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PASTORAL PSYCHOTHERAPY
469
CORRESPONDENCE THE BIRTH STIMULUS AND THE SPAWNING STIMULUS
To the Editor
of THE LANCET knowledge regarding
the SiR,-The absence of stimulus for parturition in man and other mammals is paralleled by a similar lack of information as to the spawning stimulus in marine invertebrates. The two groups of cases are essentially similar mechanically in that evacuation of either the foetus or the genital products is made from a tube closed by a sphincter; hence it is possible that the operating mechanisms may have other common features, and suggestions which apply to one group may at least focus attention to unexpected aspects in the other. In this way progress may be made. In recent years many surprising observations have been made on rhythmic breeding in marine animals and upon definite periodicity in spawning-i.e., extrusion of genital products, in relation to tidal and therefore the moon’s phases.l Although in some species it is known that flooding with gametes of one sex may induce spawning in the other, and that spawning is associated with minimum temperature levels, little is known regarding the basic spawning stimulus which is undoubtedly operating. For example, about 45 per cent. of the mature and maturing female population of oysters (Ostrea edulis) spawned simultaneously about June 13th-14th, 1936, on the Roach River oyster beds. As even higher proportions may spawn practically simultaneously in other marine species there can be no doubt whatever about the evocation of a common spawning stimulus. Among marine animals external as well as internal factors play a part, and all those factors which change with the tide-namely, temperature, pressure, salinity, alkalinity, light intensity, available food, emanations from opposite sex, and oxygen pressure-may contribute towards a spawning stimulus in those individuals which are ready internally to receive it. I have recently suggested2 that the most important factor may be the oxygen susceptibility of the gravid individual, for in the course of the development of eggs or sperm oxygen consumption will be high during preparatory and maturing stages, probably attaining a peak at maturity. In the same way oxygen requirements of the foetus in mammals will increase to a maximum about the time of parturition. It seems likely therefore that in mammals and invertebrates the organism will be hypersensitive to oxygen variation in the late gravid condition. If this susceptibility exists, as seems highly probable, then here is a trigger state in which oxygen variation may in different ways act upon the appropriate nervous centres to set in train the evacuating mechanism. The effect of the stimulus is to cause relaxation of the orifice and contraction or constriction of the tube or tubes. These events must occur in their proper phase to be successful, and it would appear that the administration of any drug or preparation which elicits only the contraction phase, for example of the uterus, may be useless and in some cases definitely harmful. Some phenomena of parturition in mammals as also of spawning in invertebrates appear to be based on oxygen susceptibility, but extended investi2
1 Fox, H. M. (1924) Proc. R. Soc. B, 95, 523. Pelseneer Jubilee Volume, Mém. Mus. Hist. nat. Belg. 1936.
gations
are
needed to reveal the actual
course
of
events ; the practical importance of accurate knowon the subject is sufficient excuse for drawing attention to the possible analogies given above. I aim, Sir, yours faithfully, J. H. ORTON.
ledge
The
University, Liverpool, August 13th.
" NO PLACE FOR AN EPILEPTIC BOY "
To the Editor
of THE LANCET
SIR,-With regard to the article under this title on p. 285 of your issue of July 31st, it seems to us that the case described is a mental defective and would be certifiable under the Mental Deficiency Acts, 1913-27, He would therefore be eligible as a moral defective. for admission to any appropriate institution and possibly would be a suitable case for Rampton State Institution. We are, Sir, yours
faithfully, J. LLOYD, J. N. JACOBSON.
Fountain Hospital, Tooting Grove, S.W., August 11th.
