bluuebunny/crossref_metadata_2025 huggingface dataset:
Aversion Relief: An Alternative to Systematic Desensitization in the Treatment of Phobias
Authors: Solyom L. , Heseltine G. F. D. , Mcclure D. J. , Ledwidge B. , Kenny F.
Published: April 2017

Twenty phobic patients, divided equally into two matched groups, were treated by using either aversion relief or systematic desensitization. Improvements were measured using a combination of psychiatrists' ratings, psychometric tests, self-assessments of phobias, neurotic symptoms and social adjustment.

The two groups showed significant benefit after twelve hours of treatment. Improvement rates were similar for both therapies and increased in each case after a further nine hours of treatment. Improvement was more pronounced in phobias, less in other neurotic symptoms and negligible in social adjustment.

Careful assessment of untreated fears was made to test for symptom substitution. On the contrary, both groups showed a generalization of effect, paralleling the decrease in intensity of the main phobia.

In addition a study correlating thirty-six variables with the outcome of treatment suggested prognostic indicators for each treatment.
Rating the Magnitude of Life Stress
Authors: Paykel E. S. , Uhlenhuth E. H.
Published: April 2017

Three hundred and seventy-three subjects were rated on a scale of 0–20 — the degree to which each of 61 life events was regarded as upsetting. Mean scores for the events ranked in a significant way from catastrophic events such as death of child or spouse at the top end of the scale to trivial or desirable events at the bottom. There was substantial agreement between different sociodemographic groups and acceptable overall individual variation.

In a pilot study of validity, scores were examined for two classes of events — exits and entrances from the social field. A previous controlled study had indicated an excess of exits but not entrances preceding clinical depression. In keeping with this difference, scale scores for exits were found to be high and for entrances low with only minimal overlap. A small study using an alternative scaling concept of adjustment to life change suggested that the scale based on upsetting was more valid for depression.
Speed in Test Performance in Relation to Depressive Illness and Age
Authors: Weckowicz T. E. , Nutter R. W. , Cruise D. G. , Yonge K. A.
Published: April 2017

The performance of depressed and non-depressed subjects in three age groups was compared on speed and power cognitive and psychomotor tests. It was found that even when the groups were equated on the level of education, depressed and older subjects tended to perform more poorly than controls on speed tests. The performance on the power tests was affected to a lesser extent. Eyelid conditioning carried out on the subjects indicated that there were no differences amongst the groups in conditionability, nor was the latter related to the speed and power measures. The ‘alpha’ factor analyses confirmed the hypothesis that power and speed tests load on separate factors. The general implications of this study are discussed.
An Animal Model for Psychopharmacological Research with Relevance to Psychiatry
Authors: Peachey John E. , Stancer Harvey C.
Published: April 2017

The concept is presented that animal models for psychopharmacological research should take into account clinical methods if they are to yield information which is relevant to psychiatry. Animal species with appropriate behavioural characteristics should be selected, drugs should be administered chronically and groups of animals should be used if social interaction is to be observed. Some of the relevant pharmacological, behavioural and environmental factors are presented and illustrated with examples taken from a study on groups of squirrel monkeys who had received parachlorophenylalanine or alpha-methylparatyrosine to lower specific brain amines. It is noted that social interaction may affect the expression of the drug effect.
Considerations Pratiques Sur La Therapie Familiale
Authors: Solomon Martin-L.
Published: April 2017

This paper, directed to family therapists in training, presents a practical analysis of family therapy process in an attempt to establish a framework for understanding family therapy regardless of the individual therapist's personality, techniques or theoretical formulations. The therapist's role and family change are seen within the context of three distinct stages: the Confrontation Stage during which the therapist deals with the ‘here and now’ of family interaction; the Interpretation Stage in which current interaction is linked to past conflict; and the Separation Stage where the family works through termination of therapy. The resistances used by the family to prevent change and to maintain its pathologic equilibrium are categorized as Resistance to Therapy, Resistance to Interaction and Family Specific Resistances. The discussion deals with the increasing diversity of family therapy as families of widely different pathologies and social backgrounds are accepted in treatment, requiring continual adaptation of therapeutic techniques and goals as well as specialized methods (such as videotape and role-playing) for teaching inexperienced therapists to handle a complex range of practical problems.
A Therapeutic Community for Persistent Offenders: An Evaluation and Follow-up Study on the First Fifty Cases
Authors: Angliker Colin C.J. , Cormier Bruno M. , Boulanger Paul , Malamud Betty
Published: April 2017

This is an evaluation of the first 50 persistent offenders admitted to the Clinton Diagnostic and Treatment Center (New York) where the method of treatment was re-education and resocialization through the development of relationships. The men were observed over sixty-four months, and their adjustment in liberty following release from the Center was compared with a control group who served their sentences in other prisons. The results showed that although the rate of recidivism was comparable in the two groups, there were qualitative differences both in personal adjustment and in the types of violation; the experimental group violated more frequently on technical grounds, whereas the control group had a higher incidence of new arrests.

