Psychiatric Consultation in Medico-Surgical Settings

Abstract

The author resents a frame for evaluating patients in various medical contexts and discusses principles of brief intervention. the frame relies on a basic assumption differentiating the approach of the mind from that of the brain whereby the subjective experience of the patient is compared with the reality process of medical procedures. In that specific context, psychiatric symptoms are seen as elaboration of the gap between the subjective experience of the patients and the objective medical assessment. Psychiatric evaluatiion is therefore subjected to that context where assessment of anxiety and coping mechanisms is paramount to search for the central psychic position from which the patient experiences the clinical episode. Principles of brief intervention are based on the interplay of psychic and external reality. Such principles are spelled out in ten different items along the clinical course of patients as to follow a short, stepwise path to help patients move from accommodating the external reality to their subjective experience to the other way around.