PASTORAL PSYCHOTHERAPY
To the Editor
of THE LANCET SiR,-This correspondence has certainly called forth some interesting and surprising expressions of opinion and has provided a concrete illustration of the difficulties clinical psychology has to contend with as an important branch of medicine. When mental phenomena are the subject of discussion, it is obvious that the task of maintaining the purely rational attitude becomes a very difficult one. Dr. Batten quietly begs the whole question in asking if only qualified medical men are fit to minister to sick souls. Sick bodies we know and sick minds we know, but are we to understand that the sick soul is different from the latter1 If so, and if, as Mr. Fletcher claims, pastoral psychotherapy is designed to deal with spiritual disorders of the personality, to avoid confusion and aid differential diagnosis it would be a great help if we could have a brief description of two or three of these spiritual diseases and some indication as to how to separate them from the ordinary psychological disorders. It would, furthermore, be less equivocal if the word " psychotherapy were given up in this connexion and a distinguishing name like " pastoral spiritotherapy " used in its place-if the purists would not be too horrified at the hybrid. Dr. Hubble in his admiration for unqualified medical practice makes one wonder if he carries the same admiration into other spheres of life. Does he, for instance, prefer to have his prescriptions dispensed by an unqualified chemist, and does he go to an unqualified solicitor to help him in a legal difficulty’? His letter is not without unconscious humour when he describes the patient who underwent " complete cure " of an anxiety state by a minister of religion as having come easily through her relapse. May we be permitted to hope that she will come equally easily through future relapses ? Incidentally, is an anxiety state a spiritual disorder of the personality ? Cannot an answer to the questions at issue be put quite briefly in saying that as progress in all other departments of medicine has, with one or two exceptions which do not affect the general principle, been brought about by strict adherence to the scientific
something
"
470 method the high probability is that authentic progress in psychotherapy will be brought about by the same means ?z? I am, Sir, yours faithfully, FREDERICK DILLON.
‘’4 impole-street, W., August
To the Editor
15th.
of
THE LANCET
SiR,-Dr. Clifford Allen is fortunate in that he finds the ideas of those who oppose him " childish." He is less fortunate in that his own views have not as yet commanded the representative support of his brother psychotherapists. There is but one course for him. The Guild, undeterred by his opposition, will continue to sow what he so confidently believes to be tares. He will continue to sow what he believes, with equal confidence, to be wheat of the best quality. And the harvest’? Those of us who live till 1960 may see Dr. Allen attending a demonstration of psychotherapeutic technique by the Reverend So-and-So, the distinguished psychotherapist, just as the British Orthop2edic Association found itself sitting at the feet of Sir Herbert Barker. Unfortunately we shall be denied any amusement on that occasion for this sprightly controversy will have long since been forgotten. I am, Sir, yours faithfully, DOUGLAS HUBBLE. Derby, August 15th. To the Editor
of THE LANCET comparison of Dr. Clifford
Allen’s SiR,—A cursory latest letter with his earlier ones to you will make it apparent that he has effectively denied his own argument. Taking to task some of his professional colleagues who have ventured to disagree with him, he accuses them of precisely those mental limitations which, in his view, make the clergy unfit to practise psychotherapy. Having urged that the physician is by training " detached, unemotional, and scientific," Dr. Allen now discovers in his fellow practitioners " ignorant prejudice " and " a great capacity for drawing conclusions with insufficient evidence to support them " ; thus contradicting his earlier
premises. Dr. Allen affirms that psychotherapy is a branch of medicine. He seems not to have observed that it is also a branch of psychology. " The basic principles which support the whole " are by no means exclusively the principles of physical medicine. Indeed, one could with some cogency argue that they are essentially philosophical and religious. Certainly, by his own argument, Dr. Allen would have no reason to complain if the philosopher or theologian-and imperatively the metaphysician-should require him to produce evidence of his competence in these sciences, as he would require evidence of medical competence in them, before they acknowledged his qualification to undertake the treatment of personality disorders. No good service is done to any point of view by an evasion of the difficulties raised both for religion and medicine by psychotherapeutics. Dr. Allen affirms his admiration for the church and his respect for the ministries of religion. If he is sincere in his desire for a scientifically objective attitude to this matter let him consider the real problem raised for all concerned by the psychophysical nature of human personality. Can he provide a definition of psychotherapy that will enable both clergy and doctors to discern where the limitations of both their provinces are in the mutual task of making personalities "whole," bearing in mind the obvious fact that a medical man is no more equipped by his scientific training for the cure of souls than the "I clergyman is by his training for the cure of bodies As I have
to show, this is a real and pressing deserves consideration with all the scientific detachment and goodwill at the command of everybody concerned, and I am sure that many beside those who are interested in the Guild of Pastoral
already tried problem that
Psychotherapy
will
their indebtedness
acknowledge
to Dr. Allen if he will make a constructive contribution to its solution. In my previous letter I omitted to say that I shall be glad to post copies of the memorandum about this Guild (a perusal of which led Dr. Allen to write to you) to any of your readers who will send me a
card
the request. I am, Sir, yours faithfully,
making
A. B. W.
FLETCHER,
Hon. Sec., The Guild of Pastoral Psychotherapy.
