Search for mental health; Family help

Forest Hospital located in displaying the Illinois presents the search for mental health. An exploration of the newest advances in psychiatry during this series. Physicians and other professional personnel working in the area of mental health at Forest Hospital a hundred bed facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism and adolescent behavior marital problems problems of the aged. So what emotional problems and others will be presented on the search for mental health. Your host for this series is Mr. Morris Squire administrate or of course hospital. This is more squire a special guest for today's Dr. David Rubenstein assistant professor of psychiatry at Temple University Medical School and the research medical scientist at the Department of clinical research in eastern Pennsylvania Psychiatric Institute. And

he was educated both in Havana Cuba and in this country. Thank you I'm Stan you have a special interest in family therapy. What is family therapy. Family therapy includes serious Take needs and new approaches and take me new approaches in the way of looking at things and terms of how psychopathology has been created in individuals. It is also a new way of teaching psychiatry. So if you ask me what is family therapy you can focus on the question from three different standpoints standpoint of method of treatment from the standpoint of the method of investigation into human psych pathology. From the standpoint of a way of thinking psychiatry.

Well let's focus on the first one why would you treat a family instead of a patient as such as which is traditional. But this is derived from the new way of looking at things that a human psychopathology is not only determined by the conflicts or problems or difficulties that one single individual would present but also his connections with the natural group that he has been raised in our natural group that he had been living with. So the logical consequence of this is that we would prefer to treat a natural group. At the same time that we created and the paperwork that is being showing symptoms of illness. We assume that the present symptomatology in any given individual is not only determined by something

that happened 20 years ago in the Bloods and the life of that individual but also something that is happening right on this part in the here and now interaction between that individual and the other members of the group that is living with it. So if we accept this kind of assumption we will derive from this that an intervention that would be a carrot at changing the behavior of that individual would have to take into account by necessity all the interaction that is taking place between that individual and other members of his natural group that he lives with namely the family. Well this is a sort of existential family psychiatrist is the here and now of therapy. Do you pay attention at all to the fact that he was a was we nearly You Are you worried about the fact that the.

His father died when he was three years old. Family Therapy is it is it just today that you're concerned with. Yes I do pay attention to that I understand that there are many other. Time with upis who don't pay attention to that who I'm more concerned with the here and now. The process I said to develop in front of them rather than anything else by then what happened 10 years ago or even five years ago so depends on the school already the inclination of the particular psychiatrist that is examining the material. Sometimes some psychiatrists will pay more attention to the past. Some of the psychiatrists will pay more attention to the president as it is developing in front of their eyes. What do you as a psychiatrist feel is the optimum number of treatments necessary for family therapy as compared to individual therapy as compared to group therapy do you have a specific set goal do you treat your

people effectively in a half hour hour. Does it take 15 sessions does it take two years does it take 10 years. My own personal experience has varied according to the seriousness of the pathology of the of the problem. If this series non-self the problem sometimes it is necessary only just a few sessions to make a quick recommendation based on the understanding of the nature of the problem. That might be sufficient. That might be in our plan that it's not really necessary to go into a deep and prolonged exploration of old the different aspects of family life or aspects of that individual patient. On the other hand there are other types of problems. In which it would be extremely difficult to disentangle those sorts of problems in just a few sessions.

You would have to go into a very long restructuring kind of process of everyone of the family who is involved and it may take a couple of years before anything happens. Is it true or do you feel that when you have a sick patient you have a sick sampling. Is everybody a subject first for family therapy. Every family is subject for Santa family therapy as long as one elected member is sick. Not necessarily I don't think so. I don't think that every single patient who comes into my office comes into the hospital has to abide by the by the strict assumption that everyone in his family has to come in for treatment too. I don't think so. I think that we have to tailor our indications for treatment according to our understanding of the process of what goes on.

Otherwise it would mean that we would have a ready made tailored procedure that we would apply to everyone who comes in and to our offices. Well don't all analysts treat on the couch. Yes but all analysts only treat those cases who are analyzable nice and well that wasn't me. And every case that comes into their office have to go through psychoanalysis I think a serious analyst would make a discrimination of what kind of cases he's going to treat. I am not only a family therapist. Even those who have a major interest in family therapy don't. They're not only family therapists they would use family therapy as an approach that has crossed SR that they would include in their set up for those situations that are called for. So what kind of research is going on in family therapy now I understand your research medical specialists tell me is this part of your research.

