PSYCHOLOGY AND THE MEDICAL SCHOOL * 
 
 By E. STANLEY ABBOT, M. D., 
 
 Pathologist and Assistant Physician, McLean Hospital, Waverley, Mass. 
 
 That psychology should bear the same relation to psycho¬ 
 pathology and psychiatry that physiology does to general medi¬ 
 cine is a truism that is almost a platitude. It is perhaps less 
 obvious, though to my mind not less true, that psychology should 
 rank among the fundamental sciences, on a par with anatomy and 
 physiology, if not with chemistry, physics and biology, necessary 
 for all students of medicine, not merely for those who intend to 
 take up certain specialties. Until recent times, however, little 
 effort has been made to introduce this study into the medical 
 curriculum. It will be introduced if the demand is strong enough, 
 and it is the object of this paper to interest thl^ society and urge 
 it to take some action in the matter. 
 
 The need of psychological instruction is not an altogether new 
 subject. In December, 1911, it was considered at a symposium at 
 the combined meetings of the American Psychological Association 
 and the Southern Society of Philosophy and Psychology, in which 
 Drs. Meyer, Franz, Prince and others took part. Since then the 
 subject has been brought up at meetings of other societies. But 
 I believe it has not been discussed, at least in recent years, by this 
 association, which, on account of its name, its membership and 
 its size, should be able to exert a strong influence. 
 
 Certain specialists need psychology. For example, it is obvious 
 that physiological psychology lies at the basis of neurology. And 
 it is probably that field that Lancaster ^ had in mind when, in out¬ 
 lining recently an improved course in ophthalmology, he included 
 15 hours out of a 300-hour course to be devoted to “psycholog¬ 
 ical problems.” In otology, rhinology and laryngology, too, there 
 are a few problems that belong in this field. Psychiatry’s need 
 of psychology has already been noted. 
 
 Besides this, there is a rapidly growing demand for more 
 thorough investigation of the mental states and processes, not 
 only in such groups as the neurasthenic and the very sick, who 
 
 * Read at the sixty-ninth annual meeting of the American Medico- 
 Psychological Association, Niagara Falls, Canada, June 10-13, 1913. 
 
 87 
 
44^ PSYCHOLOGY AND THE MEDICAL SCHOOL [Oct. 
 
 come under the observation of the general practitioner, and in 
 such groups as the obviously feeble-minded, the epileptic, and the 
 hysterical, who usually come under the observation of the neurolo¬ 
 gist or the psychiatrist, but also in such groups as the deaf mute, 
 the slightly backward school child, the defective delinquent, the 
 criminal, the pauper and the prostitute. 
 
 Most of these latter groups are defectives. For the best ways of 
 dealing with them the community naturally turns to the physician, 
 though, if there were a large body of trained psychologists, it 
 might turn to them. The school and the police physicians, who 
 usually see these cases in the first instance, are general practition¬ 
 ers, and it would be helpful if they had the requisite grounding 
 in psychology to deal with them. Franz^ and White® have 
 pointed out the need of such grounding. 
 
 But it may be urged that the generM practitioner sees after all 
 only a comparatively small number of such cases; that they can 
 be referred to specialists who are sufficiently grounded in psy¬ 
 chology, and that the teaching of psychology might well be limited 
 to those who wish to fit themselves for these specialties. 
 
 To that it can be answered that since in almost every medical 
 school psychiatry is a required course, its foundation science, psy¬ 
 chology, should be taught as a prerequisite. But^ even apart from 
 that, not only the specialist but every practitioner of medicine and 
 surgery needs psychology. 
 
