Patient Identification Quotes

Nature or Nature’s God” is not a statement, but a name, internally divided by tolerated uncertainty. It has the singularity of a proper name, whilst parenthesizing a suspended decision (Pyrrhonian epoche, of which much more in a future post). It designates rigidly, but obscurely, because it points into epistemological darkness — naming a Reality that not only ‘has’, but epitomizes identity, whilst nevertheless, for ‘the sake of argument’, eluding categorical identification. Patient in the face (or facelessness) of who or what it is, ‘we’ emerge from a pact, with one basic term: a preliminary decision is not to be demanded. It thus synthesizes a select language community, fused by the unknown.

The first of these uses is in the service of projective identification. In this the patient uses words as things or as split-off parts of himself which he pushes forcibly into the analyst. Typical of the consequences of this behaviour is the experience of a patient who felt he got inside me at the beginning of each session and had to be extricated at the end of it. Language

Accordingly, identification, or the formation of composite figures, serves different purposes: first, to represent a feature both persons have in common; secondly, to represent a displaced common feature; but thirdly, to find expression for a common feature that is merely wished for. Since wishing it to be the case that two people have something in common is often the same as exchanging them, this relation too is expressed in the dream by identification. In the dream of Irma's injection, I wish to exchange this patient for another, that is, I wish that the other were my patient, as Irma is; the dream takes account of the wish in showing me a figure who is called Irma, but who is examined in a posture in which I have only had occasion to see the other.

unemployment neurosis.” And I could show that this neurosis really originated in a twofold erroneous identification: being jobless was equated with being useless, and being useless was equated with having a meaningless life. Consequently, whenever I succeeded in persuading the patients to volunteer in youth organizations, adult education, public libraries and the like—in other words, as soon as they could fill their abundant free time with some sort of unpaid but meaningful activity—their depression disappeared although their economic situation had not changed and their hunger was the same. The truth is that man does not live by welfare alone.

Awareness, no matter how confused it may be, develops from every act of rebellion: the sudden, dazzling perception that there is something in man with which he can identify himself, even if only for a moment. Up to now this identification was never really experienced. Before he rebelled, the slave accepted all the demands made upon him. Very often he even took orders, without reacting against them, which were far more conducive to insurrection than the one at which he balks. He accepted them patiently, though he may have protested inwardly, but in that he remained silent he was more concerned with his own immediate interests than as yet aware of his own rights. But with loss of patience—with impatience—a reaction begins which can extend to everything that he previously accepted, and which is almost always retroactive. The very moment the slave refuses to obey the humiliating orders of his master, he simultaneously rejects the condition of slavery. The act of rebellion carries him far beyond the point he had reached by simply refusing. He exceeds the bounds that he fixed for his antagonist, and now demands to be treated as an equal. What was at first the man's obstinate resistance now becomes the whole man, who is identified with and summed up in this resistance. The part of himself that he wanted to be respected he proceeds to place above everything else and proclaims it preferable to everything, even to life itself. It becomes for him the supreme good. Having up to now been willing to compromise, the slave suddenly adopts ("because this is how it must be . . .") an attitude of All or Nothing. With rebellion, awareness is born.

Fifty years ago, I published a study2 devoted to a specific type of depression I had diagnosed in cases of young patients suffering from what I called “unemployment neurosis.” And I could show that this neurosis really originated in a twofold erroneous identification: being jobless was equated with being useless, and being useless was equated with having a meaningless life. Consequently, whenever I succeeded in persuading the patients to volunteer in youth organizations, adult education, public libraries and the like—in other words, as soon as they could fill their abundant free time with some sort of unpaid but meaningful activity—their depression disappeared although their economic situation had not changed and their hunger was the same. The truth is that man does not live by welfare alone.

Fifty years ago, I published a study devoted to a specific type of depression I had diagnosed in cases of young patients suffering from what I called "unemployment neurosis." And I could show that this neurosis really originated in a twofold erroneous identification: being jobless was equated with being useless, and being useless was equated with having a meaningless life. Consequently, whenever I succeeded in persuading the patients to volunteer in youth organizations, adult education, public libraries and the like - in other words, as soon as they could fill their abundant free time with some sort of unpaid but meaningful activity - their depression disappeared although their economic situation had not changed and their hunger was the same. The truth is that man does not live by welfare alone

The relationship between doctor and patient, especially when a transference on the part of the patient occurs, or a more or less unconscious identification of doctor and patient, can lead to parapsychological phenomena. I have frequently run into this. One such case which was particularly impressive was that of a patient whom I had pulled out of a psychogenic depression. He went back home and married; but I did not care for his wife. The first time I saw her, I had an uneasy feeling. Her husband was grateful to me, and I observed that I was a thorn in her side because of my influence over him. It frequently happens that women who do not really love their husbands are jealous and destroy their friendships. They want the husband to belong entirely to them because they themselves do not belong to him. The kernel of all jealousy is lack of love.

