- Email: [email protected]
Psychiatry and the general hospital: An editorial
Psychiatry and the General Hospital: An Editorial
The hospital is a place where ailing people seek and receive care. But it is much more than that. It is the common pathway for the clinical education of medical students, nurses, and virtually the whole spectrum of health professionals; it provides continuing education for the practicing physician and, indeed, increasingly serves the function of an institution of higher learning for whole neighborhoods, communities, and regions. As a social institution, the hospital is unique and complex, reflecting the traditional as well as the new. The hospital is a living litmus to political, economic, scientific, ethical, technologic, philosophic, and humanistic ferment. It is impressive that the vital function of health care is served so effectively in what, to some, may at times appear as a battlefield of ideas. Sociologists have found hospitals to be a rich resource for scientific study; authors, playwrights, and cinematographers record high drama and intrigue in medical settings. The same characteristics of hospitals that make them havens for some make them horrors for others. Indeed, the pilgrim of the Middle Ages who sought the hospitalium for protection and a night’s rest on his trying journey would hardly recognize (or perhaps even be welcome at) the technological monument which has become today’s modem hospital. The warmth, hominess, and humane hospitality of the simpler hostel may be all but obscured. It would be not only heartening, but charitable, to believe that psychiatry had found a welcome place in the general hospital as a keepsake for the easily displaced humanistic and artful side of medicine. But history suggests a less lofty and more serendipitous route for psychiatry’s inroads into the medical setting. The joining of the trickling tributary of psychiatry to the majestic mainstream
General Hospital Psychiatry @ Elsevier North Holland, Inc., 1979
of medicine has long had the character of a rivulet flowing uphill. Progress has nonetheless been made. Contributory thrusts have come from persevering liaison psychiatrists, psychosomaticians, and those who believe that the logical place for the treatment of psychiatric illness is the general hospital. World War II, perhaps less admirably, promoted psychiatry’s acceptance through its success in returning traumatized soldiers to the battlefield. In recent years, the proliferation of psychiatric inpatient units in general hospitals often seems catalyzed more by economic concerns of hospital administrators and the political pressures of deinstitutionalization than by purely humanistic concerns for the patient. Further impetus has come from the infusion of federal mandates and fundsfirst in the sixties through the Community Mental Health Act, and in the seventies through an emphasis upon primary care and family medicine. Whatever the determinants, psychiatry has clearly established its rightful role in and valid contribution to the teaching and practice of medicine. Now the potential exists for psychiatry to reach beyond the historical perspective. From its wellestablished base in the general hospital, psychiatry can move in tandem with medicine in exploring new directions in health care. Already, the emphasis upon disease prevention, health promotion, education, self-help, and pluralistic health care programs makes the general hospital more than a limited resource for episodic acute medical-surgical care. The explosion of emergency, ambulatory, and walk-in services offers a veritable supermarket of resources to the troubled person with problems of environmental, psychosocial, or physical origin. As the general hospital increasingly assumes the
1 ISSN 0163-8343i79/010001-02W2.25
D.
R. Lipsitt
role of “surrogate” family physician for many unable to find other sources of continuing care, it reaches out in response to people’s needs. The evolving health care system becomes a network embracing schools, health maintenance organizations, satellite clinics, neighborhood health centers, community programs, social agencies, doctors’ offices, and community libraries. With greater public enlightenment and integration of physical and mental health services, psychiatry has the opportunity to move medical care and education toward a biopsychosocial model with the broadest application to human needs. It is this physical, social, and psychological wholeness of the person that GENERAL HOSPITAL PSYCHIATRY will address, with a firm base in the role of psychiatry as taught, practiced, and researched in the general hospital-whether public, private, university, county, or community. Conceptually, the Journal will embody more than psychiatry in medicine, or even psychiatry and medicine, but will strive toward a suffusion of languages that elucidate human events affecting health and disease. It is the Journal’s objective to promote psychiatry’s educational imperative in the new frontiers of medicine. GENERAL HOSPITAL PSYCHIATRY extends the lessons of liaison-consultation psychiatry, the experience of the psychiatric unit in a general medical institution, and the role of psychiatry in emergency services and special care units beyond the confines of institutional walls. The Journal will
translate theory and philosophy into practice and application, confronting the complex mind-body dilemmas encountered in a variety of settings. It is in the broadest medical context that the Journal views psychiatry’s role. The general hospital is a sociocultural matrix through which psychiatry can fulfill its function. Psychiatry can promote an integrated holistic approach to health and illness, with the general hospital and its extensions serving as workshop, laboratory, institution of continuing education, and therapeutic center. Patients, physicians, students, social workers, nurses, psychologists, and many other health professionals are part of a kaleidoscopic interplay of the individual with the collective institution of medicine. The Journal will invite the interest of those concerned with the biopsychosocial interrelatedness of patients, their families, and their communities and institutions; advances in primary care and family medicine offer new opportunities for a comprehensive approach to patient care in general. The medical center, in its most humane sense, I,. . . should be a forum for social studies where problems of the body, aspirations of the soul, and needs of society are integrated into a new science of human and social engineering.“l This new Journal, GENERAL HOSPITAL PSYCHIATRY, endeavors to explore and contribute to this new science.
DON
R. LIPSITT,
M.D.
