Journal Article•
The study of efficacy of family ward treatment in hysteria in comparison with the open ward and the outpatient treatment.
TL;DR: A comparative study of the efficacy of treatment of hysterical patients among three group of patients—patients treated in family wards, open wards and out-patients finds significant differences among three groups on certain parameters like personality.
Abstract: A comparative study of the efficacy of treatment of hysterical patients is made among three group of patients-patients treated in family wards, open wards and out-patients. The number of patients is fifteen in each group and they are matched for age, sex, per capita income, duration of illness and type of illness. Significant differences among three groups on certain parameters like personality have been eliminated. The results are discussed.
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TL;DR: The features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy are elaborated to evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India.
Abstract: Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.
307 citations
TL;DR: The use of psychosocial interventions for conversion disorder requires more research and it is not possible to draw any conclusions about their potential benefits or harms from the included studies.
Abstract: Background
Conversion disorder is an alteration or loss of physical functioning suggestive of a physical disorder that is thought to be due to a psychological stressor or conflict. The fact that many theories about the cause of conversion disorder focus on psychological and social factors would suggest that a psychosocial intervention might be of most benefit.
Objectives
To investigate the efficacy of psychosocial interventions on people diagnosed with conversion disorder compared with standard care, a biological intervention or another psychosocial intervention.
Search methods
We searched the Cochrane Depression, Anxiety and Neurosis Group Trials Register (May 2004), various databases on OVID (February 2004), handsearched reference lists and textbooks on conversion disorder and contacted relevant authors.
Selection criteria
We included all randomised controlled trials that compared psychosocial interventions for conversion disorder with standard care or other interventions (biological or psychosocial).
Data collection and analysis
We reliably selected, quality assessed and extracted data from the studies. For dichotomous outcomes we calculated a relative risk with its associated 95% confidence interval and a number needed to treat. For continuous data we calculated a weighted mean difference.
Main results
The search identified 260 references, 217 were clearly not relevant to this review and excluded on the basis of their titles and abstracts, 40 more were excluded after reading the full papers (the reasons are given in the excluded studies tables) and only three studies (total n =119) met the inclusion criteria. One study was concerned with paradoxical injunction therapy and the other two studied the value of hypnosis. The three studies had different interventions and control groups so the results could not be combined. All of the studies were of poor methodological quality and it is therefore difficult to place much value on the results of the studies. We were unable to include some data because of poor reporting.
Authors' conclusions
Randomised studies are possible in this field. The use of psychosocial interventions for conversion disorder requires more research and it is not possible to draw any conclusions about their potential benefits or harms from the included studies.
124 citations
TL;DR: The psychodynamics of family life and its relation both to the individual, and to the socio-cultural setting of the present day are discussed in this paper. But the authors focus on the individual and do not address the social aspects of the individual.
Abstract: The aim of the book is to describe in a comprehensive manner the psychodynamics of family life and its relation both to the individual, and to the socio-cultural setting of the present day. The need for such an approach is intensified through rapid and unassimilated changes in the culture and the consequent increase in mental illness. The thesis of the book is that mental functioning of the individual can be understood only in the context of the family in its cultural setting of the present time. Mental health is a process of balance and adaptation. The emotions and behavior of each member of a family are affected by ever)' other member. The family is a primary group, intermediate between the individual and wider society. This thesis is presented under five headings —Introduction, Mental Health, Social Change, and Family: Part I Theoretical Aspects; Part II Clinical \\spects; Part III Therapeutic Aspects; and Part IV Wider Perspectives; including Problems of Family Research. The book is based on a familiarity with Freudian theory and a long experience with psychoanalysis as applied both to individual and group therapy. The author is one of a number of psychoanalysts who have criticized the instinctual theory of Freud. He points out the distortions and inadequacies of the classic theory as applied both to the functioning of the individual in the family and the family in society. He regards the progressive stages of personality organization as advancing levels of biosocial integration with, and differentiation from, the environment. The chapter on homeostasis of behavior is perhaps the kernel of the author's viewpoint. He applies Cannon's definition of this term to the psychological aspects of behavior, and also expands the concept to include not only the idea of the restoration of equilibrium, but also the need for this equilibrium as a base from which to grow. This principle homeostasis, he says, signifies the capacity for creative, fluid adaptability to change. The essence of life is change, growth, learning, adaptation to new conditions, and creative evolution of new levels
80 citations
TL;DR: The need for family therapy in India and its evolution as an integrated academic discipline and widespread form of clinical practice is examined and a brief outline of a training the trainer approach is provided.
