(Automatic transcript - may present inaccuracies)

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>> Howard R. Craig: It is my privilege and my honor, on behalf of the New York Academy of Medicine to open these exercises to be held this afternoon and this evening commemorating the anniversary, the 100th anniversary of the birth of Sigmund Freud. It is entirely fitting that this academy hold these exercises in commemoration of Dr. Freud's birth because many of the pioneers in the development of Dr. Freud's concepts and theories, over the years, many of the pioneers were fellows of this New York Academy of Medicine. I'd like to mention just a few of them in passing. Dr. A.A. Brill whom I think we all knew. He translated Freud's works. Smith Ely Jelliffe who was Professor of Psychiatry at the College of Physicians and Surgeons at Columbia. Our much-loved Clarence Oberndorf who passed away only a very short time ago. Dr. Paul Schilder through the kindness of Dr. Lauretta Bender, we now have a very excellent portrait of Dr. Schilder. Dr. Fritz Wittels whose book, I must confess, in my ignorance and in my ineptness in preparation for these things, I've just finished reading. Dr. Wittels was a fellow of this academy up until 1950. It's rather interesting to me in reading the story of Freud and the introduction of his concepts, the impression one gets. The impression of an outlander, so to speak is that he was really more of a philosopher than he was a psychiatrist or earlier still, a neurologist. It's also interesting to me that the development of Freud's concepts, the center of development seems to have moved to this country, a country which on his visit, his only visit to this country in 1909, I think, '09 or '10, was rather of a disappointment to him and I think he rather felt from what I've read that the trip was hardly worthwhile. And yet the center, the core of his thinking and the development or perhaps the diversion and the discussion and the ramifications have gone on from the original Freudian concepts. A great many of them have been developed in this country. I'm not going to take up your time with a long introduction and open these meetings. But some 18 years ago, I was at a meeting of the Distributions Committee of the Friedsam Foundation of which I was a member at that time and the Chairman of the Board was Dr. Bernard Sachs, whom as many of you know was, I believe, a very articulate and vociferous opponent of the ideas of Sigmund Freud. They had worked together back in the early days at Vienna and I judge they'd been rather intimate. And then their paths had led in opposite directions or in varying directions, diverse directions. But one evening, when we were meeting, dealing out money as was our function, Dr. Sachs said he had received this letter from Freud. It was dated in 1938 and this was, I think, in 1938. When Dr. [Inaudible] asked me if I would open this meeting, my mind traveled back to that evening because it made an impression on me. Here were two men approximately 80 or thereabouts, perhaps a little over 80, both of them powerful, I judged powerful personalities. Of course, I never knew Freud but I did know Sachs very well. My mind went back to that evening so I called Louis Hausman who was very closely associated with Dr. Sachs over many years and asked him if he remembered the evening. And he said yes. He said, "What a memory you have." And I said, "Where is the letter?" Well, he said, "I think Helen Straus has it." That is, Dr. Sachs' daughter, the wife of Nathan Straus whom I'm going to meet in about 15 minutes. He said, "I'll see if I can get it for you." So the letter turned up and then we had it transliterated, that is, from Dr. -- from Freud's handwriting to a little more legible German handwriting and from that, to a translation. And I thought it would be of interest to read this translation. I'm not going to attempt to read the original German because I'd merely hash it up. But the original letter reads thus. It was dated on the 19th of July 1938 at 39 Elsworthy Road, London, Northwest three. Dear Dr. Sachs, for an enemy and the enemy is in quotation marks, your letter is amiable enough. It pleases me great. It pleased me greatly. I can also say honestly that I have never been angry at you. The old impressions of our laboratory days did not permit that. And I have often had to think of the help you gave me at that time in correcting my poor English in the translation of some technical notice, I believe. At the present time, I would need your help even more than in the olden days. Since I have fortunately not been hostile to organic neuropathology, I was made happy whenever I read of your great successes. Especially happy, however, when I heard that you although as old as I, or older, could boast of perfect health. I must confess, however, not entirely without envy. In recollection of our early friendship, accept my heartiest greetings. Truly yours, Freud. P.S. It is good news that Marburg is well. He has my fullest sympathy. I thought the letter was a very sweet and a very interesting letter. It made an impression on me some 18 years ago and we dug it out of Mrs. Straus' archives. This letter, the original letter and the photostats which our library has very kindly made, are down in the exhibition case on the ground floor. I think it's pertinent at this point for me to call attention also to the fact that the library has set up an extremely interesting exhibit of Freudiana and also which will be on exhibit downstairs in the main foyer, and also that there will be also an exhibit of memorabilia of Freud arranged by the American Psychoanalytic Association which will be shown not as of now, but it will be shown in the President's Gallery which is the large room on the ground floor from May 9th through May 19th. And I think it may well be of interest to not only all of you but all physicians. Now, it is my pleasure and my honor to introduce the chairman of the afternoon, Dr. Paul Hoch. Usually in introducing someone, who nominally is well known to everybody and people who read the papers and the journals and so forth, and Dr. Hoch, of course, has been known to me in connection with his official position and some of his previous work. Perhaps more of you know this than I but I looked up Dr. Hoch's biography and it again, struck me as being something of really very great interest. Here's a man who was born 54 years ago in Budapest. And today, he is our Commissioner of Mental Hygiene in this great state of New York State. He was educated, these are always rather trite information and data, but this struck me as being rather unusual. Educated in Gottingen in Germany, had his internship there in the University Clinic. He was Assistant at the neuropsychiatric clinic at Gottingen. He was Assistant Psychiatrist in the Clinic Board in Zurich and First Assistant in charge of the outpatient at [Inaudible] in the laboratory up until 1933 when apparently, according to the records, he came to this country. And from that point on, he was in charge of the shock treatment at Manhattan State Hospital. He was an adjunct at the neurology of the hospital for joint diseases. He's been associated with the Psychiatric Institute of the Columbia University [inaudible] since 1943. Of course, it's reasonable to assume that in all this time, he was doing research and teaching. During this last war, he was consultant in psychiatry in the United States Public Health Service. I can guess a rather unusual career and sometimes, they don't appreciate some of the people who are right at our own elbows. It gives me great pleasure indeed to introduce Dr. Hoch as Chairman of the Committee, oh, Chairman of the Meeting.

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>> Paul H. Hoch: Thank you very much, Dr. Craig. I am here this afternoon essentially also to do introductions because I was asked to introduce the speakers. The idea today is to commemorate the birth of Sigmund Freud and his work. Freud revolutionized not alone psychiatry but many neighboring disciplines and had a mark and sustained influence on our whole culture. Freud, furthermore, is the unique figure amongst scientists that he remained until today in many ways, a controversial figure. Usually a scientist and his work after so many years is either accepted or rejected. He continues to be through some of the controversies which he created, a dynamic force. His concept of the unconscious, the libido theory, the stratification of society seen in dynamic terms, free association, the deterministic and motivational interpretations of psychic functioning are still formulated, reformulated, confirmed and altered in our day. The same is true about psychoanalysis as a matter of treatment and as a discipline of practical insight into interpersonal relationships and also into social forces. Freud's contribution, they are not simply recognized and then set aside. But they continue dynamically to shape our thinking today. The appraisal and re-appraisal of Freud's work will continue far into the future. The Freud Centennial Committee of this Academy of Medicine assembled a galaxy of speakers who will help us to understand and probably integrate Freud's influence on the sciences of human behavior. And I am very happy to be entrusted with the task to introduce the speakers this afternoon. The first speaker is Dr. Kenneth Appel. He is the Director of the Clinic of Functional Diseases in the University of Pennsylvania Hospital and Professor of Psychiatry at the University of Pennsylvania Medical School. I don't want to enumerate all the degrees he has but it would be interesting to you to know that he has an AM, a PhD and an MD all from Harvard University. He worked in psychiatry with Dr. Claude in Paris and with Dr. Putzel in Vienna and he is connected with the Pennsylvania Hospital since 1930. He specializes in psychoanalysis which he practices in Philadelphia. Where most renowned teachers [inaudible] and he's one of our most renowned teachers in psychiatry and is eminently qualified to appraise the role of Freud in psychiatry. Dr. Appel?

