Evaluation of the Psychiatric Patient: A Primer by Seymour L. Halleck

By Seymour L. Halleck

A few months earlier than the ultimate manuscript of this ebook was once despatched to the writer, Dr. Karl A. Menninger died, almost immediately prior to his 90­ 7th birthday. therefore, whilst I sat all the way down to write this preface, he was once a great deal on my brain. I remembered that it have been virtually 40 years seeing that he wrote A guide for Psychiatric Case examine, now not one in all his famous yet essentially the most sensible of his books. The psycho­ analytically informed a part of me started to ask yourself what had stimulated me to put in writing a publication on a subject so just like that which had previous drawn the eye of my respected instructor. there is not any urgent want for an additional ebook on psychiatric overview; in addition, overview is a really diffi­ cult topic to write down approximately in a simple method. no matter what my subconscious motivations can have been, i am hoping they have been less important than these of which i used to be acutely aware. I wrote this booklet in most cases as a part of an attempt to opposite sure developments in psychiatric educa­ tion. within the final decade psychiatrists have more and more been expert in an atmosphere that emphasizes short evaluate of sufferers and de­ emphasizes educating in regards to the complexity of human habit and ex­ perience. Trainees not learn psychiatric assessment in a scientific demeanour. They take fewer extensive histories, fill out types rather than describing the patient's psychological prestige, and, with infrequent exceptions, will not be taught the right way to conceptualize organic and psychosocial interactions.

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Some patients may avoid self-disclosure simply because they are unaccustomed to talking about themselves, or because they cannot perceive how self-disclosure may be relevant to their illness or their treatment. Often, even a skilled clinician is unaware that the patient is withholding information. Clinicians who do long-term psychotherapy (therapy that continues for months or years) are very familiar with situations in which patients suddenly reveal some previously unsuspected but vital information about themselves, many weeks, months, or years after treatment has been initiated.

Here, the patient "defends" against pain caused by a loss of vital cognitive functions by drastically altering the accuracy of his or her thinking. Such patients may be viewed as disturbed by observers, but as long as they can sustain their "defenses," these patients may not appreciate a need for help and may approach the psychiatric evaluation with little motivation to cooperate. The beginning psychiatrist is often tempted to attack the reliance of some patients on pain-diminishing avoidance or distortion in the hope of increasing their motivation.

Still other patients visit psychiatrists to obtain forensic examinations that may have a bearing on their employability, their quest for worker's compensation, or the outcome of criminal or civil litigation in which they are involved. Depending on whether they view the examining psychiatrist as a potential helper or as an adversary, they will approach the examination with varying degrees of enthusiasm. Finally, patients who are brought to the psychiatrist on petition for civil commitment are there involuntarily and may resist the process of evaluation.

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