Mention has been made of the problems of evaluating and comparing such a group with a control group. As the aim of a therapeutic community is to make each individual aware of his behaviour and thus gain insight and motivation to seek help, each individual should act as his own control. Success or failure cannot be measured only by the presence or absence of recidivism; if these men seem happier with their lot, less alienated and succeed in maintaining themselves in freedom (either permanently or for longer periods of time than hitherto) this in itself could be a better indication of success than the legal criterion of whether or not they recidivated.
The Use of Psychoactive Drugs by Adults
Authors: Fejer Dianne , Smart Reginald
Published: April 2017

A survey of psychoactive drug use was conducted among 1,200 adults in Metropolitan Toronto. The sample chosen compared well in age and sex characteristics to the census figures for this area. The overall rate of prescription for psychoactive drugs, the use of tranquillizers, barbiturates and stimulants and various social, demographic, health, and psychological characteristics were investigated. Data indicated that 23.8 percent of the sample had at least one prescription for psychoactive drugs in the last year. Most with prescriptions were females. Young persons (18-19) had fewer prescriptions than those over 60. The estimated prescription rate for the area was 76 per one hundred adults, which was slightly lower than that found in other American and Canadian studies.

Tranquillizers were the most commonly used of the psychoactive drugs (12.7 percent) followed by barbiturates (8.6 percent). Only a small proportion of the sample (3.6 percent) used stimulants.

Tranquillizer use involved primarily females from varying backgrounds. Barbiturate users tended to be older and have unhappy marital histories. Stimulant users were young males and females. Except for stimulant users almost all users of these drugs obtained them by prescription.

Barbiturate and tranquillizer users tended to have poorer health than non-users but stimulant users did not. Users of each drug had received treatment for psychological problems more often than non-users, but no significant differences between users and non-users were found on the EPI. For a large proportion of the using population the use of these drugs seemed to be related to some medical or psychological problems, but this was not the case for an almost equally large number. Research is needed to discover the reasons for psychoactive drug use among this apparently healthy segment of the population.
Chlordiazepoxide in Depressive Neurosis: An Open Label Cross-over Study with Amitriptyline
Authors: Kellner Robert
Published: April 2017

Sixty-five depressed outpatients were treated in an open label cross-over study of chlordiazepoxide and amitriptyline. The treatment was changed only in those patients in whom the response to the first medication was inadequate. Global rating and self-rating scales were compounded into a rating of treatment preference.

For the group as a whole chlordiazepoxide appeared to be more effective than amitriptyline. The patients who responded to treatment with chlordiazepoxide tended to show reactivity, symptoms of anxiety or tension and were not retarded.

Chlordiazepoxide appeared to be more effective in patients who were initially diagnosed as suffering from exogenous depressions, whereas amitriptyline appeared to be more effective in those with endogenous depressions.

The findings suggest that in a large proportion of depressed patients it is possible to predict from their clinical features which class of psychotropic drugs is likely to be more effective.
Involuntary Sterilization of the Mentally Retarded
Authors: Gibson David
Published: April 2017

The rise and fall of legislation governing the involuntary sterilization of the mentally retarded in Canada is traced. Some origins of the continuing eugenics debate are identified with a view to clarifying the issue towards more rational solutions.
Some Etiological Factors in Phobic Neurosis
Authors: Solyom L. , Beck P. , Solyom C. , Hugel R.
Published: April 2017

A group of 47 phobic patients (92 percent agoraphobic and 8 percent specific phobics) were matched with the same number of controls on age, socio-economic status and education. All subjects were assessed by two independent psychiatrists, on psychometric tests (IPAT, FSS) and on self-assessment of neurotic symptoms and social maladjustment. Among the control group 40 percent were found to have specific phobias and 5 percent agoraphobia; the severity of both being much below that of the patients. The rate of incidence of other neurotic illness (obsessions, alcoholism, depression, and so on) in the families of phobic patients was higher than in the control group. Mothers of phobic patients had a higher incidence of phobic neurosis and were more frequently described as overprotective than were control mothers. Childhood fears were more frequent among the phobic patients (slightly obsessive, worried persons) long before the onset of the phobic neurosis. On the IPAT anxiety scale and on the FSS, agoraphobic patients scored higher than the specific phobics, who scored higher than the controls. Specific phobias in both patient and control groups seemed to have begun in childhood and persisted until treatment.

