Residency Training Directors Research Articles

Proceedings of the American Association of Directors of Psychiatric Residency Training

Proceedings of the American Association of Directors of Psychiatric Residency Training

American Association of Directors of Psychiatric Residency Training

American Association of Directors of Psychiatric Residency Training

American Association of Directors of Psychiatric Residency Training

American Association of Directors of Psychiatric Residency Training

The Resurgence of Biological Psychiatry: New Promise or False Hope for a Troubled Profession

THE RESURGENCE OF BIOLOGICAL PSYCHIATRY: NEW PROMISE OR FALSE HOPE FOR A TROUBLED PROFESSION LEE WEISS* Although psychological dysfunction has been recognized, described, and speculated about for centuries, psychiatry as a "formal" medical specialty has a relatively short history. As a developing field, psychiatry is beset with all the problems common to the early stages of any discipline with scientific aspirations, that is, limited knowledge, primitive and incomplete explanatory systems, uncertainty as to its proper position in the hierarchy ofscientific disciplines in general and medical specialties in particular, etc. In addition, by virtue of its subject matter, psychiatry is confronted by problems not encountered to any great extent by the other medical specialties. Pediatricians, for example, may argue about the etiology or treatment of choice for a particular disorder, but there is generally no disagreement about what properly belongs within their field and what sort of methodology is acceptable for deciding important questions. Within the psychiatric community, these issues have been and are currently the subject of intense debate. In spite of periodic attempts to institute a comprehensive approach to the study and treatment of psychopathology [1, 2], twentieth-century American psychiatry has been characterized by the existence of a variety of essentially reductionistic approaches vying with each other for hegemony in the field. While various orientations have assumed positions of temporary importance (witness the recent rise and fall of the community mental health "movement" as an alternate model of diagnosis and treatment in a span of about 10 years), two approaches to psychopathology and treatment have been continuously influential, albeit to varying degrees, during the modern era. One ofthese, the biologically oriented approach associated with the medical model, has a lengthy history of application to mental disorders. The other major approach, the intrapsychic model espoused by psychoanalysts and ?Director of Residency Training, Illinois State Psychiatric Institute, 1601 West Taylor Street, Chicago, Illinois 60612. Perspectives in Biology and Medicine ¦ Summer 1977 | 573 psychodynamically oriented psychiatrists, is of more recent emergence as a model of influence. Both of these models continue to influence contemporary clinical practice, research, and training even as new approaches appear. In this essay I will attempt to outline the evolution of biological psychiatry as well as its recent reemergence as a dominant force in American psychiatry. I will conclude with a critical analysis of the assumptions and implications of this approach, especially when practiced in its "classical" form. Although a complex system in itself, biological psychiatry can be conceptualized as the application of the medical model, in both its clinical and scientific forms, to the problem ofabnormal behavior. (The distinction between the clinical and scientific medical models will be explored later.) Long before psychiatry emerged as an autonomous medical specialty , physicians were observing, describing, and treating patients with bizarre or unusual behavior. In addition, physicians, especially those with a philosophical bent, began speculating about the etiology ofmental disturbance. As early as 600 b.c., Alcmaeon related sensation to brain functioning and concluded that defects in reasoning resulted from brain pathology. In addition to the espousal of a naturalistic view of disease and acceptance of the brain as the center of mental and emotional functioning, Hippocrates (460-367 b.c.) established the tradition of the detailed personal case history. Included in his writings are excellent descriptions of postpartum psychosis ("puerpural insanity"), phobic neurosis, states of delirium associated with infectious disease, and epilepsy. Unfortunately, deficiencies in knowledge led to the position of erroneous views about the etiology ofthe conditions that he observed as well as the prescription of traditional treatments based on these fallacious conceptions. For example , in the Sacred Düease, Hippocrates states, "The corruption of the brain is caused not only by phlegm but by bile. . . . Those who are mad through phlegm are quiet, those maddened through bile are noisy and restless, always doing something inopportune" [3, vol. 2, p. 177]. In addition, hellebore, a powerful cathartic, was commonly prescribed to treat certain types of mental disturbances. It is somewhat ironic that Hippocrates used this "medication" to treat the alleged mental illness of the materialist philosopher Democritus, a man who firmly believed the Hippocratic views on the etiology of madness. It may seem odd that the acknowledged...

The American Association of Directors of Psychiatric Residency Training

The American Association of Directors of Psychiatric Residency Training

Psychiatric Residency Identity Crisis: Resolution Through Group Process

A time-limited group process experience for the purpose of expediting the natural course of group process in a first-year resident group facilitates group cohesion for learning purposes, accelerates the role-identity as psychiatrist, and assists the residency training director in enhancing each individual resident’s learning according to his learning deficit and psychological need. A faculty advisor resists the role of therapist, and follows the group process experience with didactic material. The experience resolved some regression and transference and did not encourage the residents to become patients by continuing as a therapy or sensitivity group. The group briefly explored the dynamics of adolescent rebellion and a desire to divide the faculty while supporting each other with such problems as providing psychotherapy, becoming a member of a treatment team, and so on. Afterward residents became cotherapists in treatment groups. Advantages of this approach are discussed.

Group psychotherapy with psychiatric residents.

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsBenjamin J. SadockDr. Sadock is Assistant Professor of Psychiatry and Director, Division of Group Process, New York Medical College—Metropolitan Hospital Center.Harold I. KaplanDr. Kaplan is Professor of Psychiatry and Director of Psychiatric Education and Residency Training, New York Medical College—Metropolitan Hospital Center, New York, New York.