LETTERS
TO
THE
EDITOR
high-quality objective research in an area long a subject entific controversy. Much work is now being done, and required before we will find useful answers.
of scimore is
I.
Lieher AL, Sherin CR: Homicides theory of lunar influence on human Psychiatry 129:69 74, 1972 2. Wing LW: The effect of latitude 98:1202 1205, 1962 3. Levy NB: On the Journal and Pokorny (Itrs to ed). Am J Psychiatry
and the emotional on the
cycles.
Ann
toward Am
NY
moon, and 132:85, 1975
Acad
reply
L. LIEBER,
SIR:
(January
a J Sci
of
AD
F/a.
for the Elderly
“The Psychiatrist’s Involvement 1975 issue) by Floyd K. Garetz,
with M.D.,
Aged Patients” is an interesting
this
situation
students
in
from
and psychiatric aspects of later Hospital Center is attempting
the
clerkship
special
which
medical
students’
Albert
in
life. to remedy
psychiatry
offered
to
College of Medicine. The ( I, 2) and includes field trips to long-term care facilities for the aged, provides medical students with a unique opportunity to become familiar with the clerkship,
the
clinical
recent
and
psychiatric
interest
in this
creased proportionately. If programs such nificant barrier to services
by
the
Einstein
uses
elderly
texts
problems
segment
be
REFE
I.
Busse
EW,
Pfeiffer
DC, American 2.
Butler Mosby,
E:
Mental
Psychiatric
RN. Lewis 1973
of
of our
the
Ml:
The
has
in-
generally, a sigof psychiatric
removed.
in Later
and
Life.
Washington,
1973 Mental
B.
SEYMOUR
Associate
Health.
Louis,
CV
both
patient
physician nc
Psychiatrist
Hospital
Center
Bronx,
and Couldn’t
of
concerns
and
Shouldn’t
consultation?
the nursing
to ask
him
the patient’s
Dying
N. Y.
there
Patients
in treating
metastatic
were
referred
his
fatal
that
a 61-year-old
carcinoma disease.”
is superior
who
670
A m J Psychiatry
psychiat-
rather
practiced
132:6, June
his excellent
/975
precepts,
than
manifested
What
truck
does
the
who
massive therapist
denial
grandiose stability,
patient projecting or being for psychiatric consultation
driver
stoi-
is dying
denial
have
to
offer
him
monologue and vocational
of
former feats”?
physical Was this
paranoid when after being referred by his nurses he viewed physicians
as “sadistic, negligent, and cause he was overwhelmingly
inadequate?” Was he unrealistic resistant to any behavioral sultation, whether it was from a nurse, social worker, or cian, or because he felt suspicious of all educated people anything that seemed at all intellectual? I think he had cellent reason for these attitudes. Discussion by the medical and nursing staffs of their tudes toward psychiatrists will not help if they correctly ceive that psychiatrists are more harmful than helpful comfort ofdying patients.
like
to add
one
of
toward
of a sense of . . . inferiority”
suggestion
to those
offered
Dr.
Levinson
states
we must
influence
“official
beconphysiand of an cxattiperto the
by Dr.
attitudes”
clinical
into
reill of
to
experience
are
enough
for
a medical
he
Dr. Leinson SIR:
points. channels
student
a physician. GLICKMAN,
Brooklyn,
any type of psychotherapeutic treatment lie within ourselves rather than our patients. Treatment of the dying patient is no Levinson
request
“who
“employed
to his “total
and “ongoing and strength, emotional
psychiatric
SIR: I would like to comment on Dr. Penitz Levinson’s aptly titled article, “Obstacles in the Treatment of Dying Patients” (January 1975 issue). It is a truism that many ofthe obstacles to
If Dr.
than
Is stoicism pathological? If it is true that “pathological defenses usually must be supported rather than challenged,” what advantage to the patient is
Patients
exception.
to
physician,
LEwIS
with
staff rather
cism
to grow
Dealing
in
conducive to rapport with to accept referrals only from the be requested to tell the patient’s
-nurses
their
evidence important.
is particularly urgent that the with the primary care physiconsultant contribute to this
referrals from Isn’t it more
physician
is ample
of the most
improve the care of dying patients. Unfortunately, he is again looking outside the purview of psychiatry for the cause of the impediments he met. One “official attitude” we must influence is that of the American Board of Psychiatry and Neurology, which in August 1974 decreed that four months of non-
M.D.
