/I. Behov. Thu. d Exp. P,ychiar. Vol. I. pp. 93-94. Perpamon Press. 1970. Printed in Great Britain.

THE AGE OF AQUARIUS

NEIL EDWARDS

Temple University Health Sciences Center, Department of Psychiatry

(Received 5 October 1969)

WE ARE in age of revolution-not only in society in general but specifically in psychiatry, and the younger members are the most involved. It is only fitting, therefore, that the first issue of this journal, which is part and parcel of psy- chiatry’s revolution, should contain a general statement by one of the ‘trainees’ in psychiatry on how the neophytes fit into the current turbulent stream.

Whereas speculation about ‘inner states’ used to be the favorite psychiatric past-time, it is no longer accepted as being enough, and indeed it has been suggested that it may be harmful , . . Certainly there is mounting evidence that it leads to no useful therapeutic results. Add to this the gnawing suspicion in many of our minds (not to mention the minds of many of the public) that any fairly bright person who takes the trouble to learn the vocabulary could do just as good a job of talking learnedly about repression, the unconscious, dreams, etc., as a therapist who has spent some 12 years preparing himself to treat psychiatric patients, and the foundations look even more insecure. Fortunately, most able men in psychiatry are taking a new, harder look at themselves.

There is no doubt that psychiatry today is in turmoil, and this is reflected at the resident level as well as among those well established in the field. A new brand of psychiatric resident has been born and is maturing. He no longer accepts and dotes on the master’s word simply because it is the word of the master. Pontification is out; verification is in. The primeval father is in his death throes; and I speak of no particular father but rather of primeval fathers as a

category. The new psychiatric resident demands empirical justification of what he is told by his mentors, both in theoretical matters and in therapeutical operations. He argues, he cajoles, he censors, he even quips (for a sense of humor is necessary at all costs).

Reassuringly, the psychiatric resident is meeting with some success in his rebellion. As recently as 5 years ago, questions which challenged the basic tenets of Freudian psy- chology were simply avoided for the most part, certainly at the resident level. Equally unexplored were any questions concerning the validity of the medical model in the explanation and treatment of psychiatric disorders. It was simply bad form to ask a question such as “Why is infantile sexuality so ah-important”, or “Why can we not simply treat a patient’s presenting complaint rather than assuming that there is some basic ‘disease’ underlying his ‘symptoms’?” Only first year medical students had the temerity to ask such ridiculous questions. By the time they had become second year medical students, almost all had become aversively conditioned by the punitive responses aroused by such queries. It is an unusual student who can bear repeatedly hearing, verbahy or otherwise, that there must be something wrong with his cognitive functions for him to be capable of such unfounded doubts.

Now things have changed, so that even psychiatric residents can ask once horrifying questions: “What is the evidence for the existence of the Oedipus complex?“; “Why do you insist on psychoanalyzing a patient when behavior therapy will work much more rapidly

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and economically?“; “What is the evidence that pschoanalysis works at all?“; “Of what demon- strated usefulness are the concepts of the unconscious, defense mechanisms and the structural theory of personality?“; and “Haven’t several invesrigators recently raised the possibility that the use of the medical model with regard to neuroses may be doing more harm than good?” Of course, sensible answers are not always forthcoming; even now we sometimes find the brick wall of ‘analytic stance’ or looks of incredulity when we challenge basic postulates. But usually at least an attempt is made at an answer, and that is a vast improvement. The senior citizens of psychiatry are coming to realize that their strong convictions are no longer sufficient to stave off the searching questions of the new psychiatric resident.

Nevertheless, the empirical evidence we ask for is not always available. Only in therapy based on learning theory and in all too few of the

organic conditions does it exist at all. All possible efforts should be directed to developing a comprehensive and accurate theory of human behavior.Onlythroughcarrying out thenecessary empirical studies will a true science of human behavior emerge. To those therapists who object to a science of human behavior on the grounds that it would make automatons of people, there is an answer inherent in their own role as therapists. What is therapy in psychiatry but the inducement by whatever means possible of durable change in a person who is not functioning normally? It is impossible reliably to induce such change if one does not know the lawful relations of behavior, and if one cannot control the factors that determine change. Prediction and control are the two bywords of science. Why not practice the science systematically? We shall find ourselves saving vast amounts of time, effort and patients’ money.