5. Psychiatry: Science, Art, and Scientism

5 Psychiatry:Science,Art, and Scientism HERVEY M. CLECKLEY Hardly anyone can deny that medical knowledge and practice have made more progress in the last forty years than in all the prior centuries of recorded history. I would estimate that in the last twenty years our methods of effective therapy have advanced at least as much as they did between the days of the Pharaohs and the attack on Pearl Harbor. The net effect on society of this vastly increased security of life and of well-being is difficult to gauge. So, too, it is difficul t to express numerically the effect of public health programs. They have eradicated or at least con trolled many dread diseases that only a few decades ago could ravage large areas of the earth. Only an eccentric could regard as trivial these relatively direct influences of medicine on society. Despite these undoubtedly substantial effects on the life and well-being of mankind, leaders of general medicine (and of surgery) have shown little inclination to set themselves up as arbiters of law or government, to present humanity with fresh and reputedly superior spiritual goals and values, to demolish 'cher ished but allegedly outworn institutions, or to offer new and "scientific" explanations of man's "true nature." In only one branch of medicine, psychiatry, we find that precisely the opposite holds true. With tremendous confidence, with what perhaps may 83 84 Psychiatry and Responsibility impress some observers as blithe audacity, some leading figures in our field, and in ancillary areas, have all but proclaimed a millenium, proffering enlightenment to experts in nearly all fields of endeavor and to all mankind a new orientation and new horizons.

It is perhaps natural that psychiatry, being concerned with the "mind," or the human entity as a functioning unit, should also, more than other branches of medicine, concern itself with these complex and lofty matters. But has psychiatry during the present century made progress comparable with that of general medicine in discovering the origin and effecting the cure of mental disorders? Has psychiatry also achieved a profound new and scientific understanding of the human personality? If so, one might logically argue that psychiatry has something of substantial, even of unique, value to offer in extramedical areas. Even greater progress than this would, however, scarcely justify some of the assumptions made by our spokesmen. Freud and His Public Both in the lay press and in our professional journals appear an endless barrage of claims urging those outside our field to be lieve that psychiatric progress since the beginning of this century has been spectacular. About thirty years ago there was wide ..

spread applause when Karl Menninger and others 1 called psy chiatry the Cinderella of Medicine, a long unrecognized princess who had at last, after decades of neglect, assumed her rightful place of glory and of predominance in medical circles. Apparently assuming that the regal touch of therapy had been amply and undeniably demonstrated within her long-established province (that of the psychoneuroses and the psychoses), many zealous knights at arms and ambassadors of the new princess began to carry her triumphant banner on into far fields. Over the last several decades this evangelistic movement has continued at an ever accelerating pace. These remarkable territorial claims are usually staked out in the broad name of psychiatry. Nearly always, however, the asPsychiatry: Science, Art and Scientism 85 serted magical insight, the revolutionary enlightenment, is said to have come primarily through the discoveries of Freud. In 1953, Oberndorf tells us that "psychoanalysis began to revolutionize psychiatry fifty years ago." 2 Literary historians give us vivid glimpses of young novelists, poets, and assorted bohemians in Greenwich Village shortly after World War I happily ffdiscover ing" in themselves hitherto unrecognized "natural impulses" to ward sodomy, incest, sadism, and other perverse aspirations. 3 These they flaunted under the aegis of science in the hope of shocking the bourgeois public. At this time relatively few psychia trists had been much impressed or influenced by the new psychology.4 An interesting volume, Freud on Broadway,5discusses in min ute detail the influence of "dynamic psychiatry" on the efforts of playwrights to portray human relations and explain the under ..

lying and basic motivations that determine human fate. Some of these products, it must be said, do not fairly represent Freud's actual teachings or discoveries. For instance, Robert Sherwood in his popular play, Reunion in Vienna,6 portrays a psychoanalyst who bows to his scientific faith and, without protest, allows his wife to be taken out for a night of sexual diversion by a Hapsburg Grand Duke. The Duke, who had formerly enjoyed her favors, has returned to Vienna for only a few days. This, I believe, is not a true interpretation of Freud's conclusions, be they right or wrong. It shows, nevertheless, hOlY Freud has been identified by the public with sex in the sense of accepting and applauding natural erotic impulses, and also of proclaiming "sexual freedom" and even a subhuman promiscuity that would render love alto gether meaningless. Such distorted concepts made of psychoanalysis (and conse..

quently of psychiatry, which the public often regards as synony mous with Freud's school) an appealing cause to countless ama teur rebels, angry young men, and other somewhat irresponsible, and, often, sexually aberrant, verbal crusaders for "progress" and a new order. This confused identification of Freudian discoveries ("dynamic" psychiatry) with the very obvious and long..known fact that sexual activities can give great delight was exquisitely 86 Psychiatry and Responsibility illustrated for me only a few months ago by a middle-aged widow who knew little about psychiatry. After I expressed skepticism about some ideas she attributed to Freud, she murmured, with parted lips and almost aghast, "But surely you believe in sex} don't you?" Aside from such popular misconceptions, we find a general belief that "dynamic" psychiatry has achieved a scientific under standing of personality disorder and has adequate means to relieve and even to prevent it.7 In emphasizing the need for more trained psychiatrists, many of our leaders strongly imply, even when they do not specifically assert, that it is chiefly our numerical weakness that stands in the way of virtually wiping out mental illness.

In addition to this asserted power of psychiatry in its traditional field of responsibility, the treatment of patients with neurosis and psychosis, our more ambitious spokesmen seem to be con vincing the public that we not only have the means of preventing these maladies, but also of curing criminals and of curbing de linquency and crime. Some assure us of a scientific solution for marital unhappiness and for the problems that arise in industry, government, social planning, and international relations. Many have insisted that our reputedly new knowledge should be used to implement fundamental changes in the law and have ridiculed particularly the law's methods of determining criminal responsibility.8 A few of our leaders seem to be convinced that our knowledge is so profound, so new, and yet so thoroughly established, that we can and must remold the body politic and bestow collective in sights that will lead to hitherto unknown happiness and to prog tess never before dreamed of. I t is not enough for us to heal those already regarded as ill; let us bring to those who now think themselves well and happy a far more abundant life. Along with all this, some advocate that we must rid society of various preju dices and rigidities that are alnlost universal. Thus, in accordance with our wonderful revelation, psychiatry must help drastically revise social institutions. 9 Authorities in other fields have often been responsive to our Psychiatry: Science) Art and Scientism 87 demands. Distinguished jurists have joined psychiatrists in de manding abolition of the M'Naghten rules. These rules have been repeatedly condemned by both parties as an archaic obstacle to the new scientific light with which psychiatrists are now able to illuminate the old and complex question of criminal responsi bility. Since the Durham case, psychiatrists and jurists have been congratulating one another on the new rules of determining legal responsibility. 10 Fortas speaks of Judge Bazelon's decision thus: "Its importance is that it is a charter, a bill of rights for psychiatry .... " 11 The judge received official honors and a Certificate of Commendation from the American Psychiatric Association for his memorable contribution. Along with other prominent legal scholars, Judge Sobeloff has expressed the conviction that "science," "scientific facts," and "the latest knowledge of human behavior" have made obsolete the M'Naghten rules. He has heartily welcomed the op portunity for this new knowledge· to be applied freely in criminal trials. 12 Hakeem, a skeptical criminologist, scarcely exaggerates when he says, "Judge Bazelon himself could not have been idolized more had he discovered the cause and cure of schizophrenia .... " 13 A few legal scholars have questioned the validity of this step.

