Michael S. Gaylor’s scientific contributions

A 1975 Dartmouth Outward Bound Mental Health Project, begun with a pilot project for disturbed adolescents, has evolved into an ongoing treatment option in three separate clinical settings for psychiatric patients and recovering alcoholics. Outward Bound consists of a series of prescribed physical and social tasks where the presence of stress, uncertainty, and the need for problem solving, communications, and immediate judgment provide situational analogues for problematic areas in the patient's daily life. The Outward Bound session consists of traditional activities such as individual and group problems solving activities, ropes course, rock climbing, hiking, orienteering, canoeing, and cross-country skiing. Patients in the diagnostic categories of schizophrenia, mood disorders, neurotic and personality disorders, alcohol and drug abuse, and adjustment disorders have participated in the program conducted by a treatment team consisting of an attending physician, resident physician, nursing staff, social service, and activity therapy staff. Follow-up studies of participating patients indicate that Outward Bound was a very positive experience which increased patients' self-esteem. These studies support the postulates that performance accomplishments are an influential source of information and that, when perceived to be of great magnitude, these accomplishments tend to be generalized to other situations in which performance had formerly been inhibited due to feelings of personal inadequacy. (NEC)

The paper addresses two significant risk management considerations in conducting an adventure program in a therapeutic setting: the potential hazards of psychiatric medications and psychological emergencies. Focusing on the potential hazards of psychiatric medications, the first section discusses climatic conditions (heat, cold, and sun) and the limitations of propranolol, phenothiazines, tricyclics, or antiparkinsonian medications on program activities. The symptoms of orthostatic hypotension, dystonia, akathisia, pseudo-parkinsonism, and tardive dyskinesia are discussed. The second section discusses two types of psychological emergencies: primary (symptoms are produced by emotional illness) and secondary (the behavior is a manifestation of a medical problem). Basic guidelines for properly labeling and managing a problem as either medical or psychological are outlined. These basic guidelines cover three steps: (1) assessment procedures--a mental status examination to assess cognitive functioning, indicators of emotional distress, and a symptom assessment; (2) intervention--observation, evacuation, interviews with individual, and outcome; and (3) evaluation of intervention--evacuation of individual and use of incident as a learning experience. (NQA)