Showing papers in "Psychiatric Quarterly in 1972"

Origins of creativity.

Abstract: The sorrows and joys of this rare condition are well understood, but there have been relatively few convincing attempts to fathom its origins. In this major contribution to a neglected area, Dr. Markowitz hypothesizes that creativity develops as a product of the necessities facing an individual whose early environment permitted occasional depersonification of thought.

Fatherhood and mental illness: A review and new material

Abstract: Although there is an extensive literature on mental illness associated with motherhood, the related area of mental illness associated with fatherhood is only beginning to develop.

What benefits patients? An inquiry into the opinions of psychiatric inpatients and their residents.

Abstract: Over 300 psychiatric inpatients and their residents responded to a questionnaire eliciting their views concerning the degree of benefit derived by patients from each of 20 aspects of the inpatient experience in a university hospital psychiatric service. Three major trends emerged:

Failures on a therapeutic milieu

Abstract: “An intolerance of increasing regressive behavior seems to oblige the patient to control herself. This seems similar to the young child who gets hurt outside the house but is able to control himself until home with his mother, at which time he is able to relinquish controls. In other words, the readiness to regress appears to be related in part to its acceptance by those in the environment.”

Methadone fatalities in heroin addicts.

Abstract: The present paper is based upon a review of the pertinent literature; the study of 12 human fatalities that had been attributed to abuse or overdosage of methadone in heroin addicts ; and acute experimental investigations in rodents. Table I summarizes the most common adverse and ~oxicologic methadone reactions in tolerant cases (heroin addicts enrolled, or \"drop-outs\" ; or those who had been discharged from a methadonemaintenance program) and nontolerant cases (both adult and children), following the use of methadone for maintenance of heroin withdrawal, for detoxification abuse, or for accidental or suicidal overdosages. The percentage of methadone fatalities reported by various investigators differs in relation to the variety of individual scales:

On the use of psychiatric diagnosis for comparing psychiatric populations.

Abstract: The work of the US-UK Diagnostic Project has brought us face to face with the problem of comparing psychiatric disorders between different populations. I t seems appropriate to review today this aspect of our work, because such comparisons are an important part of research into the interaction between social factors and psychiatric disorders. Our work began in 1967 as a joint collaborative project between the Institutes of Psychiatry in New York and in London, with Dr. John Cooper heading the London team and myself (Barry GuEand) heading the U.S. team. The question initially posed for us by Dr. Joseph Zubin, the Project director, and Dr. Morton Kramer, of the National Institute of Mental Health, was whether diagnoses made by hospital psychiatrists during the course of their routine duties could be used to point up differences between the patient populations of the US and the UK (1, 2). Many eminent psychiatrists had already drawn attention to the startling differences between the

Urbanization and mental health: a reformulation.

Abstract: Human beings vary in many contextual ways that are of prime behavioral significance. Central to the discussion in this paper is the size, density and complexity of the environing community, ranging on a broad continuum from the small, dispersed and relatively homogeneous settlement, at one extreme, to the huge, ultra-dense and enormously heterogenous metropolis, at the other extreme, with all the psycho-sociological corollaries of the latter. In order to simplify this presentation, I shall use \" u r b a n \" and \" c i t y \" as interchangeable words, referring broadly to the band of large centers near one end of the continuum, and \"rural\" or \"v i l lage\" or \"coun t ry\" to refer to the class of small settlements, by Census Bureau definition holding under 2500 people, that historically and heuristically anchors the other extreme. Thus, \" r u r a l \" and \" u r b a n \" are one pair of antonyms, \"v i l lage\" and \" c i t y \" another pair. The paper is divided into three parts: (1) a brief review of past professional assessments of city and country living; (2) a summary of recent research evidence bearing on this issue, as it relates to somatic and mental disorders; (3) a reformulation of the consequences for mental health arising out of the city in general and the metropolis in particular. One theme running through the long social evolution from village to metropolis, particularly since the Industrial Revolution,

Infantile trauma, narcissistic injury and agoraphobia.

Abstract: This detailed report of a seven-year analysis illustrates how childhood traumata, including blatant sexual traumata, culminated in crucial fixations that ultimately played a major role in the evolution of a markedly narcissistic character structure from which the ultimate symptom complexes emerged.

A contribution to the nosology and dynamics of adolescent schizophrenia.

Abstract: “The so-called turmoil view of adolescence, which characterizes this period as one of major symptomatic and behavioral storm and stress, cannot be accepted as valid for the majority of chronological adolescents. ... Thus, failure to apply Bleuler's criteria or, worse, viewing overt or latent classical thought disorder as more or less expected of the adolescent, regularly leads the clinician into the profoundest diagnostic errors.” In his long and definitive study, the result of more than 12 years of work in the area of residential psychiatric treatment, the author presents his views from a combined developmental-object relations vantage point, and draws on a vast bibliography concerned with psychopathology as an expression of developmental failure.

Treatment participation related to hospitalization goals of alcoholic patients and their families.

Abstract: Three groups of male, hospitalized alcoholics—a total of 105 patients—were studied In addition, the expectancies from hospitalization of the relatives of one of the groups was related to the participation in treatment of that group

Comments on past and present in genetic research on schizophrenia.