On the other hand, agoraphobia developed much later, and half the patients reported temporary remissions. Other neurotic symptoms (hysterical signs, obsessive symptoms, and so on) while clinically unimportant, were still significantly more frequent in the phobies than in the control group. The agoraphobic syndrome showed surprising uniformity from patient to patient.

It was postulated that agoraphobia is due to reactivation of separation anxiety, while specific phobias develop as a conditioned fear response.
Day Treatment: innovation reconsidered
Authors: Goodman Marvin
Published: April 2017

Innovation of an atypical program involves complex ramifications as exemplified by the establishment of a day treatment service for children within a traditional mental health clinic. While implementation of such a service affords increased program variability, detailed implications and results have not been examined. Examples of areas considered are: program components; evolvement of staff roles and functions; variables pertaining to their interdependence and communication; specific organizational outcomes; and staff readiness. These areas are potentially problem-laden, requiring intricate examination and understanding. In the development of any new program, a major deterrent to the achievement of objectives is the tendency to compromise over ideals, because of staff resistance to risk and change.
The Parents of Stuttering Children
Authors: Quarrington Bruce
Published: April 2017

Reappraisal of the literature dealing with the personality, attitudes, and behaviour of the parents of stuttering children suggests they are characterized by low social dominance, and points to the mothers of beginning stutterers as particularly permissive and/or passive regarding the shaping and control of the developing child's behaviour. While instructional passivity appears to persist in the mothers of chronic stutterers, the emergence of specific punitive attitudes is also noted.

The possible roles of instructional passivity and punitive parental reactivity in the precipitation and maintenance of stuttering behaviours are considered briefly.
Classification of Mental Illness: The Value of Certain French Nosological Concepts
Authors: Jones Gerald C.
Published: April 2017

The thesis of this paper is that a reintroduction of the concepts of psychosis derived from French psychiatry would be of value in terms of clinical precision, research and treatment.

The relatively few diagnostic entities employed in North America in the classification of psychoses other than depressive and organic is contrasted with a more extended French nosological system.

The demonstrated usefulness of the precise classification of depressive syndromes suggests that similar discrimination applied to other psychoses would be a promising area for research.
Notes on Five Years of Office Consultations in Psychiatry
Authors: Hunter R. C. A.
Published: April 2017

The statistical characteristics of 169 patients referred for office consultation over five years have been presented, and compared with the 1971 community mental health clinic statistics of the Province of Ontario. Some of the less well-known factors in managing such a practice are discussed.
Prevalence of Psychiatric Disorders in a Southern Baffin Island Eskimo Settlement
Authors: Sampath H. M.
Published: April 2017

The only evidence we have that mental disorders occurred in the Eskimo population prior to Euro-Canadian contact is the reports by the early explorers of the “pibloktoq” syndrome and the reminiscences of the older surviving Eskimos (13). This study shows not only that most of the major mental disorders do exist in contemporary Eskimo settlements but also that their prevalence is high when compared to the rates found in southern communities. Furthermore, etiological implications would appear to revolve around changes in the social organization which are the result of the modernization process now taking place in the Arctic.
Why We Have to Say Good-Bye: A Psychological Examination of a Social Custom
Authors: Forrester Roland
Published: April 2017

Beginning with the analysis by Freud of a game first played by a small boy, the author illustrates his theme of separation anxiety by a clinical vignette, the work of Ronald Fair-bairn and his experience with psychiatric residents.

Theories of separation anxiety are examined and the essay is concluded with another clinical example, demonstrating the ambivalence present in all relationships, and with a series of nine propositions which analyse the determinants underlying the compulsive quality of saying good-bye when two or more people separate.
Practical Application of Mental Health Consultation Techniques: A Description of Four Programs
Authors: Fine Stuart , Krell Robert , Stephenson P. Susan , Freeman Roger , Berlin Irving
Published: April 2017

A brief definition of the consultation process is presented. Four different consultation programs (to schools, to a public health unit, to agencies for the handicapped and to a welfare agency) are described and the value of this process in providing service is stressed. Some indication of how the consultation process can be taught is mentioned and the need for more research and evaluation is emphasized.
Monthly Intermittent Chemotherapy of Chronic Schizophrenic Outpatients with Pipothiazine Palmitate
Authors: Laurent Jacques St. , Carle Roger , Dumais Bernard , Domingue D.
Published: April 2017

A long-term open study of a new sustained action neuroleptic was undertaken in 23 chronic schizophrenic outpatients. Pipothiazine palmitate (R.P. 19,552) was administered by intramuscular injection at an average dose of 100 mg every four weeks.

Psychiatric assessments revealed that the drug provided good control of psychotic symptomatology, and there were indications that patients responded better to the test medication than they did to their standard oral antipsychotic maintenance therapy.