In particular, I think of the mass of people who are today unemployed. Fifty years ago, I published a studyfn3 devoted to a specific type of depression I had diagnosed in cases of young patients suffering from what I called “unemployment neurosis.” And I could show that this neurosis really originated in a twofold erroneous identification: being jobless was equated with being useless, and being useless was equated with having a meaningless life. Consequently, whenever I succeeded in persuading the patients to volunteer in youth organizations, adult education, public libraries and the like—in other words, as soon as they could fill their abundant free time with some sort of unpaid but meaningful activity—their depression disappeared although their economic situation had not changed and their hunger was the same. The truth is that man does not live by welfare alone.

Identification with one particular function at once produces a tension of opposites. The more compulsive the one-sidedness, and the more untamed the libido which streams off to one side, the more daemonic it becomes. When a man is carried away by his uncontrolled, undomesticated libido, he speaks of daemonic possession or of magical influences. In this sense manas and vac are indeed mighty demons, since they work mightily upon men. All things that produced powerful effects were once regarded as gods or demons. Thus, among the Gnostics, the mind was personified as the serpent-like Nous, and speech as Logos. Vac bears the same relation to Prajapati as Logos to God. The sort of demons that introversion and extraversion may become is a daily experience for us psychotherapists. We see in our patients and can feel in ourselves with what irresistible force the libido streams inwards or outwards, with what unshakable tenacity an introverted or extraverted attitude can take root. The description of manas and vac as “mighty monsters of Brahman” is in complete accord with the psychological fact that at the instant of its appearance the libido divides into two streams, which as a rule alternate periodically but at times may appear simultaneously in the form of a conflict, as an outward stream opposing an inward stream. The daemonic quality of the two movements lies in their ungovernable nature and overwhelming power. This quality, however, makes itself felt only when the instinct of the primitive is already so stunted as to prevent a natural and purposive counter-movement to one-sidedness, and culture not sufficiently advanced for man to tame his libido to the point where he can follow its introverting or extraverting movement of his own free will and intention.

People today associate rivalry with boundless aggression and find it difficult to conceive of competition that does not lead directly to thoughts of murder. Kohut writes of one of his patients: "Even as a child he had become afraid of emotionally cathected competitiveness for fear of the underlying (near delusional) fantasies of exerting absolute, sadistic power." Herbert Hendin says of the students he analyzed and interviewed at Columbia that "they could conceive of no competition that did not result in someone's annihilation." The prevalence of such fears helps to explain why Americans have become uneasy about rivalry unless it is accompanied by the disclaimer that winning and losing don't matter or that games are unimportant anyway. The identification of competition with the wish to annihilate opponents inspires Dorcas Butt's accusation that competitive sports have made us a nation of militarists, fascists, and predatory egoists; have encouraged "poor sportsmanship " in all social relations; and have extinguished cooperation and compassion.

right brain and associated neurocircuits. This is predicated on the formation of a trusting relationship between the patient and therapist, who must be sensitive enough to receive the patient’s underlying negative state, and implicitly empathically resonate with what is going on within the client’s right brain and within his body. All therapeutic techniques sit on top of the therapist’s ability to access the implicit realm via right-brain-to-right-brain communications. A strong therapeutic alliance depends on the therapist’s knowledge about the patient from the inside out, rather than from the top down. The patient’s emotional growth depends on the therapist’s ability to move, and to be moved by, those that come to him for help. The therapist has to help patients to learn how to regulate feeling associated with trauma so that the patient can integrate them into his emotional life, rather than having to dissociate when they arise. When a patient is catapulted into a hyperaroused state and subjectively experiences the therapist through the lens of the previous insecure internal working models, this is the expression of “negative transference.” For a patient who is in the midst of a negative transference the therapeutic alliance is severely ruptured, and the therapist is seen as an analogue of the early misattuned other and is experienced as source of dysregulation rather than interactive regulation. However, if the therapist can maintain an attuned connection to the client, then the door opens to working with what was laid down early in the patient’s life and reorganization becomes a possibility. A problem may arise if the therapist cannot contain the negative emotions created in negative transference and in projective identification. There is an old adage in therapy that no patient can achieve a greater level of healing than the therapist has achieved. With modern scientific knowledge we can be more specific: the patient’s unconscious right brain can develop only as far as the therapist’s right brain can take them. For a therapist to stay with a dissociating patient who is projecting his trauma onto

