Co N V E NTI ON I S S U E Vol. 4 No. 5 January 1965

Newsletter Louisiana Psychiatric Association

A district branch of the American Psychiatric Association

DISTRICT BRANCH

Arthur P. Burdon, M.D., Editor 3720 Prytania St., New Orleans, La. 70115

3rd ANNUAL MID-WINTER Phil Reed Highlights

MEETING HELD IN the Scientific Meetings

BILOXI, MISSISSIPPI at the L.P.A. Convention

The Buena Vista Hotel served as Head-quarters for the 3rd Annual Mid-Winter meeting of the L.P.A. which was a success matching that of previous meetings in Baton Rouge last year and in Shreveport the year before. The importance of the meeting was attested to by the attendance of 53 Members, 43 Wives, 5 Guests, 8 Chil-dren and 1 Mother-in-law.

In spite of a chilly reception from the weather man and some hidden hotel ex-penses not expected by our Treasurer, a good time was had by all.

Particularly appreciated was the Style Show and Luncheon attended by the ladies of the L.P.A. at noon on Saturday, Janua-ry 16th. Carolyn Kitchen, Myrtis Lief, Dorris Super, and Jo Shannon were es-pecially pleased with the Style Show as they were awarded prizes and gift certifi-cates.

In the afternoon the ladies group broke up for various activities of their own par-ticular interests. Some of the ladies visited the new air-conditioned shopping center and Mall nearby and made some pur-chases for their family and themselves. Others entered into serious sessions of bridge for most of the afternoon. Still others congregated in the room of Louise Ritter where the star of the meeting, baby girl Ritter, aged 4 months, held the center of attention.

At the luncheon President Cohen had words of welcome to all the wives and Association guests. He also had some serious words for them concerning the advisability of their organizing into a Ladies Auxiliary on a permanent basis, to render service both to psychiatrists and their wives, as well as to psychiatry as a profession throughout the year.

As Speaker of the Assembly of District Branches of the American Psychiatric Association, Philip Reed was eminently well qualified to address us on the topic of major interest, "Professional Inter-relationships in Mental Health Fields." Speaking before the entire membership, Phil deplored the problems attendant on our psychiatric "Image" which have come out recently in our national press and news media. Psychiatrists have been criti-cized for being so pre-occupied with other concerns as to be not only detached from patients and their families but the refer -ring physician as well. With equal vigor the charge is made that the psychiatrist does not sufficiently involve himself in the mental health of the community. Dr. Reed made it clear that if the average psychiatrist followed only half of the sug-gestions that have been offered to correct but one of these presumed defici-encies, he would have no time or energy left for any other psychiatric activity. It is thus unfair to both the public and psy-chiatry to further encourage the fantasy that would have the individual psychiat-rist or any other "mind magician" become all things to all people. Dr. Reed did, how-ever, stress that psychiatry must face and answer all reasonable criticism some of which comes from our medical colleagues. He spoke of some of the problems between the psychiatric consultant and the non-psychiatric physician over the handling of referrals, written reports, psychiatric treatment delegated to others, and the arbitrary choice of consultants as well as the return of the patient to his personal or family physician. Until the questions re-lated to these and similar problems are answered by psychiatrists in a direct and consistent manner many physicians will continue to believe that some psychiatrists

William A. McBride, M.D., Associate Editor

PHILIP REED, B.S., M.D., F.A.P.A.

The L.P.A. was proud to have as its invited guest speaker Dr. Philip B. Reed of Indianapolis. Currently he is member of the American Psychiatric Association's Council, Executive Committee, and Re-ference Committee Task Force. Speaker of the Assembly of District Branches, Chairman of the Commission on Recogni-

(Continued on page 6)

The New Orleans Society of Neuro-logy and Psychiatry ,announces they are having a Gala Carnival Saint Valentine's Day Ball, Saturday, Febru-ary 13th, from 8:30 P.M. to 1 A.M. at the Royal Orleans, East Salon. There will be cocktails prior to dancing to the outstanding orchestra of Paul Bar-barin followed by a late Buffet at 10:30 P.M. No charge for Society Members. $7.50 charge for guests, associate mem-bers, wives, dates, etc. Contact Dr. Arthur Samuels for reservations.

(Continued on page 6) (Continued on page 2) 1-.