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>> Kenneth E. Appel: Dr. Hoch, ladies and gentlemen -- This is an extraordinary occasion, this tribute to Sigmund Freud. It is a celebration and a commemoration. We are filled with great appreciation that such qualities, such generating perception, penetration and vision, such energizing and organizing capacity should have come together in one man, catalyzing the culture of our own country and our discipline of psychiatry. It has been given to few to make such contributions -- Aristotle, Copernicus, Darwin, and who shall we select of the Nobel Prize mathematicians and atomic physicists? Today, my primitive brain as well as my cortex is stimulated. It is a great gratification to have shared in the enlightenment which Freud has initiated. I am going to present some slides to you. I am not going to discuss the different elements of the slides. But it seems to me it is helpful in taking over Freud's contribution and his place in psychiatry to get some sort of an outline of this discipline we call psychoanalysis. So these slides as I talk will just be presented to you which will stimulate perhaps your memories and your fantasies and your reveries and your free associations. And will help, perhaps to orient you with regard to this movement called psychoanalysis. May I have the first slide please? Several diagrams are presented for a coup d'oiel of the historical perspective in which psychoanalysis developed. And it is perfectly clear, as you see, the antecedents of man's thinking which has eventuated into psychoanalysis and modern psychiatry. I will not go into details with regards to these diagrams. However, it is important to think of the medieval and the Judeo conceptions of lunacy, the concepts of witchcraft, the thoughts of astrology and Paracelsus, and the contributions of Pinel and Tuke. The next slide, please. And here, we get into more modern thinking, more modern lines with regard to the development of psychiatry. And their names there which reverberate in all of us with great interest and great inspiration. May I have the next slide, please? And this moves from people like Dubois and Dejerine who are part of the great tradition we are thinking of today, through Kraepelin, to people beyond Freud, beyond Cannon, beyond the Wolff's, the Selye, and Rank, and the New York Freudians who have contributed to the criticism and creative thinking in the field of human behavior. Witchcraft derives from the Judeo-Christian tradition and was dealt with by man's inhumanity to man, by persecution, torture, death. This has not been limited to Salem. It remains in our midst, in many of our institutions and common cultural ideas concerning the treatment of much mental illness. In addition to the humanitarian methods of Pinel and Tuke, a healing tradition developed from the concept of the Royal Touch and Paracelsus' notions of the influence of the stars and the value of magnetism in healing. From all this derives a line of development to Mesmer, Charcot, Liebeault, Bernheim, Breuer, and Freud. Witchcraft was hysteria. The Royal Touch and Mesmerism became hypnotism. The contrast between psychoanalytic psychiatry and psychoanalysis is shown in several slides. The next slide, please? Mapother, an English psychiatrist presented the simplest modern classification of reaction types in nonanalytic psychiatry. And you see these are the broad general divisions which we still think of in academic nonanalytic psychiatry. Compare this simplicity, this simplicity of definition and designation and classification with the following diagram which you will not be able to see really because of its complexity but which it seems to me has a value. The following diagram in the following slide and the two following slides are the simplest, the broadest outlines of psychoanalysis that I have been able to formulate. And may I have just for your consideration, just for your view; don't try to look at the detail. May I have the next slide, please? This, the reason I present this is because people say that Freud is sex. Freud is sexuality. Now, very briefly, he did indicate that at the top, that sexual energy manifested itself through certainly, certain bodily areas on the left and in certain types of activity on the right, towards certain objects in the bottom, and the fact that those objects seem to indicate an evolution, a development. And it is a very, very complex thing indeed. The slide is an abbreviated form of that very abbreviated, again, the energy which comes from metabolism manifests itself in certain body areas with certain activities towards certain objects. Next slide, please? And these objects seem to indicate a development as maturation proceeds and perhaps, we don't know enough about maturation either psychologically or physiologically. The reason I present this is that this represents the great complexity, even in outline of analytic theory early in his development. I think I may have another slide -- can I have the next slide -- which shows an evolution in Freud's concepts in which he added the aggressive instinct or the death drive or Thanatos on the right. What you saw previously was an elaboration of the Eros or life drive. All this, you can turn that off. All this represents the complexity in outline of Freudian thinking which enables us to orient ourselves to some degree, perhaps even to a limited degree, in some of the labyrinths of the human being personality and behavior. All this is not confined to the bizarre, the neurotic, the extreme. It also is representative in part of the normal. Some believe these psychoanalytic paradigms which I've just represented and sketched for you, these psychoanalytic paradigms of human behavior presents some serious limitation not emphasizing sufficiently biological, physiological, chemical, and cultural factors in the genesis of behavior. Charcot, Adolph Meyer, Freud, all started as pathologists and moved from the materially and physically observable to the world of psychology. Meyer, from his observations thought schizophrenia was the accentuation of habits of withdrawal, exaggerations of maladaptive techniques in the face of life's problems and frustrations -- in contrast to Kraepelin who believed toxic factors were important in the origin of this diverse condition. Meyer's classification, next slide please, with its very Greek terminology was very much in ascendancy and nearly a quarter of this century with its emphasis on the ergasias when I was a student in the early decades of the century. Freudian concepts gave us not only a more elaborate codification of impulses and behavior but related clinical conditions to developmental stages of the individual as shown in the following diagram. Next slide, please? And I need not elaborate this which is familiar to all of you. However, all this has indicated the complexity of psychoanalytic thinking in contrast to the simplicity of Mapother, of Adolph Meyer, of standard psychiatric conceptions. A new rationale appeared in psychiatry. A new system of exploration was seen. Disorders were related to developmental blockages, fixations or regressions rather than to changes in the brain following the premises of pathology long established in medicine since Koch, Virchow and Pasteur. Another slide shows the essential concept of psychoanalysis. Next slide, please? Which I will not discuss, familiar to all of you but it seems to me boiled down to essentials, these are the basic elements of psychoanalytic thinking. Copernicus removed the earth from the center of the universe. Darwin displaced man from the center of creation. Freud reduced man's personality in his concepts to the mechanization of impulses and complexes. Hence the age of anxiety, the loss of selfhood and some even feel dignity and worth, through the destructive effects of mechanization and hostility. Diego Rivera has a terrorizing mural of colorful mosaic representing this process in a new hospital in Mexico City. Newton discovered the pull of bodies, the forces of gravity. Freud directed attention to the pull of the past, the importance of the past, past experience in the functioning of the individual, childhood experiences, parent-child relationships. As the twig is bent, the conditioning of the past. Newton split white light with a prism into its component wavelengths and colors. Freud saw the varieties and distribution of human behavior and resolved them with his penetrating intellect into a spectrum of fundamental forces, impulses, motivations and mechanisms. In addition to some of the concepts indicated, Freud introduced many terms and expressions describing behavior. They have become common in popular speech. The genius of Freud is shown in a number of words which through his observations and emphasis have become part of the established vocabulary and cultural currency of our time. What other genius has had numerically such an influence on the language and thinking of a people? Some of the most important terms and complexes are shown in the following slide. In contrast to the dynamic, this is the -- you see the outline of this concept of psychoanalytic therapy. I meant the following slide. We could have a few seconds on this then put on the following slide, please. Some of the most important terms and complexes are shown in this table. In contrast to the previous ones of Mapother and Adolph Meyer and we could include Kraepelin and Strecker and Ebaugh, and others, and Henderson and Gillespie. In contrast to the dynamic epistemic concept of psychoanalysis, one recalls the descriptive, classificatory, delineating, relatively static concepts which have been part of standard psychiatry. One sees the concept of psychoanalysis which have been incorporated into the psychiatry of today, down to and including Number 12. Concerning certain concepts there is much argument and disagreement. Others are excluded and there seems to be below 12, disagreement, discussion about the concepts below the line under 12. In addition to this, of course, would be the physiological and the anatomical thinking which people believe Freud minimized or psychoanalysis neglected. Table 13, next slide please, shows not necessary to try to read that in detail at all. It shows the translation or table of approximate equivalents of the terms of