Am
J Psychiatry
136:8,
August
1979
GERALD
The diagnosis of manic-depressive illness was missed in all of the patients described above, despite the fact that they had been treated in various hospitals, including state hospitals and community mental health centers. The families ofthese patients were supportive and tolerant; they came for help only when the patients became extremely difficult to manage. On the basis of the case histories we conclude, 1. Manic-depressive illness exists in mentally retarded people. 2. Knowledge of the patient and close study of his or her symptoms and the natural history of the illness should suggest the correct diagnosis, even though this is difficult to accomplish. 3. It is more difficult to diagnose depression than to diagnose mania, but when recurrent acting out is present, a detailed history of symptoms is essential. 4.
Use
of lithium
as a prophylactic
agent
BY GERALD
Teaching A. MELCHIODE,
havioral
13, 1978; revised
March
but
they
often
lack
sufficient
knowl-
is helpful
REFERENCES I. Baastrup PC, Schou M: Lithium as a prophylactic agent. Arch Gen Psychiatry 16: 162-172, 1967 2. Coppen A, Noguera R, Bailey J, et al: Prophylactic lithium in affective disorders. Lancet 2:275-279, 1971 3. Davis JM: Overview: maintenance therapy in psychiatry: II. Affective disorders. Am J Psychiatry 133:1-13, 1976 4. Reid AH: Psychoses in adult mental defectives: I. Manic depressive psychosis. Br J Psychiatry 120:205-2 12, 1972 5. Reid AH: Psychoses in adult mental defectives: II. Schizophrenic and paranoid psychoses. Br J Psychiatry 120:213-218, 1972 6. Naylor GJ, Donald JM, LePoidevin D, et al: A double-blind trial of long-term lithium therapy on mental defectives. BrJ Psychiatry 124:52-57, 1974
in Medical
Education
M.D.
IT
Nov.
pattern,
edge to do so. Adequate training in clinical psychiatry and psychopharmacology is therefore essential, not only for the medical staff but also for the nursing staff who deal with such patients.
The author sent a questionnaire to directors of medical student education in psychiatry to determine the role ofpsychoanalytic concepts in medical education. Practically all ofthe 66 respondents indicated that psychodynamic theory had been incorporated into major required courses. More than ha If considered the concepts of defense mechanism, countertransference, transference, and dynamic unconscious necessary to general education. The author concludes that psychoanalytic principles will continue to provide a unique view into illness behavior and the doctor-patient relationship.
Received 1979.
MELCHIODE
importance of routine blood tests, as well as the need for adequate fluid and salt intake. 6. Nursing staff who deal with retarded patients should be the first to observe a manic-depressive be-
in preventing the intensity and severity of manic and depressive episodes, especially manic episodes. 5. The families of mentally retarded patients are often protective, taking great pains to keep the patient at home. They really want the illness to be controlled. They should be instructed about side effects and the
Psychoanalytic
A.
2, 1979; accepted
Dr. Melchiode is Director of Medical Student Education try and Associate Professor of Mental Health Sciences, Medical College and Hospital, 230 North Broad St., Pa. 19102.
0002-953X/79/09/107
March
PURPOSE
ory ranked of medicine. trists, dents
in
this
paper
last
last
physicians, of information
© 1979
nonpsychiatrists
by the psychiatrists Callen and associates
tioners
21,
the
in Missouri.
36 items in order tice of medicine. analytic concepts dents.
and
of importance A working was ranked
Psychiatric
and
role
that surthe-
medical and skill
students
were
and
general asked
in the day-to-day knowledge of 34th by the
may be left with the education is concerned, outlived its usefulness. Association
stuin or-
An understanding of theory was ranked
polled. (2) surveyed Respondents
The casual reader that as far as medical analytic theory has American
the
very low in importance to the daily practice Johnson and associates (I) had psychia-
nonpsychiatrist rank 21 categories
by
to define
plays in medical education. Two published in which psychoanalytic
der of importance to patient care. the principles of psychoanalytic
in PsychiaHahnemann Philadelphia,
l/03/$00.40
IS MY
psychoanalysis veys have been
next
to
practito rank
pracpsychorespon-
conclusion psychoMeissner 1071
PSYCHOANALYTIC
(3)
defined
and
the
changes
tion and distribution
Am
TEACHING
relationship
affecting
discussed and
cost
between
medical
psychoanalysis
and
psychiatric
medical
focuses
on
environmental
increase
in
and
clinical
not
the cornerstone
psychiatry.
