LETTERS
TO
tion,
me---an
and
continuation
THE
of
various article.
EDITOR
ex-U.S. the
Army
physician-may
“suspiciousness
organizations
and
in Bangkok
represent
hostility”
which
a
between
I referred
the
to in my
REFERENCE
(January 1975 issue). forth in that article,
L, LangnerTS,
Michael
ST. et al: Mental
Health
in the Me-
New
York,
McGraw-Hill
Book
Co.
1962
GEORGE
in
of patient
this
area
K0JAK,
M.D.
Somatopsychic
with that
the conclusions more
should
than
The
a case
of mine,
twice
what
best of the public
load
per
and
I charge.
outpatient
professional
their
that
John
“Mental (February tecting havioral dramatic adults
For ferred
Gatewood,
costs
The task
per
patient
force
report
R0NAI.u
Symptomatology M.D.,
Changes Associated 1975 issue) brought
and
associates
in their
clinics hour
cited
well
as children
and
example, several for psychotherapy
with Hyperparathyroidism” to mind the importance of de-
adolescents.
years ago a 14-year-old girl by the guidance department
school because she was obnoxious, undisciplined, quarrelsome, and inattentive in class. The parents
her behavior
at home
had deteriorated
was reof her
hyperactive, reported that
in the previous
6 months
and that she was extremely touchy, suspicious, and a “pain in the neck.” The change in her personality had occurred both in school and at home in a relatively short period of time. In the written report that I received prior to seeing her, it was also stated that she constantly opened the windows at home and at school, even though it was winter at the time. The mother complained that the patient ate voraciously and without concern for other people in the family.
The patient and her eyes
was tall, thin, and agitated. Her speech was rapid bulged. Her pulse was racing (180 a minute), and
there was a noticeable tremor of her hands. confirmed severe hyperthyroidism. Medication suffice and she required surgery. Postoperative follow-up showed an excellent return
to
premorbid
behavior
for psychotherapy other than help put things in perspective.
and
function.
Laboratory alone
did
tests not
with
was
and no
need
the family
to
I believe that psychiatrists must always be aware of somatic illnesses as a possible etiological factor in mental disorders as
well as in behavioral difficulties in children, adolescents, and adults. This is why I oppose the abolition of the internship for future psychiatrists. I believe that a medical internship provides a clinical experience which can make a significant difference in the psychiatrist’s diagnostic skills. LEON
TEC,
Norwalk,
On the Advantages SIR:
try and
Private
668
I was pleased Accountability:
Practice”
of Private
by Steven
A m J Psychiatry
M.D. Conn.
Practice
to see the article A Response
entitled “Private to the APA Task
Sharfstein,
132:6. June
M.D.,
1975
Research
on Chinese
A.
SHELLOW,
M.D.
and
F/a.
PsychiaForce on
associates
Health
Care
SIR: I was pleased by the appearance in the Journal of “ Psychiatnic Training and Practice in the People’s Republic of China” by Philip D. Walls, M.D., and associates (February 1975 issue). There is no doubt that China offers important alternatives to Western definitions and treatment of mental illness.
Most
of the firsthand
accounts
of visits
to China
by U.S.
mcdi-
cal personnel published in the past three years have been limited to descriptions of visits to China’s major cities and larger institutions. As I have suggested elsewhere ( I ), it is now appropriate to venture beyond these descriptive accounts to a more basic analysis.
The
and the definition
plored.
middle
and
cultural, social, and treatment
lower
levels
of
the
health
care
and political variables relevant of mental illness remain largely
I wish to describe
three
areas
I consider
system
to the unex-
crucial.
First, although the Chinese medical care system emphasizes primary contacts at the periphery of the system, these are the areas about which we know the least (with the exception of descniptive material on the “barefoot doctors”). We lack studies
of pathways with
to treatment
reference
Second, adjustment There
a few sessions
are
four
article
somatopsychic phenomena. The mental changes and bemanifestations secondary to organic disease can be so that they overshadow the primary source of illness in as
said
is approxi-
Miami, SIR:
set be
failures of the private sector--but the public sector of psychiatry had made no further progress to solve these failures of patient care. I therefore wish to stress the conclusions of Dr. Sharfstein and associates that “ it is premature at this time to assert the superiority of private care over public care” --a possible exception to this being the areas ofcost and personnel efficiency.
Wash.
Editor’s Note: I plan to address questions ofJournal selection procedures and editorial policy such as those raised in Dr. Stewart’s letter in an editorial in a forthcoming issue.
Recognizing
service. have
one-third
more
Seattle,
me
of the private practice of psychiatry. over a 10-year period of full-time practice has been approximately 300 patients-the same as that reported in the task force report. I am presently charging $40 per
mately tropolis.
I agree to
concerning the advantages My average case load
hour I. Srole
Although it seems
to mental
while
it has
and
referral
within
the organization
illness. been
stated
(by
Walls
and
associates
and
others) that no one consistent theory of mental illness is accepted by the Chinese, the boundaries between their conceptions of types of deviance-criminal, political, and psychiatric -have not been explored. Analysis in this area should center on the influence of current conceptions of deviance on the actions of professional groups and the general population. Third, we know sadly little about the mental health of the vast majority of Chinese, who have no contact with the few trained mental health workers. Data have related to the eradication of certain forms of mental and social pathology (e.g.,
drug
addiction
and prostitution)
and to the diagnosis
and treat-
ment of the severely ill. China is a particularly interesting case because of its policy of intense social integration and political awareness and its continuing social and cultural revolution. One possible study would be an application of our current literature on life events and symptomatology to segments of Chinese society undergoing relocation from urban settings to the countryside. Restrictions on travel and on access to records make it difficult to study China. However, many American authors have acknowledged the cooperation and interest of the Chinese in their
TO
tion,
me---an
and
continuation
THE
of
various article.
