Volcanic Study Guide Exam One Study Guide NONREDUNDANT v2a Abnormal Psychology Exam One (with Atwood) This is a compilation of the study guides everyone submitted. All we want to do is pass the test. Everyone put in their hard work for this study guide and I thank them. ? Abnormal Psych Class of Fall 2009. The following is the first section of Professor Atwood?s Review Sheet which means: FOUNDATIONS OF PSYCHOPATHOLOGY Foundations of Psychopathology Anorexia nervosa ? (11) an uncommon disorder, that blights the lives of young women, 1/10 of whom die of its effects; of interest to clinical investigators because of its relation between the psychological and physiological are clear function of the anterior pituitary is diminished due to inanition secondary diminution of function of the target endocrines w/ a measurable drop in blood and urinary hormonal levels Anorexia nervosa Mary, teenager dieted with friends, started at 114, danced, worked, dieted, led to weight loss down to 71 pounds, two months later hospitalized to 63 lbs, died from pneumonia Illness began when she started on a course of dieting Patients voluntarily refrain from eating, hide food, flush it down the toilet, vomit, avoid the permanent intake of nourishment, they will sometimes indulge in orgies of ravenous overeating An emotionally distressing event may precipitate the disorder The physiological disturbance is often an exaggeration of a common and normal bodily companion of the emotional response; nausea and vomiting for example are not infrequently concomitants of the feeling of disgust Prolonged physical response that persist beyond the immediate reaction to the stimulus constitutes an illness that may have grave consequences for the physical and emotional health of the sufferer The behavior of the physician plays an important part in worsening as well as bettering the patients symptoms Definition: a rare psychogenic syndrome, most commonly affecting adolescent girls, characterized by a refusal to eat, marked weight loss, and when appropriate amenorrhea. Fatal in 10 percent of cases, it is accompanied by marked abnormalities in character structure and interpersonal relationships Anorexia Nervosa- Intention to become thin but there is no limit. It?s a pattern of limitless dieting restriction of food intake perusing unreachable ideal of thinness. It?s an acting out as a way to get control of themselves. Compulsions? (308) - a neurotic symptom that results from an irresistible impulse to carry out an act, often repetitively, despite the actor?s intellectual recognition that his behavior is unnecessary, undesired and frequently absurd Obsessions ? (312) ? a neurotic symptom consisting of a thought, often highly emotional, which forces itself on the individual?s conscious awareness against his wish to think it or contemplate it, and despite the fact that intellectually he recognizes the logical absurdity of the idea Conversion in the case of Francis S. Conversion: the psychological mechanism by which an unconscious psychological conflict is translated into and represented by manifestations of abnormal physiological functioning, primarily in the sensorimotor apparatus, to a lesser extent in the autonomic nervous The case of Carol E. (131) - Suffered from a phobia of boats Case of Daniel Paul Schreber (17) - He woke up one morning and thought how delightful it would be to succumb to sexual intercourse as a woman. He thought this wasn?t his own thoughts at all and he?s in a state in which his thoughts are his psychiatrist?s thoughts inside his head. The psychiatrist telepathically did hypnosis experiments implanted in his brain from way far away. This was the tip of an iceberg that surfaced. He felt he was a victim of a vast conspiracy by god in heaven himself by his psychiatrist as his instrument for performing this persecution. The persecution was transforming from a man to a woman. This was soul murder to him, and he coined this term. God sits in heaven and generates these rays down from heaven and plunge down into him these changes are called diabolical miracles with parts of soul murder. Freud associated sexuality to his paranoia, and said that he loved his dad and wanted to be sexually intimate with him. Freud said he went from I love another man and it?s a conflict so defend against it to I hate him because he hates and wants to destroy me. This is a reaction formation. Schizophrenia ? (315) ? a psychotic syndrome characterized by major distortions of thought processes (including hallucinations and delusions), disintegration of ego boundaries, disturbances in affect (flatness or inappropriateness of affect), and serious impairment of the individual?s capacity to enter into relationships with others Delusion ? (309) - the unshakable belief in an idea, or set of ideas obviously contrary to logic, to the reality of the external environment, or to the accepted communal beliefs of the individual?s culture Castration anxiety ? (143) ? Oedipal phase of development, central to genital mutilation; (308) ? an anxious apprehension of bodily harm or mutilation, of being made weak and inadequate, or of suffering any diminution of one?s powers, capabilities, or position Pathological grief reaction ? (168)- The term is not brought up in the book directly but explained through a case, so I just went on the internet and searched the term up; its pretty simple?.A pathological grief reaction may be diagnosed after a long time (one or more years) have passed and the grieving person is not improving. By labeling someone's grief as pathological, a doctor is indicating that the grieving process resolution is delayed for some reason and that professional help is needed. Identification in grief and in depression ? (145/156) ? in simple grief does not find the feelings of guilt nor the self-accusatory attitudes that characterize the depressed patient; pathological forms of grief occur in people who are made especially vulnerable to losses of all sorts by an organization of character structure which is narcissistic Turning inward of aggression in depression ? (194) ? there are three (3) steps; In the first place the tendency toward self-criticism for failure to achieve one?s ideals forms a ready channel along which aggression may flow. The more exacting and demanding the super-ego organization, the greater the amount of aggression that is directed self ward. Second, ego defense of turning in of affect brings about a change in the direction of aggression from objects toward the self as a means of controlling the impulse. Relation between depression and mourning ? (153) ? in both there is the same inner anguish, the same loss of interest in a dreary, empty world, the same isolation from other people, the same loneliness and feeling of inner emptiness. Both mourning and depression are processes having duration in time. Defense mechanisms of isolation ? (113) ? In technical terms the affect and the impulse have been rendered unconscious by the defense mechanism of isolation from the fantasies. But though unconscious, these forces still strive for expression; they constantly exert their influence on the patient?s conscious mentation; they require a continuous effort on his part to keep them contained. Denial ? (309) ? a mechanism of defense in which the facts or logical implications of external reality are refused recognition in favor of internally, derived, wish-fulfilling fantasies Undoing ? (316) ? an ego mechanism by which, with a physical or mental operation, one (often irrationally and magically) attempts to counteract the effect one assumes (often irrationally and magically) to have resulted from an unconscious drive, feeling, or idea. Undoing is frequently the mechanism underlying a compulsion. Reversal of affect ? (314) - the turning of an affect of one quality into an affect of a quality opposite to it. Reversal is also used to describe the turning of the active mode into the passive and vice versa Repression ?