Physical and sexual abuse histories of male psychiatric patients.
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Biomedical subjects
Publications and source records attributed to M F Myers.
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In the last two decades, men's social roles have changed to incorporate the increasing time they spend with their families, their greater concern about adult children's leaving or returning home, and alternative sexual preferences and life-styles. One related development is the increased amounts of psychiatric distress reported by men in recent years. Mental health professionals should be familiar with these and other complex issues specific to men and with how such issues might manifest themselves in psychotherapy.
It is well known that delusions, obsessions and phobic reactions may centre on items which are of current topical interest. We report a case of obsessive-compulsive disorder manifested primarily by intrusive thoughts about AIDS. The patient eventually responded to an unusual combination of medications.
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Previous research on sexually victimized men has mainly addressed the acute symptoms seen in hospital emergency rooms and psychiatric clinics. Findings are reported on 14 men, all but 1 of whom had been sexually traumatized much earlier in life, as boys or young adults. Several problem areas are described: repression, denial, or normalization of the trauma; self-blame and shame; posttraumatic stress disorder; male gender identity fragility; sexual orientation ambiguity and internalized homophobia; sexual difficulties; mistrustfulness of adult men; and disturbances of self-esteem and body image. Gender issues in treatment are discussed.
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Previous research has addressed the marital problems of male but not female physicians. The author reviews the literature on women in medicine, reports findings on 16 female physicians with dysfunctional marriages whom he saw as patients, and describes several problem areas: delayed help seeking, self-blaming attitude toward subjective symptoms, ambiguity in self-image, "passivity" in marital communication, role strain, unmet needs in husbands, bilateral competitiveness, and problems with intimacy and sexuality. The author emphasizes a biopsychosocial approach to treatment and discusses transference-countertransference issues.
Specific objectives include provision of a neutral and nonjudgmental atmosphere, ventilation of each partner's concerns, facilitation of improved "communication," attention to issues involving affection (both sexual and nonsexual), new perspectives and suggestions where appropriate, and a supportive attitude and manner to combat demoralization. A useful treatment format involves seeing each partner alone, then both partners together for three or four sessions.
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The unique problems that the professional woman brings to therapy are presented here. It is the author's contention that the career woman's difficulties are not adequately realized or understood by many male therapists. Many of these patients are disappointed with or highly critical of their therapy with male psychiatrists. Two sub-groups of professional women are described: the married professional woman and the unattached professional woman. There are critical sex-role relate issues and countertransference problems which arise with the male therapist: professional woman patient dyad. Other implications for male psychiatrists are outlined and suggestions offered toward therapist enlightenment.
This paper describes the commoner psychiatric difficulties of homosexual patients seen in a family practice. It is written primarily to aid general practitioners in deciding who should be referred to a psychiatrist. Recent developments in the study of homosexuality indicate that homosexual persons are no more likely than heterosexuals to suffer psychiatric problems. Practical suggestions are made for management and counseling, and some of the misconceptions about the gay community are dispelled.
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PURPOSE: To learn the extent to which HMOs and academic genetic centers (1) are involved in predictive genetic tests for common, complex disorders and (2) interact with each other. METHODS: Surveys of HMO medical directors and directors of U.S. academic genetic centers. RESULTS: In 1996, approximately 28% of HMOs were covering predictive tests for breast and colon cancer, but 75% of all medical directors said their HMO would consider policies regarding predictive testing in the next 5 years. Approximately 80% of directors of academic genetic centers said they provided genetic counseling services for common adult-onset disorders for patients covered by managed care organizations (MCOs), but they ranked the volume of services they provide for pediatric and prenatal indications much higher. Most academic genetic centers (72%) have contracts with MCOs. CONCLUSION: Although genetic services are being provided by academic genetic centers to patients who are members of managed care organizations, many patients with whom genetic testing for adult onset disorders is discussed may never see a geneticist. Academic genetic centers should educate nongeneticist professionals about the use of tests for common disorders.
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