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Some observations of mental illness and its treatment in the People's Republic of China.

A visit to the People's Republic of China provided impressions of the use of psychiatric concepts and the organization of mental health services. The Chinese report of low rates of mental illness appears to reflect narrow definitions of disorder and somatic expressions of personal and social distress which are viewed by health personnel as physical conditions. Acute mental health services are provided at commune and county hospitals, and special psychiatric hospitals are maintained for more intractable patients. Chronically disturbed patients may receive long term care in sanatoriums associated with large industries or may be maintained in home beds in their production brigades assisted by family and barefoot doctors. Psychiatric practice in teaching hospitals is similar to psychiatric practice in the West, although little attention is devoted in general medical care to psychosocial problems. Question for future visits and possible collaborative research are suggested.

Adult↗

Situational influences on verbal affective expression of psychosomatic and psychoneurotic patients.

Group comparisons between psychosomatic and psychoneurotic patients using the Gottschalk-Gleser method of speech content analysis are presented. Two matched patient groups (N = 40 each) were discriminated on the basis of anxiety and hostility scores derived from verbal samples collected during psychoanalytically conducted first interviews. A concordance with clinical classification was reached in 79.75 per cent of cases, with psychosomatic patients exhibiting lower affect scores. These results could not be replicated in a comparison between 92 psychoneurotic and 56 psychosomatic patients based upon verbal samples produced in responses to a request to narrate a dramatic life episode (standard instruction). Percentage of correctly classified cases was 62.84 in the second study. Factor structures derived from affective variables showed more similarity between independent samples of psychoneurotic than between samples of psychosomatic patients across both exploration situations (interview and standard instruction). A major factor exhibiting high loadings from guilt anxiety and ambivalent hostility was evinced, being more important in psychoneurotics. These results are discussed against the background of the alexithymia notion. Methodological considerations pertaining to diagnostic applications of the Gottschalk-Gleser content analysis are presented.

Adult↗

Behavioral treatment of psychogenic vomiting in the context of social phobia.

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patient's behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patient's records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patient's personal, social, and vocational life has also occurred.

Adult↗