from the
AMERICAN PSYCHIATRIC ASSOCIATION ANNUAL MEETING
MAY 19-24, 2007 - San Diego, Calif.
The William C. Menninger Memorial Convocation LectureNobel laureate John Nash Jr., Ph.D., at the age of 30, descended into the debilitating blackness of severe paranoid schizophrenia. Despite the odds, however, his perseverance and genius eventually led to his winning the 1994 Nobel Prize for Economics for landmark work he had begun in the 1950s on the mathematics of game theory. Yet, this is no fairytale ending; it provides powerful support for the growing movement within psychiatry to help patients with severe mental illness focus on recovery, not pathology.
Lecture given by Professor John F. Nash, Jr.
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From a 1998 PSYCHIATRIC NEWS
"The philosopher Henry James once said that three things in human life are important: "The first is to be kind, the second is to be kind, and the third is to be kind,"Joel Feiner, M.D., in a lecture on the evolution of community psychiatry at APA's 1998 Institute for Psychiatric Services last month in Los Angeles.
Feiner's belief that proper attachments in rehabilitation are critical to recovery from psychiatric illness.
The therapist's positive view of the patient allows the patient to feel valued. "When a person feels valued, he is willing to risk new things and try new behaviors," Feiner said.
The interaction between case manager and patient is critical, but high turnover means that case managers often leave, severing the patient's link to the psychiatric clinic. It is therefore risky to let patients invest a great deal emotionally in their relationship with the case manager, he added.
The relationship between the clinician and the patient should take precedence over the relationship between the caseworker and the patient, since in most cases, the clinician is far more likely to remain accessible than is the caseworker, observed Feiner. When a good relationship between clinician and patient is not established, compliance is undermined. Mental Health Connections has a high level of compliance, although noncompliance in most mental health programs is a huge problem, said Feiner.
About half the patients in most other programs are medication noncompliant in the first year after discharge, he observed. Noncompliance is costly in both human and economic terms, resulting in unnecessary hospitalization, lost productivity, additional treatment, and death, Feiner noted. Another cost of noncompliance is "compassion fatigue," sometimes called "burnout," among overworked psychiatrists".