standard psychiatry and those of psychoanalysis. And anyone who is studying psychiatry has to learn to translate what one set of terms into another. Now, I'll never forget Mclee Camel who was one of my teachers who said, "You don't clarify things by pouring one pitcher of muddy water into another pitcher of muddy water." And we have to think of that, I think, because so often, we are so in search of clarification that we think if we get terms and terminology clear, we have made some progress. Psychoanalysis thus has pointed out, emphasized certain broad concepts. The push and pull of the past, the importance of development, of not only physiological but emotional and personality development, the handicaps of development, the rationale of the irrationality, the non-genitality of much sexuality, the non-sexuality of much sexuality, the extension of a sexuality to include sensuality, gratification, interest, cathexis. The indirection, disguises, modifications, symbolization of impulse, thought, communication behavior. You can turn that off [inaudible]. It seems to me the unconscious, the indirect, symbolic impulses and mechanisms of therapy are underestimated in psychoanalytic therapy and traditional and classical psychotherapy and need to be investigated. Much of psychoanalysis appears to be too formalized, ritualized, intellectualized, obsessive and compulsive. Much theory is built on a paradigm of 19th century physics which our physicists and mathematical physicists tell us is outmoded. Novelty, emergence, the creativity of relationship and struggle are concepts that psychoanalysis perhaps has underemphasized and which Kierkegaard and Sartre and Tillich and the Existentialists have described as essential aspects of reality. Perhaps there are other aspects of reality that are seen outside the consulting room of the psychiatrist. Out of years of painstaking labor, study and research in the laboratory, the dialective history, the dialectic of history, culture and science moved Freud into the clinic. He made fundamental studies on the brainstem of different species of animals, significant observations on cerebral diplegia. He discovered the use of cocaine in anesthetizing the cornea for ophthalmological surgery. He had a brilliant and penetrating mind with a remarkable memory. He had unlimited energy. He must have had the conviction of destiny which his mother felt and the fortune-tellers in the Prather fostered. He was brilliant in his studies. He suffered the effects of the loss of parental income when the Industrial Revolution deprived his father of his traditional work. He suffered the personal, cultural and professional persecution of the Jew. His young, warm, overprotective mother gave a vitality and security that his older, non-appreciative, disciplining father threatened. The age of his father, the youth of his mother, the confusing family relationships, no wonder he had night terrors, enuresis and hallucinations! No wonder the Oedipus relationships were strikingly delineated or etched in the strong feeling, perceptive, determined, brilliant, unusual child. One shudders to think what would have been lost if Sigmund Freud had had normal personality reactions, normal family relationships, normal comfortable cultural and economic conditions and if he had the comfort of what he desired in academic life under either Brucke or Meynert. Unreason, suffering, conflict, disappointment, humiliation were plentiful in the background of this man. He was not a shaman nor a necromancer. He was a scientist. His hurts, humiliations and persecutions must have quite naturally built up a rigidity and compulsiveness to protect him against disruptive hostility. No wonder he seemed paranoid at times. The revolt of favorite pupils seemed to accentuate the amphyctyonic league of the elect. But the very strength of the opposition was a sign of cultural vitality, a gain for society. The strength of his feelings accentuated differences and dissidences which were psychiatrically and culturally valuable as the emphasis on Ego psychiatry, cultural study and anthropology have shown. The contrasts have even forced supplementary thinking about heredity, constitution, physiological and neurological considerations, and recently, the newer drugs. I believe those who have strongly opposed Freud even though the organicists have had their wits sharpened and have been stimulated to more enlightened perspectives and effectiveness. Freud's life is shot through with irony. Anatole France, whom Freud admired, wrote in his Garden of Epicurus , that irony is one of the universal themes of life and one of the great strands of life. The volte face in attitudes about psychoanalysis that took place even in the course of Freud's lifetime was truly remarkable. Culpin has some quotations that are now almost unbelievable. The Lancet , 1916, these psychoanalysts, "should be repressed with all the strength and force of a controlling hierarchy." The British Medical Journal , 1916, "Psychoanalysis is now exposed, blown up and discredited. Its day is now past." Journal of Mental Science , 1916, "Psychoanalysis is a slimy, useless and offensive agitation of human sludge." British Medical Journal , 1917, "The psychoanalysts are at their pernicious work in the lunacy wards of the great war hospitals." However, in '21 a change took place. Farquhar Buzzard, in his presidential address to the Royal Society said, "Psychoanalysis is as necessary for the study of psychiatry as accurate patient history-taking is necessary for the elucidation of medical problems of organic origin." And he quotes Bernard Hart, "It is certain that Freud's work has opened a new era in psychology and has fertilized immeasurably the arid field of old academic psychology." And McDougall in 1936, in his book and his lectures of critique of psychoanalysis, Psychoanalysis and Social Psychology , "In my opinion, Freud has quite unquestionably done more for the advancement of our understanding of human nature than any other man since Aristotle." This from the opposition and the critic. And in the Journal of the American Medical Association in 1939, it was written, "Freud discovered the most fundamental dynamic factor of psychology, the fact of repression and resistance. Psychoanalysis has become firmly established in psychology, education and in medicine." Here we have a picture, a rapid picture of the transformation and the change of attitudes toward psychoanalysis, the development of a cultural change in regard to a medical and social discipline. Freud was a scientist and a seer. He was also an artist to whose ability Thomas Mann has paid tribute. He was scientifically charismatic but in the penetration and depth of his psychological ultra-microscopy, he missed at times the breadth of the lower power. He was unable to assimilate the divergencies of perspectives. Another irony, he studied and defended individuality in his patients and really in culture, but he could not accept it in his own cultural camp. He recognized difference and the importance of individuality. Often he could not recognize the obligation of dissidence , novelty, the inadequacy of determinism, the inevitability of change, the universality of change. The impossibility of freezing life for long and rigidly mechanistic formulae of making cultural rigid and interfering with the survival of personality. The constructive uses of individual perspective, differences and dissonances were concepts he had difficulty in assimilating. The iconoclast becomes the conservative of the next generation. This has happened in psychoanalysis. The danger is that the radical empiricism of Freud will be displaced by the authoritarian control of conservatism and the spirit of Freud will be lost. The incorporation and integration of the energy and vitality, the enthusiasm and the adventure of psychoanalysis into psychiatry, and the sciences of human behavior and into university education and function present untold opportunities for research. Guided by the discipline of the scholarly tradition and the science that one finds in university and the objectivity of the scientist, psychoanalysis is not the millennium. It is not the final word about human nature in psychiatry. It can, however, make still greater contributions with its closer integration and collaboration with other medical and social disciplines. The insights and contributions of Freud have been epochal. Let us not get stalled and hung up on doubtful and debatable details or parochial particularities. The view that Freud has opened is illimitable, stimulating and offers many directions to which we can apply our energies. There is no finality to thought or to science or to education. A mountain has different outlooks and there are different roads to the top. Let not our narcissism, and wishes for omnipotence cause blockages to the progress to which the great psychoanalytic movement has pointed the way. Psychoanalysis formed the ferment in the great mass of discouraged or apathetic patients and relatives. At first, it was esoteric, almost cabalistic. It presented a challenge to understanding, once one had gotten over the initial boldness in some of the suggested theory. Even to get one thinking in dynamic terms, in terms of psychological and social etiology, was a tremendous contribution. The point is not the formulations and the rituals arrived at, however neat, consistent and comforting they be, and not the relative disappointment in therapeutic results. We must not get stuck on the incompleteness and fantasies and speculations. We must not be discouraged with the diversity of views and perspectives. These are healthy signs. The importance lies in the ferment psychoanalysis has stirred, the new look it has developed, the new perspectives it has presented, the roads and possibilities it has opened. We should not think of the past but the possibilities of the future, the future of research. Therefore, the opportunities to psychoanalysis to join the body of university scholars, scientists, educators and social researchers in all areas of human behavior. Commemoration, yes -- but dedication to new directions and devotion, the incorporation of a past into the future which Allport indicates in his concept of "Becoming". This is the challenge for psychiatry and psychoanalysis. Thank you.