Page Two LOUISIANA PSYCHIATRIC ASSOCIATION January, 195

LOUISIANA PSYCHIATRIC ASSOCIATION EXECUTIVE COUNCIL ALVIN COHEN, M.D., President

New Orleans WILLIAM C. SUPER, M.D., President-Elect

New Orleans GEORGE J. CARUSO, M.D., Vice President

Baton Rouge THOMAS L. YOUNG, M.D., Vice President

Slhreveport CHARLES A. FEIGLEY, M.D., Secretary

Baton Rouge KENNETH A. RITTER, M.D., Treasurer

New Orleans ARTHUR P. BURDON, M.D.,

Newsletter Editor, New Orleans HAROLD I. LIEF, M.D., Past President

New Orleans ANDRE TOUZET, Assembly Delegate

New Orleans COORDINATING CHAIRMEN MARVIN F. MILLER. MD., New Orleans EDWARD NORMAN, M.D., New Orleans EDWARD H. KNIGHT, M.D., New Orleans

MINUTES OF THE MEETING EXECUTIVE COUNCIL

JANUARY 16, 1965 Present for the meeting were Doctor

Phil Reed, guest, and Doctors Caruso, Young, Ritter, Super, Burdon, Touzet, Lief and Feigley.

The application for membership of William Bayard Drummond was read and approved.

The Treasurer reported that $333 is owed in dues, that second natices have been sent out. After the convention is paid for, $873 will be in the Treasury.

Doctor Super reported the last minute details of the convention.

Committee Reports were not given, but were to be presented to the general membership in the body of the Mid-Winter Meeting.

Those members to be presented to the A.P.A for Fellowship were announced by President Cohen. Doctor Philip Reed, Speaker of the Assembly of District Branches, emphasized the importance of being a Fellow, and pointed out how sen-iority and intensity of interest do aid the District Branch as well as our combined efforts in the American Psychiatric Asso-ciation.

a. The Treasurer and Newsletter Editor notified Council that it costs $100-150/issue of the NEWSLETTER to print and mail to the 130 members and 800 other recipients.

b. The President announced that Arthur Samuels has accepted appointment as NEWSLETTER Editor, with Charles Smith, Bill Sorum and Bill McBride as Associate Editors.

The President reported correspond-ence from Dr. Daniel Blaine concerning a new Group Insurance Program of the United Auto Workers, including certain coverage for out-patient Psychotherapy. The Mental Hospital Achievement Award was mentioned; Louisiana applications are are urged. It was announced that Dr. Philip Solomon has accepted an invitation to speak to the Association in March.

A letter from Don Gallant relative to a recent request to support an approach to the problem of drug addicition was read; he urged that the Association not endorse the program. Council accepted his letter; the President is to ask him for a consensus of opinion from the Committee on Drug Addiction and Alcoholism. Harold Lief told

an item of historical interest wherein the City of New Orleans had a successful Clinic for Addition, dispensing free drugs to addicts, as early as 1923.

Concerning the recent item of attorneys being present while their clients are ex-amined by physicians, Council received with interest an announcement that the presiding judge had rescinded his own court order.

The President reported receiving an A.P.A. Guide for District Branch Officers and directed the Secretary to see that it is passed on to new officers each year.

9. Doctor Phil Reed, Speaker of the Assembly of District Branches, talked with Council concerning policy matters, the importance of Fellowship in the A.P.A., and gave an outline of his anticipated talk to the general membership. 10. The Date for the next council meeting was set for Thursday, February 11, 1965.

Respectfully submitted, Charles A. Feigley, M.D. Secretary, Louisiana Psychiatric Association

PHIL REED HIGHLIGHTS MEETING (Continued from page 1)

are neither in the mainstream of medicine nor do they wish to be. Until a mutually acceptable and more nearly uniform code of communication is in general medical use, the development of true community psychiatry will necessarily lag.

Dr. Reed sees the future of psychiatry as naturally connected with the future of medicine and deplored implicit much less explicit approval by some psychiatrists of any and all developments that would foster the attempt of non-medical personnel to treat emotional or mental illness without the total person and hence the need for medical collaboration. Reference was made to certain clinical psychiatrists who are encouraging clergymen with more or less training in p a s t o r a 1 counseling to consider that their treatment is "substantively unique" and as such re- quires little or no collaborative relation- ship with medicine. He commented favora- bly on the new Louisiana law governing the clinical behavior of psychologists and complimented the L.P.A. on its part in developing this new law.