and
(4)
that
of
its identity crises and suggested that a core integrated with other views pro-
tion, Engel (5) reviewed ics ofthe doctor-patient
medical
its application relationship
to the educa-
to the dynamand, in particular,
to the 83 members of Medical
.
or have
of the As-
Student
Psychiatry. The questionnaire consisted and space for comments. I What percentage of faculty who students are analysts ing? 2. How has this
had
percentage
Education
of9
in
questions
concepts? 4.
you
have
specific
If yes,
Have
into other 5. How choanalytic
medical
psychoanalytic
receptive
rater
changed
in the
please
courses
to comment
were
last
10
a space
changes
was
of attitude
concepts to psyhostile to
left
for the
in the
last
how
relevant, or neither? a) psychic determinism, b) drives, c) dynamic unconscious, d) genetic derivation of psychic structure and organization, e) significance of object relations, f) transference, g) countertransfer-
and
i) defense
mechanism.
7. Do students see individual patients in insight-oriented psychotherapy? 8. If yes, how do you view this experience? What are some of the advantages? Problems?
9. 1072
major
teaching
analytic
concepts
How
are
these
the percent
increased
in the
receptive,
students
supervised?
requests others
now with
of last
that per-
in psythat ran
were
incorporated
efforts,
e.g.,
into
Practically the departbehavioral
and clinical clerkships. students’ reactions to
sci-
psycho-
indicated that reactions tolerant, 13% not receptive,
were and
13%
60%
Eight
percent
felt that
Some
noted
the student
an increased
for more psychoanalytic observed students to be
see their departments an increased integration a broader theoretical
Nine following
in
reaction
students’
interest
teaching less receptive.
and
whereas Many
as more interdisciplinary of psychoanalytic theory perspective, which has re-
greater
acceptance
psychodynamic concepts order according to
of
psycho-
derivation
were ranked respondents’
in the beliefs
to general medical education: (#{233}onsidered necessary by 78% 2) countertransference (72%), 3)
transference (66%), 4) dynamic significance of object relations (42%), 7) psychic determinism
9) genetic
Comlast 10 could
teaching.
about their importance I) defense mechanisms of the respondents),
describe.
offered:
on any
h) resistance,
had
concepts
psychopathology, evaluating the
analytic
in psychoanalytic
10 years.J 6. Relating to general medical education, would you rate the following concepts-necessary,
ence,
ment’s
sulted
train-
you incorporated psychoanalytic courses? If yes, please describe. would you rate students’ reactions concepts? [Choices ranging from
very
responding
members
8 to 16 hours.
ence, In
into
teach
years? Do
(79%) were of medi-
was mixed or varied throughout the 4 years. ments on changes in student reaction during the years varied considerably so no significant trend
a questionnaire of Directors
the director
schools polled had specific courses concepts: most were electives
be discerned.
I sent
distributed
by either
departments
trained
6% hostile.
interview.
forms
other courses in 92% of the departments. all of these were required and represented
very
METHOD
sociation
83
Psychoanalytic
in
fragmentation
the
returned
10 years, 3 1% reported a decrease, and 43% stated the number had remained the same. Twenty-two
is con-
vided the field with a unifying theme. In regard relevance of psychoanalytic theory to medical
3.
analytically
cent of the choanalytic
programs the
of
and
In 26% ofthe
specifically
in a position
discussed
1979
cal student education in psychiatry or the department chairman. The average percent of medical school faculty members who had had analytic training was 24%. The range was from 0% in 5 schools to 90% in I school.
elec-
at all, is Meissner which
of psychoanaly-
ofgovernment-supported
Baum
to the
Sixty-six
completed
from is therefore
to the aims
psychiatry psychoanalytic
change
change,
theory. Psychoanalysis
trary
an
Psychoanalytic theory, if it is taught during the shortened preclinical years. the influence of community psychiatry,
on individual tic
and
August
RESULTS
the emphasis in our society on the of health care, which threatens to
curriculum
136:8,
educa-
force psychoanalysis to play a minimal role as a viable treatment modality. A number of emerging theories of behavior now compete for time in the curriculum of medical schools, thus leaving less time to teach psychoanalytic theory. There is a shortening of the core tives. taught noted
J Psychiatry
of psychic
unconscious (52%), 5) (48%), 6) resistance (33%), 8) drives (28%),
structure
and
organi-
zation (25%). Fifty-three percent reported that their students see individual patients in insight-oriented psychotherapy. Those who viewed the experience as beneficial commented on the students’ better understanding of their patients, of principles of psychotherapy, and of the doctor-patient relationship. The problems observed in permitting students to conduct psychotherapy were the lack of time due to 6-week rotations, the unfairness to patients of endless transfers, and the quantity of faculty time it takes to locate a suitable patient and provide supervision. Medical students who conducted therapy were supervised in most schools by staff psychiatrists. There was no correlation between the percent of an-
Am
J Psychiatry
/36:8,
August
/979
GERALD
alysts and the importance of psychoanalytic concepts or between the percent of analysts and the degree of students’ receptivity. Nor was there a correlation between the percent of analysts and whether or not students conducted insight-oriented psychotherapy. There was no correlation between the provision of opportunities
changes teaching.