Hall asks: What then are this "science," these "scientific facts," and that "latest knowledge of human behavior" to which Judge Sobeloff has access? We shall later examine some of the items Hall questions. After expressing skepticism about the Durham rule, Hall also suggests means by which the old M'Naghten rules can be used so as not to neglect any genuine knowledge that psychiatrists may offer in efforts to determine criminal responsibility. He shows that the attacks on the M'Naghten rules often become "an attack on ex perience and common sense." 14 Both Hall and Cumming develop arguments that illustrate the dangers of leaving such complex value judgments on imponderables as the judgment of crimi nal responsibility solely to any sort of expert known today. Though it is maintained by some that psychiatrists now have a 88 Psychiatry and Responsibility scientific method of arriving at such a decision, the points made by Hall and Cumming raise grave doubts about this assumption and suggest that this is an area not yet proved accessible to methods that are genuinely scientific. Efforts to force the qualifica tion of science upon judgments for which science is not equipped do not endow such. judgments with validity, whatever words we may use.

From Hakeem's extensive, thoroughly documented, and im pressive studies· a vivid picture emerges of psychiatric endeavors in the broad fields of delinquency, predelinquency and crime. Before attempting any estimation of the results of this work, he calls our attention to these points. Psychiatrists, psychologists, social workers, and other psychiatrically oriented personnel have been powerfully influential in the work on the prevention of juvenile delinquency. The ideology of the psychiatric approach has had widespread acceptance. Psychiatrists and others who share their persuasion are much sought after for help with the prob lem. Their counsel is attended to eagerly. In turn, these practitioners have been more than generous with their advice.I5 Despite the prevailing optimism, Hakeem 16 shows through abundant documentation from various authorities, our experts do not agree on what constitutes delinquency or predelinquency or on what their causes are. Nor do they agree on whether or not all antisocial conduct should be classed as illness. This lack of consensus among the experts does not seem to disturb the firm convictions of those who urge the public to accept psychiatry as a panacea in this area. 17 The public is exhorted to believe that we have scientifically established the causes of antisocial conduct and have at hand the means of detecting at an early age potential malefactors as well as effective methods of preventing delinquency and crime. These optimistic assumptions are apparently accepted 'without question not only by state organizations and federal bureaus that expend vast sums for social welfare, but also by international groups of experts and by agencies of the lJnited Nations and the World Psychiatry: Science) Art and Scientism 89 Health Organization. Is A typical spokesman for this point of view, Dr. Edward Glover of London, representing the Institute for the Scientific Treatment of Delinquency, thus reported to a Royal Commission on Capital Punishment: HIf sufficient trouble were taken, pathological cases liable to commit murder could be detected during early childhood; in other words, pathological murder is potentially preventable." 19 Few crusades have been so ambitiously planned, so enthusias tically launched as mental health drives, movements, and or ganizations at city, state, national, and international levels. A recent editorial in World Health exhorts us: The battle for mental health is being fought on many fronts. The psychiatrist has ceased to be merely a "doctor for the insane." ...

there is an increasing tendency to introduce mental health concepts into public health practice and to seek the advice of psychiatrists on wider social issues such as community planning and industrial organization. It is impossible to show all these aspects of mental health work in one issue of World Health or to do justice to the quiet and unspectacular toil to prevent mental illness that is being carried out day by day in hundreds of mental health units all over the world. Nevertheless, the following pages assembled for the general public may be able to dem onstrate that rapid progress is taking place in this branch of medical science. Also they may show that we can hope to win our battle and that in the fight that is going on, no one can remain neutral. 20 Statements and proclamations made at international meetings often suggest that psychiatric discoveries can now be relied upon to replace or reshape basic spiritual values and that a vast reor ganization of the world must be confidently and immediately undertaken to implement this transformation. In a statement pre pared for the International Congress on Mental Health in London, we read: Principles of mental health cannot be successfully furthered in any society unless there is progressive acceptance of the concept of world 90 Psychiatry and Responsibility citizenship. World citizenship can be widely extended among all peoples through the applications of the principles of mental health ....

it is evident that we stand on a new threshold of the science of man . . . . The sciences concerned with mental health derive from intensive studies of human beings .... and of the pathology of group functioning. These sciences are said to be based on findings that "have been tested by modern methods of analysis and investigation." 21 Brock Chisholm, a psychiatrist who has been very active and influential in these areas, expresses these opinions: If the race is to be freed from its crippling burden of good and evil, it must be psychiatrists who take the original responsibility .... The reinterpretation and eventual eradication of the concept of right and wrong are the belated objectives of practically all effective psychotherapy most psychiatrists and psychologists and many other respectable people have escaped from these moral chains and are able to observe and think freely." After pointing out eloquently various major defects of society, Dr. Chisholm insists that: With the other human sciences, psychiatry must now decide what is to be the immediate future of the human race. No one else can. And this is the prime responsibility of psychiatry.22 Again he exhorts psychiatrists saying, "Let us accept our own responsibility to remodel the world in bolder, clearer, more honest lines." He compares the reluctance of society to accept psychiatric guidance to the ignorance, prejudice, and supersti tion that still cause some parents to let their children die from diphtheria and smallpox despite the well-known fact that toxoid, antitoxin, or vaccination would have saved their lives. He seems to imply that a general resistance to the application of psychiatric discoveries also lies in "the attitudes of parents who are incapable of accepting and using proven know ledge for the protection of their children."

One who carefully reads Dr. Chisholm's addresses will see that Psychiatry: Science} Art andScientism 91 he means to offer something positive and constructive. Such a reader will not necessarily conclude, despite the impression given by his sweeping statements, that this eloquent advocate of psy chiatry really means to abolish all distinctions between right and wrong. I am concerned primarily with his apparent assumption that psychiatry now possesses special scientific knowledge that can enable us wisely to engineer such a profound and sweeping moral reorientation of mankind. Considering the scope on which he believes psychiatry must be applied, it is not surprising that Dr. Chisholm should insist on the necessity of "one or two or three millions" of traiped psychiatrists and advise that they also "be trained as salesmen and taught all the techniques of breaking down sales resistance." 23 Psy"chiatry and the Criminals Enthusiasm has been expressed for the dynamic psychother apy of criminals carried on over a period of many years. Obvi ously, it would be wise to cure these enemies of society and restore them to useful and happy lives instead of merely punishing them.

Many psychiatrists urge so vehemently treatment instead of pun ishment for the criminal that the reader would certainly be justified in assuming that effective and thoroughly proved meas ures of therapy are available. "Criminology today," Zilboorg and Henry wrote many years ago, "like demonology of yesterday, is a battlefield for the right ful possession of which the psychiatrist is still fighting." 24 Karl Menninger also said with confidence, "The scientific attitude as shown in psychiatry must sooner or later replace existing legal methods." 25 Karpman, in his Criminal Psychodynamics: A Plat form} almost militantly demands that society and the law recog nize that there is "newer light available," accept "well-tested, genuine, scientific psychiatric formulations," and provide means by which "psychogenic cases" can be treated. According to Karpman, "they can be cured, as many have been." Insisting also that "the criminal is more sinned against than sinning," he sends forth in the first issue of his new journal the Archives of Criminal 92 Psychiatry and Responsibility Psychodynam.ics a itclarion call to arms to all psychiatrists in terested in criminality" urging them "to bring forth material that will stimulate advancement in the field." 26 Karpman deplores the reactionary attitude of some psychiatrists who "are as yet unwilling to accept and absorb the more dynamic teachings that are subsumed under the heading of psychody namics." He says, "It is difficult to believe that in this day and age there. are psychiatrists who have missed so completely the import of the more progressive advances in medicine and science ....