Yes. Right now I think one of the major efforts that we are trying to do in terms of research is to try to understand more a series of questions. For example what kind of. Specific problems exist in families that we could contact with specific kinds of behavior and the vigil patients for example. Is there any specificity. To families who could use certain kinds of problems like schizophrenia. Is there a specific city about a special type of family that produces schizophrenia. Is there. We don't know of that. I want he said that you have to have three generations to produce a schizo phrenic. Yes but we don't know if there is a special type of family I see. We don't know if there is a special type of family which produces delinquency for example does it require certain social class of a certain type of family to go to school English

if we have such widespread problems like this. I think that we should concentrate our efforts in trying to research this area more and trying to find some kind of way of. Of classifying which families produce what what kind of problems and families produce what kind of problems in individuals. Have you been able to classify families liabilities we have not been able to get. I see we assume that we can classify a family just by the symptoms of the primary patient but this has not been a successful effort yet. NC Have you found anything is in the in your laboratory in your research that would lead you to believe that there are certain kinds of things within families that cause sickness of a member. Because that's what you do family therapy I presume is because you presume the family is one of the responsible factors.

Yes we can. We can go at trying to solve this problem by just the reverse way by observing what happens to the family and what happens to the symptoms of the patient once. Once we have intervened into the living of the family into the living arrangements of the family the kind of role the family has set up and the establishing rules for living and the new arrangements and a new kind of contract of their lives I think they kind of modification of behavior that we observe in the patient who came in with his symptoms and his problems. Speaks very strongly about the idea that family influencing the family and doing something out about a family's kind of flipping has something to do with the final outcome of the individual patient. Natural we could reverse the

question. And so I did the family cause and in what way did they cause the symptoms and the patient. I think this is would be more difficult to answer. We know that by doing family therapy by intervening in the family's life and establishing new rules and new arrangements for their lives. We can bother. We do influence the course of illness of the individual patient. However if we take the same question in the reverse and we say did they cause it and in what way did they cause it I think it would be much more difficult to answer. Had you done any laboratory procedures to identifying these. Formally only by starting statistically and by using psychological assessment methods and trying to classify the responses in the laboratory of types of families. We have not

otherwise been able to study enough cases of families to reach to a statistical significant conclusion except our own subjective feelings about their experiences about animals that we have been observing so clinically you have been able to verify your findings. Yes Dr Remus and I want to we can turn our attention for a moment to the laboratory. Have you in your experience and done anything in the way of a larger longitudinal study study of a family that you have said OK mom is now going to be the boss and wear the pants like you feel our country and pop is going to be that the soft one what happens to the kids. He's done that. No I have not done that. I think one of the most important steps to try to to achieve one of a series of steps in

understanding more about family dynamics. I just don't think that we could actually we could not assign roles to a mother or a father and tell a mother now you're going to be dominant or now you're going to be passed to the Father. Which was originally one of our own assumptions of how a family of a panic patient would be that father would be always a passive saddled a mother would always be a very aggressive and dominant personality. This did not hold out to be true throughout all our observations later on as we went on and we continue to observe families obscure panic patients. We were observed that this was not exactly so I we found just the reverse case also to be true and maybe less amount of cases in which a father was extremely aggressive and extremely domineering mother was extremely

passive depressive and maybe if she was controlling she was controlling the very hidden away. However taking on a loan due to the no study of families I think is enough for that couple. People across the country are trying to do is just papering timeless in their natural habitat as they go along throughout life and will take a series of years before we will be able to reach any conclusions because the idea is not to set up the kind of roles that are going to play because that would be an impossibility. We know how difficult it is to assign anyone a role for a long amount of time but therapeutically you reassign their roles change their roles. We do We however we are continuously checking out. All the time we're checking out. I don't think that we are able to tell any mother or any father or any song or any

grandmother now from now on you're going to do this and forget about it expecting that this is going to happen. To the contrary. Once we give our instructions once we give them small tasks we have to come back over and over again and find out that what ever we instructed last week was not carried out and whatever we are planning to instruct again we have to repeat it over and over again and check out that this has been done. As soon as we are doing that we are getting involved in doing treatment. If we are going to do any research about longitudinal observations and families with assigned roles we will try to avoid doing any treatment because then we could always have a biased result and if we don't get the kind of families from this we would say well we did not because we were treating them and if we look at the Planet families we might have a bias.

