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Duke University Medical Center, InterGom
Human Behavior
tioii of kii()wl(‘(lrc from tlie various
beliavioral scieiiccs in terms of llicir
relevaiu'o to medicine, a task for which
the psychiatrist, knowledf^eable in the
behavioral sciences and clinical medi
cine, is well equipped. Thus, Dr. Hine
points out, while a few schools of
medicine have initiated their human
behavior programs in the form of
separate departments, the rreat ma
jority favor its orf'anization as a divi
sion within the Department of Psy
chiatry. Experience over the country
in the past few years appears to have
borne out the wisdom of this view.
In addition to p.syehiatrists and
other physicians with interest in the
behavioral aspects of medicine, the
faculty of human behavioi' ])rojrams
is composed of scientists from the
fields mentioned above, usually those
members of the various ])rofessions
whose interests include some aspect
of medicine. For example, the sociol-
()?ist is likely to be one with an inter
est in the processes of medical edu
cation or the social implications of
illness. The i)syeholof^ist, who has
for a lonj' time been a close colleague
of the 7)sychiatrist in clinical woi’k,
now brings to the human behavior
projjram his knowdedge of experimen
tal, developmental and social psychol-
0!?y. Tlie iieurophysiolonrist or psy
chophysiologist studies the relation
ships of man’s brain functions to
behavior. His participation in this
teaching is an extension of a long and
important history of collaboration
with psychiatry and with medicine in
general.
At Duke the Department of Psy
chiatry’s Division of Human Behav
ior came into being in 1961 under the
direction of Dr. Albert Silverman.
The program is designed to bring to
first and second year medical students
a body of knowledge concerning hu
man behavior and to demonstrate that
adefiuate patient understanding and
care must include recognition of psy
chological and sociological as well as
biological data.
For many years tlie relevance of
anatomy or physiology or biocliemis-
try to the practice of medicine has
been un(juestioned. Not so, the rele
vance of the behavioral sciences. The
first function of a human behavior
program is to demonstrate that the
body of knowledge it presents is as
relevant and essential to intelligent
medical practice as are the older, ‘ ‘ ac
cepted” sciences. In the Duke pro
gram lectures are supplemented by
small group conferences and, at times,
by individual projects of the students’
own conception. The essence of the
small group meetings is the presenta
tion and interviewing of patients from
throughout the hospital with a view
to clarifying the relationship between
theoretical concepts and just-observed
behavior. The possibility of a video-
taj)e library to fill in gaps in available
[jatient material is being ex])lored.
Students are recpiired to write uj) a
patient from each of the various
points of view ])resented by the fac
ulty, thus demonstrating the contribu
tion to the i)hysician’s total under
standing of combining a variety of
a])proaches to the same |)atient. The
student resjjonse to this exercise has
been particularly enthusiastic.
In addition to the several ])oints of
view presented formally as part of
the course, the student’s contact with
a faculty of diverse clinical and re
search interests serves to broaden his
viewpoint about the field of medicine.
A sampling of interests from the
members of the Duke Human Behav
ior program may convey to the reader
some feel for this broadening process.
One of the psychologists participating
in the human behavior program stud
ies that part of the nervous system
most closely associated with emotions
in order to determine ways in which
changes in the nervous system itself,
in the environment and in life expe
riences cause changes in emotional be
havior. Sharing this interest in y)sy-
chophysiology is one of the j)sychia-
trists in the group who also has a
special interest in clinical electroen
cephalography. Another of the psy
chiatrists has a background in j)a-
thology of the nervous system atul
BE(i. A major re.search interest of
one of the sociologists is a study of the
steps by which medical students be
come doctors and come to see them
selves as doctors through their con
tacts with ])atients and faculty. An
internist who teaches in the first-yeai'
human behavior course collaborates
with a sociologist in the study of the
effects of group pressures ui)on blood
fat levels. A psychologist in the
group is conducting research into the
way in which the personality of the
l>sychotherapist may affect the suc
cess of his therapy and the type of
patient he is best able to help. An
other sociologist includes among his
research interests a study of the way
obese people think of themselves and
the w'ay they are seen and responded
to by i)hysicians. He also is investi
gating patterns of activity and satis
faction in the aged, and patterns of
drinking in adolescents. A child psy
chiatrist with extensive experience in
the field of mental retardation in
cludes among his present research
activities a study involving the early
identification of mental retardation
by systematically studying normal
and suspect young children with a
view toward correcting the causes of
retardation where possible or develo])-
ing new methods of correction. All
of the psychiatrists teaching in the
first-year jjrogram devote portions of
their time to clinical work wdiich at
times includes specialized activities
such as the administration of the
Duke Hospital Psychiatric In-Patient
Service and suj)ervision of the Psy
chosomatic Consultation Service. In
addition to the regular freshman fac
ulty, who teach througlurat the year,
other members of the Department of
Psychiatry and other departments are
brought in from time to time to con
tribute their specialized knowledge.
The sophomore course, somewhat more
oriented toward pre]>aring the stu
dent for practical ai)plication of his
behavioral insights during the clinical
years, draws upon still other mem
bers of the Department of Psychiatry.
The essence of the human behavior
I)rogram is the belief that an under
standing of the behavioral sciences is
relevant and necessary to the fully
educated physician.