The mentor and the trainee in academic clinical medicine

Medicine is a scientific discipline, but it is sometimes difficult to separate what is scientific and what is a clinical, practical activity. Man is the object, but he is always the subject of medical research and therefore these two elements become closely bound together by a thread of moral interdependencies. Every mentor of a young academic and all institutions dealing with the teaching of and research into medicine must understand multidimensional, multifaceted, and multilevel aspects of their activity and give them due regard in the educational process. The educational mission of an academic institution and of the teacher working there may be summed up in one phrase: Teach thinking! At the same time, the task of a school and the individual mentor is to teach the student to distinguish personal freedom from a lack of the feeling of responsibility. The medieval principle “Universitas magistrorum et scholarium”, and thus the corporation, the community of teachers and students, has not lost any of its relevance and value today. The situation is, in its far-reaching consequences, tragic in which the “insufficiently tutored teach”. Both physician and teacher, and especially physician-teacher, are not only professions, but also callings. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

Family crisis intervention: fish or fowl?

This paper considers the status of family intervention as an area of interest defined by its literature (70 publications) and includes a brief history, assessment of present status, and recommendations for future development of family crisis intervention as a distinct field with concepts and goals that can be clearly defined, taught, researched, and repeated in treatment. Recommendations are made for the development of an explicit paradigm for intervention with a clear, common language of terms and concepts for family involvement. Suggested directions for developing the paradigm and language are explored.     

Divorce in the kibbutz: Past and present

In the kibbutz today, there are no ideological or economic barriers to prevent a couple from deciding to divorce. Both husband and wife are assured continued economic security and equal opportunities for co-parenting, thus reducing fears of disruption in the daily contact with the children. In spite of these favorable circumstances, marital breakups in the kibbutz are less frequent than in the larger cities in Israel. In recent years, however, at a time when a stronger and more intensive family life has gained legitimacy within the kibbutz structure, there is a marked tendency toward a rise in the rate of divorce. In this article we analyze the possible causes of the variations in the frequency of divorce within the kibbutz framework.The authors express appreciation to Esther Mivtzari, a psychologist on the staff of the Kibbutz Child and Family Clinic and a member of the religious kibbutz Ein-Tzurim, for assistance in gathering data on divorce in the religious kibbitzum.     

Vicissitudes of the Suicidal Impulse in Dreams

ABSTRACT: The author presents several dreams reported by psychosomatic patients which contain an overt or disguised act of suicide. In the latter instances various transformations of the act of suicide had been brought about by the defensive functions of the dreaming ego. Paradoxically, in several of these instances it was the very efforts of the dreaming ego to defend itself which allowed the suicidal impulse to reach its consummation.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

The role of blood pressure, cortisol, and prolactine among soldiers injured in the 1991–1993 war in Croatia

Ninety soldiers with at least three months of combat exposure—60 injured soldiers (30 with permanent disabling and 30 with nondisabling injuries), 30 noninjured soldiers and 30 healthy controls—were interviewed and investigated with physiological (Prolactine, Cortisol, BP, Hb) and psychological tests (MMPI), IES-15 (Impact of Event Scale), PTSS (Post-Traumatic Symptom Scale). Their was related injuries had a different effect on the physiological stress response of the soldiers as reflected in the levels of prolactine, cortisol, hemoglobin and blood pressure. In a report of personality characteristics of the same soldiers, we demonstrated that the experience of posttraumatic stress was not dependent upon physical injury, but rather on the psychological appraisal of the situation. The results of the present article confirm earlier findings that the relationship between physiological and psychological consequences of trauma are complex, and that the perception of an event and the social context within which the traumatized soldier exists is as important as the event itself. The physiological response to the trauma varied greatly among the soldiers regarding the psychosocial impact of the consequence of the injury. So the anticipation of future possible trauma among less severely wounded soldiers (expected to go back to war) was followed by pathological stress responses. Trauma seems to operate somewhat independently from the overt conscious appraisal of the situation and relationship between psychological, psychosocial, and physiological aspects are interrelated in a multifactorial way. An integrative approach is therefore of great importance in assessment as well as in treatment of Posttraumatic Stress Disorder (PTSD). Editorial Note This historical article is being published for the first time. It is based on the Ph.D. thesis of Dr. Harry A. Teitelbaum for which he was awarded a doctorate by the University of Maryland in College Park in 1936. The dissertation was stored prior to publication and was not rediscovered until 1997. Teitelbaum’s work was performed during the early days of the development of knowledge regarding the mechanisms that regulate endocrine function. The understanding of the broad capability of interactions among endocrine glands was evolving. It was a field that Teitelbaum contributed to for several years, many of which were spent in collaboration with Horsley Gantt in his laboratory at Johns Hopkins. Although some of the experimental strategies and some of the wording of the report seem quaint today, the contribution of Teitelbaum’s research was solid and highly relevant to questions being asked at the time.