 Lyon,® reporting last February for the Committee on Peda¬ 
 gogy at a meeting of the Association of American Medical Col¬ 
 leges, states one of the aims of general medicine to be to give 
 the student as much knowledge as possible of human beings into • 
 whose life he must enter in a much broader, more sympathetic 
 relation than that of engineer to machine.” Franz ^ calls at¬ 
 tention to the fact that the general physician depends on the 
 patient for information about his illness, and that the patient’s 
 sensations and feelings have weight in the diagnosis. White * 
 refers to the fact that there is a mental side to every illness, even 
 to a sore finger, and that the patient is a thinking, feeling being. 
 They might have added that wherever the patient’s co-operation 
 in the examination and in following out directions for treatment 
 is concerned, there are psychological factors of the utmost im¬ 
 portance—factors which are present to a greater or less degree 
 
 88 
 
1913 ] 
 
 E. STANLEY ABBOT 
 
 449 
 
 in all cases except those in infancy and childhood and of un¬ 
 consciousness and stupor. Moreover the bodily and mental effects 
 of such emotional states as dread (of operation, death, going to a 
 hospital, certain illnesses, etc.), courage, hope, despair are neither 
 negligible nor infrequent; neither are the effects of prejudices, 
 errors, superstitions, or ignorance on the general attitude of the 
 patient toward his illness, his treatment and his physician. These 
 are psychic factors that every physician and surgeon is likely to 
 meet and meet frequently. 
 
 Furthermore, it is the psychic factor in all illness and in all 
 ^therapy that has given such vogue to many of the recent psycho¬ 
 therapeutic movements, whether scientific, pseudo-scientific, or 
 fraudulent. It is the psychic factor that makes the success of the 
 quack, the charlatan and the nostrum vendor. A knowledge of 
 psychology would help each physician and surgeon in the use of 
 that which is true and in the fight against that which is false in 
 all these doctrines and practices. The recognition of the impor¬ 
 tance of these psychic factors is growing, and some grounding 
 in them must be given, if the forementioned aim of medical teach¬ 
 ing is to be fulfilled. 
 
 11 . 
 
 To find out how extensively psychology is being taught in the 
 medical schools of this country, inquiries were made of all the 
 medical schools classified by the Council on Medical Education of 
 the American Medical Association as A -f (acceptable), A (col¬ 
 leges lacking in certain respects, but otherwise acceptable), and 
 B (colleges needing general improvements to be made acceptable). 
 No inquiries were made of the class C schools (colleges requiring 
 a complete reorganization to make them acceptable). To the 
 deans of the 85 schools of these three classes the following ques¬ 
 tions were sent, together with a request for the catalogue, an¬ 
 nouncement or bulletin of the school: 
 
 1. Is psychology required for admission to your school? 
 
 2. Is psychology taught in your school? 
 
 3. If so, is it a required or elective study? 
 
 4. If elective, roughly what proportion of students elect it? 
 
 5. In what year or years is it taught? 
 
450 
 
 PSYCHOLOGY AND THE MEDICAL SCHOOL 
 
 [Oct. 
 
 6. How many hours are given to it? 
 
 7. Is the instruction by (a) lecture, (b) text-book, (c) labora¬ 
 tory, or by what combination of them ? 
 
 8. What text-books are used? 
 
 9. Has the instructor in psychology a knowledge of psychiatry 
 gained from clinical experience? 
 
 From these questions it will be seen that no effort was made 
 to determine the type of psychology that is taught, except as this 
 might be shown by the text-books. 
 
 Replies were received from 58, and bulletins from only 24 of 
 these. Most of the schools are associated with or are integral 
 parts of some university, many of them state universities; most 
 require at least the equivalent of two academic years for ad¬ 
 mission to the medical school. A few give only the first two 
 years of the medical course, omitting clinical teaching. 
 
 The following data are based on the 58 replies received. The 
 extent of psychological teaching is shown in the table: 
 
 PSYCHOLOGY IN THE MEDICAL CURRICULUM. 
 
 
 Class A- 1 -. 
 
 Class A. 
 
 ClassB. 
 
 Total. 
 
 
 Full 
 
 course. 
 
 First 
 
 2 years 
 only. 
 
 Full 
 
 course. 
 
 First 
 
 2 years 
 only. 
 
 Full 
 
 course. 
 
 
 Pre-Medical Years. 
 Required for admission. 
 
 I 
 
 
 2 
 
 • • 
 
 • • 
 
 3 
 
 Advised for admission. 
 
 3 
 
 2 
 
 2 
 
 • • 
 
 I 
 
 8 
 
 Pre-medical course offered .... 
 
 5 
 
 2 
 
 4 
 
 3 
 
 I 
 
 15 
 
 Medical Years. 
 