who cannot see motives; who have neither grasped nor seemingly are 'constitutionally' able to grasp the meaning of unconscious motivations." 27 In tones like those of Cassandra, many authoritative voices ring out, warning us that we shall perish unless we quickly accept the new and scientific salvation. Dr. Robert Lindner, from his "vast experience" in "psychoanalytic practice" and in criminology, confirms the "theories of modern psychology" and finds them "sound." This sound knowledge, according to a statement on the dust jacket of his latest book, demonstrates "that all Western society is 'neurotic.'" Like so many who exhort us on behalf of mental health in terms of national or world-wide social revolu tion, Lindner speaks as a prophet certain of the truth revealed through Freudian discoveries and serenely confident of their efficacy: Psychology knows beyond question what in the world and in our responses to the world makes for personal unhappiness, waste, and failure; for neuroses, psychoses, and psychosomatic disorder on the personal level; for antagonism, aggression, hostility, and destruction on the person-to-person level; for strife, struggle, conflict, war,. and col lapsing societies on the group level. These things it knows. Diagnosti cally there is little fault to be found with psychology; it has reached a stage of near perfection. It is for its failure to take the next step, for its lack of courage, in short, that it should be criticized. For, knowing these things, knowing why and where the world must be changed-and even, in many cases, knowing how such changes can be wrought-it has done nothing to oversee that what must be done is swiftly done. 28 Psychiatry: Science, Art and Scientism 93 Lindner repeatedly insists that salvation is now within our grasp if only we could be persuaded to accept it: "The corpus of genuine knowledge about ourselves-which is the business of psychology-is immense. . . . it is available and will, it can be predicted, become immediately accessible to eyes that prepare themselves to see and brains no longer fogbound." He names a few of these "significant truths about ourselves, our place in the world and in the Universe:' but not all of them. "The list," he says, "is endless." It adds up, however, to a special orientation which, if adopted, will lead to no less than a "renewed lease for man on a planet that is now apparently mortgaged to death." 29 In contrast to these almost messianic assertions, the material furnished by Hakeem demonstrates clearly the confused and con tradictory concepts that are actually applied in the name of dynamic psychiatry at various mental hygiene clinics and other institutions to the problems of child rearing, to the prevention of delinquency and crime, and to their cure. His thoroughly documented survey illustrates with quotations from influential leaders in this vast area of mental health many conflicting im plausibilities and absurdities that are urged upon the public as a scientific panacea. 30 Some experts in child guidance seem certain they have proved that delinquency is an "acting out" of frustration when the child is thwarted in his normal satisfactions and emotional needs.31 The antisocial conduct is a pathetic "cry for help." Others are equally confident that most if not all the severe emotional disorders of childhood and adolescence can be shown to arise from maternal deprivation, usually during the first year or the first few years of life. This deprivation may result either from absence of the mother or from her inability or unwillingness to meet adequately the infant's emotional needs.32 Another widely recognized authority, Adelaide Johnson, pro fesses to have irrefutable proof that the delinquency of the child Qr teen..ager is caused by the parents' own unconscious im pulses toward antisocial conduct. The child, she tells us, is craftily used as a pawn and unconsciously encouraged in theft, 94 Psychiatry and Responsibility arson, sexual promiscuity, violence, or sexual perversion in order

to fulfill the parents' unconscious emotional needs to carry out such conduct themselves. Furthermore, unwilling to give up their vicarious criminal satisfactions, they actively block the psychia trists' attempts at therapy.33 Under these conditions it is plain that the parents also must have therapy and "the task of treating a delinquent becomes prodigious." One girl and her parents are described as receiving a minimum 'of twelve hours of psycho therapy each week "and this for months and years." 34 There is little wonder that Dr. Brock Chisholm has insisted that we must at once produce three million psychiatristsl Or that our federal government has provided funds to support and amply remunerate physicians if they give up their practices ·in other fields and under take training in psychiatry. An influential therapist, Eissler, accuses society of joining forces with the parents in this deliberate work of corruption. Society, she finds, does not want to rehabilitate the criminal or the de linquent. Through delinquents and criminals, she tells us, it relishes keenly its own criminal satisfactions. Even the authorities in correctional institutions (including psychiatrists), she has dis covered, sometimes work unconsciously to promote crime. This causes them to dismiss superintendents or therapists who attempt to introduce progressive measures. She sadly concludes, "Ap parently the community could not tolerate a future without criminality" and protests against "society's insistence that delin quency and crime be nourished and perpetuated." 35 While Wertham thinks that lurid sex and violence presented in the comic books constitute a major cause of delinquency, other experts ·attack censorship and imply that if obscene or semi obscene literature with plenty of four-letter words were readily available to all adolescents, perverse murder and other shocking acts of violence by teen-agers might be avoided or at least diminished. 36 Some authorities, such as Schmideberg, are less specific, but nevertheless optimistic: "Psychoanalysis, I can say with confidence, shapes up to be the most significant tool for research and treatment of the psychosocial disease called crime." 37 The criminologist, Hakeem, however, carefully examined the Psychiatry·... Science} Art· andScientism 95 effects of therapy reported by many ,mental hygiene clinics and other institutions in which these and other methods have been applied to large numbers of subjects. These reports strongly indi cate "that the number of therapeutic failures or successes is' the same irrespective of the school of thought to which the therapist has allegiance." The statistics so laboriously and expensively com piled were often rendered meaningless through lack of a control group by which delinquents andnondelinquents (and their parents) could be compared. Of one such study Hakeem suggests that a group of the participating social workers who were parents of nondelinquent children might have been utilized for this purpose. "The anal and oral conditions of the social workers could then have been compared with those of the parents of delinquents." When it was possible to make accurate comparisons between these children who had. been under therapy and' others who had not received any treatment or guidance, statistics indi cated approximately the same degree of improvement or worsen ing in each group over similar periods of time. No definite evidence emerged to indicate. that the thousands' of children and adolescents who had participated in these prolonged, extensive, expensive, and supposedly scientific programs received any benefit whatsoever.

Anyone who examines the material reviewed by Hakeem will find it hard to contradict him in his conclusion: "Actually, there is no specific medical or psychiatric treatment for delinquency . . . . at present, advocacy of one or another form of treatment is dictated more by passionate conviction than by scientific evi dence." Yet, as he has amply illustrated, "the zealousness of psychiatrists in making unsubstantiated claims and their success in winning support and in implementing their views seem boundless." 38 So far as I am able to determine, there are no statistical studies that contradict those analyzed by Hakeem, no published reports that furnish reliable evidence of any beneficial results from the operation of all the mental hygiene clinics that are spread over our nation. It is my own opinion that children are sometimes helped by such agencies. This, however, is merely my clinical 96 Psychiatry and Responsibility opinion, not an item of scientific evidence. My modest and tenta tive impression of possible benefits to some is not, let me add, anything comparable to the extravagant claims of the therapists quoted by Hakeem. If substantial benefit does occur, surely it is urgent that evidence be obtained to prove it. Many millions of dollars are expended each year to support this work, here and abroad. Real evidence of its efficacy would be useful to our gov ernment and to international agencies for mental health in determining whether to expand or curtail the present program; or whether, perhaps, to modify the prevalent methods of dealing with such problems.

