Am

J Psychiatry 135:9, September

diose and unreasonable changing society, for ly?

The training do we not train ists

in human

Do we need and

supervise

paraprofessionals

The man the

as which

our Dr.

1978

LETTERS

accepting the Bourne castigated

of paraprofessionals adequate psychiatrists,

burden of us severe-

is a loaded issue. Why if we are the special-

behavior and the physicians of mental illness? psychiatrists’ assistants? If so, then let us train them. Let us define the roles of mental health and pay them adequately.

comparison

of psychiatrists

with

Rolls

Royce

crafts-

when Fords are needed is a sign of the degradation to ‘marketing personality. ‘ ‘ If 30% of the population needs treatment, then it needs expert treatment, not assistance. If the remaining 70% need help in ordering their lives, then experts in causes for disordered lives should be called in. When our special body of knowledge exposes the psychopathology rampant in this country, will we be accepted? I am all for a definition of our role and skills. Would Dr. Bourne start the ball rolling? ‘

we were

at fault

competent

and

that

patients

psychiatrists

did

TO

THE

of competent

not

commit

EDITOR

trainees

and

Some

of us

suicide.

felt that we would be afraid ever to see a suicidal again. Initially we had each felt alone in our experience. tunately, we became aware cided to meet as a group.

that we Through

were our

patient Fordewe

not unique and group meetings

were able to support each other and work through many our feelings about the suicide (2). I would suggest that since this is a common experience psychiatric

when

residencies,

residents

openness

do have

be

patients

who

encouraged

of in

so

commit

that

suicide,

they

can meet in groups that involve self-examination in a supportive atmosphere. This may help alleviate the pain and loneliness of the experience. In addition, working through feelings about a patient suicide can allow the resident to continue to grow professionally, and to become willing to treat

other

suicidal

patients.

REFERENCES

HELEN

STEIN,

M.D.

Fresno, Calif.

Dr. Bourne

Replies

SIR:

Unfortunately, interpretation of what ‘

‘The

make

major

Dr.

Stein’s

concern

arises

from

a mis-

I said in my article. The statement to psychiatry in the next decade is to

challenge

skills available to all Americans’ ‘ was not meant to we should train everyone in psychiatric skills. Perhaps I should have said (for greater clarity) that we should try to make our services available to the largest possible number of Americans. This would mean reducing the financial barriers to care, perhaps through national health insurance; training additional psychiatrists; and increasing the involvement of psychologists, psychiatric social workers, and family physicians in areas that do not require psychiatrists. Presumably this would make psychiatrists more availimply

able sionals training

training and opportunities entitled “On the Emotional 127th annual meeting of the Detroit, Mich, May 6-10, et al: Working through in training. Suicide and

San Francisco,

that

to a larger

number

of people.

can play an important and supervision.

role

Obviously, if they

with

Patients’

have

M.D. (June 1978 issue). I agree with the author

that

patient

article by

suicide

‘

Ralph

SIR: We enjoyed tions of Cultural M.D. , and Mary

There

have

the excellent Psychiatry’ Oman, MA.

been

several

‘

paper ‘ ‘Overview: by Armando R. (March 1978 issue).

attempts

to meld

FoundaFavazza,

psychiatry

and

anthropology

appropriate

Although these efforts have met with general approval from both fields, there has been insufficient use and followthrough of the extremely important cross-fertilization result-

into

interdisciplinary

frame

of

reference.

ing from

D.C.

We believe much can be achieved by intimate teamwork between a psychiatrist and an anthropologist or ethologist. Dr. Favazza and Ms. Oman have attempted to cover the

‘Patient SuiF. Henn,

is not an infre-

quent occurrence during a psychiatric residency. One survey of a university psychiatric residency program indicated that 16% ofall residents had had a patient who committed suicide (1). Although this is lower than the figures quoted by the author, it is nevertheless a significant percentage. The author states that professional ‘ ‘ survivor victims” had ‘ ‘bitterness and torment. ‘ ‘ I would like to share one method of dealing with this. When I was a resident, I was one of four trainees who had a patient commit suicide within a 2-month period. We met together for almost a year to deal with the trauma. We found that the experience of a patient suicide left each of us with feelings of embarrassment, guilt, and self-doubt. We were embarrassed because we felt that

such

an

M.D.

Suicides

‘

Cross-Fertilization

paraprofes-

G. BOURNE, Washington,

SIR: I would like to comment on the cide as Part of Psychiatric Residency’

Anthropological

of Life

M.D. Calif.

REN#{201}EBINDER,

our

PETER

Dealing

I . Rosen DH : Mental stress in residency for prevention. Presented in a panel Well-Being of Psychiatrists” at the American Psychiatric Association, 1974 2. Kolodny 5, Binder R, Bronstein A, patients’ suicides by four therapists Threatening Behavior (in press)

collaboration.

broad range of mutually beneficial congratulated on their thorough like to add to their list two areas

exchanges and are to be job. We should, however, in which we ourselves have

been working. We have investigated the persistence in humans of phylogenetically embedded response systems that are no longer adaptive, the circumstances that lead to their activation, and their potential to emerge as psychoneurotic, psychophysiological,

reference

or psychosomatic

provides

a biological

disturbances.

basis

This

that

lends

frame

itself

corporation into a medical model without requiring resort to metapsychological concepts. It also provides logical basis for some psychodynamic formulations

We also

believe

gy is available ‘ ‘fossils’ ‘ can

the social many

that

from provide

interactions

instances

are as valuable

such

an unexpected psychiatry. material

bonus

one to a bio(I).

for anthropolo-

Some of these behavioral to aid our understanding

of the precursors behavioral

as anatomical

of

to in-

vestiges

ones

of homo provide

in deciphering

of

sapiens. clues

In that

the stages 1113