Are You Always Worrying?

(See Cover)

The average man doesn't know much about psychiatry, but he knows what he dislikes and suspects about it. One psychiatrist, paraphrasing Artemus Ward, has said of his specialty: "In no other field of medical knowledge does the average man know so many things that ain't so."

Psychiatry is not yet 60 years old; it is the youngest and most controversial branch of medicine. But psychiatry's solemn clinical lingo (see box) has been snatched up, misused and overused by the man in the street. Parents and teachers speak knowingly of "inferiority complexes." The comic strips and the movies refer familiarly to "frustrations" and "repressions." Psychiatry has been hotly debated and bitterly denounced by clerics (it seems to poach on their preserves), by Communists (it puts too much emphasis on the individual), by materialists (it claims that illness need not have a physical basis)--and even by some doctors.

The average man has a sneaking suspicion that psychiatry is either hilariously funny or else a bit sacrilegious. Possibly it is some new form of "European smubtlety"--or maybe just a lot of pompous nonsense? The public has taken this relatively new scientific whatsis home on approval, but has not yet bought it.

The Salesman. Psychiatry's practitioners are also, of course, its salesmen. One of its most earnest practitioners and salesmen is a rangy, friendly, 49-year-old Kansan named William Claire* Menninger (with a hard g). This month Dr. Menninger is spending only nine days in his neat, pine-paneled office in Topeka. The rest of the time he will be on the road, making speeches and drumming up enthusiasm at committee meetings, policy conferences, and get-togethers of the high brass of U.S. psychiatry.

Dr. Will is president of the American Psychiatric Association (A.P.A.), official organization of the 4,432 U.S. psychiatrists;* chairman of the Group for the Advancement of Psychiatry (G.A.P.), an organization of 150 psychiatrists known in the profession as the "Young Turks"; president of the American Psychoanalytic Association; president of the Central Neuropsychiatric Association.

This week Dr. Will has been busy with some psychiatric promotion on his home grounds in Topeka: a meeting of psychiatrists and interested laymen to discuss a topic full of heavy psychiatric overtones: "Our Children in the Atomic Age." Thanks to the Menninger family, Topeka, in the U.S. heartland, is a world center of modern psychiatry. It is the only city in the U.S. where psychiatrists outnumber all other kinds of doctors; it is the largest training center for psychiatrists in the world; it trains 15% of all the psychiatrists now being trained in the U.S. Topeka is the home of the Menninger Foundation (formerly Menninger Clinic), of which Dr. Will is general secretary and clinical director; it is also the home of the Winter General Hospital, center of the Veterans Administration's psychiatric training program, whose teaching psychiatrists are largely supplied by the foundation.

What Is Psychiatry? What exactly, is this science that all the fuss is about? In one of his three books* published this year (You and Psychiatry, Scribner, $2.50, written in collaboration with Munro Leaf, author of Ferdinand the Bull), Dr. Will has given a textbook definition: "Psychiatry is that branch of clinical medicine that concerns itself with the diagnosis, treatment and prevention of personality disorders." Instead of "personality dis orders," some authorities chop off four syllables and call it "mental illness." Despite the claims of some of its enthusiasts, psychiatry does not pretend to be a philosophy, nor take the place of religion. It tries to prevent mental illness and to "minister to a mind diseased." It is essentially optimistic and believes that man can learn to live at peace with himself and his fellow man.

Psychiatry recognizes two main types of mental illness, although there is no sharp distinction between them. The man who wanders so far from reality that he lives in a daydream is a psychotic, suffering from, a psychosis (psychiatrists consider "insanity" an oldfashioned, legal term, without medical meaning). The man who cannot be happy with his environment or himself -- who suffers from his own slanted view of the world -- is suffering from a psychoneurosis (neurosis for short). A psychotic is much sicker; but both psychotics and neurotics can be cured.

Psychiatry has no wonder drugs or surgery (though it is trying both drugs and surgery -- notably, operations on particular parts of the brain). Psychiatrists do not think that they have all the answers, but they believe that their techniques of healing, still very largely in the experimental stage, have had some extraordinary results. They are not always sure just how or why their techniques work, but so long as the patient gets better, they are content to plug away at the techniques and let the theories wait. Psychiatrists use great doses of good will, some guesswork, and a few tricks picked up from mankind's troubled past.

