Digital Commons Network^™

The Ideal Psychiatry Training Program: A Resident's Viewpoint, James E. Deming, Jr., Md

Jefferson Journal of Psychiatry

The journey between medical school graduation and specialty board certification in one's chosen field of medicine may comprise the most challenging, exciting and important times of a young professional's life. This journey is called residency education. While the most obvious objectives are cognitive education and practice in the field, trainees also face fundamental life challenges such as developing identity, intimacy and a direction for their own generative goals in the world.

Psychiatry residency should be viewed as a personal as well as professional developmental process (1). It contains all of the turbulence of adolescence revisited (2), where "normative crises" (3) …

War Of The Worlds Revisited: The Effect Of Watching "The Day After" On Mood State, David G. Daniel, Md, Frances Wolff, M.Ed., Maribeth Smith, Ma

Jefferson Journal of Psychiatry

In the fall of 1983, "The Day After," a fictional account of a nuclear attack on a civilian population, was broadcast on television in the United States and viewed by I00 million Americans . "The Day After" was said to differ from previous movie treatments of nuclear war by the vividness with which it forced its audience to experience the ground zero effects of a nuclear blast on human beings (I) . In what was described as "the most horrifically searing footage ever to pass a network censor,"the audience was shown "group immolation, a carnage of mass vaporization" and "graphic …

Trauma And Its Ramifications In Vietnamese Victims Of Piracy, Stuart Kleinman, Md

Jefferson Journal of Psychiatry

Approximately 400,000 Vietnamese fled by boat from their homeland to the United States during the years 1975 to 1985. Many of these people were brutally attacked by pirates during their sojourn. This paper is a preliminary investigation of various ramifications of this trauma in seven Vietnamese "boat people."

We found significant psychopathology which is temporally related to the pirate attacks in two of those interviewed and a prominent absence of survivor guilt in all of those interviewed. Factors such as mastery of previous trauma, advanced knowledge of potential traumata, empowerment fantasies, religious beliefs, and altruistic actions may have helped people …

In Response: New Controversial Diagnoses: Self-Defeating And Sadistic Personality Disorders, Frederic Kass, Md

Jefferson Journal of Psychiatry

Until several years ago the entire literature on Masochistic Personality was theoretical or anecdotal. Dr. Fuller's recent paper, "Masochistic Personality Disorder: A Diagnosis Under Consideration," is a timely contribution in that it is one of a growing number of empirical studies on this topic (1). His major finding, that Masochistic Personality describes a disorder which is not adequately described by the existing Axis II disorders, is consistent with data we recently reported (2). We have found, in addition, that the diagnosis is common, and that the criteria have good internal consistency, specificity, and sensitivity (3,4). At this point the data …

Masson's Assault On Truth: A Critique, Emmanuel E. Garcia, Md

Jefferson Journal of Psychiatry

In his book, The Assault on Truth, j. M. Masson (I) proposes to challenge the very foundations of psychoanalysis by showing how Freud 's abandonment of the so-called seduction theory of the etiology of neurosis was erroneously predicated.

Masson's argument, in essence, may be summarized as follows. Freud, while studying with the eminent neurologist Charcot in Paris (from October 1885 to February 1886), found himself exposed to the prevalent horrors of ch ild abuse, which were copiously detailed in the French medical literature at the time, and which were very probably demonstrated to him at the …

Should Psychotherapy Be Taught To Psychiatric Residents? A Debate., Donald W. Black, Md, John Ascher, Md, Hal Cash, Md, John Markowitz, Md, Paul Hamburg, Md, Jeffrey Satinover, Md, Alan Mellow, Md

Jefferson Journal of Psychiatry

Much of this discussion was inspired by a debate held at the 1984 APA Annual Meeting, entitled " Does Psychodynamic Theory Have Little Relevance to Contemporary Psychiatric Care?" We saw the need for a debate, resident generated, that would address a corollary issue in residency training.

Our program will include an introduction, a debate involving statements for the affirmative, that is, that psychotherapy should be taught to psychiatric residents, and two statements for the negative, that psychotherapy should not be taught to psychiatric residents. Concluding remarks will follow.

