John D. Adamson

Somatic Symptoms in Schizophrenia

The work reported here is an extension of a project (18, 19) undertaken primarily because textbooks and standard references do not provide an adequate descriptive account of schizophrenic illnesses. In daily clinical psychiatric practice observations are often made which are not mentioned in textbooks, or are in some way discordant with what seems to be accepted thinking about the disorder. A corollary of this inadequate documentation of the clinical material is that much of the theorizing about schizophrenia must be suspect. Initially a descriptive and phenomenological study was conducted on forty-four patients hospitalized for the first time for schizophrenia (18). The picture of acute schizophrenic psychosis which emerged differed somewhat from that propounded in textbooks. A major feature of early overt psychosis was an oneirophrenic state of which perceptual disturbances were a

An appraisal of the DSM-III system.

DSM-III is a major document in the history of psychiatry. The DSM-III system is here seen as an instrument that promotes the scientific development of psychiatry and the clarity of cummunication among psychiatrists. However a major theme of this review is that reliability does not ensure validity. While making this point it is recognized that the major defects in the DSM-III system result from scientific inadequacies inherent in present day psychiatry. This review also may be taken as an amplification of the statement in DSM-III-R that it is not a textbook. In particular the data required to arrive at diagnoses in the DSM-III system do not provide sufficient information to arrive at a comprehensive biopsychosocial case formulation, a shortcoming that has relevance for teaching and clinical practice.

Tears of joy.

“Tears of joy” refers to crying when there has been a psychological gain, not a loss. The dynamic explanation of the phenomenon is that the need to repress sadness is lifted because of the gain; genetically the crying is over past losses. A clinical vignette illustrating the phenomenon is given here. It relieved the patient to be told that her symptoms did not mean that she was sick and requiring medication.

Training in formal psychotherapy in the psychiatric residency program.

This report has been prepared by the Nucleus Committee of the Section on Psychotherapy of the Canadian Psychiatric Association. It is based on a questionnaire study of training in formal psychotherapy in psychiatric residency programs. We received replies from ten of the twelve university centres in Canada which currently have such programs, and from some selected centres in the United States and Great Britain. Our findings support the contention that psychoanalytically-based training in psychotherapy is a generally accepted mandatory feature of residency programs in Canada. This training is carried out in a similar way in both the United States and Canada. Our study indicated that there is a tendency in Canada for this training not to be as organized as it should be and we recommend that steps be taken to improve this situation. Particular concerns were lack of knowledge of the numbers of patients treated in psychotherapy by a resident during the residency program and the number treated for more than a year. Stemming from the further discussions of the Nucleus Committee, recognizing the facts that there are a number of different valid theoretical orientations to psychotherapy and that there are differences among centres which lead to different teaching techniques, we also recommended: a) That the resident be exposed to different theoretical approaches, but in such a way as to avoid excessively confusing him. b) As one method of achieving objective (a), that a resident receive supervision from at least two different teachers during his residency. c) That, providing other aspects of the program are adequate, didactic seminars need not total more than forty. d) Because interviewing skills and psychodynamic understanding are essential skills of the psychiatrist, that whatever the particular orientation and methods pertaining to training in psychotherapy in a teaching setting, the psychotherapeutic approach should pervade the residents total learning experience. e) That formal training in psychotherapy should begin in the first residency year, with the practical experience optimally being individualized according to the residents level of development of psychotherapeutic skills. f) That the resident should have experience in treating patients in formal psychotherapy for more than a year. g) Where the residents experience of psychotherapy deviates significantly from what he can expect when he is fully qualified, that the nature and implications of these deviations be clarified with him by the supervisor (s); these deviations include failure to obtain objective (f), and limitations on psychotherapy that are a direct result of factors that are unique to the training situation. We also commented on other features of the supervisory role, including responsibilities to patients.