(314) ? the basic mechanism of defense by which drives, feelings, and ideas are involuntarily excluded from conscious awareness by a psychic force opposing their emergence into consciousness, or by which mental phenomena, once conscious, are involuntarily made unconscious and maintained in that state Projection ? (212) ? an ego mechanism of defense in which drives and their derivatives arising within the individual are attributed to people and situations outside of himself, often with a reversal of the active mode to the passive Rationalization ? (314) ? a mechanism of defense by which occurrences arising from or motivated by irrational drives are explained as being the result of circumstances or logical thought processes. Even where the latter are relevant motivating forces, they are treated by the individual as the only etiological factor, and he remains unaware of the inner irrational emotional forces that contribute to the end result. Primary process thinking ? (313) ? a type of autistic mentation characteristic of dreams, psychoses, and the early stages of life in which logical thought processes, reality and the restrictions of time and space are ignored. Id ? (311) - a theoretical construct compromising that unorganized part of the personality structure that contains the basic drives. The Id is by definition unconscious. Ego ? (309) - a theoretical construct compromising that organized part of the personality structure which includes defensive, perceptual, intellectual-cognitive, and executive functions. Conscious awareness resides in the ego, although not all of the operations of the ego are conscious Superego ? (315) - a theoretical construct compromising that organized part of the personality structure, mainly unconscious, that includes the individual?s ego ideals and the psychic agency (conscience) that criticizes and prohibits his drive, fantasies, feelings and actions Libido ? (150,312) ? a word designating that emotional force I all of us that reaches out to objects in a positive way: liking, loving, wanting appetite, sexual desire are all aspects of libido; the sexual drive including the mental representations of the drive obsessions and compulsions in the case of Chester B. (101 - 123) ? Chester B. used obsession and compulsion as defense mechanisms against his inner aggression. His obsessions included an irrational fear of contracting cancer from a cancer patient, fear of dirt and germs, and avoidance patterns for elevators and streetcars caused by the fear of harming people. He would compulsively wash his hands to rid himself of germs in an effort to protect himself and others. He would also compulsively check to make sure that he did not actually harm anyone while in the immediate area of streetcars or elevators. Chester B.?s obsessions isolate his aggressive impulses and keep them out of his immediate awareness. This is not entirely successful, and creates anxiety. In turn, this forces Chester B. to initiate compulsions to combat the consequences of his obsessive thoughts. The obsession and compulsion together helped control Chester B.?s destructive fantasies and reduce anxiety. Phobia of elevators Fear of getting sick Avoided things he feared to remain free of anxiety---developed phobia Afraid of girl who had cancer, tried to convince himself he was clean and healthy Amnesia - loss of a large block of interrelated memories; complete or partial loss of memory caused by brain injury, shock, etc. Hypermnesia (67/68) - the condition of having an unusually vivid or precise memory Delirium (308) ? a mental state associated with gross brain dysfunction characterized by disturbances in consciousness and the sensorium with confusion, disorientation, hallucinations, illusions, delusions, restlessness, and sometimes marked agitation. Psychosomatic medicine ? (276? , 314) ? a method of studying and conceptualizing illness as the response of an organism to stress by the simultaneous and related manifestations of physiological and psychological dysfunction Regression in mental illness (219) ? the regression in illness to developmentally more primitive patterns of mentation is, however, never complete. The manifestations of the adult?s illness result from the fact that specific regressions in his mental functioning to more primitive modes of thought lead to a serious distortion of his entire personality. A study of the factors leading to such a regression of thought processes is central to the complex problem of the etiology of the major mental disorders. Role of conflict in symptom formation (121) ? The symptoms of obsessions and compulsions are the end-product of the mixture of elements from both an unconscious impulse and the ego defenses directed against it. The symptoms are a compromise formation, the result of vectors of forces showing the summated effects of all the elements. This is the process of symptom formation. It is apparent from this that symptoms may be viewed from the outside in clinical, descriptive terms, or from the inside, as the consequence of casually related physiological forces. Anxiety - A painfully unpleasant affect characterized by physical manifestations of autonomic discharge (sweating, tachycardia, etc) and a subjective, often not completely describable, apprehensiveness; as opposed to fear (a reaction to real external dangers that is appropriate to the stimulus), anxiety is a response to an inner affect or thought that is frightening because of the consequences, real or imagined, that would ensue if the individual acted upon the affect or thought. Childhood roots of emotional disorders ? (74) ? this presentations of psychopathology emphasizes the role of conflict and defense, the unconscious and repression, and the childhood roots of emotional roots of emotional disorder in symptom formation Psychogenesis ? (313) - the derivation of adult behavior and psychic structure from infantile and childhood developmental processes The following is the second section of Professor Atwood?s Review Sheet which means: MAD IN AMERICA Mad in America Benjamin Rush 3-8 (first sex pages of ch. 1) p.13- 18 A Quaker who worked at the Pennsylvania Hospital starting in 1783 Wanted to bring the practice of medicine used in England on mentally ill over to the United States Wrote first psychiatric text published in US called ?Medical Inquiries and Observations upon the Diseases of the Mind? Wanted liberal, humanitarian reforms to the treatment for the insane, although he was into science and tried the new medical techniques like draining blood and other ways to normalize blood flow in the brain; eager to make Pennsylvania hospital a place of modern medicine Although he preached the need to treat in a kind manner ? He said, ?Fear accompanied with pain and a sense of shame, has sometimes cured disease.? Gyrator: Patients suffering from torpid madness, would be strapped horizontally and spun at very high speeds ? he called this is GYRATOR THE TRANQUILIZER CHAIR ? would strap until cannot move and their sight was blocked by a wooden block, also placed a bucket underneath their seat for the patient would be restrained for long periods of time Egas Moniz (107-108, 111-114) Found reason to believe that inflicting injuries on frontal lobes could prove beneficial to the mentally ill Said prefrontal lobotomy worked because schizophrenia and emotional disorders resulted from pathological thoughts becoming fixed in connected cells in the prefrontal cortex; the surgery made manic depression patients less emotional Believed cutting holes in the scalp allowed demons to escape from a poor lunatics brain; then squirted alcohol onto the nerve fibers; his assistant started to use a leucotome Went to London & heard Freedman, but interpreted it differently thought frontal lobe operation would change people?s emotions Invented prefrontal lobotomy and awarded Nobel Prize in 1949; Nominated 2 previous times for Nobel Prize but did not win those times and became obsessed with winning it Walter Freeman (115-117, 121-127) Any damage to the frontal lobe would inevitably be followed by great repercussions to the whole personality ? said at a conference; Lost some parts of your personality, but since it improved patients, patients did not mind Freeman also performed frontal lobe (lobotomy) surgery Went to meeting and more doctors began to use this and showed success as well Began to question idea of destroying part of the brain, but nearly all who tried it said it worked wonders so questioning about lobotomy faded away (didn?t affect a lot of capabilities such as arithmetic) Reasoned that with using the lobotomy technique, better results could be gained if only certain parts of the brain were destroyed Transorbital lobotomy: Invented a ?quick-fix surgery? , took a shorter period of time , no anesthesia, no brain surgery needed ? went through the eye socket into the frontal lobe The more posterior the entry point, the more the disconnect (thus the more serious the diagnosis, the further back they?d cut). Their notes showed that the surgery was something different ? creating a ?surgically induced childhood? in which the highest recovery the person could hope to achieve was ?at the level of a domestic invalid or household pet.? Some could rise higher but not even hold jobs that required anything more than a minimum of everything. Advertised his technique as ?surgery of the soul,? claiming it could get rid of even