Extensive laboratory and functional tests demonstrated that the drug is well tolerated. Local tolerance at the site of injection was also satisfactory. Side effects were generally not serious and included primarily somnolence, tremor, akathisia and blurring of vision. A few patients became more depressed but were easily controlled by a tricyclic medication; while somewhat surprisingly others appeared to show an improvement of certain depressive manifestations.

As the drug demonstrated its capacity to control psychotic symptoms with low dosages over an extended period of time, it is suggested that a double-blind study comparing this drug with other neuroleptics is warranted. It appears that pipothiazine palmitate may be an efficient form of maintenance therapy for ambulatory patients. In some patients intermittent therapy with pipothiazine palmitate would offer a viable alternative to continuous high-dosage oral medication.
Evaluation Des Effets Secondaires Chez Les Nevrotiques - Un Essai Avec La Mesoridazine: Et Le Placebo
Authors: Lapierre Y. D.
Published: April 2017

The incidence of side effects following administration of mésoridazine and placebo was studied in a neurotic outpatient population using an open questionnaire and a symptom check-list. Men on mésoridazine reported more side effects with a symptom check-list than on the questionnaire. This difference was not significant in women. More symptoms were elicited with a check-list while the patients were on the drug than by questioning. These side effects were mainly gastro-intestinal and were mild. Cardio-vascular symptoms were as frequent on placebo as on the active drug. After six weeks of double-blind administration there was no difference in the total number of side effects reported for placebo and for mésoridazine.
The Etiology of Hysterical Seizures
Authors: Standage K.F.
Published: April 2017

Four patients have been described who were believed to be suffering from hysterical attacks. The recent literature on hysterical seizures has been examined and the four new patients were added to two other reported series to provide a profile of 25 cases. Preceding or accompanying physical illness was a common finding, and 32 percent of subjects had a previous history of neurological disease. The existence of a substrate of CNS damage is supported by the finding of EEG abnormalities in 40 percent of patients.

In other ways the cases resembled classical descriptions of subjects liable to hysterical illness. The operation of either dissociative or conversion mechanisms during the attacks was difficult to demonstrate, and suggestion was sometimes the only factor found to account for the form of the symptoms. Further studies to examine the nature of the relationship between brain damage and hysterical disorders appear justified.
Possible Psychiatric Significance of Excessive Coffee Consumption
Authors: Furlong F.W.
Published: April 2017

We have seen several well-marked cases of coffee excess. … The sufferer is tremulous and loses his self-command; he is subject to fits of agitation and depression; he loses color and has a haggard appearance. The appetite falls off, and symptoms of gastric catarrh may be manifested. The heart also suffers; it palpitates or it intermits. As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery.

A System of Medicine [ 1909] (1)
The Problem Oriented System in a Multidisciplinary Psychiatric Milieu
Authors: Lowe Gordon R.
Published: April 2017

This paper outlines and discusses a conceptual model of the problem oriented system, amplified to facilitate its application to a multidisciplinary psychiatric milieu.
Electroconvulsive Therapy: Is Further Investigation Necessary?
Authors: Costello C. G.
Published: April 2017

Recent reports in the lay literature and professional house publications both have brought into question the validity of electroconvulsive shock as a therapy, and highlighted the iatrogenic effects of the treatment. The failure to complete a study of the therapeutic effectiveness of ECT is reported. The study incorporated two conditions thought to be essential for an adequate evaluation of the treatment: a placebo-ECT group; and double-blind procedures. The failure of the study revealed the difficulty of conducting to completion an adequately controlled investigation of a treatment already accepted by clinicians. Other placebo-controlled double-blind studies are reviewed, and alternative study designs are discussed.
The Multidiscipline Patient Care Conference: Learning in Groups
Authors: Berger David M.
Published: April 2017

The process of learning in groups, as exemplified by the author's experience in a multidiscipline conference on a surgical ward of a general hospital has been examined. A sequence of six developmental stages has been identified: initial ambivalence; passive-receptivity; resistance; task orientation; the work group; and consolidation. These findings have been compared with those of other studies dealing with sequential stages in group development. The psychiatric consultant's role in expediting these phases and some of the difficulties encountered have been mentioned.
Self-Induced Television Epilepsy: A Study of two Patients
Authors: Cléament Pierre , Andermann Frederick , Dongier Maurice
Published: April 2017

A unique method of deliberate self-induction of epileptic seizures, using the TV screen was encountered in two young women. Both suffered from highly photosensitive primary generalized corticoreticular or centrencephalic epilepsy. Self-precipitation developed in periods of their life when spontaneous attacks no longer occurred. The seizures consisted of absence or generalized tonic clonic attacks. (The latter are almost never encountered in ‘hand waving’, the most common form of self-induction reported in the literature.)

