Problems and Challenges of Consultation Psychiatry in Gynecology and Obstetrics

Abstract

Clinical experiences of consultation-liaison psychiatry in gynecology and obstetrics were reviewed. Observations were based on the modality of ‘host-agent’ interaction. Most published reports concentrated on the psychiatrist’s role in the consultative function. The present paper emphasized specific reactions of the ‘host’ (consultee) in a survey of 23 gynecologists and obstetricians in the setting of a general teaching hospital. While the overall reactions of the consultees were found to be similar to those reported about medical and surgical wards, some specific differences were pointed out. The definition of ‘clinical duality’ in gynecology was stressed, relating to the function of the gynecologist in the alternating therapeutic role between activity and passivity. Specific therapeutic fields were mentioned as areas of conflict and sources of countertransference for the gynecologist. In spite of the difficulties presented, an optimistic view is maintained about the future of integrated psychological counselling for the two clinical disciplines. Prolonged and continuous cooperation not only in ward setting but through organization of special integration clinics is advocated to help free both professions from mutual preconceived prejudices. Such clinics will promote training and research interest, develop the gynecologist’s ability toward deeper awareness of psychological problems and stimulate the psychiatrist for active participation in the investigation of psychophysiological processes. This mutual growth through case-finding and diagnosis should lead toward better integration of a community-oriented approach, centered mainly around sexual education, study of problems of parenthood and marital interaction. Some possible complications emerging in the trainees must be carefully watched, like identity crisis, increased resistance stirred by therapeutic zeal and exaggeration in the evaluation of psychological stresses. They have to be dealt with through intensive supervision and active participation of senior psychiatric consultants. There is still a wide gap between the goals set by consultation psychiatry and their realization. We have to be constantly reminded that teaching is a never-ending process of learning. One can only hope that with every additional effort on our part to bring understanding to others, we shall gain knowledge to meet the multitude of challenges still ahead of us.