minor things like depression, anxiety, hallucinations (not exactly minor), nervous states etc. Definition of Lobotomy: the operation of cutting into a lobe, as of the brain or the lung. Eugenics (42, 288) - the study of or belief in the possibility of improving the qualities of the human species or a human population, esp. by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits (negative eugenics) or encouraging reproduction by persons presumed to have inheritable desirable traits (positive eugenics). They believed that like Darwinian traits, insanity was acquirable, and having one in the lineage tainted the bloodline. Blacks, and the poor were to be gotten rid of too eventually but the main problem were the insane. Attempt to keep the mentally ill separate from the rest of society, and prevent them from reproducing US Supreme Court in 1927 Buck vs. Bell ruled that it was constitutional to sterilize the mentally ill Pg 42; ?America?s eugenicists even encouraged Nazi Germany in its massive sterilization of the mentally ill, a program that led directly to the crematoriums of the Holocaust Pg 288; ?eugenics had stirred America to treat the severely mentally ill with scorn and neglect, and it was time to change our ways. We welcomed the mentally ill back into society. Asylums would be replaced with community care. But the design of the reform also rested on a medical notion of the most unusual sort, that neuroleptics ?might be described as moral treatment in pill form.? The confusion in that perception was profound; Neuroleptics were a medical treatment with roots in frontal lobotomy and the brain damaging therapeutic of the eugenic era. Our vision for reform and the medical treatment that would be the cornerstone of that reform were hopelessly at odd Atypical antipsychotic medications (254) - New type of the same old drugs. Came about differently than the others because of the well oiled machine of the pharmaceutical company?s PR firms who presented the atypicals as drugs which worked better than the old antipsychotics. The old drugs caused NIDS (neuroleptic-induced deficit syndrome) which mimicked natural disorders like Parkinson?s, or encephalitis lethargica, as well as a host of other symptoms ? blunted emotions, TD, blindness, fatal blood clots etc. The old also didn?t control hallucinations very well. The old weren?t bad, the new are just better ? they could treat the positive symptoms (psychosis) and the negative (lack of emotion) as well and this was the story Electroconvulsive treatment - Electroshock ? developed by Cerletti after seeing how a slaughterhouse killed pigs by stunning them in the head. The therapy in effect stunned the brain-wave activity of the patient and it would then take weeks for it to return to normal, in effect producing something similar to the insulin comas of the past. It wasn?t controversial that it harmed (and pained) the patient ? people like that in all of their treatments ? what was controversial was if it was a permanent craniocerebral trauma. Pg 73-74 At this time psychiatry embraced a quartet of therapies one of them being electroshock, that all worked by damaging the brain. And from there, one can follow a path forward to the therapeutic failure documented by the world health organization of the 90s, when it determined that schizophrenia outcomes were much better in the poor countries of the world than in the united states and other developed nations 96-102 Electroshock the invention of the Italian psychiatrist UGO CERLETTI; did research in a way to improve on metrazol therapy. For part of his studies of epilepsy, he had been using electricity to induce convulsions in dogs. Public though of it to be barbaric and dangerous due to the electric chair, death of animals, etc. the key to using electricity to induce seizures in humans was to apply it directly to the head, rather than running the current through the body electroshock was introduced to US hospitals in 1940s was not new, but Cerletti had simply developed a better method for inducing convulsions. Electricity was quick, easy, reliable, and cheap---made popular because of that yet electroshock also advanced brain damaing therapeutics a step further Freudians criticized therapy Worked with electrodes placed at the temples, the jolt of electricity passed through the temporal lobes and other brain regions for processing meomory; as patients spasmed into convulsions, they lose consciousness, the brain waves in the cerebral cortex falling silent, a state called extinguished; it would take weeks for brain activity to be normal Memory loss caused by electro show was also seen as helpful to mentally ill Intensive electroshock was also tried on schizophrenic children 122-123 (after prefrontal lobe) Freeman and Watts advised stunning patients with electroshocks even as early as a week after the brain surgery. A few electric shocks may alter the behavior in a gratifying manner, when employed, it should be rather vigorous, two to four grand mal seizures a day for the first two days, depending on the results 236-238 (drug induced psychosis) Hoch studied whether electroshock and lobotomy would block drug induced psychosis, people in this experiment underwent a grueling series of assaults on their brains; 1st injectd with mescaline to see how they reacted to drug, then injected a second time with mescaline and hit with electroshock to see if it would knock out their psychosis, it did not 102-106 (public view) electroshock said by the patients, was like having a bomb fall on you, painful punishment as viewed by the patients talks about the painful experience of close to death with electroshock American physicians and hospitals shocked patients without their consent Misbehave patients given double sized course of electricity 142 (regression of schizophrenics) electroshock remained a mainstream treatment in state hospitals, and it was often used to deliberately reduce patients to confused states such as incontinent, unable to feed or dress themselves, and mute Neuroleptics: These drugs affect the D2 receptors in dopamine pathway in the brain; make patients vulnerable to relapse and dependence to drug, having withdrawal if taken off drug. People not using the drugs had a lower relapse rate than those on drugs - Pharmaceutical companies formed the public?s image that these drugs were safe while actually side affects made them dangerous - Common side effects: nausea, headache, muscle spasms, anxiety, insomnia pg 144-146 in 1955, deniker and delay coined the term neroleptic to describe the effects produced by chlorpromazine and other phenothiazines that have been introduced. The word came from the Greek, meaning to ?take hold of the nervous system,? reflective of how the drugs were perceived to act as chemical restrains chlorpromazine can ?metamorphose a highly mobile, flighty manic into a static, slow motion shuffler neuroleptics were perceived to work by hindering brain function; chlorpromazine, lehmann observed, has the remarkable property of inhibiting lower functional centers of the central nervous system without significantly impairing the function of the cortex 150 in short, in the 1950s what American physicians and the general public learned about new drugs was molded, in large part, by the pharmaceutical industry?s marketing machine. This molding of opinion, of course, played a critical role in the recasting of neuroleptics as safe, antischizophrenic drugs for the mentally ill 288 neuroleptics were a medical treatment with roots in frontal lobotomy and the brain damaging therapeutics of the eugenics era. Our vision for reform and the medical treatment that would be the cornerstone of that reform were hopelessly at odds in the 1960s, the national institute of mental health concluded that neuroleptics were safe and antischizophrenit. But a short while later, the NIMH found in a follow up study that the patients who had been treated with neuroleptics were more likely than the placebo patients to have been rehospitalized the drugs were apparently making people chronically ill and that was quite apart from whatever other drawbacks they might have neuroleptics, by dampening down the dopamine system, produced an immediate pathology in brain function Tardive Dyskinesia: a side effect found from the long term usage of dopamine, which is characterized by repetitive involuntary movements?may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking, impaired learning and memory, Parkinson?s disease: side effects found very similar to Parkinson?s; central nervous system damaged, muscle rigidity, tremor; masklike visage, drooling 190-193 reported by French psychiatrist, 1959, where the toung is permanently