Comprehensive Textbook of Psychiatry [antikvár]

PrefacePhilosophy. The Comprehensive Textbook of Psy-chiatry has emerged from out expcriences in establishing an undergraduate and graduate program in psychiatry. The responsibility for teaching students psychiatry has made us acutely conscious of the expansion of the field, of the many relevant additions to the traditional corpus of the discipline. Recent progress in psychiatry has come about not only as a result of the continuing search for etiologies, but alsó because of the fiexibility afforded bv new treatment modalities in a variety of settings.The underpinnings of clinical psychiatry have in-creased both in number and in strength; the practi-tioner now has at his disposal large amounts of new knowledge in three major areas of behavioral science which must be incorporated within the existing theoreti-cal and therapeutic knowledge in psychiatry. These three areas are the basic sciences, such as neuro-physiology and neuropharmacology; those social sciences which deal with individuals; and those which deal with the behavior of groups and of systems. Knowledge in those fields is not to be viewed as a kind of intellectual veneer to cover over the student's rough edges. It is in fact a prerequisite for clinical competence. The perplexing array of drugs, for example, not only invites comprehension of their mode of action on the central nervous system; it demands such understanding to obviate the mechanical dispensing of preparations in the rnanner of a tradesman.Similarly, the increasing awareness of the contribu-tion of social factors to the development as well as the maintenance of mentái illness calls for systematic training of the student in relevant aspects of the social sciences. The interplay between individual and social sfcructure is especially important in disorders like addiction, alcoholism, delinquency, and educational disabilities, problem areas that psychiatry can no longer avoid.While the limits of concern for psychiatry are not yet fixed or elear, the extension of the boundaries is re-flected in such events as the passage of the Community IMental Health Centers Act of 1963, which mandates an increasing involvement by the mentái health pro-fessions in the milieu of the patient in addition to the traditional focus 011 the individual and his family. Moreover, implementation of the Act requires somé insight into the political process of the stated goal if comprehensive care is to be achieved.Thus, modern psychiatric practice can clevelop only along the lines of a model sufficiently complex to allowfor new inputs and sufficiently flexible to adapt- to a rapidly changing social scene. Such a model should at least take into account certain features of American life that distinguish it from that in other highly de-veloped countries.The organizing principles for this textbook are de-rived from certain distinctive characteristics of American life that are rooted in our history and form the guidelines for the development of our social institu-tions. The first of these is pluralism. American communi-ties are composed of a multitude of governmental structures and priváté groups, each with a measure of power and strength, sometimes cooperating, but often acting competitivel}r. Each has its own responsibilities out of whose fullillment arises still more diffuse goals. The operations of such groups are seldom conducive to the formation of unified conceptual systems, and the history of American psychiatric schools is 110 exception to this rule. To present this diversity in all its richness and contradiction, it is necessary to be truly eclectic. It has been our aim in this volume to include all the major contributions and trends that are now influencing the directions of the field. The genesis of this diversity is based not only on the steady growth of knowledge within the United States but alsó the constant enrich-ment of American intellectual life through immigration. New ideas brought here by our colleagues from abroad have taken root and flourished. Many such notions are now incorporated in the body of American psychiatry, which has been in this way enhanced immeasurably.If pluralism is a feature of American life that demands recognition, pragmatism is one requiring compensation. While truth needs testing by the practical consequences of belief, everyday American pragmatism often goes beyond empiricism to a disregard for theory. Thus, American psychiatry has shown strength in the development and application of treatment methods while neglecting nosology and clinical description. Nosology is of relatively minor interest when psychiatric therapies are nonspecific; and indeed classification is not of practical use for those who are wedded to single generál purpose therapies. To compensate for these weaknesses, we have stressed the development of theoretical models, the presentation of adequate clinical description, and the importance of classification schemes. To the same end, we have emphasized the behavioral science raa-terials the full comprehension of which is required not only for practice but for expansion of theoretical understanding.