EDITORS' INTRODUCTION

Although there have been concerns about the use of the term neurosis, which has been eliminated in DSM IV, the term has been retained in ICD-10 and used widely, although pejoratively at times. The prevalence of neurosis varies across cultures and the cultural pressures determine how these symptoms persist. The classical example of this is the use and diagnosis of the term neurasthenia. Used extensively in the Far East, China and other nations, the symptoms are not too dissimilar to depression or chronic fatigue and the diagnosis carries a social cachet.

In this chapter, Chaturvedi and Desai provide an overview of the concept of neurosis. They point out that neurosis is considered a maladaptive pattern of behaviour following a stressful situation which leads to an avoidance of responsibility and the stressful situation itself. They argue that there must be an evidence of stress, the reaction to the stress must be maladaptive and there should be an evidence of anxiety proneness. The anxiety provoking situations in the past should have resulted in excessive nervousness, depression or somatic symptoms. They point out that not only is the diagnosis influenced by culture but the importance given to symptoms and the meaning assigned by the clinician will depend upon culture. These symptoms may reflect a failure to cope but may also be a cry for help, requiring support and understanding from the friends, families and professionals.

Introduction

The term ‘neurosis’ has been ascribed various meanings and definitions.

EDITORS' INTRODUCTION

Liaison psychiatry or consultation–liaison psychiatry (also known as general hospital psychiatry) deals with psychiatric aspects of physically ill individuals. Occurring both in out-patient and in-patient settings, this specialty within psychiatry has continued to evolve over the last 50 years or so.

In this chapter, Chaturvedi and Thoduguli provide an outline of the history of development of psychiatry and various models which are used. Providing a cultural context, they point out that the patient's perception of their physical disease and means of coping with it are subject to cultural influences in a big way. The treating team's relationship with the patient and carers is likely to be determined by cultural factors. For example, in cultures where clinicians are given tremendous status, the therapeutic relationship may have stronger elements of dependence. In addition, religious and spiritual factors may play a bigger role. Using examples from medical specialties such as cardiology, oncology, nephrology and gynaecology, these authors discuss specific difficulties related to somatization.

Introduction

Consultation–liaison psychiatry is a clinical discipline which deals with biological, psychological and social factors in the causation and management of any disorder, particularly the psychiatric manifestations. The field has its origins in the early nineteenth century, when medicine sought to explain all illnesses as the result of a specific biological cause. Parallel to this was the trend in psychiatry to view the major psychiatric disorders as resulting from biological disturbances.