The teaching of the concepts and techniques of dynamic psychotherapy to residents is a formidable task facing most all residency directors and faculty. The challenge of \u27new\u27 therapies and the revolution in neurobiology has led to a significant deemphasis in dynamic training in many programs in recent years.  Where once there was relative uniformity of philosophy, a variety of approaches now abound.  Medical school graduates can choose from programs that offer intensive training in psychoanalytic psychiatry as well as those that mention Freud only in passing.  Most call themselves \u27eclectic\u27 and teach a potpourri of therapies that vary with faculty interest.  Graduates of all these programs become psychiatrists though their clinical experiences and expertise may differ widely.  The array of approaches available often leaves the prospective patient (and third party payers) bewildered

Schwartz, MD, Harvey J.

English

Jefferson Digital Commons

Jefferson Journal of PsychiatryVolume 3 | Issue 2 Article 3July 1985Faculty Advisor's ColumnHarvey J. Schwartz, MDThomas Jefferson University HospitalFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationSchwartz, MD, Harvey J. (1985) "Faculty Advisor's Column," Jefferson Journal of Psychiatry: Vol. 3 : Iss. 2 , Article 3.DOI: https://doi.org/10.29046/JJP.003.2.006Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol3/iss2/3

Faculty Advisor\u27s Column

It has been a pleasure and a privilege to have been the Faculty Advisor for the Jefferson Journal of Psychiatry for the past 10 years. We began this resident written and edited journal in 1983 as a small in-house publication designed to encourage our residents to put their thoughts about patient care into written form. Since then we have grown considerably and now serve as the only national resident journal in medicine. Many people over the years have made this effort possible. I would like to pay special thanks to our generous and supportive sponsors and to the editorial boards which consisted of the members of the APA Committee of Residents and Fellows and Jefferson residents. I would like to express my particular appreciation to the Jefferson Chief Editors and their Assistants who devoted themselves to the considerable and time consuming task of publishing such a journal while also being quite busy as senior residents. Special thanks also go to the editorial assistants who have kept on top of the numerous details that go into producing such a journal. We are most indebted though to the many residents from programs through out the country who over the years have shared with us their clinical experiences through the articles they wrote

Jefferson Journal of PsychiatryVolume 11 | Issue 2 Article 3June 1993Faculty Advisor's ColumnHarvey J. Schwartz, MDThomas Jefferson UniversityFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationSchwartz, MD, Harvey J. (1993) "Faculty Advisor's Column," Jefferson Journal of Psychiatry: Vol. 11 : Iss. 2 , Article 3.DOI: https://doi.org/10.29046/JJP.011.2.010Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol11/iss2/3Faculty Advisor's ColumnIt has been a pleasure and a privi lege to have been th e Faculty Advisor for theJ dfrrsonJournal ofPsychiatry for th e past 10 years. We began this resid ent written andedi te d journal in 1983 as a small in-house publicat ion design ed to enco urage ourresi de n ts to put the ir tho ug hts abo u t pa t ient ca re into wr itt en form. Since then wehave grow n cons ide ra bly a nd now se rve as th e only na t ional resid ent j ou rn al inmedi cin e. Many peopl e ove r th e yea rs have made this effor t possibl e. I would like topay spec ia l th anks to our generous a nd suppor t ive sponsors and to th e ed itorialboards which cons iste d of th e members of th e APA Commit tee of Resid ent s an dFellows a nd J efferson resid ents. I wou ld like to express my particul ar apprec ia t ion toth e J efferson Chief Editors a nd th eir Assist ants who devot ed themselves to thecons ide ra ble a nd time consu ming task of publishing such a journal whi le a lso be ingquite busy as se nior resid ents. Spec ia l th anks also go to the edito r ial as sist ant s whohave kept on top of th e num erou s det ai ls th at go int o prod ucing such a journal. Weare mos t ind ebted th ou gh to th e many res iden ts from pr ograms throu gh out thecoun t ry wh o over th e years have sha red wit h us th ei r clinica l expe rie nces through thea r t icles th ey wrot e.A year a nd a hal f ago I decid ed to leave my posi tion as Residency Director a tJ effe rson, in which I se rved for 10 years, in orde r to pu rsu e my clinical interest s in thefu ll ti me private practi ce of psychi at ry a nd psych oa nalysis. As I e nj oyed my prior workI now find grea t sat isfac t ion in my eme rs ion in th e clinica l encounte r with patien ts. Atth e pr esent t ime I would like to pass th e baton of Faculty Adv isor to theJ ourna l to myable successor a t J efferson , Dr . Edwa rd Silberm a n, in whose hands I have greatconfidence .I would lik e to also ex press my a pprecia t ion to the Editors of th e J ourn a l forreviewing in this issu e 's Book Review Sect ion the books I have ed ite d a nd coe dite dover my years as advisor. This is especially the case for the forthcoming PsychodynamicConcepts in GeneralPsychiatry (APPI) which is int ended as a tex tbook for resid ent s an ded uca tors th at focus es on a n in-depth psych odynamic a pproach to the pa t ien ts th atresidents ca re for.Man y thanks a nd best of luck.Harvey.J. Schwa rtz, M.D.2