The seizures were almost always induced in situations of guilt and/or frustration. They were followed by a feeling of tension relief rather than pleasure. Both patients were reluctant to discuss the circumstances under which self-induction occurred, and had difficulty in accepting psychotherapy or complying with antiepileptic medication. The similarity between the two young women was striking, and suggests that patients with this and other forms of self-induced epilepsy should be more fully studied from a psychiatric point of view.
Cognitive Adaptation in Latency: The Construction of Social Reality
Authors: Elkind David
Published: April 2017

This paper looks briefly at cognitive adaptation as it pertains to the child's construction of social reality, and suggests that what sociologists call “frames” can be a useful concept for specifying what it is the child must conceptualize to deal appropriately with social situations. In addition, the concepts of deference and demeanour, the actions of an individual as actor and audience, are useful in understanding why children learn to behave appropriately in behaviour frames. Much of the paper is devoted to describing frames, suggesting some of the cognitive processes employed in their construction and to some of the behaviours resulting from inappropriate frame behaviour.

It is necessary to point out that while the frame approach to social adaptation may be useful it has limitations. It is perhaps excessively situational and does not pay sufficient attention to more abiding motivations and cognitive activities. Frame behaviour thus cannot provide a complete explanation of children's social behaviour, but it does add an important and missing dimension to the usual accounts of social behaviour. To some extent the child's behaviour is determined by the frames in which he is participating. Accordingly, the understanding of frame behaviour should add to the understanding of child behaviour in general and to the behaviour of the latency-age child in particular. For it is in the latter that failures to behave in frames are the most frequent and the most apparent, and are therefore the most likely to be misinterpreted by adults.
Disulfiram-Ethanol Reaction to Implanted Disulfiram
Authors: Wilson Allan , Davidson William J. , White John
Published: April 2017

It is postulated that a recent suggestion that the disulfiram implant technique is not pharmacologically effective may be premature. Some literature is cited in support of this contention, and three case histories of disulfiram implant patients who experienced disulfiram-ethanol reactions when they recommenced drinking are reported. It is suggested that the disulfiram-ethanol reactions to implanted disulfiram may be delayed in onset and of longer duration than those obtained from orally-administered disulfiram. Possible mechanisms are discussed.
Effets du Renforcement Positif, de la Punition et du Contrôle Du Stimulus Dans Le Traitement d'un Tiqueur
Authors: Trudel Gilles , Soulières André , Gaudette Gilles
Published: April 2017

Two procedures were used to treat tics in a psychotic patient who also had many severe behaviour problems. The first step in the treatment consisted of a technique based on positive reinforcement and punishment. Applying this technique, the tics were almost eliminated at the termination of the first session. However, the withdrawal of this technique at the thirteenth session resulted in a significant increase in the frequency of tics. A technique based on stimulus control begun at the fourteenth session and continued until termination of the treatment resulted in a progressive decrease in the rate of tics. At the seventeenth session, the withdrawal of this procedure did not cause an important increase in the frequency of tics. This technique was used until the tics disappeared entirely. A two-year follow-up revealed that the patient was free of the symptoms.
Opening Moves and Sequential Strategies in Child Psychotherapy
Authors: Mcconville Brian J.
Published: April 2017

This model of sequential psychotherapy seems to indicate a reasonable and rational approach for planning opening moves and later strategies during therapy with many different types of children. After the initial diagnostic evaluation there is a period of contractual negotiation, followed by a second stage of behavioural, interactional and affectual rehearsal, which leads into a final stage of exploration into more involved intrapsychic, environmental and intrafamilial issues. Although the complexities of the case will often suggest very complicated psychodynamic possibilities, the initial strategies are often couched in rather simple behavioural terms, and even though they become more complex as therapy progresses they still maintain their inner consistency. As the child achieves greater skills he internalizes increasing self-esteem, and is therefore able to attack the more buried, and sometimes very frightening historical instinctual and other material which then emerges in therapy. Even when such material emerges, behaviourally-based approaches often provide the best inroads into these complex interactional and intrapsychic problems.
Supernatural Influence in Psychopathology: Puerto Rican Folk Beliefs about Mental Illness
Authors: Gaviria Moises , Wintrob Ronald M.
Published: April 2017

Puerto Ricans living in urban areas of North-Eastern United States, whether patients or randomly selected residents of the community, differ very little in their conception of the causes of mental illness. They distinguish two broad categories — “craziness” (or psychotic behaviour) and “nervousness” (bad nerves), which we would categorize as psychosomatic or neurotic conditions. For both types of conditions there is believed to be a range of causative factors which can be considered either supernatural or natural. Spiritism, witchcraft, and fate are believed to be the most important supernatural causes of mental illness, and become clearly apparent as the main factors when informants are asked about them in such a way that they are not obliged to speak directly about their own personal beliefs in supernatural determinants of illness. The authors discuss the significance of supernatural beliefs in mental illness causation in the context of patients’ appeal to community folk healers or to mental health clinics.
Koro in an Anglo-Saxon Canadian
Authors: Ede Anizor
Published: April 2017