In discussing the business of the Assem-bly of District Branches, Phil greatly emphasized the importance of our L.P.A. having a Delegate and Alternate who is in attendance for some period of time to become acquainted with and become powerful enough to wield an influence on the National scene. He reminded us there are now 8,000 members of the Assembly out of the 14,000 (approximate) A.P.A. members.

The recent Special Session of the A.P.A. Council has many extremely significant

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NEWS FROM THE STATE MENTAL HEALTH

PROGRAM Capitol Improvement funds have been

requested from the new $35,000,000 bond issue passed by the Louisiana Legislature. Requests include money for the three state mental hospitals, for furnishing the second floor of the New Orleans Regional Mental Health Center and matching funds for construction of other health centers in the State.

Mental Health Planning deadlines have been extended so that the State Plan for Planning may now be submitted as late as September 1, 1965. The State Plan for Construction of Community Mental Health facilities must be submitted no later than June 30, 1965 to encumber funds that are currently available to Louisiana. Every effort is being made to submit Louisiana's plans far ahead of the deadlines.

Personnel actions include re-appoint-ment of Dr. Berthan Stokes as psychiatrist on the staff of East Louisiana State Hos-pital. Dr. E. G. Ward has accepted an ap-pointment at East Louisiana State Hospital to begin work in January. Active recruit-ment is slowly paying off in terms of in-creased staff at this Hospital. Willian N. Tarver, social worker, has been appointed as Chief social worker, has been appointed as Chief, Division of Alcoholism, in the State office. He has been administratively in charge of the Alcoholism Treatment Service at East Louisiana State Hospital.

Dr. Paul Pratt has been appointed by Governor McKeithen as Louisiana's repre-sentative to the SREB Commission on Mental Illness. He is also a new member of the National Association of State Mental Health Program Directors.

Winborn E. Davis has been appointed Special Consultant to the U. S. Surgeon General to serve on the In-Service Train-ing Committee which reviews grant ap-plications from State Mental hospitals and schools for retarded. Dr. Victor Gonzales is now Clinical Director at the Donaldson-ville Guidance Center where he servieS on a part-time basis.

Budgets for fiscal 1965-66 are being prep-ared. Additional operating funds will be requested again for full implementation of the Regional Mental Health Centers at New Orleans, Baton Rouge and Shreve-port. The Shreveport Center is under con-struction and is now 34% complete.

January, 1965 LOUISIANA PSYCHIATRIC ASSOCIATION Page Three

PHIL REED HIGHLIGHTS MEETING (Continued from page 2)

portents for the future of American psy-chiatry if the majority of its propositions are adopted. Abbreviating these develop-ments, Phil made a memorable statement for all of us to remember. "These new A.P.A. rules would make the District Branch the important voice of the A.P.A.; this makes the District Branch member the most important person in American Psychiatry and its future today." The Assembly will become the business arm of the A.P.A.

Commenting on the A.P.A's position with regard to the Community Mental Health concepts of recent years, Phil stressed the need to involve the private practitioner in the commurity mental health approach. "The entire community approach can be helped by wisely using private practition-ers and their advice, techniques, and consultative efforts." He strongly under-scored the abEolute requirement for deci-sive leadershiç for psychiatric clinics and child guidance clinics to be in the hands of psychiatrists. He urged the active leadership and participation of the L.P.A. and its members in State Mental Health Planning. He commended Louisiana on its new Commissioner of Mental Health and on its active program of initiating and sponsoring nev ideas in community mental health through the L.P.A. and its com-mittee structure.

Paul Pratt addresses plenary Session.

Paul Pratt, of Baton Rouge, our first Louisiana Commissioner of Mental Health was welcomed at the morning session for an address on his activities after taking over his job within recent months. Paul was most helpful to the audience in spel-ling out some of the recent plans and activities concerning the pressing prob-lems connectej with the East Louisiana State Hospital at Jackson, Louisiana. Paul announced that Allan Johnstone has re-cently been appointed as the new Clinical Director at Jackson and that he would at-tempt to cope with the many problems facing the hospital which have been en-demic over the many years. No one ex-pects that there is an immediate cure for the difficu:Lties but there is a patient and deliberate effort to slowly master the problems which have plagued this institution for generations. The major problem of pro essional personnel is slowly being cured by the appointment of new staff as well the hope of new additions to the staff th:.s summer.