Name not available

This second issue of our resident journal enlarges our educational effort s in two important ways. The first is obvious . As you can see, we have published this forum in an attractive new form at. This is highlighted by the new cover designed by Dr. Jeffrey Sarnoff. The second piece of progress is our enlarged audience. In addition to our own Jefferson faculty and residents, the Journal is now being distributed to psychiatrists throughout Pennsylvania. For both of these improvements in form we are indebted to the Mead Johnson Pharmaceutical Division for their generous sponsorship

Jefferson Journal of PsychiatryVolume 2 | Issue 1 Article 4January 1984Faculty Advisor's ColumnHarvey J. Schwartz, MDThomas Jefferson University HospitalFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationSchwartz, MD, Harvey J. (1984) "Faculty Advisor's Column," Jefferson Journal of Psychiatry: Vol. 2 : Iss. 1 , Article 4.DOI: https://doi.org/10.29046/JJP.002.1.008Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol2/iss1/4FACULTV ADVISOR'S COLUMNThis second issue of our resident journal enlarges our educational effort s in twoimportant ways. The first is obvious . As you can see, we have pub lished this forum inan attractive new form at. Thi s is highlighted by the new cover designed by Dr. JeffreySarnoff. The second piece of progress is our enlarged audience. In addition to our ownJefferson faculty and residents, the Journal is now being distributed to psychiatriststhroughout Pennsylvania. For both of these improvements in form we are indebted tothe Mead Johnson Pharmaceutical Division for their generous sponsorship.Lest one be concerned about the proverbial 'cover' of the book, I am pleased thatthe content of this issue continues to demonstrate the quality a nd depth of ourresidents ' work. Under the talented leadership of this year 's chief editor, Dr. KarlDoghramji, the Editorial Board consisting of Drs. John Dorn , Sharon Riser , JeffreySarnoff, and James Stanch, has performed admirably in gathering and editi ng th earticles. The dedication of these editors though would be for naught were it not for theefforts of the contributing residents. It is to these residents again that we must expressour appreciation. They allow us to see the world of patients and ideas through thei reyes even as we contribute to the sharpening of their vision. Their work as evidenced inthis issue of the Journal enlightens us all.In an overall sense there are two themes in this issue. Drs. Dorn and Stanchpresent intriguing material on sta te of the art psychobiological theory and trea tment.Their appreciation of the molecular bases of major psychiatric dysfun ct ion is quitethorough and stimulating. Drs. Buxbaum, Doenlen and Miller present mat eria l on thepsychological basis of emotional conflict. While each of these latter papers is certainlydifferent, in all of them the authors demonstrate their sensitiv ity to thei r patien t' suncon scious functioning. I would dr aw the reader's a tt ention though to a par ticul arl yrefreshing theme common to these papers. In all three, the authors reveal some aspec tof their own internal processes and acknowledge its impact on the ir work with patients.It is a delight to see this often minimized facet of our work presented with such honestclarity.The potential union of the organic and dynamic perspectives is discussed inthought provoking detail in Dr. Scola's paper. His ideas challenge the com fortab leniches we tend to assign ourselves to and force us to examine the boundari es of ourtheoretical constructs.All the articles in this issue bring a unique perspective to our psychi atric th inking.As such , they inevitably will be controversial. In the interests of encourag ing andexploring dialogue we have inaugurated our Letters to the Editor section in th is issue.We welcome comments from all of our readers and look forward to a stimulatingexchange of thinking.Harvey J. Schwartz, M.D.Director of Residen cy T rainingFaculty Advisor to Th e Journal