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>> Paul H. Hoch: Thank you very much, Dr. Appel, for this very illuminating presentation, Freud and Psychiatry. From psychiatry, we go on now to a larger field. Dr. Roy Grinker from Chicago will discuss Freud and Medicine. Dr. Grinker is specially qualified to discuss this subject because he has besides psychoanalysis and psychiatry, background in neurology and his research and teaching was devoted to a considerable degree to the field of psychosomatic medicine in which he has eminent contributions. I believe that he will discuss here in detail Freud and Medicine. Dr. Grinker?

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>> Roy R. Grinker: Dr. Hoch, ladies and gentlemen, in 1939, shortly after the death of Sigmund Freud, I wrote an essay in his honor entitled, "Reminiscences of a Personal Contact with Freud." My closing sentence may be used to set the tone of this presentation, "Psychoanalytic science will be much more progressive and productive in the way Freud himself would have wished, if we do not deify him and deny him the human privilege of error." Freud himself was never satisfied and restlessly kept reformulating his theories and challenging new frontiers of the unknown as a great scientist would. He could not accomplish everything even during his lengthy lifespan. But left to his followers much unfinished business which can only be completed if yesterday's ideas are considered as points of departure and not as fixed limitations. In the intervening years since Freud's death, only a few unbiased evaluations of his contributions have been made. Now that Ernest Jones has courageously told the story of Freud, his life and his work, with friendly objectivity, perhaps it may be possible to evaluate the original psychoanalytic theory and methodology repeatedly from a changing frame of successive decades of progress. In participating in this centenary celebration of Freud's birth, I feel keenly the honor implied, but equally the responsibility of discussing more than those positive contributions which helped our medical ideas about health and illness. Indeed, I shall indicate what in my opinion are some of the areas of unfinished business and the modification of psychoanalytic concepts and methods necessary for their contribution to even more progress in psychosomatic medicine. In this essay, I shall discuss only Freud's influences without including later accretions from his students or followers. One of Freud's earliest papers dealt with the somatic source of anxiety. He postulated the notion that the blocking of libidinal expression due to various influences that prevented sexual experiences resulted in the transformation of libido into anxiety. This was a prototype, although not the first of its kind, of the influence of the soma on the psyche or a special somatopsychic approach. As the years went by, Freud modified this theory of anxiety although he never abandoned it. He continued to maintain that it was derived from a phenomenological approach in contrast to a more recent metapsychological theory. His last writings reaffirmed that the source of those instincts which give mental expression to the id is in the somatic organization. Today, we view lesser quantities of anxiety according to Freud's second formulation. As a function of the ego signaling the perception of future danger from internal sources and thereby setting into action a variety of preparatory defenses. Although we do not now consider that anxiety is transmuted repressed libido, the phenomena and processes by which somatic disturbances express themselves during development in permanent ego deformations, or in maturity by creating peculiar affective states have become an object of intense study. Destructive and disintegrating processes within the human organism are often experienced psychologically long before the medical man is capable of diagnosing or localizing them. For example, many individuals suffer from atypical psychological depressions and report dreams, the contents of which indicate a somatic malignancy before this is apparent to other observers. We have lately become interested in the prophetic expression of impending death before tissue changes reveal the process to the physician. Freud's most direct contribution to what we today call the psychosomatic field is found in a basic psychoanalytic principle derived from his studies of conversion hysteria. Repression of unacceptable emotional memories may be followed by bodily symptoms which symbolically represent what has been repressed with a simultaneous punishment. Often the neurotic usurpation of somatic structures interferes with our physiological uses. In Freud's earliest writings, we see few evidences that he considered that repressed painful memories could also interfere with the function of organs innervated by the vegetative nervous system which seems to be the primary focus of psychosomatic medicine when that term is defined in a limited sense. He did recognize that many visceral disturbances constituted the perceived effects of anxiety. But in general, he did not extend his concern with somatic experiences beyond the tri-leveled oral, anal and phallic models of instinctual expression. Physiological knowledge was not far enough advanced to permit significant correlations with the psychological understanding available from psychoanalytic studies. Regression to infantile psychological patterns seemed to revive not only all points of fixation but also concomitant behavior and physiological activities of a less mature order. Thus the phenomena of repression precipitated by the stress of conflict includes a change in somatic functions. The form and content of symptoms resulting from regression is usually understood on the basis of Freud's concept of stages of libidinal development linked to experiences with various bodily zones which mature at successive ages. Intensities of satisfaction and degrees of frustration facilitate fixation, and hence, regression, in times of stress and influence patterns of ego function and content of self-images. Much clinical data indicate that early infantile experiences whether they be positive in the nature of satisfactory relations with the mother or negative such as maternal rejection, childhood diseases, or various restrictions of activity, have profound effects on ego functions, self-esteem and growth potentials. These carry with them throughout life the predisposition for regression and disturbance of function. Freud's contributions to the field of medicine also include more general influences. His continued and restless search for etiological factors arising from past experience of the organism was in great contrast to the search in his time for specific bacterial agents and to the naïve acceptance of constitutional hereditary process as being singly the most significant etiological factors. However, Freud also clearly recognized the limitations of psychogenesis. In several contexts, he indicated that psychology could not grow beyond a certain point and he hoped that cooperative biochemical or endocrinological explanations eventually might be forthcoming. Finally, in his utilization of transference which is the heart of psychoanalytic therapy, he reconstructed the doctor-patient relationship and formulated it in a new and scientifically understandable form. Although not explicitly utilized in the context that transference connotes in psychoanalysis, the transactions between doctor and patient can now be formulated and taught to the medical profession as important in all therapeutic relationships. Freud did not fully commit himself to the psychosomatic approach and by that I mean the need to consider that all functions in health or illness involve both psychological and somatic processes. Apparently, after several attempts to apply concepts of physics and physiology, especially neurophysiology to psychology, Freud concluded that there was no direct relationship between mind and body. Yet he often expressed the notion of lineal relationship with such terms as sexual libido causes anxiety or repressed emotions produce paralyses. Jones explains these statements as shorthand, not meant to be taken literally and comments that modern psychosomatists do that same. Freud then concentrated entirely on the psychological system since he was concerned only in interpreting its general laws of functioning by the technique of psychoanalysis. He insisted that psychological processes should be treated in the language of psychology, a basic principle which is often forgotten by those research workers who used physiological concomitance of emotion as indicating emotions themselves hence making their psychophysical correlations impossible. Freud's psychoanalysis thus brought man into clear focus as a natural entity being, a natural unitary being as far as his psychology is concerned. He is both animalistic and rational, conflictual, past-directed and future-oriented, restlessly growing, learning and evolving new forms of social existence and propagating the old. These many facets are integrated in new and individual forms for each person by his organizing self-identity. But after Freud's unsuccessful attempts to unify mind and body in any grand conceptual scheme, psychoanalysis tended to dichotomize man by isolating psychological concepts from biology. Its basic hypothesis of psychogenesis shifted emphasis away from biology and from the natural trend of science toward unified theory. It is interesting that although Freud worked almost entirely in the field of psychology, except for his early years, and did not promulgate any general principles applicable to the mind-body relations or the psychosomatic approach, he always recognized the limitations of psychogenesis. Likewise, his theories leaned heavily on constitutional strengths of the instinctual drives and of the ego functions. There is a tendency in any young discipline of science or medicine, that when a man of genius has contributed the initial impetus and most of the conceptual framework to continue operating within the original theories and methods. These are difficult to relinquish and are used as long as possible though they may not continue to be fruitful as newer ideas and methods develop from tangential fields. To preserve the purity of a science or the uniqueness of a tool of investigation, may not add more to the sum total of knowledge but may delay progress. Certainly, maintenance of the authority of Freud's written words of yesteryear adds little to his unquestioned place in the history of medicine, psychology and the humanities. I shall now enumerate briefly some aspects of psychoanalysis as applied to medicine that need modification. One, the search for single causes of illness. This is an implicit concept because Freud often mentioned constitution and heredity especially in relation to the strength of the instincts but could do little with them by the method to which