Psychiatry in Pakistan

Psychiatric services in Pakistan have undergone considerable changes since independence 50 years ago. There has been an increased awareness of psychiatric illness on both public and professional levels and great emphasis has been laid on the education and training of medical and related professions in recent years. Although old traditional methods still prevail, it is becoming increasingly common to seek professional psychiatric advice. Like any developing country, however, much remains to be done especially on a government level in order to meet the basic mental health needs of the nation.     

Psychiatry today

A COMMON SITUATION: Primary care physicians often provide care for schizophrenic patients. The main approaches include drug regimens, psychotherapy and psychosocial support. DRUG THERAPY: Neuroleptics should be given in single drug regimens in a continuous protocol for long periods. Side effects, particularly neurological effects, can be countered with antiparkinson medication. The aim is to reach the best possible balance between the therapeutic effect and side effects. PSYCHOTHERAPY: The general practitioner does not necessarily use sophisticated psychotherapeutic protocols but rather relies on a certain number of attitudes aimed at helping the patient accept the medications and control the main pathological mechanisms the schizophrenic state as expressed in the relationship with the health care provider. PSYCHOSOCIAL SUPPORT: A series of assistance measures (allocations for handicapped adults, adapted housing, protection of property) often involve a team of workers who should all take part in the therapeutic strategy.     

Psychiatry and physician-assisted suicide

The psychiatric literature on physician-assisted suicide is scant and almost universally opposed to legalization. This opposition stems from the traditional perspective of suicide as a symptom of mental illness and the tendency of psychiatrists to extend their view of suicide in the medically well to the terminally ill. This article examines the basis for and validity of this opposition and makes recommendations about the role of the psychiatrist in physician-assisted suicide.     

Psychiatry and psychotherapeutic medicine

Starting from a sketch of the basic view points from which the topic will be elucidated, the author focuses on the different logics of psychiatry and psychotherapies. The connections between the topic and the somatopsychosocial model, the intercorrelation of psycho-genetic interpretative models and indication for psychotherapy indicate an approach which is oriented towards the disordered person (and not the disorder). This concept is compared with the often used definition of psychotherapy by Strotzka. The dependence of the concept on traditions in psychiatry (Krafft-Ebing, Jaspers, Kretschmer, E. Bleuler, and M. Bleuler) and its consistency with modern multiaxial diagnostic systems (Frances et al.) are stressed. Finally the border to psychotherapeutic medicine outside psychiatry, both in theory and practice, is stressed.     

Psychiatry, the healthy invalid

The author examines the reasons that have been offered in support of a pressimistic appraisal of psychiatry's future. The consequences for psychiatry of increasingly detailed knowledge of the interaction of psychological and physiological processes are emphasized, and the author concludes that psychiatry will continue to play a dominant role in the study and treatment of medical and surgical illness. Thus, although the field is in a transition period, it is certainly not moribund.     

Dimensions of Folk Psychiatry.

This article presents a social-cognitive model of laypeople's thinking about mental disorder, dubbed "folk psychiatry." The author proposes that there are 4 dimensions along which laypeople conceptualize mental disorders and that these dimensions have distinct cognitive underpinnings. Pathologizing represents the judgment that a form of behavior or experience is abnormal or deviant and reflects availability and simulation heuristics, internal attribution, and reification. Moralizing--the judgment that individuals are morally accountable for their abnormality--reflects a form of intentional explanation grounded in everyday folk psychology. Medicalizing represents the judgment that abnormality has a somatic basis and reflects an essentialist mode of thinking. Psychologizing--ascribing abnormality to psychological dysfunction--reflects an emergent form of mentalistic explanation that is neither essentialist nor intentional. Implications for psychiatric stigma and for cross-cultural variations in understandings of the psychiatric domain are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatry and children in the child welfare system

The child welfare system is, for better or worse, an unavoidable associate of the child and adolescent psychiatrist. Although the child psychiatrist rarely plays an integral role in decision making about the children who are involved with the system, the authors point out that a large percentage of children maintained in and involved with the system have psychiatric and developmental disorders. When these children's difficulties are either minimized or unrecognized by child welfare workers, the interventions and treatment that the children receive may be inappropriate. Worse still, when the children's difficulties are improperly addressed, the vicissitudes of the system may further harm them. The authors propose several ways in which the child and adolescent psychiatrist can have an important reparative role and voice in child welfare systems.     

Psychiatry and the primary care physician

Psychiatry makes an important contribution to the training and practice of primary care physicians by emphasizing a holistic approach to patient care, by teaching psychiatric skills and by providing knowledge that enables primary care physicians to give basic psychological care to the large numbers of their patients who need it. Consultation-liaison psychiatry and psychiatry education programs for medical students, both of which are given high priority for support by the Psychiatry Education Branch of National Institute of Mental Health (NIMH), are model settings in which to teach the psychiatric aspects of primary care.     

Comment on Relations with Psychiatry.

In order to promote greater mutual understanding with medical people, the author suggests that at least one-half of the delegates whom we send to these intersociety meetings (e.g., AMA, American Psychiatric Association, and American Psychological Association) be psychologists who have the MD in addition to the PhD (we have several of these, e.g., J. G. Miller, Arnold Gesell, Norman Cameron), and, furthermore, that the other societies make an effort to send delegates who have considerable formal training in psychology in addition to their standard medical training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic change in crisis intervention

The author describes his work integrating psychodynamic theory and therapeutic methods in a crisis center. Crises can be seen as situational mediators that place an individual's typical defenses and resistances in question. This state of crisis can allow for dynamic change, beyond the relief of symptoms typically expected in crisis work.