It is with great pleasure that with this issue of The Jefferson Journal of Psychiatry-A Resident Publication we are expanding into a national journal for psychiatric residents. As part of that effort, we welcome the American Psychiatric Association Committee of Residents as our national editorial board. Our circulation will include all psychiatry residents, residency directors, and department chairmen nationwide . We look forward to continuing our three year tradition of presenting scholarly, thought provoking and creative ideas from psychiatric residents around the country. Our commitment to the two pillars of clinical and theoretical thinking-psychoanalytic and psychobiologic psychiatry-will continue to be reflected in the pages of this forum. We look forward to wide participation

Jefferson Journal of PsychiatryVolume 4 | Issue 1 Article 3January 1986Faculty Advisor's ColumnHarvey J. Schwartz, MDThomas Jefferson University HospitalFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationSchwartz, MD, Harvey J. (1986) "Faculty Advisor's Column," Jefferson Journal of Psychiatry: Vol. 4 : Iss. 1 , Article 3.DOI: https://doi.org/10.29046/JJP.004.1.008Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol4/iss1/3Faculty Advisor's ColumnIt is with great plea sure tha t with this issue of The J efferson J ournal ofPsychiatry-A Resident Publication we are ex pand ing into a national journal forpsychiatric residents. As part of th at effort, we welco me the American Psychiat-ric Association Committee of Residents as our national editoria l board. Ourcirc u lat io n will include all psychiatry resid ents, residency d irector s, and depart-ment chair men nationwide . We look forward to cont inuing our three yeartradition of presenting scholarly, thought provoking and creative ideas frompsychiatric residents around th e country. Our co m mittment to the two pillars ofclinical and theoretical thinking-psychoanalyti c and psychob io logic psychia-try-will continue to be refl ected in th e pages of th is fo rum . We look forward towid e participation .The learning of analytic psychotherapy remains th e most difficult andchallenging task for th e psychiatric resident. Stepping out of the secure fram e ofth e medical model permits a constructive engagement of o ne's otherwiseconstrained creativit y, given th e guidance of proper therapeutic techn iqu e an dth e co nd ition that countertransference temptations remain in the observin gsphe re. For th e new resident, th e common ly observed in itia l incl inations to act,suppor te d as th ey are by years of medical training, a re often able to mature intoa more subtle app re ciat ion of patients' underlyin g needs to be understo od .Ideally, bilateral patient-resident gratifica t ions from ac tivity are supplanted byth e latter's growing understanding of th e latent co nflicts that motivate pa tien ts'manifest symptomatology as well as one's ow n 'helping ' r ea ction formations.Both introductory psychotherapy texts reviewed in this issue's Book Reviewsec t ion stu dy th e nature o f th e unconscious co nfl icts from which patients'su ffe r ing arises. It is this step over th e repressio n barrier, th at pecu liar line th atbewild ers and occasionally emba rrasses th e young th erapist , that defines aqualitatively new type of data that is to become for the resident th e subject ofinten sive study.This illogical level of abstract ion similarly requires its own un iq ue instru-ment fo r information gather ing. The use of one's own unconscious, under th ecareful guidance of cogn it ive hypothesis checking, to lea rn about th e latentfantasies of one's patient is a powerful to ol ena bling del icate therapeuticinterventions. Personal therapy or analysis is felt by most to be a helpfu l, if no tessent ial, exper ience to fam iliarize th e clinician with th e cha racter of thisreal/not real illu sory th erapeutic space .In Werman's recent book , The Pra ctice of Supportive Psychotherapy, th eeveryday task of th e psychiatric resident is g iven new meaning as what was oncedismissed as mere ly derivati ve is now defined as co mplex, worthw hile and wit htechniques all its own . Werman demonstrates how th e diagnosis of an ego defect2FACULTY ADVISOR'S COLUMN 3is not arrived at simply by exclusion, requires a thorough knowled ge ofdevelopmental theory, and perhaps most fundamentally demands a differentform of analytic space for its treatment.Feeling one's way along th e supportive-insigh t co ntinuum, ideally freedfrom one's own need to define patients one way or another, invol ves the abilityto provide different st rengths of therapeutic vacu um for the evocation ofpatients' unconscious fantasies . With analysis on th e o ne hand and th e medica-tion clinic