This is a case of a 21-year-old Canadian male schizophrenic who developed a Koro syndrome following the surgical removal of a coccygeal cyst. It is felt that the clinical manifestation of the Koro sydrome as observed in South East Asia and in the West are not identical. In the West, the conviction of a fatal outcome must be very rare, while it is usually present among the South East Asians. This difference may reflect cultural influences. Furthermore, although the depersonalization syndrome of genital shrinkage may occur in any psycho-pathological condition, it was observed that the typical Koro syndrome as described among South East Asians is more often associated with a neurosis (anxiety neurosis, hysterical neurosis), while the atypical Koro syndrome as described in the West is more often associated with a psychosis (functional psychosis, organic psychosis) or a state of intoxication (drugs, alcohol).
Retirement as a Life Crisis: Myth or Reality? A Review
Authors: Macbride Arlene
Published: April 2017

The literature on retirement has herein been examined with particular emphasis on whether the negative retirement stereotype is myth or reality. There appears to be very little hard data to support the stereotype. On the whole recent studies seem to indicate that people do quite well physically, mentally and socially after retirement and that the negative stereotype is indeed a myth. However, there is a definite need for much closer attention to experimental detail in future studies if the stereotype is to be unequivocally refuted. Moreover, there appear to be factors such as health, income, socioeconomic status, and personality structure which can predispose individuals to less fortunate retirement outcomes. Further research delineating these higher risk groups is needed before relevant intervention programs can be developed.
Medicolegal Aspects of Transsexualism
Authors: Nelson C. , Paitich D. , Steiner B.W.
Published: April 2017

Transsexualism, a clinical syndrome which has been recognized for the past twenty years, has been surprisingly neglected in regard to the medicolegal aspects which are involved in surgical sex reassignment. There is a lack of legal definition of sex which further enhances the problems for the future of the transsexual patient. The change of document identification, such as change of: name; birth certificate; other documents, are discussed; in addition matrimonial and criminal considerations are explored, as well as the legality of surgical sex reassignment. In conclusion, it is noted that apart from recent legislation passed in British Columbia, Alberta, New Brunswick and Manitoba, establishing the legal status of the reassigned transsexual, little or no attempt has been made by the law to deal with the special problems which this type of patient presents.
L'intake Et La Liste D'attente
Authors: Plante G. , Meloche M. , Winnicott D.W.
Published: April 2017

So far we have been operating traditionally at our clinic under the principle: “first come first served” and due to the small size of our team, we automatically placed a new patient on a waiting list. During that time our secretary could write to obtain the necessary information concerning the waiting cases. For several years, we noticed that more than half of the waiting people no longer needed us when we were ready and able to look after them. Very puzzled by this, we decided to examine this phenomenon more closely.

We reviewed much of the literature on the subject without finding a readily applicable solution. We analysed our intake procedure more closely and made a retrospective study of a group who dropped out before the evaluation was completed. We then tried a new intake system by which the patient was seen almost immediately but very very briefly. We made a lot of these brief evaluations. With this procedure, we got rid of our waiting list.

In 15 to 20 percent of the cases, we could help these people find a solution and they did not require any further attention. As for the others, the necessary information was gathered much faster, the paper work was reduced and the children were better prepared for the evaluation. We could also check the urgency of the requests. The anxious parents no longer needed to phone the secretary again and again.

To further improve this system, a central appointment office equipped with a computer would help the patients and the personnel. The clinic must be geographically accessible. Patient-representatives could help usher some of our patients through our labyrinthine hospital.

As for broken appointments, we noticed that people who insisted on an immediate appointment very often did not show up if we offered to see them right away. We observed that the “non-shows” have often been more or less forced to come by the referring person who wished for this consultation much more than the patient himself. A postcard to contact a “non-show” remains a good method. To fill the vacuum left by a “non-show”, we keep one or two families on stand by for a few weeks and call them in when we have such a gap; it works well if this arrangement is adequately made with a family who lives nearby.

It is not easy to forecast who will continue to a final evaluation and treatment if we do not examine the relation between the referring person and his patient. If the referring person does not take the necessary time to prepare the patient but pushes him toward child psychiatry, chances are that this patient might not pursue.