for
students
in students’
to see
attitudes
individual
toward
patients
and
psychoanalytic
tional
problems”
chemistry
The naires
and
of mental
problem as far
dents
with
the Johnson
as psychoanalytic
are
useful,
and ‘
chiatry,
human
development,
and
the
psychological
basis of medical practice? The fact that practically all psychoanalytic teaching that is done is within the framework of larger courses would support this view. The information or skills that were ranked in the top three places in the Johnson and associates study were I) the ability to talk with patients about their personal problems, 2) familiarity with the dynamics of the doctor-patient relationship, and 3) an understanding of the emotional aspects of the chronically ill or dying patient. In the Callen and associates survey the skills ranked highest were 1) the ability to talk with patients about their personal problems, 2) the ability to treat depression, 3) the ability to evaluate a patient with potential for suicide, 4) an understanding of psychosomatic disorders, 5) an understanding of the emotional aspects of the doctor-patient relationship, 6) techniques of interviewing patients to uncover emotional problems, and 7) an understanding of the emotional aspects of the chronically ill or dying patient. All of the above skills would be strengthened by a working knowledge of defense mechanisms, transference, and countertransference, whether the student or physician recognized it or not. The skill of treating a patient in congestive heart failure edge of physiology. I am sure that cal skills and information, the
would rank the treatment high and the principles fact, the physicians in the est “a working knowledge
presumes a knowlgiven a list of medigraduate physician
of congestive heart failure of basic physiology low. In Callen survey of drugs used
ranked to treat
highemo-
to
last
“the
bio-
illness.”
and
Callen
theory
enabling
general analytic’ may have whereas the director ate the extension of of clinical interpretation.
How does one explain the apparent contradiction between the Johnson and Callen surveys (1 , 2) and these results? Could it be that medical students and general physicians can no longer identify what is psychoanalytic because so much of what is basic psychoanalytic theory has been subsumed under general psy-
next
MELCHIODE
question-
is concerned
is
that they mix categories of skills and knowledge. one considers the skills ranked high in those studies overall objectives one could see that psychodynamic principles
DISCUSSION
ranked
A.
objectives.
physicians surveyed, only had an esoteric of medical education psychoanalytic theory
For
If as
the
stu-
“psychoconnotation can apprecito the level
CONCLUSIONS
Basic
psychoanalytic
concepts
remain
a necessary
and essential component of medical education. Because of integration with many other perspectives they are less identifiable but not less important to the medical student and graduate physician. As long as the physician
relies
on the
clinical
interview
of information about patients, ciples will continue to provide
as a major
psychodynamic a unique view
source
into
prinill-
ness behavior and the doctor-patient relationship. Psychoanalytic concepts should be integrated into broader courses and clinical experiences whenever possible. There is a danger in trying to teach them as a separate
course because all students have a tendency to compartmentalize knowledge and not to apply it to the daily practice psychiatry
of medicine. will help by
Here liaison and consultation bringing in a psychodynamic
understanding to medical and surgical patients. Separate courses in psychoanalytic theory could be offered in the curriculum as electives for students who express special
interest.
REFERENCES 1. Johnson W, Snibbe J, Hoffman K, et al: Focused psychiatric curriculum selection: student, psychiatrist, and nonpsychiatnst physician expectations. Am J Psychiatry 134:1126-1130, 1977 2. Callen KE, Davis D: The general practitioner: how much psychiatric education? Psychosomatics 19:409-413, 1978 3. Meissner WW: The relationship of psychoanalysis to current changes in medical and psychiatric education-historical perspective. J Am Psychoanal Assoc 24:329-345, 1976 4. Baum EO: Why a psychoanalytic core in psychiatric education? AmJ Psychiatry 132:1281-1285,1975 5. Engel GL: Psychoanalysis, alive and well at 80. JAMA 23 1:579582, 1975
1073
J Psychiatry
136:8,
August
1979
GERALD
The diagnosis of manic-depressive illness was missed in all of the patients described above, despite the fact that they had been treated in various hospitals, including state hospitals and community mental health centers. The families ofthese patients were supportive and tolerant; they came for help only when the patients became extremely difficult to manage. On the basis of the case histories we conclude, 1. Manic-depressive illness exists in mentally retarded people. 2. Knowledge of the patient and close study of his or her symptoms and the natural history of the illness should suggest the correct diagnosis, even though this is difficult to accomplish. 3. It is more difficult to diagnose depression than to diagnose mania, but when recurrent acting out is present, a detailed history of symptoms is essential. 4.