on the other, most psychotherapies entail a var iab le presenta tion ofreal vs. illusory self. Understanding for whi ch patients and wh at t imes their pleasfor guidance and factual information should best be met by interpretation asopposed to titrated gratification is a lifelong task th at begi ns on day one ofre sidency training.It is th e di scovery of this illu sory therapeutic space-the arena within whichtransference flourishes-that differentiates th e psychiatric resid ent from h is/her medical coll eagues. Becoming intimately acquainted with its in trapsychicand in terpersonal dimensions allows the resident to create this u nique space withhis/her patients and th rough it help them di scov er th ei r forgotten past anddisavowed present. It forms th e substrate of th e unique relationship that isdesigned to be th erapeutic and for many will be an end less source of personaland professional fascination.The courage to confront th e hidden dimensions of man 's psych ic life, firstin himself and th en with hi s patients, is th e hallmark of Freud's end uring legacy.Relatively undaunted by personal r esistances or social ostracism, his ceaselessquest for the truth about human nature yielded find ings of such magnitude thatman's view of himself has been inexorably tran sformed . Mo re than just apersonal search for meaning, Freud's evolving di scoveries ca me to inclu de aswell a reproducible method for th e study of the newl y described un consciousprocesses. As Emanuel Garcia reports in his paper , " Psychoana lysis: Science orFiction?" the technique of psychoanalysis is one th at is teachable , generates itsown data, confirms or invalidates hypotheses and has enormous explanatorypower. Accordingly he feels it meets th e essent ial cri teria for being a science.Notable in his exposition is the awareness that wh ile scientific in its basis, themysteries unraveled by the analytic method include both th e apparent ly mun-dane as well as th e great artistic and creative passions of mankind and as such isitself graced by poetic vision.One's appreciation of th e timelessn ess of th e un conscious is most challengedin one's evaluatio n of th e elderly patient fo r exploratory psych othe rapy. Theinfantile origins of the presenting neurotic con flict may be di sguised under themultiple real life dilemmas of th e older patient only to be revealed in transfer-ence reactions that manifest the characteristic irrationali ty one ex pects fromunconscious fantasy. Mark Miller, in his paper, "Usin g Psych oana lyt icallyOriented Psychotherapy with th e Elderly," presents an o lder patient whosegeneticall y derived conflicts over her ma gicall y endowed aggressive wishes4 JEFFERSON JOURNAL OF PSYCH IAT RYdetermined not only her presenting depressive symptomatology, but contrib-uted as well to lifelong characterological rigidity. Miller demonstrates th e ut ility,if not the necessity, of a carefully graduated interpretive approach that canresolve acute dysfunction as well as make possible a greater variety of lifeappreciating attitudes.The interdependency of psyche and soma has long been a matter of medica lfolk lore. Intuitive impressions of seasoned genera l practitioners and hallw aychats among experienced oncologists frequently suggest some vague un specifiedrole for characterologic predisposing factors in a multitude of physical ills.Increased post bereavement occurrences of illness and d isab ility have lon g beendocumented and mark the early tra nsi t ion from my thology to scientific study .Recently, the revolut io n in psych oendocr ine resea rch is beginning to reveal th eun derly ing path ophysiology of what has co me to be called "stress." As BernardEdelstei n discusses in h is paper, "The Stress Factor: Exploring the Possibility ofa Psyc ho log ica l Compone nt to Ca ncer," th e p hys io logic mechanisms by whi ch anewly widowed pat ient may become susceptib le to oncogenesis is suggested bycurrent research on stress-ind uced alterations in lymphocyte activity, cor tiso llevels, and antibody synthesis. Emphasizing the fundamental importance of howpatients perceive and respond to stressors, th e st udies discussed document th atloss, conflict over aggression, and dep ressive helplessness ma y be va lua bleprognostic indicators in patients with ma lignancies. As Edelstein implies, therole of the psychiatrist in the evaluation and treatment of the seriously ill pat ientwill undoubtedly grow as one's unique blend of medica l/psychological skills willbe shown to most accurately complement the psycho-physiologic pathology ofthese pa tie nts.Each new medication that is discovered to have therapeutic psych otropiceffects no t only b r ings symptomatic relief to otherwise intractably ill pat