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ReformersThe reformers of the reformation
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The Psychological Training of Abraham Flexner, the Reformer of Medical Education David J. King
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Oregon State University , USA Published online: 02 Jul 2010.
To cite this article: David J. King (1978) The Psychological Training of Abraham Flexner, the Reformer of Medical Education, The Journal of Psychology: Interdisciplinary and Applied, 100:1, 131-134, DOI: 10.1080/00223980.1978.9923481 To link to this article: http://dx.doi.org/10.1080/00223980.1978.9923481
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Published as a separate and in The Joiirnal of Psychology, 1978, 100, 131-137.
T H E PSYCHOLOGICAL TRAINING O F ABRAHAM FLEXNER, T H E REFORMER O F MEDICAL EDUCATION* Oregon State University
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DAVIDJ. KING SUMMARY The great reformer of American medical education was Abraham Flexner. His basic emphasis was to insist that medical education should be solidly based on science. Not a physician, Flexner’s specialized training was in psychology. This paper traces the major influence on Flexner’s thinking (primarily the works of Hall, Stumpf, and Lotze) and relates these influences to his emphasis on the importance of basic science. Medical education in the United States was given its modern standards primarily by the efforts of Abraham Flexner. His report for the Carnegie Commission in 1910, commonly called “The Flexner Report,” forced a revolution in the education of physicians. The report was explicit in pointing out the deficiencies of most medical schools (lax or nonexistent admission standards, number and adequacy of the training of the faculty, the size and utilization of endowment, poor laboratory facilities particularly for the first two years of training, and, finally, the relationship between the medical school and the training hospitals). Following the publication and dissemination of the report, many of the more disgraceful schools closed, many were merged, and the general movement toward quality medical education, based on fundamental laboratory sciences, was well begun. The general and lasting importance of the Flexner Report is reflected in the Winter, 1974, issue of Daedalus. This issue was devoted to reviews of twentieth-century classics. One of the 16 works selected for review was The Flexner Report. The reviewer of the report, Carleton B. Chapman, presented a most interesting review, contrasting some of the modern countercurrents (medicine as an art) with the original thrust of the report. In his review, Chapman clearly outlines one of Flexner’s major emphases, that of
* Received in the Editorial Office on July 15, 1978, and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press. 131
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the necessity of solidly basing medicine on science. Chapman continues to state that “And science to him meant the natural sciences which, in view of the fact that his graduate work in Germany was in the field of psychology, seems unexpected” ( 2 , p. 107). My interest was caught by his reference to Flexner’s psychological training. I had known that Flexner was not a physician but had no idea as to his specialized training. It is the purpose of this paper to outline the nature of Flexner’s psychological training. Following a modest high school education, Flexner, in 1884, journeyed from his home in Louisville, Kentucky, to the Johns Hopkins University in Baltimore. From his autobiography, it seems clear that most of his studies were concentrated in the classical curriculum. Thus, “The studies at the Hopkins were organized on the group system, allowing scope for choice, but preserving continuity. I selected the classical group; others followed the scientific group or the history and political-science group” (4,p. 32). After two years of concentrated study, Flexner graduated in 1886. Flexner returned to Louisville in June of 1886 and accepted a position in the local high school where he taught, primarily Latin and Greek, for four years. In 1890 Flexner started his own school which was essentially a preparatory school for college examinations. “Mr. Flexner’s School,” as it was called, was highly successful, even attracting the attention of President Eliot of Harvard. Flexner continued his school for 15 years. In 1905 he closed his school with the intention of going to Europe to study. Prior to his European trip he went to Harvard to obtain the background he felt necessary. Here, Flexner’s autobiography is very explicit: In the autumn we went to Cambridge, where for a year I worked with Munsterberg, Holt, and Yerkes in the psychological laboratory, with George H. Parker in the Agassiz Museum, and with Josiah Royce in philosophy. For its possible bearing on educational problems, I had looked forward especially to work in the field of physiological psychology with Munsterberg; but I was sadly disappointed. Munsterberg put me to work at once on a time-reaction experiment. The instrument was out of order and during the next two or three months was recalcitrant most of the time, though Holt generously devoted time and ingenuity to making it work. But even had his efforts succeeded, I was getting nowhere. I attended Munsterberg’s lectures and found them equally unsatisfactory. Gradually I began to feel that, able and learned as he was, he did not regard his work at Harvard very seriously. I abandoned his laboratory, after reminding him that, as I had told him at the outset, I knew neither anatomy, physiology, nor psychology enough to warrant my embarking on a highly specialized bit of experimentation. To my surprse, he expressed the opinion that my decision was wise. Was he disappointed in my work or relieved that I was leaving? I shall never know (4, p. 63).
