Carl Jung 卡尔 荣格
320 Psychiatry is a stepchild of medicine. All the other branches
of medicine have one great advantage: the scientific method. In all other branches there are things that can be seen and touched, physical and chemical methods of investigation to be followed. The microscope reveals the dreaded bacillus, the surgeon’s knife halts at no anatomical difficulty and gives us glimpses into the most vital and inaccessible organs. Psychiatry, the art of healing the soul, still stands at the door, seeking in vain to weigh and measure as in the other departments of science. We have long known that we have to do with a definite organ, the brain; but only beyond the brain, beyond the anatomical substrate, do we reach what is important for us-the psyche, as indefinable as ever, still eluding all explanation, no matter how ingenious.


321 Former ages, endowing the soul with substance and personi-
fying every incomprehensible occurrence in nature, regarded mental illness as the work of evil spirits; the patient was looked upon as one possessed, and the methods of treatment were such as befitted this conception. It is not unknown for this medieval view to find credence and expression even today. A classic example is the expulsion of the devil which was successfully per¬formed by the elder Pastor Blumhardt in the famous case of the Dittus sisters. 1 To the honour of the Middle Ages be it said that there were also early evidences of a sound rationalism.


Thus, in the sixteenth century at the Julius Hospital in Wiirzburg, mental patients were already being treated side by side with the physically sick, and the treatment seems to have been really humane. With the opening of the modern era and the dawn of the first scientific ideas, the original barbaric personification of unknown powers gradually disappeared; a change arose in the conception of mental disease in favour of a more philosophic moral attitude. The ancient view that every misfortune was the vengeance of offended gods returned in a new guise to suit the times. Just as physical diseases can, in many cases, be traced back to some frivolous self-injury, so mental diseases were believed to be due to some moral injury, or sin. Behind this conception, too, lurks the angry deity.


1 Bresler, “Kulturhistorischer Beitrag zur Hysterie” (1897); Zlindel, Pfan’er J. C. Blumhardt (1880). [Also Cal”ter, Pastor Blumhardt.-EDIToRs.]

322 Such views played a great role right up to the beginning of
the last century, especially in German psychiatry. In France, however, at about the same time, a new idea was appearing, des¬tined to sway psychiatry for a hundred years. Pinel, whose statue fittingly stands at the gateway of the Salpetriere in Paris, re¬moved the chains from the insane and thus freed them from the stigma of the criminal. In this way he gave the most effective expression to the humane and scientific conceptions of modern times. A little later Esquirol and Bayle made the discovery that certain forms of insanity ended in death after a relatively short time, and that regular changes in the brain could be demon¬strated post mortem.2 Esquirol had discovered general paralysis of the insane (or, as it was popularly called, “softening of the brain”), a disease which is always accompanied by chronic in¬flammatory shrinkage of the cerebral tissue. Thus was laid the foundation of the dogma which you will find repeated in every text-book of psychiatry: “Mental diseases are diseases of the brain.”


323 Further confirmation of this view was furnished about the
same time by the discoveries of Gall, who traced partial or com¬plete loss of the power of speech-a psychic faculty-to a lesion in the region of the lower left frontal convolution. Later this view proved to be exceedingly fruitful. Innumerable cases of extreme idiocy and other serious mental disorders were found to be caused by tumours of the brain. Towards the end of the nine¬teenth century Wernicke (recently deceased) localized the speech-centre in the left temporal lobe. This epoch-making dis¬covery raised hopes to the highest pitch. It was expected that the time was not far off when every characteristic and every psychic activity would be assigned its place in the cortical grey matter. Gradually, more and more attempts were made to trace the primary mental changes in the psychoses back to parallel changes in the brain.

2 [For these and other historic medical personages mentioned in this volume, cf. ZiIboorg and Hemy, History of Medical Psychology, index, S.V.-EDITORS.]



Meynert, the famous Viennese psychiatrist, pro¬pounded a regular system in which the alteration of the blood-supply to certain areas of the cortex was to play the chief role in the origin of the psychoses. Wernicke made a similar but far more ingenious attempt at an anatomical explanation of psychic’ disturbances. One visible result of this tendency can be seen in the fact that nowadays even the smallest and most out of the way asylum has its anatomical laboratory, where cerebral sections are cut, stained, and examined under the microscope. Our numerous psychiatric journals are full of morphological con¬tributions, investigations on the path of the fibres in the brain and spinal cord, on the structure and distribution of cells in the cerebral cortex, and the various ways they are destroyed in dif-ferent mental diseases.


Psychiatry has been charged with gross materialism. And quite rightly, for it is on the road to putting the organ, the instrument, above the function-or rather, it has long been doing so. Function has become the appendage of its organ, the psyche an appendage of the brain. In modern psychiatry the psyche has come off very badly. While immense progress has been made in cerebral anatomy, we know practically nothing about the psyche, or even less than we did before. Modern psychiatry behaves like someone who thinks he can decipher the meaning and purpose of a building by a mineralogical analysis of its stones. Let us try to form a statistical picture of the number and types of mental patients who show any clear lesions of the brain.


