Abstract
The role of the psychiatrist who deals with the patients with functional impotence was discussed, especially from the standpoint of the doctor-patient relationship in medical treatment. According to our statistics, 31 patients suffering from functional impotence consulted the Neuro-psychiatric Clinic of Hiroshima University School of Medicine, during the period from January 1976 to December 1978. 1) Almost all of these patients, except 4,made their first contact with other clinical departments ; Urology 16,Gynaecology & Tocology 7,Orthopaedic Surgery 2 and Internal Medicine 2.Subsequently they were referred to the Neuro-psychiatric Clinic. This indicates that the urologist and the gynaecologist play a more important role in the primary examination of functionally important patients than the psychiatrist. Therefore the urologist and the gynaecologist have a duty to give the patients proper advice and promptly refer them to the best possible therapists. This is because there are a limited number of experienced psychiatrists who can offer psycho-therapy to impotent patients in Japan. 2) The psychiatrist, in treating impotence, must realize that he should be experienced in differential diagnosis which requires accurate and detailed knowledge of specialization. This was revealed in our data : 31 functionally impotent patients included some non-psychogenic patients. Eighteen cases were finally found to be non-psychogenic despite their apparent "psychogenic" outlook at first glance. They were not psychogenic but rather psychotic including schizophrenic 8,depressive 6,epileptic l, mentally retarded I and so on. They should undergo an appropriate drug therapy under the supervision of a specialist. Our data showed that only 13 were "psychogenic" impotent patients. 3) The psychiatrist as a psychotherapist can possibly classify the "psychogenic impotent patients" into two groups according to the level of their psychological problems. One group is that of actual psychogenesis and the other is of subconscious psychogenesis. Patients with actual psychogenesis have a therapeutic indication to behavior therapy, suggestive psychotherapy and supportive psychotherapy, etc. Patients with subconscious psychogenesis, on the other hand, have an indication to psycho-analytical psychotherapy. Our 13 psychogenic impotent patients included 7 in the first group and 6 in the latter, With regard to the treatment of psychogenic impotence, the role of psychiatrist as a psycho-analyst seems to be lesser than it has been generally expected.
