PSYCHIATRY, that branch of medicine which deals with diseases of the mind. Histor ically while mental diseases have always been recognized, they have often been thought to be of divine or diabolical origin and their con sideration has been hopelessly entangled with religion and with metaphysical speculation. Even after mental diseases came to he recog nized as the legitimate occupation of medicine their study was for a long time confined to the more serious varieties, collected under the cap tion "insanity," which were found only in the asylums, and correspondingly the study of these patients and their illnesses became a dis tinct specialty of the asylum physicians (alien ists). The practice of mental medicine in this restricted field tended for a long time to be little more than the custodial, albeit kindly care, of the seriously ill of mind. The great mass of practitioners of medicine had little or no interest in the subject. During the asylum period in the history of psychiatry very little was accomplished in the way of the scientific development of this branch of medicine. Its very isolation operated to prevent its growth and when finally progress did gain access to the asylum it was more occupied with humani tarian than with more strictly scientific prob lems. Then, too, the sciences upon the basis of which a firm foundation for psychiatry could be laid were not far enough advanced to warrant much progress. The science of psy chology was honeycombed with metaphysical speculations and has only come to a systematic effort at an experimental elaboration of its data during the past generation. As a result of these conditions the early history of psychiatry is a history of more or less crude speculations, classifications and descriptions. Little was sus pected of underlying causes and metaphysical discussions of the relation of mind and body effectually prevented all practical considera tions of human behavior.
Present-day psychiatry has been made pos sible by the advances which have been made in the sciences upon which it rests, particularly by the advances in psychology, or more particu larly that department of psychology which deals with abnormal mental reactions, namely psychopathology. A better understanding of the nature of mind and its position in the gen eral evolutional scheme has made it evident that mental disease is the psychological mani festation of difficulties and defects of adjust ment due either to causes operating within (endogenous) or from without (exogenous). Psychiatry thus becomes concerned with dis covering these causes and makes a therapeutic approach to the problem presented by the symp toms of mental diseases by attempting to se cure a better adjustment by removing the causes, avoiding their operation, or effecting some compromise solution. Inasmuch as de fects of adjustment of some sort are present in practically every one, psychiatry has come to deal with all problems of mental health and not only the severe types of maladaptation found in the hospitals for the insane. Its therapeutic armamentarlum includes not only all of the mechanical (surgery) and chemical (drug) methods of general medicine, but psychological methods (psychotherapy) as well as efforts at social rehabilitation and readjustment. It therefore includes the whole field of mental medicine, reaching into the field of social adap tation as a very important point of its domain and including, on the preventive side, the prob lems of mental hygiene.
To particularize the more important fields in which psychiatry has become important in recent years. In the first place there is of
course the field of the so-called insanities or the frank psychoses such as we see in the hospitals for the insane. This field has been greatly broadened of late by appealing to patients to seek the assistance of the hospital before be coming seriously ill and availing themselves of the hospital's help after recovery to re-establish themselves socially. Then there is the immense field of the defective including the problems of the idiot and imbecile; the backward child in the school; and the innumerable problems of social maladaptation which have their roots in defectiveness such as many of the problems of prostitution, criminality and poverty. The whole field of criminology belongs essentially in the domain of psychopathology and thus comes within the practice of mental medicine psychiatry. The most important field of mod ern psychiatry is perhaps the neuroses and psy choneuroses, which include those conditions known as hysteria, neurasthenia, obsessions, doubts, fears, impulses, etc. The persons who manifest this group of symptoms are not infre quently well endowed mentally, but their effi ciency is greatly impaired by their illness. They can now be greatly helped by appropriate psy chotherapeutic treatment. A study of these conditions has shown so clearly the conditions from which they grow that a further advance in preventive medicine along these lines will project the findings of psychiatry upon the problems of education and in fact the whole great group of problems involved in successful living. The principles which are found appli cable to all these various abnormal conditions are as truly applicable to transient mental disturb ances in quite normal people such for example as various types of nervousness, unhappiness or difficulties of adjustment dependent upon some character trait. The differences between the normal and the abnormal mind is only one of degree so that the field of psychiatry has now broadened to include what but a short time ago would have been considered the normal but where minor maladjustments prevent the full est efficiency.
Krtepelin, Emil, 'Lectures on Clinical Psychiatry' (authorized translation from the German by Thomas Johnstone, New York 1904); Jelliffe, Smith Ely and White, William A., 'Diseases of the Nervous System' (New York and Philadelphia 1917) ; id. (eds.), 'The Modern Treatment of Nervous and Men tal Diseases' (by American and British au thors, ib. 1913); White, William A.. 'Mechan isms of Character Formation' (New York 1916); id., 'Principles of Mental Hygiene' (New York 1917) ; id., 'Outlines of Psychiatry' (Washington, D. C., 1918): Tanzi, Eugenio, 'A Text book of Mental Diseases' (authorized translation from the Italian by W. Ford Roberston and T. C. Mackenzie, London 1909); Tuke, D. Hack,