Controlled mentalization, identification and understanding of emotional reactions, and emotional regulation are significant problems for eating-disordered patients. In general, bulimia nervosa patients show problems in emotional hyperarousal and flooding. The opposite, a dominance of detached and flattened effect, is typically seen in patients with anorexia nervosa.

may seem logical that if you identify with a patient, it will make the work easier because you intuitively understand her, but in many ways, this kind of identification makes things harder. I’ve had to be extra-vigilant in our sessions, making sure that I’m seeing Charlotte as a separate person and not as a younger version of myself that I can go back and fix.

This felt like a classic example of projective identification. In projection, a patient attributes his beliefs to another person; in projective identification, he sends them into another person. For instance, a man may feel angry at his boss at work, then come home and say to his spouse, “You seem angry.” He’s projecting, because the spouse isn’t angry. In projective identification, on the other hand, the man may feel angry at his boss, return home, and essentially insert his anger into his partner, actually making the partner feel angry. Projective identification is like tossing a hot potato to the other person. The man no longer has to feel his anger, since it’s now living inside his partner.

For some time, an arbitrary line in the sand was drawn at the end of the first trimester as the demarcation marking the beginning of "life". Of course, advances in medical technology continued to force those who stood on that line to retreat further and further toward the beginning of gestation. For instance, it has been established that a fetus has brain waves which can be measured by EEG only 40 days after conception, and merely 18 days after conception, the fetus has a measurable heart beat. In fact, they were getting so close to the beginning of gestation, i.e., conception, that the PC pro-abortion genderists then had to adopt the more ephemeral "viability" position. Of course, according to their definition of "viability", comatose patients would not be considered human being because, in some ways, a fetus is actually more "viable" than someone who is comatose. As obstetrical and gynecological medicine continued its inevitable advance, revealing more and more about the nature of a human fetus, the pro-abortion forces continued their retreat until now they do not even discuss the fetus at all. As with all politically correct positions, if a fact gets in the way, it is simply changed or ignored. Unfortunately for the pro-abortion genderists, the fetus is a fact, a fact which is itself usually the result of "choices". Furthermore, the simple scientific fact is that at the moment of conception, the embryo is not a part of the mother's body. At that point and forever more it is a genetically distinct being with its own genetic code that is completely and totally different from every other human being who has ever lived or ever will live, including the mother. So here is the first instance of PC genderism crashing into scientific fact. It also seems ironic that while more and more law enforcement agencies in this country are now turning to DNA identification in criminal investigations and our courts are now admitting such identification as evidence in criminal prosecution, the rights of a fetus, which has its own, distinct DNA code at the moment of conception, are still not legally recognized in all cases. Now they are recognized in some cases, for there have been instances of people being prosecuted for two murders when they have killed pregnant women. There are also cases where mothers who have given birth to babies who are addicted to illegal drugs have been prosecuted, but there are no consistent standards or guidelines. It is also a macabre irony that in this country it is illegal to destroy the egg of an American bald eagle, but the government uses our tax dollars to destroy human embryos and fetuses.

When an experience is an unusually powerful emotional event, there may be a series of reactions. These are both common and normal. Signs and symptoms of critical-incident stress include the following: 1. Physical—enduring fatigue, sleep dysfunction (either needing too much or insomnia), change of appetite (eating too much or too little), gastrointestinal upset, headache, backache, chills, nausea, muscular twitches or tremors, shock-like symptoms (especially in acute stress), hyperactivity, or its opposite, underactivity. 2. Emotional—anger, irritability, fear, grief, anxiety, guilt, depression, feeling overwhelmed, identification with the patient(s) in a rescue, emotional numbness, feelings of helplessness or hopelessness. 3. Cognitive—memory loss, especially anomia (the inability to remember names); inability to attach importance to things other than the incident; concentration problems; loss of attention span; difficulties with calculations, decision-making, and problem-solving; flashbacks; nightmares (especially recurrent ones), amnesia for the event; violent fantasies; confusing the importance of trivial and major tasks.