JACOBSON,
Attending
The Bronx-Lebanon
St
“It
rapport psychiatric
two
rapport by accepting from the physician? physician?
there
at least
Levinson. The foundation for the ability to recognize and spond to the emotional needs of patients who are terminally can only be acquired at the bedside during the experience being the physician who is responsible for their care.
RENCES
Illness
However,
stated,
establish Does the
I would
Association, Aging
elderly.
population
as this were adopted more the appropriate utilization would
Dr. Levinson
ing is-despair?
contribution to our understanding of why it is that although many elderly people in the United States experience mental and emotional disorders, the elderly as a group seem to underutilize psychiatric services. There are many reasons for this phenomenon. Dr. Garetz implies that some of them may be found in factors influencing psychiatrists’ attitudes toward the aged, one of which is the limited or nonexistent attention given in medical school curricula and in psychiatric residency training programs
to the psychological The Bronx-Lebanon
obstacles.
he neglected
the nurse, inform the patient that psychiatric consultation has been requested, and why? How would Dr. Levinson feel toward the internist who examined and treated his hospitalized patient without first obtaining his consent? Shouldn’t the physician who is responsible for the patient’s care be given the opportunity to refuse the services of a psychiatric consultant? Isn’t refusal of psychiatric consultation appropriate in instances where patients may have been, as Dr. Levinson reports, “ referred by the nursing staff because they were not experiencing the level of feeling associated with fatal disease”? I wonder what that level of feel-
M.D.
Miami,
To Care
that
First,
lunar cycle: disturbance.
ARNOLD
Psychiatrists
find fewer
psychiatrist cian
REFERENCES
Training
would
his article
M.D. N. Y.
Replies
Dr. Glickman’s stimulating critique focuses on two main The first is that the failure to go through traditional of referral undercuts rapport with the primary care
TO
THE
EDITOR
high-quality objective research in an area long a subject entific controversy. Much work is now being done, and required before we will find useful answers.
of scimore is
I.
Lieher AL, Sherin CR: Homicides theory of lunar influence on human Psychiatry 129:69 74, 1972 2. Wing LW: The effect of latitude 98:1202 1205, 1962 3. Levy NB: On the Journal and Pokorny (Itrs to ed). Am J Psychiatry
and the emotional on the
cycles.
Ann
toward Am
NY
moon, and 132:85, 1975
Acad
reply
L. LIEBER,
SIR:
(January
a J Sci
of
AD
F/a.
for the Elderly
“The Psychiatrist’s Involvement 1975 issue) by Floyd K. Garetz,
with M.D.,
Aged Patients” is an interesting
this
situation
students
in
from
and psychiatric aspects of later Hospital Center is attempting
the
clerkship
special
which
medical
students’
Albert
in
life. to remedy
psychiatry
offered
to
College of Medicine. The ( I, 2) and includes field trips to long-term care facilities for the aged, provides medical students with a unique opportunity to become familiar with the clerkship,
the
clinical
recent
and
psychiatric
interest
in this
creased proportionately. If programs such nificant barrier to services
by
the
Einstein
uses
elderly
texts
problems
segment
be
REFE
I.
Busse
EW,
Pfeiffer
DC, American 2.
Butler Mosby,
E:
Mental
Psychiatric
RN. Lewis 1973
of
of our
the
Ml:
The
has
in-
generally, a sigof psychiatric
removed.
in Later
and
Life.
Washington,
1973 Mental
B.
SEYMOUR
Associate
Health.