I would like to suggest, in response to Karpmants vehement clarion call to psychiatrists, urging them to assert themselves in dealing with crime, that no material would stimulate advance ment in this field so much as evidence, even the smallest item of evidence, that psychodynamic measures have met with success. Even Bromberg, who seems to share much of Karpman's faith in dynamic explanations of criminality, frankly admits, "knowledge of psychologic motivation has neither solved nor prevented indi .. vidual crimes nor diminished the number of criminals." 39 UntiI it does, should we not be more modest in urging society to let us, with "our new scientific insight," empty the prisons and abolish crime? Society as the Villain The doctrine, of psychic determinism is regarded by many as one of Freud's most important discoveries. 40 It is a basic tenet of the dynamic psychiatry. Though it is often assumed to be a fact established by psychoanalytic research, we may note that Freud and all his followers have produced no scientific evidence to establish it. A truly logical conclusion from psychic determin ism would, of course, abolish the concept of personal responsibility altogether and along with it all the value judgments .that underlie ethical conduct and even rudimentary civilization. A genuine be lief in this doctrine would make it impossible to distinguish in Psychiatry: Science) Art and Scientism 97 value between the most sadistic unprovoked murder and the most heroic deed of altruism. This point is discussed by True blood in chapter 2 of this volume and we need not elaborate it here.

Let us bear in mind, however, that those who profess allegiance to the doctrine almost never follow it to the inevitable conclu sions it logically demands. There are many, nevertheless, who respond to its influence sufficiently to arrive at peculiar and inter esting assumptions. Some of these are now popularly regarded as the essence of a liberal and scientifically enlightened mind. Going part of the logical way, but not all the way, they conclude that when crimes are committed, the fault (responsibility) is never that of the criminal but, inevitably, of society. Some are less pro gressive and admit that the fault is shared about equally. Those who maintain that the guilt for crime. belongs, not to the malefactor, but to society, also often insist that legal penalties have little or no correctional value and little or no influence as a deterrent. This argument against the efficacy of penalty as a deterrent has been emphasized and reiterated Qve); many decades by those who oppose capital punishment. Despite the sincere conviction of people who hold this belief and their dedicated devotion to their cause, it is notable that none of them have called for the abolition of legal penalties for violations of the income-tax laws. Are we to assume that their convictions, through some subtle statute of limitations, fail to extend into this area?

We have noted that a number of authorities argue that the law is wrong in punishing culprits. As an example of the diverse views that may emerge when dynamic concepts are applied broadly and enter into social issues and value judgments, let us quote another prominent psychiatrist, Foxe, in his thoughts on the sub ject of crime and responsibility: Let us say that a man kills another man because the latter had been involvedin an act of infidelitywith the killer's wife. He readily might be acquitted. One wonders how a single act of sexual infidelity can be equated with a life. It really is perplexing to one who is not dominated 98 Psychiatry and Responsibility by a purely emotional reaction. Even the law is dogmatic in the matter; dogma usually develops where no one really knows the why. Let us look at it in another way. The man who has sexual relations with another man's wife, but is unable to recognize that the husband is a potential killer, is not a very smart person. Nor is the wife very smart to traffic with such a man. Perhaps society does not care very much, in such a case, if the man is deprived of his life and the wife is deprived of her pleasure. Hence, there is no crime. The advantage taken by the lover was minimal, and if he were alive, he might protest, in his own stupid way, that a crime had been committed in the attempt to kill him. Society would not pay much attention to him. "There was no crime!"

Here for once we seem to find a criminal psychodynamicist complaining of the jury's leniency rather than of its severity. Proceeding with his meditations, Foxe expresses the opinion that "obviously, a sex act is no 'great guns' "; but he concludes that the offended husband might logically have stronger grounds for his resentment through suspicions that, along with the act of adultery, his wife. might have more seriously damaged him by "making revelations to her lover of matters of domestic secrecy, dealing with possessions.... [etc.]." Before expressing the judgments just quoted, Foxe has casti gated "psychiatrists who believe the province of crime is not one for psychiatrists to meddle with or to probe for scientific understanding." Such men, he says, "may be professional psy chiatrists, but they are very lay scientists." 41 Do dynamic insights often bleach from the awareness of the specialist so much of what a normal man must naturally and inevitably feel under the circumstances described by Foxe? If so, there is little wonder that Hall and Cumming argue against leaving to such an expert the profound and complex duty of assessing another human being's ultimate guilt or innocence. 42 Most men, whatever their wisdom or scientific qualifications, hesi tate to assume so deep a responsibility, particularly on the basis of possessing proved or final knowledge. Perhaps the law is wise in leaving this to a jury of twelve laymen who, admitting their human frailties and imperfections of judgment, prayerfully do Psychiatry: Science} Art and Scientism 99 their best. It is a traditional belief that only God has true and unquestionable knowledge in such an issue.

Our society is being bitterly condemned by many as being cruel not only to arsonists, thieves, and murderers, but also to those who carry out flagrant acts of sexual perversion. Dr. Albert Ellis is a prolific author. According to information on the dust jacket of one of his books, he holds degrees from one of our most celebrated universities and practices "psychoanalytic therapy and marriage counseling." He has this to say about sex aberrations and society: In summation: sexual "perversion" is so universally condemned and deliberately suppressed in American society that very little frank, sly dog, or ribald undercover enjoyment of it is permitted. When it does express itself, it generally does so in an anxiety-ridden, morbid or ridiculously exaggerated way (e.g., the mincing manners and garish display of Greenwich Village homosexuals). This may be one reason why, while adultery, fornication, whoremongering and other immoral sex outlets are,utilized by millions of fairly normal Americans, homo sexuality, sado-masochism and other abnormal sex practices, when they are habitually and exclusively used as modes of sex participation, are so frequently concomitants of seriously neurotic behavior. It may not be sexually perverted acts which make a society sick or decadent, but society's own mores which, by their expressing unduly' harsh attitudes toward certain sex acts, render the acts "perverted" and "abnormal"

and thereby encourage their habitual or exclusive employment by many of society's neurotic members. 43 Just what is it that Dr. Ellis demands of society? What new attitude does he ask that we take toward, say, the sado-masochism he mentions? Should society tolerate and smile upon the deeds of a sadist who clubs to death and disembowels a seven-year-old child? Certainly he does not ask this. Neither the public nor the law now finds acceptable or respects as normal the act of a man who flagellates little girls moderately, or mildly, until he achieves a sexual orgasm. Is it this alleged popular prejudice and not the perversion itself that we should blame chiefly for the "morbid exaggeration" of milder sadistic enterprises into an act of murder?

100 Psychiatry and Responsibility If so, should we encourage, perhaps even applaud, the expression of sadism in its less drastic forms so that gross felonies and extreme disasters resulting from it may be avoided? In another book, Albert Ellis assures the public that partici pation in homosexual activity, along with heterosexual relations, has been proved by science to be entirely normal. He insists, furthermore, that men who strictly confine themselves to women as sexual partners must be regarded as "fixated," "neurotic," or "abnormal." In comparing exclusive homosexuality and exclusive heterosexuality, he finds them equally "fetishistic," somewhat quaintly insisting that "what is sauce for the goose is sauce for the gander." 44 If psychiatry has, indeed, produced aU these miracles claimed by some, she deserves to be called not merely Cinderella, as Menninger once did, but also the Fairy Godmother.

