Table Of ContentPSYCHIATRY
THE STATE OF THE ART
Volume 7
Epidemiology and
Community Psychiatry
PSYCHIATRY
THE STATE OF THE ART
Volume 1 CLINICAL PSYCHOPATHOLOGY
NOMENCLATURE AND CLASSIFICATION
Volume 2 BIOLOGICAL PSYCHIATRY, HIGHER NERVOUS ACTIVITY
Volume 3 PHARMACOPSYCHIATRY
Volume 4 PSYCHOTHERAPY AND PSYCHOSOMATIC MEDICINE
Volume 5 CHILD AND ADOLESCENT PSYCHIATRY,
MENTAL RETARDATION, AND GERIATRIC PSYCHIATRY
Volume 6 DRUG DEPENDENCE AND ALCOHOLISM, FORENSIC
PSYCHIATRY, MILITARY PSYCHIATRY
Volume 7 EPIDEMIOLOGY AND COMMUNITY PSYCHIATRY
Volume 8 HISTORY OF PSYCHIATRY, NATIONAL SCHOOLS, EDUCATION,
AND TRANSCULTURAL PSYCHIATRY
PSYCHIATRY
THE STATE OF THE ART
Volume 7
Epidemiology and
Community Psychiatry
Edited by
P. PICHOT
Academie de Paris
Universite Rene Descartes
Paris, France
and
P. BERNER, R. WOLF, and K. THAU
University of Vienna
Vienna, Austria
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
World Congress of Psychiatry (7th: 1983: Vienna, Austria)
Epidemiology and community psychiatry.
(Psychiatry, the state of the art; v. 7)
"Proceedings of the VII World Congress of Psychiatry, held July 11-16, 1983, in Vien
na, Austria"-T.p. verso.
Includes bibliographies and index.
1. Social psychiatry-Congresses. 2. Psychiatric epidemiology-Congresses. 3. Com
munity mental health services-Congresses. 1. Pichot, Pierre. II. Title. III. Series: World
Congress of Psychiatry (7th: 1983: Vienna, Austria). Psychiatry, the state of the ari; v. 7.
[DNLM: 1. Community Mental Health Services-congresses. 2. Community Psychiatry
congresses. 3. Mental Disorders-occurrence-congresses. W3 W05385 7th 1983e / WM
30.6 W9258j
RC455.W675 1983 362.2 85-9546
ISBN 978-1-4684-4702-6 ISBN 978-1-4684-4700-2 (eBook)
DOI 10.1007/978-1-4684-4700-2
Proceedings of the VII World Congress of Psychiatry,
held July 11-16, 1983, in Vienna, Austria
© 1985 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1985
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
AII rights reserved
No pari of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
record ing, or otherwise, without written permission from the Publisher
PREFACE
The purpose of the World Psychiatric Association is to coordinate
the activities of its Member Societies on a world-wide scale and to
advance enquiry into the etiology, pathology, and treatment of mental
illness. To further this purpose, the Association organizes mono- or
multi thematic Regional Symposia in different parts of the world twice
a year, and World Congresses dealing with all individual fields of
psychiatry once every five or six years. Between these meetings the
continuation of the Association's scientific work is assured through
the activities of its specialty sections, each covering an important
field of psychiatry.
The programs of the World Congresses reflect on the one hand the
intention to present the coordinating functions of the Association and
on the other to open a broad platform for a free exchange of views.
Thus, the VII World Congress of Psychiatry, held in Vienna from July
11 to 16, 1983, was composed of two types of scientific events - those
structured by the Association and those left to the initiative of the
participants. The first type comprised Plenary Sessions, planned by
the Scientific Program Committee, anq Section Symposia, organized by
the WPA sections; the second embraced Free Symposia, free papers,
video sessions, and poster presentations prepared by the participants.
Altogether, 10 Plenary Sessions, 52 Section Symposia, and 105 Free
Symposia took place, and 78 free papers and poster sessions and 10
video sessions were held.
The editors of the Proceedings of the VII World Congress of Psy
chiatry were immediately faced with two major problems, namely how to
deal with such a great number of presentations and how to present them
to the reader. The only way to solve the first difficulty was to re
strict the Proceedings to Plenary Sessions and Symposia. The second
obstacle was surmounted by grouping the Plenary Sessions and Symposia
according to their scientific content, which meant waiving the chrono
logical order of the Congress. In order to achieve reasonable uni
formity in the lengths of the volumes, it was not possible to devote
each of the eight books comprising the Proceedings to a single theme.