If our title is provocative , if what we have to say …

A Review Of Ethnopsychiatric Studies Of Depression, Nancy E. Wilson, Ab, Daniel R. Wilson, Md

Jefferson Journal of Psychiatry

One of the common goals in medical anthropology is to elucidate the significance of culture in determining health and thus clarify the complex biopsychosocial model to provide better, more appropriate care (I). Prominent among environmental influences is the society in which a person develops: and it is his position in this constellation of people, with their shared ethos and world view, which molds experience, cognition, and affect (2). Cultural meanings, norms, and power arrangements shape illness to a great degree by defining the sick role and consequent illness behaviors. Medical anthropology, as a discipline, has among its concerns the cultural …

Infant Depression: Nature Seeking Nurture, Paul V. Trad, Md

Jefferson Journal of Psychiatry

Of the numerous clinical and theoretical problems confronting medicine today, infant depression represents an increasingly compelling and misunderstood concern (1). Early studies notwithstanding, the concept of infant depression remains in the embryonic and evolving stages of clarification. In studying infant depression, the clinical investigator is initially faced with the difficulty of devising a specific operational definition. Several definitional schemes have been proposed. The first advocates that depression is a proliferative idea that retains a concrete, immutable definition; another scheme argues that depressive affect, a key index of the disorder, is merely an illusory signal that masks the underlying process; still …

Hypnosis In The Criminal Case: Facts And Fallacies, Phyllis E. Amabile, Jd, Md, Thomas H. Jobe, Md

Jefferson Journal of Psychiatry

Throughout the past century, criminal cases have been documented in which a party has sought to introduce into evidence information obtained through the process of hypnosis. The usefulness of the technique of hypnosis in various psychological the rapies has already been well established. The courts, however, have differed markedly in their decisions on the admissibility of hypnotic material into evidence. Consequently, no clear rationale or guidelines for admissibility have been established.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor.

In Response: The Biological Basis And Treatment Of Bulimia, Jeffrey M. Jonas, Md

Jefferson Journal of Psychiatry

The recent papers in the Jefferson J ournal of Psychiatry by Drs. Levin ("Bulimia as a Masturbatory Equivalent, " July, 1985) and Wilson ("A Discussion of 'Bulimia as a Masturbatory Equivalent'," Winter, 1986) contain a number of theories and recommendations about the etiology and treatment of bulimia which should be addressed. In large measure, both papers present a dynamic view of this disorder. However, psychodynamic formulations are but one of many theories put forward to explain this disorder. Other theories of etiology include notions that bulimia arises from cultural factors and an increased attention to body image, from disorders with …

Dynamic Considerations In Psychiatric Crisis Intervention, Keith Cheng, Md

Jefferson Journal of Psychiatry

One of the most challenging tasks for psychiatrists and psychiatric residents is emergency room triage. This task becomes more frequent as more patients depend on the emergency room for psychiatric treatment. Various social and economic pressures account for an increased utilization of psychiatric triage. The government funds that were to provide community care for the ex-patients of state hospitals have never materialized in adequate amounts (1). Many of these patients become dependent transients who in a crisis must use the emergency room as a psychiatric clinic. To keep premiums down, some insurance companies have eliminated their outpatient psychiatric coverage, often …

Masochistic Personality Disorder: A Diagnosis Under Consideration, A. Kenneth Fuller, Md

Jefferson Journal of Psychiatry

In the past three decades, few diagnoses in psychiatry have had a more turbulent history than the personality disorders (1). Labels such as inadequate, emotionally unstable, and asthenic personalities entered the official nomenclature and were later withdrawn. Borderline, antisocial and compulsive personality disorders are additions that have become entrenched in the classification of mental disorders. The turmoil maintains its course with a diagnosis of Masochistic Personality Disorder under consideration to join the existing categories of personality disorders in the revised edition of DSM-III (DSM-III-R) (2).

The category of Masochistic Personality Disorder does not exist in the three earlier versions of …

Letter To The Editor

Jefferson Journal of Psychiatry

Dr. Chessick responds to Dr. Dorn's Review of why Psychotherapists fail.