The Dynamic Science A technique long known to cause serious confusions of thought and errors of judgment is the "mixed-package concept." If we combine under one term an obvious truth and a ques tionable assumption and insist that they be accepted as a unity and that one verbal label be used to designate them, it is easy to see that rational thought and conduct are not thereby promoted. The basic psychoanalytic practice of using almost any resem blance, or even any symbolic contrast, to establish evidence of identity can scarcely fail to result in anything but a wholesale production of mixed-package concepts. According to dynamic postulates, the orifice of the ear, the anus, the mouth, the vagina, the opening of a milk bottle, and the nostrils are, in the unconscious, symbolically interchangeablE: and equated with one another. If a man inserts a finger tip in his ear to scratch, this act may constitute, not necessarily proof, but one item of evidence that he is anally fixated and wants to masturbate rectally.

Though such terms as "depth psychology" or "the new psy chology" are still occasionally used to designate this panacea, the Psychiatry: Science) Art and Scientism 101 more popular terms are "dynamic psychiatry," "dynamic psycho pathology," "dynamic psychotherapy," or "the psychodynamics." 45 These words "dynamic" and "psychodynamic" are endlessly re· iterated in the psychiatric literature and at our professional meet' ings. The uninitiated observer might wonder whether they serve as an incantation for a trance; or perhaps form part or a tribal ritual, a cabalistic outcry by which professional status seekers maintain or advance their position in a mystic hierarchy.4p Though the term "dynamic" has sometimes been used to indi .. cate more modest propositions, today it nearly always signifies the concepts and methods primarily derived from Freudian theory and discoveries that are said to support it. "Dynamic" is a flexible word with confident implications of force and effectiveness. It is particularly useful for verbally identifying two disparate items in a mixed-package concept. The contributions made by apostates of the strict orthodoxy (Stekel, Adler, Rank, Jung) and by Neo Freudians (Sullivan, Horney, Fromm) are usually accorded some measure of the blessing inherent in the term. Its most funda mental implication today is perhaps to separate the sheep from the goats, to distinguish those who claim (often among many other things) proved knowledge of the real causes of personality disorder and effective scientific methods for its cure from those benighted reactionaries who cannot make such a claim. 47 Let us list a few of the basic discoveries attributed to Freud and alleged to have galvanized psychology and psychiatry from hope less immobility into this dynamic state: That man is largely governed by motivations of which he is unconscious.

That a Royal Road has been made to this arcane region, and its con ten ts charted. That a reliable method of traveling to the unconscious has been devised and that it can be used freely by the elect who have learned its application. That a scientific and effective therapy has been developed for the psychoneuroses; and that this consists in making the patient aware of attitudes and forces in the unconscious so that he can then cope rationally with his conflicts. He must also interact 102 Psychiatry and Responsibility emotionally with the therapist (in "the transference") so that his conflicts may be diminished and his personality be, to some degree, remolded. 48 Let us now consider a few of the truths that have been pro claimed by all those who have traveled the Royal Road. Psychoanalytic expeditions into the unconscious are said to have demonstrated that the infant's ingestion of food and his defecation are really sexual activities and that components of normal adult sexual feeling remain anal and oral. Psychoanalysts believe they have proved that every little girl grows up under the humiliating misconception that she has been genitally mutilated and every little boy under the paralyzing dread that he may be castrated by his father because of his specific incestuous choice of his mother as a sexual mate. It is this dread that keeps him from making more persistent and obvious efforts to seduce the mother. These major ordeals of human childhood mayor may not be known even at the time to those who undergo them, but they occur universally in the unconscious. If the child becomes aware of them during the Oedipal period (age three to six years), they are nearly always repressed later and henceforth cannot be recalled except by dream interpretation and free association under the direction of an analyst, or, at least, of a "dynamic" psycho therapist. These fears continue as important motivational factors in the unconscious all through normal adult life.

The libido (defined as the energy of the sexual instinct-some times as the energy of Eros as a whole) is said to be always and totally masculine. 49 Any erotic initiative or response shown by a female, or any positive or energetic reaction in life, occurs only because of the masculine component of her being. Research along these lines has regularly demonstrated as a fact that all men and all women are bisexual. It has also been revealed that there are two basic drives (in stincts) that motivate the human being, one (Eros), which is creative and constructive, and the other, a death instinct (Than atos), which is aggressive and destructive and which may turn against its possessor and actively promote disaster for him or even his extinction. When either of the two drives seeks expression in Psychiatry: Science} Art and Scientism 103 a socially unacceptable form, the ego (containing the rational and reality-oriented levels of human function) represses the forbidden impulse by various mental mechanisms or dynamisms. The act of repression is unconscious. This strife produces the various mani festations known as psychoneuroses. If the effort is unsuccessful, the ego is shattered or grossly damaged and psychosis occurs. An incompletely successful effort to restrain the unacceptable impulse may result in repetitive delinquent, antisocial, or even criminal behavior through the mechanism termed "acting out." 50 What is the evidence for this current popular system of thought and practice? It has been repeatedly maintained that no one is capable of assaying the validity of Freud's discoveries (or assump tions) unless he himself has been successfully psychoanalyzed. 51 Since the analysis cannot be completed without devout acceptance of the basic doctrines, there is apparently no means recognized by the orthodox psychodynamicist of examining his theory except by agreeing with it. Despite this unusual and somewhat dis quieting obstacle, let us consider a few points.

One of these is Freud's method of investigation and of estab lishing proof for the conclusions he reached. His works contain many examples. Few are more typical than that given in his long paper "From the History of an Infantile Neurosis." 52 Here Freud presents his interpretation of a brief dream reported to him by a male patient (age twenty-six years) which, according to the patient's recollection, occurred when he was a little boy of four. In the dream a window opens before the foot of his bed reveal ing six or seven white wolves with big tails and pricked ears sitting in a large walnut tree. They are still but gaze at him attentively. The dream was accompanied by great terror. By in terpreting this simple dream symbolically, Freud reaches some remarkable conclusions. With a greater elasticity than that allowed the augurs of ancient Rome, Freud identifies various details of the dream on a basis of either similarity or dissimilarity with details of a dramatic scene that he vividly imagines and attributes as an actual experience to an infant eighteen months of age.

Out of this meager dream material Freud constructs a stirring little drama in which the infant watches his mother and father 104 Psychiatry and Responsibility have sexual relations three times in succession. This, however, is not all. The interpreter proves to his satisfaction that the amorous couple chose the a tergo position in which to enjoy themselves and that their infant son deliberately cut short their lively sport by having a bowel movement, which he used as a pretext for an outcry. The number of wolves in the dream (six or seven) indi .. cates to Freud that it was actually two people seen years earlier. The big, long tails of the wolves, according to Freud, indicate (by reversal) taillessness, which in turn reveals the infant's impression that a male genital organ had been amputated from the mother's perineum. The stillness of the wolves demonstrates the parents' vigor in coitus and the attentive faces of the wolves in the dream reveal the keen absorption of the baby boy in what his parents were doing. The fear experienced in the dream is taken by Freud as adequate evidence that, later at age four, his patient suffered great fear about castration at the hands of his father, which he thought would be provoked by an almost overwhelming urge he entertained for the father to carry out acts of sodomy upon him.

Decades later Freud expressed absolute conviction that he had scientifically demonstrated castration fear in this patient. ".... the analysis of his dreams," Freud wrote, "makes any other proof superfluous." ~3 Let us note that Freud, though convinced of his theory by items which he projected into this simple dream, did not ever report success in bringing out into the patient's consciousness any actual memories to confirm it. Nor was any other objective evi.. dence advanced to support the interpretation. No one, to my knowledge, has denied that this is a fair example of Freud's method~ The basic fallacy in reasoning by unsupported analogy, of course, was well known long before Freud lived, and the ab.. surdity of his method has been pointed out repeatedly by many authors, including the present one. Other basic reports on which Freud's doctrines rest have been carefully studied and, so far as I can determine, shown clearly to be the product of obvious and naive fallacies.~4 We have briefly illustrated the method by which castration fear was discovered and the sort of evidence by which it is can ..