projected forward and backward following a rapid rhythm; at times the projection is to the side, sometimes to the right, sometimes to the left?the lips participate in this dyskinesia in the form of stereotyped suction motions, pursing, rolling, and incessant champing in synergy with rhythmic contractions of the jaw this description above clearly indicated something had gone wrong with the brain center controlling motor movement; not only affect the facial muscles but also people suffered from jerky, spasmodic motions of all types such as arms, ankles, fingers, toes, torso, neck, larynx; some patients had difficulty walking, sitting, or standing, speech became incomprehensible, trouble swallowing and eating, etc TD is a neurological disease, such as Huntington Patients with TD show accelerated impairment in learning, memory, and a variety of other intellectual task Weird tongue movements common to td may warn of a ?larval dementia? Cuase of td is said to be by neuroleptic damage neurons because they elevate levels of oxidative stress; ALSO speculated that TD is related to the brain becoming supersensitive to dopamine. IN ADDITION, this hypertrophy, which can be seen with MRIs within 18th months of neuroleptic use can be associated with greater severity of both negative and positive symptoms 203-207 TD was first reported, 1959, to linking neuroleptics to irreversible motor dysfunction 209-210 incidence of dystonia,- painful, sustained muscle spasms increased risk of suicide 255 TD, a neuroleptic malignant syndrome, patients had to worry about blindness, fatal blood clot, arrhythmia, heat stroke, swollen breast, leaking breast, impotence, obesity, sexual dysfunction, blood disorders, painful skin rashes, seizures, and offspring with birth defects 278-read dopamine theory of schizophrenia ? thought that schizophrenic patients had an abundance of dopamine, so the theory was to use neuroleptics such as haloperidol and chlorpromazine to block the dopamine receptors and thus normalize dopamine levels. 196-199 neuroleptics clearly reduced dopamine activity in brain to a pathological level, there was still the possibility that schizophrenics started out with hyperactive dopamine systems. Dopamine transmission in the brain works in this manner: a presynaptic neuron releases the neurotransmitter into the synaptic cleft, the space between neurons, and then the neurotransmitter bind with receptors on a postsynaptic neuron. The dopamine hypothesis suggested that either the presynaptic neurons were releasing too much neurotransmitters or else the postsynaptic neurons had too many receptors and thus were hypersensitive to dopamine dopamine metabolites measured in patients blood, urine, and cerebrospinal fluid Malcolm Bowers determined that levels of dopamine metabolites is unmediated schizophrenics were quite normal Dopamine turnover markedly increased after people were medicated, normal brains trying desperately to cope with drugs blocking of its dopamine signals Twist to dopamine story: research teams and NIMH determined that dopamine turnover in some unmediated chronic schizophrenics was abnormally low, which spurred some to characterize schizophrenia as a dopamine deficiency disease Researchers had speculated that schizophrenics naturally suffered from overactive dopamine systems, but this wasn?t so. In sense, the drugs were agents that turned a normal brain into a schizophrenic one Scientist now know that the causes of schizophrenia and psychosis are often rooted in powerful chemicals in the brain called neurotransmitters. One of these neurotransmitters is dopamine. Schizophrenia and psychosis can result when the brain has abnormal dopamine levels. Because of recent advances, drugs are able to alter dopamine levels free many patients from the terrible effects of mental illness Kraepelin and dementia praecox and encephalitis lethargica ? Kraepelin was a german psychiatrist. He split up psychotic disorders into groups. Patients who had psychotic episodes along with emotional disorders suffered from manic-depressive illness. Patients who exhibited a lack of affect or emotion suffered from dementia praecox. Kraepelin renamed dementia praecox as ?schizophrenia.? Encephalitis lethargica was a side effect of neuroleptics that caused brain inflammation and left people apathetic and unwilling to do anything. Kraepelin- Bringing patient into the hall whose sentences have no relation to the general situation. They feel Kraepelin is objecting because he does not want to prostitute himself in front of the students. EP questions his experiences saying what he is about in speaking and acting this way. Cant? look at patient as if he has signs of a disease but to try and understand his past in terms of his present and relate his actions and his way of experiencing the situations he is in with us. Moral treatment - in the early 1800s, there arose a form of care in England and France known as moral treatment, which emphasized treating the insane with kindness and empathy, and avoiding medical remedies that "worked" by weakening the patient. It emphasized that mental patients should be seen as part of the human family. Kraepelin pg 165 Invention of schizophrenia can be traced back to the work of german psychiatrist Emil Kraeplin. After studying case histories of asylum patients for more than a decade, put such practices to rest by developing classifications that tied symptoms to predicted outcomes. He divided psychotic disorders into two principle groups. 1. patients who had psychotic episodes along with emotional disturbances suffered from manic depressive illness and they could hope to get better. 2. psychotic patients who exhibited a lack of affect or emotiona suffered form dementia praecox or premature dementia. Their predicted fate was gloomier; 75% or more could be expected to deteriorate into an end stage dementia Dementia praecox 165-166 psychotic patients who exhibited a lack of affect or emotiona suffered form dementia praecox or premature dementia. Their predicted fate was gloomier; 75% or more could be expected to deteriorate into an end stage dementia Encephalitis lethargica moral treatments Late 1800s Kraepelin was doing his pioneering work, encephalitis lethargica was not known People who suffered from this were dumped into a pool of lunatics housed in asylums E sorted them out, identified a common type of patient, which became part of his dementia praecox group, that had peculiar physical symptoms. Patients usually had mental and emotional problems plus walked oddly and suffered from facial tics, muscle spasms, and sudden bouts of sleepiness, their pupils reacted sluggishly to light, drooled, difficulty swallowing, chronically constipated, unable to complete willed physical acts; suffered from a global illness which affect their mental emotional, and physical spheres, these were patients most likely to become demented Those who became delirious, or drop into a stupor or started walking in a jerky manner were described as epidemic parkinsonism, epidemic delirium, epidemic schizophrenia Loren Mosher?s Soteria project ? Loren Mosher acted under the belief that mentally ill patients needed ?love and food and understanding?not drugs.? His project was a study that showed the difference of outcomes from these two methods. Thus he opened up the Soteria house in which patients were treated with love and kindness and were allowed to roam free, and much better results were attained than typical drug use. Obviously encountered resistance from higher up psychiatrists overseeing funding and was eventually shut down. Attitude of the Quakers toward mental illness - Attitude of the Quakers toward mental illness pg 24-27 Humble in nature, did not believe that their care would unfailingly help people recover. Quakers professed to do little more than assist nature they wouldn?t even try to talk their patients out of their mad thoughts, rather, they would simply try to turn their minds to other topics in essence the Quakers sought to hold up to their patients a mirror that reflected an image not of a wild beast but a worthy person capable of self governance first saw them as animals, now human family Philadelphia Quakers opened the first moral treatment asylum in America in 1817 The role of money in studies of psychiatric medications (265-269) - the psychiatric medication business grew exponentially since its start, and thus it was a very lucrative opportunity. Studies began to be performed with the sole intent of profit in mind and the general well-being of the people was thrown to the wayside. This lead to massive amounts of corrupt clinical testing, most prevalently of which was Borrison and Diamond. Rockefeller