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WHO GOES TO A PSYCHIATRIST? A Report on 100 Unselected, Consecutive Cases
Am J Psychiatry 1950;106:845-850.
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The Psychiatric Center, N. K. Rickles, M. D., Director.

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This statistical review has emphasized the following points:1. Into the office of the private practicing psychiatrist come people from all walks and situations of life. They are in practically all respects average American citizens, undistinguishable from any others. Their only common denominations are nervous symptoms or emotional problems which they cannot handle themselves and for which they seek professional help.2. The majority are in extremely modest financial circumstances, but they are willing to make certain sacrifices in order to receive psychiatric care.Since 12% of our 100 cases were obliged to forego therapy because they could not afford it or because they could not leave their jobs during working hours, it appears on the basis of this study that a prime requisite for the mental health of any community is the establishment of evening clinics for such people. They need and want treatment, they are willing to pay for it within the limits of their capabilities, and they are willing to give up their leisure time to obtain it. Surely, then, there should be facilities to meet their simple requirements.Clinics should also be established for daytime care on a reduced fee basis, where young psychiatrists under the capable supervision of older men would be able to render valuable psychiatric aid to those who need it, while at the same time adding to their own fund of knowledge and experience. As further inducement for young psychiatrists to identify themselves with such clinic procedures, the American Board of Psychiatry and Neurology should give proper credit for this experience, as being an essential part of their training period.In the realm of preventive psychiatry, we believe that the teen-age group offers a tremendous and fertile field for education, and that the precepts of mental hygiene should be inculcated in a wholesome way by making them an integral part of the accepted school curriculum. If adult problems, such as marriage and the choice of a career, are clarified for young people before they actually have to face them, many traumatic experiences would be avoided in later life.In regard to the acute psychotics, we feel that modern psychiatric procedures have proved that they can be cured at about the same ratio as people suffering from acute physical disorders, and that proper facilities should be made available for their care. There should be more beds for acute psychiatric patients, both in general hospitals and in small, homelike sanitariums. Our experience has shown that large institutions have a tendency to defeat their purpose, as the individual loses his identity and suffers from the lack of security and warmth. With this in view, it is recommended that in the future, in planning for inpatient psychiatric care, both public and private facilities be established on a cottagelike basis. Whenever possible, these patients should be accepted in the various group medical insurance plans on a par with other medical disorders.Finally, we wish to urge—in common with practically all our confreres—that a public education program be actively pursued in order that people be informed and kept abreast of the developments and improvements in psychiatric services.

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