Psychiatry: Science) Art and Scientism 105 sidered to be established. If the absence of real evidence for the articles of faith becomes inescapably obvious, an illusion of evi dence can always be obtained by changing the definition of plain words until they include such truisms that they no longer have specific referents. After maintaining that "the threat of castration lies over the pubertal boy," and insisting that this fear is universal earlier in life, Brown, in his popUlar textbook The Psychody namics of A bnormal Behavior, thus defines his term: By the castration complex, psychoanalysts understand much more of infantile behavior than is shown in the fear of actual castration. The castration complex covers fears of all sorts of painful retaliation on the part of the parents because of the sexual and aggressive wishes of child hood .... Possessivelove in the child leads to jealousy, which leads to imagined aggressions, which lead to the fear of punishment (castration as only one form) for these imagined aggressions and fear of the loss of the love of the one who is the object of the aggressions. The castration complex refers to the whole behavioral situation ...55 Let us use Brown's logic for one moment. Suppose I say that in the meadow on which we look I have discovered a piebald uni corn grazing among the dozens of horses, cows and sheep that are in plain view to everyone. Other observers investigate the meadow but cannot find the unlikely creature that I have re ported. I thereupon extend the definition of my piebald unicorn and subsume under that term all horses, cows and sheep, and perhaps all goats as well. If I am allowed this privilege, I can immediately demonstrate not only one but many piebald uni corns in the meadow.

Articles published in our most respected psychiatric journals during the last few years show even further the easy infallibility of that cherished method. In these articles some dare to venture even farther than the master into uncharted and, to most psychiatrists, implausible areas of the dynamic unconscious. 56 Both Peerbolte and Fodor, like Freud confidently relying upon symbolism to establish proof, interpret their patients' dreams and report in detail discoveries of intrauterine experiences that befell them long before birth. 57 106 Psychiatry and Responsibility I should like to consider the possibility that sometimes a method developed on the basis of dubious or even demonstrably false assumptions will show some efficacy in its practical applica tion. For decades it was maintained by many learned men that breathing night air caused malaria ("bad air"). Those who acted in accordance with this false belief often avoided the Anopheles mosquito which is more active at night. And so they escaped malaria. Could the case be similar with the effects of dynamic princi pIes?

The reports we have so far discussed do not indicate success for the dynamic methods in dealing with delinquency or crime. Delinquency and crime are not, to be sure, the original province of dynamic psychiatry. Freud, unlike some of his successors, never pretended that psychoanalysis is an effective therapy for the psychoses. Though various dynamic measures are advocated today as an effective remedy for schizophrenia 58 and for manic-depre.s sive psychosis,59 no statistical validation has been offered to sub stantiate their worth. The method of psychoanalysis was, of course, devised by Freud during his treatment of the neuroses (psychoneuroses), and it was for these conditions that he thought it effective. During a period of more than sixty years psychoanalysis has been available for this purpose. During the last two decades particularly, tens of thou sands of patients have also been treated by various modifications of Freud's orthodox technique. They are dynamic psychotherapy, group therapy, psychoanalytically oriented psychotherapy, and methods developed from the currently popular ego-psychology. If we seek to appraise the effectiveness of dynamic methods, surely it is here that we are most likely to find evidence of convincing success.

A number of statistical studies have been made through which the results of prolonged psychoanalytic therapy can be compared with the results of simpler, much shorter, and less ambitious psychotherapeutic measures such as those often used by a physician in general practice. 60 Other statistics are available that show the progress or lack of progress in comparable groups of people with similar neurotic disorders who received no specific psychiatric Psychiatry: Science) Art and Scientism 107 treatment at all over approximately the same period of time during which treated patients were undergoing psychoanalysis. 61 Eysenck, on the basis of data available to all of us, thus sum marizes the results of these comparative studies: We thus lind that among neurotic patients being treated. by psycho analytic or eclectic psychotherapy, about two out of three recover. Similarly, among neurotics treated by their general practitioners along non psychotherapeutic lines, or obtaining simple custodial care, again two out of three improve. It is difficult to interpret these results as supporting in any way the hypothesis that psychotherapy has a bene ficial effect. These are the facts: It would be easy to take them too seriously and conclude that psychotherapy had no effect at all. It would be equally easy-and equally wrong-to discard them altogether by saying that the data here summarized are too faulty to deserve serious consideration. The data are faulty, but they are the only ones in existence; if we are to look for any justification for mod ern psychotherapeutic practices, it is to them that we must look, and if we do that, the conclusion is inescapable-not that they prove psycho therapy to be valueless, but rather that they fail conspicuously to show any positive consequences to follow its use. It is still possible that more adequate research may disclose such effects, but until such research has been carried out, we must surely conclude with the old Scottish verdict of not proven. 62 The Effects of Dynamic Psychology on Society Who can estimate the impact of this new psychology on the public, on man's conception of himself, on his orientation toward his fellows, on his sense of what he will try to live by and for?

Though the notion of human beings not possessing full insight into their deepest motivations was hardly an entirely new idea, there is no reason to doubt that Freud's concept of the uncon scious has focused more attention on this point than had ever been devoted to it before. 63 One cannot doubt that this has stimulated introspection. But how much did both accurate and inaccurate notions of the allegedly universal Oedipus situation influence the spontaneity 108 Psychiatry and Responsibility of mothers toward their/ young sons? Did these concepts playa small or a large part in the doctrines of infant training almost universally accepted as the gospel of science twenty-five years ago? Those rigid schedules for feeding, precise regulations about immutable discipline, those stern admonitions against going to the infant who began to cry, were emphatically enunciated in a little booklet furnished by the United States Public Health Service and warningly entitled Are You Raising Your Child to Be Happy? Both pediatricians and psychiatrists (including even the most dynamic ones) teach parents today almost directly the oppo site behavior and attitude. The booklet was discontinued long ago.

Even today, however, we occasionally encounter a mother who takes care that her five-year-old son never catch a glimpse of knives or scissors because "every little boy lives under the fear that he is going to be castrated." 64 Despite the inefficacy and even the absurdity that seems plain in some of their applications, those who promote the psychodynamic concepts continue to proclaim them as scientific truths. Their influence on mental health programs in our country and on the world health movement seems to be increasing. Does this indicate that basically the principles are sound, that they will eventually prevail, and, perhaps in a somewhat modified form, rejuvenate society? Perhaps. Let us, however, note several points. The history of medicine shows that the testing of therapeutic agents is not nearly so simple as one might think. Even in the lifetime of our fathers those who developed appendicitis ("acute indigestion") were often fatally purged. It was considered wise to bleed the already virtually exsanguinated patient with pernicious anemia. 65 Where real knowledge is fragmentary at best, it is natural for man to welcome avidly hypotheses that he would ridicule if in troduced into areas where knowledge is established. No sane man with a medical education takes seriously the creed of chiropractic.

It is, however, perfectly logical, once we overlook its faulty prem ise. I think it probable that a hundred years ago this creed might have seemed not only a plausible hypothesis but even a brilliant scientific discovery to some of the best minds in medicine.