donated money for psychology/the mentally ill The psychologists/doctors gave the results Rockefeller wanted, even if they weren?t true because he was funding their studies Lobotomy was profiting neurosurgeons as well They got states to fund lobotomy by showing them how if the patients are given surgery a good amount of them would leave the hospital and some would die, saving them money (the state funded these hospitals) Quality of the research supporting the effectiveness of medications (265-269) - Quality of the research was flawed at best. The researchers were usually in the drug company?s pocket and thus extremely biased to present favorable results. Beautiful women were hired as study coordinators, their main purpose being to coax the men into drug trials, the women even given recruitment bonuses. Although lacking medical training, coordinators decided whether patients qualified for trials, making up information so that patients met eligibility criteria. The researchers were hardly available on scene, only caring about the number of patients being introduced into the study. Effects of medication on patients experiencing of their worlds (175) - The most common response in patients to their medication was extremely negative. They described the medications as poisons producing the worst misery, turning them into zombies, closing them in, mummifying, petrifying, and confusing them. Many patients even went to courts protesting the use of their medications as well as the rights of the patients to refuse medication. Comparison of schizophrenics? long-term recovery rates of America and third-world countries (227-232) - According to two studies done by the World Health Organization (WHO), it was found that people who fall mentally ill have a better chance of recovery as well as stay recovered longer if they are in third world countries. The only reason that could be found for this strange disparity was that it was the drugs themselves that caused people in first world countries to have lower long-term recovery rates. Sterilization of the mentally ill in Nazi Germany (234-235) Americas eugenicist encourages Nazi Germany?s mass sterilization of the mentally ill 1933 Adolph Hitler came to power and passed a comprehensive sterilization bill Nazi bill was morally superior than U.S. state law Germany realized that they spent lots of money on mentally ill; therefore they gassed and killed 70,000 mentally ill patients (only stopped because sent concentration camps over to West to kill Jews) Established scientific knowledge of the causes of schizophrenia (285-286, 290-291) - There is none. No one has ever been able to conclusively state the cause of schizophrenia and that is just part of the bigger problem facing modern psychiatry. Splitting processes in schizoid conditions Another way of seeing it is as someone goes through a traumatic experience the person may go through self-annihilation and create another self out of safety to escape. At time these selves will eventually create a relationship and disrupt each other in speech as mentioned above. marketing of Thorazine, 141-142 in may 1954 smith, kline, and French introduced chlorpromazine into the US market selling it as Thorazine. This drug was the first antipsychotic medication to be developed and it is typically remembered today as dramatically different in kind from lobotomy and the other brain disabling therapies that preceded it. 150-155 had popular press magazines were promised advertising revenues if they would publish features mentioning a company?s drug in positive light. Writers earned extra fees on the side for doing the same, writers were also bribed with free dinners, limousine rides, and other perks much of what appears in popular press has in essence been placed by the public relations staffs of the pharmaceutical firms. 1950s, American physicians and the general public learned about new drugs was molded in large part by the pharmaceutical industry?s marketing machine television show was the kickoff in an innovative, even brilliant plan for selling drugs wooed state legislatures to allot funding for use of drug in mental hospitals; force organize speakers trained by bureau to coach hospital administrators and psychiatrists on what to say to the press and state officials thorazine contributed $116 million --- some states were now spending approximately five percent of their mental hospital budgets for Thorazine Marketing of Thorazine Pharmaceutical companies, through the use of bribes, had writers write and publish articles that were in their favor. Truth and hard facts were kicked to the side when faced with the opportunity to make more then their yearly salary for publishing one article. Along with the published articles the pharmaceutical companies produced a national television show attempting to show the American public how safe Thorazine was. The pharmaceutical companies also formed a task force of 50 people who were each assigned to a state legislature. They taught doctors and hospital administrators what to say about the drugs to put them in a more favorable light. Supporting quote: ?In short, in the 1950s, what American physicians and the general public learned about new drug was molded, in large part, by the pharmaceutical industry?s marketing machine. This molding of opinion, of course, played a critical role in the recasting of neuroleptics as safe, antischizophrenic drugs for the mentally ill? (Pg 150) Phenothiazines (142-143) Originally used as an insecticide it was found to limit locomotor activity. In the 1940s it was tested on rats who were trained to climb ropes to escape being shocked. Once the rats were administered phenothiazines they were no longer able to climb the ropes to escape being shocked. Doctors were interested in the drugs ability to numb a patient and immobilizing then without putting them to sleep. pg 142-143 chlorpromazine, which was synthesized in 1950 by Poulenc, a French pharmaceutical firm, belonged to a class of compounds known as phenothiazines that were developed in the late 1800s for use of synthetic dyes in 1930 us department of agriculture employed phenothiazine compounds for use as an insecticide and to kill swine parasites. Then in 1940s, phenothiazines were found to sharply limit locomotors activity in mammals but without putting them to sleep. Rats that learned to climb ropes to avoid electric shocks could no longer do this after administered phenothiazines the effect inspired French researchers into whether phenothiazines could be used during surgery to enhance the effects of barbiturates and other anesthetics, perhaps phenothiazines could numb the central nervous system in a novel way. Metrazol convulsive therapy (Reference: Pages 73, 92-96, 107, 265 in Mad in America) Metrazol was used to induce seizures in mentally ill patients. It was believed that they seizures would ?shock? the patients mind and in some way make them more lucid. The down side was that these drug induced seizures were extremely violent taking a great toll on patient?s body. Supporting quote: ?Metrazol triggered an explosive seizure. About a minute after the injection, the patient would arch into a convulsion so severe it could fracture bones, tear muscles, and loosen teeth.? (Pg 93) 73 metrazol convulsive therapy along with insulin coma, electroshock, prefrontal lobotomy, etc, worked by damaging the brain 92-96 introduced shortly after Sakel?s insulin treatment, could be administered quickly and easily with one physician able to treat fifty or more patients in a single morning remedy that could be traced back to the 1700s metrazol did change a persons behavior and moods and in fairly predictable ways. Metrazol triggered an explosive seizure. About a minute after the injection, the patient would arch into a convulsion so sever it could fracture bones, tear muscles, loosen teeth---able to suffer from spinal factures other complications included fractures of the humorous, femur, pelvic, scapula, clavicle bones, dislocation of the shoulder and jaw, broken teeth studies in animals showed that it caused seizures that led to hemorrhages in various organs such as lungs, kidney, and spleen, and in the brain leading to brain trauma to the waste of neurons in the cerebral cortex Meduna (Hungarian) acknowledge tat his treatment, much like insulin coma therapy, made brutal inroads into the organisms Patients would usually resist after first injection; patients undergo painful convulsive therapy As can be seen by physicians comments, metrazol created a new emotional tenor within asylum medicine. Physicians may have reasoned that terror, punishment, and physical pain were good for the mentally ill, but the mentally