Divergencies between a medical and a psychiatric hospitalization: Admissions, aggressiveness, and characterological suicidality in severe personality disorders

Context

There have been significant advances in organizational and administrative practices of modern psychiatric institutions. These advances have allowed their capitalization in the therapeutic use of social sub-systems and the interaction between staff and patients, in inpatient hospital programs. The therapeutic use of the interaction between patients and personnel is the essence of contemporary psychiatric divisions: this is what truly distinguishes modern psychiatric services from traditional medical models. However, the enormous gap between these advances and their more universal applications to the contemporary psychiatric hospital is disconcerting.

Objectives

(a) To raise awareness of the differences between a medical and a psychiatric inpatient program; (b) so as to truly appreciate the importance of the therapeutic use of the interaction between personnel and patients; (c) particularly in the context of treating aggressiveness and characterological suicidality in severe personality disorders.

Method

In this study the divergencies between a medical and a psychiatric hospitalization are critically explored along four dimensions: (1) body versus mind; (2) reasons for admissions; (3) pharmacological approaches; and (4) characterological suicidality and aggressiveness in severe personality disorders.

Results

Lamentably, the non-delimited and confusing transposition of traditional and psychiatric models, in inpatient psychiatric programs which do not integrate a comprehensive supraordinate psychotherapeutic framework at the service of their primary tasks, results in the risk of highly restrictive and merely custodial care of patients; unintegrated salads of multiple psychotherapeutic modalities, without a holistic approximation to articulate them; and the mixture of interventions that cancel each other out and could even result iatrogenic for patients and staff. It is precisely in the dimensions of characterological suicidality and aggressiveness, that the overall containment and treatment of suicidal behavior and the rampant infiltration of aggression in severe personality pathology call for a clear demarcation between a medical model and a genuinely psychiatric one.

Interpretations

Contrary to the erroneous prediction of a few decades ago, about the disappearance of the psychiatric hospital, the need of modern psychiatric institutions and psychiatry programs that integrate the achievements and contemporary proposals in mental health and psychotherapeutic sciences is more imperative than ever. This situation will demand an ongoing effort to explore critically our psychiatric practices and to address the enormous challenges represented by the training of staff, professors, and residents in psychiatry, toward the optimal use and advancement of available hospital resources.