Psychiatry: Science} Art and Scientism 109 In areas where the testing of hypotheses is extremely difficult, hypotheses may survive indefinitely and even in time become regarded as factual or largely factual. When some logical system based on an incorrect but inaccessible premise is offered, our feelings prompt us toward accepting it. This is pleasant and seems more promising than to admit freely our ignorance and accept this ignorance with patience. The mere fact that orthodox psychoanalysis usually takes several years to complete makes it extremely unlikely for failure to become apparent, and almost impossible for gross inefficacy to be proved. Though general medical knowledge is by no means complete, it is almost infinite compared to genuinely demonstrable knowl .. edge in psychiatry. The currently popular system of psychody.. namics developed in an area almost entirely barren and has continued to grow in response to an acute need for understanding in what may be the most complex and inaccessible realm of darkness ever to confront mankind.

We seldom recall the fact that during and just after World War I many eminent, sincere, and astute psychiatrists and neurolo gists discovered and proved beyond any reasonable doubt that schizophrenia is caused by specific lesions in the brain. Vast amounts of microscopic evidence supported their discoveries.66 Southard, who was without question one of the most able and revered of all American psychiatrists, could, by merely running his practiced hand over a brain at autopsy, discover with cer.. tainty whether or not the patient had been afflicted with schizo phrenia. He could also determine whether a patient had heard hallucina,tory voices or suffered only from paranoid delusions. Areas of varying density in one lobe of the brain or another re vealed these amazing facts.o7 The cause of these changes in the brain was also discovered and the cure of schizophrenia widely proclaimed. Chief among those who seemed to be emptying the mental hospitals was Cotton who, along with others, had found that a toxin caused by focal infections produced the specific brain damage in this dread ..

ful, widespread, and heretofore mysterious disorder. os The belief that toxins from foci of infection caused psychiatric disorder was 110 Psychiatry and Responsibility not new. It is mentioned by William James just after the turn of the century in his lectures published later as the well-known book Varieties of Religious Experience. The final confirmation of this, however, awaited the work of Cotton and his colleagues, which, in the 1920's, seemed to establish positively the cause of schizophrenia and demonstrate its cure. The psychotic patients examined by Cotton were found "without exception" to have "infected teeth." About fifty per cent of the males showed infec tion of the seminal vesicles. A large percentage of the women impressed these investigators as having an infection of the uterine cervix. There also seemed to be evidence of infection in the colon and the tonsils of both men and women. Foci of infection were also found in many other organs and regions of the body.

A clarion call for surgery rang ou t. Teeth were extracted willy nilly. Tonsils, uteruses, and seminal vesicles were excised without delay. It is difficult to estimate how Inany yards of the human in testinal tract were surgically removed in this tremendous scientific breakthrough. Antitoxins were devised to combat the effects of bacteria lodged in any overlooked or inaccessible organ. The results appeared to be marvelously successful and were thought by many to prove a toxic cause and surgical cure of schizophrenia. It did not take many years to test Cotton's theory and methods and to find them entirely worthless. The results or lack of results from such surgery, unlike those from procedures that extend over years, could be determined in a short period. Even in this short period there were apparently enough spontaneous changes in these patients to convince many intelligent and technically trained observers that the surgery was effective.69 Despite the skepticism expressed about some of our most popular theories and our extraordinarily optimistic efforts to shed light on fields of endeavor not yet within our province of com. petency, I am by no means discouraged about the progress of psychiatry. Apparently most of psychiatry's spokesmen who are well known to the public profess the creed of psychodynamics.

But I still believe that only a minority of our profession attempts rigorously to treat patients in accordance with its basic theories. Today, nearly all the officially qualified psychoanalysts that I Psychiatry:ScienceJ Art and Scientism III know seem to be concerned mote with what is often called ego psychology than with attempts to make patients aware of emo tional traumata sustained when nursing at the breast or while shuddering (unconsciously) at the dangers of genital dismember ment by the father. Even those who seem to accept the remarkable things 14reud is said to have revealed about the unconscious tell me that they find it more effective to work at functional levels of the personality remote from the hypothetical region where these recondite memories are said to lurk in their abode. There are some common and very severe psychiatric disorders for which I believe treatment has improved since my years in medical college fully as much as the treatment of pneumonia and far more than the treatment of tuberculosis. The most effective therapeutic measures that I know in psychiatry are altogether empirical. They are not based on a scientific knowledge of the disorder's cause. It would be a relief to learn the real causes of these common disorders or of any other psychiatric illness. I think, however, that an effective remedy without adequate knowl edge of the cause is far more valuable than knowledge of the cause without the remedy.

Among the therapeutic measures that I consider valuable is psychotherapy. This, too, in my opinion, is still chiefly empirical. I cannot, like some, proclaim it as a scientifically understood process or as a regular Iy effective cure for severe psychiatric ill ness (or for criminals). But, in a more modest sense, it has, I think, earned a worthy place not only in psychiatry but in all of medicine and surgery. Psychotherapy may eventually prove itself of value in the mental hygiene and child guidance clinics that have arisen all over our nation. There is, however, no evidence yet that it will be the messianic force described by its more en thusiastic devotees or that it will accomplish even a small fraction of the miracles that the public has been led to expect of it. It would be difficult for me to prove that any psychotherapy today is appreciably more scientific than psychotherapy as it was sometimes practiced in 1900. It would be hard to convince me, nevertheless, that efforts toward psychotherapy are not far more regularly and persistently made. However nearly correct or fan112 Psychiatry and Responsibility tastically wrong Freud may eventually be proved, there is no doubt that his genuinely sincere efforts have stimulated a search for means of psychotherapy as well as man's attempt to under stand himself and his fellows. Even if his assumptions finally should turn out to be no more accurate than those of Gall and the other phrenologists about cerebral localization, his contribu tion to introspection will make him remembered always, and with honor.

NOTES 1. Karl Menninger, "Fundamentalism and Modernism in Psychiatry, U. s. Naval Bulletin~ XXVII (April, 1929), 291..297. T. W. Salmon, "Psy" chiatry, Cinderella of Medicine: A Modern Fairy Story," Medical Journal and Record~ CXXXIV (September 2, 1931), 253-254. 2. C. P. Oberndorf, A History of Psychoanalysis in America (New York: Grune & Stratton, 1953), p. 7. 3. F. J. Hoffman, Freudianism and the Literary Mind (Baton Rouge: Louisiana State University Press, 1945), p. 208. 4. Arthur Clutton-Brock, "Evil and the New Psychology," Atlantic Monthly~ March, 1923. 5. W. David Sievers, Freud on Broadway (New York: Hermitage House, 1955). 6. Robert E. Sherwood, Reunion in Vienna (New York: Random House, 1936), pp. 759·822. 7. Karl Menninger, The Human Mind (New York: Alfred A. Knopf, 1947); Searchlights on Delinquency; New Psychoanalytic Studies~ ed. by K. R. Eissler (New York: International Universities Press, 1949); Benjamin Karpman, "Criminal Psychodynamics: A Platform," Archives of Criminal Psychodynamics~ I (Winter, 1955), 3-100; Robert Lindner, Prescription for Rebellion (New York: Rinehart & Co., Inc., 1952); "Mental Health and World Citizenship," World Federation for Mental Health (London: ll~ K. Lewis & Co., Ltd., 1948).

