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TO THE EDITOR: The Research Committee of the Group for the Advancement of Psychiatry (GAP), a specialty think tank,has addressed psychiatry’s need for a unifying scientific foundation. Such a foundation would consider the disorders commonly treated by psychiatrists in terms of the physiolog

Because of the widely varying symptomatology seen in the neuroses, questions have been raised about whether they constitute a realistically defined category of illness. The authors followed 4074 Navy enlisted men diagnosed as neurotic between 1966 and 1969 and compared disposition decisions and posthospital outcomes for four major neurotic subtypes (anxiety, hysterical, depressive, and phobic-obsessive-compulsive). Neurotic patients as a group were also compared with patients in other diagnostic categories. Although posthospital outcomes were found to differ among the four neurotic subtypes, the differences were not large when compared with the differences between the neuroses as a group and other major diagnostic categories. Those findings suggest that the neuroses are a distinct group with regard to outcome, and that the use of this diagnostic category should not be abandoned without further study.

Although the development of psychiatric residents has been studied extensively, continuing changes in psychiatrists after graduation from training have not. The authors present results of a survey research study of 263 psychiatrists recently graduated from a wide variety of training programs. The psychiatrists reported alarming symptoms of stress during this period, yet they used effective coping mechanisms and perceived themselves as increasing in growth, mastery, and confidence. Their overall contenment with their personal and professional lives effective coping mechanisms were those involving the establishment of support systems with loved ones.

In order to cope with the accelerating rate of change in health care, new strategies must be considered. Vertical integration as one such strategy is discussed by the author with specific reference to psychiatric services for youth.

The authors assess the advantages and disadvantages of data systems in child psychiatry. After careful review of this topic, the authors conclude that the use of standardized collection of clinical data, computer storage of those data, standardized methods of documentation of treatment offered, and standardized methods of documentation of outcome will all be used increasingly in the future.

The ability to predict both homicidal and nonmurderous violent behavior would theoretically be helpful in some types of crime. 1 Considerable efforts have been made in this direction. Statistical studies, although they are not helpful in individual prediction, show that violent behavior is more likely to occur in the mentally ill who have been chronic patients in psychiatric hospitals than in the population at large. 2 Adult crime is said to be more likely in those who as children showed a triad of enuresis, firesetting, and cruelty to animals, but this syndrome is not present with greater frequency in violent than nonviolent individuals. 3 It has been generally agreed that dangerous acts cannot be predicted in a person who has not acted in a dangerous way. 4 However, recognizable homicidal characters have been shown on the stage ("Lorenzacchio," A. de Musset). Most psychiatric literature attempts from retrospective studies to deduce what ought to be sought to make the prediction of homicide possible, but recently some psychological tests on prisoners have been shown to have a predictive value indicating the possibility of violent behavior, s A study of ten adolescents, nine boys and one girl, in whom a prediction of murderousness was made, describes definable syndromes in which the attempted murder of another human being is more or less inevitable.

The authors surveyed psychiatric residency programs to see what educational resources were available to residents assigned to provide emergency services during evening and nighttime hours. Almost half the sample of 89 programs assigned first-year residents to provide emergency care. The primary immediate means of support for the residents was telephone assistance, in 49 per cent of the programs, or the presence of a non-psychiatrist professional, in 35 per cent. The general lack of educational resources reflects the traditional dispositional model of emergency psychiatry, the authors say, with its emphasis on briefly evaluating the patient and referring him elsewhere for services; current training practices cannot meet the goals of the crisis system model in which a comprehensive treatment program is begun in the emergency room.

Adopted children suffer an increased incidence of psychopathology and are therefore commonly seen in consultation and treatment. Due to current trends making it increasingly possible for adolescents to locate their biologic parents, therapists must respond by at least considering the involvement of the biologic parent in the treatment. In certain carefully selected cases of severely disturbed and very resistant youngsters, it may be the participation of the biologic mother which is crucial to the adolescent's working through a common, core intrapsychic psychopathologic configuration involving idealization of the lost biologic mother and splitting of object relations. A case is presented as an example of how such an approach can be helpful.

The authors describe the efforts made to meet the mental health needs of Vietnamese children and their families in a large refugee camp. Many of the children received strong emotional support from the multigenerational Vietnamese families, and they adapted well to the new environment. However, children separated from their families demonstrated increased emotional vulnerability, and foster placement of children without families presented a serious problem. The authors suggest that our national commitment to these refugees may have ended when they left the confines of the refugee camp.

The authors suggest that there are a number of shortcomings in DSM-II's classification system for psychophysiologic disorders, which lists this group of disorders as a distinct group of diseases different from other organic diseases. They propose a new, multiaxial method of classification in which the clinician could indicate the role of psychological factors in the initiation, exacerbation, or maintenance of any physical disorder. This method would make it possible for the first time in psychiatric nomenclature to indicate a clinical judgment of the importance of psychological factors in all physical disorders rather than focusing on a small group of illnesses traditionally regarded as psychosomatic or psychophysiologic.

Although community consultation is common for psychiatrists, such activity is usually carried out on an elective rather than emergency basis. In a world troubled by community disaster situations—children are often at risk. Psychiatrists, through the use of skillful crisis consultation, can be of great help to these young people. This report describes the efforts of a mental health consultation team to meet the needs of a large population of children under acute stress.

Drawing on their experience, the authors explore the opportunity for learning administrative process that is available to the psychiatric chief resident. They categorize six models of the psychiatric chief residency and document two of them, the ward chief and the interface chief, as providing particularly rich administrative experiences. Although the chief resident's administrative experience is only a preliminary one, it can be a first step in solidifying his identity as a clinician-executive.

The authors provided psychiatric consultation to medical personnel in charge of a Vietnamese refugee camp in California. Although the emergency measures that supplied clothing, food, shelter, and medical care to nearly 60,000 refugees were immensely successful, consultation was requested to assist with selected mental health problems. The recommendations of the consulting team were related to the stage of camp development: early recommendations concerned easing adaptation to the camp setting; later efforts included creating a psychiatric crisis clinic and carrying out a mental health survey on a random sample of refugees. The results of this survey helped camp directors to understand how refugees responded to the camp experience. Language: en

(1974). Flight from Autonomy: Problems of Social Change on an Adolescent Inpatient Unit. Psychiatry: Vol. 37, No. 4, pp. 360-371.

Adolescents referred for clinical assessment may present a kaleidoscopic variety of symptoms having many meanings. The literature that debates the meaning of symptoms in adolescents is reviewed briefly, and an approach to assessment is outlined. The conceptual approach is illustrated by clinical vignettes.

Troubled children of divorced families represent a substantial portion of clinical practice. Adolescent development involves regression with a propensity for movement into relationships characterized by splitting. Parental divorce and continued conflict may exaggerate this process as the adolescent finds it far too easy to perceive one parent as right (gratifying) and the other as wrong (frustrating). A multistage treatment program is outlined involving the divorced parents together with the adolescent. Indications and contraindications are discussed.

The validity and usefulness of the diagnostic category transient situational disturbance were evaluated by studying the course and outcome for 2,078 hospitalized naval personnel. The condition was found to be less severe and disabling than other major psychiatric disorders in terms of chronicity, length of hospitalization, and disposition. Outcomes in terms of rehospitalization rates and work effectiveness also were relatively favorable. Based on three or more years of follow-up, a substantial proportion of patients originally diagnosed as having a transient situational disturbance subsequently manifested personality disorder problems. The results suggest that clearer criteria are needed to define situational disturbances operationally and to identify patients with underlying personality disorders.