The Canadian Journal of Psychiatry

A hypothesis is put forward in regards to what is called “chronic schizophrenia” that those observations which suggest a continuing disease process may turn out not to be intrinsic facets of schizophrenia as a neurochemical instability but rather neurotic reactions to the acute schizophrenic process. The hypothesis goes on to suggest that this reaction to the acute psychosis is such as to constitute a traumatic neurosis and that while controlling the psychosis with an “umbrella” of major tranquilizers, it is possible to resolve this neurosis. Resolution of the neurosis requires a particular approach to therapy. This is a hypothesis which is very much open to experimental examination and one which may, if proven, markedly affect the post-psychosis management of schizophrenia.

The past decade has seen the emergence of popular “new psychotherapies” such as Gestalt Therapy, Transactional Analysis, and Primal Therapy, each with substantial followings. This paper puts forward a hypothesis about what these divergent systems may possess in common.

Certain aspects of these therapy systems, in particular the induction of new patients and trainees, are examined in terms of Paul Tillich's concepts of the universal necessity of a rationale for courage. The significance of Tillich's analysis of courage for various historical movements is reviewed.

In each system an element of unconditional commitment to a particular world view is required, as evidenced in the writings of the proponents of these systems, for the patient to be accepted into the particular system. These theoretically divergent systems possess, in common, a factor of an initial commitment to and induction into a collective belief system comparable to what Tillich describes as “the courage to be as a part”.

This paper is one of several examining he variety of patterns in the delivery of psychiatric health care in the Province of Saskatchewan during 1971 and 1972. Previous papers dealt with an overview of service sectors, patient volumes, types of contacts and some patients career characteristics. This paper deals with sociodemographic and medical characteristics of patients treated in the various sectors of the psychiatric care delivery system in Saskatchewan.

The private and public psychiatric care delivery systems deal with essentially separate psychiatric populations. These differ in volume, in type of psychiatric disorder, in socio-demographic characteristics and in patient career characteristics. The “private” sector saw proportionately more females in the 20-39 year age group, whereas the public sector saw proportionately more males and females in the 0-19 year age category. The “private” sector also treated more people in rural, village and town areas whereas the public sector appeared to be more city-based. General practitioners were more active in rural and small towns, while psychiatrists tended to be more active in the larger urban areas. This reflects the general practitioner's role as a primary health care source. The vast majority of private sector patients were seen for neurotic and psychosomatic disorders. The public sector patients included those treated for the more intractable schizophrenic, organic, affective, and neurotic depression diagnoses.

Comparative data on both the private and public sectors show considerable increases in the volume of services being delivered. Previous data demonstrate a relatively strong relationship between availability of psychiatric services and utilization rates within a region. It would appear that the presence of a psychiatric inpatient facility serves an educative function and increases the volume of general practitioner treatment for psychiatric problems.

The present data indicate that the majority of persons seen for psychiatric reasons by medical practitioners in Saskatchewan suffer from relatively minor psychiatric ailments. Therefore, we must question the suitability of the present service delivery system. Is there a need to screen out “medical problems” from “problems of living” which may be better treated by non-medically-oriented counselling services, thus freeing some of the medically-skilled manpower to focus on better and more comprehensive care for the more intractable mental disorders?

Under the impact of women's liberation, many couples are seeking to develop relationships in which roles are less sex-linked and more androgynous. To help such couples and their families, therapists must re-examine and modify their own sexist preconceptions. However, to be effective even the most “liberated” therapist and couple must distinguish between problems arising from sexism and from each member's personal history and psychodynamics.

A newly devised therapy technique to desensitize individuals for body image anxiety arising from conversion symptoms and psychophysiologic disorders is outlined. One application involves the projective use of inkblots with high anatomical content which provide a source of visual input to stimulate somatic images in consciousness. When these are activated in a state of relaxation the anxiety content of the pathologic anatomical imagery is reduced. A case history involving desensitization treatment for a psychoneurotic patient's psychophysiologic symptom of premature ejaculation is cited. It is primarily designed to alert interested clinical investigators to this technical innovation in treatment.

The recurring dilemma of having to deal with an intoxicated person in possession of a gun uttering homicidal or suicidal threats along with the current debate on gun control prompted this controlled survey of the characteristics of individuals with problems arising from the joint abuse of alcohol and possession of a gun.

A comparison of the data point to violence as being the most significant differentiating variable involved. This violent potential was reflected by the presence among the alcoholics involved of more past and present antisocial traits, a higher rating on the Nicol's scale of violence, more offences committed against the person and homicidal behaviour. The availability of a gun was a significant factor. No correlation was found between the severity of the drinking problem and the risk of dangerous handling of a gun.

The need for more stringent gun controls is supported but their implications to the physician and especially the psychiatrist as a potential guarantor for a licence application ought to be further explored by the professional bodies involved.