Louis,
CV
both
patient
physician nc
Psychiatrist
Hospital
Center
Bronx,
and Couldn’t
of
concerns
and
Shouldn’t
consultation?
the nursing
to ask
him
the patient’s
Dying
N. Y.
there
Patients
in treating
metastatic
were
referred
his
fatal
that
a 61-year-old
carcinoma disease.”
is superior
who
670
A m J Psychiatry
psychiat-
rather
practiced
132:6, June
his excellent
/975
precepts,
than
manifested
What
truck
does
the
who
massive therapist
denial
grandiose stability,
patient projecting or being for psychiatric consultation
driver
stoi-
is dying
denial
have
to
offer
him
monologue and vocational
of
former feats”?
physical Was this
paranoid when after being referred by his nurses he viewed physicians
as “sadistic, negligent, and cause he was overwhelmingly
inadequate?” Was he unrealistic resistant to any behavioral sultation, whether it was from a nurse, social worker, or cian, or because he felt suspicious of all educated people anything that seemed at all intellectual? I think he had cellent reason for these attitudes. Discussion by the medical and nursing staffs of their tudes toward psychiatrists will not help if they correctly ceive that psychiatrists are more harmful than helpful comfort ofdying patients.
like
to add
one
of
toward
of a sense of . . . inferiority”
suggestion
to those
offered
Dr.
Levinson
states
we must
influence
“official
beconphysiand of an cxattiperto the
by Dr.
attitudes”
clinical
into
reill of
to
experience
are
enough
for
a medical
he
Dr. Leinson SIR:
points. channels
student
a physician. GLICKMAN,
Brooklyn,
any type of psychotherapeutic treatment lie within ourselves rather than our patients. Treatment of the dying patient is no Levinson
request
“who
“employed
to his “total
and “ongoing and strength, emotional
psychiatric
SIR: I would like to comment on Dr. Penitz Levinson’s aptly titled article, “Obstacles in the Treatment of Dying Patients” (January 1975 issue). It is a truism that many ofthe obstacles to
If Dr.
than
Is stoicism pathological? If it is true that “pathological defenses usually must be supported rather than challenged,” what advantage to the patient is
Patients
exception.
to
physician,
LEwIS
with
staff rather
cism
to grow
Dealing
in
conducive to rapport with to accept referrals only from the be requested to tell the patient’s
-nurses
their
evidence important.
is particularly urgent that the with the primary care physiconsultant contribute to this
referrals from Isn’t it more
physician
is ample
of the most
improve the care of dying patients. Unfortunately, he is again looking outside the purview of psychiatry for the cause of the impediments he met. One “official attitude” we must influence is that of the American Board of Psychiatry and Neurology, which in August 1974 decreed that four months of non-
M.D.
JACOBSON,
Attending
The Bronx-Lebanon
St
“It
rapport psychiatric
two
rapport by accepting from the physician? physician?
there
at least
Levinson. The foundation for the ability to recognize and spond to the emotional needs of patients who are terminally can only be acquired at the bedside during the experience being the physician who is responsible for their care.
RENCES
Illness
However,
stated,
establish Does the
I would
Association, Aging
elderly.
population
as this were adopted more the appropriate utilization would
Dr. Levinson
ing is-despair?
contribution to our understanding of why it is that although many elderly people in the United States experience mental and emotional disorders, the elderly as a group seem to underutilize psychiatric services. There are many reasons for this phenomenon. Dr. Garetz implies that some of them may be found in factors influencing psychiatrists’ attitudes toward the aged, one of which is the limited or nonexistent attention given in medical school curricula and in psychiatric residency training programs
to the psychological The Bronx-Lebanon
obstacles.
he neglected
the nurse, inform the patient that psychiatric consultation has been requested, and why? How would Dr. Levinson feel toward the internist who examined and treated his hospitalized patient without first obtaining his consent? Shouldn’t the physician who is responsible for the patient’s care be given the opportunity to refuse the services of a psychiatric consultant? Isn’t refusal of psychiatric consultation appropriate in instances where patients may have been, as Dr. Levinson reports, “ referred by the nursing staff because they were not experiencing the level of feeling associated with fatal disease”? I wonder what that level of feel-
M.D.
Miami,
To Care
that
First,
lunar cycle: disturbance.
ARNOLD
Psychiatrists
find fewer
psychiatrist cian
REFERENCES
Training
would
his article
M.D. N. Y.
Replies
Dr. Glickman’s stimulating critique focuses on two main The first is that the failure to go through traditional of referral undercuts rapport with the primary care
