dis- order .scenes to himii so ill-defined, eveen mvsterious, that he scarcel klnows where to begin.He finds it far from easy to persuade the relatil-es that early removal to a special hospital is desirable, although lhe assuires them that thus onl-y can thie patient receive proper treatment.This is a most generous attitude on hisl part, for lie knows that, except for moral control and outdoor exercise, the case will rieceive much the same symptomatic treatnient as he himself is well able to supplv-c-hiefly laxati-es and seda- tives.But it is undesirable thlat any case of illness should present itself to a medical man as a nuisance, alnd for this those ho practise and teach psychiatry are largely to blame.The limited time available in a crowded curri- culum precluides the teacher from directing the attention of tlhe senior student to the phyisiological and neurological aspects of mind, so that, cominig fresh from more exact histological and biochlemlical laboratory methlods, he is given "nothling to get hold of."We miiay as well admit ouLr ignorance-we cannot teacl 'what we do not know; for, let there be no doubt about it, theories of the causation of mental illness are higlhly problematical.But thie best way to tackle a problem is to set up a theory an-cd then proceed to dentolislt it, until fromii the ruills a sounder edifice cani be creCted.Tliet-e ate no mental diseases p)roperly so called, there is only disordered actioni of the braini cortex; there is no essc-ntial (lifference between the neuroses, the psyccho- iieuroses, anIi the psychoses; t-lIe diseased l)roc-esses which result in mental illness are juist those which w*e are accus- tomed to recognize in physical disorders, and that the clinical presentations are so different is more a social than a medic-al p)roblem.Therefore I believe that t-he general practitioner coult l help the psychiatrist beyonid measure if he had tijime to mak-e a niote onl hlis Clinmicalf cases of all the slighlit mlenital clianiges whichl occur fro]n day to day-the attituide, faciial expression, mental outlook expressed in coniversation, memory, attention, initerests, dreams, re- actioni to paini, and so oni, carefullyv correlated to the somatic-signs preseiit.Tlis addmess is fmaink prop)aganda; its object is to seek the lhelp of outr medic-al colleagues in fuc therinig the great cause of mien-tal welfare, onle imlportant aspect of whiti is tIme pathology of mental dis- order.it may.enilist theii-interest if I mention a few of tIme alniost in;nUi -nerable problems 111u01on whit-l we slhouIld like liglht to be tlirowrc.These are Iiot sc-let-ted qiuite at random, biut because over forty years of chlinial experienice suggest to ine that some of them may iultimiately yield useful resuilts in furtheminig tlle cauise weh1av-e at heart.The efforts of Piimel, Tlcie, Cannly^-, anti otliems at the begimmuinig of last centumry anii eea-liel wemle devoted to the social ameliormation of the inisane rathiem than to tIme scienitific side, so that France anii Englaudl laogged belciitl Gern.any; norhad the United States, whete of late years more w-ork has beemn dqne than anywhei-e else, vet enitered the lists.But for imearly a telntlury a long roll of dis-