he consecrated his life. This his followers forgot. It is assumed that single causes were and are to psychoanalysis, psychological. Although within that system, the principle of multiplicity of causes is accepted under the term of over-determination. Two, the formulation of specific etiology associated with nosological entities. Here too is an implicit concept which became the focal approach of large groups of psychoanalytic investigators in the psychosomatic field. For much too long a time, specific formulations were derived to explain so-called psychosomatic syndromes which led to repetitive subtle variations of two basic themes, unsatisfied dependency and repressed hostility. The current search for specificity no matter how disguised as profile, character structure or vector processes is a one-cause concept. Three, the possibility of cure of those diseases in which psychogenesis plays a role in etiology. Freud often spoke of cures like any medical man of his era. Yet later, he recognized that psychoanalysis was an inefficient therapy, rarely curing and at the best, ameliorating illness. As the most rational available psychological therapy, its role in curing or worsening illness has not yet been carefully evaluated. Furthermore, the results of treatment are not adequate indications of validity of causal relationships. Four, the theory of a mobile psychic energy or libido including derivative notions of sources, effects, quantities and displacements. It is interesting that Freud's project for a scientific psychology emphasized quantity and energy in his early attempt to view physiology, that is neurophysiology and psychology as unitary approaches. This basic interest entered psychoanalysis via the concepts of libido and cathexis and has been perpetuated. We cannot envision at present how quantitative concepts can be tested by psychoanalytic methods alone. Even now analysts who do not accept the libido theory are viewed askance. Yet in our time, we have become more interested in ego functions concerned in learning and in their intimate connections with body functions in development and regression. From a libido theory corresponding to 19th century biology, we have moved to learning theory, organizing principles and the communication of information through signs and symbols depending on the level of organization in focus. We do not as yet know if these theories and hypotheses will prove more fruitful in psychology. Five, the heavy emphasis on instinctual drives, even though not to exclusion, has been maintained by analysts attempting to preserve in pure form the supposed true Freudian tool of investigation. As a result, biological and sociological advances penetrate slowly and difficultly into psychoanalytic theory. But today, instinct theory has become revived scientifically by the investigations of the ethologists who study innate releasor mechanisms of primitive social responses in animals. The readiness to love and the displacement of aim and object gives validity to the part-role of instincts in personality theory. It may be well in contrast to enumerate some current principles of a psychosomatic approach considered as part of modern behavioral science. One, all functions of the living human organism, whether in health or illness, are both psychic and somatic. All disturbances in human functions are adaptive and involve multiple processes and causes. Three, varying constellations of processes may find the same functional expression in the final common pathway. Four; the total human organism in varying inter-relationships with other organisms in a material world and the part functions of any single human organism among themselves are viewed as transactional processes in fields of observed or defined extent. Five, rather than utilizing the notion of psychic energy you view relationships frame of reference of communications and the transmission of information this is possible whether we are talking about social, psychological or somatic behavior. Six, the influence of strain on the organism differs through the phase of the developmental process on the state of regression at the time and that stress is the sum total of organismic response. Seven, heredity, constitution, strength of instinctual forces, life experiences with the first nuclear family, an ever-extending social group, precipitated factors etcetera are all important in the production of illness. Each has a place in the transactive field of strain and adaptation. Eight; the organs that comprise the human body should not be isolated as single targets or a study of healthy function or illness where they are organized into open systems with highly permeable bondage. We should give great praise to Freud's theories for their profound effect and the progress of modern medicine in his time even though as progress takes many are no longer fruitful. However, the influence of psychoanalytic techniques on the psychosomatic field has contributed some impedance. This I should like to emphasize now as illustrative. The time moves on and that the method of medicine and science require change. Psychoanalysis was applied to physiological disturbances remained as isolated as psychoanalysis in general and the other disciplines of science and medicine became isolated from medicine at the time when his first and greatest discoveries of psychoanalysis were communicated to the world. Many contemporary psychoanalysts insist that psychoanalysts continue to remain isolated with the justification that they are following Freud and preserving the purity of the method. Many others have broken with strict and slavish adherence to tradition and cooperate with other signs, however, more are needed. The use of psychoanalytic techniques based on the body of psychoanalytic knowledge is essential for the observation of many aspects of psychosomatic illness which are not available through conscious reporting and isolation of psychoanalysis is a deterrent to further progress. Many individuals in the past have contributed a great deal to the development of the psychosomatic field of the years of the psychoanalytic method alone. In fact, the first formulations of specific unconscious dynamic patterns and medical syndromes were made by psychoanalysts using classical techniques. However, it is becoming increasingly apparent that this no longer suffices. Under such conditions of isolation, no symatic examination or exact measurements of functions of organs or systems involved in a patient's disturbance or those uninvolved in his complaint can be carried out. Significance is attributed to psychological data alone because of the method of observation the focus and bias of the observer. Without the synthesis of techniques of interview, psychoanalysis and experimentation, the relationship between physiological processes and psychological functions cannot be established. I must state here that Freud personally opposed the experimental method in any relation to psychoanalysis with great vigor and considered that each psychoanalysis was an experiment in itself but that its low significance of reliability initiated correlations without other experimental data. When we use one method alone, we're always confronted with the problem of determining to what depth and level an individual corresponding to task time, and to what particular somatic function we may attribute a relationship which constitutes the essential pattern of illness. The use for the psychoanalytic method for the treatment of the neurosis when transposed to psychosomatic research has resulted in un-physiological conclusions regarding regression as if they were specific levels of psychological development at which only single zonal processes were significant and hence influence the dysfunction to exclusion. Some imitating the Freudian explanation of conversion hysteria have considered vegetative symptoms as symbolic processes even including for example, the peptic ulcer represents a specific view or attack or that it symbolizes a specific introjective object. Others have expressed the view that a physiological disturbance implies partial suicide based on the Freudian concept of the silent internal operating death instinct. To round out this presentation, I would should to point briefly toward current research in the psychosomatic field which takes cognizance of the vast body of knowledge and methodology developed by Freud and utilizes as well many other scientific points of view. Current research is directed to the necessary understanding of laws involving the general relationships between psychological and somatic functioning before concepts of specificity of patterns may be developed. The need for multiple simultaneous [inaudible] of observations and multidisciplinary research in which careful controls are utilized is recognized. In every research the field and time of observation and the methods utilized are carefully defined. The methods of observation utilized in apparently logical systems and tested variables that are suggestive from clinical experience. The psychosomatic research today is transactional which involves the study of relationships among many [inaudible] within a large field not only in cross-section of current time, but also longitudely in the development from the earliest days of life. Current research is more concerned with general emotions or affects either in isolation or in combinations, than in specific dynamic states. These are definable and measureable and are more productive of coralatable information than the indirect quality of latent attitudes. Finally, research today views emotions which are coralatable with significant bodily functions and health and illness, as conscious reportable experiences on the subject under observation. Psychoanalysis as a tool specific to itself may function in linking the unconscious repressed affect which can be uncovered by its techniques to what psychiatric studies reveal occurs on a conscious level. Finally, I should like to point out that widespread acceptance of psychoanalytic practice by the public help popularize the psychosomatic field especially after World War Two, but also demoralized psychosomatics as a science. The term psychosomatic has obtained the dubious position of a household word, the stirring of interest in physiological medicine has resulted in a sacrifice of science to quick conclusions although in truth the effect is influenced on results. The initial stimulus has been beneficial only to a point for today our stereotype psychosomatic formulations are largely conglomerations of vagueness [phonetic]. Now we should retrace our steps and relate psychodynamics, physio-dynamics in a more scientific manner. Because of my experience in the last 25 years, I can understand Freud's misgivings when I discussed the psychosomatic trend in this country in 1933 with him. He stated that that is the medicine of the future. Perhaps the second half of the 20th century will be the future of which he spoke.