ients,but even more importantly, furnishes valuable data on the chemistry of psych icfunctioning. Ca rbamazepine, perhaps through its structural similarity to ch lor-promazine and imi pramine, has been demonst rated to be effective in ameliorat-ing aggressive outb ursts related to bipolar d isease as well as providing rel ieffrom th e more usual , but no less devastating, manifestations of this illn ess.Lauren Pate , in "Car bamazepi ne in Treatment of the Violent PsychoticPatient," detail s th e indicat ions, hypothesized mech an isms of action, metabo-lism , dosages, and side effec ts of this well kn own anticonvu lsant. O f particularnote is th e suggestion that ca rba mazepine wor ks by inhibiting subcorticalse izu res th at lead to behav ioral pathology, but wh ich do not produce EEGabnor malities .T he increasing ability of ne urophys iologists to identify the bioch emicalsubstrates of psych ological functioni ng holds great promise for future researchand thera peut ics. These advances in knowledge continuously confront th eclin ician with th e primit iveness of organic treatments of only a few yea rs ago. Astu dy of the classic characters from fictio n , on the other hand, allows aco mfortab le arm chair pe rspect ive on th e evolving insights into neuropsychiat-FAC ULTY ADVISOR'S COLUMN 5ric dysfunction. Alan Cohen has studied Othello and writes in "The Neuropsy-ch iatr ic Syndrome of a Psychomotor Seizure Disorder-Shak espea re 's Othello,The Moor ofVenice" on th e role of this personality deforming se izure disorder inthe elaboration of the protagonist's characte r and in th e p lo t development of theplay. A new shading to Shakespeare's talent is revealed as he master fully weaveshis medical knowledge , perhaps gleaned from his physicia n son-in-law, into atimeless drama that captures and reflects the ubiquitous fantasies of hisaudience.The strictly phenomenologic DSM-III approach to diagnoses has dramati-call y di vided the medical and dynamic communities in psychiatry. While theformer applaud the greater interrater reliabilit y and specificity, the lattermourn th e lost recognition of individual meaning and motivation . O verlooked ,perhaps, is the issue of pertinent level of abstra ction . For predict ing pharmaco-logic response and genetic susceptibility, highly refined research diagnoses areinvaluable. On the other hand, for formulating a dynam ic d iagnosis anddetermining appropriate therapeutic technique, what is requi red is an evalua-tion of anxiety tolerance , capacity for symboliza tion, an d the proportion oftr iangu la r conflict. Henry Do enlen , in hi s paper, " Decision Trees for Use inChildhood Mental Disorders," walks the reader th rough a step-by-step approachto a descriptive evaluat ion of childhood psychopathology. T hrough the use ofthese increasingly refined diagnostic instruments, th e clinicia n will be on firmerground in recognizing these consensually validated constella tions tha t reflectthe myriad of children's unconscious fantasies and co nflicts .The case report by James H . Dallman , " Diagnosis in the NeurolepticMalignant Syndrome," re view s this synd rome and presents case material thatdemonstrates its severity, its association with low doses of neuroleptics, thevariety of its presentations, and th e course of recove ry. The suspected pathogen-esis and new pharmacologic treatments of this underrecognized and potentia llylethal disorder are dis cussed. Ulhas May ekar in , "Folie a Deu x- A CaseReport ," presents the rare finding of a "sha red paranoid di sorder " between apsychotic daughter and her invalid mother. The shared delusion ce nters on thefather, whose death was denied, and whose body remained in th e parental bed.As described, treatment enta ils separation of the 'healthy' partner from the onemore grossly ill.In the Creative Writing sec tion, David Mit chell in " Canoe T rip" tak es thereader along on a fictionalized medical stud ent rotation. Us ing th e surgica lscenario as a stage upon which to demonstrate th e familiar compone nts of atrainee's developmental rite of passage, Mitchell traces th e maturation of a na iveonlooker who initially is afraid to see, into a more acti ve participant who remainsan observer but nevertheless is beginning to be empowered by and iden tify withthe skills of his elders.The breadth, thoughtfulness , and creativity demonstrated by resi dents inthis issue's articles reveals the academic enthusiasm and soph istica tio n of our6 JEFFERSON JOURNAL OF PSYCHI ATR Ytrainees. We look forward to providing an arena where the ri chness and depth ofour residents' thinking-and of the field itself-will co nt inue to flouri sh .HarveyJ. Schwartz, M.D .Director of Residency TrainingFaculty Advisor to th e J ournal

