EDITORIAL
The role of history in the treatment of patients in the current days
Carmem Keidann
Editor, Rev Psiquiatr RS
In this issue of our Journal, the focus of editorials is on history. There are some possible approaches to this subject: history of psychiatry, psychiatric and psychotherapeutic care, history and development of the theories that support the psychiatrist's scientific work. There are also histories regarding the evolution of patient care and, in this sense, one more possibility of thinking arises, concerning the patient's life history and the history of care that is developed through the process.
We can, therefore, establish a connection between the psychiatrist's work with his patient and the insertion of the patient's personal history in that represented by the patient-psychiatrist pair.
In patient care, when evaluating symptoms and/or problems brought to the treatment since initial assessment, practitioners are dealing with history. The person's history is an essential diagnostic factor. Through it, the patient's pattern of functioning and his family relationships can be assessed, and these data are crucial both for clinical/pharmacological and psychotherapeutic treatment. The patient's history data, how he lived and what he accomplished, despite the disease, provide an adequate diagnosis and a more specific indication of treatment.
Especially in psychotherapeutic approach, interest in the individual's history is perceived by how he built his subjectivity and how he has been dealing with his suffering. Such data are integrated in the psychiatrist's mind, and understanding of how the patient shares and selects facts to be told end up by shaping and conducting the history of psychotherapeutic care itself. It can be observed, during psychiatric care, that the patient's version about data from his history changes, dependent on the moment of life and also on the moment of treatment. Therefore, history is being built, and characters acquire new features as the patient's understanding increases.
The American sociologist Immanuel Wallerstein, at University of Yale, has recently been to Porto Alegre, participating in a cycle of activities called "Frontiers of the thought." In an interview given to a local newspaper, he talked about something that applies to the ideas we are discussing here. Wallerstein said: "(...) Facts are there, they are also creations. We do not approach the history of the universe when we write history; we select what makes sense. And we call that facts!"1
Such conception about history reinforces its importance in clinical work with patients. Psychiatrists seek facts that make sense to form an idea about the patient and about the therapeutic conduct to be followed. And also to help the patient find meanings for emotions and facts remembered by him. Practitioners should follow their patient in such path as long as it takes. But they should acknowledge that their role is to conduct patient's treatment, and not life, and this is a major ethical recommendation to be emphasized.2
It is good to remember that we are active and passive agents of history. By working as a psychiatrist and organizing a journal with editorials focusing on history of psychiatry, we are functioning as active agents, since we are trying to communicate something that has already been established throughout time. The weight of history of our profession falls on each individual, and since our function is mostly determined by their history, we are also passive agents. There are responsibilities implied by knowledge. The profession's identity is inevitably associated with its history. It is essential to respect its origins and development.
Therefore, in this issue, we try to bring readers remembrances about the beginning of psychiatry in our country. In a contrast with the previous issue, in which we conjectured about the future, we thought about revisiting the past to provide a retrospective that would allow us to follow a previous path and learn with accumulated experiences to keep evolving.
We invited our colleague Walmor Piccinini to present this issue's cover, which takes us to the past with a historical appraisal and pertinent and explanatory comments on the images contained in the photograph.
Next, we have three invited editorials by colleagues of acknowledged experience in Brazilian psychiatry. Othon Bastos Filho and Luiz Salvador de Miranda-Sá Júnior shed a light on this theme with aspects of history of psychiatry in Brazil, relating historical context aspects with practice pf psychiatry in its origins. Dr. Sérgio Annes, one of the pioneers in our state, performs a personal report of his experience, sharing with us his development as a psychiatrist and psychoanalyst.
We wish everyone a good and enlightening reading.
References
1. Wallerstein I. [entrevista]. Caderno de Cultura. Zero Hora, 25/08/07.
2. Cruz JG, Golbert SI. Ética em psicoterapia de orientação analítica. Rev Bras Psicoter. 2005;7(1):61-72.
Publication Dates
-
Publication in this collection
13 Dec 2007 -
Date of issue
Aug 2007
