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The Mosaic of Contemporary Psychiatry in Perspective Anthony Kales Chester M Pierce Milton Greenblatt Editors

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The Mosaic of Contemporary Psychiatry in Perspective Anthony Kales Chester M Pierce Milton Greenblatt Editors The Mosaic of Contemporary Psychiatry in Perspective Anthony Kales Chester M Pierce Milton Greenblatt Editors The Mosaic of Contemporary Psychiatry in Perspective With 14 Illustrations Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest Anthony Kales, MD Chester M Pierce, MD Department of Psychiatry and Central Pennsylvania Harvard Medical School and Harvard Graduate Psychiatric Institute School of Education Milton S Hershey Medical Center Cambridge, MA 02138 Pennsylvania State University College of Medicine USA Hershey, P A 17033 USA Milton Greenblatt, MD Department of Psychiatry and Biobehavioral Sciences University of California at Los Angeles School of Medicine Los Angeles, CA 90024 USA Library of Congress Cataloging-in-Publication Data The Mosaic of contemporary psychiatry in perspective / edited by Anthony Kales, Chester M. Pierce, Milton Greenblatt. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-4613-9196-8 e-ISBN-13: 978-1-4613-9194-4 001: 10.1007/978-1-4613-9194-4 1. Psychiatry. I. Kales, Anthony. II. Pierce, Chester M. III. Greenblatt, Milton. RC458.M64 1992 616.89-dc20 91-42161 Printed on acid-free paper. © 1992 Springer-Verlag New York, Inc. Softcover reprint of the hardcover 1st edition 1992 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production managed by Francine Sikorski; manufacturing supervised by Robert Paella. Typeset by Asco Trade Typesetting Ltd., Hong Kong. 987654321 Preface For more than a 40-year span beginning in 1950, ence it was agreed that the papers presented Louis Jolyon West has been a driving force in could form the nucleus of a book, which could our profession. For 15 of those years, he chaired be expanded by invited contributions from the Department of Psychiatry, Neurology and other clinicians and researchers, contempo­ Behavioral Sciences at the University of Okla­ raries of Dr West, whose careers had also been homa School of Medicine; then for the next 20 significantly influenced by him. years he chaired the Department of Psychiatry The purposes of this volume are: (1) to trace and Biobehavioral Sciences at the UCLA the evolution of major developments, changes, School of Medicine. During this 4-decade and advances in the field of psychiatry; and (2) period, there has been a dynamic evolution in to discuss and review Dr West's many, multi­ the field of psychiatry. Psychiatry, neurology, faceted contributions to the field. These two and the biobehavioral sciences have undergone approaches are quite complementary. While a tremendous information explosion, with contemporary psychiatry is truly a mosaic of subsequent rapid changes in concepts of etiol­ numerous intertwining and interacting perspec­ ogy, diagnostic approaches, and treatment tives, the same can be said of Dr West's career, methods. As a result, the clinical mental health interests, and contributions. West has exem­ professions have experienced pronounced shifts plified in his work the need to utilize fully as well in preeminence from psychoanalytical to be­ as to extend the limits of our psychiatric knowl­ havioral to biological models of thought, while edge, although it involves risks, requires cour­ recently moving toward a more integrated and age, and may even have negative political or eclectic framework. This synthesis and integra­ social consequences when one is too bold for the tion of conceptual frameworks are congruent community's grasp of a current issue. Few in with Dr West's lifelong, broad perspective contemporary psychiatry have accomplished about our profession. what he has, or have done it so well in so many To honor Dr West on the occasion of his different areas, as is evidenced throughout retirement from the University of California this volume on The Mosaic of Contemporary at Los Angeles Neuropsychiatric Institute, a Psychiatry in Perspective. The following topic gathering of psychiatrists, neuroscientists, and areas are included among West's seminal mental health researchers was held in Los studies: alcoholism; cocaine abuse; marijuana Angeles on May 12 and 13, 1989. Topic areas and the amotivational syndrome; LSD; drug de­ covered a broad spectrum of psychiatry and pendency; sleep deprivation; hallucinations, biobehavioral subjects. Each speaker was en­ dreaming, and neurophysiology; racism; civil couraged to reminisce and elaborate on West's rights; violence; Tarahumara Indians; cults and contributions to the field as well as on his or her quacks; homosexuality in the military; remedi­ own career development. Following the confer- calization of psychiatry; and the medical school v vi Preface curriculum, particularly the incorporation of their involvement in the development of fresh the behavioral sciences. insights into their solutions. Each author has the The traditional focus of psychiatry has been knowledge and clinical and research experience rooted in philosophical, theological, and scien­ to write authoritatively, clearly, and concisely tific origins. In the last century, however, a in his/her particular area. One objective of complex array of subdisciplines (biological the book is to produce an up-to-date, well­ psychiatry, psychoanalytic/dynamic psychiatry, integrated, and technically sound text that will social and community psychiatry, and cul­ enhance the knowledge and technical skills of tural psychiatry) has evolved, each with its all clinicians in every field of mental health, but respective model of mental illness. Along with especially in the practice of psychiatry. Another the emergence of these models has come an important objective is to facilitate clinicians in unfortunate tendency toward fragmentation their endeavors to integrate coherently the past, and a polarization of intensely valued views. present, and future in a variety of areas in Like the proverbial blind men describing the psychiatry . elephant, all are correct-but only partially. Louis Jolyon West unfailingly combined and Furthermore, priorities in funding and shifts integrated within his own unique style and cap­ in social and political policy have created dis­ abilities: an abiding interest and curiosity for tortions in the emphasis of one area of spe­ complex issues; consistent and reliable sup­ cialization over another. As a result, a growing port and encouragement for junior and senior need exists for meaningful integration of these colleagues; caring and compassion for his fel­ subdisciplines into a single, broad mosaic of low human beings; extensive experience and psychiatry. Psychiatrists, by the nature of the knowledge of the community and culture; en­ complex problems that afflict patients, must thusiasm and zeal of -the dedicated investiga­ be increasingly multidisciplinary and inter­ tor; wide general erudition; and vast clinical disciplinary in their perspectives. knowledge and skills. He has made major con­ The Mosaic of Contemporary Psychiatry in tributions in the field of psychiatry from Perspective is organized into six main topic clinical, societal, educative, research, and ad­ areas: Social and Community Psychiatry; ministrative standpoints. His fresh viewpoints Anthropological/Sociocultural Considerations; led the way to looking at vexing problems in Brain and Behavior and Mental Phenomena; new and creative ways, thus leading to innova­ Psychiatric Disorders and Dysfunctions: Phe­ tive approaches to their solutions. In addition nomenology and Treatment; Drug and Alcohol to his own many noteworthy achievements, Abuse; and Education and Administration . West's encouragement and support for the The overall goal of this volume is to address efforts of others have been extraordinary. As these major lines of thought that have shaped many of the contributors to this volume ac­ and influenced the scope and breadth of knowledge, West is the optimal leader-an modern-day psychiatry. In general, individual excellent recruiter of the best people, and a chapters begin with a historical perspective on provider of maximal support and encourage­ the topic discussed, followed by a description ment without interference or overdirection. and overview of the subject, and conclude with Finally, he has accomplished this while exem­ a look at the future of psychiatry in that area. plifying the finest personal characteristics. Authors frequently cite West's published works To quote one of our contributors, Robert as well as include, in their chapters or in their Coombs, "I regard him as a model of human respective
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