PSYCHIATRY IN A GENERAL HOSPITAL

Of a group of 100 cases seen in psychiatric consultation in the wards of a general hospital, only 12 per cent had mental conditions that could be considered the direct result of organic disease. Fifty-one per cent of the patients were found to have some organic pathology, but in the majority of these the psychic factor could rightfully be considered predominant. Hence psychotherapy, or some form of psychiatric treatment, had to be considered a vital part of the therapeutic program. In another 30 per cent of patients no significant organic pathology was discovered, and in this group psychiatric treatment, in most instances psychotherapy, was the only appropriate form of treatment. These latter two groups taken together form 81 cases requiring some form of psychiatric help, not only while in the hospital but after discharge as well. Due to the great amount of time required to carry out an adequate psychotherapeutic program, the available personnel of the psychiatric departments of most general hospitals cannot be considered sufficient to cope with the problems presented by such a number of patients.

The matter of extramural care is obviously more difficult to handle. These patients must return to their home communities which in few instances provide any type of formal psychiatric help. The general practitioner who must look after the patients will usually be unable, due to lack of training or interest, to continue adequately the investigation and treatment of the emotional problems involved.

One thing which may not be readily recognized and hence not managed as skillfully as desirable, is that hospitalization itself is a powerful psychotherapeutic agent. It necessitates separation of the patient from his home environment, provides for a short period an emotionally neutral atmosphere and relieves him of burdensome duties, the value of which factors is often overlooked. Unfortunately this therapeutic aid is too often counter-balanced by the emotional influences incident to the personality of the hospital.

In reviewing the whole problem it would seem that there is a wealth of psychiatric material in every ward and clinic. Clinicians are becoming increasingly aware of the significance of psychiatric findings in their patients and are demanding ever-increasing service of the psychiatrist in the general hospital.