Competent adolescents from different socioeconomic and ethnic contexts.

In this report two groups of adolescents have been compared and contrasted--black adolescents from working-class families and white adolescents from middle- and upper-middle-class families. The comparisons were based on detailed content analyses of intensive interviews. Although from very different neighborhoods, levels of family income, and life opportunities, the adolescents in these two groups shared an important asset. They were from families determined by rigorous research methodology to be functioning at the more competent end of the continuum of family competence. A preliminary hypothesis that ethnic and socioeconomic forces would cause these two groups of adolescents to be very dissimilar was incorrect. The similarities were, in fact, striking. This important research finding underscores the power of the family as the crucible of human development.

A psychotherapeutic approach to silent children.

This paper presents through clinical material a practical conceptual framework in the treatment of silent, nonproductive children. Based on systems theory, the therapist is encouraged to routinely take an inclusive view of the child and his world and make a focused evaluation of the meaning of this resistance at several different levels: (a) the greater, nonfamilial social system, (b) the family system, (c) the dyadic relationship with the therapist, and (d) the intrapsychic economy.

Psychiatrists' transition from training to career: stress and mastery.

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.

A longitudinal study of neurosis in young men.

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.

Psychiatric education in the emergency room: must teaching stop at 5 p.m.?

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.

Transient situational disturbances: course and outcome.

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.

A new method of classification for psychophysiologic disorders.

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.

Psychiatric consultation in a Vietnamese refugee camp.

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.