29, Dorset-square, London, N.W.1, August 16th. " BIOCHEMICAL CONTROL OF CANCER"
To the Editor
of
THE LANCET
recent award of a Civil List pension to Copisarow must be taken to mean that, in some direction, he has done important service to science, with even less reward through normal channels than comes to most research workers. His attempt to solve the cancer problem by biochemical speculation must, accordingly, command a certain respect. The
SiR,-The
Dr.
indication, however, of the
nature of his theories, in his letter published in your issue of August 7th, by reference to " oxidation enzymes, the glutathione does not equilibrium, vitamins E, Bh B2, &c.," convey any clear idea ; nor is understanding assisted by the claim that " these conclusions " have now been supported by experimental evidence from various sources," since much of what is cited has no obvious relevance. Possibly a study of Dr. Copisarow’s earlier publications might reveal a greater coherence. Of much greater importance, however, than Dr. Copisarow’s theoretical speculations, is his statement that he has been led by them to a corrective treatment for cancer, and the suggestion that this also has been supported by the assortment of evidence quoted. The treatment consists of two items : (1) the administration of yeast with what is termed an " enzymebearing medium, such as unrefined sugar or honey " ; and (2) " the injection of certain non-toxic sulphurlabile compounds," of which mustard-gas (dichloro"
diethyl sulphide) is, curiously, quoted as an example. One has heard of the simultaneous ingestion of yeast and sugar, as a device for procuring cheaply a thorough alcoholic intoxication, and of the drawback due to the concomitant distension of the stomach with carbon dioxide ; but mustard-gas, as a non-toxic sulphur derivative suitable for injection, is surely a therapeutic novelty. It is to be hoped that none of your readers. will be so much impressed by the show of theory, and the list of references to experimental evidence cited in its support, as to give the suggested treatment a practical trial, without some much clearer and more detailed indication of the way in which its rather obvious disadvantages can be avoided. "
I am,
"
Sir, yours faithfully,
August 14th.
BIOCHEMIST.
of THE LANCET SiR,-In your issue of August 7th Mr. Copisarow refers to the " recent experimental work of several and gives investigators with methylene-blue references to two works published in 1933. As I happened to be particularly interested in this subject at the time these articles appeared, I ransacked the To the Editor
"
London medical libraries for further informatiort
CORRESPONDENCE THE BIRTH STIMULUS AND THE SPAWNING STIMULUS
To the Editor
of THE LANCET knowledge regarding
the SiR,-The absence of stimulus for parturition in man and other mammals is paralleled by a similar lack of information as to the spawning stimulus in marine invertebrates. The two groups of cases are essentially similar mechanically in that evacuation of either the foetus or the genital products is made from a tube closed by a sphincter; hence it is possible that the operating mechanisms may have other common features, and suggestions which apply to one group may at least focus attention to unexpected aspects in the other. In this way progress may be made. In recent years many surprising observations have been made on rhythmic breeding in marine animals and upon definite periodicity in spawning-i.e., extrusion of genital products, in relation to tidal and therefore the moon’s phases.l Although in some species it is known that flooding with gametes of one sex may induce spawning in the other, and that spawning is associated with minimum temperature levels, little is known regarding the basic spawning stimulus which is undoubtedly operating. For example, about 45 per cent. of the mature and maturing female population of oysters (Ostrea edulis) spawned simultaneously about June 13th-14th, 1936, on the Roach River oyster beds. As even higher proportions may spawn practically simultaneously in other marine species there can be no doubt whatever about the evocation of a common spawning stimulus. Among marine animals external as well as internal factors play a part, and all those factors which change with the tide-namely, temperature, pressure, salinity, alkalinity, light intensity, available food, emanations from opposite sex, and oxygen pressure-may contribute towards a spawning stimulus in those individuals which are ready internally to receive it. I have recently suggested2 that the most important factor may be the oxygen susceptibility of the gravid individual, for in the course of the development of eggs or sperm oxygen consumption will be high during preparatory and maturing stages, probably attaining a peak at maturity. In the same way oxygen requirements of the foetus in mammals will increase to a maximum about the time of parturition. It seems likely therefore that in mammals and invertebrates the organism will be hypersensitive to oxygen variation in the late gravid condition. If this susceptibility exists, as seems highly probable, then here is a trigger state in which oxygen variation may in different ways act upon the appropriate nervous centres to set in train the evacuating mechanism. The effect of the stimulus is to cause relaxation of the orifice and contraction or constriction of the tube or tubes. These events must occur in their proper phase to be successful, and it would appear that the administration of any drug or preparation which elicits only the contraction phase, for example of the uterus, may be useless and in some cases definitely harmful. Some phenomena of parturition in mammals as also of spawning in invertebrates appear to be based on oxygen susceptibility, but extended investi2
