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In chemistry we require common terms or else we simply do not know what we are talking about. Also we must have common terms in the observation of the subjective states envisaged by psychiatry else we are likewise talking in the air. But this analogy between the data of chemistry and the commonly admitted data of psychiatry is so obvious that it may be completely dismissed. This is an objectively patent analogy and its validity is generally admitted. There is no psychiatrist who does not follow with routine fidelity a consistency of terminology that is directly parallel to that obtaining in the biological sciences. And so the question of the adequacy of our objective terminology in regard to the subjective materials of psychiatry is not at all my point. Any misapprehension in this connection can only tend to confuse the essential issue upon which this paper rests. The consideration here has to do solely with the identity of the subjective state of the observer and the state presented subjectively by the patient. Common subjective terms are dependent upon common subjective reactions precisely as common objective terms are dependent upon common objective reactions. It is my postulate that the terms of judgment of the observer depend wholly upon the admission by him of states of feeling within himself that are identical with those of the patient under observation. The consensual admission and utilization of these subjective concurrences of mood become the terms or symbol equivalents which render possible the requisite social synthesis of the patient's repressed material. In the absence of the recognition of these mood identifications and of their assimilative interaction in the process of conscious laboratory technique, there cannot be the subjective understanding and assimilation socially of these processes as they occur singly within the individual. In a word, we cannot possibly have common terms if we have private repressions in regard to the states subtended by these terms. If there is lacking in the social mind a consistency of terms or a consensual basis of observation in the subjective mood, we cannot make a truly objective observation of the disagreement in terms or of the condition of conflict as it exists subjectively in the individual mind.
Due to the present subjective involvement of psychiatry, every individual under observation, and every one of the so-called objective findings which psychiatry records, stands in a quite personal and detached position. There is no generic basis of correlation among them. The reason is that there is no consistency or established agreement among the social sense perceptions upon which the various observers depend for the establishment of their scientific determinations. A mode of subjective and
uncodified inference utterly obscures our clear objective evaluation of them. It needs to be recognized that this mode of habitual and uncorrelated inference represents a socially unconscious reaction that is identical with the unconscious reactions comprising the habitual and uncodified data of the individual. My position is that in the absence of a common social analysis there is lacking the consensual agreement among the several observers such as is the requisite basis for conscious stabilized recognition of the materials observed.
I do not say that psychiatry has not an objective aim. I do not say that in this objective aim psychiatry does not envisage objective data. What I do say is that the objective data envisaged by psychiatry are the external signs of subjective reactions and not the direct objective observation of these subjective reactions themselves. Under the stress of the analysis the analyst may observe the flushed face, the perspiring brow, the blanched lips, the trembling hands and the countless other external signs of the patient's emotional state. But because of the social barrier between the psychiatrist's own subjective feelings and his objective observation of them there is organically precluded the objective observation of these identical feelings as they exist in the patient before him. My point is that where the psychiatrist should confront the direct objective data comprising the immediate subjective states of the individual before him, these identical subjective states existing in socially repressed form within the psychiatrist intervene to cloud his clear laboratory observation of the subjective states in question.
The astronomer in his casual subjective mood speaks of the sun as rising or setting, but in his laboratory he refers to the diurnal cycle as due to the earth's rotation upon its axis. But does this discrepancy mean that the astronomer is lacking in a basis of mental consistency? Not at all. In both instances he is speaking in strict conformity to conceptual symbols for which there is the substantiation of an accepted social consensus. In the one he employs the symbols of feeling for which there is a subjective mood consensus. In the other he uses the symbols of reason for which there is an objective thought consensus. In neither instance does he employ an arbitrary and isolated standpoint. In neither case does he abjure the accepted canons of the social consensus governing the sphere in question. His reason and feeling, thought and mood, objective and subjective spheres, are easily kept distinct because of the accepted symbols through which a consensus has been established within each of these spheres.
But with the psychiatrist the situation is different. The psychiatrist Med. Psych. v
fails to keep distinct these two spheres-his mood experience and his thought experience-and this subjective confusion renders his processes definitely inconsistent. For in the study of psychiatry or of the reactions that are internal to man, the presumable sphere of observation is clouded throughout by the internal feelings and reactions comprising our own subjective states. And in the absence of a social consensus with its established symbol consistency we merely preserve the casual and uncodified mode of our habitual and subjective experience. In this view the study of man's subjective states is precluded through man's own involvement in his habitual subjective interpretations. He does not permit himself a consistency of observation based upon a conceptual consensus with its correspondingly accepted symbol equivalents. The result is that psychiatry and psychoanalysis fail to apprehend the objective materials proper to them. They represent unconscious artistry but not scientific observation.