Use
of lithium
as a prophylactic
agent
BY GERALD
Teaching A. MELCHIODE,
havioral
13, 1978; revised
March
but
they
often
lack
sufficient
knowl-
is helpful
REFERENCES I. Baastrup PC, Schou M: Lithium as a prophylactic agent. Arch Gen Psychiatry 16: 162-172, 1967 2. Coppen A, Noguera R, Bailey J, et al: Prophylactic lithium in affective disorders. Lancet 2:275-279, 1971 3. Davis JM: Overview: maintenance therapy in psychiatry: II. Affective disorders. Am J Psychiatry 133:1-13, 1976 4. Reid AH: Psychoses in adult mental defectives: I. Manic depressive psychosis. Br J Psychiatry 120:205-2 12, 1972 5. Reid AH: Psychoses in adult mental defectives: II. Schizophrenic and paranoid psychoses. Br J Psychiatry 120:213-218, 1972 6. Naylor GJ, Donald JM, LePoidevin D, et al: A double-blind trial of long-term lithium therapy on mental defectives. BrJ Psychiatry 124:52-57, 1974
in Medical
Education
M.D.
IT
Nov.
pattern,
edge to do so. Adequate training in clinical psychiatry and psychopharmacology is therefore essential, not only for the medical staff but also for the nursing staff who deal with such patients.
The author sent a questionnaire to directors of medical student education in psychiatry to determine the role ofpsychoanalytic concepts in medical education. Practically all ofthe 66 respondents indicated that psychodynamic theory had been incorporated into major required courses. More than ha If considered the concepts of defense mechanism, countertransference, transference, and dynamic unconscious necessary to general education. The author concludes that psychoanalytic principles will continue to provide a unique view into illness behavior and the doctor-patient relationship.
Received 1979.
MELCHIODE
importance of routine blood tests, as well as the need for adequate fluid and salt intake. 6. Nursing staff who deal with retarded patients should be the first to observe a manic-depressive be-
in preventing the intensity and severity of manic and depressive episodes, especially manic episodes. 5. The families of mentally retarded patients are often protective, taking great pains to keep the patient at home. They really want the illness to be controlled. They should be instructed about side effects and the
Psychoanalytic
A.
2, 1979; accepted
Dr. Melchiode is Director of Medical Student Education try and Associate Professor of Mental Health Sciences, Medical College and Hospital, 230 North Broad St., Pa. 19102.
0002-953X/79/09/107
March
PURPOSE
ory ranked of medicine. trists, dents
in
this
paper
last
last
physicians, of information
© 1979
nonpsychiatrists
by the psychiatrists Callen and associates
tioners
21,
the
in Missouri.
36 items in order tice of medicine. analytic concepts dents.
and
of importance A working was ranked
Psychiatric
and
role
that surthe-
medical and skill
students
were
and
general asked
in the day-to-day knowledge of 34th by the
may be left with the education is concerned, outlived its usefulness. Association
stuin or-
An understanding of theory was ranked
polled. (2) surveyed Respondents
The casual reader that as far as medical analytic theory has American
the
very low in importance to the daily practice Johnson and associates (I) had psychia-
nonpsychiatrist rank 21 categories
by
to define
plays in medical education. Two published in which psychoanalytic
der of importance to patient care. the principles of psychoanalytic
in PsychiaHahnemann Philadelphia,
l/03/$00.40
IS MY
psychoanalysis veys have been
next
to
practito rank
pracpsychorespon-
conclusion psychoMeissner 1071
PSYCHOANALYTIC
(3)
defined
and
the
changes
tion and distribution
Am
TEACHING
relationship
affecting
discussed and
cost
between
medical
psychoanalysis
and
psychiatric
medical
focuses
on
environmental
increase
in
and
clinical
not
the cornerstone
psychiatry.