Abstract: It has been a great pleasure to hear Dr. Rainer's tribute to the research of Franz Kallmann, not only because Dr. Kallmann's memory holds a very special meaning for all of us who worked with him, but because pioneering workers in science often fail to obtain their jus t due. They are, after all, prey to many dangers: the cumbersomeness of infant methodologies; the penetrating hindsight afforded to their later-day critics, and sometimes even the misfortune of publication in out-of-the way sources. But most of all, they are so often victims of time. For it seems that, for ideas in science, as for all other things, there are seasons and times ; there is a time of rejection and a time of acceptance. To many essentially correct ideas the time of acceptance comes slowly, while false or trivial notions are able to win instant sanction, chiefly because they appear to be harmonious with certain views of the moment. This occurs especially often, perhaps, in the disciplines that have to do with human behavior, where emotional attitudes about the nature of man are apt to overshadow scientific objectivity and to blur recognition of \" t ru th s \" and \"untruths.\" A comparatively long time has passed since genetic theories about the etiology of schizophrenia were first formalized, and since the orderly collection of research data in support of such theories began. Fifty-five years ago, the first systematic family risk study was reported by Ernst Riidin (1916), the father of Edith ZerbinRfidin, who is one of our guests and speakers today. Out of Riidin's laboratory came Kallmann and many of the other workers who developed psychiatric genetics and introduced it internationally.

Planning and the environment of a community mental health center

Abstract: “In community mental health centers with poorly developed planning units... the director may find himself in a state of intermittent crisis attempting to meet one unanticipated environmental problem after another. Such a reactive stance to environmental events makes it difficult a reactive stance to environmental events makes it difficult to be proactive in developing innovative programs, since organizational resources are quickly captured by makeshift attempts to deal with a series of emergencies.”

Perspectives on the genetics of schizophrenia: a re-evaluation of Kallmann's contribution--its influence and current relevance.

Abstract: This 75th Anniversary celebration of the Psychiatric Institute provides us all with an opportunity to look back and took ahead, to build our future research in the firm tradition of that which has gone before. We are reminded that, ten years ago, the Institute was host to another anniversary symposium, marking the 25th anniversary of the organization of the department of Medical Genetics by Franz Kallmann in 1936. After a series of presentations on recent scientific advances in genetics both in the United States and abroad, Kallmann addressed himself to the public health aspect of the discipline and, in a formulation that was typical of him, said, \" I n planning research at the family and population levels, neither human genetics in general nor mental health genetics in particular can afford to be an ivory tower science, confined to the laboratory and restricted to theoretical deduction and impersonal extrapolation. Through concerted action, they form a science of genetics applied to people, to benefit people, and to be understood by people for their own good and that of their progeny.\" Present at that celebration were some very prominent figures who had been instrumental in Kallmann's re-establishment of his scientific productivity in this country and in this Institute in 1936 --among them Dr. Nolan D. C. Lewis, who wrote the Introduction to The Genetics of Schizophrenia, Kallmann's unsurpassed, sere-

Evaluation of community psychiatric practice

Abstract: As a result of various studies of the Washington Heights community by the Department of Psychiatry and the School of Public Health of Columbia University, a hospital improvement grant application was submitted to the National Institute of Health. The project was approved and began operation in February 1965, as the Washington Heights Community Service of the New York State Psychiatric Institute. Prior to the inauguration of the service, psychiatric care for residents of the Washington Heights District had been inadequate and fragmented. Patients from the area were admitted first to Bellevue, an overcrowded city hospital; if continued hospitalization was indicated, they were then transferred from there to Rockland State Hospital. Upon discharge, only inadequate follow-up care was available. The Washington Heights Community Service was established at the Psychiatric Institute and offered inpatient, day and night hospitalization, home care, outpatient aftercare, and a \"halfway house\" that was located in the local community. In addition, a close collaboration was initiated with the 24-hour emergency service and outpatient department of the Columbia-Presbyterian Hospital. The original catchment area included Health Areas 3 and 4, with a population of approximately 50,000. On July 1, 1970, Health

The program of the Biometrics Research Unit.

Abstract: I have often been asked what Biometrics Research is and what we do. Although I am sometimes tempted to respond that biometrics is what biometricians do, I feel that there is some justice in the query. I will therefore try to answer it as well as I can. In order to understand how biometrics research entered the field of psychopathology, we have to begin by taking a look at the status of the field during the middle third of this century. It was what you might call \"the time of the great invasion,\" when social scientists and biological scientists were \" invading\" psychopathology and establishing their territorial rights. From the social sciences there came those field theories in which ecological forces began to be examined--for example, in the studies by Faris and Dunham. From the biological field came the geneticists, the biochemists and the neurophysiologists, with their more atomistic approaches--for example, twin studies and studies of metabolic processes. Already well-established in the field were the phenomenological approaches of Jaspers; the psychodynamic approaches of Freud and his followers; the clinical approaches of Kraepelin; and, to a lesser degree, the laboratory approaches of the experimental psychologists, and the diagnostic testing approaches of the clinical psychologists. The appearance of all of these diverse disciplines in the same arena suggested that some form of rapprochement was necessary between these different viewpoints. Among the first to make such an attempt was Madison Bentley who, with F. V. Cowdry, undertook a study under the aegis of the National Research Council, which was published in 1934. Unfortunately, their efforts were dismissed at that time by some clini-

Team transference and resistance in the treatment of patients who act out.

