Psychiatry Changes Course

Psychiatry in the U.S. is altering its course. Last week, at the 112th annual meeting of the American Psychiatric Association, 2,200 members* and 1,000 guests packed a dozen Chicago meeting halls for five days of reports and speeches that showed a momentous 90DEG turn to the right. It is a turn from a narrow course, oriented on Freudian psychoanalysis (TIME, April 23), which had been followed for more than a quarter of a century, to a broader channel made by the confluence of a score of scientific disciplines and at least six major psychiatric research flows. It is a change that in a sense demotes psychoanalysis from the main current to only one of several main currents in the study and treatment of the human mind. But it is a change that some influential analysts, e.g., Chicago's Dr. Franz Alexander welcome as a means of closer cooperation between psychoanalysis, other branches of psychiatry, and such sciences as biochemistry, genetics.

High Priest. If it showed its shoulder to Freud, U.S. psychiatry was far from turning its back on him. Many of the most illuminating of the hundreds of papers given (see below) were firmly rooted in psychoanalytic theory. Moreover, this was the centenary of Freud's birth, and thousands drawn from the conventioner's and the public milled in iconolatrous rapture around a devoutly assembled collection of Freudiana--busts, portraits, manuscripts, letters. Some 2,500 made a symbolic return to the womb when they crowded into the Morrison Hotel's sub terranean Terrace Casino to hear the high priest of the pure Freudian cult, Britain's Dr. Ernest Jones, 77, eulogize the master. They gave Jones a standing ovation.

Next day an equal number packed the same hall to hear the University of Illinois' tart-tongued Neurologist Percival Bailey, a top brain surgeon, dissect the entire psychiatric revolution of the 20th century's first half. Revolutions, Bailey said, "bring change but not necessarily progress." Echoed Cincinnati's Dr. Howard Fabing: "The second half of our century finds us in a swing back to a more orthodox type of medical investigation."

Bailey's attack was directed not just against Freudian theory, but against a wide range of psychiatric practices that owe little or nothing to Freud. Psychosurgery, said Bailey, has built a sorry monument of mutilated frontal lobes. "I am frankly appalled by the [aftereffects] of lobotomy and similar operations--abusive and obscene language, uninhibited sexual drive, obnoxious mannerisms, stealing, suggestibility . . . The great neuro-surgical revolution has proved abortive; it has not emptied our state hospitals." Later, "much the same panegyrics attended the spread of the shock gospel as had attended the spread of lobotomy and --in a previous generation--the spread of phrenology." Electric shock is in a way a "punitive" treatment, Dr. Bailey suggested, and should be limited to the involutional anxious melancholic, a type of case in which it is sometimes spectacularly effective.

Quietly Dropped. Neurologist Bailey used his sharpest scalpels on Sometime Neurologist Freud: "His ideas were often launched with great enthusiasm, like scare headlines in a newspaper, and then quietly dropped without retraction . . . Many of Freud's psychological writings are not scientific treatises, but rather, reveries--a sort of chirographic rumination . . ."

Psychoanalysis, complained Bailey, is not a science--if it were, "psychoanalysts would ere this have merged into the academic community . . ." Bailey had a final cut for the process of analysis: "Deep psychotherapy is as dangerous as deep surgery. The technique of deep analysis seems to be to lead the patient along the very brink of the abyss, hoping that he will not fall in--something like Dulles' diplomacy." Finally, affirming his own faith that the problem of schizophrenia will be solved by the biochemist, he quoted Boston's late great neurosurgeon Dr. Harvey Gushing: "The task of the psychiatrists is to get back into the asylums and laboratories which they are so proud to have left behind them, and prove . . . that their concepts have scientific validity."

The Trend to Drugs. There may have been as much heat as light on Surgeon Bailey's operating table, but the trend toward new directions was illustrated by several other speakers who had proposals to make rather than criticisms. Montreal's famed Stressor Hans Selye (TIME, Oct. 9, 1950) flew in to declare his faith that physiological change is related to emotional disturbance. Recent research shows that three classes of hormones can create such varied "psychic" disorders as pathological confusion or excitement, chronic fatigue (neurasthenia), deep depression, psychoses or neuroses during pregnancy, convulsive seizures, paralytic "spells," and even degenerative conditions of the brain and central nervous system.

The dominant trend in psychiatry's new direction, it became plain, is the search for psychiatric answers and cures in the field of chemistry. A score of researchers reported progress with ataraxic or tranquilizing drugs (TIME, March 7, 1955).

In a dozen papers on the tranquilizing drugs there was general agreement that none of them by itself has cured a single patient; some patients, especially those in hospitals for many years, get no help at all. But granting their limitations, there is no doubt that the drugs have effected a revitalization (if not a Baileyan revolution) in mental hospitals. One psychiatrist after another reported that his hospital had nearly abandoned the use of psychosurgery, electric and insulin shock, tubs, wet packs and restraints. In many state hospitals the former "disturbed wards" are now places of peace and quiet.

Of Men & Monkeys. The most dramatic and perhaps most significant of the researchers' forays into new territory was reported at a final dinner meeting on "Frontiers of Psychiatric Research" by Tulane University's Psychiatrist Robert G. Heath. A daring researcher, Heath has long sought clues to mental illness by planting electrodes deep in the brains of monkeys and humans, studying their brain waves and also noting their behavior when a weak current is passed through the electrodes (TIME, April 13, 1953). Now Heath and his Tulane team have found a sub stance in the blood of schizophrenics which they can find nowhere else.

From 500 cc. of blood (about a pint) they were able to extract just a tenth of a teaspoonful of this far-from-pure substance, still unidentified (though they believe it to be a protein enzyme). They injected it into monkeys. The animals "developed a full-blown catatonic picture with waxy flexibility, looked dazed and out of contact, and would stare into distant corners of the room gesticulating and grimacing inappropriately so as to suggest that they might be hallucinating." The monkeys' brain waves became almost identical with those of severely schizophrenic patients. Was this the key to schizophrenia, which keeps more than 300,000 victims locked in state hospitals?

Since monkeys cannot talk, and schizophrenia is described in psychological terms dependent on patients' reporting, Heath and co-workers decided to take the next step and test the serum extract on human volunteers. Two were found at the Louisiana State Penitentiary at Angola. Carefully examined by psychiatrists, they showed no trace of latent mental illness. Given only the same tiny dose as a seven-pound monkey, the men developed similar symptoms within five minutes, reaching a peak after about half an hour.

Surprisingly, from the same extract, one got the symptoms of catatonia, with his mind retarded and blocked, while the other got a paranoid reaction with delusions and hallucinations. (The fact that different reactions can be provoked by the same substance in itself raises an intriguing psychiatric question: What causes one subject to become catatonic, another to become paranoid?) Within two hours the effect wore off, and the men have been normal since. Dr. Heath emphasized that his report on only two human cases was preliminary. But it was significant, and his substance will be tested as soon as possible by other researchers.

It was by no means the first time in medical history that hope had been raised by discovery of a chemical difference between schizophrenics and normals, but it was by far the most specific, and done under the most rigorous research conditions.

*Out of 9,000 or more U.S. psychiatrists, of whom some 95% are A.P.A. members.

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