Search for mental health; Treatment of the young

Forest Hospital located in displaying the Illinois presents the search for mental health and exploration of the newest advances in psychiatry during this series of physicians and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed Creek main facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental help. Your host for this series is Mr. Morris Squire administrators of Forest Hospital. This is my Squire broadcasting from the American Psychiatric Association convention hall in Atlantic City New Jersey and our special guest for today is Dr. Sherman S. Feinstein the assistant director of the adolescent program adolescent service at Michael Reese Hospital in

Chicago and a psychiatric consultant to the Jewish Children's Bureau in Chicago and also a consultant of the voice hospital adolescent program in Chicago. Dr. Feinstein you have been continuously concerned with the adolescent and his treatment. And there seems to be a growing interest today in this body of treatment more people are paying attention to the adolescents are there more adolescents around or are they more trouble. Well I think that probably both issues are true. First of all I think the. Population is becoming much younger predictions are that. In the next 10 or 15 years the number of young people will grow immeasurably and that the hospital populations will increase in terms of younger people so that possibly by 1970 or 1975 50 percent of

the the people projected to require hospitalization will be 25 years and younger. So with an increasing population of younger people plus. The problems of increased tension in the world all these seem to be resulting in an increased incidence and emotional problems that are being recognized in adolescence and also. And with that a growing interest in the treating of these issues. I was a psychiatrist totally concerned with this particular age area age group. Tell us what kinds of things are happening today in the treatment of adolescence. Or. Well some very exciting things are actually happening. First of all the interest in psychiatrists in dealing

with adolescents is increasing for the reasons we previously mentioned. We are beginning to take a deeper look at kids who are beginning to understand them better. We are no longer afraid of them we have deeper insights into what is going on with them so that individual treatment techniques are being enhanced. For example the development of. Societies for the treatment of adolescence. The study of adolescence and psychiatry have come into existence in the last. Few years which are forums. In which both child and adult psychiatrists who have been treating adolescents are beginning to talk about their mutual problems and sharing their learning that's a curious thing that you know you get training in child psychiatry but you treat adolescence is a training in adolescent psychiatry. There's no training in adolescent

psychiatry per se because. Most people feel that adolescence as a specific entity can be differentiated only with difficulty when does adolescence begin and when does it end. So they're actually in practice. The child psychiatrist who in essence deal with children from. Birth. Through Adulthood and adult psychiatrists who treat adults from the beginning of they are adults good into old age really treat an overlapping period of time. Parents in this area that we really were talking about which is defined generally as adolescents. The gray area the gray area the people who have to go to school in spite of everything else. They're the only population rural battle Hyma said you must do this in a higher culture. I'm wondering since this is the gray area why there wouldn't be

specific training for this. This group of people if this is a high coming population in treatment needs. Why there's not a requisition record recognition of this. Well there are people who feel actually that this is an area for potential subspecialty and possibly in the years to come this will happen at the current time most at least I feel that there's no real need for creation of another subspecialty since we really haven't learned enough. In the particular areas we're struggling with to concentrate. On specifically and also the problems of adolescence are very diffuse. The. Upsurge in some of. The. The feelings that accompany growth at this period of life. Are not measurable in every individual in the same way they

vary the intensity the quality the quantity varies from child to child so that it makes really for a great deal of difficulty in specifically pinning down. An area in internal medicine. If you want to specialize in the cardiovascular system you are you. There are limitations. That are pretty well anatomically definable whereas adolescence is a much more diffuse. Area. And. Right from the ages of when a child reaches adolescence when he gets to be too Albert 13 years old is when he begins having different kinds of problems than he had when he was a child up to 10 or 12 years old up to the get. And he develops certain kinds of aspects of growing up until he's 12. But Francis Michael Reese Hospital or our hospital for example you. There are special problems with this this is a problem that the child has to cope with the in-between years between being a child and taking some responsibility for being an adult.