Long term plans for Jackson include the phasing out of the acute treatment pro-gram at Jackson and the possibility of

building a three hundred bed hospital in Baton Rouge for the acutely psychotic patients. The forensic psychiatry unit at Jackson will also be moved, hopefully to the New Orleans area. Both of these moves involve major expenditures of monies, probably in the neighborhood of thirteen million dollars. This money may be included in a proposed bond issue by Governor McKeithen.

Paul indicates that there may be three million dollars additionally available to the mental health program within the near future. Paul regrets that there must be more money spent at Jackson to make the place liveable for the present inmates. In addition, he indicates the need for a new Children's House at Mandeville and some renovations at Forest Glen at Central State Hospital. He also indicated the pos-sibility of pay raises for some mental hospital personnel in March, 1985.

Paul agreed fully with Dr. Reed that psychiatrists should be the heads of psy-chiatric hospitals and clinics throughout the State, but he commented on the prob-lems of staffing which were rather difficult at this time. He mentioned the need to do away with the old fashioned "Child-Guid-ance" model of staff conferencing over patients individually with a great loss of professional time and at consequent at great expense to the State. He suggested that experiments have been underway as to methods of speeding up and improving the services to patients and their families without loss of quality of service through various group methods.

Panel on The Adolescent Patient

A panel on the special problems in treat-ment of the adolescent were moderated by David Freedman, and brief talks of a formal nature were presented by the four discussants, followed by a lively inter -change of questions and answers from the audience. Cyril Phillips presented some theoretical formulations of Anna Freud about the nature of adolescence, and of-fered a memorable quotation from Winni-cott, in which adolescence is described as a Disorder in Time, cured by the Pass-age of Time.

Vann Spruiell spoke of the relative "pa-tienthood" of the adolescent consultee and warned against the family use of a scape-goating mechanism for their child when the locus of the family problems may be elsewhere than in the teen-ager. Levels of motivation for psychotherapy and levels of maturity within adolescence were dis-cussed at length.

Don Lathrop spoke of the difficulty and intensity of emotional pressure encoun-tered in doing group psychotherapy with middle-adolescent children—those children

whose major life task seems to be to survive through their High School days. He spoke of their deep concern over life-and-death issues within their own social framework. He stated that little inter-pretive work need be done but that re-lationship work was necessary of a high order—that of the therapist indicating his ability to survive and to maintain hope in the face of these youngsters' overwhelm-ing emotional pressures.

Allan Johnstone spoke of the adolescent units at Southeast Louisiana State Hos-pital in which there are 102 white adoles-cent children and 50 Negro adolescents. Dr. Carolyn Kitchen is in charge of the Negro program. He mentioned that young-sters between the ages of 12 and 19 are acceptable on this unit and that the hos-pital provides an environment in which average frustrations and rewards for an adequate behavior are maintained. A school is maintained for the adolescents at the Institution. Dr. Johnstone spoke of the problem of over-identification with the teen-ager, an almost universal phenomena of newcomers to the field. He mentioned that broader experience has underscored the necessity of learning better the entire family's attitudes and reactions in coping with the problems of a teen-ager. Particu-larly he stressed the parents need for an acceptance of the emotion of depression in themselves and in their children, since this as a common symptom of adolescent life.

Panel on Family Therapy

The afternoon panel was moderated by Mottram Torre. Family therapy, both the theoretical aspects of family approaches, and the technical approaches to psycho-therapeutic strategy were discussed by the four L.P.A. Members on the panel.

Arthur Burdon presented his thesis that family therapy as a theoretical construct was as old as one human being being interested in how another human being became upset; and explained it in terms of family considerations. Specifically, he outlined the early concepts of family in Freud's work around the turn of the cen-tury; emphasizing that Freud considered the realities of family involvement and behavior crucial in his early Traumatic Theory of neurosis. Even later, with the emphasis shifted to an Instinctual Theory of neurosis, the structure of the defences against instincts depended greatly upon the realities of the family inter-action. Thus, ego structure is a condensation of the realities, both internal and external, in the life of the developing individual.