This issue of our Journal marks a new stage in our development. We have started accepting papers from residency programs other than our own. Encouraged by the enthusiastic response our prior issues have elicited from psychiatric educators around the country, we are embarking on a program of expansion. In doing so we hope to provide a unique arena for psychiatric resident thinking. Residents nationwide are invited to share with each other and their faculties, their discoveries, their uncertaintiesand the newness with which they view their work

The season during which this issue of the Journal is being assembled is Autumn.  It is a time of change, of growth, of new development.
For a small group of psychiatrists around the country, this period has an additional special meaning-it is recruitment season. For program directors and faculty it is this time every year that the mating ceremony known as the \u27match\u27 is prepared for . The mutual cueing and seductiveness, and indeed the ceremonies of courtship itself, are set in motion as faculty and soon-to-be medic al school graduates begin their unique dance

Jefferson Journal of PsychiatryVolume 3 | Issue 1 Article 3January 1985Faculty Advisor's ColumnHarvey J. Schwartz, MDThomas Jefferson University HospitalFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationSchwartz, MD, Harvey J. (1985) "Faculty Advisor's Column," Jefferson Journal of Psychiatry: Vol. 3 : Iss. 1 , Article 3.DOI: https://doi.org/10.29046/JJP.003.1.010Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol3/iss1/3FACULTV ADVISOR'S COLUMNThe season during which this issue of the Journal is being asse mbled is Autumn. Itis a time of change, of growth, of new development.For a small group of psychiatrists around the country, thi s period has anadditional special meaning-it is recruitment season. For program directors andfacuIt y it is this time every year that the mating ceremony known as the 'match' isprepared for . The mutual cueing and seductiveness, and indeed the ceremonies ofcourtship itself, are set in motion as faculty and soon-to-be medical school graduatesbegin their unique dance.This encounter between the profess ional generations though is more than just anexercise in career building. As the regulator of who enters our field, it serves as thesemipermeable membrane through which must pass the nutrients for our profession'sgrowth. Who and how we choose those who will succeed us determines to a grea t extentthe concept and direction of mental health care for decades to come .Not long ago I was asked by an applicant what it is that we are looking for in thosewho appl y to our program. This disarmingly straightforward question took me aback.While accustomed to detailed queries regarding on-call timetab les and electiveschedules, I had never actually been asked exactly what it is we value in an aspiringpsychiatrist. A series of thoughts entered my mind.On the surface we, like all medical speci alties, evaluate medical school perfor-mance-both basic science and clinical. We look for intell igence, thoroughne ss, and acommitment to scientific ideal s. When one adds to this list a measure of emotionalstability and an interest in patient care, one has all the basic makings of a competentphysician. However, this fourth-year student was not appl ying to a surgical or internalmedicine residency, he wanted to be a psychiatrist.I was therefore forced to regard this first strata on idea s as incomp lete and wasfaced with the necessity of exploring the more challenging underlying question. Whatcharacter abilities represent our psychiatric ideals? This led me to consider what it isthat we ask our trainees to learn that is unique to psychiatry. Th e answer was apparent.In their role as psychiatric psychotherapists, we expect our students to be interested inand able to empathically enter, study, and exit the deepest and most conflictual layersof human (un)consciousness-their patients' and their own. At the sam e time, we askthem to accomplish this extraordinary undertaking with technical prec ision andartistic grace.While representing something of an ideal, thi s accurately characterizes thespecial task that psychiatric physicians must be able to undertake with some of theirpatients. However, I had not yet succeeded in answering the question of what it is wetry to identify in the candidate that would enable him to learn our difficult craft.It seemed that the capability for sublimated curiosity best described this elusivetrait. This relatively neutralized wish to see, borne from the childhood situa tion butevolved beyond constricted stereotyped gratification, energizes the creati ve inquisitive-2Faculty Advisor's Column 3ness of our most successful