Abstract: This paper examines the need for family therapy in India and its evolution as an integrated academic discipline and widespread form of clinical practice. Included is a discussion of the numerous factors placing Indian families at risk today, both common and more serious child, marital, and family difficulties, the current status of mental health services and minimal emphasis on family-based treatment, and the potential benefits of family therapy to such a radically diverse and rapidly changing society. Targets of and settings for family therapy training are highlighted, and a brief outline of a training-the-trainer approach is provided.
33 citations
TL;DR: The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment, and further downgrading was performed due to imprecision, few participants and inconsistency.
Abstract: Background Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them. Objectives To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults. Search methods We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial). DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias. Main results We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P Authors' conclusions The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
16 citations
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3,277 citations
TL;DR: The psychodynamics of family life and its relation both to the individual, and to the socio-cultural setting of the present day are discussed in this paper. But the authors focus on the individual and do not address the social aspects of the individual.
Abstract: The aim of the book is to describe in a comprehensive manner the psychodynamics of family life and its relation both to the individual, and to the socio-cultural setting of the present day. The need for such an approach is intensified through rapid and unassimilated changes in the culture and the consequent increase in mental illness. The thesis of the book is that mental functioning of the individual can be understood only in the context of the family in its cultural setting of the present time. Mental health is a process of balance and adaptation. The emotions and behavior of each member of a family are affected by ever)' other member. The family is a primary group, intermediate between the individual and wider society. This thesis is presented under five headings —Introduction, Mental Health, Social Change, and Family: Part I Theoretical Aspects; Part II Clinical \\spects; Part III Therapeutic Aspects; and Part IV Wider Perspectives; including Problems of Family Research. The book is based on a familiarity with Freudian theory and a long experience with psychoanalysis as applied both to individual and group therapy. The author is one of a number of psychoanalysts who have criticized the instinctual theory of Freud. He points out the distortions and inadequacies of the classic theory as applied both to the functioning of the individual in the family and the family in society. He regards the progressive stages of personality organization as advancing levels of biosocial integration with, and differentiation from, the environment. The chapter on homeostasis of behavior is perhaps the kernel of the author's viewpoint. He applies Cannon's definition of this term to the psychological aspects of behavior, and also expands the concept to include not only the idea of the restoration of equilibrium, but also the need for this equilibrium as a base from which to grow. This principle homeostasis, he says, signifies the capacity for creative, fluid adaptability to change. The essence of life is change, growth, learning, adaptation to new conditions, and creative evolution of new levels
80 citations
TL;DR: For instance, the authors found that families who continued in conjoint family therapy tended to be of lower socioeconomic status and contained spouses who had more highly authoritarian attitudes as measured by the California F Scale (1), while families that contained a severly disturbed member had a poor rate of engagement in treatment.
Abstract: Thirty-eight families who continued in conjoint family therapy were compared on a variety of antecedent variables to 13 families who dropped out. Three potentially important predictors of continuance in family therapy were found: (a) which spouse initiated the search for treatment; (b) the level of authoritarianism in the spouses; and (c) family socioeconomic status. Families that dropped out of treatment tended to be of lower socioeconomic status and contained spouses who had more highly authoritarian attitudes as measured by the California F Scale (1). Families that contained a severly disturbed member had a poor rate of engagement in treatment, but if both spouses in such a family were low in authoritarianism, the engagement rate was 100 per cent. When both spouses initiated the search for treatment, engagement was also nearly perfect. The difficulty in engaging families from the lowest socio-economic class may be attributed partly to the authoritarian attitudes of the husband.
42 citations
TL;DR: Simmons and Freeman suggest, by implication, that psychiatric and other medical aspects are less important in determining case outcome than are the attitudes of relatives to whom the patient is returned.
Abstract: constantly be made about readiness for discharge based upon reasonably efficient criteria of outcome. The difficulty in predicting posthospital adjustment derives in part from the lack of understanding of the etiology of most of the mental diseases. It also derives to a considerable extent, however, from the variety and diversity of objective and subjective factors-prehospital, hospital and posthospital-which seem to play some role, singly and in combination, in determining posthospital success and failure and adequacy of functioning. These formidable obstacles, fortunately, have not prevented researchers from investigating prehospital, and posthospital variables as they may relate to case outcome. Simmons and Freeman suggest, by implication, that psychiatric and other medical aspects are less important in determining case outcome than are the attitudes of relatives to whom the patient is returned.' Brown has found that the type of living arrangement to which patients were returned was the most significant factor in their success or failure.2 Others have reasoned that the nature
35 citations
"The study of efficacy of family war..." refers background in this paper
..., ANGRIST AND BENJAMIN, P. (1961). Psychiatric and social attributes as predictors of case outcome in mental hospitalization. Social problems. 8, 322, 328. DOUGLAS, G. (1956). Psychotic mothers. Lancet, 1, 124. GROT J O H N , M. (1960). Psychoanalysis of family neurosis. N- Y. : W. W. Norton. HOLINGSHEAD, B. AND REDLICH, C (1958). Social class and mental illness....