The maturation time of that is very sudden at this time. And those people who are skilled therapist of adults won't touch of an adolescent because they don't understand how to treat the adolescent acceptably and the child psychiatrist some of them won't touch that age group. And I'm just wondering if we need to do more investigation certainly but there are some very adequate treatment programs. Maybe you can talk about the treatment programs and how this then bears upon what we do with children who are in trouble in this age group. I know that schooling is very important for the adolescents. For instance. Can we. Can you tell me how you developed the concept of treatment programs. I had research for instance. Well we were. Faced with the traditional. Treatment problem in adolescence in which these kids were brought into

a hospital designed essentially for adults. And were treated as little adults and their rights were deeply invaded because they were children but they were expected to. React to would adultery environment in a way that seemed appropriate to the staff. There was no. Special feeling about schooling or any particular programming. Because these children had really failed in the three critical areas of their life in their families in their schools and in their peer relationships so they were outcasts and seriously disturbed but actually as a specific approach to their problems nothing very much existed except in the few institutions set up specifically for adolescents. We felt that

we see that since the reality existed that every psychiatric hospital had had. A group of adolescents who sort of sat around and got adult type of treatment that possibly by meeting their specific needs and programming. So specifically for what they needed that we could begin to approach the treatment. And by the way the fact that. These kids were. Really. Negative factors as far as the hospital was concerned every hospital administrator. Would be very unhappy with them they would. Control in the straw and lots of acting out and do a great deal of damage to themselves and others. Our first proposition was that if these children had failed in these three

crucial areas of life. We possibly could begin to approach them by making them at least feel sons some success in these areas. One was school. I had spent some time with Loretta bender in New York. And was very impressed with her concepts of education in children. And one thing I realized as I talk to her was that she felt the children of sensually wanted to be in school that no matter how they acted out against school in terms of truanting and. And. So on. They really would appreciate it if they could attend a school in which they could accomplish something. School is known for his age group. That's right and. We just accept the negative factors that they are forced to go to school and they're fighting

against it but we really didn't think. About the possibility that in terms of feeling comfortable that they would appreciate it. And this was also borne out in some studies of very young children that we had done at recess. For five and six year old psychotic children who couldn't could not conceivably go to school and we created a special little nursery school for them which they recently acted to very positively. So. We created a school which met their needs was a real school. And at the same time gave them a chance to to grow academically. And they have they have responded tremendously to this and feel comfortable in this area and this is in a sense the approach we've used in every other area. Creating a highly structured program. And when I show program a special program with special people who work

specifically with the adolescents even though they live in a general psyche hattrick hospital. Frequently with an adult as a roommate they have a special bed time. They get up. They operate throughout the day as much as possible as a group in school and planned activities to take cognisance of the fact that they are still adolescents and humor age group as such but also have very special needs as adolescents. And the consequence of this is that they can then begin to feel comfortable as adolescents and begin to work through the numerable. Emotional struggles that they have to accomplish the adolescent tasks. That have to be worked through in order for them to gradually. Form their own identity and begin to separate from their very dependent relationship with their parents and begin to gradually. Become more autonomy. Doctor I'm talking about the inpatient

treatment of the adolescents as they integrated. Person within a adult population. There have been some attempts at doing adolescent programs separated how do you feel about this. I feel that these are very adequate programs and also these are approaches that are very well needed. I don't feel there is anyone a youngster who the needs of the adolescent in those situations where a separate adolescent unit can be established and adequately staffed. I think we have many many advantages. Some of the children however cannot be contained in separate adolescent units and as a consequence are in the general hospital in many of our state hospitals as many integrated adolescences can operate in an adolescent unit not contain but those who are.

Too sick or too disruptive are. Placed in the general population so that actually there is no one approach needed and actually. And then handsome into the development of every conceivable kind of program from day care projects night hospital projects and integrated programs separate adolescent units. These are all areas that have to be and who are infinitely explored. OK I want to hit on that. We have more adolescents currently available to us that we can treat. With adequate staff and personnel our facilities. What. Do you see for the possibility for the treatment of those people who so sorely need it. Well of course this is a. And. Unanswerable problem as we but on the other hand as

there is a need demonstrated that in a society in which hopefully the demand increases the services we will be training more and more people in encouraging people in this field at Michael Reese. Every resident whether he is a child psychiatry fellow or a straight adolescent street adult. A straight adult psychiatric training is given and they experience on the adolescent program so that we are training all psychiatric people in the treatment of adolescents. We feel that this is the only way we can begin to meet the need to create a a subspecialty would actually decrease the number of people available. And and so that this is been our approach to make it makes a meaningful experience with adolescents. Part and parcel of the