We believe this new system advantageous enough to adopt it permanently.
Treatment of the Difficult Patient in Psychotherapy
Authors: Michels Robert
Published: April 2017

Difficulty in psychotherapy may be viewed as excessive effort by the therapist, perhaps taking the form of the therapist's struggle against resistance. It is experienced by the therapist as being unable to understand the patient or that he may be defensively confused by the patient. Different patterns of difficulty may be stimulated by the various phases of therapy or by the therapist's level of experience. Although difficulty may be responded to in different ways by therapists it is stressed that it is an essential component in promoting therapeutic change. Several cases help to clarify the meaning of difficulty.
Psychiatry and the Dangerous Sexual Offender
Authors: Greenland Cyril
Published: April 2017

A study of Dangerous Sexual Offenders, undertaken for the Canadian Law Reform Commission, reveals that about one-third of DSOs seriously threatened or actually endangered the life of the victim. One-third were moderately assaultive. The remainder, mostly homosexual pedophiles, were offensive but not physically violent.

The role of psychiatrists, employed by the Crown in the process of securing an indeterminate sentence, is described. Most of them did not declare their role as ‘double-agents’. Their expert testimony before the Courts also revealed a failure to discriminate between fact and opinion. Individual prejudice was, not infrequently, presented as the wisdom of the psychiatric profession.

The life of DSOs, in Canadian penitentiaries, is likely to be exceedingly brutal. Four of them have been murdered while in custody. Others have killed themselves or made determined attempts to do so.

Since it is obviously unethical for psychiatrists to participate in any procedure which is likely to result in harm or the death of an individual, the author urges the Canadian Psychiatric Association to support the Law Reform Commission's condemnation of the DSO legislation. As an interim measure psychiatrists should be urged not to collaborate in DSO cases.
The new Psychotherapies: The Courage to Be
Authors: Furlong F.W.
Published: April 2017

The past decade has seen the emergence of popular “new psychotherapies” such as Gestalt Therapy, Transactional Analysis, and Primal Therapy, each with substantial followings. This paper puts forward a hypothesis about what these divergent systems may possess in common.

Certain aspects of these therapy systems, in particular the induction of new patients and trainees, are examined in terms of Paul Tillich's concepts of the universal necessity of a rationale for courage. The significance of Tillich's analysis of courage for various historical movements is reviewed.

In each system an element of unconditional commitment to a particular world view is required, as evidenced in the writings of the proponents of these systems, for the patient to be accepted into the particular system. These theoretically divergent systems possess, in common, a factor of an initial commitment to and induction into a collective belief system comparable to what Tillich describes as “the courage to be as a part”.
Counter-Transference Problems in Treating Obsessionals
Authors: Buchanan Joseph R.
Published: April 2017

One of the most valuable tools one has in working with the obsessional is the therapist's own personality, providing one can use this tool skillfully. Each doctor-patient relationship is unique and will bring with it its own unique counter-transference problems. Common problems of which we are consciously aware include boredom, escape into fantasy, impatience, argumentative behaviour, dislike and feeling of inadequacy. Hopefully we can utilize these feelings to further our understanding of the patient's dilemma. One problem we should be alert to is our unconscious sadism which may find expression in the nature of our interpretive behaviour.
Frontal Lobe Lesions Masquerading as Psychiatric Disturbances
Authors: Carlson Richard J.
Published: April 2017

This paper presents three cases of frontal lobe lesions from the author's experience (subdural hematoma, meningioma and astrocytoma) which initially appeared as schizophrenia or depression. Attention is drawn, in the absence of specific neurological signs, to the importance of headache and somnolence in offering clues to the presence of a lesion. Disturbances in thought, affect and perception cannot always be assessed as purely functional.
The Total Encounter Capsule
Authors: Barker Elliott T. , McLaughlin Alan J.
Published: April 2017

For the last nine years, groups of patient volunteers in the Social Therapy Unit of the maximum security section of the Mental Health Centre at Penetanguishene have been making regular use of the Total Encounter Capsule. The Capsule is a specially constructed, soundproof, window-less, but continuously lighted and ventilated room, eight feet by ten feet, which provides the basic essentials — liquid food dispensers, washing and toilet facilities — and in which it is possible for a group of up to seven patients to live for many days at a time, totally removed from contact with the outside. It functions as a place of undisturbed security where a small group of voluntary patients can focus upon issues they feel important enough to warrant the exclusion of the usual physical and psychological distractions (including staff), in a setting where the risks of suicide or homicide that might attend extremely intense personal encounters are at a minimum. The many ways in which groups of patients have used this facility are reviewed and the problems of researching the effectiveness of the program are discussed.

Included in the paper is an overview of the historical development of all the intensive coercive milieu therapy programs at Penetanguishene so that the purpose and function of the Capsule can be seen in context.