EDITOR
ex-U.S. the
Army
physician-may
“suspiciousness
organizations
and
in Bangkok
represent
hostility”
which
a
between
I referred
the
to in my
REFERENCE
(January 1975 issue). forth in that article,
L, LangnerTS,
Michael
ST. et al: Mental
Health
in the Me-
New
York,
McGraw-Hill
Book
Co.
1962
GEORGE
in
of patient
this
area
K0JAK,
M.D.
Somatopsychic
with that
the conclusions more
should
than
The
a case
of mine,
twice
what
best of the public
load
per
and
I charge.
outpatient
professional
their
that
John
“Mental (February tecting havioral dramatic adults
For ferred
Gatewood,
costs
The task
per
patient
force
report
R0NAI.u
Symptomatology M.D.,
Changes Associated 1975 issue) brought
and
associates
in their
clinics hour
cited
well
as children
and
example, several for psychotherapy
with Hyperparathyroidism” to mind the importance of de-
adolescents.
years ago a 14-year-old girl by the guidance department
school because she was obnoxious, undisciplined, quarrelsome, and inattentive in class. The parents
her behavior
at home
had deteriorated
was reof her
hyperactive, reported that
in the previous
6 months
and that she was extremely touchy, suspicious, and a “pain in the neck.” The change in her personality had occurred both in school and at home in a relatively short period of time. In the written report that I received prior to seeing her, it was also stated that she constantly opened the windows at home and at school, even though it was winter at the time. The mother complained that the patient ate voraciously and without concern for other people in the family.
The patient and her eyes
was tall, thin, and agitated. Her speech was rapid bulged. Her pulse was racing (180 a minute), and
there was a noticeable tremor of her hands. confirmed severe hyperthyroidism. Medication suffice and she required surgery. Postoperative follow-up showed an excellent return
to
premorbid
behavior
for psychotherapy other than help put things in perspective.
and
function.
Laboratory alone
did
tests not
with
was
and no
need
the family
to
I believe that psychiatrists must always be aware of somatic illnesses as a possible etiological factor in mental disorders as
well as in behavioral difficulties in children, adolescents, and adults. This is why I oppose the abolition of the internship for future psychiatrists. I believe that a medical internship provides a clinical experience which can make a significant difference in the psychiatrist’s diagnostic skills. LEON
TEC,
Norwalk,
On the Advantages SIR:
try and
Private
668
I was pleased Accountability:
Practice”
of Private
by Steven
A m J Psychiatry
M.D. Conn.
Practice
to see the article A Response
entitled “Private to the APA Task
Sharfstein,
132:6. June
M.D.,
1975
Research
on Chinese
A.
SHELLOW,
M.D.
and
F/a.
PsychiaForce on
associates
Health
Care
SIR: I was pleased by the appearance in the Journal of “ Psychiatnic Training and Practice in the People’s Republic of China” by Philip D. Walls, M.D., and associates (February 1975 issue). There is no doubt that China offers important alternatives to Western definitions and treatment of mental illness.
Most
of the firsthand
accounts
of visits
to China
by U.S.
mcdi-
cal personnel published in the past three years have been limited to descriptions of visits to China’s major cities and larger institutions. As I have suggested elsewhere ( I ), it is now appropriate to venture beyond these descriptive accounts to a more basic analysis.
The
and the definition
plored.
middle
and
cultural, social, and treatment
lower
levels
of
the
health
care
and political variables relevant of mental illness remain largely
I wish to describe
three
areas
I consider
system
to the unex-
crucial.
First, although the Chinese medical care system emphasizes primary contacts at the periphery of the system, these are the areas about which we know the least (with the exception of descniptive material on the “barefoot doctors”). We lack studies
of pathways with
to treatment
reference
Second, adjustment There
a few sessions
are
four
article
somatopsychic phenomena. The mental changes and bemanifestations secondary to organic disease can be so that they overshadow the primary source of illness in as
said
is approxi-
Miami, SIR:
set be
failures of the private sector--but the public sector of psychiatry had made no further progress to solve these failures of patient care. I therefore wish to stress the conclusions of Dr. Sharfstein and associates that “ it is premature at this time to assert the superiority of private care over public care” --a possible exception to this being the areas ofcost and personnel efficiency.
Wash.
Editor’s Note: I plan to address questions ofJournal selection procedures and editorial policy such as those raised in Dr. Stewart’s letter in an editorial in a forthcoming issue.
Recognizing
service. have
one-third
more
Seattle,
me
of the private practice of psychiatry. over a 10-year period of full-time practice has been approximately 300 patients-the same as that reported in the task force report. I am presently charging $40 per
mately tropolis.
I agree to
concerning the advantages My average case load
hour I. Srole
Although it seems
to mental
while
it has
and
referral
within
the organization
illness. been
stated
(by
Walls
and
associates
and
others) that no one consistent theory of mental illness is accepted by the Chinese, the boundaries between their conceptions of types of deviance-criminal, political, and psychiatric -have not been explored. Analysis in this area should center on the influence of current conceptions of deviance on the actions of professional groups and the general population. Third, we know sadly little about the mental health of the vast majority of Chinese, who have no contact with the few trained mental health workers. Data have related to the eradication of certain forms of mental and social pathology (e.g.,
drug
addiction
and prostitution)
and to the diagnosis
and treat-
ment of the severely ill. China is a particularly interesting case because of its policy of intense social integration and political awareness and its continuing social and cultural revolution. One possible study would be an application of our current literature on life events and symptomatology to segments of Chinese society undergoing relocation from urban settings to the countryside. Restrictions on travel and on access to records make it difficult to study China. However, many American authors have acknowledged the cooperation and interest of the Chinese in their