ill saw it as quite less abstractly. Ideas of assault 107 it dimmed brain function, crude method for achieving this effect, there was no precise control over the region of the brain that was disabled, nor was there control over the degree to which the brain was traumatized similar to insulin coma and electroshock Nuremburg Code for Ethical Experimentation - Ten-point code, following the Nuremburg trials two American physicians (Andrew Ivy and Leo Alexander) formed a guide for ethical human experimentation. At the heart was the ?natural law? which was the principle that the interests of science should never take precedence over the rights of the subject. Research subjects always needed to give informed consent and were never to be viewed as a means to an end. ? Never properly followed in American psychiatric human trials. pg 235 Leo Alexander and Andrew Ivy wrote then point Nuremberg Code for ethical human experimentation. At the heart of the code, which America promoted as a natural law, that should be respected by all, was the principle that the interests of science should never take precedence over the rights of human subjects. Research subjects were not to be seen as means to a scientific end, and they needed to always give informed consent. Paul Hoch and the use of LSD and mescaline in studying schizophrenia Attempted to develop a model for schizophrenia and decided that by using drugs (LSD and mescaline) to experimentally produce delusions and hallucinations in the mentally ill, he could elucidate the chemical background of the experimental psychoses. The drugs were found to heighten schizophrenic thoughts and trigger full blown schizophrenia in those who originally didn?t display many sign of schizophrenic thinking. He also studied whether electroshock and lobotomy could stop drug-induced psychosis by injecting mescaline to see how patients reacted to the drug and then injected again with mescaline followed up with EST to see if it would block the psychosis (it didn?t.) He then lobotomized some and injected them once more with mescaline, noting that he was able to bring back psychosis but with a lower patient response to the psychosis. Pg 235 to 238 By using drugs to experimentally produce delusions and hallucinations in the mentally ill, hoch argued, it would be possible to elucidate the chemical background of these experimental psychoses Settled on LSD and mescaline as the psychedelic agents of choice 1949 to 1952 began experiments with 60 mentally ill patients. Both drugs heightened the schizophrenic disorganization of the individuals and thus are very important in magnifying the schizophrenic structures in schizophrenic patients. In addition, LSd and mescaline could trigger full blown schizophrenic episodes in pseudoneurotics who, prior to the experiment did not display many signs of schizophrenic thinking. Such patients, when given LSD and mescaline, suffered intensely and underwent a marked intellectual disorganization and were dominated by their hallucinatory and delusional experiences. Was helping to establish psychiatry as a solid fact finding discipline Studied if electroshock and lobotomy would block drug induced psychosis Ethics were not questioned but saw as scientific knowledge being pursed Such surgery damaged the personality, made people apathetic, lacking in will and emotionally shallow, idea of amputation of the soul Drugs showed that patients were profoundly in disorganized regressive states pg 24-27 Humble in nature, did not believe that their care would unfailingly help people recover. Quakers professed to do little more than assist nature they wouldn?t even try to talk their patients out of their mad thoughts, rather, they would simply try to turn their minds to other topics in essence the Quakers sought to hold up to their patients a mirror that reflected an image not of a wild beast but a worthy person capable of self governance first saw them as animals, now human family Philadelphia Quakers opened the first moral treatment asylum in America in 1817 The following is the third section of Professor Atwood?s Review Sheet which means: THE DIVIDED SELF, ESSAYS AND LECTURE THIRD SECTION Ontologically secure person has a sense of his presence in the world as a real, alive, whole, and continuous person; he can live in a world others experienced as equally real and meet new people Ontological insecurity ? a partial or almost complete absence of the assurances derived from an existential position (aka primary ontological security) where anxieties and dangers arise; one who suffers from ontological insecurity is preoccupied with preserving rather than gratifying oneself; once the low threshold of security has been overcome, the ordinary circumstances of life no longer threat one?s own existence; Three forms of anxiety: engulfment, implosion, petrification Engulfment ? preoccupation with preserving one?s existence rather than gratifying oneself; ?I am arguing in order to preserve my existence?; felt as a risk in being understood, in being loved, or even simply in being seen; complete loss of being by absorption into the other person (main maneuver for preserving identity under pressure, because of fear of engulfment, is isolation). One either isolates oneself, or allows oneself to be engulfed by another person Implosion ? individual feels that he is empty and longs for emptiness to be filled, yet dreads the possibility of this happening because he has come to feel that all he can be is the awful nothingness that he is; any contact with reality is experienced as a dreadful threat; ?Reality, as such, threatening engulfment or implosion, is the persecutor.? Petrification [and depersonalization] ? terror, dread of the possibility of turning from a live person into a dead thing, an it without subjectivity; depersonalization is a technique that is universally used as a means of dealing with the other when he becomes too tiresome or disturbing; to an ontologically insecure person, the fear of depersonalization is brought out in their relationships ? if one experiences the other as a free agent, one is threatened at the possibility of experiencing oneself as an object Case 1: Anxiety at feeling alone ? Mrs. R had agoraphobia, a dread of being in the street; grew up alone and longed to be significant to someone else; married an army officer, who was posted abroad ? she experienced severe panic; finally felt loved when she had to take care of her dying mother; became unsatisfied with attention her husband gave her; had anxiety (when she was not in the presence of someone close to her) of no one caring and being alone in the street or rather at feeling on her own ; lack of ontological autonomy ? ?her sexual life and phantasies were efforts, not primarily to gain gratification, but to seek first ontological security? Case 2 ? Mrs. D had an intense fear of everything; sounded like a mother complaining about a difficult child ? mother indeed seemed to be coming out of her all the time, complaining about her childishness; ?a most curious phenomenon of the personality? ? someone else?s personality seems to ?possess? them while their own personality is temporarily ?lost? or ?gone?; her life was a misery as she was acting out as her mother and not as herself The embodied and unembodied self Those which are ontologically insecure come to experience themselves split into a mind and a body, and they usually feel more closely identified with the ?mind? Embodied experience ? feeling that one begins when one?s body begins and that one will end when one?s body dies; one feels one?s body to be alive, real, and substantial as one feels oneself alive real and substantial Unembodied experience ? one who does not go through life absorbed in one?s body but rather find?s oneself to be somewhat detached from one?s body; deprives oneself from direct participation in any aspect of the life of the world (engages in nothing directly); unembodied self becomes hyper-conscious A ?Borderline? Case ? David ? only child whose mother passed when he was ten; studied philosophy at a university, where he attended lectures in a cloak, carried a cane, etc? father accounted him to be perfectly normal; never caused any trouble, inseparable from his mother, ?took over? from his mother when she died; ?I had simply been what she wanted?; his view of human nature was that everyone was an actor; his self was never revealed through his actions; threatened by spontaneity, acted out women?s roles in front of mirror ? he dreaded these female impersonations (self vs. false self); tragic paradox is that the more the self is defended by withdrawing within a central citadel, the more it is destroyed" Being- in- the- world