The Training of Mental Hygienists
The Psychological Clinic Copyright, 1930, by Lightner Witmer, Editor Vol. XIX, No. 5 October, 1930
- Author:
Samuel W. Ferxberger
Professor of Psychology, University of Pennsylvania and Editor of the Journal of Experimental Psychology.
The author of this article has no personal axe to grind. He is an experimental psychologist of the laboratory type. lie has never been interested in the practice of clinical psychology and it is doubtful if he ever will be. He thinks that he can speak on this topic, therefore, entirely without prejudice or bias. On the other hand, be has been in a department of psychology for over 20 years in which a clinic plays a primary part and he has been in contact with clinical psychology and with clinical psychologists all of this time. The present article grows out of a request from Dr Bronson Crothers to express my opinion with regard to mental hygiene in connection with the White House Conference on Child Health and Protection.
As one surveys the field of mental hygiene today, its practice is in the hands of a group with curiously divergent training and most divergent interests. One finds the practice largely in the hands of physicians?especially the pediatricians and the psychiatrists?to which are added a sprinkling of psychologists, sociologists and educators. Each group approaches the problems and the practice of mental hygiene from a different point of view, and in many 1 The obvious medium for the publication of this article on the training of mental hygienists being “MENTAL HYGIENE,” Dr Fernberger first submitted it to that journal for publication. The medical director of the National Committee for Mental Hygiene and the editor of “MENTAL HYGIENE,” being unable to publish the article in that journal, returned the manuscript to Dr Fernberger. The editor of the “PSYCHOLOGICAL CLINIC” hastens to give this article publicity, believing that Dr Fernberger, who is a specialist in experimental psychology, has touched upon a tender spot in the professional equipment and training of psychiatrists, psychologists and educators who are at present engaged in the promotion and practice of mental hygiene. Ligiitner Witmer, Editor.
cases, each criticizes the points of view of the other groups. The result seems to be a conflict of cross purposes which, I believe, cannot but be harmful to this highly valuable movement. And no one, I think, would question the value of the mental hygiene movement. It seems worth while, therefore, to analyze this new field of endeavor and to discover the stuff out of which it is made. As a first principle, we can say that mental hygiene is an art or technicology and that it is not a science. Any art employs the results, the methods and the points of view of several sciences or of several sciences and other arts. Thus medicine is an art which takes contributions from the sciences of anatomy, physiology, pharmacology, toxicology and what not besides.
The next problem, then, is to determine the minimum list of sciences and arts necessary for the adequate accomplishment of mental hygiene. On this question there will, undoubtedly, be differences of opinion. It is doubtful if this minimum list would fail to include the following: medicine, psychology, sociology and education. Undoubtedly some individuals would extend the list. It is because these four sciences and arts do contribute and must contribute to mental hygiene, which would seem to be the reason why individuals with a background of any of these four systematic fields are to be found in the movement.
But it would seem that one of the difficulties with mental hygiene up to the present time is that most workers have had adequate training in only one of these disciplines and that this training has given a one-sided emphasis to their work. Hence the physician has emphasized the medical aspects without an adequate knowledge of mental and behaviorial processes, normal or abnormal. The psychiatrist has emphasized the abnormal aspects. And neither have the background of education or sociology. And this last is also true of the psychologist and he is furthermore lacking in the medical approach. The sociologist and the educator do not know enough each of the material of the other nor that of the medical man or the psychologist. Here, it seems to me, is the basis of conflict between the groups, a conflict of opinion, of fact and also of point of view. Another difficulty is the determination of the distinction between normal and abnormal. I think that I can illustrate this point with a personal incident. Recently, while attending a psychiatric clinic of Dr Charles W. Burr at the University of Pennsylvania, he remarked to me: “One trouble with psychiatry is due to you psychologists. If you would only define the normal for us, our job would be easy.” Whereupon I told him that I was quite willing to define the normal which I did in the following terms:
“A normal individual is one in whom you, Dr Burr, are not professionally interested as a psychiatrist.” But this much we can say: the normal is not to be conceived as an average individual (I’homme may en of Quetelet) but must be conceived as a range showing great individual variability within itself. And the abnormal must be conceived as anything falling outside that range. It is my belief that the limits of this range must always have a sociological definition. For example, take the case of feeblemindedness. The definition of this varies from time to time and from place to place, hut it is always determined by whether or not the individual can get along or make a living in his community. So an individual might well be feebleminded in an industrial city but not feebleminded on a farm ten miles away. And similarly, an individual may be a subject for the mental hygienist in the same industrial city and not on the farm ten miles away.
