Observations on Psychiatric Residency Training

Gaskill, Herbert S.

doi:10.1001/archpsyc.1968.01740010009002

Cited by 18 publications

(2 citation statements)

References 2 publications

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“…At the same time, the rise of psychoanalysis and the psychodynamic model undermined the concept of disease and treatment specificity, a clash noted by Roy Grinker, who wrote in 1964 that psychiatry was riding madly in all directions [ 61 ]. The basic science of psychiatry was held to be a comprehensive understanding of the unconscious [ 62 ], while the fundamental tools of the psychiatrist were held to be psychotherapy and the dyadic therapeutic relationship [ 63 ], all of this in contrast to the rapid rise of psychopharmacology and neurochemistry [ 3 , 4 , 7 , 11 ].…”

Section: The Search For Diagnostic Specificity and Reliability: A Conmentioning

confidence: 99%

Social inequality, scientific inequality, and the future of mental illness

Dean

2017

Philos Ethics Humanit Med

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BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.

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Section: The Search For Diagnostic Specificity and Reliability: A Conmentioning

confidence: 99%

Social inequality, scientific inequality, and the future of mental illness

Dean

2017

Philos Ethics Humanit Med

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“…Even though emergency room rotations are traditionally anxiety producing, we feel that ours is structured enough to provide optimal learning and to minimize the chances of developing pathological defenses against disturbing behavior (Gaskill and Norton, 1968). This experience allows the trainees to listen more carefully to their patients because they will be less frightened of what they hear.…”

Section: Implications For Trainingmentioning

confidence: 99%

The emergency service: A setting for internship training.

Zimet¹,

Weissberg²

1979

Psychotherapy: Theory, Research & Practice

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The Emergency Psychiatric Service is only recently being added as a training setting for clinical psychology interns within a program of varied rotations. Reasons are discussed why this is probably the last of the clinical settings in which psychologists have played an integral role both in terms of staffing as well as training. The paper focuses on the roles of psychology faculty and trainees on the Emergency Psychiatric Service and the importance of learning to deal with patients in acute crises. It is an especially important training setting for those expecting to go into independent practice where seriously disturbed patients are not expected to be seen.

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Community psychiatry and the education of psychiatrists

Rogawski

1969

Community Ment Health J

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Opinions vary as to the place in psychiatric education of training for community psychiatry. The confusion is partly due to the assumption that community psychiatry represents a new subspecialty and that therefore training for community psychiatry should follow basic clinical education. With the exception of certain administrative and research aspects, the practices and the knowledge employed by community psychiatrists are becoming part of all effective contemporary psychiatric practice and should be part of the basic education of every psychiatrist. A three-year residency program which coordinates clinical and community psychiatric knowledge and experience is presented. The needs of participants in mental health programs, of teachers and of researchers in community psychiatry, can best be met by specific postgraduate instruction combined with simultaneous job experience.

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Observations on Psychiatric Residency Training

Cited by 18 publications

References 2 publications

Social inequality, scientific inequality, and the future of mental illness

Social inequality, scientific inequality, and the future of mental illness

The emergency service: A setting for internship training.

Community psychiatry and the education of psychiatrists

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