Evil Spirits. From earliest times through the Middle Ages, mental illness was taken to mean that the victim was "possessed" by evil spirits. For centuries people with abnormal mental quirks were either revered, treated as harmless "naturals," or chained, flogged or burned at the stake.

The study of mental illness did not make much progress in the 19th Century. Victorian doctors, concentrating on the microscope and on the autopsy table, were determined to find a physical reason for every illness. Fascinated by blood, bone and bowel, they decided that neuroses were caused by upset "nerves" or "brain." The treatment of mental illness lagged--with a few exceptions--until fairly recent times.

Nevertheless, here & there through history, men had speculated about the mind's disorders. Paracelsus, born the year after Columbus discovered America, came to a conclusion about the dual nature of the mind that today's psychiatrists have very little quarrel with. Wrote Paracelsus:

"One should with diligence take note of the spirit of man, of which there are really two, that are inborn.

"For this is indeed true, that man is in the image of God and thereby has a Godly spirit in him; but, on the other hand, man is also an animal, and as such has an animal spirit. These spirits are two antagonists, and yet the one must soften the other."

Hint from a Hypnotist. Austrian Anton Mesmer, who gave his name (mesmerism) to a technique now called hypnotism, has been called a faker. More likely, some modern psychiatrists think, he was a stupid man who blundered into an idea too big for him: the phenomena of suggestion and suggestibility. A Frenchman, Jean Martin Charcot, demonstrated that hypnotism could both arouse and quiet symptoms of hysteria. Charcot also bid for fame as the teacher of a Viennese neurologist named Sigmund Freud (rhymes with overjoyed).

Freud was, without any dispute, the father of modern psychiatry. He started fights that are still raging; but every psychiatrist, pure Freudian or not, admits his debt to the master. During the past 25 years, Freud's ideas have in some way influenced--or thrilled or outraged--almost every literate person on earth.

Before Freud, psychiatrists had worked on the "insane." They did not bother with--in fact, they knew almost nothing about--the infinitely larger number of people who weave a miserable course halfway between the mad and the crotchety. After taking his M.D., Freud "specialized in structural diseases of the nervous system. He was fascinated by patients who had "pains," but no structural disorders--i.e., neurotics. The key problem with a neurotic patient, he decided, was to get him to "remember" things that had been "forgotten"--not forgotten in the usual sense, but "repressed"' because they were too painful or disagreeable to remember.

The Id & I. Freud did a lot of listening to his patients' troubles before he talked about his theories. Most of the human mind, he announced, is like an iceberg. Just as most of the iceberg is out of sight under water, most of the mind is buried deep in the Unconscious. The mind, Freud said, is divided into three parts:

The Id, which makes up most of the Unconscious, contains man's prehistoric, primitive, must-have-it-now, animal drives. The Id's theme song is "I want." Man is born with an Id and soon develops an Ego, which learns the community rules and makes the decisions. The Ego says "I will" or "I won't." Last, there is the Superego, which is the censor or conscience. The Superego says, speaking to the other two, "You must" or "You must not," and demands punishment (in the form of a guilty conscience, worry, etc.) if its commands are violated.

Most personality disorders are caused by conflicts--conscious or unconscious-- between selfish desires (the Id), what society demands (the Ego), and what you think is right (the Superego). So Freud concluded, and so most psychiatrists agree.

Dr. Will Menninger has a simple illustration of the Conscious v. Unconscious conflict. The mind, he says, is something like a clown act featuring a two-man fake horse. The man up front (the Conscious part of the mind) tries to set the direction and make the whole animal behave; but he can never be sure what the man at the rear end of the horse (the Unconscious) is going to do next. If both ends of the horse are going in the same direction, your mental health is all right. If they aren't pulling together, there's likely to be trouble.

How Does It Work? How does a psychiatrist straighten out the conflicts? Freud, after finding hypnotism inadequate, devised the most sneered-at tool in all psychiatry: the couch. The couch is supposed to make the patient relax. The analyst places his chair at the head of the couch, where he is unseen by the patient. The idea is to get the patient to put all his thoughts and feelings into words. Such "free association" is the essence of psychoanalysis.