With this requisite factor of a consensual basis of observation there will be secured to psychiatry the condition that is recognized as essential to all objective inquiry-the condition, namely, which provides that the substance or process to be examined shall come under direct observation and study. As every student knows, it is essential that the substance or process submitted to scientific examination shall be presented for immediate observation. No mere report about a substance can for a moment be countenanced in a scientific laboratory. No element in the analysis may under any circumstance be taken for granted or accepted on hearsay, but each step in the process must be actually presented for direct observation. In a word, the examination must occupy itself with immediate material. But psychiatry does not present immediate material for direct observation because it does not possess as yet a basis of consensual agreement among the observers as to what constitutes its immediate material.
It is conceded that the first condition of observation within the objective laboratory of science is the presentation of actual material and that the criteria of accurate observation presuppose a common basis of sense perception among the laboratory observers. In the biological laboratory we do not accept any second-hand description as to the nature of a tissue presumably under examination, but the tissue itself must be directly submitted for actual examination, and for this it is further provided that there shall exist a consensus of sense impressions among the several observers.
I think it must become clear that within the mental sphere or in
psychiatry there is an absence of both of these conditions requisite to scientific inquiry. There is not the immediacy of the material or condition necessary for examination, nor is there the continuity or perceptual consensus among the examiners. In psychiatry we depend upon the report of the patient or upon his family or friends for our knowledge as to his condition or feeling or for our objective material. The patient or his family or his friends tell us about the materials or reactions he presents. Such a procedure may have its value historically and philosophically but it is not scientific examination. It cannot be included among the processes of laboratory inquiry. As regards the neural consensus requisite to the determination of the condition under examination, no patient presents his emotions for immediate examination but, due to the covenant of social repression existing between himself and his examiner, he carefully guards his direct emotional expression and prudently discourses about what he conceives this emotion to be. He presents the material of his dreams, his childhood reminiscences and endless free associations, but his emotional feeling in the immediate moment escapes direct observation. The patient's actual feeling therefore is not submitted to direct scientific observation because of the subjective and internal states that obscure it. Or if he presents feeling at all, it is necessarily confused by reason of the subjective feeling of his examiner. Consider, for example, the patient who in his gentle bearing or demeanour brings up to one psychoanalyst the tender feelings associated with this analyst's mother. The same patient may offer a very different stimulus to the psychoanalyst to whom the patient's appearance or character recalls at once the feelings associated with this analyst's dominating and overbearing father. In other words, the same patient may stimulate in one psychiatrist the psychiatrist's mother complex and in another the father complex. Or he may in the same psychiatrist stimulate at one time the psychiatrist's father identification and at another his mother identification, with the result that the psychiatrist necessarily reacts in an entirely different manner under these two different conditions of so-called observation. Yet this reaction is called judgment or analysis. But "there needs no ghost come from the grave" to tell us that the patient who seeks the aid of the psychopathologist for his condition cannot obtain from him a consistent observation. Were it so, it would not be the very general custom of patients to go about from one psychoanalyst to another because they find a satisfactory and vicarious solace in the totally different interpretations of their several analysts. Nor would it be the unfailing practice among psychopathologists, whenever two meet privately together, to
criticize as inadequate the methods and results characteristic of a third psychiatrist. Such disparities in our analytic interpretations could not exist were there a consensual agreement of subjective states or common terms in relation to the material under analytic observation. If the psychoanalyst is not socially free from the limitations of the social repression, he cannot make a free and unrepressed observation of the socially repressed individual opposite him.
The idea that I should like to place uppermost is this. If there is a social consensus of repression, there cannot be a social consensus of observation. If in our individual minds there are repressed and private terms of interpretation, there cannot exist in the social mind mutually agreed and commonly accepted terms of observation. I cannot accept a social agreement in terms with respect to the evidences of emotional conflict in a patient unless I have accepted these same terms with respect to emotional conflict within myself. If my analysis and observation of myself lack social co-ordination-if I have not a pragmatic basis of organic symbol agreement in the observation of my own emotions and repressions—I cannot possibly bring the requisite basis of concurrence to the observation of others whose organic gestures of emotion and repression are identical with my own.
According to prevailing clinical methods, psychiatry is dependent, in what it calls its scientific judgment, upon quite whimsical reactions that are wholly unpredictable and beyond the control of a socially consensual basis of objective agreement. In view of this quite unconscious situation in the sphere of our subjective determinations it seems to me imperative that we secure conditions for a definite laboratory technique in the observation of the material presented by our psychiatric patients. There is definitely requisite a social consensus of observers-observers who are consensually preserved against the private interpretations of their private complexes and who accordingly possess a scientific basis of conscious recognition of the data under examination. There will thus be demanded the presentation of fresh and actual material and not any second-hand report of the material as recorded either by the patient himself or by his friends. Emotions that are to be recognized and studied must be demonstrated, and in order that they be demonstrated they must secure conditions of observation which preclude the private prejudices of the particular observer. In short, it is required in the subjective sphere no less than in the objective that we be presented with immediate data of laboratory observation and that our conditions of observation shall provide such controls as afford a consensual consistency or give