Medicine: Preventive Psychiatry

When she was eleven years old, the patient was taken to the hospital with a stomachache. There, a young intern recommended a psychiatric examination and sent her home with some aspirin. The aspirin seemed to work wonders. Neither the girl nor her parents saw much need for psychiatry.

Later the persistent stomachache returned, and the girl started a 35-year tour through American hospitals. She had nine abdominal operations and some 5,600 hours of free medical attention, but the doctors never found any physical basis for her aches & pains. She became a helpless invalid before she finally took the first young surgeon’s advice. Then it was too late. No psychiatrist could turn back the clock. By then the doctors agreed that her first trouble had been a simple, psychogenic stomachache, but it had snowballed until every problem in her life brought gastrointestinal distress. She became a hopeless hypochondriac, obsessed with her mentally tangled intestines, incurably ill with what the late great Sir William Osier, who was not given to psychiatric terminology, called “bowels on the brain.”

“This is not an extreme or exceptional example,” says Psychoanalyst Lawrence S. Kubie in the current Bulletin of the New York Academy of Medicine. Some 50 hours of preventive psychiatry might well have prevented the “fantastic generosity” of 5,600 hours of surgery and medicine—which in this case were “not only wasted, but were actually destructive.” What the U.S. badly needs, says Dr. Kubie, is a nationwide program of preventive psychiatry. It “would be an economy for every general hospital … for individual private practitioners, but above all, in the lives of … patients.”

Kubie concedes that it would be difficult to put such a program into practice. The people he wants to treat are not very sick, nor are they likely to recognize the nature of their symptoms. More often than not, they will object if a general practitioner advises psychiatric attention: too many people live with a primitive fear of insanity.

“What we lack,” says Dr. Kubie sadly, “is a magic mirror which would make it possible for [an] individual to look 10 or 20 years into the future to see the price that he will pay for [the] nagging problem which he is able to lock up in some watertight compartment today.”

Lacking a magic mirror, Dr. Kubie offers physicians a rough test for detecting psychiatric disturbances: “If a patient can use common-sense advice effectively, no more is needed, and our patient cannot have been very ill. When [commonsense advice] rolls off the proverbial duck’s back, then that duck is ill, and needs technical help as early as it can be brought to bear.”