1 Fox, H. M. (1924) Proc. R. Soc. B, 95, 523. Pelseneer Jubilee Volume, Mém. Mus. Hist. nat. Belg. 1936.
gations
are
needed to reveal the actual
course
of
events ; the practical importance of accurate knowon the subject is sufficient excuse for drawing attention to the possible analogies given above. I aim, Sir, yours faithfully, J. H. ORTON.
ledge
The
University, Liverpool, August 13th.
" NO PLACE FOR AN EPILEPTIC BOY "
To the Editor
of THE LANCET
SIR,-With regard to the article under this title on p. 285 of your issue of July 31st, it seems to us that the case described is a mental defective and would be certifiable under the Mental Deficiency Acts, 1913-27, He would therefore be eligible as a moral defective. for admission to any appropriate institution and possibly would be a suitable case for Rampton State Institution. We are, Sir, yours
faithfully, J. LLOYD, J. N. JACOBSON.
Fountain Hospital, Tooting Grove, S.W., August 11th.
PASTORAL PSYCHOTHERAPY
To the Editor
of THE LANCET SiR,-This correspondence has certainly called forth some interesting and surprising expressions of opinion and has provided a concrete illustration of the difficulties clinical psychology has to contend with as an important branch of medicine. When mental phenomena are the subject of discussion, it is obvious that the task of maintaining the purely rational attitude becomes a very difficult one. Dr. Batten quietly begs the whole question in asking if only qualified medical men are fit to minister to sick souls. Sick bodies we know and sick minds we know, but are we to understand that the sick soul is different from the latter1 If so, and if, as Mr. Fletcher claims, pastoral psychotherapy is designed to deal with spiritual disorders of the personality, to avoid confusion and aid differential diagnosis it would be a great help if we could have a brief description of two or three of these spiritual diseases and some indication as to how to separate them from the ordinary psychological disorders. It would, furthermore, be less equivocal if the word " psychotherapy were given up in this connexion and a distinguishing name like " pastoral spiritotherapy " used in its place-if the purists would not be too horrified at the hybrid. Dr. Hubble in his admiration for unqualified medical practice makes one wonder if he carries the same admiration into other spheres of life. Does he, for instance, prefer to have his prescriptions dispensed by an unqualified chemist, and does he go to an unqualified solicitor to help him in a legal difficulty’? His letter is not without unconscious humour when he describes the patient who underwent " complete cure " of an anxiety state by a minister of religion as having come easily through her relapse. May we be permitted to hope that she will come equally easily through future relapses ? Incidentally, is an anxiety state a spiritual disorder of the personality ? Cannot an answer to the questions at issue be put quite briefly in saying that as progress in all other departments of medicine has, with one or two exceptions which do not affect the general principle, been brought about by strict adherence to the scientific
something
"
470 method the high probability is that authentic progress in psychotherapy will be brought about by the same means ?z? I am, Sir, yours faithfully, FREDERICK DILLON.
‘’4 impole-street, W., August
To the Editor
15th.