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..., ANGRIST AND BENJAMIN, P. (1961). Psychiatric and social attributes as predictors of case outcome in mental hospitalization. Social problems. 8, 322, 328. DOUGLAS, G. (1956). Psychotic mothers. Lancet, 1, 124. GROT J O H N , M. (1960). Psychoanalysis of family neurosis....
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...Douglas (1956) reported that mothers with post partum psychotic reactions improved further when they were admitted with their children. Main and Weiss (1964) support this. Cote el al. (1954) used the relatives in the care of the mentally ill becaure of the financial stringency....
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...• Professor of Psychiatry & Medical Superintendent * Lecturer in Psychiatric Social Work treatment and rehabilitation....
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..., ANGRIST AND BENJAMIN, P. (1961). Psychiatric and social attributes as predictors of case outcome in mental hospitalization. Social problems. 8, 322, 328. DOUGLAS, G. (1956). Psychotic mothers. Lancet, 1, 124. GROT J O H N , M. (1960). Psychoanalysis of family neurosis. N- Y. : W. W. Norton. HOLINGSHEAD, B. AND REDLICH, C (1958). Social class and mental illness. N. Y. Wiley, London Chapman and Hall. HOWELLS, H . G. (1968). Theory and Practice of family psychiatry. London : Oliver Boyd. JACKSON, D. D. (1957). Question of family homeo—stasis....
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TL;DR: Results of an epidemiological investigation of eleven somatic disorders in terms of their lifetime prevalence among a large sample of adults in the age range of 20‐59 are reported, finding that tension‐anxiety appears to be a generalized phenomenon in the study population, and also a frequent phenomenon.
Abstract: Summary By way of summary, the present paper reports partial results of an epidemiological investigation of eleven somatic disorders in terms of their lifetime prevalence among a large sample of adults in the age range of 20-59. This investigation is one phase of a larger epidemiological study of mental health in a central residential area of New York City. Summary One focus of this paper was on the relationships of these somatic ailments, taken separately and collectively, to one of the primary forms of social differentiation in the American community, namely, socioeconomic status. It was found that: Summary Ten of the somatic disorders covered in the study manifest four different and clearly delineated patterns of distribution on the status scale. Summary With the number of such disorders a person has had as a criterion, the rates of multiple ailments do not vary with socioeconomic status, except for the groups at the two extremes of the scale, where the rates are higher. Thus, the status distribution of multiple ailments takes the form of a shallow U-shaped curve. Summary If two or more somatic disorders in a person raises the probability that at least one of the disorders has a psychogenic basis, then the lifetime prevalence of psychosomatic ailments is at a high level of frequency in our population. Summary The second focus of this paper was on the psychological dimension of tension-anxiety as measured by a questionnaire method appropriate to mass interviewing. With this focus it was found that: Summary While all other psychological dimensions covered in our questionnaire are highly correlated with socioeconomic status, tension-anxiety is not so related. It therefore appears to be a generalized phenomenon in the study population, and also a frequent phenomenon. Summary Tension-anxiety is correlated with nine of the eleven somatic disorders covered. It is not correlated with asthma and hypertension. Summary Tension-anxiety is highly correlated with multiple somatic ailments, especially in the very top and bottom status groups. Summary From the social-status focus and the tension-anxiety focus in combination we have in no small measure found confirmation that in most of the large series of somatic conditions covered, both sociological and psychological variables are vitally involved. Summary As to the specific hypotheses tested here, to some the data gave full support, to some the data lent only the partial support that compels modification, and to others the data offered no support whatever. Summary But even for the hypotheses that did not suffer rejection, the findings pose many questions that are as yet unanswered. It is hoped that our continuing analysis of still unmined data will generate answers, or at least new hypotheses that will point the directions in which possible answers may be found. Summary We would close with the observation that when an epidemiological investigation has completed its work and rendered its final report, any discoveries of differential distribution patterns of a disease serve to narrow the search for specific etiological conditions that underlie and account for such differences. The paths of such simultaneous search are two. First, further epidemiological investigation that takes off from but pushes out with better methods toward farther frontiers than its predecessor. Second, clinical research that seeks to disentangle the dynamic processes that lie between the discovered social covariables and the disease end product. Summary Our incomplete findings to date give us grounds for the hope of advancing such developments on the crucial scientific fronts of the psychosomatic and mental disorders.
29 citations