training and this is actually. Being utilized this concept is being utilized in other fields of medicine pediatrics internal medicine. Obstetrics. Where are the these residents rotate through our service because as the adolescent population increases special facilities and all the medical. Areas are necessary and actually a need as existed there also as an adolescent hospitalized in the general medical hospital has the same dilemma he's too big. For a crib. But he still may be within the amed age range that requires him to be on the pediatric survey. That's a strange phenomenon. Now if there is such tremendous need for treatment people and Adolescent Services. Is there a concerted effort now happening. Are you getting more adolescent psychiatrist or more child psychiatrist trained. Besides it varies.

Unfortunately there seems to be an inverse proportion to the need and for some peculiar reason the demands for people going into medicine is not me at all holding up. With the with the enlarging population and the people interested in child psychiatry. Are not. Maintaining their interest that at the level that it previously existed. Well that's very bad doesn't look like a very good future for the field in general especially for the people who have needs for treating the adolescent as such. Are you training other kinds of people to then take the place of the psychiatrists psychologists social workers other adjunctive people childcare workers. Are they being used more liberally.

Yes I think that there is a decided movement in the field. To train psychologists and social workers more in the treatment areas. And also I'm very interested in the professionalizing of child care workers. There are several programs at. Universities in the area. The University of Illinois for example. Has an active program for the training of child care workers and other universities. And the analytic Institute in Chicago recently undertook a program and in training teachers and actually has had some kind of a childcare training program for many years. So that the real hope for the future is to provide the a professional background to services

utilizing psychoanalytic theory to enhance the f the efficiency of teachers childcare workers social workers psychologists there never will be. Enough psychiatrists to individually treat or treat in groups all the people who are in need and the best we can do is to teach and supervise and encourage other specialties to be the actual participants and the therapist whereas the psychiatrist in this instance will be the consultant to the service and operate on a level of teacher to other specialties doing the work and as such that's right because if children can be recognized in the school situation very early and corrective measures taken we can. Save a tremendous amount of effort and energies by heading off the development of a

serious emotional illness. If you don't want to spend some money doing this once a treat the healthy population what they're really talking about is early recognition I think and developing some sort of schemes and methods of teaching those people who handle the problem they're the schoolteacher who really has an opportunity to do some very interesting early corrective kinds of things with both families if they would take the time. So school social worker or the teacher to take the time with the family and the child to see how Johnny can better learn without you know making him. Disability forever you know making room for somebody who's not going to be able to operate in the future. Has this conference brought new light on different kinds of treatment areas for adolescents other new areas beside inpatient outpatient. Well there are many new areas that are of great interest and there have been some very interesting presentations and in

the utilization of cycle dramma family therapy group therapy all these ancillary therapeutic programs have. Been subjected to scrutiny. And many people are becoming extremely interested in these areas. Especially in the dealing with community health projects the utilization of group techniques is one way of recognizing. Early development of serious emotional illnesses and hopeful prevention and these can be applied by less skillful people than the psychiatrists apparently get under supervision under supervision. Yes but many of these techniques are valuable. To. Organize. Community. Institutions into various groups so that observations can be made.

Well it looks like there is going to be a very positive complementary future where U.S.A. able to accept group therapy. I think the younger people in the field are very interested in group therapy there are many. There is actually a analytic group psychotherapy society so that the original impact of these things are gradually becoming less and less troubling as we see them not as panaceas But as having a effect when kept within their proper perspective. As a part of the treatment so Talley thank you very much Dr Sherman C. Feinstein of Chicago and I was the system director of the adolescent program and service at the Michael Rees and a consultant to the Forest Hospital adolescent program. And this is more a squire.

You have just heard another in the series the search for a mental health produced by Forrest hospital in this plains Illinois in cooperation with this station. During this series the citizens and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility will discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior problems problems of the aged and others will be presented on the search for mental health. The host for this series is Mr. Morris Squire administrator of Forest Hospital. The search for mental health is produced and directed by Jack rigamarole. This program was distributed by national educational radio. This is the national educational radio network.