Designed initially as an attempt to overcome the problem of the escapist role-playing of the articulate psychopath, the greatest value of the Capsule is now seen more importantly as the way in which it provides a brief, very intense, but safe experience for a patient to look forward to or back upon as a bench mark during a lengthy stay in hospital.
A Suicide Epidemic on an Indian Reserve
Authors: Ward J. A. , Fox Joseph
Published: April 2017

A series of eight suicides within a twelve month period in a small rural community in a large northern Ontario Indian Reserve was studied by means of interviews with the families and neighbours of the victims. The victims corresponded to the usual age group for suicides on an Indian Reserve but were different in the sex distribution and marital status. They were vulnerable individuals who had negative self esteem, were socially isolated, tended to internalize feelings and conflicts and thus were overdependent on their families. Associated with their stress situation were marked family discord, threat of an actual break-up of the family, loss of the support of a significant relative, and extensive alcohol misuse by the families. The victims' defenses of escape — withdrawal, internalization and alcohol misuse — failed with resultant hopelessness. The social conditions of acculturation, cultural conflict, negative self-image, loss of extended family, alcohol misuse, all contributed to a state of anomie which made the situation worse. Failure of identity resolution in the victims probably accounted for their age selection. Malignant influences are also considered as part of the contributory picture.
Responses to Moral Dilemmas in Medical Students and Psychiatric Residents
Authors: Stevens Carey , Firth S. T.
Published: April 2017

There has been an increasing interest in the area of medical ethics as indicated not only by the recent proliferation of books and articles but also in the re-emergence of crucial moral issues such as euthanasia, abortion and the like. The difficulty with the existing literature is that these reports are often descriptive, anecdotal and situationally relative to the decision maker.

In this study, the authors utilized a cognitive developmental approach to studying responses to moral situations not only because this approach is cross-culturally universal but also because it is not subject to situational variables. In this regard, the results of the assessment of medical students and psychiatric residents are presented as well as a comparison of moral reasoning stages in relation to the C.M.A. Code of Ethics. Recommendations for further research are presented.
Obsessionality and Schizophrenia*
Authors: Birnie W.A. , Littmann S.K.
Published: April 2017

A review of the psychiatric literature suggests that obsessional thinking and obsessive-compulsive neurosis may well be antecedents of schizophrenia. This is in keeping with the observation that severe anxiety and phobias are occasionally seen in the prodromal stage of schizophrenia. In rare cases established schizophrenics may continue to have obsessions. Clinical examples are presented in vignette form. The emergence of obsessional thinking de novo in the established schizophrenic must be considered a rare phenomenon.
The Role of Mechanical Restraints in the Management of Disturbed Behaviour
Authors: Guirguis Ezzat F. , Durost Henry B.
Published: April 2017

The use of mechanical restraints for the management of disturbed or violent psychiatric patients continues to be a controversial issue.

A survey of their use was carried out by means of a questionnaire sent to 370 psychiatric facilities in Canada to which there was a 62.2% response. General hospital psychiatric units, psychiatric hospitals and mental retardation centres accounted for 83.0% (191) of the returns and were the only facilities analyzed.

The study showed that the vast majority still use mechanical restraints. The types of restraints in order of frequency of use included posey belts or shirts, isolation room, straps, sheets, strait jackets, wet or dry packs, hydrotherapy, and others. Violent behaviour is the main reason for which restraints are used. Medical orders, recording procedures and staff training in techniques of managing disturbed behaviour are reviewed.

An important finding is the significant majority of facilities that have no stated policy permitting or forbidding the use of restraints.

The findings are briefly related to Tuke's work in 1882 pointing to similarities in practice.

Finally, the authors emphasize the need to deal with this contentious issue in an enlightened manner reflecting modern day demands.
Encounter and Psychotherapy
Authors: Wiltshire E. Bevan
Published: April 2017

Human relations training has moved from the original T-group emphasis on group process, through focusing on the individual's mode of interacting in the group, to the use of the encounter situation for fostering personality change. Psychotherapy is moving out of the dyadic relationship into groups using increasing degrees of confrontation. The resulting overlap in group techniques calls for examination of the part each can play in the overlap area between the clear-cut functions of each specialty. The theoretical basis for differentiation lies in the respective models of awkward (“neurotic”) behaviour: psychotherapy starts from the pathological and emphasizes intrapersonal structure, while encounter starts from full-functioning behaviour and emphasizes interpersonal interaction. Practical responsibilities can be divided between encounter and psychotherapy on the basis of the level achieved by an individual moving through a hierarchy of ascending personal achievement levels. Because of the high probability of individuals interchanging between encounter and psychotherapy, practitioners will need to have at least basic knowledge of both systems. Rapprochement could eventually come through the systematic extension of existential psychotherapy.