Roger Peele

Patient rights and patient chronicity.

Uncritical efforts to extend and promote rights for the mentally ill may ameliorate the degree of chronicity for some patients, but can also contribute to chronicity for others. A positive definition of chronicity emphasizes the need for psychiatric services to attain maximum possible independence from the consequences of illness. Three categories of rights–-autonomy, equality and entitlements–-each contribute to chronicity for some patients. Successful programs for chronic patients display assertive, innovative and pragmatic characteristics that, in effect, incorporate the advocacy of “rights” into the armamentarium of humanistic medicine. Medicine–-not the judiciary–-is better able to act on these discoveries for the benefit of the patients.

Standards and quality control: Problems and pitfalls

The proliferation of standards and quality assurance programs is posing a major problem for mental health administrators. The authors review some of these problems and emphasize the differences between cost and quality controls. They propose that quality controls be judged on their ability to improve patient care and suggest that administrators consider the establishment of quality control offices.

Being Henry David

A teenager wakes up in Penn Station, New York City, with loss of all autobiographical memories, including his name. The only possession, besides his clothing and

Get the Diagnosis Right: Assessment and Treatment Selection for Mental Disorders

10, is a torn copy of Henry David Thoreau’s Walden. Using the book as a stimulus, he adopts the name “Henry David,” which gets shortened to “Hank.” Further, because of the book, he decides to travel to Walden Pond, Massachusetts, where the bulk of the novel takes place. Central to keeping the reader’s interests are three themes: uncovering the mystery of who Hank is, learning why he developed amnesia, and discovering who Hank is to become. In pursuing these themes, we meet other sympathetic folks who are also down on their luck. In addition, short relevant quotes from Walden are scattered throughout the book to highlightHank’s situation at key moments. This book about teenagers and for teenagers provides a very accurate understanding of fugue states. Onset occurs during a depression after a traumatic event. The person travels many miles before awaking. Upon awaking, the person has excellent recall of everything except his or her identity and all autobiographical information. During the fugue period, there may be situations in which the person is uncomfortable but for which there seems to be no explanation. Recovery of the memory comes in parts, not usually at once. Although there are cases in which the whole memory returns at once, these tend to occur during hypnosis, and hypnosis is not featured in this novel. In the end, the prior identity and the new, alternative identity become fused. While many of the events in this book seem unlikely, the characterization of fugue states is quite accurate. Dr. Peele is a clinical professor with the Department of Psychiatry, George Washington University, Washington, D.C. Dr. Gupta is with Saint Elizabeths Hospital, Washington, D.C.

Outcome Measurement in Psychiatry: A Critical Review

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