The legal system and juries customarily weigh evidence more regularly than the psychoanalytic profession.
Sections of this chapter previously appeared in a chapter by Kliman in Gerber, et al (1979) Perspectives on Bereavement, Arno. NY Times Press.
Here you will meet several children helped by Cornerstone who suffered from tragic losses and tragic circumstances. This chapter is essentially practical in its orientation to technique, describing several forms of treatment of bereaved children, with a minimum of theoretical essay. Probably the best definition of "mourning" for our current purposes is, "the totality of reaction to the loss of a loved object." We omit from this definition any immediate consideration of whether mourning can occur at various stages in childhood, and if so, to what extent one or another investigator judges it has occurred, although such consideration is worthy of volumes. To simplify the task somewhat, because it is actually of extreme complexity, Freud's (1915) definition of the work of mourning will be used, with no detailed reference at this time to the more modern contributions such as those of Bowlby (1960). Since considerable review of literature on childhood mourning, including the few clinical cases reported in the literature in any detail, has been made elsewhere by me (Kliman, 1968), a repetition will be avoided here.
The Center for Preventive Psychiatry (White Plains, New York) was created to assist adults and children in dealing with severe emotional burdens and situational stresses and strains. Over 1000 persons came to the Center during its first 12 years of operation. Many were victims of severe, traumatic sudden crises other than the loss of a loved one (object loss). Some were children who were sexually molested, or who had been badly beaten, or who had witnessed murders in their families. Some were suffering adverse effects of their involvement in highly over-stimulating experiences, such as witnessing romantic involvement with adults of the same sex, or incestuous relations within their own families. Some were severely physically ill. Some had sustained psychological trauma, developmental derailment and loss of home and property due to sudden, mass disasters such as floods or tornadoes. No patients however, attracted more of our systematic professional interest and consumed more of our professional energies than adults and children who suffered the sudden and then chronic strains of bereavement.
Never a momentary injury, loss of a loved person is often a long-enduring pathogenic influence. It deserves preventive intervention whenever the loss has occurred early in life, and especially when the early loss is that of a parent. From its beginning, the Center for Preventive Psychiatry had been interested in helping healthy orphans in order to develop techniques of primary prevention of mental illness. Data concerning a series of 18 untreated orphans show that few orphans are free of neurotic symptomatology. Often we found that even orphans referred to us very soon after bereavement -specifically for preventive support- already presented important neurotic symptoms. In fact, the majority of recently bereaved children suffered recognizable symptoms of neurosis, and in some cases, psychosis.
Dr. Gilbert Kliman, won the International Literary Prize for Best Book concerning the Well Being and Nurture of Children, "Responsible Parenthood" and is the recipient of grants from over 50 private foundations and The National Institute of Mental Health. His research interests include the Psychological Trauma and Treatment of Severely Disturbed Children and their families, in-classroom psychotherapy.
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Objective: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. Methods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians (T = -3.56, P = .000).
In order for a medical opinion to be admissible as evidence in civil, criminal and administrative cases, the basis of the opinion must fulfill either the Daubert Criteria or the Frye test, depending on the jurisdiction. The judge of the court rules on the admissibility of the expert opinion. The effect of Daubert has been to limit expert testimony to opinions which are based on a scientific foundation. Daubert specifies that adequate scientific support and method and a known error rate must exist. The testimony of a mental health expert rendering an opinion using criteria which does not meet Daubert standards is weakened by the implication that it is not based on "sound science." In some instances, for example, a mental health expert uses an approach where there are no peer-reviewed studies or methods, such as when psychologists compose their own neuropsychological test batteries. In most cases where an attorney is considering a "Daubert challenge," a contemporaneous and up-to-date literature search is indicated. Also, extensive case law presently exists as to specific issues. Being familiar with the Daubert criteria enhances effectiveness in challenging a mental health expert's opinion, whether on voir dire or cross examination. On direct examination, the strengths of an opinion reached under Daubert criteria become a "teaching moment" for the trier of fact, because it will be founded on the science of mental health assessment.