[ Applause ]

>> Paul H. Hoch: Thank you Dr. Grinker for the excellent presentation of the psychosomatic trends in relationship to psychoanalysis. The sub speaker is Dr. Paul Lemkau who will speak on fright and prophylaxis. Dr. Lemkau has a background of Public Health and Psychiatry. He was Consultant of the Mental Hygiene at the Maryland State Board of Health and he was Commissioner of Health at the Baltimore Health Department. He's Professor of Public Health Administration at the John Hopkins University as well as instructor in Psychiatry. Dr. Lemkau is on leave from John Hopkins University and is Director of the largest community mental health services in the country today in New York City. His background and his contributions to Public Health and Psychiatry makes him outstandingly fitted to discuss the topic I indicated, Fright and Prophylaxis. Dr. Lemkau?

[ Applause ]

>> Paul V. Lemkau: Dr. Hoch, ladies, and gentleman. I need hardly repeat the words of the preceding speakers concerning the honor one feels at being invited to discuss any one of the important issues of this Centenary Anniversary. To be tendered the honor of thinking together with you about Freud's relation to prophylaxis of psychiatric illness the field to which I have devoted my professional life, is so flattering that I am afraid I accepted the challenge without thinking first of the responsibility that went with it. Such a lecture should come from a very thorough student of Freud's work who can quote incident, chapter, and verse. I am not such a student and have never subjected myself to the vigorous study of the master entailed in training in a psychoanalytic institute. To be perfectly frank, it has often seemed to me that much of such detailed study preoccupies the kind -- the candidate's evenings and his thoughts for an even longer time to such an extent he becomes more a monk than a worldly-wise psychiatrist a matter to which both of the previous speakers have referred in a less personal way. I have however, made a consistent search in Freud's writings for many years for references to prophylaxis. In the course of the preparation of my paper, The Implications of the Psychic Genetic Hypothesis for Mental Hygiene, I wrote to a considerable group of outstanding scholars, some of whom shared the honor of being on this program, asking them certain questions regarding Freud's concepts on prophylaxis. Freud made no direct mention of the problems so far as I have been able to find. We all recognize that he felt analysis much more an experimental investigative procedure and a therapeutic or preventative one. He appears to have been concerned with the ever new vistas of his exploration not with tidying up, to see what of his new facts could harnessed to the purveying duties of prevention of disease. This fact leaves us with the rather delicate task of exegesis, growing implications for one purpose from statements made and concepts used in other contexts. Before proceeding to this task, it seemed appropriate to examine briefly, the general background of thinking about the prophylaxis of psychiatric illnesses and conditions. In the first place, there has been a great deal of confusion in the field because the all-inclusive concept of mental illness has seduced scientific workers into a concept that there should be one prophylaxis for this presumably unitary illness. Realizing that there are probably as many psychiatric illnesses as there are recognized infectious ones, it seems far wiser to think in terms of the mental illnesses and of multiple methods of prophylaxis appropriate for each. Some of these are appropriate for discussion in connection with Freud, some are not. The prevention of hysteria with amnesia is a problem of prophylaxis to be discussed in relation to Freud. Amnesia due to loss of brain substance even though it be preventable is not a matter of psycho-dynamics significance Freudian or otherwise. This is true even though it is clearly recognized that the precise nature of what is forgot and how much is forgot may be of dynamic significance. So for the purposes of today's discussion, we are not concerned with the prevention of brain damage in the direct sense nor with the results of brain damage. We are concerned with the prevention of the psychogenetic mental illnesses and the behavioral complexes which are related to them and to the states of mind that lead individuals to expose themselves to risks and some sorts of brain damage such as, alcoholism and [inaudible]. In other words we are concerned with the prevention with states of mind which are themselves illness, or make the appearance of later illness all but inevitable. It is popularly supposed that Freud believed that past events in a life determined the presence or absence of illness at some future date. In an early [inaudible] era, he didn't make such a direct cause and effect statement regarding some sorts of sexual activity and some sorts of anxiety. In general however, the models Freud eventually developed were far more complex and dealt with so many vectors of force from so many difference angles, from parent child relationships to cultural influences, from aspirations to instincts, but the effect of any one could no longer be predicted. The analogies of levels, energy units to be satisfied, of checks and balances, of Eros and Pentecost, are so complex that the challenge to prophylactic adjustments of the forces and circumstances is avoided by most of Freud's followers. They even defend this position on theoretic grounds as though to indicate that therapy can cut these multi-stranded ropes, but the same concepts cannot be used to cut the individual strands as the rope is being woven. A further problem is of course that Freud was not a systemitist and had no intention of being one. He did not respond to the challenge to relate forces discussed at different periods of his own development to each other, perhaps he didn't think it worthwhile. I doubt if he would have tried to make a virtue of it, however. The only -- the point I wish to make is however, that Freud did not directly discuss prophylaxis and that to use his specific concepts systematically appears impossible. This being the case, we shall proceed to see what can be drawn from Freud's contributions that have been useful in the development of prophylactic programs in psychiatry. Most of these ideas did not originate with Freud directly. Many critics and historians have pointed out that many of his ideas are older than himself and that he himself used symbols going back to the earliest human thinking we know of, such as the trinity of the ego and super ego. The modern movement of prophylaxis in the promotion of mental health however, considered Freud responsible for some basic concepts which I will discuss. I leave to historians to decide as to whether attribution is completely justified. First an overall consideration that overrides any of the more or less specific points that will be made later. Freud's works and the popularization of his ideas partly because his concepts were at first so fiercely attacked, induced in an era of thinking in terms of the psychological meaning of life events that has furnished the soil which ideas about the prevention of psychogenic mental illness could grow. He furnished the multitude of hypothesis that arrested the interest not only of medical men, but of many other people as well. Not only professionals and the educated, but a considerable proportion of the total population. The population for the most part I suspect had little or no idea of what Freud's basic philosophy really was. This made no difference for he was the symbol for the psychological interpretation of events and this idea made a very great change in the scientific milieu. Out of this milieu, grew the hoax and the hypothesis of prophylaxis in psychiatry. Fundamentally, this movement prophylaxis has had within it more optimism than its Freudian origin seemed to justify. Freud did not speak much of constitution which had been the pessimistic concept that had dominated the psychiatric ideological thought before him and in those who had opposed him strongly early in his career. But to some extent, his acceptance of the idea of instinct is also a pessimistic idea, not much removed from constitutionalism. It is really but the analysis of a general non-specific concept to which more specific and more clearly characterized parts. Instinct is inborn and it, the popular concept of optimism about psychoanalysis as a form of treatment is almost a perversion of what appears to have been Freud's general attitude. It is interesting, at least as I observed the situation, that in this country Freud's pessimism dominates many of his followers' thinking about the possibility of prophylaxis while they seem quite sanguine when about the use of his concepts and techniques for curative purposes, an attitude I was impelled to complain about in the paper referred to earlier. The first generalization gone from Freud and which is important in prophylaxis is that behavior is caused in every instance, that no significant action nor reaction occurs without antecedent events that determine it. Early in the Freudian period as already mentioned, these relations seemed rather clear but as the structure was built up individually then seemed to lose importance until many workers took the pessimistic view already described. Suffice it to say that the hypothesis of physiologic determinism seems fundamental to any prophylactic program in psychiatry. If we are working in a psychogenetic illnesses in a field of random [inaudible] of events with no predictability, then prophylaxis is certainly impossible. Freud attempted to make illness and illness precipitating states