Categories
Adolescent Psychiatry

Editor’s introduction

Editor’s introduction

Esman, Aaron H

The current volume of The Annals is a landmark in the history of the American Society for Adolescent Psychiatry (ASAP). Appearing as it does in the year 2000, it marks the 25th publication in ASAP’s series of reports on the status and prospects of the field of adolescent psychiatry and the professional activity of its scholars and practitioners. In the years since Drs. Feinstein, Miller, and Giovacchini initiated this project, much has changed in American psychiatry in general and in our subspecialty in particular, yet the overriding concern of ASAP and its leaders remains the same-the promotion and development of the best possible means of assessing, understanding, and caring for the large numbers of troubled adolescents in our communities. Volume 25 remains faithful to this tradition.

Section I of this volume continues an initiative begun in Volume 23-a reappraisal of traditional concepts of adolescent development in the light of newer trends in psychoanalytic thought (specifically, self psychology, attachment theory, and interpersonal psychodynamics). Here, Shelley R. Doctors pursues these themes along lines delineated by the late Richard C. Marohn in Volume 23. Then, Charles M. Jaffe enlists the resources of general systems theory to formulate a sharply revised perspective on the developmental process and a psychotherapy based on this reconceptualization. Last, Saul Levine addresses a neglected aspect of adolescent development-the spiritual and ethical issues that give shape to emerging identity.

One of the most contentious issues in the study of adolescent psychopathology has been that of the status of “personality disorder” as a diagnostic concept in this age group. In Section II, Drew Westen and Christine Chang, attacking the question head-on, conclude from their empirical and clinical studies that such conditions are in fact appropriately diagnosed in adolescence, and set forth a research program for refining our understanding of these difficult and often perplexing disorders. Benjamin Garber, in turn, develops a clinically based thesis about mourning reactions in adolescence and proposes a psychotherapeutic approach to such conditions.

The broad range of psychotherapies for adolescent disorders is explored in Section III. Theodore Shapiro surveys the history of psychoanalytic thinking about this age group and of conflicting views about the applicability thereto of psychoanalytic modes of treatment. Emphasizing the need for openness and flexibility, he delineates both the strengths and the limitations inherent in such work. Laura Mufson and Kristen Pollack Dorta provide a state-of-the-art review of one of the newer focused techniques-Interpersonal Psychotherapy-in the treatment of adolescent depression. J. Christopher Fowler and Claire Rosenberg, detailing an integrated, multidisciplinary therapeutic approach to the long-term care of severely disturbed late adolescents, remind us that there remain a few facilities in which such comprehensive care, remodeled to suit current economic realities, can still be provided. Last, Larry Gaines, Irving Berkovitz, and Ben Kohn propose an innovative technique-the use of chess-as a means of gaining therapeutic access to otherwise resistant and guarded narcissistic youths.

Section IV addresses some forensic issues. Saul Levine lucidly explores the ethical and practical problems surrounding the question of informed consent in the care of seriously ill minors. Everett Dulit differentiates the motives and psychodynamics of adolescent girls who seek to deny the actuality of pregnancy and, in rare but tragic instances, carry this repudiation to the point of infanticide.

The range of issues considered in Volume 25 and the depth with which they are explored testify once again to the strength and vitality of the field of adolescent psychiatry. It is in this setting that I lay down the reins as Editor in Chief. It has been an honor and a distinct pleasure for me to have shepherded these past four volumes into print. The reins will be picked up by Dr. Lois T. Flaherty, Coeditor of Volume 21 and a valued Associate Editor during my tenure. She brings to the task a comprehensive grasp of the field and admirable editorial skills. I wish her every possible success as she steers The Annals toward the uncharted but vastly promising terrain of the 21st century.

Copyright Analytic Press 2000

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