Feast day service honoring pioneers in medicine.

The Standing Liturgical Commission of the Anglican Church in the United States has identified persons whom they consider Holy men or Holy women, and who are celebrated in Lesser Feast and Fast day services. In 2009, the triennial General Convention of the Anglican Church, USA, ratified the recommendation of the Commission that Dr. William W. Mayo and Dr. Charles Menninger and their sons, as pioneers in medicine, were worthy of such a designation. The author was approached to deliver the following homily at a service at the Palmer Memorial Episcopal Church in Houston, Texas, March 6, 2013.

Menninger faces the 21st century.

The origin of the Menninger Clinic and Foundation stems from the vision of a family practitioner in a small midwestern community in the early 1900s, implemented with the participation of two sons who became psychiatrists. They articulated their hopes for the future of the institution in 1953, which surfaced only after the passing of the last founder in 1990. At that time, trends in healthcare financing were challenging the capacity of the institution they founded to fulfill its stated mission. This article reviews the origins and mission of Menninger, the challenges prompting a reassessment of operations and the search for an affiliate in order to fulfill the full institutional mission. Also cited are some principles for the future, and the impact on the midwestern community.

Uncontained rage: a psychoanalytic perspective on violence.

Explosions of violent behavior have periodically riveted public attention. While such behavior may be associated with a major psychiatric illness, there is a continuing challenge to understand the emotional underpinnings of such behavior, the sources of aggression, hostility, anger, hate, rage, and violence. Analysts from Freud to Karl Menninger to Kernberg and Kohut have speculated as to the confluence of psychological and real forces that prompt violent outbursts. Other analysts have explored the manifestations of aggression and rage in infancy and childhood. An instance of a violent outburst is presented, and underlying factors are explored. Critical elements prompting such behavior include: (1) an individual perceives a narcissistic injury that is experienced as being profoundly unfair; (2) the individual has no hope for achieving a reasonable resolution of the injury; (3) the individual reaches the decision that the injury cannot be tolerated further and must be responded to with action; (4) the individual has access to weapons to enhance the capacity and potency to respond; and (5) the individual feels a sufficient sense of potency and/or disregard of the consequences to initiate violence.

The tipping point from private practice to publicly funded settings for early- and mid-career psychiatrists.

OBJECTIVE: Practice settings for American psychiatrists were examined for recent trends. METHODS: Surveys were conducted in 1996 (N=970) and 2002 (N=917) among members of the American Psychiatric Association. RESULTS: Between 1996 and 2002 the percentage of direct patient care hours in publicly funded settings increased from 40 to 50 percent for early-career psychiatrists and from 29 to 44 percent for mid-career psychiatrists. By 2002 the percentage of direct patient care hours was higher in publicly funded settings than in solo office practices for early-career psychiatrists (50 percent versus 17 percent) and mid-career psychiatrists (44 percent versus 29 percent). CONCLUSIONS: The popular image of the psychiatrist sitting in a private office does not conform with current survey data, which show that psychiatric practice is increasingly taking place in publicly funded settings. Because it extends to mid-career psychiatrists, the shift from private office practice to publicly funded settings is not just a manifestation of early-career psychiatrists' earning a salary while building up their private practices but is a more enduring change in the landscape of psychiatric practice. The authors discuss the implications of these findings with regard to professional identity and training of psychiatrists.

Contributions of Dr. William C. Menninger to military psychiatry.

This review of the contributions of Dr. William C. Menninger to military psychiatry includes: (1) a brief biography with particular reference to Dr. Will's work with the military in World War II; (2) the status of psychiatry in the Army in 1944 at the time Dr. Will was appointed to head psychiatry in the Army; (3) Dr. Will's discussion of the characteristics of an effective military psychiatrist; (4) psychiatric treatment in combat situations as it evolved in World War II; (5) the concept of prevention, which Dr. Will felt was critically important; (6) a summary of Dr. Will's experience in World II; and (7) reflections from Dr. Will's colleagues.