Why the future belongs to psychiatry.
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Biomedical subjects
Publications and source records attributed to L L Havens.
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Physical medicine has a body of normal findings that make possible the definition of disease states. The routine procedures of psychiatry do not include any such tests of health. As a result, the psychiatric concept of illness has no stable base from which specific conditions can be described. The author suggests two human capacities, connectedness and self-protectiveness, that can be assessed by the psychiatrist in attempting to evaluate the patient's overall psychological health.
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The author presents a broad view of the principal forces at work in twentieth-century psychiatry. He describes the approach of the various psychiatries--psychoanalytic, biological, behaviorist, social, interpersonal, and existential--to the diagnostic enterprise and the therapeutic enterprise. He finds twentieth-century diagnosis dominated by objective-descriptive psychiatry and therapy by the extraordinary growth of psychotherapy in the industrial nations. The newer psychotherapeutic methods have made the first systematic additions since Freud to our understanding of the ways in which personal change occurs.
The first interview presents dilemmas to the psychiatric practitioner. Is he or she to concentrate in objective-descriptive fashion, observing symptoms and signs, seeking the likely syndrome or disease concept? Is he or she to work associatively, toward unconscious themes as developed by the psychoanalytic schools? Would an existential approach be best, an attempt to understand the patient's life purposes and difficulties empathically? Alternatively, should the therapist grasp the patient's situation in interpersonal terms? The authors suggest that these decisions are less central than the need to establish a working relationship in order to continue the investigation or treatment and to uncover as much as possible of the relevant data, and that the newer schools of existential and interpersonal psychiatry offer the critical keys to achieving this.
In recent years, numerous forms of short-term psychotherapy have been developed, without clear guidelines for choosing among them. There are three major approaches in terms of both their techniques and their criteria for patient selection. The "interpretive" method stresses the use of insight produced by a therapist's interpretations, the "existential," the maturational effect of a brief empathic encounter with the therapist, and the "corrective," the behavioral changes resulting from patient management by the therapist. The question facing a short-term therapist is how to choose a particular method for a particular patient. A framework is proposed based on developmental phases of adult life to help therapists match patient and method.
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