Frederick R. Hine

Traditional vs. Consultation-Liaison Psychiatry Clerkships: A Closer Look

This year-long study compared training experiences and outcome of consultation-liaison (CL) and traditional psychiatry clerkships. CL students reported greater improvement in their ability to employ psychiatry skills with general medical patients, and more favorable changes in their attitude towards psychiatry as a potential specialty. Analyses of actual training experiences showed that these more positive CL outcomes were associated with greater experience in primary care settings and more positive senior staff relationships. The remainder of results agree with past findings showing no significant differences in knowledge, skill and attitude outcomes, and extend past findings by showing a parallel similarity in the content and methods of training across services. Directions for future research are suggested.

The Neurobiology of Agression

As noted in the previous chapter, it is convenient to subdivide aggressive behavior into two general types, affective and predatory. In addition to the differing behavioral characteristics of these two types of aggressive behavior, there is considerable evidence that they also have different neurobiological substrates. In this chapter we shall review this evidence, concluding with a consideration of the implications of the experimental studies, conducted almost exclusively in animal models, for aggressive behavior in humans.

Personality: Developmental Aspects

We have defined personality as a hypothetical construct referring to an organized system of reaction tendencies that mediates relations between the person and his or her environment, and rendering the person’s behavior distinctive and more or less uniquely identifying. In this chapter we are going to consider this uniquely “identifying signature”—personality—from a developmental perspective. It is beyond the scope of our present endeavors to consider the developmental postulates of the major theories of personality; the interested reader is directed to the classic work of Hall and Lindzey (1957). Furthermore, it is not the goal of this chapter to present the one “best” theory. The goal is to facilitate understanding of the process of personality development.

Definitions and Conceptual Orientations

This chapter attempts to develop a functional definition of the emotional aspects of behavior, of emotion as subjective and bodily response to those features of the environment (external and internal) experienced by the organism as significant, and of emotion as motivation or pressure to act upon the environment to change or maintain it. Learning in certain of its basic forms (association, learning, conditioning) is intimately connected with emotional (motivational) processes. As we shall see, those types of learning deriving from Pavlov’s original experiments (classical conditioning) are involved in the process whereby circumstances and events come to have emotional significance (the learning of motives). Similarly, the learning of effective ways of meeting needs (satisfying motivations or drives) is an essential feature of the other major type of basic learning (operant or instrumental conditioning, reward learning). For this reason, we will deal with these more simple varieties of learning here rather than in a separate presentation.

Impulse Disorders Associated with Cerebral Dysfunction: A Development Perspective

This Unit concludes with a consideration of the association of impulse disorders with cerebral dysfunction. Two specific disorders, hyperactivity or minimal brain dysfunction (MBD) and Gilles de la Tourette’s syndrome, will be presented as useful examples. The state of knowledge about these disorders is by no means complete, and we stress the complexity and uncertainty of interactions of nature-nurture and organic-psychological factors in understanding aggressive behavior. Our intention is to develop an awareness of the influence of cerebral factors in manifestations of impulse disorders. We will consider briefly what is known about etiology and manifestation of impulse disorders and the implications for management.

Dimensions of Individual Difference in the Neonate

There has been an increasing recognition of the capacities and competencies of the newborn infant, and an appreciation of the infant’s active role in eliciting, shaping, and determining aspects of his/her environment. This recognition and appreciation has fostered a change of view about the infant’s development from that of a relatively passive recipient of environmental socialization factors to an active participant in the determination of outcome. As a result, there has been a focus upon some of the characteristics which an infant manifests from the time of birth, in terms of the effect these have on the infant’s interaction with the environment and ultimately on the infant’s growth and affective, cognitive, and personality development. These characteristics are variously referred to as inborn, congenital, or constitutional.

Behavioral Approaches to Prevention and Treatment of Physical Disease: Practical Applicatons

The recent upsurge of interest in behavioral medicine is due in part to the hope that application of behavior modification techniques will prove effective in modifying risk factor behaviors and lifestyles, thus improving our ability to prevent such major diseases as cancer and coronary heart disease. Additional impetus has come from the demonstration in the mid 1960s that application of instrumental conditioning techniques, or biofeedback, could be successful in directly modifying physiological functions previously thought to be beyond voluntary control. While there continues to be controversy in academic psychology regarding the precise mechanisms whereby control is achieved in humans, that early work has spawned a new clinical specialty of behavioral medicine whereby biofeedback and other behavior therapy techniques have come to be used on an ever-increasing scale in the direct treatment of a wide range of physical disorders that had previously proven resistant to traditional clinical medicine’s treatment approaches. In this chapter we shall review this burgeoning area which might be termed “applied” behavioral medicine.

Introduction to the Concept of Biobehavioral Dispositions

The biobehavioral dispositions generally equal or exceed in complexity the more complex of the basic functions considered in Unit 1. Thus, although the behavior function hierarchy is extended in the direction of “higher“ mental activity, there is no implication of sharp discontinuity between these first two areas (or, for that matter, between any areas in the total schema). The constitutional core of general intelligence could certainly have been included in this part, and the points made here about biobehavioral dispositions should certainly be understood to apply to that function. The decision to discuss intelligence in Unit I was based largely on its traditional association with the clinical definition of organic brain syndrome. Like intelligence, most of the functions to be considered next include central, integrative, as well as sensory and motor aspects and therefore fall to some degree under the laws of mass action and equipotentiality. These are not sharply localized in a particular brain area or system.

Pressures Toward Socially Disintegrated Behavior: The Sources of Agression

The approach taken in this book assumes that successful socialization is socially integrative. In the typical case, the developing individual acquires information about society’s expectations and develops associated emotional patterns required to give that information motivational significance. Individuals know how to order their behavior so as to derive the benefits provided by the society and avoid the punitive sanctions imposed by that society for major deviations from its norms. Socialized individuals typically want to do what they are expected to do. They also want to perform the behaviors that are socially approved and will fear, to a degree appropriate to the real consequences, to engage in major transgressions of law, custom, and role expectations. These statements are not intended to rule out the possibility that the individual may want and attempt to change the society, even at the risk of failure and retaliation. But, in the socially integrated person, activities aimed at protest and reform will, not be undertaken blindly and impulsively but rather from a position of cognitive and emotional appreciation of the society, a position that increases the probability of success while reducing where possible the likelihood of personal cost and distress. Moreover, the events of everyday life are not free of conflict since the objectives of individuals and social groups are sometimes contradictory. Social groups may, in fact, ritualize conflict in the form of contests in which aggressive behavior is condoned and applauded. Violent collective behavior in the form of war may have a socially integrative effect for combatants and produces heroes distinguished by the success of their violence. Nevertheless, the survival of individuals and social groups depends on keeping expressions of aggression within tolerable bounds. Uncontrolled aggression is a threat to orderly development of individuals and to the functioning of social groups.

Role Thoery and Social Life

Systematic observation of organisms in their natural environments has always been important in science. Observed regularities in patterns of behavior in animals, including the human ones, are frequently the outcomes which scientists. want to describe precisely, classify, understand, explain, and predict. While explanation and prediction are the ultimate goals of science, the penultimate goals of description, classification, and understanding are necessary precursors which prove to be quite challenging in themselves. The ethnographic tradition in anthropology and sociology has produced documentation of similarities and differences in behavior between and within groups which gave rise to the concepts of culture, role, status, and norms. Such constructs do not explain observed patterns of human behavior, but they do provide essential and useful tools for describing the social contexts in which human beings interact. In emphasizing the social context of behavior, this chapter complements the other chapters in this Unit which focus primarily on intraindividual aspects of behavior.