The individual in his family : an adaptational study / by Alfred A. Messer.

  • Messer, Alfred A., 1922-
Date:
[1970], ©1970
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: The individual in his family : an adaptational study / by Alfred A. Messer. Source: Wellcome Collection.

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    whole concept of the pathogenesis of illness. Frequently, as in this example, one member of a family is designated the scapegoat (or patient) for some other disturbed family member, and the method selected for therapy, i.e. psychoanalysis, family therapy, etc., must take these factors into account. The choice between individual therapy, including psychoanal¬ ysis, and family treatment is not an either/or proposition. As a matter of fact, a patient can be in analysis while he is also un¬ dergoing family treatment. There are clinical indications for each. In other words, it is sometimes necessary to deal mainly with the interactional elements in a person's environment and at other times to deal primarily with the phantasies and perceptions in one individual. The psychiatrist must therefore be able to shift back and forth with some flexibility, depending on the clinical indica¬ tions. Our experience in screening draftees and classifying many as emotionally disturbed during World War II has forced us to focus on more than the perceptions of the individual before deciding about the presence or absence of psychiatric illness. Over ten mil¬ lion men were psychiatrically screened using pre-World War II standards, and by these indices, almost half of the group were unacceptable for military service. This situation necessitated a revision of psychiatric screening standards. Further, many men had functioned adequately in their home environment; only after being drafted did they turn up with disabling symptoms. (The converse was also true, but to a lesser extent: many men who showed typical sociopathic personality disturbance in civilian life did well in the military service.) Clearly, psychiatric evaluation and diagnosis had to be broadened to include a study of the indi¬ vidual's environment as well as study of his phantasies and percep¬ tions. While this procedure now appears obvious, for most of the past century patients have been sent off to state hospitals for treatment and, when improved, have been sent back to the same environment from which they came. It is not surprising that the relapse rate has been extremely high. One of the purposes of this book is to emphasize that behavior viii