Editor-in-Chief
‘Dubos R: Human Nature: Man and His Environment, Vol. 1. Brittanica Perspectives, Chicago, William Benton, 1968
The hospital is a place where ailing people seek and receive care. But it is much more than that. It is the common pathway for the clinical education of medical students, nurses, and virtually the whole spectrum of health professionals; it provides continuing education for the practicing physician and, indeed, increasingly serves the function of an institution of higher learning for whole neighborhoods, communities, and regions. As a social institution, the hospital is unique and complex, reflecting the traditional as well as the new. The hospital is a living litmus to political, economic, scientific, ethical, technologic, philosophic, and humanistic ferment. It is impressive that the vital function of health care is served so effectively in what, to some, may at times appear as a battlefield of ideas. Sociologists have found hospitals to be a rich resource for scientific study; authors, playwrights, and cinematographers record high drama and intrigue in medical settings. The same characteristics of hospitals that make them havens for some make them horrors for others. Indeed, the pilgrim of the Middle Ages who sought the hospitalium for protection and a night’s rest on his trying journey would hardly recognize (or perhaps even be welcome at) the technological monument which has become today’s modem hospital. The warmth, hominess, and humane hospitality of the simpler hostel may be all but obscured. It would be not only heartening, but charitable, to believe that psychiatry had found a welcome place in the general hospital as a keepsake for the easily displaced humanistic and artful side of medicine. But history suggests a less lofty and more serendipitous route for psychiatry’s inroads into the medical setting. The joining of the trickling tributary of psychiatry to the majestic mainstream
General Hospital Psychiatry @ Elsevier North Holland, Inc., 1979
of medicine has long had the character of a rivulet flowing uphill. Progress has nonetheless been made. Contributory thrusts have come from persevering liaison psychiatrists, psychosomaticians, and those who believe that the logical place for the treatment of psychiatric illness is the general hospital. World War II, perhaps less admirably, promoted psychiatry’s acceptance through its success in returning traumatized soldiers to the battlefield. In recent years, the proliferation of psychiatric inpatient units in general hospitals often seems catalyzed more by economic concerns of hospital administrators and the political pressures of deinstitutionalization than by purely humanistic concerns for the patient. Further impetus has come from the infusion of federal mandates and fundsfirst in the sixties through the Community Mental Health Act, and in the seventies through an emphasis upon primary care and family medicine. Whatever the determinants, psychiatry has clearly established its rightful role in and valid contribution to the teaching and practice of medicine. Now the potential exists for psychiatry to reach beyond the historical perspective. From its wellestablished base in the general hospital, psychiatry can move in tandem with medicine in exploring new directions in health care. Already, the emphasis upon disease prevention, health promotion, education, self-help, and pluralistic health care programs makes the general hospital more than a limited resource for episodic acute medical-surgical care. The explosion of emergency, ambulatory, and walk-in services offers a veritable supermarket of resources to the troubled person with problems of environmental, psychosocial, or physical origin. As the general hospital increasingly assumes the
1 ISSN 0163-8343i79/010001-02W2.25
D.
R. Lipsitt
role of “surrogate” family physician for many unable to find other sources of continuing care, it reaches out in response to people’s needs. The evolving health care system becomes a network embracing schools, health maintenance organizations, satellite clinics, neighborhood health centers, community programs, social agencies, doctors’ offices, and community libraries. With greater public enlightenment and integration of physical and mental health services, psychiatry has the opportunity to move medical care and education toward a biopsychosocial model with the broadest application to human needs. It is this physical, social, and psychological wholeness of the person that GENERAL HOSPITAL PSYCHIATRY will address, with a firm base in the role of psychiatry as taught, practiced, and researched in the general hospital-whether public, private, university, county, or community. Conceptually, the Journal will embody more than psychiatry in medicine, or even psychiatry and medicine, but will strive toward a suffusion of languages that elucidate human events affecting health and disease. It is the Journal’s objective to promote psychiatry’s educational imperative in the new frontiers of medicine. GENERAL HOSPITAL PSYCHIATRY extends the lessons of liaison-consultation psychiatry, the experience of the psychiatric unit in a general medical institution, and the role of psychiatry in emergency services and special care units beyond the confines of institutional walls. The Journal will
translate theory and philosophy into practice and application, confronting the complex mind-body dilemmas encountered in a variety of settings. It is in the broadest medical context that the Journal views psychiatry’s role. The general hospital is a sociocultural matrix through which psychiatry can fulfill its function. Psychiatry can promote an integrated holistic approach to health and illness, with the general hospital and its extensions serving as workshop, laboratory, institution of continuing education, and therapeutic center. Patients, physicians, students, social workers, nurses, psychologists, and many other health professionals are part of a kaleidoscopic interplay of the individual with the collective institution of medicine. The Journal will invite the interest of those concerned with the biopsychosocial interrelatedness of patients, their families, and their communities and institutions; advances in primary care and family medicine offer new opportunities for a comprehensive approach to patient care in general. The medical center, in its most humane sense, I,. . . should be a forum for social studies where problems of the body, aspirations of the soul, and needs of society are integrated into a new science of human and social engineering.“l This new Journal, GENERAL HOSPITAL PSYCHIATRY, endeavors to explore and contribute to this new science.
DON
R. LIPSITT,
M.D.
Editor-in-Chief
‘Dubos R: Human Nature: Man and His Environment, Vol. 1. Brittanica Perspectives, Chicago, William Benton, 1968