and
(4)
that
of
its identity crises and suggested that a core integrated with other views pro-
tion, Engel (5) reviewed ics ofthe doctor-patient
medical
its application relationship
to the educa-
to the dynamand, in particular,
to the 83 members of Medical
.
or have
of the As-
Student
Psychiatry. The questionnaire consisted and space for comments. I What percentage of faculty who students are analysts ing? 2. How has this
had
percentage
Education
of9
in
questions
concepts? 4.
you
have
specific
If yes,
Have
into other 5. How choanalytic
medical
psychoanalytic
receptive
rater
changed
in the
please
courses
to comment
were
last
10
a space
changes
was
of attitude
concepts to psyhostile to
left
for the
in the
last
how
relevant, or neither? a) psychic determinism, b) drives, c) dynamic unconscious, d) genetic derivation of psychic structure and organization, e) significance of object relations, f) transference, g) countertransfer-
and
i) defense
mechanism.
7. Do students see individual patients in insight-oriented psychotherapy? 8. If yes, how do you view this experience? What are some of the advantages? Problems?
9. 1072
major
teaching
analytic
concepts
How
are
these
the percent
increased
in the
receptive,
students
supervised?
requests others
now with
of last
that per-
in psythat ran
were
incorporated
efforts,
e.g.,
into
Practically the departbehavioral
and clinical clerkships. students’ reactions to
sci-
psycho-
indicated that reactions tolerant, 13% not receptive,
were and
13%
60%
Eight
percent
felt that
Some
noted
the student
an increased
for more psychoanalytic observed students to be
see their departments an increased integration a broader theoretical
Nine following
in
reaction
students’
interest
teaching less receptive.
and
whereas Many
as more interdisciplinary of psychoanalytic theory perspective, which has re-
greater
acceptance
psychodynamic concepts order according to
of
psycho-
derivation
were ranked respondents’
in the beliefs
to general medical education: (#{233}onsidered necessary by 78% 2) countertransference (72%), 3)
transference (66%), 4) dynamic significance of object relations (42%), 7) psychic determinism
9) genetic
Comlast 10 could
teaching.
about their importance I) defense mechanisms of the respondents),
describe.
offered:
on any
h) resistance,
had
concepts
psychopathology, evaluating the
analytic
in psychoanalytic
10 years.J 6. Relating to general medical education, would you rate the following concepts-necessary,
ence,
ment’s
sulted
train-
you incorporated psychoanalytic courses? If yes, please describe. would you rate students’ reactions concepts? [Choices ranging from
very
responding
members
8 to 16 hours.
ence, In
into
teach
years? Do
(79%) were of medi-
was mixed or varied throughout the 4 years. ments on changes in student reaction during the years varied considerably so no significant trend
a questionnaire of Directors
the director
schools polled had specific courses concepts: most were electives
be discerned.
I sent
distributed
by either
departments
trained
6% hostile.
interview.
forms
other courses in 92% of the departments. all of these were required and represented
very
METHOD
sociation
83
Psychoanalytic
in
fragmentation
the
returned
10 years, 3 1% reported a decrease, and 43% stated the number had remained the same. Twenty-two
is con-
vided the field with a unifying theme. In regard relevance of psychoanalytic theory to medical
3.
analytically
cent of the choanalytic
programs the
of
and
In 26% ofthe
specifically
in a position
discussed
1979
cal student education in psychiatry or the department chairman. The average percent of medical school faculty members who had had analytic training was 24%. The range was from 0% in 5 schools to 90% in I school.
elec-
at all, is Meissner which
of psychoanaly-
ofgovernment-supported
Baum
to the
Sixty-six
completed
from is therefore
to the aims
psychiatry psychoanalytic
change
change,
theory. Psychoanalysis
trary
an
Psychoanalytic theory, if it is taught during the shortened preclinical years. the influence of community psychiatry,
on individual tic
and
August
RESULTS
the emphasis in our society on the of health care, which threatens to
curriculum
136:8,
educa-
force psychoanalysis to play a minimal role as a viable treatment modality. A number of emerging theories of behavior now compete for time in the curriculum of medical schools, thus leaving less time to teach psychoanalytic theory. There is a shortening of the core tives. taught noted
J Psychiatry
of psychic
unconscious (52%), 5) (48%), 6) resistance (33%), 8) drives (28%),
structure
and
organi-
zation (25%). Fifty-three percent reported that their students see individual patients in insight-oriented psychotherapy. Those who viewed the experience as beneficial commented on the students’ better understanding of their patients, of principles of psychotherapy, and of the doctor-patient relationship. The problems observed in permitting students to conduct psychotherapy were the lack of time due to 6-week rotations, the unfairness to patients of endless transfers, and the quantity of faculty time it takes to locate a suitable patient and provide supervision. Medical students who conducted therapy were supervised in most schools by staff psychiatrists. There was no correlation between the percent of an-
Am
J Psychiatry
/36:8,
August
/979
GERALD
alysts and the importance of psychoanalytic concepts or between the percent of analysts and the degree of students’ receptivity. Nor was there a correlation between the percent of analysts and whether or not students conducted insight-oriented psychotherapy. There was no correlation between the provision of opportunities
changes teaching.
