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JAMA Revisited
January 14, 2020

The Patient Himself

JAMA. 2020;323(2):192. doi:10.1001/jama.2019.13257

Originally Published January 10, 1920 | JAMA. 1920;74(2):69- 73.

Among the vices of advancing years are carping criticism, garrulity and needless admonition. To all of these I plead guilty and so can only beg your indulgence while I say a few things that I think should be said, knowing that I say them poorly and that I add nothing to our store of knowledge.

My theme is that much neglected individual, the patient himself. Concerning his organs and their functions, we have numberless tomes. Concerning the diseases that attack his parts, we have whole libraries. Concerning the various ways of cutting him open and sewing him up, there are several six-foot shelves. For the manifold instruments, machines and appliances of our armamentarium, an extensive congeries of industries is in constant operation. Indeed, some of us are so used to practicing medicine by machinery that the cortical cell bids fair to shrink into sterile desuetude. But of the patient himself—the man, the woman, the child—relatively little is thought or written.

The Patient Above the Eyebrows

What do I mean by the patient himself? I mean what we mean when we speak of our friend, our enemy, our son, our daughter. We like a man because he is sensible, kind or entertaining; dislike him because he is selfish, irritable or pessimistic. So do we admire or despise because of certain mental, not physical, qualities: traits that reside above the eyebrows. Our attitude depends on the individual’s personality: the biggest thing to us and to him. It is more important than his kidneys and his liver, and its disorders are as momentous to him and to society as is disease of his organs. His personality is what he is—the man himself; and he is the sum of all his tendencies and experiences; his desires, aversions, affections, hates, passions, inhibitions, appetites, reflections and knowledge. The tendencies are few and simple, the experiences myriad. And a little thought shows that most of this experience has been in the form of conflicts. From the beginning, life is a conflict: an effort to live and be happy—that is to say, an effort to adapt ourselves to the conditions under which we must live. The struggle between what we consciously or unconsciously wish to do, and what the present state of society requires us to do begins in infancy and never perfectly stops. Very early the normal child learns that certain natural functions may not be fulfilled in a completely natural way. He may not urinate in the parlor nor appropriate anything he happens to see. As we grow older these conflicts become more complex and more acute. Some of us come out of them pretty much to the satisfaction of ourselves and our neighbors. We are the happy, the well and the successful. Some of us are unable to make the adjustment. We, then, are the unhappy, the ill or the unsuccessful. Now, as every one of us has these conflicts and has them all the time, it does not take much perspicacity to see that there are many defeats….

The Results of Maladaptation

The whole question of health is one of adaptation or adaptability. We have typhoid fever either because individually we are still vulnerable to the typhoid germ, or because as a community we have failed successfully to combat it. Some of us have neuroses or psychoses because we are unable successfully to harmonize with our environment—and for no other reason. Often this fact is overlooked. What has social inadequacy to do with the practice of medicine? A great deal, because it starts a multiplicity of symptoms which the patient expects the physician to relieve....

The Outcome

And for our encouragement, we may remember that the temperamental individual who is confused and discouraged by life’s perplexities and takes refuge in physical disabilities is, when rightly placed, likely to be the finest enthusiast, the most glowing optimist. Just as he is dominated and defeated by a depressing idea, so is he exhilarated and activated by sanguine ideas. Some of the greatest and most beautiful work of all time has been done by these men and women who are too much controlled by their emotions, too sensitive to the jars of a battling society, too unstable to carry the gross burdens of a materialistic world. Ours the task, then to strengthen their intellectual control, to toughen their shrinking sensibilities, and adjust the burden to the bearer. Thus may we, too, add to the sum total of human health, happiness and progress.

Hugh T. Patrick, M.D., Emeritus Professor of Nervous and Mental Diseases, Northwestern University Medical School, Chicago.

Presidential address, read before the Institute of Medicine of Chicago.

Section Editor: Jennifer Reiling, Assistant Editor.
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted.