Prophylaxis in the Psychoneuroses*

Dr. Nicholas Murray Butler in The President's Annual Report for 1921, among other things in reference to The Medical School, states the following: “The medical school of tomorrow will be conceived of as a public service institution to promote public health and to spread a knowledge of preventive medicine; training in the detection and cure of disease will then appear as an incident in this larger and finer program.” This is a program, the realization of which is much desired, but which to the active practitioner seems far away. Yet there can be no doubt that preventive medicine is the future field of medicine, for that is the only means by which we can hope to deal with our vast problems in a big way.

In the branch of mental medicine, as represented in part by the psychoneuroses, prevention is still far from having reached any measure of success. The cause for this is that little of the true nature of these conditions was known until the past two decades. With increasing knowledge, prevention in this field of medicine is taking on a more hopeful aspect, and it is to this that this short and somewhat incomplete communication is devoted.

Whether the approach to the study of psychoneuroses is the psychoanalytic in the strict Freudian sense or not, most workers in the field have arrived at some well established conclusions as far as they have gone. These conclusions as to the causes of the psychoneuroses and some of the psychoses warrant us in stating that none of the conditions which have so far been studied have all their causes in the present, but that the essential causes have been traced back to the early life of the patient. This statement takes into account the commonly accepted knowledge that neurotic and some psychotic conditions are intimately associated with the emotional (in the Freudian sense, the repressed or unconscious) life of the sufferer.

I do not mean to imply that none but Freud, either before or following the appearance of his writings, and independen