All Dis-Ease is not Disease: A Consideration of Psycho-Analysis, Psychotherapy, and Psycho-Social Engineering

Like the proverbial elephant examined by several blind men, psychiatry seems (or feels) remarkably different to various individuals who contact its different parts. With its rapid evolution into the legal, educational, welfare, and many other fields, the psychiatrist increasingly finds himself involved in matters quite far removed from medicine as it has been known in the past. There is need to examine what goes on, not only between psychiatrists and their various kinds of patients, but also the growing host of other personnel with whom they interact in the complex social structure of our day. It is vitally important that neither psychiatrists nor their heterogeneous clientele misunderstand, misrepresent, or misuse their relationship.

There are vast differences between medicine's earlier physicalistic concept of disease and treatment and the twentieth century tendency to conceive of all behaviour and feelings as manifestations of sickness or health. In our society an increasingly common tendency is to equate distress, dissatisfaction, or discomfort with sickness, and to assume there is an 'answer', a cure, an expectation that relief can be produced by scientific means. Individual and personal as well as group socio-economic and political problems are frequently classed as 'ills', and those who suffer from them are prone to expect relief through treatment by the appropriate 'doctor'. One is allowed, encouraged or sometimes forced to be dependent and to place responsibility in the hands of mental, economic, or political experts. Thus psychiatrists are often confronted by parents, families, schools, courts, or medical colleagues who want distress taken away—relieved by something performed or prescribed by the doctor, as in surgery or medicine. This creates a dilemma for any psychiatrist who is both ethical and scientific. More than other kinds of doctors, he is subject to pressure from many sides, and prone to become an agent of people who want him to fulfil th