 Normal psychology required ... 
 
 I 
 
 
 
 I 
 
 2 
 
 4 
 
 Normal psychology elective.... 
 
 I 
 
 I 
 
 
 I 
 
 * * 
 
 3 
 
 Abnormal or path, psych, re¬ 
 quired . 
 
 I 
 
 
 I 
 
 
 
 2 
 
 Abnormal or path, psych, elec¬ 
 tive . 
 
 I 
 
 
 I 
 
 
 
 « 
 
 2 
 
 Planning to offer courses. 
 
 3 
 
 
 2 
 
 I 
 
 I 
 
 7 
 
 Teaching in connection with 
 other courses . 
 
 
 
 8 
 
 
 3 
 
 II 
 
 Total requiring, advising or 
 teaching. 
 
 9 
 
 2 
 
 7 
 
 5 
 
 3 
 
 26 
 
 Ignoring psychology. 
 
 
 6 
 
 15 
 
 9 
 
 30 
 
 Number replying to inquiries .. 
 
 17 
 
 2 
 
 22 
 
 5 
 
 12 
 
 58 
 
 Number of schools. 
 
 24 
 
 39 
 
 22 
 
 85 
 
 90 
 
1913] 
 
 E. STANLEY ABBOT 
 
 451 
 
 Pre-Medical Teaching. 
 
 In only three schools is psychology required for admission. 
 
 In eight schools it is scheduled or advised, but not required. 
 
 In 15 schools, including all but one of these eight, pre-medical 
 courses in psychology are offered—required in three, elective in 12. 
 
 The number of students electing psychology varies from a few 
 to nearly all, but averages about half. 
 
 In these pre-medical courses the time occupied varies from a 
 total of five hours to a full year’s course of at least three hours 
 a week. Most of those that give such courses teach it for one or 
 two terms. 
 
 It is taught chiefly in the second, but sometimes in the first, of 
 the two pre-medical years. 
 
 In only three schools has the teacher of psychology had any 
 psychiatrical experience, and in two of those it is “ limited ” or 
 ‘‘ slight.” 
 
 Only five mention the text-books used. They are Angell, Sea¬ 
 shore, James, Pillsbury, Titchener, Storring, Janet, etc. 
 
 The method was not stated in all cases, but appears to be chiefly 
 by lecture, with considerable laboratory work. 
 
 Teaching in Course. 
 
 In the medical course proper, only six schools require psychol¬ 
 ogy as a separate study, and five others offer electives, making 
 II which teach it. Two more expect shortly to offer electives, 
 and will probably do so next fall, while five others are trying to 
 arrange for it, and may accomplish it within a year or two. 
 
 Eleven replies tell of teaching psychology only in connection 
 with physiology or with psychiatry or neurology. In most this 
 does not mean much, but in three it means that a definite number 
 of lectures in the course on physiology or in that on psychiatry 
 is devoted to normal psychology. 
 
 Of the II separate courses in psychology that are offered, four 
 are described as “ elements of abnormal psychology,” ‘‘ the appli¬ 
 cation of psychology to neurology,” “ pathological psychology ” 
 and “ psychopathology, psychology in its medical bearing.” The 
 other seven appear to be courses in physiological or more general 
 psychology, in which such text-books as James, Titchener, An¬ 
 gell, Pillsbury, Yerkes, Thorndike, and Witmer are used. 
 
 91 
 
452 PSYCHOLOGY AND THE MEDICAL SCHOOL [Oct. 
 
 The time devoted to psychology varies from 5 to 108 hours, 
 averaging perhaps 45 hours. 
 
 It is taught in the first year in two schools, in the second in 
 five, in the third in one, and in the fourth in three. 
 
 It is taught chiefly by lecture and text-book; in three schools 
 there is also laboratory work; in one it is taught by lecture and 
 recitation. 
 
 In six of these 11 schools, the psychological instructor has had 
 no psychiatrical experience; in two he has had slight, and in two 
 considerable. One fails to reply to this question. 
 
