Relational Mental Health: Beyond Evidence-Based Interventions

405 Pages·2004·1.378 MB·English

by  José Guimón (auth.)

Relational Mental Health
Beyond Evidence-Based Interventions
Relational Mental Health
Beyond Evidence-Based
Interventions
Jose´ Guimo´n
UniversityofGenevaMedicalSchool
Chene-Bourg,Switzerland
KLUWER ACADEMIC PUBLISHERS
NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW
eBookISBN: 0-306-47967-2
Print ISBN: 0-306-47857-9
©2004 Springer Science + Business Media, Inc.
Print ©2004 Kluwer Academic/Plenum Publishers
New York
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ThisbookisdedicatedtoJose´,PabloandMariana
Contents
Acknowledgements.................................................... ix
Foreword................................................................ xi
Chapter1. MentalHealth:ConceptsandTrends ................... 1
Chapter2. IsMentalHealthFoundedonTrulyScientific
Conceptions?......................................................... 11
Chapter3. Aetiology:VulnerabilityandHomeostasis............. 19
Chapter4. TheoriesandIdeologiesinMentalHealth ............. 33
Chapter5. RelationalAspectsofMentalHealth,
Part1:PsychologicalFactors ........................................ 59
Chapter6. RelationalAspectsofMentalHealth,
Part2:SocialFactors................................................. 77
Chapter7. ClinicalAssessment...................................... 83
Chapter8. RelationalAssessment:DynamicAspects.............. 91
Chapter9. RelationalAssessment:SocialAspects ................. 101
Chapter10. RelationalDiagnosis.................................... 109
Chapter11. Organic,IncludingSymptomatic,Mental
Disorders(F00–F09).................................................. 121
Chapter12. MentalandBehaviouralDisordersDueto
PsychoactiveSubstances(F10–F19)................................. 131
vii
viii Contents
Chapter13. Schizophrenia,Schizotypal,andDelusional
Disorders(F20–29)................................................... 143
Chapter14. Mood(Affective)Disorders(F30–39) .................. 165
Chapter15. NeuroticDisorders(F40–49)............................ 179
Chapter16. Stress-RelatedDisorders................................ 185
Chapter17. SomatoformDisorders(F45).Behavioural
SyndromesAssociatedwithPhysiologicalDisturbances
andPhysicalFactors(F50–59) ....................................... 193
Chapter18. DisordersofAdultPersonalityandBehaviour
(F60–69)............................................................... 207
Chapter19. IndividualPsychotherapy .............................. 217
Chapter20. GroupTherapy.......................................... 235
Chapter21. MilieuTherapy.......................................... 249
Chapter22. CombinedTreatments .................................. 263
Chapter23. CommunityMentalHealthInterventions:The
PresentandtheFutureofPsychiatricCare......................... 273
Chapter24. EfficacyofPsychosocialInterventions................. 283
Chapter25. MentalHealthProfessionals ........................... 299
Chapter26. Psychiatrists:FromSorcererstoBureaucrats.......... 315
Chapter27. TheTherapeuticTeam.................................. 337
Chapter28. TheProfessionalintheInstitution..................... 347
Chapter29. TheBurn-OutSyndrome ............................... 357
Chapter30. TrainingTomorrow’sMentalHealthWorkers......... 373
Chapter31. TrainingofNon-PsychiatristProfessionals ........... 387
Index .................................................................... 397
Acknowledgements
ToDeloriesDunnforthetranslationofmostofthematerialofthisbook
ToBrocherFoundation(Geneva)forthesupportgiventotherealization
ofthemanuscript
ix
Foreword
The present volume, authored by one of the most prestigious European
psychiatrists,ProfessoroftheDepartmentofPsychiatryoftheUniversity
of Geneva Medical School, offers a refreshing, actual, broad scope per-
spectiveontheprofessionofpsychiatryanditsroleinthefieldofmental
health.Itoffersthereaderaclearlystated,balancedviewofwherethefield
of mental health delivery systems is moving at this time, and the role of
psychiatryandthementalhealthprofessionatlargeinthisrapidlychang-
ingprofessionalarea.Itsmainpurpose,excellentlyachieved,istoprovide
the psychiatrist, the biological researcher, the psychoanalyst, the mental
health practitioner, the educator and the researcher in these areas with a
broad overview of the concepts of mental health and mental illness, and
thepresentcontroversiesregardingetiology,psychopathology,treatment,
and prevention. Dr. Guimo´n’s text is one of the very rare ones that com-
binesadeepunderstandingofbiologicaldeterminantsofillnesswiththe
psychodynamicconceptofpersonalitydevelopment,andthecontribution