In Response: A Discussion Of "Bulimia As A Masturbatory Equivalent", C. Philip Wilson, Md

Jefferson Journal of Psychiatry

My research and that of my colleagues in the psychodynamic cause, structure and treatment of patients with bulimic anorexia nervosa correlates with and confirms the hypotheses presented by Levin ( 1) that bulimic symptoms may represent a masturbatory equivalent.

In our recently published book, Fear of Being Fat: The Treatment of Anorexia Nervosa and Bulimia (2) we confirmed Sperling's findings (3) that unresolved preoedipal fixations to the mother contribute to difficulties in psychosexual development and that anorexic girls and boys displace sexual and masturbatory conflicts from the genitals to the mouth.

Folie Á Deux, Ulhas Mayekar, Md

Jefferson Journal of Psychiatry

Folie a deux, also called dual psychosis, involves the transfer of delusional ideas from a psychotic individual to a nonpsychotic individual within the framework of a close relationship, with the eventual in corporation of the delusional system into the psyche of the previously non psychotic individual.

Decision Trees For Use In Childhood Mental Disorders, Henry A. Doenlen, Md

Jefferson Journal of Psychiatry

The third edition of The Diagnostic and Statistical Manual ofMental Disorders (DSM-III) (1) provides specific diagnostic categories for use in childhood mental disorders, even though these diagnoses are not limited to children. In addition, many of the diagnostic categories used for adults are considered appropriate for use in children. DSM-I II instructs the clinician to diagnose children by first considering the section "Disorders First Evident in Infancy, Childhood, or Adolescence" before considering the disorders described elsewhere. However, this may lead to problems because some major diagnostic categories such as affective disorders and schizophrenia are not included …

The Stress Factor: Exploring The Possibility Of A Psychological Component To Cancer, Bernard M. Edelstein, Md

Jefferson Journal of Psychiatry

As dwellers in the same house, it seems only logical that psyche and soma would be interdependent , that well-being in one would promote health in the other, and that illness in one would soon become manifest in its partner. Yet quantifying this intuitive relationship has long been a difficult task. Establishing a mechanism for disease-heart disease, infectious disease, neoplastic disease which can withstand the scrutiny of experimental rigor, is difficult enough. To introduce a seemingly not quantifiable entity such as psychology in the form of stress or anxiety presents such great complexity that for a long time it seemed …

Psychoanalysis: Science Or Fiction?, Emanuel E. Garcia

Jefferson Journal of Psychiatry

The completion of this paper comes coincidentally at a time when a book by a scholarly philosopher, Adolf Grunbaum, entitled The Foundations of Psychoanalysis:A Philosophical Critique, has just been published and purports to answer the question of the scientific status of analysis. This temporally follows Jeffrey Masson's work (1) which accuses Freud of abandoning the so-called seduction hypothesis and by so doing laying unsound groundwork for the "science" that consumes Freud's nearly limitless energies . In short, it is a period in which psychoanalysis finds itself condemned, but perhaps in a …

Faculty Advisor's Column, Harvey J. Schwartz, Md

Jefferson Journal of Psychiatry

It is with great pleasure that with this issue of The Jefferson Journal of Psychiatry-A Resident Publication we are expanding into a national journal for psychiatric residents. As part of that effort, we welcome the American Psychiatric Association Committee of Residents as our national editorial board. Our circulation will include all psychiatry residents, residency directors, and department chairmen nationwide . We look forward to continuing our three year tradition of presenting scholarly, thought provoking and creative ideas from psychiatric residents around the country. Our commitment to the two pillars of clinical and …

Senior Transportation Abstracts: A Focus On Options, Helen Kerschner, Nina M. Silverstein

Gerontology Institute Publications

This collection of abstracts represents a publication of importance for understanding the needs, challenges, solutions, and/or every day issues related to senior transportation services. While several of the abstracts include information about senior driver safety, the collection’s primary purpose is to present a holistic approach to transportation options for older adults. Such a collection is timely because, although the practice of providing transportation to older adults is not new, research and preparation of practical informational and technical materials related to older adult transportation service needs and service delivery are quite recent.

