ACADEMY FORUM - The American Academy of Psychoanalysis and Dynamic ...

irrelevant to the mainstream practice of physicians who were
using bleeding procedures. Gradually these practitioners became
incorporated into the long standing organizations of traditional
physicians. So eventually the distinction between no rituals at
all and the need for rituals as part of a bleeding procedure of
any kind became disregarded by the vast majority of general
physicians, who only tolerated this gradually shrinking rebel
group of doctors for the sake of wanting to appear as giving
lip service to something that at one point had been so exciting
and seemed so revolutionary an improvement in the practice
of medicine.
As these ideas died out there was also a gradual evolution in
the strict ritual group that moved it farther and father away from
the medical field, and that group became a kind of repository
for the treatment of patients for whom ordinary bleeding did
not seem to have an effect. Hostile critics called these patients
“the worried well.” But that group was never able to convince
ordinary doctors that their strict ritual procedure of bleeding
was any better than non-ritual bleeding used by the general
physicians, and their members were treated with scorn and
ridicule. As a result this cult became smaller and smaller and
attracted more and more characters who seemed to have less
and less of a concept of what they were doing. They seemed to
be confused about how it was different or the same from what
the general physicians were doing, and what relationship their
current procedures had to the practices of the original founder
of the strict bleeding technique. They even no longer read the
meticulously prepared manuscripts of their “Jewish genius”
in their training and education, and began to regard him as a
fossil and out of date with modern thought. Those who insisted
on basing their work on what they had learned by going back
to the original manuscripts written by “the professor” were
considered eccentric, and ignored. All of this has faded out now,
near the end of the Merovingian dynasty, and is only recorded
now in these chronicles as a part of church history assigned
by Esteemed Brothers to be written by this humble monk. Sic
transit gloria mundi.
* * *
The honorable readers of the Academy Forum I am sure
will be delighted to know that the bleeding procedures that
are used today, carried out by the use of phlebotomy or even
in some places still the application of leeches to the patient,
is becoming more common and there is a good chance it may
revive. Also, as we in the field of psychiatry approach the birth
of DSM V we can feel secure that our psychiatry rests on the
firm biological basis that was established for it by neurologists
in the 19 th century and has finally come around to reviving the
classifications and pharmacologic practices that were extant
at that time. There has even been some improvement since
then, in that these pharmacologic procedures have now been
liberally applied to children, sometimes even to two year olds.
It is very befuddling to the average practitioner to understand
why their parents and other disturbed persons would object to
such advances in medical practice and even picket our medical
meetings.
I have brought your attention to the controversy that went on
in the Merovingian era to reassure you how basic medical and
psychiatric practice have continued unchanged in the mainstream
since the fall of Troy in spite of temporary intruders like “the
professor.” I have found it helpful and I sleep better knowing
that the procedures from the time of Hippocrates which are used
today have the authority of thousands of years of announced
success, even though the concept of experimental demonstration
has not been always bothered with. It is comforting to know that
we are practicing biological psychiatry in a tradition of chemical
imbalance that is parallel to and based on a classical practice
from twenty-five hundred years ago. With the exception of a few
obviously eccentric Greek intuitive geniuses who recommended
that psychiatric patients should go to the temple at Asclepius at
Epidaurus in the north-eastern Peloponnese and dream there in
order to have their dreams read by the priests at the temple, most
practices such as bleeding were carried out without any interest
or exploration of how the patient got sick or why they were sick
or even why they preferred to remain sick. These matters were
usually attributed to the will of the gods.
The process of bleeding, just like the process of prescribing
drugs, is very short, and a trained nurse practitioner can
bleed several patients either at once or sequentially in a very
reasonable amount of time, guaranteeing for herself and for
the corporation of doctors that employ her, currently known by
the curious epithet as “mental health providers” and no longer
as “Esteemed Brothers,” a suitable income from a plethora of
patients who are convinced by classical authorities that they
have a chemical imbalance. As the eminent physician W. Michell
Clarke writes about the history of bleeding patients in the British
Medical Journal of July 17, 1875:
We cannot yet say, in many cases, here is such and such a
group of symptoms; they indicate a definite derangement,
which can be met with mathematical precision by such
and such remedies; in some cases, we do almost attain to
this accuracy, and it is highly desirable that the numbers
should be increased; but in the meantime, in the majority,
we take a safer course in following the path that the stored
up information that has been gathered in the past leads us.
(p.69)
How fortunate we are that only about 135 years later DSM
V will have finally solved this problem for the diseases that are
addressed by psychiatry!
Clarke also points out that, “Most of the older of us will have
met with instances in which permanent injury has been done to
the individual…I have heard many stories of the way in which
the patients at the infirmary and other places used to be bled all
around by the students, and that in the most lavish manner.” He
could not know that bleeding would be back in practice today
but he thought that the reason it was given up was, “I think
we should be inclined to say that it was the excess of the last
generation that caused the utter collapse of the practice” (p.63).
Plus ça change, plus cest la même chose.
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