 These data may be summed up as follows: 
 
 Of the 58 schools replying, 30 (over 50 per cent) quite ignore 
 psychology; three require it for admission; eight advise it for ad¬ 
 mission; 15 offer pre-medical courses. During the medical years 
 proper, six require it, five offer electives, seven are planning to 
 teach it as a separate study, while 11 teach it more or less in con¬ 
 nection with other courses. 
 
 It is probable that the amount of psychological teaching in the 
 schools that sent no replies is less rather than more than that 
 shown here. 
 
 It is of interest to note that in no curriculum that I have seen 
 has psychology been mentioned as one of the fundamental 
 sciences. 
 
 This state of affairs, though not good, is encouraging, for 
 there is distinctly indicated by the replies received a growing 
 tendency toward the introduction of psychology into the medical 
 curriculum. 
 
 III. 
 
 The reasons for the lack of teaching and for the diversity 
 where it is taught are various. They are grouped about two main 
 lines, one the evolution of the science, the other the evolution of 
 the schools. 
 
 About the middle of the last century the science of psychology 
 grew out of philosophy. At that time Spencer’s materialistic and 
 mechanistic conceptions were influencing scientific thought, es¬ 
 pecially among English-speaking people. There was, however, 
 no one accepted philosophy, but many philosophies with irre¬ 
 concilable differences in fundamental concepts. The psychologies 
 
 92 
 
1913] 
 
 E. STANLEY ABBOT 
 
 453 
 
 which grew out of these philosophies inherited the defects of their 
 parents, but showed a rather strong tendency to be influenced by 
 the Spencerian environment into which they were born. So, as 
 was natural with young sciences, they dealt chiefly with the con¬ 
 crete, tangible phenomena of sense perceptions, sensations, re¬ 
 flexes, time reactions, etc., and avoided the more elusive but more 
 fundamental and vitally important factors that determine human 
 conduct. 
 
 Owing to the irreconcilable differences, due to their origin, 
 there has been no one generally accepted psychology, as there is 
 one physiology, but several psychologies. Hence scientists in other 
 fields have felt a certain distrust of all psychologies, just as they 
 have of all philosophies; and owing to the avoidance of the vital 
 factors which determine conduct, psychology has seemed out of 
 touch with life, often impractical, and not especially helpful where 
 the need for help has been felt. Even the recent growth of applied 
 psychology, as seen in the latest book by Miinsterberg and in the 
 studies in animal and human behavior, has not been able to over¬ 
 come psychology’s hereditary defects, though approaching much 
 nearer to what is wanted than earlier efforts did. What is needed 
 is an application of eugenics to psychology. Out of biology, not 
 philosophy, should the new psychology be born, sired by scientists 
 of broad views, not unacquainted with, but unafraid of, the 
 various philosophic viewpoints, and with courage to attack the 
 most complicated and intangible of problems. Such a psychology 
 would be a healthy normal science, well-developed, whose funda¬ 
 mental concepts, view-points and methods would be as generally 
 recognized and accepted as are those of physiology. It would be 
 found helpfully applicable to the various problems of life, and 
 could be taught with as great advantage as physiology now is. 
 
 The medical curriculum long antedated the science of psychol¬ 
 ogy. There was therefore no place for this science in the old 
 curricula. The enormously rapid growth of the other biologic and 
 seemingly more strictly medical sciences has been crowding and 
 stretching the curriculum. Hence, though the importance of the 
 psychic factors in disease has been increasingly recognized and the 
 need of psychological investigation of them has been increasingly 
 felt, it has been difficult to make a place for psychology in the medi' 
 cal course. The facts above noted, that psychology has not been a 
 
 93 
 
454 PSYCHOLOGY AND THE MEDICAL SCHOOL [Oct. 
 
 unitary science and that it only remotely touched the needs of 
 the medical student or physician, have delayed its inclusion as 
 a required course. These are the chief general reasons why psy¬ 
 chology is not more generally taught in the medical schools. 
 
 Others are more local and personal to the individual schools, 
 
 W. 
 
 At the above mentioned symposium and elsewhere three sug¬ 
 gestions for courses in psychology have been published; one by 
 a psychologist, one by a neurologist, and one by a psychiatrist. 
 