Nevertheless, we hope that the final arrangement will enable colleagues
interested in only certain subjects to restrict their purchases to the
v
particular volume or volumes of their choice. The Proceedings in
their entirety, however, represent a complete and comprehensive
spectrum of the current areas of concern in psychiatry - the state
of the art. .
We are greatly indebted to our colleagues Rainer Wolf and
Kenneth Thau. Their untiring efforts made the publication of these
Proceedings possible.
Peter Berner
Secretary General, WPA
at the time of the VII
World Congress of Psychiatry
President, Organizing Committee
VII World Congress of
Psychiatry
Chief Editor, Congress Proceedings
ACKNOWLEDGMENTS
First and foremost, we should like to express our sincere
appreciation to all colleagues whose scientific contributions com
prise the content of these Proceedings.
We should also like to thank the immediate administrators of
the VII World Congress of Psychiatry (Congress Team International),
as well as the staff of the Vienna Secretariat of the World Psy
chiatric Association, for their collaboration in the compilation of
this publication.
We should finally like to explain that, for technical reasons
connected with the actual printing process, it has not been possible
in every instance to eliminate minor typing errors.
Various reasons also prevented the compilation of all chapters
in exact conformity with the presentations as contained in Plenary
and Symposium Sessions.
Despite these problems, we hope that our aim to structure the
content of the individual volumes as clearly as possible has met
with an adequate measure of success.
INTRODUCTORY REMARKS
The World Psychiatric Association was born out of the Organizing
Committee of the World Congress of Psychiatry. Thefirat World Con
gress, held in Paris in 1950, was an event of the utmost importance.
For the first time, psychiatrists of the whole world met to exchange
their ideas and experiences and to promote the progress of our spe
cialty. It later became obvious that such large congresses, convening
every five or six years, needed to be complemented by a more permanent
organization and by more frequent meetings smaller in scope and of a
more specialized nature. The national psychiatric societies decided
on the creation of a World Association which could assume all the re
sponsibilities connected with such a complex task. I had the honor to
be elected President of this Association at the VI World Congres.s in
Honolulu and to hold this responsibility for six years until the advent
of the Vienna Congress.
Whatever the importance of the various functions of the WPA, the
organization of these World Congresses has remained its major task.
It has become fashionable to criticize World Congresses because they
attract too many participants, because the scientific presentations
are not always of the highest quality, and because the multiplicity of
the subjects discussed in simultaneous sessions obliges the partici
pants to limit attendance to only part of the entire program. Some of
the criticisms may be justified, but the fact remains that such con
gresses fulfill an important function. The majority of the psychia
trists of the world are not highly specialized research workers but
practitioners. Many of them live in countries where they are rela
tively isolated and where there is little opportunity for scientific
interchange. The World Congresses, by presenting not only the latest
technical discoveries but also general surveys through leading spe
cialists in the different fields of psychiatry, allow every partici
pant to keep abreast of the state of the art. There is no better
opportunity to become acquainted with developing trends, and personal
experience of this type cannot be replaced by the reading of scientific
journals. Of course, the value of such Congresses depends on the care
with which the program is prepared. The readers of these Proceedings
will have the opportunity to convince themselves that the Austrian
Organizing Committee, under the chairmanship of Prof. Peter Berner,
ix
Secretary General of the WPA at the time of the Congress, has attained
this goal, and that the scientific quality of the papers presented and
now printed is worthy of the tradition of our World Congresses of
Psychiatry.
Pierre Pichot
President, WPA
at the time of the VII
World Congress of Psychiatry
President, Scientific Committee
x
CONTENTS
SOCIOLOGICAL ASPECTS OF PSYCHIATRY
The Contribution of Sociology to Psychiatric
Research
H. Hafner
Familial Factors in Depressive Disorders:
Children at Risk •• • • • • • • 13
M. M. Weissman
The Contributions of Sociology to the Understanding
of Mental Disorder • • • • • • • 17
D. Mechanic
Sociology of Psychiatric Care Systems • • • • • • • • • • • 33
R. Sadoun
Notes on the Relevance of Sociology for Psychiatry in
Latin America: The Case of Cali, Colombia. • 39
C. A. Le6n
Social Relationships and the Onset of Depressive
Disorders: The Limitations of Social Variables
for Aetiological Research • • • • • • • • • • • 45
A. S. Henderson
MENTAL HEALTH SERVICE RESEARCH
Mental Health Services Research • • • • • • • • • 53
H. Hafner
Mental Health Services in the United Kingdom 57
J. K. Wing
xi
