Border Country
By H. J. EYSENCK rirHE most readable and to the layman the most interesting of these four books is Fringe Medicine* which apparently owed its inception to an article by Geoffrey Murray in the Spectator. Unfortunately Inglis has a thesis to propound and this has tended to come between the author and his topic by constantly forcing him to interpret and select data in a way which makes it impos- sible to rely on him as a safe guide to his subject. He starts off by briefly tracing the history of orthodox medicine, which he claims to be largely a system of 'allopathy'; with this he 'contrasts a large number of methods of treatment which do not find favour with the medical establishment although he believes that they have a great deal to contribute. Orthodox medicine conies in for a great deal of criticism, particularly in relation to its use of modern antibiotic drugs; Inglis has no difficulty in citing a number of instances: some of which will be familiar to all readers, where tragic consequences have resulted from the appli- cation of certain drugs.
How seriously should we take this powerfully written indictment? In the first place, I think Inglis is wrong in believing that orthodox medi- cine is systematically derived from allopathic prin- ciples; modern medicine is essentially pragmatic and empirical, and it is doubtful if demonstrably useful techniques would be rejected for theoreti- cal reasons. Inglis is on safer grounds when he criticises the indiscriminant use of the very powerful drugs now at our disposal. But, of course, much of this is hindsight; the drugs them- selves, and the realisation of their nefarious side- effects, are all essentially post-war –phenomena, and while the medical profession, the drug com- panies and the Government might all be justly criticised for waking up rather late to these dangers, we must nevertheless not forget the appalling difficulties involved in any system of safeguarding the patient without stultifying re- search. Inglis certainly has a point, but he tends to overdo it a little.
Inglis goes on to discuss methods of treatment which are unorthodox and which he seems to believe have much more to be said for them than orthodoxy would admit. He deals with homeo- Pathy, acupuncture, osteopathy, psychotherapy, auto-suggestion, Christian Science, and many others. He is always informative, usually accurate in his facts but rather too credulous to be con-
vincing.
Consider now a case of special pleading. In his chapter on psychotherapy Inglis notes that critics have maintained that there is no evidence for the effectiveness of psychotherapy, and he notes that 'in theory it might be possible to com- pare, say, two groups in a mental hospital; one having psychotherapy, the other not. But—the stat- isticians object—those patients who received PsYchotherapy might do better simply because they are aware that an interest is being taken in Ulm; so their improvement may be due to Placebo-effect, rather than from the pyscho- therapy itself.' But statisticians do not object; on the contrary they have always called for such a comparison, and the evidence .to hand suggests Yen, clearly that no difference in outcome would, In fact, be observed. Thus such an experiment would disprove the hypothesis that psychotherapy is useful and effective. If the outcome had been different, of course, we would still be left with the problem of just why the treatment was effective,
but we would at least have some facts to go on.
Inglis next advances an argument which is equally illogical, and contradicts his previous one, that our failure to demonstrate the effectiveness of psychotherapy may be due to the' inadequacy of our measuring instruments. He says, quoting Carstairs, that the failure to prove the effective- ness of brain surgery and insulin coma did not prevent doctors from using these methods until finally they discovered their very limited useful- ness; why then should pyschotherapy not have the same privilege? But the point surely is this, that all these methods had to be used in the begin- ning without proof of their effectiveness; insulin coma and brain surgery were subjected to proper experimental tests and we now know that their effectiveness is limited, and they are only used for certain types of disorders. If our methods of assessment are adequate to reveal the ineffective- ness of these 'orthodox' methods, why are they supposed to be inadequate when applied to psychotherapy and other 'unorthodox' methods?
Orthodox methods, when tested and found not to work are abandoned; unorthodox methods when found not to work are excused by reference to the alleged difficulties of proof and are happily used on all and sundry. This built-in bias against orthodoxy unfortunately runs throughout the whole book and reaches its apotheosis when Inglis even finds virtue in dowsing, Reich's 'orgone' treatment and radiesthesia. One almost feels like echoing Wellington's famous remark when he was greeted in the street by a man who said: `Mr. Smith, I believe.'—'If you believe that you will believe anything.'
