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Liaison psychiatry: a service for averting dehumanization of medicine. Recent psychosocial changes in medicine.

Recent technical advances of medical science have become responsible for the altered role of the physician and changes in the practice of medicine. As the practice has become hospital-centered, the importance of the individual physician and the prestige of the medical profession have markedly decreased. Dehumanization of medicine has been a natural outcome of these changes, for as the scientific approach to patient care increased the psychosocial support of the physician and significant others decreased. Liaison psychiatry, the therapeutic arm of psychosomatic medicine, utilizes the holistic principle which incorporates the psychosocial nuances of human behavior into the medical model. It is felt that this service must be utilized with increased frequency if further dehumanization of medical practice is to be prevented.

Ethics, Medical

Amygdaloid nucleus syndrome and dehumanization syndrome.

Through statistical tests 3 groups of impulsive-aggressive patients were studied: group 1, 100 individuals with temporal dysrhythmia; group 2, 18 individuals with temporal dysrhythmia submitted either to group analytical therapy or to psychoanalysis; group 3, 25 impulsive-aggressive individuals. Moreover the author differentiates between the amygdaloid nucleus and dehumanization syndromes, through psychoanalytical or psychiatric studies, and stresses the importance of the molding periods in relation to social factors (frustration-aggression-injustice). Amygdalotomy of the hippocampus was suggested in special cases.

Aggression

Any nurse can prevent dehumanization by the CCU experience.

This presentation deals with the Air Force Nurse as a movice assigned to a CCU area and her contributions to patient care as a member of the Air Force Health Care Team. The novice nurse's contributions to the patients care lie in her ability to manage expected behavioral responses to the CCU experience even with a basic working knowledge of normal sinus rhythm and CPR procedure. The expected responses to the CCU expereince discussed are: anxiety, denial, depression, and aggressive sexual behavior. These usual behavioral responses have, at times, been referred to as "a disease of medical progress" or the so-called "intensive care syndrome". The nurse is in a key position to observe the patient's behavioral responses since she spends most of the time with the patient. When these behavioral patterns are considered as part of a normal patterns of adaptation, the nurse can utilize these for effective management of the patient's hospitalization experience as well as an indicator to the patient standpoint in his process of adaptation. It would be wise to mention that the detailed manifestations and primary causes of these behavioral responses should be part of the nurse's working knowledge and can be easily referred to in recent texts on coronary care nursing. The presentation progresses to specific discussion on nursing intervention of the behavioral responses. In summary, the Air Force novice nurse to a CCU area can be an equally contributory member on the Health Care Team if not compelled to place an exaggerated amount of attention on equipment, but focus more on the patient, leaving more technical learning until she becomes more aware of the unit administration and has the opportunity to attend a coronary training course.

Acute Disease

Medical malpractice suits can be avoided.

As medical treatment has become increasingly complex over the years, patient care has become more and more dehumanized. The author explains how this feeling of dehumanization can cause patients to file malpractice suits and explores ways in which hosptial administrators can attempt to remedy the situation.

Hospital Administration

An ethical assessment of intensive care.

Any evaluation of intensive care must include an ethical assessment of that technology. This allows us to consider the use of technology in light of the ends that we desire. The most pressing ethical issues in intensive care are: forgoing life-sustaining treatment, dehumanization of patients and staff within the technological environment, and the allocation of the technology that is integral to intensive care.

Consensus

Centerfold. An essay on excitement.

A woman who poses for soft-core pornography reports that she has never felt she belonged to her body, that she is and wants only to be an erotic product manufactured by a team of specialists for the use of a viewing audience of males, that since age 5 she has been a nude dancer, and that she has no other material existence except in this form. She is, then, a fetish. Her success illustrates the hypothesis that erotic daydreams in pronography represent fantasies of revenge in which the consumer imagines he is degrading--dehumanizing--women.

Adult

Naturalistic studies of aggressive behavior: aggressive stimuli, victim visibility, and horn honking.

Three studies extended laboratory research on aggression to a naturalistic setting which involved horn honking from drivers as a measure of aggression; the studies were adapted from Doob and Gross. The results from a survey (Study 1) of 59 drivers suggested that they were frequently irritated by and aggressive toward other drivers. A second study (using a 3x2 factorial design with 92 male drivers) indicated that manipulations of a rifle in an aggressive context and victim visibility (dehumanization) both significantly influenced horn honking rates subsequent to obstruction at a signal light. A third study with 137 male drivers and 63 female drivers examined the interactive effects of a rifle, an aggressively connotated bumper sticker, and individual subject characteristics (sex and an exploratory index of self-perceived status) on horn honking. The results for three studies in naturalistic settings offer possible extensions of laboratory based findings on aggression. The role of inhibitions in modifying the pattern of results was also discussed.

Aggression

The ophthalmologist's office: planning and practice. Patient traffic flow and use of paramedical personnel.

In order for the ophthalmologist to achieve the greatest earning power and personal satisfaction, he or she must devise traffic flow techniques that efficiently allow for maximum utilization of all examining areas and paramedical personnel in the office without dehumanizing patients. By delegating as much responsibility as possible to staff, the ophthalmologist will have the opportunity of performing his or her specialized skills to the fullest extent, and therefore will achieve optimal personal gratification. This emotional reward indemnifies the future of private practice, because it can exist only in the presence of a close patient-physician relationship, which is the cornerstone of the private practice of ophthalmology.

Ophthalmic Assistants

Women's attitudes toward gynecologic practices.

Seventy-five female students and faculty members at a community college completed a questionnaire exploring their attitudes toward gynecologic procedures, their physicians, and the discussion of sexual concerns. Eighty-five percent reported negative feelings toward the pelvic examination (anxiety, vulnerability-humiliation, and dehumanization). Forty-one percent expressed negative feelings toward their physician's behavior, while 43% reported positive feelings. Seventy-two percent would not discuss sexual concerns with their physicians. A large percentage of recommendations (87%) addressed themselves to the doctor-patient relationship rather than to procedural matters (29%). These findings recommend serious self-scrutiny and behavior change on the part of physicians. Specific recommendations to alleviate the current situation are provided by the authors, and suggestions are made for incorporating the findings into educational environments.

Attitude

Disaster at Buffalo Creek. Family and character change at Buffalo Creek.

Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.

Character

Helping Holocaust survivors with the impact of illness and hospitalization: social work role.

Illness and hospitalization can trigger intense reactions for Holocaust survivors and their families which derive from the brutal and dehumanizing experiences they endured during World War II. Some characteristic problems and reactions to illness and hospital care they and their families experience are reviewed, as are indicated social work interventions based on crisis theory.

Adaptation, Psychological