Quentin Rae-Grant

Psychological aspects of chronic illness.

With improvements in the treatment of infectious diseases and the ever-increasing ability to sustain life, the practicing pediatrician is increasingly relied on to aid with management of the child who is severely and chronically ill. In this capacity he may be able to control the rate of progression or the frequency and severity of complications, may help the child compensate for some of the more destructive effects, and may help child and family to face the limitations, anxieties, and discouragements which accompany the disease-all of which require an understanding of what the illness means to the child and the family.

Psychological Problems of the Child and His Family

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Child psychiatrists in the 90's: who will want us, who will need us.

Child Psychiatry is now a well recognized and established sub-speciality in Canada. It has gone through a period of vigorous and healthy growth. Like psychiatry in general it now faces a number of challenges which provide potential threat but which may lead to better definition of priorities and of its most effective function. Other disciplines, medical and non-medical, increasingly compete for a place on the therapeutic spectrum. Within psychiatry the rhetoric between different schools of thought provides ammunition for those who have no use for any form of psychiatry however it may be provided. The challenge is to develop more effective ways of using the skills of the child psychiatrist within a recognition that the number of practitioners will never approach what would be required to have child psychiatry alone cover the treatment needs of children and adolescents. The field requires the adoption of a more flexible metaphor for training and practice with competence in the different schools of theory and of therapy. Attention needs to be paid to the consumer movement, to the impact of better informed parents and public and to the developing of a parsimonious and selective approach to the use of scarce professional time. The healthy growth of research in child psychiatry is a development long overdue and places the discipline on a scientific rather than a clinical practice base. At a time when funding and the cost of health care are crucial issues the development of a secure knowledge base, efficient methods of service delivery and the integration with other mental health care providers are opportunities and grounds for optimism about the future of the sub-speciality.

Presidential address. Family violence--myths, measures and mandates.

V iolence runs like a bright and discordant thread through the fabric of society. In history, mythology and religion, politics, media, sports and entertainment, it is simultaneously condemned and condoned, deplored and defended. It is a recurrent and fascinating theme in both public and professional concerns. While theories regarding violence abound, clear supporting evidence is strikingly inadequate. Like many things in psychiatry and the social sciences the contributing factors derive from biology, psychology, sociology and human organization. Psychiatry has become involved in the diagnosis, assessment, and prediction of violence and may have alloweditself to be saddled with the responsibility for its treatment. Like many of the seductive invitations that come to psychiatry, it is important that we neither diminish what we can legitimately contribute nor arrogate to ourselves the assumption of answers to issues outside our competence and field of knowledge. The one option not open to us is to stand aside, disclaiming any responsibility to contribute to better understanding, better control and the general mitigation of one of the most objectionable features of human behavior. Psychiatric expertise consists of teasing out individual, family and group factors which may contribute to violent behavior. Therefore, the invitation to move glibly to explanatory social or political concepts must be declined. Psychiatry plays a role as the moderator of macro-social manipulation and can try to steer a middle course between attributing violence solely to individual or family factors on the one hand and flaws in the general organization of society on the other. This is not the most popular course, as the answers that command most respect are those which are clear, dogmatic and unfortunately most frequently wrong. While ethological research has revealed that violence occurs towards other members of the same species in both human and animal societies, humans are unique in

Current issues in child psychiatry: a dialogue with John Bowlby.

A condensed account of Bowlbys work, particularly his advocacy of an ethological approach and of attachment theory, is followed by comments by three child psychiatrists. His work is critically discussed and ranges from questions concerning the theoretical status of Bowlbys work, to concerns about the de-emphasis of constitutional and temperamental factors, and to concerns that current realities render impractical (and perhaps unnecessary) the traditional models of child rearing. Dr. Bowlby responds to each discussant. In this three days at Lake Couchiching, John Bowlby was the most available and charming of guests. He welcomed discussion with delegates in his every free moment, including mealtimes. It was a privilege to have him in dialogue with us.

Hare Krishna movement What attracts the Western adolescent

Summary The HKM is but one of the many Eastern religious beliefs imported into the West. However, because of the way it is practised, it is the one which confronts North American values most directly. It is an offshoot of Hinduism and comprises a wide diversity of beliefs. It attracts many Western youths, much to the anguish of their parents and community leaders. Those who look at the HKM from a Western cultural point of view argue passionately with those who believe in it. The authors, one of whom (I.N.K.) has cultural roots in Hinduism and Western training in child psychiatry, attempt to look at this phenomenon dispassionately and analyze some of the relevant factors which attract Western youth to this culturally alien religion. A brief historical sketch of the HKM is given followed by an account of the significance of religion from a psychoanalytical perspective. The case history of a 15 year old adolescent male is presented and discussed in psychodynamic terms followed by an attempt to understand his attraction to the HKM. The manner in which the HKM met the needs of this adolescent may have implications for the management and understanding of similar cases, especially when professional interventions do not bring about the desired results of solving rather than just suppressing the intense and painful conflicts of development in adolescence.

Family Reactions, Physician Responses, and Management Issues in Fatal Lipid Storage Diseases

In these, the father and mother have mutual respect, support and affection, communicate well with each other, are able to resolve differences contructively, and have a set of commonly shared goals toward which they work as a team. This ability to face issues and to support each other in difficult times enables them to sustain each other in face of loss. The external support from extended family members, although helpful, is secondary to their own capacities to make appropriate adaptations to the loss of the child.

Looking Back, Moving Forward

A s 2003 draws to a close, the Canadian Journal of Psychiatry prepares to enter a new era. As in most areas of our lives, there are endings and new beginnings. My time as Editor-in-Chief ends in the next 2 years, and I look back on my tenure with great pride. It has been an exciting and challenging time for both the Editorial Board and staff. The last 2 years have seen great changes. The look of the Journal was redesigned and has proven very popular. Most significantly , the new format of the journal has incorporated a unique image for each cover, and we have used artwork from mental health patients for some. Our goal of also using art from psychiatrists is still under development. Further, we added a July issue this year and will take the Journal to 12 issues per year with our inaugural January issue in 2004. Please join me in congratulating Dr Joel Paris, who has been selected as the Editor-in-Chief designate of the Journal. Dr Paris has served faithfully as an Editorial Board member of the Journal for the past 15 years and as a Deputy Editor since 1998. He and I will work together to the end of my tenure, and I am confident he will provide leadership to move the Journal forward. In the current climate of change in the publishing field, there will be many areas in need of exploring to keep the Journal evolving with the times. The Journal has had the privilege of publishing the Table of Contents of the British Journal of Psychiatry for the past year. I thank the staff and Editorial Board of the BJP for their cooperation in this endeavour. Because of requests by other journals to initiate similar reciprocal publishing agreements, the BJP unfortunately has chosen to terminate the agreement with the Journal rather than try to accommodate all the other requests. As this arrangement ends, we will be implementing a similar agreement with the Australian and New Zealand Journal of Psychiatry, which will begin in 2004. We look forward to this collaboration and the opportunity to reach our colleagues in the Southern Hemisphere. There are still many challenges that face the Journal, and I look forward to continuing to play a role in its evolution in the coming years. I am grateful for the support of my colleagues and wish Dr Paris success …

The role of pharmaceutical companies in research and development--plaudits and cautions.

While the progress has been impressive, the downside is the decrease in medical-psychiatric use of forms of psychotherapy, which have become the territory more of other mental health professionals, some of whom have been campaigning for prescription rights. Some would go so far as to claim that psychiatry has become a less caring profession and that this may partly account for recent reduction in the number of medical students enrolling in psychiatry, a trend that seems to have been reversed this year.

Spring Clean Up

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