of
THE LANCET
SiR,-Dr. Clifford Allen is fortunate in that he finds the ideas of those who oppose him " childish." He is less fortunate in that his own views have not as yet commanded the representative support of his brother psychotherapists. There is but one course for him. The Guild, undeterred by his opposition, will continue to sow what he so confidently believes to be tares. He will continue to sow what he believes, with equal confidence, to be wheat of the best quality. And the harvest’? Those of us who live till 1960 may see Dr. Allen attending a demonstration of psychotherapeutic technique by the Reverend So-and-So, the distinguished psychotherapist, just as the British Orthop2edic Association found itself sitting at the feet of Sir Herbert Barker. Unfortunately we shall be denied any amusement on that occasion for this sprightly controversy will have long since been forgotten. I am, Sir, yours faithfully, DOUGLAS HUBBLE. Derby, August 15th. To the Editor
of THE LANCET comparison of Dr. Clifford
Allen’s SiR,—A cursory latest letter with his earlier ones to you will make it apparent that he has effectively denied his own argument. Taking to task some of his professional colleagues who have ventured to disagree with him, he accuses them of precisely those mental limitations which, in his view, make the clergy unfit to practise psychotherapy. Having urged that the physician is by training " detached, unemotional, and scientific," Dr. Allen now discovers in his fellow practitioners " ignorant prejudice " and " a great capacity for drawing conclusions with insufficient evidence to support them " ; thus contradicting his earlier
premises. Dr. Allen affirms that psychotherapy is a branch of medicine. He seems not to have observed that it is also a branch of psychology. " The basic principles which support the whole " are by no means exclusively the principles of physical medicine. Indeed, one could with some cogency argue that they are essentially philosophical and religious. Certainly, by his own argument, Dr. Allen would have no reason to complain if the philosopher or theologian-and imperatively the metaphysician-should require him to produce evidence of his competence in these sciences, as he would require evidence of medical competence in them, before they acknowledged his qualification to undertake the treatment of personality disorders. No good service is done to any point of view by an evasion of the difficulties raised both for religion and medicine by psychotherapeutics. Dr. Allen affirms his admiration for the church and his respect for the ministries of religion. If he is sincere in his desire for a scientifically objective attitude to this matter let him consider the real problem raised for all concerned by the psychophysical nature of human personality. Can he provide a definition of psychotherapy that will enable both clergy and doctors to discern where the limitations of both their provinces are in the mutual task of making personalities "whole," bearing in mind the obvious fact that a medical man is no more equipped by his scientific training for the cure of souls than the "I clergyman is by his training for the cure of bodies As I have
to show, this is a real and pressing deserves consideration with all the scientific detachment and goodwill at the command of everybody concerned, and I am sure that many beside those who are interested in the Guild of Pastoral
already tried problem that
Psychotherapy
will
their indebtedness
acknowledge
to Dr. Allen if he will make a constructive contribution to its solution. In my previous letter I omitted to say that I shall be glad to post copies of the memorandum about this Guild (a perusal of which led Dr. Allen to write to you) to any of your readers who will send me a
card
the request. I am, Sir, yours faithfully,
making
A. B. W.
FLETCHER,
Hon. Sec., The Guild of Pastoral Psychotherapy.
29, Dorset-square, London, N.W.1, August 16th. " BIOCHEMICAL CONTROL OF CANCER"
To the Editor
of
THE LANCET
recent award of a Civil List pension to Copisarow must be taken to mean that, in some direction, he has done important service to science, with even less reward through normal channels than comes to most research workers. His attempt to solve the cancer problem by biochemical speculation must, accordingly, command a certain respect. The
SiR,-The
Dr.
indication, however, of the
nature of his theories, in his letter published in your issue of August 7th, by reference to " oxidation enzymes, the glutathione does not equilibrium, vitamins E, Bh B2, &c.," convey any clear idea ; nor is understanding assisted by the claim that " these conclusions " have now been supported by experimental evidence from various sources," since much of what is cited has no obvious relevance. Possibly a study of Dr. Copisarow’s earlier publications might reveal a greater coherence. Of much greater importance, however, than Dr. Copisarow’s theoretical speculations, is his statement that he has been led by them to a corrective treatment for cancer, and the suggestion that this also has been supported by the assortment of evidence quoted. The treatment consists of two items : (1) the administration of yeast with what is termed an " enzymebearing medium, such as unrefined sugar or honey " ; and (2) " the injection of certain non-toxic sulphurlabile compounds," of which mustard-gas (dichloro"
diethyl sulphide) is, curiously, quoted as an example. One has heard of the simultaneous ingestion of yeast and sugar, as a device for procuring cheaply a thorough alcoholic intoxication, and of the drawback due to the concomitant distension of the stomach with carbon dioxide ; but mustard-gas, as a non-toxic sulphur derivative suitable for injection, is surely a therapeutic novelty. It is to be hoped that none of your readers. will be so much impressed by the show of theory, and the list of references to experimental evidence cited in its support, as to give the suggested treatment a practical trial, without some much clearer and more detailed indication of the way in which its rather obvious disadvantages can be avoided. "
I am,
"
Sir, yours faithfully,
August 14th.
BIOCHEMIST.
of THE LANCET SiR,-In your issue of August 7th Mr. Copisarow refers to the " recent experimental work of several and gives investigators with methylene-blue references to two works published in 1933. As I happened to be particularly interested in this subject at the time these articles appeared, I ransacked the To the Editor
"
London medical libraries for further informatiort