Proc. 4th Congr. Int. College Psychosom. Med., Kyoto 1977 Psychother. Psychosom. 31:93-97 (1979)

On Education and Research in Ecological Medicine (Psychosomatic Medicine) Psychosomatic Medicine of the Year 2000 Nicholas Destounis Veterans Administration Hospital, Battle Creek, and Michigan State University College of Human Medicine, Lansing, Mich.

Abstract. Because advances in our field have increased the complexity of our work, I feel that the name of this discipline should be changed. I suggest a more pragmatic term, namely, Ecological Medicine. Ecological Medicine is a science relating to physiological, biological, genetic, socioeco­ nomic, cultural, etc., changes now taking place in our cosmos. It is concerned with disease and health processes of several components of the living organism, its task is to recognize, evaluate, prevent, and treat all the above variables which arc in integral part of the disease process. 1 should like to stress here that the central thinking must be a strategic one: to devise and apply means, ways, and methods for the exchange of information between those working in clinical and humanistic disciplines and of those in laboratories. In other words, I, personally, believe that the research scientists, who are working in any laboratory, cannot afford to ignore the psychological, socioeconomic and cultural factors affecting people’s health. Consequently, they must, on one hand, orient themselves in accordance with the above-mentioned demands, and collaborate with the scientists of the humanistic disciplines, on the other. Thus, in this way, only the anthropos can be thoroughly and completely investigated as a unique psychophysiological, socioeconomic, and cultural ecologic entity.

New Concepts of Education and Research in Ecological Medicine

Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 6:47:48 PM

Education - Training In this main lecture 1 shall discuss my philosophical and pragmatic concepts of how to introduce an educational-training and research program into the medical schools in order to prepare the physician of the year 2000, and in

Dcstounis

94

particular the psychiatrist, to understand the unity of the bio-physio-medical and psycho-ecological interrelationship and be capable of recognizing, evaluating and treating the whole of the anthropos. Today there is a deficit in the medical education. In my opinion, the student, in order to work effectively, must be competent in the basic principles, methods and theories underlying primarily two clinical disciplines: medicine and psychiatry, and to understand that the soma, as an open system of communication, is interacting with the exoteric cosmos and its ecological processes.

Among other things that I teach to my students and residents are that the genesis of mental illness, in addition to well-known factors, could be contributed to: (a) ecological processes which are taking place today in our cosmos (biologi­ cal, genetic, behavioral, socioeconomic and cultural, etc.), and (b) the low threshold of adaptation to these changes leading inevitably into a failure of the person’s equilibrium (1).

Syberifora in Greek is behavior.

Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 6:47:48 PM

In addition, my teachings arc specifically directed towards the following: the develop ment of human behavior; the development of biological, genetic, physiological, psychologi­ cal, sociocultural forces that influences medical-ecological disorders and the treatment of such illnesses; the interviewing skills and complexity of doctor-patient relationship; the development of psychopathology and sociopathology and the recognition of abnormal (pathological) Syberifora1; the presence, recognition of psychiatric syndromes; the treat­ ment-management of common behavioral problems as seen by nonpsychiatrists (human crises, marriage counselling, sexual dysfunctions, dying patient, etc.); the validity of research from molecular biology to research methodology, epidemiology, psychopharmacology, statistics, consultation liaison, and generally speaking, the multidisciplinary approach with the emphasis that the art of medicine should not be lost in the advancements of the scientific technology but rather the opposite; the social structure of a university general hospital (milieu) and its medical disciplines; the team approach and management of psychiatric patients on the wards of the general hospital; group process and interdisciplinary approach in the medical, surgical, pediatric services, etc.; crisis intervention with the critically ill patient and his family; family dynamics and therapy; development of skills in dealing with students, resident-physicians, attendants, nurses, and auxiliary personnel; the patient ‘management problem’; the management of 1CU patients; the referral technique; sociocultural aspects of disease; the management of the dying patient and his family; medical leadership and administration; psychotherapy within Ecological Medicine; research into psychological components of somatic disease; learning of application of psychiatry to the function of a general hospital and to the clinical conditions in medicine, surgery, obstetrics-gynecology, pediatrics and other disciplines (psychosomatic liaison-consultation).

Psychosomatic Medicine of the Year 2000

95

Methodology The consultation function of the specialist in psychiatry during the past 5 -1 0 years has become an increasingly important aspect of his professional role. In the consultation process, the psychiatric physician is in direct contact with medicine and with his non-psychiatric colleague. It is within the context of the psychiatric consultation that the liaison between psychiatry and the rest of medicine can best be maintained. In the working relationship of the consulta­ tion, the psychiatric specialist and his medical colleague meet, get to know and work with one another, and learn to understand the possibilities, the needs, and the limitations of one another. Thus, in this way, a complete, thorough, and scientific medical communication is developed. The psychiatrist’s consultation with the other helping disciplines offers many opportunities for direct and indirect service to the public too, in both treatment and prevention. Thus, in this way, the contribution of our field to social medicine is achieved (college health services, schools, the clergy, social welfare, governmental agencies, etc.). In each of these situations, the psychiatric consultant is in a unique position to further the course of prevention of psycho-socio-cultural and ecological difficulties and to foster early case findings and proper treatment. In order to learn consultation techniques, the resident physician in psychia­ try, in my opinion, should spend an extra full year (Fellowship) in training. Thus, by devoting himself exclusively to the Ecological Liaison and Consulta­ tions Service, he will be exposed to the learning of: the application of psychiatry to the function of a general university hospital, and to the clinical conditions in medicine, surgery, obstetrics-gynecology, pediatrics and other disciplines; the social structure (milieu) of the general university hospital and its medical disciplines; the psychiatric training of nonpsychiatric professionals; the broader psychiatric and sociocultural implications of disease processes and dynamics of professional groups; the clinical psychiatry, ecological disorders, psychotherapy within Ecological Medicine, as well as research into emotional components of somatic disease. In addition, the trainee will learn of the following: (a) to focus on the multiple conscious and unconscious motivations of each participant in the consultation process; (b) to recognize that the patient, the consultée, and the consultant may each have a very different motivational agenda for par­

Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 6:47:48 PM

New Concepts of Ecological Liaison (Psychosomatic) and Consultations Service

Destounis

96

ticipating in the consultation, and (c) to define the goals of the specific intervention. Research To define research is a rather difficult task. Nevertheless, I shall attempt to introduce my own definition: ‘Research is the profound concept of a careful and diligent inquiry of a scientific truth’ (2). In addition, my own concept of research is also intimately related to the development through which we are capable of obtaining specific benefits of the subject matter under investigation. The success of any scientific endeavor and research depends upon the following factors: the investigator should remain on alert, by seeing, thinking and reviewing; it should always be a recognition and identification of the research objectives; the researcher should be in a position to formulate one protypon and with enough imaginative theoretical thinking; the investigator should be capable of forming (shaping) new ideas which he must check out experimentally; any research endeavor must be based upon specific methodology which will allow the analysis of the obtained data; the researcher should be in a position to develop healthy interpersonal relationships with his co-workers.

Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 6:47:48 PM

In my research teachings with medical students and residents in psychiatry, I always stress the following major groups of studies into the medical-ecological research: the necessity of investigating the role of specific biological, genetic, and physiological factors in the etiology of a variety of human diseases; the necessity of studying research from molecular biology to community psychiatry as related to any disease process; the necessity of inquiring into the psychosocio-economic-cultural factors as related to the development of physical ill­ nesses; the necessity of studying the psycho-socio-economic-cultural factors as related to the medical-ecological disorders (psychosomatic); the necessity of investigating the effectiveness of any therapeutic protypon, from psychoanalysis, milieu therapy, behavioral modification, etc., of the medical-ecological disorders (psychosomatic). It has been always my view that most of the psychiatric disorders, even acute psychotic conditions, can be treated in a general hospital. Our studies have also shown that psychiatric complications are very common among the physi­ cally ill, and that medical and psychiatric illnesses coexist in almost 80% of the patients studied in two university hospitals (AECOM, N.Y. and University of Athens, Greece) (3). From our obtained data, the striking phenomenon was that most of the medically physically ill patients were suffering from depression.

Psychosomatic Medicine of the Year 2000

97

In addition, by introducing via our Ecological (psychosomatic) Liaison-Consultations Service the concept of therapeutic community within the structure of the hospital staff, we developed the most effective and salutary milieu in which only 5-20% of the physically ill psychotic patients had to be transferred to the psychiatric unit. The rest - 80-95% - were treated in their private rooms or wards of the nonpsychiatric services (medicine, surgery, obstetrics-gynecology, neurology, neurosurgery, pediatrics, etc.).

This new concept of approach demonstrates very adequately the validity of the Ecological (psychosomatic) Liaison and Consultations Service, and its con­ tribution to the whole of the field of medicine. Psychiatric Nurse The role of the psychiatric nurse in the Ecological (psychosomatic) Liaison and Consultations Service is unquestionable and invaluable. I should like to propose here my own concept: The psychiatric liaison nurse is a professional nurse prepared to work intimately and collaboratively with other professionals in the Ecological (psychosomatic) Liaison and Consultations Service, and be capable of meeting the psychological-emotional needs of the patients and of their families.

References

2 3 4

Destounis, N.: On teaching psychosomatic medicine to medical students. Paper read at the 1st Congress of the International College of Psychosomatic Medicine, Guadalajara 1971. Destounis, N.: On biomedical research. Paper read at the Regular Meeting of the Hellenic Society of Psychosomatic Medicine, Athens 1973. Destounis, N.: Depression - its recognition and treatment. Paper delivered at the University of Athens, Athens 1970. Destounis, N.: Aggression: culture and psychosomatic medicine. Proceedings of the 2nd Congress of the International College of Psychosomatic Medicine, Amsterdam 1973. Psychother. Psychosom. 24: 123-125 (1974).

Prof. N. Destounis, MD, PhD, Veterans Administration Hospital, Battle Creek, Mich. (USA) Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 6:47:48 PM

1

On education and research in ecological medicine (Psychosomatic medicine). Psychosomatic medicine of the year 2000.

Proc. 4th Congr. Int. College Psychosom. Med., Kyoto 1977 Psychother. Psychosom. 31:93-97 (1979) On Education and Research in Ecological Medicine (Ps...
440KB Sizes 0 Downloads 0 Views