Evaluation of the Psychiatric Patient: A Primer

A few months before the final manuscript of this book was sent to the publisher, Dr. Karl A. Menninger died, shortly before his ninety- seventh birthday. Thus, when I sat down to write this preface, he was very much on my mind. I remembered that it had been almost forty years since he wrote A Manual for Psychiatric Case Study, not one of his well-known but probably the most practical of his books. The psycho- analytically trained part of me began to wonder what had motivated me to write a book on a topic so similar to that which had earlier drawn the attention of my revered teacher. There is no pressing need for another book on psychiatric evaluation; furthermore, evaluation is a very diffi- cult subject to write about in a straightforward way. Whatever my unconscious motivations may have been, I hope they were less significant than those of which I was aware. I wrote this book mainly as part of an effort to reverse certain trends in psychiatric educa- tion. In the last decade psychiatrists have increasingly been trained in an environment that emphasizes brief evaluation of patients and de- emphasizes teaching about the complexity of human behavior and ex- perience. Trainees no longer study psychiatric evaluation in a systematic manner. They take fewer intensive histories, fill out forms instead of describing the patient's mental status, and, with rare exceptions, are not taught how to conceptualize biological and psychosocial interactions.