false self: the actions of the false self do not gratify the inner self. The false self of the schizoid person is compulsively compliant to the will of toehrs, it is partially autonomous and out of control, it si felt as alien; the unrealness, meaninglessness, purposelessness which permeate its perceptiosn, t houghts, feelins, and actions, and its overall deadness are not simply producations of secondary defences buta re direct consequences of the basic dynamic structure of the individual?s being. role of compliance in the false self: the personality, false self, mask, front, or persona that such individuals wear may consist in an amalgam of various part-selves, none of which is so fully developed as to have a comprehensive personality of its own. -person reveals that his observable behavior may comprise quite deliberate impersonations along with compulsive actions of every kind self-body dualism: 2 distinct splits between the body and self . Self( (body/ other) instead of the individual meetinghet world with an intergral self-hood, he disavows part of his own being along with his dosawvowal of immediate attachment to things and people in the world. existential phenomenology: to have the therapist understand what the patient is experiencing himself and the world, including oneself. If one cannot understand him, one is not in a position to begin to love him in any effective way. (Cannot love anyone without knowing who he really is.) Julie ? chronic schizophrenic, hallucinated, mostly mute, she said the trouble was that she was not a real person, she was trying to become a person, said her mother was smothering her; here?s what happened? [Patient was good] ? [Patient was bad] ? [Patient was mad] Good ? never a demanding baby, mother viewed this as being a good child (yet this is the description of a child who has in some way never come alive, because a really alive baby is demanding) ?She never wanted for anything but I felt she was never satisfied?; weaned without any trouble ? since she never established an autonomous self-being, she could not begin to work through the issues of presence and absence to the achievement of the ability to be alone by herself? (she was never really weaned) Bad ? accused her mother of not wanting her, of not letting her be a person, of smothering her?said she hated her mother; father withdrew himself emotionally from the family; ?hatred is expressed only in and through the very compliance of the false-self system?; both parents accepted the patient?s false self as good and rejected every other aspect of her as bad Mad ? Julie began the accusation that her mother was trying to kill her; symptom of being mad occurred when Julie thought her mother disposed of her beloved doll Peter ? 25-year-old who complained of a constant unpleasant smell coming from him and took several baths a day; only child, who made no difference in his parents? lives ? parents treated him as though he wasn?t there; never cuddled or played with; had inexhaustible patience and kindness; uninterested in office work; felt that both his parents resented his existence; Laing: ?You felt guilty about just being there?, Peter: ?Well, yes, I don?t know really? it was simply for being in the world in the first place, I suppose?; beginning to grow a sense that he was being put in a false position by everyone; ?alongside the feeling that he was worthless, there was also the growing impression that he was someone very special, sent by God for a special mission..?; began to hate and fear others; avoided experiencing anxiety by conforming to others and hardly ever revealing himself to them; ?if he could somehow be loved by a woman, then he felt he might be able to overcome his sense of worthlessness? Discussion ? Peter felt guilty simply at being in the world; Peter hadn?t been at home in his body or in his world; he was not seen by his mother; two of his techniques ? ?disconnection?, where he would widen the existential distance between self and the world, and ?uncoupling?, where he would split any relationship between his true self and his false self; he could be embodied if those around him knew nothing about him (he had to be a stranger) Splitting processes in schizoid conditions ?You can hold yourself back from the sufferings of the world, this is something you are free to do and is in accord with your nature, but perhaps precisely this holding back is the only suffering that you might be able to avoid.? ? Franz Kafka Dissociation of the self from the body is a person?s response to being enclosed within a threatening experience from which there is no physical escape; usually occurs without individual?s control; splitting can be a basic orientation to life (and not just a temporary reaction); objects perceived by the self are experienced as real; moods of futility, meaninglessness, and purposelessness are being lived and operated by a false self (a system partially dissociated from the ?true? self) The Inner Self ? prevented from having direct relationship with real thing and real people; because the self is detached, it is prevented from a full experience of realness and aliveness ? begins to lose what identity it had to begin with; the self is able to enjoy a sense of freedom which it fears it will lose if it abandons itself to the real; ?if there is anything the schizoid individual is likely to believe in, it is his own destructiveness? to be loved threatens his self? he descends into a vortex of non-being in order to avoid being, but also to preserve being from himself.? The false-self system Inner self ? occupied in fantasy and in observation False-self system ? direct relationships with the world; exists as the complement of an ?inner? self (which is occupied in maintaining its identity and freedom by being transcendent, unembodied, and thus never to be grasped, pinpointed, trapped, possessed); ?his false self does not serve as a vehicle for the fulfillment or gratification of the self?, in other words, the actions of the false self don?t gratify the inner self; observable behavior that is the expression of the false self is often perfectly normal; one of the aspects of the compliance of the false self is the fear implied by the compliance Impersonation ? there is a tendency for the false self to assume more and more of the characteristics of the person(s) whom its compliance is based, which may result in the impersonation of the other; impersonation may be either deliberate (i.e. David?s acting) or compulsive; form of identification where a part of the individual assumes the identity of a personality he is not 20-year-old girl ? overly dependent due to having an overprotective mother; hated her mother and hated her own face (caked her face in makeup, which was clownish in appearance); covered up her face to disguise her own hatred and to make a surrogate attack upon her mother?s face; ?the transitory acquisition of small fragments of other people?s behavior does tend to occur with particular insistence and compulsiveness on the basis of the schizoid false-self system? The Experience of Personal Annihilation The phenomenological exploration of annihilation states is not difficult as it focuses on the person and his or her world, in whatever state they may present themselves Self experience/World experience ? dramatic change in one may cause a change in the other (ex/ self-dissolution ? the experience of self-loss produces a disintegrating effect on the person?s experience, and results in the loss of coherence of the world itself) Annihilation ? person is dead or dying, they have no self, they don?t exist, world is not real, or they feel absent rather than present ? this feeling causes person to seek feeling of aliveness by self-inflicting pain, bizarre sexuality, or death-defying actions Fragmentation ? the breakup of the unity of the world means the loss of a stable reality in relation to which the sense of self is defined and sustained Cohesion ? the person wants to stay together (as one, as opposed to splitting which is found in Multiple Personality Disorder) Authenticity ? the world loses its authenticity (realism, validity) to the patient undergoing annihilation Affectivity ? emotional states are resistant to change when defending against anxieties Psychic deadness ? a feeling of deadness Usurpation of agency ? symbolized by a takeover of one?s brain by a supernatural entity which is suddenly felt to occur (i.e. ?picturing a distant The Influencing Machine ? (1) fantastic device (2) operated by wicked persecutors (3) sends waves, rays, energies, etc into one?s body/mind (See Truman Case) Anna delusion of blocks and Anna?s demand that her therapist ?know her whole