colleagues. This talent encompasses both the derivativefascination with the unknown as well as the disciplined unobtrusiveness tha t permitspatients their own affective journey of discovery. It is the prerequisite not only forintensive clinical work, but also for inspiring teaching. There, it enable s the instructorto take pleasure in opening the eyes of his students without insisting that they seeexactly the same as he.To paraphrase Ernst Kris, we are looking for those with cour ageous visiontempered by scientific tac t and enriched by empathic attunement.This year's Editorial Board , under the leadership of John Matt Dorn, hascontinued our tradition of presenting papers from a wide range of clinical perspectivesas well as including contributors from programs outside of Jefferson.Sharon Riser tr aces the history of Munchausen 's Snydrom e and, thro ugh thestudy of the characteristic countertransference that emerges in working with thesepatients, describes man y of the underlying conflicts that the se pati ents ac t out on andwith their bodies.In an effort to define the character of Jefferson's Department of Psychiat ry, JohnMatt Dorn set out to gather a recommended reading list from our faculty. While whatis revealed is not easily pigeonholed, it does demonstrate a firm grounding in traditionas well as a flair for the innovative.The catastrophe that the death of an adult child repr esent s to the parent has,pecul iarl y, not been the focus of considerable psychiatric study. Allan Crandell, fromthe Univer sity of Vermont, addresses thi s area and clarifies the staging of grief, itsclinical expression and common coping devices, as well as raises questions for furtherresearch . The physician's role in understanding and managing acute grief as it oftenpresents in the Emergency Ward is the topic of Jeffrey Sarnoff's work. His study of thegrieving experience leads to a numbe r of detailed technical recommendations from howone calls the survivor to the issue of viewing the body. A team approach is advocate dand follow-up referral is stressed.The similarities and differences between the medical and psychiatr ic conceptual-ization s of alcohol ism are demonstrated in this issue's Interdisciplinary Case Confer-ence with the Department of Internal Medicine. Thi s report focuses on the manyphysiologic, management, and ethical questions that are raised in the care of thechronic alcoholic pat ient.The basic science approach to the physiology of anxiety is addressed in PeterDeMaria 's paper. He reviews the relevant literature on opiate receptors and discussestheir relationship to the endocrine system. The potential importance of these investiga-tions for the pharmacologic approach to chronic pain and depression is discussed.Robert Morrow describes the use of a pat ient's artwork as a part of the overallinpatient understanding and management of a psychotic individu al. The patient'sprogress from mute negativism to collaborative optimism is facilitated by anddemonstrated through his artwork and his ability to use it as a medium of communica-tion .Luz Colon-de Ma rti in her report on the comprehensive assessment of the sexually4 Jefferson Journa l of Psychiatry•abused child stresses the importance of evaluating both pre and post trauma patho logyas they inevitably resonate in contributing to the presenting clinical picture. Shesuggests a staging of therapeutic interventions with att ention to the child's overallemotional development. Henry Doenlen, in his paper on twins, demonstrates theneurosogenic power of magical thinking as well as th e importance of parentalunconscious fantasies on the development of pathology in a child . The special issuesfaced by twins and their implications for the transference ar e also discussed.The Book Review section of our journal serves to br ing to the attention of ourreaders important books in the field and how the y are seen from the resident 's point ofview. In this issue, John Matt Dorn reviews a new book whose pur pose is to focusattention on the often understudied que stion of differenti al therapeutics. Dr. Dornindicates that this text is an important first step in a controversial a rea and is valuablereading for residents and faculty alike.In the service of encouraging faculty-resident discussion of the papers presentedin the Journal , the authors will be presenting their work at a forthcoming department-wide Wednesda y Noon Conference. We look forward to a stimulating meeting.Har vey J . Sc hwa rtz, M.D.Director of Residency TrainingFaculty Advisor to the Journal

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1316&amp;context=jeffjpsychiatry

Faculty Advisor\u27s Column

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