But the mental hygiene movement is capable of further analysis and the result of this shows that it involves at least three types of individuals necessary for its complete formulation. These types may be defined as follows:
1. Individuals interested in the diagnosing of normal and of deviated individuals, who are also able to make recommendations in those cases of deviation that may be saved for return to normal. (Diagnostic) 2. Individuals interested in the training of deviated individuals to return to normal. (Corrective) 3. Individuals interested in developing methods of education and in disseminating knowledge which will anticipate deviation. (Preventive ) All three of these types of workers are necessary for the complete realization of the mental hygiene movement. All of them must have fundamental training in all four of the contributing sciences and arts;?medicine, psychology, sociology, and education. Their fundamental training, however, must vary in emphasis for the three different types of job. Just what proportions of each is ideal must be eventually determined empirically. But it seems possible to indicate apriori and in general what some of these relations may be. One thing is certain, all three groups of workers must have enough background of sociology to guarantee a sociological approach whether they be diagnostician, corrector or disseminator. In any phase of mental hygiene the sociological aspects must never be lost. I am therefore assuming the sociological background for all three groups.
For the diagnostician, the emphasis must be on the medical and psychological aspects in relatively equal proportions and with less emphasis on educational training. I do not conceive that this training in medicine and psychology should be so complete that it would lead to the medical degree nor make the individual competent in all fields of psychology. It should be training in the points of view, the methods of these two disciplines with special training in those fields of medicine and psychology which have a bearing on the work at hand.
For the corrector, the emphasis must be on education with particular regard to teaching in specialized education (not only the training of the mentally deficient but training in corrective speech, corrective motor control, the simpler industrial operations and what not besides). But this individual, in order to give an intelligent report back to the diagnostician, must have sufficient background of medicine and psychology to make valid judgments in these fields. For the disseminator, who will formulate and spread knowledge to anticipate deviation, the essential qualification is educational, both in training and in temperament. He must have background enough to understand and interpret and evaluate the findings of medicine and psychology and special education but I do not conceive of him as an individual whose special duty is to determine the facts. One must have, therefore, coordination between these three different groups. The cooperation necessary between the diagnostician and the corrector obviously must be in both directions for efficient service. And the attitude of the diagnosticians and of the special trainers should always be that of the research worker, always striving to determine new facts and new methods. The disseminator, on the other hand, must have a much more philosophical attitude of collecting, coordinating, evaluating and expressing the results handed to him by the other two groups. His research will consist largely in the determination of better methods of expressing and of disseminating his material.
It may be that there are some individuals who are already adequately trained in the diversity of disciplines analyzed above and who therefore approach the ideal of one or another of these types. If so, the mental hygiene movement is in so far fortunate. But certainly there are many individuals at present occupied with menTRAINING OF MENTAL HYGIENISTS 141 tal hygiene who are lacking in parts of this essential training. And I know of few fields of human endeavor where success so depends on adequate personnel.
What groups today seem most nearly to approach the ideals for these three kinds of job in the matter of training? The consideration of this point is of a certain importance inasmuch as it may indicate on what existing groups it might be most efficient to build. The clinical psychologist of today seems most nearly to approach the ideal for the diagnostician with regard to training. (And here I shall be accused of bias by some). Let me hasten to add that by “clinical psychologist” I do not mean the “mental tester” but rather those clinical psychologists who have maintained a true clinical and analytically qualitative attitude toward the problem. And they are pathetically few in number. But this group have a sociological approach with the fundamental training in normal and abnormal mental processes and behavior and with a background, at least, of medicine. My basis for the choice of the clinical psychologist as approaching the ideal diagnostician rather than the physician, is because it is my experience that the clinical psychologist most frequently has a better medical background than the physician has a background of psychology.
The special class teacher most nearly approaches the ideal for the corrective trainer. But the usual special class teacher today does not have the sociological approach nor the fundamental knowledge of either medicine or psychology necessary for ultimate success. For the disseminator, one needs the outstanding teacher?one who by appearance and temperament, by a knowledge of the methods of education and experience with these methods, can teach anything of which he has specialists knowledge. He exists, here and there in the community, and his training must consist in the special sociological, medical and psychological knowledge which he must disseminate.
Summary
1. The plural?mental hygienists?in the title was used consciously. By this we meant to express the idea that the mental hygiene movement, for complete realization, must have at least three sorts of individuals: (a) diagnosticians, whose duty is to diagnose normal and deviated subjects and to suggest the plan of rehabilitation for the deviates; (b) corrective rehabilitators, who will carry through this training and (c) disseminators, who will spread the knowledge of mental hygiene in an attempt to anticipate deviation.
2. Mental hygiene is conceived as an art or technicology and not a science and, as in the case of every art, it is dependent upon the coordination of materials, methods and points of view of several other arts and sciences. The minimum list of these fundamental disciplines for mental hygiene are medicine, psychology, sociology and education.
3. Although all three types of persons, defined in section 1 above, must have training in all of the fundamental sciences and arts, the relative emphasis will be different for the different groups. All three groups must have a sociological approach. Besides this Group 1, the diagnosticians, should have an emphasis in training in medicine and psychology with less of education. Group 2, the corrective rehabilitators, must have an emphasis on education with somewhat less emphasis on medicine and psychology. And Group 3, the disseminators, must emphasize education in their training with enough medicine and psychology to be able to evaluate and clearly express the findings of the other two groups.
4. The author fails to find, at present, any existing group (there may be individuals of course)?physicians, pediatricians, psychiatrists, psychologists, sociologists or educators?who have this fundamental training in all of the necessary sciences and arts.
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