Tropical Medicine: A Clinical Text, 8th Edition, Revised And Expanded, Kevin M. Cahill, M.D.

Institute of International Humanitarian Affairs

The history of tropical medicine is as dramatic as the story of humankind. It has its own myths and legends, including tales of epidemics that destroyed whole civilizations. Today, with silent stealth, tropical diseases still claim more lives than all the current wars combined. Having had the privilege of working throughout Africa, Asia, and Latin America, as well as in the great medical centers of Europe and the United States, the author presents the details essential for understanding pathogenesis, clinical manifestations, therapy, and prevention of the major tropical diseases. The text, now in its eighth edition, has been used for …

Elderly Patients And Their Health In Pakistan: Current Status, Issues, Challenges And Opportunities, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

Health-Related Quality Of Life In The Gender, Race, And Clinical Experience Trial., Judith Feinberg, Michael Saag, Kathleen Squires, Judith Currier, Robert Ryan, Bruce Coate, Joseph Mrus

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations.

Letters To The Editor

Jefferson Journal of Psychiatry

Letters to the Editor for the Jefferson Journal of Psychiatry, Volume 3, Number 2, July 1985.

The Impact Of Hysterectomy During Adolescence In A Woman Of Reproductive Age, Susan K. Ball, Md

Jefferson Journal of Psychiatry

There is extensive psychiatric literature on the psychological effects of hysterectomy on both pre-menopausal and post-menopausal women, but a careful search covering the last ten years and beyond reveals no references to the impact of hysterectomy during adolescence. There is also nothing on this subject in the gynecological literature of the last ten years. Obviously, the incidence of severe pathology necessitating hysterectomy is extremely rare. However, there can be little doubt that a procedure of such symbolic magnitude at an age when a young woman is trying to integrate her personality, emerge as an autonomous sexual being, and experiencing a …

Psychotherapy Or Pseudotherapy?, Lawson R. Wulsin, Md

Jefferson Journal of Psychiatry

What is psychotherapy? I wish I knew . Thick books and long talks still leave me wondering. Hours of patients and almost as many hours of supervision leave the question hanging. I know what ECT is and how to give a good trial of arnitryptiline, but I am never quite sure if what I am offering is true psychotherapy. Admittedly I am young and have only been wet for five years. But I have had one experience in my short time that put the question in perspective by putting it backwards, that is, what is notpsychotherapy, or what is pseudotherapy?

A Patient With Aids, Susan Ball, Md, Stephen Hauptman, Do, Jean Helz, Md, Sheila Murphey, Md, Beth Shindell, Mss

Jefferson Journal of Psychiatry

Susan Ball , M.D.. Chief Resident: Mr. B, a thirty-five-year-old white male, was admitted to the medical service with chief complaints of fever, chills, and increasing shortness of breath. This was Mr. B's second admission. His first was six month s ago for pneumonia, leukopenia, and lymphadenopathy of unknown etiology. At that time he was treated with antibiotics; he improved and was discharged. Since that time Mr. B reported continuing to feel weak and lethargic. Two weeks before this admission he noted the onset of fever, chills, sore throat, and a nonproductive cough. He initially saw …

The Double Blind Gordian Knot, John Matt Dorn, Md

Jefferson Journal of Psychiatry

Book Review of: DIFFERENTIAL THERAPEUTICS IN PSYCHIATRY: THE ARTAND SCIENCE OF TREATMENT SELECTIONA. Frances, M.D., J. Clarkin, Ph.D., & S. Perry, M.D.New York: Brunner/Mazel, 1984395 pp., $30.00

The Importance Of Comprehensive Assessment Of The Sexually Abused Child, Luz N. Colon-De Marti, Md

Jefferson Journal of Psychiatry

In the past few years public awareness of sexual abuse of children has increased, together with the recognition of its social, physical, and psychological effects (I). We must emphasize our role as diagnosticians in doing a comprehensive assessment of the sexually abused child. It is our professional responsibility to assess the general psychological status of the child before and after sexual abuse.