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Departing Cambridge, Flexner went to New York City where his brother, Dr. Simon Flexner, provided him with the facilities “for the study of the anatomy of the brain, a knowledge of which seemed to me essential to one who was studying psychology because of its supposed bearing on education” (4, p. 64). We note an early emphasis on the natural science foundation of psychology. Obviously this belief was prior to and not a consequence of his European training. Returning to Cambridge, Flexner attended and enjoyed the lectures of Parker, while in philosophy he studied primarily with Royce but obtained at least a brief glimpse of William James. In the summer of 1906, after this period of preparation, Flexner and his family sailed for Europe. Most of his formal studying was done at the University of Berlin. Here there was a clear association with psychologists both as mentors and as fellow students. The primary professional influence at Berlin was that of Stumpf. Flexner wrote as follows: Stumpf was then the leading German psychologist. In a letter written during this period, I find myself speaking with enthusiasm of the “perfect Stumpf” discussing with marvelous fairness and lucidity “the nature, excellencies, and defects of modern logic.” I continued, “I raise my hat to him-clearest, keenest, and most modest of men. He travels through the complexities of a dry subject on a straight line, cutting, however, a broad swath, and turning it into a garden as he goes. I have yet to meet a student who does not prefer him to anyone else he hears or has heard” (4, p. 68).
Fellow students, prominently mentioned by Flexner in his autobiography, were Kurt Koffka and Herbert Langfeld. During a vacation trip to Italy, Flexner visited with another notable: I presented a letter of introduction from Stumpf to his former teacher, Franz Brentano, philosopher and psychologist. I have passed few such afternoons. Brentano discoursed freely on philosophy and psychology and prided himself on the fact that his advice had saved Stumpf from the study of law to make of him the leading psychologist of his time. A little later Brentano returned my call, talking eloquently of James, Wundt, Mach, and other eminent philosophers (4, p. 69).
Much of Flexner’s European experience involved his visiting assorted gymnasia. Ambulando discimus was a pattern that he followed throughout his work on medical and general education in America. After his European studies, Flexner returned home and started his highly influential career, first in medical education and then in higher education in general. The above, most of which was taken directly from information given in Flexner’s autobiography, makes reasonably clear his graduate training in
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psychology. The primary influence was that of Stumpf. While the first associations to Stumpf would probably relate to phenomenology and music, his rigorous scientific bent should also be considered. Boring instructs us that as a youth Stumpf “came in contact with medicine and natural sciences” (1, p. 362). While a student at Wurzburg, he became a disciple of Brentano. At that stage in his thought, Brentano “held that the scientific method is the true philosophical method, so his disciple, Stumpf, undertook to learn science in the chemical laboratory . . .” (1, p. 362). Boring continues with the following parenthetical remark: The scientific nineteenth century bred a philosophy that turned to science for its method, and it is an historical commonplace to find its young philosophers attempting to practice science, not because they were experimentally mindedthey were not; they were philosophers-but because they wished to put into practice this philosophical belief about method ( 1 , p. 362-363).
After a year with Brentano, Stumpf was sent to Gottingen to complete his degree with Lotze. There “Stumpf also pursued his science, working in physiology with Meissner and in physics with Wilhelm Weber . . .” (1, p. 363). While not primarily an experimentalist himself, Stumpf certainly was a champion of scientific method in psychology. So much for Flexner’s graduate education in psychology. His experiences were consistent with his position regarding the priority and importance of basic science in medical education and, of course, psychology. However, as was clear from the preparation he engaged in for his European venture, he already had this conception prior to his departure. Flexner’s own writings do not provide any clue as to the origin of his thinking in this area. His account of his undergraduate years at Hopkins makes no mention of any course in psychology, nor is there any mention of the question in the many years from his graduation from Hopkins to the closing of his school. While there is no mention of it in his writings, a coincidence of dates suggested a hypothesis. Flexner attended Hopkins during the period 18841886. From 1882-1888 G. Stanley Hall taught at Hopkins. Did Flexner study with Hall? If so, what did Hall teach and is this possibly one basis of Flexner’s idea about the nature of psychology? In the following, I am very much indebted to Mr. Robert E. Cyphers, the Registrar at The Johns Hopkins University, for his assistance (3). The quotations presented are given with his permission. In response to my request for information, Mr. Cyphers has determined,

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