As the patient talks, the psychoanalyst listens for evidence of "unconscious wishes." of "suppressed desires," of hidden motives. He watches for these signs in accounts of dreams, in words, in reported actions, in sudden hesitations and slips of the tongue, in strange lapses of memory. As the talks go on--and on & on--the patient gets used to having the analyst there, listening. The analyst does not try to boss, but often guides, the patient. The theory is that if the patient talks enough about his troubles, he will finally get 1) the relief any confession brings; 2) a somewhat less sentimental view of himself; 3) a realization that he too can be a grownup.

After investigating many patients, Freud decided that the basis of almost all personality conflicts is "sexual." He used the word in a very broad sense to include all kinds of love and pleasure, from eating to a fondness for abstract thought. His emphasis on sex caused bitter breaks with two of his most famous followers: Carl Jung, who was sniffy about Freud's emphasis on "sexuality" in infants, and Alfred Adler, who believed that a "drive for power" was equal in importance with "sexual urges."

There is still some medical skepticism--not to mention catcalls from the public--about Freud's preoccupation with "sex." Certainly it helped give psychoanalysis (and with it, psychiatry) a bad name. (Another reason was Freud's personal atheism.) Like the "Kinsey report" half a century later, "Freudianism" provided a handy excuse for the loose morals of Bohemians everywhere, and a handy club for belaboring all "repressed" prudes and Babbitts.

So You Won't Talk? For the couch treatment, patients must not only be supine but intelligent (with I.Q.s, many believe, of 115-120, about college level). Psychoanalysis works best on neuroses (most often of the upper income brackets); it is no good for most psychoses. Besides the protracted, cumbersome and expensive method of the couch, what specific treatments do psychiatrists use? The one that occupies most psychiatrists' time is face-to-face talks about the patients' here-&-now problems.

For serious psychoses, shock (electric, insulin or metrazol) is sometimes effectively used to jolt depressed psychotics back to normal. Some psychiatrists admit that electric shock superficially resembles the medieval torture of the insane. (The beatings that the insane used to get, with chains, whips or rods, may actually have helped them, no matter what the intent.) The modern version is applied with more humanity, no more understanding of what makes it work. But patients who are so sick that they cannot talk at all may be able to talk after shock. Psychiatrists try to use such brief lucid periods to start helpful treatment.

A milder method of dredging the mind is narcosynthesis (with some such "truth serum" as sodium amytal). In a twilight state between wakefulness and deep sleep, the patient often says things he cannot or will not say when fully conscious. Narcosynthesis works best when the patient's difficulties are recent (as in some "war neuroses"). The most desperate treatment of all, for the patient who fails to respond to anything else, is a drastic brain operation, like lobotomy (TIME, Dec. 23, 1946). Lobotomy may relieve the more troublesome symptoms, but it may also leave the patient so irresponsible or lumpish that he "seems to have lost his soul."

Psychotherapy (the treatment of mental illness) includes other surprising--and less unpleasant--methods. At the Menninger clinic, for instance, doctors might prescribe, for a depressed patient, "two weeks of unsolicited love." This means that the patient's doctor and nurses should treat him with the full measure of brotherly love that he needs but does not know how to ask for. Psychiatrists also use music as a soother, and such "occupational therapy" as publishing newspapers, carpentry and jewelry-making.

Bacteria & a Mother-in-Law. Very few --only one-tenth--of U.S. psychiatrists are out & out psychoanalysts. But any psychiatrist may try to find out a patient's troubles by thoughtful questioning. Dr. Will Menninger describes himself as a "psychodynamic psychiatrist." Says he: "The distinction between Freudian psychiatrists and non-Freudians is becoming infinitesimal. Dynamic psychiatry is being accepted more & more widely ... In other words, people are beginning to see that damage of the same kind can be done by a bullet, bacteria or a mother-in-law." The extreme Freudian approach, he thinks, is "almost metaphysical." Although strong for research, he believes that cure is more important than exact diagnosis: "One does not have to know the cause of a fire to put it out."

