Systems Understanding and Intervention, and Ethical Issues

  • Hoyle Leigh

A 67-year-old woman with a hip fracture was referred to the psychiatrist, as she wished to leave the hospital against medical advice prior to surgery. The patient was described as being hostile, agitated, and irrational by the nursing staff. On interview, the patient insisted that she had to go home, but upon further questioning, it was found that the patient lived alone with three cats, and she was concerned about not being able to care for the cats. When the consultant called the social worker, she was unaware of the patient’s concern about the cats, as she had only asked whether the patient had a home and family (human family!). The consultant explained to the nursing staff why the patient was so agitated: she was worried about her cats. They empathized with her concern. The social worker was able to contact a sister who lived in another city, who was willing to care for the cats while the patient was in the hospital. The patient was now willing to stay and have the necessary surgery.


Nursing Staff Psychiatric Consultation Basic Assumption Group Sick Role Psychiatric Consultant 
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  1. Bion WB. Experience in Groups. New York: Basic Books, 1961.Google Scholar
  2. Glazer WM, Astrachan BM. A social systems approach to consultation liaison psychiatry. Int J Psychiatry Med 1979;9:3347.Google Scholar
  3. Guggenheim FG. A marketplace model of consultation psychiatry in the general hospital. Am J Psychiatry 1978;135:1380–1383.PubMedGoogle Scholar
  4. Karasu TB, Hertzman M. Notes on a contextual approach to medical ward consultation: the importance of social system mythology. Int J Psychiatry Med 1974;5:4149.Google Scholar
  5. Meyer E, Mendelson M. Psychiatric consultations with patients on medical and surgical wards: patterns and processes. Psychiatry 1961;24:197–220.PubMedGoogle Scholar
  6. Mohl PC. A systems approach to liaison psychiatry. Psychosomatics 1980;21:457–461.PubMedGoogle Scholar
  7. Parsons T. The Social System. New York: Free Press, 1951.Google Scholar


  1. Bannink M, Van Gool AR, van der Heide A, van der Maas PJ. Psychiatric consultation and quality of decision making in euthanasia. Lancet 2000;356(9247):2067–2068.PubMedCrossRefGoogle Scholar
  2. Bronheim HE, Fulop G, Kunkel EJ, et al. The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. Psychosomatics 1998;39(4):S8–30.PubMedGoogle Scholar
  3. Bustamante JP, Ford CV. Characteristics of general hospital patients referred for psychiatric consultation. J Clin Psychiatry 1981;42:338–341.Google Scholar
  4. Fishman HC: Family consideration in liaison psychiatry. Psychiatr Clin North Am 1979;2:249–263.Google Scholar
  5. Issacharoff A, Redinger R, Schneider D. The psychiatric consultation as an experience in group process. Contemp Psychoanal 1972;8:260–275.Google Scholar
  6. Leeman CP. Psychiatric consultations and ethics consultations. similarities and differences. Gen Hosp Psychiatry 2000;22(4):270–275.PubMedCrossRefGoogle Scholar
  7. Leeman CP, Blum J, Lederberg MS. A combined ethics and psychiatric consultation. Gen Hosp Psychiatry 2001;23(2):73–76.PubMedCrossRefGoogle Scholar
  8. Lewin K. Field Theory in Social Science. New York: Harper, 1951.Google Scholar
  9. Lewin K. Principles of Topological Psychology. New York: McGraw-Hill, 1936.CrossRefGoogle Scholar
  10. Lipsitt DR, Lipsitt MI. The family in consultation liaison psychiatry. Gen Hosp Psychiatry 1981;3:231–236.PubMedCrossRefGoogle Scholar
  11. Meyer E, Mendelson M. Psychiatric consultations with patients on medical and surgical wards: patterns and processes. Psychiatry 1961;24:197–220.PubMedGoogle Scholar
  12. Miller WB. Psychiatric consultation—part I: a general systems approach. Psychiatry 1973;4:135–145.Google Scholar
  13. Miller WB. Psychiatric consultation—part II: conceptual and pragmatic issues of formulation. Psychiatry 1973;4:251–271.Google Scholar
  14. Mohl PC. The liaison psychiatrist: social role and status. Psychosomatics 1979;20:19–23.PubMedGoogle Scholar
  15. Rice AK. Individual, group, and intergroup processes. Hum Relat 1969;22:565–584.CrossRefGoogle Scholar
  16. Schiff SK, Pilot ML, An approach to psychiatric consultation in the general hospital. Arch Gen Psychiatry 1959;1:349–357.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Hoyle Leigh
    • 1
  1. 1.University of CaliforniaFresnoUSA

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