Alvin G. Burstein

The application of Kohutian self psychology to consultation-liaison psychiatry

Explanations of emotional and behavioral response to illness seen by consultation--liaison psychiatrists include crisis theory, stress theory, classical Freudian theory, grief, and alexithymia. Recent developments in self psychology are also useful. Kohut identifies empathy as central to the establishment and maintenance of a sense of personal integrity, self-esteem, tolerance, and administration of others; deficits may cause feelings of shame, humiliation, rage, emptiness, and hypochondriasis. Persons who experience insufficient empathy during development are particularly vulnerable to these findings at the slightest hint of decreased concern, support, or empathy from parent surrogates. They attempt to compensate with a grandiose self-image, or by attachment to an idealized other. Prior formulations have considered illness a real or threatened object loss, with the lost object assuming symbolic significance in the individuals emotional or behavioural experience. However, illness may also be understood as a threat to the integrity of the self. This helps explain the range of emotional reactions observed and the disturbances in the doctor-patient relationship. Intervention is directed toward reconstitution of the self. Cases are presented to illustrate the application of this theory to formulation and treatment.

Sex-Related Psychological Characteristics of Medical Students

Summary Sixty-eight female and 178 male first year medical students were given the Jackson Personality Research Form, a true/false inventory yielding scores on 20 personality traits. The data were collected over two years. There were no significant differences between years, but female students were more achievement oriented, with higher needs for autonomy, dominance, exhibitionism, and order than their male colleagues. The results are in contrast with those reported by others.

PREDICTION OF HOSPITAL DISCHARGE OF MENTAL PATIENTS BY PSYCHOMOTOR PERFORMANCE: PARTIAL REPLICATION OF BROOKS AND WEAVER

Brooks and Weavers study of the possibility of predicting successful candidates for psychiatric rehabilitation was partially replicated in a smaller research project. Forty-one chronically ill, hospitalized patients in a state mental hospital were tested on a series of psychomotor tests utilizing the Brooks and Weaver apparatus. The replication was basically successful. The most powerful, single predictor was a Pinboard that was not part of the Brooks and Weaver battery. It is suggested that tests of psychomotor performance might be useful additions to selection procedures for psychiatric rehabilitation programs and that further research would be useful on the relationships between psychomotor performance and rehabilitation.

The Psychologist as Health Care Clinician

Clearly, the health care field is turf dominated by the physician, and working in that field means involvement with physicians. As we will explore below, physician-psychologist contact in the health care field has been characterized—especially of late—by some friction. Accommodating to and constructively dealing with interprofessional role strain will be facilitated by knowing something of the history of medical/psychological involvement and something about the contemporary forces at work at that interface.

The psychotherapy of work

quently asked and immediate means of identifying another person. The fact is that a person’s capacity in the area of work is quickly and often severely limited by psychological problems. Accordingly, decompensation and growth ought to manifest themselves as clearly in work activities as in interpersonal relationships. It is, therefore, conceivable that work activities might be deliberately structured in a fashion analogous to the structuring of social relationships in a therapeutic milieu. so as to constitute themselves a therapeutic modality in a hospital or workshop-type setting. The consultation room bias which ignores work experiences and for the most part typifies the contemporary American mental health scene is fortunately not universally held. An important exception is a pilot study reported by Bernard F. Riess, Ph.D., Research Director of the Postgraduate Center for Mental Health in New York.5 Dr. Riess reports a pilot study of 450 patients of the Mental Health Center who after a median of 57 sessions reported a median weekly income rise of

Morals and money

29 per week, in sharp contrast to a predicted rise of

PSYCHOMOTOR PERFORMANCE AND PROGNOSIS OF CHRONIC MENTAL PATIENTS: AN EXTENSION OF THE WORK OF BROOKS AND WEAVER

6 per week based on Department of Labor statistics for a comparable population. The refreshingly direct notion that successful psychotherapy ought to be directly represented in substantially increased earning capacity for wage earners is a notion which Dr. Riess proposes to explore in considerably more detail. In an even more radical development, psychiatry in the Soviet Union and in other communist states has taken the position that work activities constitute an invaluable treatment modaliy.4 Joseph Wortis, M.D., in his book Soviet Psychiatry, describes the efflorescence of occupational psychotherapy programs as resulting from “the fundamental theoretical convictions

The process-reactive distinction and prognosis in schizophrenia.

The authors review the implication of the term “professional,” especially those dealing with the need for an ethic of trustworthiness and those dealing with the expectation of being paid for services. The erosive potential generated by these foci is explored, and circumstances which magnify or might ameliorate the potential described. The article concludes with a consideration of the relationship between professional ethics and world-view.

A longitudinal study of personality changes in medical students

Previous work dealing with the prediction of successful candidates for psychiatric rehabilitation was extended. 67 chronically ill patients who were hospitalized either at the time of the study or previously were tested on a series of psychomotor tests utilizing an apparatus introduced by Brooks and Weaver, plus an additional Pinboard. Prediction of discharge of patients hospitalized at the time of the study replicated previous results, including the finding that Pinboard scores were the most powerful single predictor. Job-finding was also predicted by the battery but with less efficiency. Psychomotor performance did not predict inpatient vs outpatient status at the time of testing. A composite score analysis suggests that the battery is a useful device for selection of candidates for psychiatric rehabilitation programs.