understandable and to some extent predictable. What can be predicted in human living can probably be influenced to alter that predictability. Freud was not the only person of his time to insist on such a concept. The idea is basic in the psychiatry of Meyer and other leaders as well. But it is to Freud that cause and effect relationships seem so clear that his writing sold the idea into acceptance. Actually Freud only interpreted past events. He nowhere said had this not happened this later event would have been a healthy rather than an unhealthy reaction. The movement and the direction of prophylaxis of psychogenetic illnesses has acted as thought he meant to make the statement. As such the effect of the non-existent statement has been extraordinary. The second and generally basic contribution of Freud is that behavior matures from infancy to childhood. I do not propose to discuss the various parameters of development Freud uses at different times and for different purposes, but to confine the discussion to the fact that he knew the person to be different at different ages of development. The infant was different from the schoolchild and from the adult. The attempts to pin down the idea using such terms as oral, anal, genital states, the homo and hetero erotic stages, the various complex situations such as Oedipus do not always come out into consistent patterns. So far as I have been able to discover, Freud never defined what a healthy resolution of the Oedipus situation was or how the resolution could be led to a smooth and healthy end. I have also felt that Freud but particularly some of his later followers in Child Analysis have failed to recognize that the intellectual and sensory capacity of the brain matures also along with its relationship capacity. Failure to recognize this has led to the assumption of far more complex kinds of relationships and numbers of items in the child's conscious and unconscious than there is capacity to entertain them at some particular stage of development under consideration. All of these questions do not retract from the basic concept that there is a maturational pattern and that events can change the way the pattern works itself out. This is of course, something people [inaudible] and common man have known for centuries. Its implications for mental health however, must be ascribed to Freud and his influence. The next essential factor on prophylactic theory that arises to prominence because of Freud is a derivative of that just discussed namely; that the individual not only matures but that he follows a more or less predictable course in maturation, that is one stage forms the basis for the prediction of the next series of behavior patterns. Contributions to this idea from animal psychology and child development researchers have certainly been fundamental in the development of the idea since Freud made it current. The concept is very necessary however, in the short-term evaluation of all presented efforts. In the absence of such progression, one must await the passage of many years before the effect of a procedure can be evaluated. If behavioral progressions can be established firmly, the time of movement from one step to another may offer a way to evaluate progress or lack of it. Orderly, predictable stages in maturation of infant to adult behavior is a Freudian concept of importance to the theory of prophylaxis. The next concept basic to prophylactic work is regards to psychogenic illnesses is that all individuals will have to go through certain experiences and that these will be more or less stressful. Perhaps the best example is that of the Oedipus problem. Freud contended that all had to move through it. In Freud's mind, the most important developmental situations dealt with were intentionally personal or familial problems and situations. Others gave a much broader definition to the steps -- to the developmental steps before the infant. Students of development speaking in terms of motor and sensory developmental tasks. Meyer and particularly his student Cameron was concerned with a whole range of roles to be learned. Sullivan with interpersonal relationships to be mastered. The Educational Psychologist studies what situations the child may be expected to master at a given age or stage of development. It appears that the germ of the concept of seeing maturation in terms of tasks to be surmounted and roles and relationships to be learned is justifiably fitted to Freud. The way particular developmental tasks are surmounted has offered the benchmarks of evaluation that have made possible the programitizing of prophylactic efforts. The next great idea for prophylaxis that flows from Freud's thinking is that the factor of relationship with other people is important in personality development. Put in figurative language, one might say that the furnace in which the goal of personality is refined is that of inter-human relationships. Here again, there is real doubt whether Freud actually ever thought of the problem in this positive sense, for he was more concerned with pathology, even the pathology of everyday life than he was with possible prophylactic character of relationships. It is but a step however, from the clearly Freudian concept that pathological relationships cause pathology to the concept that healthy relationships cause health whether or not Freud himself ever took this step. The quality of the affected inter-human relationship was much more the subject of enlightenment by Freud. Perhaps starting from one of the most important of his discoveries, the factors of transference and counter-transference in therapy, Freud was able to describe the force, as well as the content, of many parent-child relationships and of the relationships between peers as well. Out of this work has been evolved of a great deal of the modern educational thinking about motivation and its cultivation as well as the recognition in the management of resistances to learning. Freud dealt with these matters, primarily within the spheres of psychopathology but the way he dealt with them has made possible the development of much of modern educational technique. In this sense, the whole movement of group dynamics has its roots in Freud's recognition that all ideas have emotional auras and that changing ideas always involves changing sentiments, or attitudes, or emotional sets. In pointing to the [inaudible] really importance of the parent-child relationship, Freud opened the door to fitting mental health thinking into the pattern of prophylactic theory that was drawing contemporaneously in the public health field. It was his work that made possible the analogy between early immunization and early behavioral prophylaxis. Time may prove that the analogy is a false one as experimental tests have tended to show that many specific points of his doctrine do not correlate with observable life experience. This will not detract from the tremendous importance in the history of science, not only psychological medicine, but of the social sciences as well. The final contribution of Freud's prophylactic theory and practice that I wish to discuss is his concept that the culture in which an individual lives makes a difference and has meaning for the individual as well as for the group. Freud's contribution to anthropology is discussed by another in this symposium. Suffice it to say here that it appears that much of our present expansion of health so that it includes mental and social well-being as well as physical impactness can be traced to the pregnant ideas of Sigmund Freud. There are those I am sure who will point out that I have ascribed to Freud things which rightfully belong to other minds. There are others who will say that Freud is directly responsible for far more of present prophylactic thinking and I have given him credit for. I regret that I cannot debate with either camp on the basis of expertness in Freud's enormous literary output. I can, however, defend my views as an interpretation by a person who has for a considerable while been concerned with the problem of prophylaxis of mental illness and the promotion of mental health -- -- and one who has tried to find the origin of current concepts in the field. In summary, in my opinion, Freud contributed the basic ideas for the following fundamental tenets in prophylaxis. First, behavior is caused and the causes maybe modifiable so that undesirable behavior may be avoided. Second, there is a maturation of emotional reaction. Third, that this maturational process is orderly and to some extent predictable. Fourth, a development involves stress, a concept economically expressed in the idea of developmental tasks. Fifth, if the maturation of the personality takes place in and is modified by emotionally significant relationships and the parent-child relationship are a great moment. Six, that culture makes a difference and has meaning for the individual, and needs to be interpreted at that level as well as a purely group phenomenon. Thanks.

[ Applause ]

[ Noises ]

>> Paul H. Hoch: Thank you very much, Dr. Lemkau, for this very interesting [inaudible] presentation about the connection that we tried and prophylaxis in psychiatry today. In addition to the three speakers, we have two [inaudible] who will add their interpretation of Freud in present day psychiatry. The first discussor is Dr. Ralph Kaufman, Director of the Department of Psychiatry at Mount Sinai Hospital and [inaudible] Professor of Psychiatry at Columbia University. Dr. Kaufman is a practicing psychiatrist, psychoanalyst, a medical educator, and as a clinician, and has many contributions in this field of his own [inaudible] I'm sure would add to this discussion to the [inaudible] this afternoon. Dr. Kaufman?

