It is the time element that perhaps most impresses and depresses the student of the new prophylaxis. In a recent paper by a competent psychiatrist the writer refers as follows to the impracticability of studying a group of cases in a public hospital on the plan of getting the patients to understand and explain their own difficulties:
At the rate at which the best of the psychoanalysts work, it would not be possible properly to study in the course of the year more than a dozen cases. Furthermore, the results of such work are of importance purely for the individual, and no generalization can be drawn therefrom.... Also, no generalization being possible, it is a matter of piece work; to study one hundred cases according to this method would require the efforts of fifteen to twenty psychologists on full time for many months.
In the opinion of the faithful, Freud, the inventor of psychoanalysis, is to psychiatry what Darwin was to biology, but as Darwin's theory of evolution required more aeons than the geologists were able to oblige him with, so Freud's method requires more time than the calendar affords. Darwin's theory of the variation of species had to be modified by the theory of mutations or sports. Freud's methods, to be workable, must be adapted in some way to the indisputable fact that there are only twenty-four hours in the day, and only three hundred and sixty-five days in the year.
A careful mathematical calculation of the number of hours required to cure a psychosis by this new prophylaxis reveals an alarming disproportion between the minute number of physicians available, and the incalculable number of patients requiring their ministrations. One of the most ardent devotees of the new method is a practitioner who, according to the testimony of a confrère, enters upon his daily endurance test at 9 A. M. and without any luncheon psychoanalyzes continuously until 7 P. M. As the ordinary patient is supposed to require three hours a week of this treatment, for about five months, the doctor can, by working ten hours a day, treat twenty patients in one week, or allowing him two months vacation in summer (and he will need it) handle forty patients in one year. This, alas, is but a drop of medicine in the bucket of disease, and unless, by some homeopathic adaptation of the five-hundredth-dilution principle, we can make our medicine go farther it is only a limited number of the rich and leisure class who can ever be cured by these new methods. This is the prostrating situation that confronts the humanitarian--a little group of healers bravely but hopelessly taking up arms against a sea of mental troubles.