 Each proponent illustrates the faults of his type, though it is only 
 fair to say that each probably had the conditions in his own school 
 in mind, and that this would greatly modify the plan proposed. 
 
 It would take too long to even sketch them here, so I will merely 
 offer a few comments. 
 
 Professor Watson,^ the psychologist, outlines a course with far 
 too much physiological and far too little psychical psychology, 
 and it is too little applied to the needs of the medical student. 
 
 It makes one think of trying to teach architecture by devoting a 
 great deal of time to building materials and comparatively little 
 to design. 
 
 Dr. Prince,® the neurologist, frankly states that the course he 
 outlines is rather supplementary to Professor Watson’s than a 
 substitute for it. For a foundation course it lays altogether too 
 much stress on morbid processes, on hypnotism, and on such un¬ 
 common conditions as dissociations and syntheses of personalities. 
 Furthermore it is based on his not yet generally accepted theory 
 of the subconscious. Except as an advanced course in psycho- ' 
 patholog}^ it is uneven, with many parts too little and others too 
 much accentuated. 
 
 The third. Dr. Meyer’s,® outline, is by far the best of the three. 
 Especially good are the biological view point, the recognition of 
 “ relativity of effects ” (which I call multiplicity or complexity 
 of factors involved), and his insistence on observation and on f 
 
 study of factors which may modify reactions. He perhaps lays 
 somewhat more emphasis on some of the Freudian mechanisms, 
 such as symbolic disfigurements, substitutions, wish-fulfilments, i 
 
 etc., and somewhat less on effects of emotional states, education, 
 formation of purposes, ideals, etc., than I should, thus including 
 
 94 
 
1913] 
 
 E. STANLEY ABBOT 
 
 455 
 
 a little more of morbid psychology than a preliminary course 
 should have. But it seems a fairly well-rounded course, helpful 
 to the general practitioner as well as to the specialist. 
 
 But destructive criticism is easy, and often thankless, while 
 constructive planning is difficult. It may be hardly fair to criti¬ 
 cize any of these suggested courses before they have been tried 
 out, on merely d priori grounds, especially as those are the only 
 basis of the following suggestions. 
 
 Since the medical curriculum is already so full, the psychology 
 that is added to it should be limited to the actual needs of the 
 student—it should be a strictly applied psychology, with its appli¬ 
 cations shown throughout the course. 
 
 That part of the course in physiology which deals with the 
 nervous system and the special senses could be expanded to in¬ 
 clude the physiological psychology needed to understand the 
 tests used by neurologists (including various time-reactions, tests 
 for aphasia, astereognosis, etc.), ophthalmologists, otologists, 
 rhinologists, and laryngologists, and to include also the somatic 
 effects (motor, vaso-motor, secretory, etc.) of affective states 
 in general, such as fear, depression, euphoria. 
 
 The course in psychology proper should be largely, though not 
 entirely, an observational one, teaching the student to see what the 
 various psychological factors are which determine the conduct 
 and behavior of individuals in the ordinary acts of life. To this 
 end it would be analytical and partly introspective. There should 
 be as much experimental work as is needed to give an idea of the 
 scope and application of the Binet-Simon and other general in¬ 
 telligence tests, free and controlled association tests, memory 
 tests, attention tests, observation and reproduction (testimony) 
 tests, etc. This would give the student a certain familiarity with 
 the ordinary tests used in the investigation of the neuroses, the 
 neuropsychoses, the psychoses, and the states of mental defect. 
 
 The student should be taught the factors and mechanisms in¬ 
 volved in the learning-process and in habit-formation; in orien¬ 
 tation and grasp of the situation in which the person finds him¬ 
 self ; in instinctive action; in the formation of purposes and 
 ideals; in the carrying out of the purposes formed. He should 
 be taught the influence of the affects and affective states, not only 
 on the body, but on the other psychical processes and contents ; the 
 
 95 
 
456 
 
 PSYCHOLOGY AND THE MEDICAL SCHOOL 
 
 [Oct. 
 
 modifying effects on mental reactions (both as processes and as 
 content), not only of such bodily conditions at toxaemias, fatigue, 
 permanent or temporary destruction of nerve-cells or nerve tracts, 
 imperfect development, etc., and of other psychic states and atti- 
 ’ tildes, such as recollections, prejudices, superstitions, and affects 
 like shame, indignation, pride, etc., but also of education, exper¬ 
 iences, habit and environment. And he should be taught the 
 general directions in which these modifying factors produce their 
 effects. 
 