He came to believe that, in addition to getting rid of parts of the self, projective identification was sometimes the only way in which some very fragmented patients could communicate. The problem lay in recognising, understanding and making sense of what was being communicated by the patient, in such a way that the patient could better understand what was happening in his internal world. Before any of this can happen, however, the therapist has to be capable of receiving, and holding on to (that is, containing) ‘inside of himself what the patient has projected into him. These unprocessed, raw, fragmented, and sometimes ‘unthinkable’ thoughts and feelings were called by Bion, ‘Beta Elements’, and the capacity to process and think about them, was referred to as ‘Alpha Function’. It follows from this that an increase in Alpha Function will also lead to a greater capacity in the therapist to contain and manage stress.

Fourth, character is dynamic in that it generates new strivings, new needs and problems. It is largely through the identification of these needs that diagnosis proceeds, as when the discovery of excessive dependency or aggressiveness suggests that the patient has a particular type of character-structure.

Fiscal Numbers (the latter uniquely identifies a particular hospitalization for patients who might have been admitted multiple times), which allowed us to merge information from many different hospital sources. The data were finally organized into a comprehensive relational database. More information on database merger, in particular, how database integrity was ensured, is available at the MIMIC-II web site [1]. The database user guide is also online [2]. An additional task was to convert the patient waveform data from Philips’ proprietary format into an open-source format. With assistance from the medical equipment vendor, the waveforms, trends, and alarms were translated into WFDB, an open data format that is used for publicly available databases on the National Institutes of Health-sponsored PhysioNet web site [3]. All data that were integrated into the MIMIC-II database were de-identified in compliance with Health Insurance Portability and Accountability Act standards to facilitate public access to MIMIC-II. Deletion of protected health information from structured data sources was straightforward (e.g., database fields that provide the patient name, date of birth, etc.). We also removed protected health information from the discharge summaries, diagnostic reports, and the approximately 700,000 free-text nursing and respiratory notes in MIMIC-II using an automated algorithm that has been shown to have superior performance in comparison to clinicians in detecting protected health information [4]. This algorithm accommodates the broad spectrum of writing styles in our data set, including personal variations in syntax, abbreviations, and spelling. We have posted the algorithm in open-source form as a general tool to be used by others for de-identification of free-text notes [5].

Defenses reject reality and our feelings. The defenses do not observe the truth. They reject it, distorting the patient’s awareness. The patient, enacting an identification, looks at himself through dismissive eyes. This identification does not protect him or give him a realistic appraisal. That is why we say: “This mechanism probably saved your life in the past, and we should thank it for how it protected you then. But what protected you in the past is destroying your life today.

at best, the contemporary analyst leaves his patient at the point of purely imaginary identification – of which the hysteric remains captive, because her fantasy implies ensnarement in it’.

He’s not the same as what he was at first.” And yet the “real” Dylan has been popping up in odd places of late. In 2009, police in Long Branch, New Jersey, were alerted to the presence of an “eccentric-looking old man” wandering around a residential neighborhood in the rain and peering into the windows of a house marked with a “for sale” sign. When the police arrived, the man introduced himself as Bob Dylan. He had no identification; the officer, Kristie Buble, then twenty-four, suspected he was an escaped mental patient. It “never crossed my mind,” she said, “that this could really be him.” Dylan politely explained that he was on tour with Willie Nelson, playing a nearby resort. He was taken in the patrol car back to the hotel, where his manager identified him. Dylan was exceedingly “nice” throughout the ordeal, the officer reported, noting his odd request that, once identified, she drive him back to the neighborhood where he’d been picked up. She had interrupted him doing god knows what; she was his Person from Porlock. He has a habit of showing up at the childhood homes of fellow musical legends. The Long Branch neighborhood wasn’t far from a house where Bruce Springsteen had lived while writing Born to Run. In 2008, Dylan and his manager were discovered standing on the front lawn of the home in Winnipeg, Manitoba, where Neil Young had lived as a teenager. The owners gave the men an informal tour, during which Dylan asked a number of “thoughtful questions.” In England a year or so later, Dylan slipped unnoticed into a public tour of John Lennon’s childhood home in Liverpool, where he “lingered” over photos and other artifacts, telling the house’s curator that Lennon’s “simple upbringing was similar to his own.” Standing next to Dylan in Lennon’s childhood bedroom was, the curator reported, “surreal.