In the last four years we have admitted 1,325 mental patients to Burgholzli Mental Hospital-some 331 a year-of whom 9% suffer from constitutional psychic anomalies. By this I mean an inborn defect of the psyche. Of the 9%, about a quarter are imbeciles, congenitally feeble-minded. In them we find definite cerebral changes such as congenital microcephalus, pronounced hydrocephalus, and malformation of certain parts of the brain. The remaining three quarters of the psychopathically inferior show no trace of typical findings in the brain.


Three per cent of our patients suffer from epileptic mental disturbances. In the course of epilepsy a typical degeneration of the brain gradually sets in, which I cannot describe more closely 160


here. The degeneration is demonstrable only in severe cases and after the illness has lasted a long time. If the attacks have been present for a relatively short time only, not more than a few

years, as a rule nothing can be discovered in the brain.


Seventeen per cent of our patients suffer from progressive
paralysis and senile deterioration. Both diseases present char-acteristic cerebral findings. In progressive paralysis there is regu¬larly an extensive shrinkage of the brain, so that the cerebral cortex in particular is often reduced by one half. Especially the frontal portions of the brain may be reduced to a third of the normal weight. A similar destruction occurs in senile deteriora¬tion ..


Fourteen per cent of the patients admitted annually suffer from poisoning, at least 13% of the cases being due to alcohol. As a rule, in milder cases nothing can be found in the brain; only in relatively few of the more severe cases is there a slight shrinkage of the cortex. The number of these severe cases amounts to less than 1 % of the yearly cases of alcoholism.


Six per cent of the patients suffer from so-called manic-de-pressive insanity, which comprises the manias and the melan¬cholias. The essence of this disease can be understood even by the layman. Melancholia is a condition of abnormal sadness with no disturbance of intelligence and memory. Mania is the opposite, the rule being an abnormally excited state with great restlessness, but without any deeper disturbance of intelligence and memory. In this disease no morphological lesions of the brain can be demonstrated.


Forty-five per cent of the patients suffer from the authentic and common disease known as dementia praecox. The name is a very unhappy one, for the dementia is not always precocious, nor in all cases is there dementia. Unfortunately the disease is too often incurable; even in the best cases, in recoveries where the layman would notice no abnormality, one always finds some defect in the patient’s emotional life. The clinical picture is incredibly varied; usually there is some disturbance of feeling, very often there are delusions and hallucinations. As a rule there is nothing to be found in the brain. Even in cases of the most severe type, lasting for years, an intact brain is not infrequently found post mortem. Only in a few cases are slight changes to be found, which cannot yet, however, be proved to be regular.



To sum up: in round figures about a quarter of our patients show more or less extensive alterations and lesions of the brain, while three-fourths have a brain which seems to be generally unimpaired or at most exhibits changes such as afford abso-lutely no explanation of the psychological disturbance.


These figures offer the best possible proof that the purely anatomical approach of modern psychiatry leads-to put it mildly-only very indirectly to the goal, which is the under-standing of the psychic disturbance. In addition, it must be remembered that the mental patients who show the most strik-ing lesions of the brain die after a relatively short time: conse-quently, the chronic inmates of the asylum, who form its real population, consist of up to 70 or 80% cases of dementia prae¬cox, that is, of patients in whom anatomical changes are prac¬tically non-existent. The way to a psychiatry of the future, which is to come to grips with the essence of the matter, is therefore clearly marked out: it can only be by way of psychology. For this reason we have entirely abandoned the anatomical approach in our Zurich Clinic and have turned to the psychological in-vestigation of mental disease. Since most of our patients suffer from dementia praecox, this disease is naturally our chief prob¬lem.

这些图形提供最佳的证据:现代的精神病学的解剖的方法,温和地说,仅是间接地导致目标。这个目标就是要理解心灵的疾病。除外,我们必须记住,显示脑的明星的病变的精神病这,在比较短的时间内死亡。结果,精神病院的这些慢性的病人,形成是精神病院的主要人口。精神分裂症的个案占据百分之70到80。 换句话说,在这些病人身上,解剖的改变几乎是不存在的。到达未来的精神分裂症的途径,是要处理这个物质的本质,这个途径因此清楚地被标示出来;那就是凭借心理学的途径。因为这个理由,我们完全地放弃解剖学的途径,在我们的苏黎世的诊所,并且诉诸于精神病的心理的研究。因为大部分的我们的病人遭受精神分裂症的痛苦,这个疾病当然是我们主要的难题。

The older clinicians paid great attention to the psycho¬logical precursors of insanity, just as the lay public still does, following a true instinct. We took up this trail and care-fully investigated the previous psychological history whenever possible. Our efforts were richly rewarded, for we found sur¬prisingly often that the illness broke out at a moment of some great emotion which, in its turn, had arisen in a more or less normal manner. We also found that in the mental disease which ensued there were a number of symptoms that could not be understood at all from the anatomical standpoint. These symp-toms immediately became comprehensible when considered from the standpoint of the individual’s previous history. Freud’s pioneering investigations into the psychology of hysteria and dreams afforded us the greatest stimulus and help in our work.


A few examples of the most recent departures in psychiatry will, I think, make the subject clearer than any amount of dry theory. In order to bring home to you the difference in our con-ception I shall, in each case, first describe the medical history in the older fashion, and then give the solution characteristic of the new approach.




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