for
students
in students’
to see
attitudes
individual
toward
patients
and
psychoanalytic
tional
problems”
chemistry
The naires
and
of mental
problem as far
dents
with
the Johnson
as psychoanalytic
are
useful,
and ‘
chiatry,
human
development,
and
the
psychological
basis of medical practice? The fact that practically all psychoanalytic teaching that is done is within the framework of larger courses would support this view. The information or skills that were ranked in the top three places in the Johnson and associates study were I) the ability to talk with patients about their personal problems, 2) familiarity with the dynamics of the doctor-patient relationship, and 3) an understanding of the emotional aspects of the chronically ill or dying patient. In the Callen and associates survey the skills ranked highest were 1) the ability to talk with patients about their personal problems, 2) the ability to treat depression, 3) the ability to evaluate a patient with potential for suicide, 4) an understanding of psychosomatic disorders, 5) an understanding of the emotional aspects of the doctor-patient relationship, 6) techniques of interviewing patients to uncover emotional problems, and 7) an understanding of the emotional aspects of the chronically ill or dying patient. All of the above skills would be strengthened by a working knowledge of defense mechanisms, transference, and countertransference, whether the student or physician recognized it or not. The skill of treating a patient in congestive heart failure edge of physiology. I am sure that cal skills and information, the
would rank the treatment high and the principles fact, the physicians in the est “a working knowledge
presumes a knowlgiven a list of medigraduate physician
of congestive heart failure of basic physiology low. In Callen survey of drugs used
ranked to treat
highemo-
to
last
“the
bio-
illness.”
and
Callen
theory
enabling
general analytic’ may have whereas the director ate the extension of of clinical interpretation.
How does one explain the apparent contradiction between the Johnson and Callen surveys (1 , 2) and these results? Could it be that medical students and general physicians can no longer identify what is psychoanalytic because so much of what is basic psychoanalytic theory has been subsumed under general psy-
next
MELCHIODE
question-
is concerned
is
that they mix categories of skills and knowledge. one considers the skills ranked high in those studies overall objectives one could see that psychodynamic principles
DISCUSSION
ranked
A.
objectives.
physicians surveyed, only had an esoteric of medical education psychoanalytic theory
For
If as
the
stu-
“psychoconnotation can apprecito the level
CONCLUSIONS
Basic
psychoanalytic
concepts
remain
a necessary
and essential component of medical education. Because of integration with many other perspectives they are less identifiable but not less important to the medical student and graduate physician. As long as the physician
relies
on the
clinical
interview
of information about patients, ciples will continue to provide
as a major
psychodynamic a unique view
source
into
prinill-
ness behavior and the doctor-patient relationship. Psychoanalytic concepts should be integrated into broader courses and clinical experiences whenever possible. There is a danger in trying to teach them as a separate
course because all students have a tendency to compartmentalize knowledge and not to apply it to the daily practice psychiatry
of medicine. will help by
Here liaison and consultation bringing in a psychodynamic
understanding to medical and surgical patients. Separate courses in psychoanalytic theory could be offered in the curriculum as electives for students who express special
interest.
REFERENCES 1. Johnson W, Snibbe J, Hoffman K, et al: Focused psychiatric curriculum selection: student, psychiatrist, and nonpsychiatnst physician expectations. Am J Psychiatry 134:1126-1130, 1977 2. Callen KE, Davis D: The general practitioner: how much psychiatric education? Psychosomatics 19:409-413, 1978 3. Meissner WW: The relationship of psychoanalysis to current changes in medical and psychiatric education-historical perspective. J Am Psychoanal Assoc 24:329-345, 1976 4. Baum EO: Why a psychoanalytic core in psychiatric education? AmJ Psychiatry 132:1281-1285,1975 5. Engel GL: Psychoanalysis, alive and well at 80. JAMA 23 1:579582, 1975
1073