Serious Job. As psychiatry's U.S. sales manager, Dr. Will is well aware that any new branch of science gets a rough kicking around by the public until the idea has been well tested. Psychiatrists take some comfort in the thought that Galileo was jailed, that Lister was hooted at by his medical colleagues, and that Darwin, who changed the whole course of Western scientific thinking, was attacked viciously in his lifetime.*

Dr. Will Menninger himself is a convincing explanation of why the public is getting less skittish about psychiatry. Plainly neither a crackpot nor a "foreigner," Psychiatrist Menninger is a big (6 ft. 1 in., 189 lbs.), friendly "nice guy." He is genuinely modest about holding practically all the top posts in his profession ("They shoved me up there"). He takes his job of promoting psychiatry as seriously as if he were a Midwestern drummer selling widgets; he used to carry in his pocket a little black book full of jokes and limericks, ready for impromptu speeches at medical dinners. (He lost it moving from Washington to Topeka after the war.)

There is not a touch of the Hollywood-style, burning-eyed psychiatrist about Dr. Will as he greets friends or patients. He has a hearty Chamber-of-Commerce handshake (he belongs to the Topeka C. of C.), looks and acts like the safe kind of fellow a lonely traveler would pick to talk to on a Pullman club car. He lives with his attractive, intelligent wife (who teaches child care at Topeka's Washburn Municipal University) and three sons (Roy, 22, now at New York-Cornell University Medical College, Phil, 20, and Walter, 17) in an eleven-room, white clapboard Colonial house.

Butterflies & Sibling. Dr. Will takes his own medicine. True, he smokes two packs of Chesterfields a day, a quantity that some psychiatrists might consider a mildly alarming nervous habit. But since it is sound psychiatry to have a wholesome hobby, Dr. Will goes in heavily for hobbies. When he took a week off last August, he spent 14 hours a day on his stamp collection. He collects butterflies and goes on bird walks (his only form of exercise). He also plays the organ and piano.

The philosopher of the Menninger family is Will's older brother, Dr. Karl, 55, author of The Human Mind, Man Against Himself, Love Against Hate. Dr. Karl makes penetrating generalizations on psychiatry, and teaches other psychiatrists.* The two brothers, philosopher and organizer, work together well, with little evidence of what psychiatrists call "sibling rivalry" (jealousy among brothers & sisters). Dr. Karl and their father, Dr. Charles Frederick ("Dr. C.F."), founded the Menninger Clinic in 1920. Dr. C.F., who started as a horse-&-buggy doctor, got the idea from the Mayos. Now a gentle man of 86, he teaches mineralogy and seashell-collecting as one of the treatments for Menninger patients, supervises the planting of trees and flowers on the 34-acre grounds of the Menninger Foundation.

The Unconscious & Confession. The means psychiatry uses to make its cures are often experimental, and sometimes obscure. What about its ends? It aims to make its patients "wise up" to themselves --and thus get rid of a mysterious bellyache or a sad, twisted notion that a prince is coming to call any day now. That is an ambitious aim. Is it not, in fact, a challenge to religion on religion's own ground?

Dr. Will thinks not. So do many Catholic as well as Protestant clergy (see RELIGION). In Kansas, there is hardly an echo of the noisy controversy that blared up last year in Manhattan when Msgr. Fulton J. Sheen charged that analysis was based on "materialism, infantilism, hedonism and eroticism." Four Roman Catholic psychiatrists, at a meeting which Dr. Will sat in on, issued a denial of this charge. The carefully reassuring statement, approved by the entire membership of G.A.P., stated flatly that there is no conflict between psychiatry and religion, and concluded: "In the practice of his profession, the competent psychiatrist will therefore always be guided by this belief."

Dr. Will's own position: "The psychiatrist deals with unconscious difficulties. To do this, he must often try to remove a sense of guilt. But, remember, neurotic guilt is not the same thing as real guilt. The minister . . . deals with ... a real guilt over transgressing explicit moral laws, not the irrational guilt of the emotionally disturbed patient."

Psychiatrists think that the unconscious material dredged up in psychoanalysis may become a religious problem once it has been brought up into the conscious mind. But while it remains repressed--or unconscious--the clergyman, unless he happens also to be a psychiatrist, cannot get at it. Says Dr. Will, a Presbyterian: there are some emotional crises in which a "religious mentor may be able to provide more important support than a psychiatrist."

Who Gets It? Besides holding out an olive branch to religious leaders, psychoanalysis is slowly, id by id, trying to persuade the average man of its value. The Army's experience with psychiatry in World War II, with Dr. Will bossing the job, did as much as anything to boost psychiatry's stock, and advertise it. During the war, the "brain boys" were responsible for rejecting about 39% of the 4.828,000 men the Army did not want. Of all medical discharges, about 43% (314,500 men) were for neuropsychiatric reasons;* 163,000 others (the so-called "psychopathic personalities") were discharged for administrative reasons (anything from homosexuality to persistent flouting of rules).

