José Guimón - Böcker

The greater emphasis on quality of life and heightened public expectations about health care have resulted in increased demands for services. Expensive improvements in diagnosis and treatment have led governments, desperate to limit their expenditure, to propose the rationalization of health care. An intermediate solution - managed care - emerged in the US and soon after elsewhere. Examining the practical and ethical implications of managed care and its effect on the patient-doctor relationship, this text analyzes the after-effects of the US-born managed care revolution, and addresses the question of a European perspective: What is the European reality? How can psychiatrists adapt to the new cost-containment strategies which imperil patients' most basic needs while avoiding the ethical quagmires that would compromise their own principles?

The two most important notions concerning the rights of people with mental illnesses are among the most neglected: the first is that human rights and duties are complementary and that both must be considered in constructing a framework for mental health care. The second is that we must strive for equity in developing mental health programmes. This text addresses both these notions. It provides the background and the facts about fulfilment of needs and the protection of human rights of people with mental illnesses.

This book is the proceedings of an International Conference on Challenges of Psychoanalysis in the 21st Century: Psychoanalysis, Health and Psychosexuality in the Era of Virtual Reality, held 15-17 September, 2000, in Geneva, Switzerland. Psychoanalysis has become a basic psychiatric science in very much the same way as the neurosciences or epidemiology. However, there is a certain discrediting of psychoanalysis as a therapeutic tool stemming, to some extent, from the reluctance of psychoanalysts to submit their theories and practice to scientific scrutiny. However, as we see in this book, there is a certain movement in psychoanalysis to introduce reliable measures that would allow for a scientific evaluation of its results as a therapeutic device. Although there are great variations in respect to the role ascribed to psychoanalytic techniques in different countries, a clear upsurge of interest is apparent.During discussion of psychoanalysis and virtual reality in the new millennium, it was predicted that in the next century the differences between the conscious, unconscious, and the pre-conscious will have to be reconsidered in view of the ever-expanding concepts created by virtual reality. There will be virtual sexual acts over the Internet, ovum parthenogenesis will be possible without the intervention of the male, and clonic reproduction of the human being will be carried out in the laboratory. The child born in these circumstances will relate to a widening array of potential parental figures: the classic heterosexual couple, the single-parent family, the homosexual couple, the transsexual figure, etc. All this will of course alter the classic Oedipal constellation and without doubt the gender identity of the child. There will be attempts to undergo psychoanalysis via the Internet in the same way that other kinds of psychotherapy are being virtualized. But this will force us to redefine transference.On the other hand, it seems likely that psychoanalysis as a psychotherapeutic tool will, in the 21st century, relate more to somatic, medical patients or to the `worried well' than psychiatric patients. These brief considerations on the scope of our deliberations in some way explain the diversity of this book, but also justify its interest.

This volume contains current evidence-based diagnosis and therapeutic interventions for people with mental disorders. Students and professionals alike will find the mental health field addressed as a whole in a coherent and understandable way. Readers are offered a unified presentation of psychological and sociological approaches to diagnosis and treatment.

Two ofthe most important notions concerning the rights of people with mental illness are among the most neglected: the first is that human rights and duties are complementary and that both must be considered in constructing a framework for mental health care. The second is that we must strive for equity and not only for equality in developing mental health programs. The first ofthese notions is complex. It refers to the duties ofpeople with mental illness and to the duties ofthose who surround them. Mental illness does not liberate the person who has it from civic obligations. The most basic ofthese is to give support to others and to refuse to harm them Their carers, society and the patient's self-respect all gain through their recognition, even though the fulfilment of these obligations might be difficult or impossible in certain periods ofillness. The duty of those surrounding the patients is to recognise and respect their existence and to make the necessary arrangements to respond to their needs, protect their rights and compensate for their temporary or permanent inability to fulfil their civic duties. A society's social capital is the public good that results from the mutual supportofmembers ofa society: iffor one reason or another, some or all members ofa society fail to offer such support the social capital will diminish and the society will cease to be civic.

During discussion of psychoanalysis and virtual reality in the new millennium, it was predicted that in the next century the differences between the conscious, unconscious, and the pre-conscious will have to be reconsidered in view of the ever-expanding concepts created by virtual reality.

"Adapt or perish, now as ever, is Nature's inexorable imperative. " -H. G. Wells, Mind at the End of Its Tether (1946) Doctors are trained to treat people suffering from various diseases. This is the main form of their activity and usually the reason for which they selected medicine as their profession. The notion that they should become managers and engage in activi­ ties such as programming, calculating cost, assessing cost-benefit ratios, and thinking about pricing in accordance with the social utility of their intervention, is both foreign and abhorrent to them. They are sometimes willing to say how much they need in order to have a well-functioning service: usually they prefer to state what specific apparatus and other things they require without specifying the price of their demand. They can be persuaded to add a price tag to what they think is necessary for their work: but that was about as far as they would go, until recently. The growing emphasis on human rights over the past few decades, the greater emphasis on quality of life and the public's heightened expectations about their health led, in many industrialized countries, to a greater demand for health services. This, com­ bined with improved possibilities of diagnosis and treatment (at higher cost!), led to a significant increase in financial demands which made governments and health-care systems uneasy and ready to accept any solution that would stop the spiral of seem­ ingly endless cost augmentation.