ofthesocialsciencestoboth.
FortheAmericanreader,theinformationaboutrecentdevelopments
inpsychiatryinEurope,integratedwithathoroughunderstandingofcor-
respondingdevelopmentsintheUnitedStatesprovidesacriticalperspec-
tiveregardingtheissuesthepsychiatricprofessionisstrugglingwithtoday.
Thus,ithelpstotranscendthepotentiallyrestrictedviewpointsdetermined
byanylocalscene.Thefactthatabroadhistoricalperspectiveintroduces
manyareasofcontemporarycontroversiesregardingetiology,diagnosis,
andtreatmentalsocontributestoelevatingthelevelofdiscoursebeyond
narrowspeculations.Guimo´nelegantlyindicateshowtherevolutioninthe
neurosciencescanbecomplementedwithacontemporarypsychodynamic
approach derived from psychoanalytic understanding. He appropriately
xi
xii Foreword
challenges the psychoanalytic profession to reexamine its responsibility
towardboththescientificdevelopmentofitsfieldanditssocialresponsi-
bilityinthepreventionandtreatmentofmentalillness.Whileclearlysym-
pathetic to psychoanalytic approaches, Guimo´n points to both strengths
andweaknessesinpsychoanalyticcontributions,andiscriticalofpsycho-
analytic education as well as of frequently narrow perspectives in psy-
chiatricresidencytraining.Hiscriticalreviewofpsychodynamicresearch
approachesstrengthensthiscritique.
Thisbookexamineslucidlythecontributionsoftransculturalstudies
intheevaluationofetiology,frequency,andsymptomsofmentalillnessas
theyareinfluencedbysocio-culturalfactors,andexplorestheintegration
of this perspective in the clinical management of the main psychopatho-
logicalconstellations.Theoverviewofthetreatmentoforganicmentaldis-
orders,themajorpsychoses,andthepersonalitydisordersisenrichedby
thiscombinationofbiological,psychodynamic,andsocio-culturalperspec-
tives.Thereaderwillfinduptodatesummariesofthepresentstrategies
oftreatmentthatreflectthisintegrationofapproaches.
The major emphasis of this volume is on psychosocial modalities of
treatment,bothinthecontextofinstitutionaltherapeuticprogramsaswell
as in the individual treatment of patients. In this context, it provides the
readerwithdetailedinformationaboutthepresentstateofgroupandfam-
ily interventions, that are taught in a rather perfunctory manner in most
textsofpsychiatrictherapeutics.Guimo´nprovidesthoughtfulinformation
regardingareaswhereevidencebasedtreatmentsmaycontributesignifi-
cantlytoclinicalpractice,andareaswherethisisnotthecase:hepresents
anoriginalexplorationofthenaturallimitsofevidencebasedtreatments.
Nowadays,therearefewcomprehensivetextsinpsychiatrystillwrit-
ten by a single author. The field of psychiatry has become so broad and
complexthatmulti-authoredtextbooksaretheorderoftheday.Guimo´n’s
volumeshowsthatanextremelyknowledgeable,original,andpassionate
scholarstillmayprovideasynthesisthatenrichesthefield;stimulatesthe
reader to become concerned with it beyond his or her limited personal
sphere of activity; and, in explaining the present in terms of its develop-
mentfromthepast,signalsnewroadsandchallengesforthefuture.
∗
OTTOF.KERNBERG,M.D.
∗
Director,PersonalityDisordersInstitute,TheNewYorkPresbyterianHospital,Westchester
Division
ProfessorofPsychiatry,WeillMedicalCollegeofCornellUniversity.
TrainingandSupervisingAnalyst,ColumbiaUniversityCenterforPsychoanalyticTraining
andResearch
1
Mental Health
Concepts and Trends
Weshallbeginbydefininganumberofmentalhealthconcepts,andthen
address the concept of abnormality, ending with a discussion of the sci-
entificbasisofkeyconceptsonwhichcurrentdiagnosticandtherapeutic
interventionsinmentalhealtharebased.
MENTALHEALTHORPSYCHIATRY?
MentalHealth:AnEndeavour
The term mental health has been progressively gaining ground as
an alternative to psychiatry, to underline its preventive aspects—as first
recommended by the World Health Organization (WHO)—and the fact
thatthisfieldrequirestheparticipation,notonlyofpsychiatrists,butalso
other professionals, as well as segments of the general population, legis-
lators,andpoliticians.Therefore,morethanascienceorasimpleclinical
activity, mental health is an endeavour, and a burning issue, involving
socialandhumanitariancommitment.
The mental health field is wider than that of clinical psychiatry, be-
cause it also includes the detection of undiagnosed cases in the general
population,andpreventioninnormalsubjects,toavoidtheircontracting
psychological disorders. Indeed, in a survey conducted during the Epi-
demiologicalCatchmentArea(ECA)project(anepidemiologicalstudyin
the United States), approximately 30% of the general population had, in
theprevious6months,presentedapsychiatricdisorderasdefinedbythe
AmericanPsychiatricAssociation’sDiagnosticandStatisticalManual.This
prevalencewouldhavebeenatleast10%higherifsubstanceabusehadalso
1