Dr. Will still gets hopping mad when people claim there were too many psychiatric casualties and that "cowards" and "malingerers" were being "mollycoddled." There were about 10% more psychiatric casualties in World War II than in War I; the rate for insanity, or psychosis, stayed the same. Chief reason, says Dr. Will, is better diagnosis of neuroses; psychoses, like broken legs, are easier to spot.

During the war, men in the U.S. Army got better psychiatric care than any large group of people ever had before. If they needed a psychiatrist, they were, for the most part, able to get one quickly, easily --and free. The peacetime picture is very different. The cost of treatment can be staggering. A psychoanalysis usually costs at least $10 an hour, possibly $25 or even $50. At five times a week for 100 weeks (an analysis can easily go on that long), the total cost may run to $5,000 or more. At the Menninger Foundation, the minimum charge (for the 65 hospitalized patients) is a flat-rate $650 a month; special treatments like psychoanalysis cost extra. The mass of mentally ill, in their lives of quiet and not-so-quiet desperation, have nowhere to go but the state institutions. Some of these are good, some not much better than Hogarth's 18th Century Bedlam, but few of them can do much to cure their patients. Because of lack of money, modern psychiatry is an all-too-rare visitor in the state hospitals.

State hospitals throughout the U.S. are, in general, scandalously crowded. Thousands of mentally disordered patients are forced to live like animals in bare, foul-smelling rooms. There is an average increase of 12,000 a year in the state hospital population. Today, 41% of all hospital beds (580,273 out of 1,400,318) are for mental patients. The cost is an indication of the care given to "public charges": state hospitals, on the average, spend about $1.50 a day per patient. The cost at Menningers': $22.

Answer Yes or No. More people apparently go crazy (succumb to psychoses) every year, and perhaps the majority of the U.S. is slightly daffy (neurotic), in one way or another. There are more untreated neurotics walking the streets than anyone but a policeman or a psychiatrist suspects.

Dr. Will, in one of his new books, has a list of leading questions:

Are you always worrying?

Are you unable to concentrate for a reason you can't explain?

Are you continually unhappy without sufficient cause?

Do you lose your temper easily and often?

Do you have insomnia regularly?

Do your moods fluctuate wildly from depression to elation and back again?

Do you continually dislike to be with people?

Are you upset if the routine of your life is disturbed?

Do your children consistently get on your nerves?

Are you always right, the other person always wrong?

Are you afraid without real cause?

Are you "browned off" and constantly bitter?

Do you have numerous aches and pains for which no doctor can find a physical cause?

Do you feel rejected or inferior chronically, with too little provocation?

If you answer yes to any of these questions, says Dr. Will, your mental health is probably none too robust, and a psychiatrist would do you more good than harm.

Psychiatry, says Dr. Will sensibly, cannot save the world all by itself. He has no patent psychiatric pills for ending war, or meeting the threat of the atomic bomb--or even for getting children to stop biting their nails. But the world, he thinks, would be a better place to live in if people were healthier in their minds. Spreading the word.about psychiatry--to folks who need it, and to doctors who don't know much about it--is a job that Dr. Will finds well worth doing.

* His parents had hoped for a girl, planned to call her Clara. -Every psychiatrist must be an M.D., take years of psychiatric training (which often include a personal psychoanalysis) and pass special examinations before being considered a "specialist."

* The others: Psychiatry in a Troubled World (Macmillan, $6); Psychiatry, Its Evolution and Present Status (Cornell University Press, $2).

* And still is, by such independent intellects as George Bernard Shaw.

* The Menningers feel that every psychiatrist should himself have had some kind of psychological distress; otherwise, he might have "a kind of character rigidity" that would make it difficult for him to understand his patients' troubles. Facetious skeptics suspect that psychiatrists are themselves psychiatric cases.

* The Army at first stamped "psychoneurosis" on the discharged man's medical record. When the "pn" label scared off prospective employers, Dr. Will had the policy changed: after February 1945, the record of a man discharged for mental cause carried such whizzbang-medicalese --stunning but relatively harmless--as "conversion reactions," "somatization reactions," "anxiety reactions."

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