Family therapy as a technique, in con-trast, is quite new and has a powerful

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Page Four LOUISIANA PSYCHIATRIC ASSOCIATION January, 1965

PHIL REED HIGHLIGHTS MEETING (Continued from page 3)

impact on the en masse family in such treatment. Dr. Burdon mentioned the beneficial effects on reality testing by family confrontation with the unreal ex-pectations and difficulties in communica-tion among family members—Thus the internal psychic reality and the external reality of the individual's life might be highlighted.

William Sorum discussed further theore-tical concepts related to family therapy in the sociological and existential sense. He emphasized clearly that the family is the carrier of culture, and the crucible in which the essential humanness of the family is developed. The individuals ident-ity is almost wholly a function of the family, and in this respect the family has a central position in all of treatment. Dr. Sorum mentioned treatment efforts which he has made on the basis of extending his interest from an individual patient to the spouse, and on several occasions even to the patient's children, and beyond that to the patient's co-workers and employees in an industrial setting. Dr. Sorum mentioned that he was compelled to these increased interests in the patient's external and interpersonal realities by the necessities of the illness. He noted great success in coping with the patient's many problems in this way.

George Caruso presented a fascinating case history from his recent experience involving the family treatment of a 14 year old school failing run-away daughter, her mother, and her father. He detailed the dynamics interaction and the unfolding of the psychotherapeutic interchange be-tween himself and the child, himself and the mother and father, and the group to-gether. He demonstrated in a very con-vincing way a hidden interpersonal dynamic involving the mother's over-stimulation of her daughter's sexual fan-tasies, which had led to massive panic in the child and a fear of acting out. It was quite clear these dynamics would not have been nearly so obvious nor so psycho-therapeutically manageable if the parents and child had not been seen together as was done in this case. This particular child was highly non-verbal and extremely anxious and would not have been able to communicate with the therapist in any meaningful way for quite a long time, but because of the fortunate observation of the family interaction, Dr. Caruso was able to interpret and clearly to bring insight to the family of their unconscious defenses and unconscious wishes in a way which promoted early resolution of the major anxiety in this child.

Thomas Young presented a general dis-cussion of his experience as a member of a group of physicians practicing for many years in one community with records ex-tending over a thirty year span of time. In his collection of neuro-psychiatric cases, there are representatives of 93 patients who have had other members of their families consult at various times in the same clinic. There are 43 families in which multiple consultations have been made to the psychiatric department. Dr. Young presented several cases involving the tandem consultations between the father and the psychiatrist, then the father bringing in his daughter for consultation. Dr. Young pointed out the interesting prescience of the father with regard to his daughter's unconscious problems, when the father presented a dream of incestu-ous involvement with his adopted teen-age daughter. It was several days later when the daughter came down with what appeared to be conversion reactions of a major hysterical sort involving weakness of the left side of the body. The fear of pregnancy and anxiety over sexual fan-tasy activity was most obvious in his daughter and had been perceived by her father in advance. Dr. Young felt the theory with regard the family therapy and family structure was shaky but that he placed his belief in emperical observa-tions—that psychic structure of family members is very similar, and that an understanding at a deep level between family members can go on without con-scious awareness.

The discussion of these papers on the panel of family therapy was lively and lengthly. Cyril Phillips presented his view that serial individual sessions of one or two times with the whole family, starting with the patient and then his parents and then the other siblings was adviseable as over against seeing the entire "bowl of worms" together as in the newer forms of conjoint family psychotherapy. Ted Watters discussed his ten year work with non-psychiatric general physicians in their approach to the families and the inter digitation of individual psychodynamics in each family member. He discussed the centrality of the oedipus complex seeing it as always being structured into the present day life of his patients as well as being present in all ancient religions, folk practices, and primitive societies. Linking group psychotherapeutic methods with family psychotherapy, Dr. Watters men-tioned that the teaching of psychotherapy through group methods was the most ef-fective and only way to communicate the complex matrix of the social reality of psychiatric treatment.

Editor's Jambalaya TO THE EDITOR:

I wish to add to my comment from the floor at the January 16 Biloxi meeting of the Louisiana District Branch. From the standpoint of excellence of scientific pro-gram as well as the gracious good will reflected in social activities, yours was one of the finest District Branch meetings it has been my privilege to attend.

