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OFFICIAL REPORTS: EXPLANATORY NOTE
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doi: 10.1176/appi.ajp.116.9.825pmid: 13797215
LEO H. BARTEMEIER M.D. 1 1 The Seton Psychiatric Institute, Baltimore, Md. The predominating symptoms of the patients I have been describing have been accompanied by anxiety and they have served the function of protecting them from further developments of their psychoses. These are the patients whom a descriptive psychiatrist might classify as borderline because they have neither delusions nor hallucinations and are, therefore, not regarded as legally commitable. They are unlike the ambulatory schizophrenias described by Gregory Zilboorg, but they are representative of patients who suffer from the same group of illnesses, i.e. schizophrenias which are modified by a predominant symptom that is associated with anxiety.
BLAIN, DANIEL; POTTER, HOWARD; SOLOMON, HARRY
doi: 10.1176/appi.ajp.116.9.791pmid: 13801229
DANIEL BLAIN M.D. 1 , HOWARD POTTER M.D. 2 , , and HARRY SOLOMON M.D. 3 1 Director of Mental Hygiene, Calif. 2 Director of Education, Letchworth Village, N. Y. 3 Commissioner of Mental Health, Mass. In summary , may I state that, with the help of a number of foundations which have contributed a total of approximately $27,000, the first year has proved to be largely a matter of exploration rather than definition. A large number of interesting contacts with leading professional groups have been made. A tremendous amount of interest has been developed in the study. Many suggestions have come toward modifying it in one direction or another, perhaps most important has been the suggestion that since this is such an enormously important project, it must be done well or not done at all. The activities of the consultants have been extremely helpful. It has been of particular interest to note that the highly successful National Manpower Council working with Dr. Ginzberg and his associates also came to the end of their first year remarking that, in spite of careful planning, the first year had turned out to be largely exploratory. Of great interest was Dr. Ginzberg's remark that no definitive plan for approaching manpower studies had yet been developed. The conclusion after 8 months of effort with a small staff is that the time is now come to enter into an intensive effort over a number of months, mainly to design a series of studies and operations which will, in time, enable progress to be made in this problem. Accordingly, a staff of competent technicians in research design, psychiatric and sociological personnel with clinical and teaching experience will work with the national consultants to produce such a program as may receive financial support over such a period of time as necessary for this important subject.
doi: 10.1176/appi.ajp.116.9.777pmid: 14419564
W. S. MACLAY 1 1 Medical Senior Commissioner of the Board of Control, Ministry of Health Bldg., Savile Row, London, W. 1, Eng. The new Act has received a warm welcome throughout the country. One reason for this is the change in public attitude. Mental disorder is much more reasonably tolerated than was the case 50 years ago and this has made many old restrictions unnecessary and undesirable. The new Act makes it possible to stop enforcing them and makes legal procedure less complex and cumbersome. It shows a hopeful confidence in doctors, administrators and in an enlightened public. In this article an attempt has been made to describe some of the Act's more important features and the discussion which they have raised.
doi: 10.1176/appi.ajp.116.9.828pmid: 14402669
MARC H. HOLLENDER M.D. 1 1 Professor and Chairman, Department of Psychiatry, State University of New York, Upstate Medical Center, and Director, Syracuse Psychiatric Hospital, Syracuse, N. Y. In this article the relationship of the hospital psychiatrist and the agencies requesting information and/or recommendations concerning patients has been examined. Two questions immediately arose: 1. Whose agent is the psychiatrist? and 2. Is he oriented to therapy or to public service or does he believe that he can encompass both objectives? The types of requests for information and recommendations were enumerated. It has apparently been assumed that many requests are reasonable and should be answered. The problem then was to determine which ones were reasonable and to decide how they should be answered. It was suggested that the first issue should be that of questioning whether the psychiatrist should supply any information. This was then considered in terms of its effect on psychotherapy. Obviously, therapy will be altered if the patient sees the psychiatrist as a possible informer as well as a helper. If information is supplied, is it really useful? This brings us face to face with the issue of how well predictions can be made in instances involving many variables, some known but many unknown, which can be arranged in an exceedingly large number of combinations. Some comments were, also, made on the misleading effect of labelling. The expectation that requests would be answered and the practice of complying, in part, stems from the general practice of medicine. Too little attention has been paid to significant social factors. It was suggested that psychiatrists might be seduced to claim that they possessed special ability to foretell the future. As a result "educated" guesses might be dispensed as facts. During a period of hospitalization, the patient's family might have to be provided with information to participate in immediate decision-making. This stands in sharp contrast, however, to making decisions about the patient's ability to work or attend school after he has left the hospital and is assuming responsibility for his own welfare.
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