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Four decades ago 204 men were selected as adolescents for an interdisciplinary study of health; since then they have been followed biennially. Of the 185 men who remained in the study and in good health until 1964 (age, 42 +/- 1 years), 100 men remained in excellent physical health over the next 11 years, 54 acquired minor problems, and 31 acquired serious chronic illness or died. Of 59 men with the best mental health, assessed from the age of 21 to 46 years, only two became chronically ill or died by the age of 53. Of the 48 men with the worst mental health from the age of 21 to 46, 18 became chronically ill or died. The relation between previous mental health and subsequent physical health remained statistically significant when the effects on health of alcohol, tobacco use, obesity, and longevity of ancestors were excluded by multiple regression analysis. The data suggest that good mental health retards midlife deterioration in physical health.

Psychiatry suffers from many misunderstandings and from some of its own excursions into various schools of thought. It needs to become as realistic and meaningful as possible in terms of the doctor's grasp of the inner experience of the patient. Also, a resourceful, resilient, multifaceted approach is sought after by many. Toward these goals a realistic encounter with the primary material of human nature in its many vagaries has been designed through a specially developed use of dramatic works. As background for this, an integrated approach was used to assess the contribution of each school of thought to the development of psychiatry and its present-day potential.

ALTHOUGH narcotic addiction often manifests itself as a social problem, its medical and psychiatric ramifications suggest that it may be classified as a chronic disease. Like other chronic processes, addiction leads to multiple hospitalizations, multiple remissions and multiple relapses. Although many causes have been implicated, addiction remains a malady of uncertain etiology and of still less certain cure.1 , 2 Like other chronic diseases, it not infrequently culminates in premature death and severely impairs both employment and reproductive capacity. However, unlike most chronic diseases, addiction remains a disease with a largely uncharted course. The intention of this paper is to outline the . . .

The childhoods of 47 physicians were compared with those of 79 socioeconomically matched controls in occupations other than medicine. During 30 years of adult life, drug use, marital instability and resort to psychotherapy of the physicians was also compared with that of the controls. Physicians, especially those involved in direct patient care, were more likely than controls to have relatively poor marriages, to use drugs and alcohol heavily, and to obtain psychotherapy. Although these difficulties are often assumed to be occupational hazards of medicine, their presence or absence appeared to be strongly associated with life adjustment before medical school. Only the physicians with the least stable childhoods and adolescent adjustments appeared vulnerable to these occupational hazards. The findings may contribute to the medical and psychologic management of physician patients.