life? ? (1) after she stopped repeating ?Hit me, hit me...? (2) she tried to dissolve the blocks and walls in her mind, which are preventing her from being born ? constantly tells Atwood that he is blocking her (?Stop blocking me!?), Atwood can?t take being accused of ?murdering? her soul/mind so he finally responds ?That?s science fiction!? which goes against his own belief about phenomenology; this eventually stopped (3) now she was asking Atwood ?Can you know my whole life??; she told him she was 13 different people (13 intervals of time in her life) ? fragmentation of the axis of time; meditating journeys of her 13 intervals of life in her mind (relive her memories in as much details as possible); Atwood: ?Is the reason you want me to know your whole life, because, if I do, you will become whole?? Anna: ?There might be something to that? ? ?know my whole life? vanished after that; Relations between Cartesian assumptions and approach: The case of the man who turned into a cell phone (Jack) ? He thought doctors planted a mini cell micro chip into his brain; the chip transmitted torturing voices into his mind (?You are a dirtbag!?), so he tried to stab at his brain to rid himself of the voices; the metaphor of this is ?a desire to think his own thoughts and be his own person? Case of woman who had a man appear in her throat because of Truman ? tried to enter Harry Truman?s house, raging paranoid schizophrenic, ?Truman has my head!? ? tried to get her head back from his house; Big R ? ?Your head is right where it should be?, her response ? ?Truman!?; said rays traveled from her vagina into her throat (made weird sounds and claimed there was a man in her throat); became attached and protective of Atwood, because he took the time to listen to her; must have come from similar background as Daniel Paul Schreber; Atwood?s theory: Truman = True Man, male figure crushed her reality (as Schreber?s father did to Schreber); the influencing machine? The Influencing Machine ? (1) fantastic device (2) operated by wicked persecutors (3) sends waves, rays, energies, etc into one?s body/mind Patty Duke (A Brilliant Madness) ? delusion that there was an infiltration in the White House; it was her mission to rescue the nation by rooting out the invaders; failed effort to carry out mission was followed by episode of severe depression; she was raised, in highly abusive and exploitive circumstances, as a creature of the entertainment industry ? stolen childhood; manic states expressed an attempted freeing from the direction of her life Jamison (An Unquiet Mind) ? single author has two voices: first voice is allied with medical authority, affirming the biological reasons of the manic-depressive illness from which she suffered ? tells her story as though she is an organic disease; second voice gives expression to a love for the intensity of experience in her cycling mood states; vivid hallucination ? glass tube of blood put in centrifuge, which spun until the glass broke and blood was everywhere; daughter of an Air Force officer, expected to learn ?fine points of manners, dancing?? etc; required to fulfill unrealistic roles Nature of the manic protest, Manic states ? various departures of mood, thinking, and behavior from pre-established standard of normality; diagnostic signs ? unrealistic euphoria, racing thoughts, extravagant grandiose plans/projects, hyper sexuality, extreme irritability and insensitivity to others Post-Cartesian approach ? What are the features of mania when it is examined from a viewpoint seeking to approximate how it is experienced? What is the configuration of the intersubjective field that is typically associated with the occurrence of the manic state? Trauma and Annihilation Ego strength is the reason why some people respond to trauma successfully while others experience self- and world- dissolution The trauma that annihilates is one that subverts the person?s whole way of making sense of their life and attacks sustaining connections to the human surround at their most fundamental level The trauma that can be dissociated, although also a threat to existing organizations of experience, leaves sustaining ties intact to some degree, so that a stable platform of selfhood survives for the dissociation of the traumatic event The case of the patient who was profoundly sexually abused throughout her childhood ? mother told her to find her own way home, even though she was unable to, which was when she had her first auditory hallucination (?You see? you?re blind? you see? you?re blind..?); words dissolved, leaving her feeling unreal; entered large university where she was isolated, mother suffered from ovarian cancer, she was recently in a car accident which resulted in a concussion, father had sexually abused her from ages 2 to 13 ? reoccurring nightmare where she would constantly be trying to stay in the light at the fear of being captured by the dark; the theme of light and dark connect with her daylight and nighttime worlds during her childhood 35 year old millionaire/White Truck? Before the white truck incident, she was constantly being attacked by others because of her vulnerability in losing herself. The white truck incident was ?suppose? to be a breakthrough for her. She admitted to her therapist that when the driver of the white truck stopped and waved to her to pass the street, she thought he was trying to tell her to go kill herself? so she replied back at him ferociously. She said that afterward, she had second thought about her initial thinking. Perhaps the man wasn?t saying to her to kill herself and was just waving at her. The therapist replied that this was a good sign, however, she became more withdrawn. The therapist let her know that this was a sign of "a new theme developing" and caused the woman to become paranoid of even more attacks. mentally collapsed and then inherited million dollars from her aunt; stood up and said ?I?m feeling better?; lonely, finally decided to reach out to other people; now, impairing herself (thought the smell in her house were emanating from her neighbor?s house); the day before the chemicals came into her house, patient received a visit from her two sisters (known in the family as ?the sick one?, and very vulnerable to it) and told them she took up photography and wants to start her own business ? sisters responded sarcastically ?such a good idea? (condescending quality, ?you sick person?) Images of being poisoned by chemicals or gasses as symbols of corrosive invalidation. In Laing?s Divided Self, these images of the self being poisoned are like engulfment, implosion, or petrifaction. The gas or chemical poisoning the self are like symbols of the self being attacked/suffocated with an agent that is taking away the self. The agent could be like the corrosive invalidations that is taking away parts of the self. The case of the woman who could not tolerate be spoken to as 'you' ("Shattered worlds/psychotic states) Imagine a patient who feels she is not present, does not exist, and has no self. Imagine futher that someone not familiar with such states asks her, ?How are you today?? The use of the 2nd-person ?you? implies to the patient a degree of existence she does not experience, and a gulf of misunderstanding and invalidation opens up between her and the questioner. Perhaps the patient gives the answers, ?A billion light years,? expressing how far away she feels from the questioner... What if a second individual who speaks to the patient differently (in 3rd person rather than 2nd person). The patient, surprised by this different approach, actually begins to feel understood.. also to feel a flickering of her own existence... A clinician operating on Cartesian assumptions is not a in a position to understand experiences of nonbeing. Any reaction to communicate this view intensifies the patient's experience of invalidation and annihilation, giving rise to a spiraling of disjunctive worlds in which the patient elaborates ever more concretized images of her obliteration. Case of the woman who believed she was a member of the holy trinity- Hallucinated about god, believed she was a member of the holy trinity. Father committed suicide when she was little and this caused her inner deadness to grow. Her unbearable experience of desertation had been suppressed by family?s denial. Her delusions protected and preserved her shattered world. Her relations with god turned into full fledge delusional realities finally bursting forth in the family with great violence and precipitating the first of many psychiatric hospitalizations. It was the fathers suicide and the loss her best friend that caused this.
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