8. Michael Hakeem, "A Critique of the Psychiatric Approach to Crime and Correction," Crime and Correction (North Carolina: Duke Uni versity School of Law), XXIII (Autumn, 1958), 650..682. G. Zilboorg, Mind~ Medicine and Man (New York: Harcourt, Brace & Co., Inc., 1943). 9. Lindner, op. cit. 10. Jerome Hall, "Responsibility and Law: In Defense of the McNaghten Rules," Journal of the American Bar Association~ XLII (October, 1956), 917-919, 984·989; J. B. Cumming, "The Role of the Psychiatrist in Criminal Triab," American Journal of Psychiatry} CXV (December, 1958), 491-497.

Psychiatry: Science) Art and Scientism 113 11. Abe Fortas, "Implications of Durham's Case," American Journal of Psychiatry, CXIII (January, 1957), 575-582. 12. S. E. Sobeloff, "Sanity and the Criminal Law: From M'Naghten to Durham and Beyond," American Bar Association Journal, XLI (Sep tember, 1955), 793. 13. Hakeem, M., Ope cit., p. 652. 14. Jerome, Hall, Ope cit.., p. 918. 15. Michael Hakeem, "A Critique of the Psychiatric Approach to the Prevention of Juvenile Delinquency," Social Problems, V (Winter, 1957 1958), 194-206. 16. Michael Hakeem, "A Critique of the Psychiatric Approach to Juvenile Delinquency," Juvenile Delinquency, ed. by Joseph S. Roucek (New York: Philosophical Library, 1950). 17. Ralph S. Banay, Youth in Despair (New York: Coward·McCann, 1948); Report of the Committee on the Judiciary, U. S. Senate, 85th Congress, 1st session (Washington, D. C.: Government Printing Office, 1957); Lucien Bovet, "Psychiatric Aspects of Juvenile Delinquency," Mono graph Series No.1 (Geneva World Health Organization, 1951); Help ing Children in Trouble (Washington, D. C.: U. S. Children's Bureau, 1947).

18. Report of the International Group of Experts on the Prevention of Crime and the Treatment of Offenders, Economic and Social Council, United Nations (New York, August 9, 1949); European Social Welfare Seminar, United Nations (New York, 1950); "The Prevention of Juvenile Delinquency" (report prepared by the Secretariat of the U.N.); International Review of Criminal Policy, No. 7-8, United Nations (New York, January-July, 1955). 19. Minutes of Evidence Taken before the Royal Commission on Capital Punishment (His Majesty's Stationery Office, 1949). 20. E. Eduardo Krapf, Editorial, World Health, June, 1959. 21. Mental Health and World Citizenship, a statement prepared for the International Congress on Mental Health (London: H. K. Lewis & Co., Ltd., 1948). 22. Brock Chisholm, "The Re-establishment of Peacetime Society," Psychi atry, IX (February, 1946), 3-20. 23. Ibid. 24. G. Zilboorg and George W. Henry, A History of Medical Psychology (New York: W. W. Norton & Co., Inc., 1941).

25. Menninger, The Human Mind (1947), pp. 448-449. 26. Karprnan, see above, note 7. 27. Ibid., p. 5. 28. Lindner, Ope cit., pp. 211-212, see note 7. 29. Ibid. 30. Hakeem, see all his publications cited above. 31. William Healy and Augusta F. Bronner, New Light on Delinquency and Its Treatment (New Haven: Yale University Press, 1936); John Dollard et. al., Frustration and Aggression (New Haven: Yale University Press, 1939); Herbert A. Bloch and Frank T. Flynn, Delinquency: The 114 Psychiatry and Responsibility Juvenile Offender in America Today (New York: Random House, 1956). 32. John Bowlby, Maternal Care and Mental Health, Geneva World Health Organization, Monograph Series No.2 (1951); Lauretta Bender, Aggres sion, Hostility and Anxiety in Children (Springfield: Charles C. 'rhomas, Publisher, 1953); Margaret A. Ribble, The Rights of Infants: Early Psychological Needs and Their Satisfactions (New York: Columbia University Press, 1953); John Bowlby, Forty-Four Juvenile Thieves: Their Character and Home Life (London: Bailliere, Tindall & Cox, 1946).

33. Adelaide M. Johnson, "Sanctions for Superego Lacunae of Adolescents," Searchlights on Delinquency : New Psychoanalytic Studies, ed. by K. R. Eissler (New York: International Universities Press, 1949); Adelaide M. Johnson and S. A. Szurck, "Etiology of the Antisocial Behavior in Delinquents and Psychopaths," Journal of the American Medical Asso ciation, CLIV (March 6, 1954), 814-817. 34. Mary E. Giffin, Adelaide M. Johnson, and Edward Liten, "Specific Factors Determining Antisodal Acting Out," American Journal of Orthopsychiatry, XXIX (October, 1954), 673. 35. Ruth S. Eissler, "Scapegoats of Society," Searchlights on Delinquency: New Psychoanalytic Studies, ed. by K. R. Eissler (New York: Interna tional Universities Press, 1949). 36. Eberhard and Phyllis Kronhausen, Pornography and the Law (New York: Ballantine Books, Inc., 1959). 37. Melitta Schmideberg, "Psychoanalysis of Delinquency," American Journal of Orthopsychiatry, XXIII (1953), 13-21.

38. Hakeem, see notes 15 and 16 above. 39. Walter Bromberg, "Crime: Is There a Cause or Remedy?" A rchives of Criminal Psychodynamics, I (Spring, 1955), 326-343. 40. Arnold M. Ludwig, "The Other Side of the Coin," The New Physician, IX (August, 1960), 56-58. 41. Arthur N. Foxe, "Crime and Advantage," Archives of Criminal Psychodynamics, I (Spring, 1955), 247-256. 42. See above, note 10. 43. Albert Ellis, The Folklore of Sex (New York: Charles Boni, 1951). 44. Albert Ellis, The American Sexual Tragedy (New York: Twayne Publishers, Inc., 1954). 45. Karpman, op. cit.; see note 7 above. 46. H. M. Cleckley and C. H. Thigpen, "The Dynamics of Illusion," American Journal of Psychiatry, CXII (November, 1955),334-342. 47. Karpman, op. cit.; see note 7 above. 48. Sigmund Freud, Basic Writings of Sigmund Freud (New York: Random House, Inc., 1938). 49. Sigmund Freud, An Outline of Psychoanalysis (New York: W. W.

Norton & Co., Inc., 1949). 50. Franz Alexander, "The Neurotic Character," International Journal of Psychoanalysis, II (1930), 292-311; Otto Fenichel, The Psychoanalytic Theory of NeuTosis (New York: W. W. Norton & Co., Inc., 1945).

Psychiatry: Science) Art and Scientism 115 51. H. J. Eysenck, The Uses and Abuses of Psychology (London: Penguin Books, 1953). 52. Sigmund Freud, Collected Papers, III (London: Hogarth Press, Ltd., 1943), 473-605. 53. Sigmund Freud, The Problem of Anxiety (New York: W. W. Norton & Co., Inc., 1936). 54. Orville S. Walters, "A Methodological Critique of Freud's Schreber Analysis," The Psychiatric Review, XLII (October, 1955), 321-342; Joseph Wolpe and Stanley Rachman, "Psychoanalytic 'Evidence': A Critique Based on Freud's Case of Little Hans," The Journal of Nervous and Mental Disease, CXXX (August, 1960), 135-148. 55. J. F. Brown, The Psychodynamics of Abnormal Behavior (New York: McGraw-Hill Book Co., Inc., 1940). 56. D. E. R. Kelsey, "Phantasies of Birth and Prenatal Experiences Re· covered from Patients Undergoing Hypnoanalysis," The Journal of Mental Science, XCIX (April, 1953), 216.,223.

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