Abstract: There is more than meets the eye in the splitting of members of a treatment team. The source of these difficulties, when unearthed, revealed that the patients' actions experienced as aggression by the staff, evoked guilt feelings and retaliatory impulses which had to be denied expression. The team member may have failed to carry out an agreed-upon limit because he feared the patient's demands due to reverberation with his own past experences. He may have identified with the omnipotence of the patient and the latter's wish to devalue the therapist.

Some comments on research in a state department of mental hygiene.

Abstract: Now that money flows less freely from most sources, and not at all from some, Dr. Pasamanick's cogent balancing of the ideal with the pragmatic is very much to the point. His useful suggestions come out of hard experience, and he follows them up with a convincing plea for a larger sense of responsibility among scientists to educate both themselves and the general public and their representatives to a greater social responsibility.

Family interviews: A technique for the selection of psychiatric residency candidates

Abstract: When we select graduate physicians for specialty training, we assume the responsibility for adding new practitioners to the established professions. In the process, there may be an interference, arising out of the intent, more or less conscious, to create mirror images of the teacher or selector--whether this be preparation toward a clinical, academic or research career, or, as stated by Klein, " tha t they may eventually contribute to the progress of psychiatric practice." This somewhat nebulous process of selection has to include today the sharing of new realities. There has been a great change in the needs and responsibilities to be encountered, and our profession has been made aware of that change during the last ten years. Formerly, such needs were either dismissed, denied or compensated for. The profession by i tself--that is, by way of its highly verbal "ac t iv i s t " members-has now been awakened to this reality, and it has started to answer the challenge that is implicit in it. This strongly suggests that we need to add extensively to our criteria of selection and training, to look beyond the old criteria for professionals. Such questions as capacity for service and administration, social and community awareness, "minori ty blindness," etc., along with a number of corollary questions, must now be taken into consideration. Accurate follow-up of the careers and behavior of most trainees is usually at best minuscule. In spite of the great

Adolf Meyer lecture the future of psychiatry-A Hobson's choice?

Abstract: It is true that, in a cosmic sense, there is nothing new under the sun. What I have said here today may have been said before by other psychiatrists and behavioral scientists. The principles that Adolf Meyer delineated and designated as those of “objective psychobiology” include: the need for factual observation, validation by accurate prediction, and the testing of reliable methods of intervention. These essentials are as vital today as when they were first set forth by Dr. Meyer (14, 15). Advances in science, as well as the improvement of psychiatric services, are the result of: more accurate definitions; refinement and recognition of the significance of observations; and the meaningful integration of many parts and processes. The future of psychiatry is linked with our willingness to re-examine our beliefs and our activities, to re-order our skills and our responsibilities, and to engage in a continual evaluation of our therapeutic efforts. If we are willing to do these things promptly and efficiently, then there will be no Hobson's choice in the future of psychiatry. Instead, we will be in a position to make the sort of choice that will be most likely to reduce the massive problem of mental illness and thereby contribute to the lives of all of humanity.

Cellular biochemistry of narcotic analgesic drugs in the central nervous system of the rat.

Abstract: Morphine and other narcotic analgesics administered to man or laboratory animals in acute doses produce an array of pharmaeologieal responses; these are diminished upon repeated drug use, producing a drug-dependent state that is characterized by tolerance, physical and psychic dependence, and finally drug \"addlet ion\" (1). The riddle of drug addiction is whether or not the mechanisms by which tolerance and dependence arc produced are directly related to the mechanisms by which the acute pharmacological responses are produced. Inasmuch as the answer to ~ this riddle lies in uncovering the mechanisms of both phenomena, current biochemical research in drug\" addiction is directed toward discovering not only the \"site of the initial biochemical lesion\" produced acutely, but also the nature of the biochemical adaptation that takes place in the central nervous system during chronic drug use (2) . The anatomical sites of the action of opioids are located in polysynaptic pathways throughout the nervous system (3); the more complex responses demand higher functional centers only for the expression of these responses. Such a simple basic requiremeat implies that the nerve cell is the substrate for activity. Studies of the effects of opioids in single-cell systems suggest that the cell membrane is affected soon after drug exposure (~). Pharmacological studies in the peripheral nervous system and in isolated tissue preparations have indicated that the major effect is neither axonal nor perikaryonic (5). By a process of

Coping with stress as a theme in teaching psychopathology to medical students.

Abstract: In an era when non-psychiatric physicians are increasingly aware of their need for at least a rudimentary knowledge of psychology, medical schools are making belated attempts to remedy the situation. The effort described here succeeded because “the students did not seem to view the course as one about ‘crazy people.’ Thus, they did not distance themselves from the course material and patients.... One student said, ‘This was a course about everybody—about what people have to do to live in the world.’”