Douglas A. Kramer

The overlapping territories of psychiatry and ethology.

There have been numerous attempts since 1965 to stimulate more utilization of ethological methods and concepts in psychiatry. This literature is reviewed and an attempt is made to identify the factors which have inhibited an enhancement of this interaction to date. Most of the previous articles on this subject have appeared in edited collections, rather than in more widely circulated psychiatric or medical journals. Some of the articles focus on ethological theory, others on ethological research findings, and several on clinical analogies between animal and human situations. Regarding the specific way in which to integrate ethological thought into psychiatry, most frequently a phylogenetic approach is emphasized, however a few authors stress methodological considerations. In this paper, it is argued that artifactual differences have been the primary impediment to more interaction between these two rather similar fields. Scientific language difficulties, educational differences, and personal factors are described in this regard. Also, the real differences in approach and methodology, relative interest in normal vs. abnormal behavior, the degree of willingness to accept a phylogenetic approach, and the breadth of behavior being studied by the two fields are described. Examples of current areas of applicability of ethology to psychiatry are given: the attachment systems, early infantile autism, methodology, social psychiatry, and psychiatric education. Of these, the area where the most research has occurred and in which the findings of ethology have been the most utilized is that of the attachment systems. Clinically applicable studies based upon the premise that attachment systems exist as understood ethologically are reviewed. These include study of extra physical contact between mothers and infants at birth, the prediction of child abuse and neglect utilizing observations from the immediate postpartum period, the treatment of failure to thrive by teaching attachment behavior, and developmental differences at 1 year correlated with differences in maternal responsiveness at 3 months. The usefulness of a biological approach to behavior is discussed, particularly in terms of utilizing operational criteria and from the point of view of differentiating etiological, phenomenological, and treatment models. A curriculum stressing the writings of Tinbergen, Lorenz, Bowlby, and Hailman is presented for possible use in psychiatric training programs interested in teaching an ethological approach to psychiatry. A briefer curriculum is also suggested from the psychiatric literature for use by ethologists. The epistemology and methodology of ethology possibly will be of more use to psychiatry than the content. It is the opinion of the authors that the difficulties which have inhibited significant cooperation between psychiatry and ethology in the past are mostly artifactual, that such cooperation could be useful to both fields, and that a beginning to such interaction will require mutual familiarity with the literature.

The medical alliance: from placebo response to alliance effect.

Abstract The natural human response to illness is to seek to understand what is happening and to look for help from others. In all cultures, one finds healers, who provide explanations and offer care. Their interventions often have a placebo effect through activation of natural healing processes in the patient. Although placebo effects are relatively large and robust, physicians generally consider placebo treatment prescientific and deceptive. We review the determinants of the placebo response and show how a particular professional alliance between a patient and a caregiver is apt to equally affect treatment outcome. We distinguish the alliance effect from the placebo effect. We develop a comprehensive model of the medical alliance, on the basis of the concept of concordance, and review its relevance for clinical practice and medical education. The alliance effect represents a professional and ethical way of activating a patient’s natural healing mechanisms.

History of Family Psychiatry: From the Social Reform Era to the Primate Social Organ System

From early twentieth century social reform movements emerged the ingredients for both child and family psychiatry. Both psychiatries that involve children, parents, and families began in child guidance clinics. Post-World War II intellectual creativity provided the epistemological framework for treating families. Eleven founders (1950-1969) led the development of family psychiatry. Child and family psychiatrists disagreed over the issues of individual and family group dynamics. Over the past 25 years the emerging sciences of interaction, in the context of the Primate Social Organ System (PSOS), have produced the evidence for the family being the entity of treatment in psychiatry.