As you know I received a copy of the December Louisiana Newsletter only a few minutes before your Executive Council meeting which was immediately followed by the plenary session of Saturday morn-ing and my scheduled remarks. My only reference was to Al Cohen's President's Column as this was all that I had op. portunity to read before I spoke. Had I the time to have read Ed Knight's fine article, "Problems of Professional Ident-ity," before speaking it would certainly have been endorsed. Ed, as you expect, does a fine job of delineating the multiple basic factors which are over-simplified by some who would have the APA and the Assembly take direct and decisive action. I am not sure that a degree in "medical psychotherapy" is the best possible solu-tion but it would certainly serve to count-eract the fractionation of the total health effort which is occuring especially in states where certain groups have become certified or licensed to practice psycho-therapy under conditions which do not insure either active supervision by quali-fied physicians or true ethical collabora-tion with them. Such individuals or groups do appear to fall within the definition of "cultists" that has been long employed by the Judical Council of the American Medical Association.

Sincerely, Philip B. Reed, M.D. Speaker

* * * 4 SIR:

Reference is made to the December issue of the LPA NEWSLETTER in which it stated that according to the Public Affaris Research Council of Louisiana, $19,660,000 were spent last year on the State Mental Hospital program and $21,553,000 is budgeted for 1964-65. I don't know where these people get their figures but one thing is certain, they are wrong.

According to authoritative figures, the mental health program including clinics had $14,656,679 for 1964-65 and approxi-mately one-half million dollars less than that for 1963-64. Present budgets are being prepared and we have no idea what in-

(Continued on page 6)

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January, 1965 LOUISIANA PSYCHIATRIC ASSOCIATION Page Five

Coffee Break at the Convention. Commissioner Paul Pratt discusses the latest plans with the L.P.A.

Panel on Adolescence (I to r) Allan Johnstone, Cyril Phillips, David Freedman, moderator, Vann SpruiII, and Donald Lathrop.

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••• • fl

Panel on Family Therapy, (I to r) Thomas Young, Mottram Torre, mockrator, Arthur Burdon, President

Speaker Phil Reed holds forth. Cohen, William Sorum, and George Caruso.

These photographs furnished by courtesy of JACOB VEISLER

Page Six LOUISIANA PSYCHIATRIC ASSOCIATION January, 1965

3RD ANNUAL MID-WINTER MEETING HELD IN BILOXI, MISSISSIPPI

(Continued from page 1) The social high point of the meeting

occurred Saturday night at the Dinner Dance which was preceded by a very congenial and spirited Cocktail Party. The dinner itself was a truly sumptuous repast. Each guest had his choice in smorgasbord fashion of four or five heavily laden tables of all kinds and sorts of delicious foods. In addition to shrimp, ham, turkey, roast beef, corned beef, fried chicken, and pork chops, there was a delectable offering of roast duck. With such a pleasant combination of alcohol and food the party was well on its way. President Cohen briefly introduced the members of Council who occupied the head table along with our special guests, Dr. and Mrs. Philip Reed of Indianapolis, Indiana.

Musicwas provided by an "Imported" orchestra from New Orleans. After the lightsd been sufficiently dimmed, the dajig began in earnest and went on into , wee hours. of th-ing.

." \Suday ornii'. brunch was a Chef's delight, ,eniiig most of our convention-eerspit/ir way home by Sunday noon aftdr a Dus .1easant and satisfying per-

.od fUffip, conviviality and renewal f~d acoiintances. President Cohen ex-

tend,d'4 his special thanks to William Super( who was Program Chairman for the Meeting. The Ladies Program arrange-ments were under the direction of Dorris Super and Ruth Cohen.

Philip Reed, B.S., M.D., F.A.P.A. (Continued from page 1)

tion of Psychiatric Service magazine. He is also Chairman, Judical Commission (Grievance Committee) of Indiana State Medical Association, Dr. Reed is also Associate Professor of Psychiatry, Indiana University School of Medicine. He is in private practice in his home city of Indian-apolis. His trip was financed in part by an Eli Lilly travel grant.

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EDITOR'S JAMBALAYA (Continued from page 4)

crease will be made. However, PAR is ap- proximately $7,000,000 off the spot.

Thank you very much for your attention. I hope this will be printed to point out con-tinning misunderstanding about our finan-cial position.

John Paul Pratt, M.D. Commissioner of Mental Health