So that it becomes a call that perhaps sometimes because we set up the wrong set of assumptions I suspect that psychiatrists have roles that they play as well as actors on the stage and I suspect you can manufacture roles for people to play. Yes but you cannot really. Will our roll over it without checking out continuously what you have and really plan to be different than what you really are or as you go through a very painful prolonged training. I see so you have to train people for new roles I think and you can't do it in just two sessions then that's correct. Now maybe we can turn to another area of your interest. Have you checked out some of your findings on families as compared to our way of living and as compared to a way of living in another country for instance a country of your birth. And how did people changing family patterns and patterns of family living better

here than they are in Cuba. What about the Cuban family who comes to this country how does his role change. Yes us about four or five questions I would want first one are they better. I don't think they answered that question because that would impose a value judgment. We have no ways of comparing which one is better. Which one Cuban family is very good for the kind of cultural and social background they come from. They will not operate for the United States but American families are very good for the kind of stuff we have here. How about Cuban families who come to America. That's the best question I think I think that they have to re-adjust they have to go through a series of crisis before they can readjust their social values. Lifestyle and then some of the cases that they have been able to observe

the kind of crisis they have to meet and the readjustment they have to meet. It recreates and challenges are serious so difficult difficult. Needs a readjustment to a series of difficult resources that they have to put into and to the game to be able to readjust. Sometimes they fail completely and they show a serious up symptoms and the reawakening provocation of the serious symptoms and some of the family members reappearance of all chronic depressions that used to exist and those families they reoccur about the first year after having migrated to the cause of the stress and anxiety of those around them. What do you know about ghettos and about people who are particularly Cubans right now who are living in a ghetto kind of formation is this good or bad for them. Is

this going to be a positive thing for them. I think it is a ghetto it's always so the fans of mine over Certainly it is a defensive not only from the larger community but this defensive also from the small community that is within the ghetto the large community the fence itself by encapsulating people who are in the ghetto and also the small community who is in the ghetto. The fence itself play Taps relating themselves they find re creation of the old country and the new place is that down that way may be good as far as protecting themselves. To have to go through two serious readjustment period. On the other hand it is bad because it curtails growth and development and in the next few generations I think ghetto that lasts only one generation or a few years is fine for any given family as long as it does not impose on the family that they're going

to live forever in that ghetto and even a succeeding generation. Well a lot some people who live in ghettos in this country still after many generations need the protection of the cattle Well that's a symptom that's a symptom of the ghetto I think. Now how about the people who live there only one generation is that a positive thing in your you was a psychiatrist for a few years. I can see the positive assets they call the device spec so ghetto living in someone who comes in into the new country and tries to meet his friends from the old country or people who speak the same language or relatives who are well acquainted with his set of values and he doesn't have to try out time learn right away a new set of everything else. So I can see a good thing about the positive aspect to live like with everything else if you hang gone too long for all the critics. You have never had a chance to learn there. That's a

symptom. Are there people today who are coming to you for family therapy who have at one time been in individual therapy and found no success in that. Yes yes. This frequently. For family therapy. Many of the patients who have been previously in individual psychotherapy they become aware that their involvement in their ongoing lives with their own parents or their own siblings is so intense that they cannot make any further growth or move on less than someone else re-arranges or we adjust to the new set of things. So this upas has to intervene very actively and try to intervene especially if he considers that the other members of the family are also suffering from the kind of relationship that they have been living with and they have not been able to

change. Thank you very much Dr. David Rubenstein who is an assistant professor of psychiatry at Temple University Medical School and a research medical scientist at the Department of clinical research in eastern Pennsylvania psychiatric institute for further information please write to this station or to force hospital the plane's online this is my squad. You have just heard another in the series the search for a mental health produced by Forest Hospital in displaying zeal and eye in cooperation with this station during this series. Physicians and other professional personnel working in the area of mental health at Forest Hospital 100 bed treatment facility will discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior and marital 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 Jacques Rogge on this program was distributed by a national educational radio. This is the national educational radio network.