Dialogue

What divide?

I read "The 90-Year Divide" [Fall] with interest and concern.

Interest because I am a Johns Hopkins MD and was a Phipps psychiatric resident, so that Hopkins and Adolf Meyer are at the core of my professional identity. Concern because the authors, on the one hand, trivialize the differences that once existed between Freud's psychoanalytic and Meyer's psychobiological approaches and, on the other, overlook the current knowledge-driven reconciliation of the mind-body-social, conscious-unconscious divides.

There were some sharp differences between psychoanalysis and psychobiology in the early days, but the personal and personnel problems between Adolf Meyer and Clara Thompson, so emphasized by the authors, have nothing to do with the real differences between Freudian psychoanalysis and Meyerian psychobiology. Meyer was formulating an effort to look at the whole person, a departure at the time that is of enduring significance. Freud was engaged in paradigm-shifting work on the unconscious mind. Both were making valuable but very different contributions.

The authors' "divide" also extends to organized psychiatry. They report that [Johns Hopkins psychiatrists] [Paul] McHugh and [Phillip] Slavney question the Diagnostic and Statistical Manual of Mental Disorders and are in favor of a more Meyerian approach that takes into consideration the enduring aspects of the patient's life and their influences on the causation of illness. Psychoanalysts, too, have had objections to the DSM. In fact, a consortium of psychoanalytic organizations published the Psychodynamic Diagnostic Manual in 2006, which states that it "is a diagnostic framework that attempts to characterize the whole person—the depth as well as the surface of emotional, cognitive, and social functioning."

When the psychoanalytic consortium's PDM seeks a fuller understanding of mind and brain in a social context, the divide begins to disappear. The divide vanishes in Eric Kandel's 2012 book, The Age of Insight. Kandel, a Nobel laureate for neuronal research, demonstrates how neuroscience is illuminating the brain pathways that are the biological substrate of the unconscious mental processes Freud first glimpsed in the clinical setting. For Kandel there is no mind-body discontinuity, as the mind is firmly seated in the brain.

The idea of a "90-year divide" seems to me to be a dated concept from a time when there was no science that provided a bridge for complementary efforts to understand and serve the whole human being.

The authors' approach is entertaining but, I fear, does a disservice to the convergence of clinical and scientific observations around the social person who has both a brain and a mind.

Jon K. Meyer, Med '64, HS '64-'67, '69
Professor Emeritus, Psychiatry and Psychoanalysis, Medical College of Wisconsin
Past President, American Psychoanalytic Association
Lutherville, Maryland

Holding hospitals accountable

[Marty Makary's book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care] is admirable, to say the least ["Hospital, Heal Thyself," Fall]. Speaking as a caregiver whose children experienced medical errors in 2010 (one event was sentinel), I think we need more medical professionals willing to take on transparency and openness. It's not only good for patients and their outcomes but healthy for doctors and nurses as well. I'd like to share a short documentary, titled The House of Gort, about one of the medical errors my family experienced. It's tangible for medical professionals and done in a way that can be measured, which is something scientists love.

Tim Gort
www.timgort.com
Marquette, Michigan
Comment from hub.jhu.edu/magazine

Getting technical

I wish to compliment Bret McCabe on his well-written article "Making Notes" [Fall]. It is good insight into the collaboration of a performing artist and an instrument maker to produce an instrument that meets the performer's requirements. It reminds me of the period of time when I owned a French horn pro shop and was working on a similar project with the late Glenn Janson of the Philadelphia Orchestra. Unfortunately, due to his untimely demise, the horn never came to full fruition.

I wish to offer one technical clarification. The bore of a valved brass instrument is the inner diametric dimension of the inner cylindrical tubing coming off of the first valve. Typically, the size of the valve tubing is the same for the tubing of all three valves. In addition to the aforementioned cylindrical tubing, all brass instruments are built with a large amount of conical tubing referred to as the taper of the instrument. Verbally describing the taper of an instrument is a rather abstract task, in that the taper does not fit into the constant slope of a linear equation. A small-bore instrument as described in this article will have a more gradual taper than an instrument with a larger valve bore. In that both the small-bore and the larger-bore B-flat trumpets are 4 1/2 feet from the mouthpiece to the rim of the bell, the taper of the conical lead pipe of the smaller-bore trumpet will reach its maximum diameter at the cylindrically bored main tuning slide with a lesser increase in inner diameter per distance down the lead pipe than will the lead pipe of the trumpet with a larger valve bore. The same goes for the taper of the conical tubing from the valve cluster to the bell. In brass instrument design, the taper of the conical tubing is critical in determining the intonation of the instrument relative to itself—in other words, the bad notes that were found on the penultimate prototype described in the article.

Randolph Harrison
Instructor of Applied French Horn and Low Brass, Maryland Conservatory of Music