 The course should be given from the biological standpoint— 
 that all the activities of the individual are reactions to an environ¬ 
 ment or to other internal activities of his own; that these reac¬ 
 tions are determined partly by the environment, partly by the 
 bodily condition of the individual, partly by his capacity to react; 
 and that any given act, no matter how simple-seeming, is com¬ 
 plex and multiform, the resultant of a great many factors, many 
 of which are unknown and any one or any number of which is 
 capable of modification. 
 
 Some such course as this would prepare the student for the 
 later study of formation of complexes and of delusions, auto¬ 
 matisms, blocking, dissociations, thinking difficulties, defects, etc., 
 in the courses on psychopathology and psychiatry. It should be 
 given after the course in physiology and physiological psychology, 
 and would need probably two semesters. The methods used would 
 necessarily depend on the local conditions in each school and on 
 the instructor. 
 
 The person who should teach psychology to medical students 
 should know both psychology and medicine; and a knowledge of . 
 morbid mental states also is of especial value to such a teacher. 
 Though several of the schools offer academic courses given by 
 psychologists without experience in morbid mental phenomena, 
 some schools question the value to the medical student of psy¬ 
 chology as so taught and even the right of the faculty to make 
 psychology a required study unless it be adapted to the needs of 
 the medical student by men trained in psychiatry as well as in 
 psychology. Hence a psychiatrist with a working knowledge of 
 psychology or a psychologist with a knowledge of medicine and 
 a familiarity with mental diseases would be the ideal teacher. 
 The psychological interests of either should be not so much 
 
 96 
 
1913] 
 
 E. STANLEY ABBOT 
 
 457 
 
 in time relations, intensities of stimuli, and other factors testa¬ 
 ble and measurable by laboratory methods, as in the more elusive, 
 less easily definable factors that enable the individual to ad¬ 
 just himself to the constantly changing situations, near and 
 remote, in which he finds himself throughout his life. Though 
 there are few such teachers now, if psychology is taught in the 
 medical schools it will not be many years before there will be 
 enough to teach it well, to the great benefit of the medical prac¬ 
 titioners and the communities they serve. 
 
 V. 
 
 What can this association do ? 
 
 In its membership are many teachers in the medical schools. 
 If they could raise and agitate the question in their own faculties 
 it would hasten the introduction of this study into those schools. 
 I urge them to do this. 
 
 If the association could take official action, in the form of a 
 resolution, strongly recommending the introduction of psychology 
 into the medical curriculum, it would back up and add weight 
 to the efforts of the individual members of faculties. 
 
 A committee could be formed to investigate further the present 
 status, the results and the future possibilities of psychological 
 teaching. The reports and recommendations of such a com¬ 
 mittee could be sent to the various medical schools, to the Com¬ 
 mittee on Medical Education of the American Medical Associa¬ 
 tion, and to the Committee on Pedagogy of the Association of 
 American Medical Colleges. 
 
 Through such efforts, and others that may occur to other 
 members of the association, this desirable end may in time be 
 accomplished. 
 
 REFERENCES. 
 
 1. S. I. Franz: Jour. A. M. A., Vol. 58, p. 909. 
 
 2. W. B. Lancaster: Bost. Med & Surg. Jour., Vol. 168, p. 576. 
 
 3. E. P. Lyon: Jour. A. M. A., Vol. 60, p. 1049. 
 
 4. A. Meyer: Jour. A. M. A., Vol. 58, p. 911. 
 
 5. A. Meyer: Jour. Abn. Psychol., Vol. 7, p. 313. 
 
 6. M. Prince: Jour. A. M. A., Vol. 58, p. 918. 
 
 7. J. B. Watson: Jour. A. M. A., Vol, 58, p. 916. 
 
 8. W. A. White: Jour. A. M. A., Vol. 58, p. 1417. 
 
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