1934 BMJ (Clinical Research Edition)  
After some prefatory remarks on the admonition which he said had been given him that he must on this occasion deliver a popular address Lord Macmillan asked his audience to consider certain phenomena which,. while they fell within a special province of psychiatrists and psychologists, were at the same time matter of common observation and interest-namely, the phenomena exhibited by various tvpes of the professional mind in its daily working. The choice and practice of a profession had a
more » ... ssion had a decisive and pervasive influence on a man's whole mental outlook. The first question asked about a new acquaintance was, " What does he do?" and the answer afforded the first clue to the kind of man he was, for, wide as were the individual differences among the members of a profession, there were always common elements shared by all belonging to it. Their habits were controlled, their thoughts canalized, their prejudices formed, by the profession they practised. Even their place of residence might be dictated by their vocation, as witness the Temple for lawyers, and Harley Street for medical men. Dr. Henry Maudsley, after whom the lecture was founded,' in discussing the larger t'opic of the inculcation of morality, had described the process as one of moral manufacture, and had pointed out that the whole purpose of education in morals was to produce a nature in which moral action should have become automatic. Each moral act by the law of nervous action rendered the next more easy, and so a man's nature was gradually modified. It was by some such means, together with imitation, that the process of professional training and experience gradually moulded the mind and character until the man's reactions became largely instinctive. Thus it was said, generally in a disparagiing way, of lawyers, " Oh! He is a lawyer ; you know how lawyers always look at things." PROFESSIONAL ORGANIZATION From the earliest times the practitioners of a particular art had shown a tendency to draw away from the rest of the community and to constitute themselves a separate class with their own ceremonial rites and shibboleths. The widest of all caste cleavages in former days, and still a wide one, was that between the clergy and laity. Within the ranks of the laity in turn many associations grew up of men united by a common calling. Lines of demarcationi were much more rigidly drawn in former times, and the resulting mutual exclusiveness produced much more distinctive types of persons. Nowadays the barriers were broken down, and men of all careers mixed with each other-certainly a more excellent way of living. Nevertheless, there still remained certain typical attributes engendered by the life-long pursuit of a particular calling, and lending colour and interest to social life. COMPETING INTERESTS While it might be claimed, Lord Macmillan continued, that devotion to a common calling tended to create a sense of professional brotherhood, arid thus widened and liberalized the minds of its practitioners, there was, on the other side of the account, a mental tendency resulting from immersion in a profession which was not so meritorious. This was the tendency to resist all changes. Those who, after much time and labour, had acquired facility in the practice of a system were naturally disinclined to scrap what they had found to worls well enough. They were reluctant to make the effort of examining and adopting ntAw -r whicr-h miahf hA .azhv.raziv, :andl h.eaen natbh r THE BRITISH 907 L MEDICAL JOURNAL was so much easier to tread. As an illustration he briefly glanced at the hostility often shown towards the discoveries of the great pioneers in medicine, but in the gathering he was addressing he thought it more discreet as well as courteous to refer to the inveterate conservatism of his own profession, that of the law; or again, he might instance the Civil Service. The truth was that no profession or calling was immune from this tendency. The piophet had always been greeted with a volley of stones, for, to quote Professor Whitehead, " Routine is the god of every social system." There was a good side as well as a baid one to this instinct. It was not all obscurantism. Without the stability of routine the social fabric would disintegrate. Resistance to innovation was part of the protective armour of civilization. The same Scriptures which lamepited the stoning of the prophets bade those who followed them prove all things and hold fast that which was good. Another charge which, so far as it held good, must be placed to the debit side of the reckoning, was the proneness of the professional mind to put the interests of the craft before those of the community. Changes were often advocated in the general interest which were inimical to the interests of those engaged in a particular calling, and these were apt to resist the changes, not on their merits, but for purely selfish reasons.-Examples would occur to his audience, but he thought it better again to be discreet. He wondered what Adam Smith, who was very critical of professional and trading corporations in his time, would have thought of the innumerable congresses and conferences which in these days were constantly being held by every trade, calling, and profession. There was more lip service nowadays to lofty social motives, but the pursuit of selfish aims under the guise of public good was not an unknown phenomenon. THE LIMITATIONS OF THE EXPERT In these days an increasing resort was made in all departments of life to the particular type of professional man known as the expert. In medicine the specialist had long been a familiar figure, but there were specialists now in every branch of human affairs, the reason being that the field of knowledge had become so vast that no individual could -hope to be master of more than a corner of it. When a public problem arose in any province of administration the demand always was for the expert to be consulted, if not put in charge. The results were not always -happy. The expert mind as a species of the genus professional mind was apt to have failings as well as excellencies. The attainment of a highly specialized knowledge of one isolated subject tended to create a certain arrogance of assurance. It was not unnatural to assume that if one knew more about a subject than a,nyone else one knew it better than anyone else, but he doubted whether that was necessarily so. It might be so if human life and knowledge were divided into watertight compartments, but no one factor in the social organism could be isolated. The result was that the conclusions of the specialist had often to be corrected and modified when brought into relation with wider considerations. The constitutional tendency of experts to differ, so unjustly associated in the proverb with the medical profession only, had also to be considered. The faith of the public in political economists had been rudely shaken by the discordant advice they had tendered since the war. This proneness of experts to differ was easily explicable. Even the most arrogant expert would not lay claim to complete knowledge of his subject: he had probably devoted himself to one aspect of it to the exclusion of others, and having formed certain opinions from what was, after all, only partial knowledge, he developed a parental affection for them which became emotional rather than scientific. On the other hand, the value of specialized knowledge was incontestable, being the product of intensive research and experience quite beyond the range of the ordinary practitioner. One of the most interesting problems of the day was how best to utilize the expert in the public interest. Lord Macmillan here digressed to speak of the MAY 19, 1934] llt;w -luvcLb W.UILIII iiiigiit, tiv ZUUVUlblvv, CLIIU LIIV Liuavull jitzl.LL
doi:10.1136/bmj.1.3828.907 fatcat:iuikolavm5bhjj4jh4ev4zl4va