Stephen Fleck

Some Psychiatric Aspects Of Abortion

The psychiatric elements found in or attributed to women who request and obtain abortions under regular medical auspices are presented as distilled from relevant literature and experience with several hundred unwillingly pregnant females. The confusion of the present situation prevailing in most states and consisting of a conglomerate of medical, legal, and sociocultural traditions and beliefs makes strictly professional judgments impossible. The importance of abortion as a stopgap for contraceptive failure in the broadest sense and hence as a significant family-planning measure with inherent benefits for the emotional health and welfare of all family members has been neglected. Abortion in itself is a safe, simple procedure without clinically significant psychiatric sequellae, but it becomes an emotionally traumatic experience because of the medicolegal obstacles which lead 1,000,000 or more women to seek illegal abortions in contrast to some 10,000 legal abortions performed annually. Psychiatric considerations must extend to the unhealthy consequences of unwanted pregnancy and motherhood and the attendant risks for the emotional development and personality of the unwanted offspring.

Ego Differentiation and Schizophrenic Symptom Formation in Identical Twins

OR THE PAST seven years we have been studying intensively the intrafamilial environment in which sixteen schizophrenic paF tients had been raised. The methodology and a number of findings of the study have been reported elsewhere (4,5, 14-18). Among the patients was an identical twin whose co-twin became extremely disturbed immediately after the patient was hospitalized. The patient was treated in the Yale Psychiatric Institute and continued in analytically oriented psychotherapy after discharge, while his twin managed to remain at home receiving analytically oriented treatment from a therapist who kept detailed process notes of each sessi0n.l The parents and an older brother were interviewed repeatedly, and the interaction among family members was observed closely. All five members of the family were given a battery of projective tests. The study of these twins, together with all of the other members of the family, and the intrafamilial environment they created, permitted a unique opportunity to examine the special problems of ego development confronting twins and the impact of the family dynamics in shaping the personalities and the pathology of these twins in particular. We believe that if we wish

An approach to family pathology

Summary An approach to family pathology has been proposed which focuses on deficiencies in and deviations from salient family functions and tasks. It is not possible at present to establish specific correlation between such defects and clinical psychiatric entities. It may, however, be suggested that from such an approach to family pathology, revisions and reclassification of psychiatric diagnoses could follow. Although for discussion purposes some distinction has been made among intrapersonal, interparental, and family-wide pathological phenomena, it can be concluded that all these are relevant, but each alone is insufficient to understand family process. The most promising approaches to family functioning are the examinations of familial communication styles and interaction modes through relevant tests and therapeutically oriented participant observation. These observations, together with the familys history, must be evaluated in terms of the validity and effectiveness of the family behavior with regard to basic family tasks, which were briefly outlined in the first part of this paper.

A Comparative Study of a Psychiatric Clinic and a Family Agency: Part II

This paper is Part I of a condensed version of a series of four papers presented as a symposium at the Annual Forum of the National Conference of Social Work in St. Louis, Missouri, on May 21, 1956. Part II will appear in the February issue. Dr. Coleman is Clinical Professor of Psychiatry at the Yale University School of Medicine and Physician-in-Charge of the Psychiatric Clinic, Grace-New Haven Community Hospital. Mrs. Janowicz, who was Research Assistant of the project described, is now Case Supervisor, Family Service of New Haven. Dr. Fleck is Associate Professor of Psychiatry and Public Health at the Yale University School of Medicine, Medical Director of the Yale Psychiatric Institute, and Consultant to Family Service of New Haven. Miss Norton is Chief Psychiatric Social Worker of the Department of Psychiatry at Yale.

Unified Health Services and Family-Focused Primary Care

Unified health and primary care services must focus on family health and the family as the clinical unit. Understanding the family as the basic social system and assessing its functioning from the standpoints of evolutionary family tasks, family health behavior and family coping capacities are as important as is knowledge of body systems and their functional evaluation, and of social and ecological systems which also can be pathogenic for individuals or families. The concept of psychosomatic medicine must include familio-somatic and somato-familial medicine. Families are involved in the pathogenicity of some diseases and psychiatric disorders, and in the treatment and management of all chronic disease. Coping with dying patients and mourning are also basic family tasks. Only unified clinical services, whether hospitals or health stations, can render realistic care and relate to the many relevant systems in the community, beginning with the patients family. Clinicians must evaluate these systems as to their wholesome or unwholesome impact on a particular health issue or problem, seeking corrective as well as preventive measures.

Group and Family Therapies: Distinctions

Group and family therapies are alike in some respects and these treatments are often referred to as if they were technically and conceptually the same, but there are differences between them that are more important than the similarities. It seems useful, therefore, to spell out and emphasize the differences.

Some Observations on the Nature and Value of Psychotherapy with Schizophrenic Patients

Medical practitioners, meaning physicians during the scientific era as much as during the prescientific millennia, have always drawn inferences from more or less impressionistic therapeutic effects upon the nature of causation or etiology. Equally often, an etiological theory, once formulated, has led to therapeutic prescription, or even, in the case of schizophrenia, to therapeutic nihilism. The history of the treatment of schizophrenics is replete with enthusiastic therapeutic endeavors, sometimes based on very erroneous premises, such as the alleged mutual exclusion of epilepsy and schizophrenia, which led to convulsive treatments, therapies which then led to other etiological credos.1–4 Psychotherapy, effective as it can be with schizophrenics, is no exception to such post hoc propter hoc etiological hypothesizing. We know that the pathogenic mechanisms in psychological development and in familial behaviors which we can identify during psychotherapeutic work are basic, but we do not know if they are the only, sine qua non etiological factors. They, or some chromosomal aberration, may or may not be the first level in a spiral of abnormalities, but this is as uncertain as is the position or role of abnormal dopamine activity in such a developmental spiral culminating in schizophrenic manifestations.

The Evolution of Therapeutic Communities

Aside from isolated voices in the Greco-Roman period and such as John Weyer’s in the Middle Ages, history tells us almost nothing of systematic or planned humane treatment of the mentally ill until late in the 18th Century. The one exception in this void of care is the humane treatment accorded the mentally ill at Gheel in Belgium on religious grounds since the 14th Century. This, however, was foster-family care and not hospital- or institution-based. (1)