This is a pity because it will undoubtedly put off many, people and weakens a perfectly genuine point' which Brian Inglis is making. Putting it in my own way the argument might perhaps run as follows. Orthodox medicine tends to look with suspicion upon odd and unusual facts, treatments and people. Consequently the latent possibilities for advance and greater scientific understanding inherent in the 'unorthodox' will not be properly exploited and will be left to charlatans, quacks and odd-balls who have neither the training nor the facilities for carrying out the proper research which is required. The book clearly aims to stir up the medical establishment, but by firing off in too many directions at once, and with an un- steady aim, Brian Inglis will have done his cause less of a service than if he had restricted himself to a smaller number of more reputable causes.
Hilaire Cuny's book on Pavlovt is also meant to be popular but it is very much less well written than Inglis's, and its shortness makes it almost impossible in any case for both the life and the work to be treated properly (there are only 126 pages of text; the remainder of the book is made up of selected writings by Pavlov). Cuny certainly doesn't make the best of his topic. Pavlov's life was an interesting one and his character was such as to make him an ideal subject for a biographer. His work was of outstanding importance and makes him one of the leading scientists of his generation; indeed it is not impossible that in a hundred years' time we shall speak of Pavlov's
* FRINGE MEDICINE. By Brian Inglis, (Faber, 30s.) t IvAN PAVLOV. By Hilaire Cuny. Translated by Patrick Evans. (Souvenir Press, 21s.) t MENTAL HEALTH AND ENVIRONMENT. By Lord Taylor and Sidney Chave. (Longmans, 40s.) PSYCHOTHERAPY : A CHRISTIAN APPROACH. By E. N. Ducker. (Allen and Unwin, 21s.) century as following those of Newton and Darwin. Somehow Cony manages to make both the man and his work less interesting and less important than they really are. How exactly this difficult feat was done I am not sure; possibly•the trans- lation may have something to do with it. But it is in the main the selection of topics and the curious inter-mixture of life and work which made this biography too 'bitty' for real enjoyment.
The book by Taylor and Chavet is not for the general reader but for sociologists, psychologists, psychiatrists and medical people generally. It starts out with an hypothesis, to wit 'that a socially planned community was likely to show a reduction in the incidence of neurosis (or minor mental illness) and no change in the incidence of psychosis (or major mental illness).' To test this theory a survey was carried out of a socially planned new town, an unplanned new town and an old established one, from which many of the inhabitants of the new towns had originally come. In almost 100 tables and some seven appendices the writers present a great deal of highly interest- ing and intriguing material which, as they say, ultimately caused them to reject their original hypothesis. This rejection is due to the fact that the new towns failed to show a reduction in the incidence of neurosis, and did show a reduction in the incidence of psychosis. However, in spite of the apparently logical form of the disproof it must be doubtful whether any clear-cut con- clusions can, in fact, be drawn from the study, interesting as it is. The authors call it an 'experi- ment' but, of course, the outward movement of large numbers of post-war Londoners which con- stituted the experimental situation was not well enough controlled from the scientific point of view to make it resemble a proper experiment.
Ducker's Christian approach to psycho- therapy§ is difficult to evaluate, just as it is diffi- cult to see for whom it is written. There has been a growing tendency in the United States for psychoanalysis and Christianity to draw closer together, and for members of the Church to use psychoanalytic methods and notions in dealing with the more neurotic of their parishioners. Ducker puts this point as follows: 'Psycho. therapy reveals our hidden drives and motives, removes our unconscious pretences and evasions. It is an exercise in reality. This is basically a spiritual exercise, and therefore it should be prac- tised by the Church.' If the premise were true the conclusion might seem to follow. As there is no proof for the truth of the premise, and particu- larly as most psychoanalysts would argue against the facile type of 'exercise in reality' here pre- sented, one can only say that this book is not likely to fall on any but stony ground. The writer is obviously extremely well-meaning and keen to make use of what he conceives to be 'modern' psychological methods; rather more critical and selective reading of primary sources might have made him more appreciative of the lack of sub- stantiation of the claims which he makes for psychotherapy.
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