Medical-psychiatric units and the future of psychiatric practice

Abstract

The professional lifetime of a psychiatrist is perhaps twoscore years, enough time for revolutionary changes in professional practice. Consider a young psychiatrist completing training in 1945. Skilled in psychodynamic psychotherapy and in narcotherapy, knowledgeable regarding electroconvulsive therapy, and comfortable supervising long-term inpatient care in state or private psychiatric hospitals, our colleague encounters dozens of new diagnostic and therapeutic tools over the next 40 years. New psychotherapeutic techniques must be maste~ouples therapy, family therapy, group psychotherapy, behavioral therapies, and fmally, brief, focal psychotherapy. The indications, contraindications, and side effects ofnew medications must be learned-phenothiazines, monoamine oxidase inhibitors, tricyclic antidepressants, lithium, benzodiazepines, butyrophenones, beta-blockers, and others. Our young psychiatrist sees state and private psychiatric hospitals transformed not only by the introduction ofeffective medications, but also by the concept of the therapeutic community. He or she must learn how to effectively use this changed treatment setting as well as the new settings that have sprung up over the years--day-care programs, halfway houses, inpatient units in general hospitals, and community mental health centers. Our colleague must learn about new treatments for childhood disorders, insomnia, drug abuse, alcoholism, sexual dysfunction, psychiatric