Milton Rosenbaum

Psychologic mechanisms in malignant hypertension.

HYPERTENSIVE cardiovascular disease is essentially a nonepisodic condition in which there is no clear-cut relationship between symptoms and structural change. For this reason, it is often quite difficult to establish, with any degree of certainty, the exact date of onset or to reconstruct satisfactorily the previous course. The transition from the benign to the malignant phase, however, represents a relatively well delineated episode and thus provides the clinical investigator with an excellent opportunity for the study of psychosomatic relationships and mechanisms in hypertension. As part of a comprehensive study of this disease, we have investigated 12 patients who were in various stages of the transition from benign to malignant hypertension. In each of these patients, examination of the relationship between the life history and the medical course of the disease revealed that the precipitation of the malignant phase could be chronologically correlated with emotionally significant life situations or events. In 8, where the time of onset of benign hypertension seemed reasonably clear, similar correlations could be made. The primary emphasis of this project was centered upon a simultaneous study of the medical, psychiatric, and physiologic aspects of the transition from the benign to the malignant phase of hypertension in each patient. This report then represents an exploratory effort to arrive at some understanding of the interrelationships involved in this basic phase of the hypertensive problem. This group of patients represented routine hospital admissions and were selected only on the basis of their ability to communicate adequately.

The Family Doctor and the Suicidal Family

Suicide is a broad social problem, the full scope of which extends beyond the medical profession. The physician is, nevertheless, one of the most important figures in the field of suicide prevention. Particularly because of the growth of community psychiatry and other changes in psychiatric practice, it is more urgent than ever that the physician be alert to the problem of suicide and other derivatives of emotional and interpersonal disturbances. The presence of a great potential for saving lives and preventing suicide entails an equally great responsibility. This responsibility has not been fully met by the medical profession and especially not by the medical educators. We therefore strongly recommend that the study of the theory and prevention of suicide be made an integral part of the medical school curriculum. In the light of the importance of the family in suicide we further recommend that family interviewing and counseling be incorporated into both medical school education and post-graduate training. Such a program would include not only a knowledge of how to interview and evaluate a family, but also how to recognize when a referral to a family therapy specialist is required.