>> M. Ralph Kaufman: Mr. Chairman, esteemed speakers, ladies, and gentlemen, I should like to change the word discussor to commentator because I really do not feel that both in the content of the paper of our distinguished speakers and the occasion as it calls for a discussor or discussors, so that I would rather have myself thought on as a commentator and a very brief one at that. I think it's particularly fitting as all the things that our [inaudible] Chairman called me, that to feel that this is really an extraordinary occasion. That New York Academy of Medicine should sponsoring this particular celebration. Particularly [inaudible] as our committee in discussing this celebration -- this commemoration particularly sparked by Dr. [inaudible], intended that that presentation should be a picture of Freud as a man who is a scientist. It should be a commemoration and not a wake, because at a wake when talks only good, in quotation marks, about an individual. I think what we have heard today is three brilliant, extraordinary brilliant presentations. The fact that they are all friends of mine is not really any reason for the adjective, because being friends of mine, I -- usually as they know me, am not very [inaudible]. But the fact is we've had three brilliant presentations today that have given us a multi-dimensional portrait of a scientist and a genius, an individual who has had predecessors, and I hope will have followers rather than disciples. And this has been emphasized by everyone of the speakers. A man who has made a contribution in the life perhaps of his own theoretical concept based on what had gone before him. Plus, what he was. And the expectation, which has already been realized, and is being realized, not for the second half of the 20th century, for the middle quarter of the 20th century that the basic concept point of view scientific concepts already have made an enormous contribution to every field in human endeavor. And I think this is really what distinguishes Freud from many other individuals in science, not that the scientists contribution doesn't pour over overboard -- enter into other areas. But here is an individual who because of his own direct contribution, has touched every aspect of human behavior and human science, and this is the man, Freud, who we honor today. It's a kind expression, which is always used, let an honorary man be an honor himself, and despite of his trifles, I think this is exactly what is happening today, that we really honor ourselves by honoring Freud. As a matter of fact, as we looked at the program here and the distinguished names of the participants of the program, I think this in itself perhaps is the best commentary as to why they are able honestly and sincerely to celebrate the 100th anniversary of the birth of Freud. Now this is not a publication, but I've been warned many times, never participate in a meeting in your own home town. I've got to talk and run, because I've just got an urgent message.

[ Applause ]

[ Silence ]

>> Paul H. Hoch: The next speaker is Dr. Houston Merritt, Professor of Neurology at Columbia University and Director of the Neurological Services at [inaudible] Institute. Dr. Houston Merritt whose contributions to neurology you all know, I don't have to enlarge on that. I believe it is fitting that an organic neurologist Dr. Houston Merritt is should speak at a Centenary Memorial like this Freud. Everybody knows that Freud started out as a physiologist and as a neurologist, his contributions in neurology are -- although, they are brilliant and outstanding. His later contributions overshadow his contributions in neurology. Today very little attention is paid or only by a few experts in the neurological [inaudible]. Furthermore, in all his later work you couldn't deny that some of his original training and interest is coming through. And even though Dr. Grinker pointed out quite correctly, that after he failed even though he intended to, to use another word, [inaudible] to connect the mind with the brain. That was the last some feeble attempts he made in later on in this direction and concentrated on the purest side to logical only, then he felt that with some [inaudible], which were available in his time, he wouldn't be able to become a professor. I may add nobody accomplished it since, but intendancy to do it, or the aim to do it, would be probably one of the major tasks of future medicine. I would like to ask now for Dr. Merritt to add his observations.

>> Dr. H. Houston Merritt: Dr. Hoch, honored speakers, ladies and gentlemen, as Dr. Kaufman said, this will be a commentary rather than a discussion. I am not prepared by training to discuss the contributions of Freud as made then so eminently presented by the speakers. But I would like to have you reflect for a few minutes on Freud's influence on medical education and practice of medicine, particular as it refers to psychiatry and to medicine the special branch, neurology, which I am particularly interested in. You hear a great many comments about how strange it was that Freud did a great deal of excellent neurological work, before he became so much interested in the psychological side. I think if you just review the history of the development of medicine, you'll realize that in Freud's day all of psychiatry was done by men who also had training in critical neurology and in the branches of basic sciences of physiology and pathology, and Freud was no exception that. Freud was a -- lived in the era of the so-called neuropsychiatry, and I would like to trace his influence on the splitting of this term. It's very interesting to go back and trace the evolution of Freud's studies on the organic side. He started out with studying the spinal route [inaudible] of animals, went on through that to study was the spinal cord. He made a very thorough investigation of the brain stem, became a [inaudible] commission in neurology and made one of the most thorough reports of cerebral palsy that have ever been made. On this he went into this [inaudible] borderline between neurology and psychiatry that is the study of aphasia, and perhaps stimulated by his contacts [inaudible], when he went to Paris, his contacts with [inaudible], he became much more interested in the psychological side. He realized that hypnotism was not the tool that it was thought to be and from that went on to his deeper studies of psychopathology, which you have heard discussed by our [inaudible] speakers. I would like to spend a few words on Freud's influence in the separation of neurology from psychiatry. I think perhaps more than any one man he was influential in this separation. Maybe the times also had something to do with it too. Medicine has involved in a manner where we have so many complexities that it is natural for splitting up into various subspecialties. We take the field the General Practitioner, he has now become the internist and in the internist, we will find men that are cardiologist, gastroenterologist, allergist, and the like. If we take the field such as the Ear, Eye, Nose and Throat, which used to be practiced by one doctor, now we find very few participants in this field. We find ophthalmologists, and otolaryngologists, but I do not believe that the natural evolution of medicine was the main factor in the separation of neurology and psychiatry. I believe that Freud giving a dynamic form of therapy to psychiatry led them to spend more time in this field and prevented them from also mastering the other field, the field of organic neurology. Now we might ask, is this separation a good one or a bad one? Well, I feel certain that it has its good points. It is almost impossible in the present day for a man to become an expert in both the fields of neurology and psychiatry, and if he tries to, he is apt to feeling like one and be inadequate or partially inadequate in both. I believe that also that there perhaps in some danger in too great a separation in the two specialties. For a time and there was a trend for an almost complete dichotomy. In fact at one time in the American Board of Neurology and Psychiatry, there was agitation to split the board into two divisions, one of neurology and one of psychiatry. Somehow the head decided that this was not good and perhaps their decision will be a wise one. It would be very interesting to see what Freud's ideas and theories would be at present time. If he could have put his genius and his brain to work on the psychopathology, in light of knowledge that has been accumulated since his day I think his theories and ideas would be a great deal different than what are written and this of course has been brought out by our previous speakers. You must recall at the time that Freud wrote his works very little was known of endocrinology. He commented in some of his writings about Grave's Disease, which was the test being described at the time. Nothing was known about the thyroid or the -- very little was about the thyroid at this time, very little was known about the adrenal, the pituitary. Almost nothing was known about the role of the endocrines -- I mean the -- the words slipped me. Very little was known of electrolytes, their influence on mental activities. Very little was known of the vitamins, and I'm sure that if Freud had the benefit of all of the knowledge that is present day, his ideas might be different from what they are. And I think our speakers have emphasized this fact, that we have to build on what Freud has given us and not use this as a landmark beyond which we cannot go. It's been a great pleasure to have listened to these papers, and I consider it a great honor to be asked to make a few comments. Thank you.

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>> Thank you very much Dr. Merritt. I believe that our time is up, and I only would like to express my very sincere thanks to the speakers who gave us outstanding contributions to the centenary celebration and illuminated not only the past, but showed us or gave us at least a glimpse in what direction in the future psychiatry and psychologists may move. This celebration, Centenary Celebration Freud will continue in the evening session at 8:30 p.m. today. Thank you

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