Psychiatric Patient Quotes

The young and the old are defenseless against relatives who want to get rid of them by casting them in the role of mental patient,and against psychiatrists whose livelihood depends on defining them as mentally ill.

If you expand the boundaries of mental illness, which is clealry what has happened in this country during the past twenty-five years, and you treat the people so diagnosed with psychiatric medications, do you run the risk of turning an anger-ridden teenager into a lifelong mental patient?

The mental health system is filled with survivors of prolonged, repeated childhood trauma. This is true even though most people who have been abused in childhood never come to psychiatric attention. To the extent that these people recover, they do so on their own.[21] While only a small minority of survivors, usually those with the most severe abuse histories, eventually become psychiatric patients, many or even most psychiatric patients are survivors of childhood abuse.[22] The data on this point are beyond contention. On careful questioning, 50-60 percent of psychiatric inpatients and 40-60 percent of outpatients report childhood histories of physical or sexual abuse or both.[23] In one study of psychiatric emergency room patients, 70 percent had abuse histories.[24] Thus abuse in childhood appears to be one of the main factors that lead a person to seek psychiatric treatment as an adult.[25]

...sometimes offering a quality daily opinion about what’s going on in American politics feels like trying to compose a beautiful symphony using only the recorded screams of psychiatric patients.

One study found that an average high school student today likely deals with as much anxiety as did a psychiatric patient in the 1950s. The numbers are eye-opening

Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments of mental health problems.31 Practitioners who explore treatments are typically marginalized as “alternative.” Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients’ needs. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by means other than drugs is rarely considered.

...some patients resist the diagnosis of a post-traumatic disorder. They may feel stigmatized by any psychiatric diagnosis or wish to deny their condition out of a sense of pride. Some people feel that acknowledging psychological harm grants a moral victory to the perpetrator, in a way that acknowledging physical harm does not.

Here I want to stress that perception of losing one’s mind is based on culturally derived and socially ingrained stereotypes as to the significance of symptoms such as hearing voices, losing temporal and spatial orientation, and sensing that one is being followed, and that many of the most spectacular and convincing of these symptoms in some instances psychiatrically signify merely a temporary emotional upset in a stressful situation, however terrifying to the person at the time. Similarly, the anxiety consequent upon this perception of oneself, and the strategies devised to reduce this anxiety, are not a product of abnormal psychology, but would be exhibited by any person socialized into our culture who came to conceive of himself as someone losing his mind.

And what science had revealed was this: Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known "chemical imbalance". However, once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function, as Hyman observed, abnormally.

The ethics of psychiatric therapy is the very negation of the ethics of political liberty. The former embraces absolute power, provided it is used to protect and promote the patient's mental health. The latter rejects absolute power, regardless of its aim or use.

The World Health Organization found that Americans live in the richest country, but they are also the most anxious.2 The average high school kid today experiences the same level of anxiety as the average psychiatric patient of the 1950s.

The great unspoken paradox of the arduous process of psychoanalysis is that the best patients are the ones who never really needed it in the first place. Abnormal

American prisons and jails housed an estimated 356,268 [people] with severe mental illness.… [a] figure [that] is more than 10 times the number of mentally ill patients in state psychiatric hospitals [in 2012, the last year for reliable data]—about 35,000 people.

It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness—and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways.

The addicts started to insist on being at every meeting where drug policy was discussed. They took a slogan from the movements of psychiatric patients who were fighting to be treated decently: “Nothing about us, without us.” Their message was: We’re here. We’re human. We’re alive. Don’t talk about us as if we are nothing.

One in two recently evicted mothers reports multiple symptoms of clinical depression, double the rate of similar mothers who were not forced from their homes. Even after years pass, evicted mothers are less happy, energetic, and optimistic than their peers. When several patients committed suicide in the days leading up to their eviction, a group of psychiatrists published a letter in Psychiatric Services, identifying eviction as a “significant precursor of suicide.” The letter emphasized that none of the patients were facing homelessness, leading the psychiatrists to attribute the suicides to eviction itself. “Eviction must be considered a traumatic rejection,” they wrote, “a denial of one’s most basic human needs, and an exquisitely shameful experience.” Suicides attributed to evictions and foreclosures doubled between 2005 and 2010, years when housing costs soared.

Stella Maris Black River Falls, Wisconsin Established 1902 Since 1950 a non-denominational facility and hospice for the care of psychiatric medical patients.

Taking a pill is passive. In contrast, psychotherapy puts the patient in charge by instilling new coping skills and attitudes toward life.

The average high school kid today has the same level of anxiety as the average psychiatric patient in the 1950s.”)

Several themes describe misconceptions about mental illness and corresponding stigmatizing attitudes. Media analyses of film and print have identified three: people with mental illness are homicidal maniacs who need to be feared; they have childlike perceptions of the world that should be marveled; or they are responsible for their illness because they have weak character (29-32)." World Psychiatry. 2002 Feb; 1(1): 16–20. PMCID: PMC1489832 Understanding the impact of stigma on people with mental illness PATRICK W CORRIGAN and AMY C WATSON

Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. Clinical Psychopharmacology and Neuroscience 2014 Dec; 12(3): 171-179 The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry

An incurably psychotic individual may lose his usefulness but yet retain the dignity of a human being. This is my psychiatric credo. Without it I should not think it worthwhile to be a psychiatrist. For whose sake? Just for the sake of a damaged brain machine which cannot be repaired? If the patient were not definitely more, euthanasia would be justified.

It is no coincidence then that doctors and patients and the entire Lyme community report—anecdotally, of course, as there is still a frustrating scarcity of good data on anything Lyme-related—that women suffer the most from Lyme. They tend to advance into chronic and late-stage forms of the illness most because often it's checked for last, as doctors often treat them as psychiatric cases first. The nebulous symptoms plus the fracturing of articulacy and cognitive fog can cause any Lyme patient to simply appear mentally ill and mentally ill only. This is why we hear that young women—again, anecdotally—are dying of Lyme the fastest. This is also why we hear that chronic illness is a women's burden. Women simply aren't allowed to be physically sick until they are mentally sick, too, and then it is by some miracle or accident that the two can be separated for proper diagnosis. In the end, every Lyme patient has some psychiatric diagnosis, too, if anything because of the hell it takes getting to a diagnosis.

When Paul announced himself in a rather formal way to the secretary, he said simply, “I am Watzlawick.” She suspected he was a new psychiatric patient showing up for an appointment at the wrong time, and she interpreted his introduction as, “I am not Slavic.

It has been fashionable in some psychiatric and lay circles to blame the mother for whatever goes wrong in development. [...] If blame must be assessed it should be placed on the human condition which requires such prolonged dependence on one individual for development to take place. This makes the child extraordinarily vulnerable to the idiosyncrasies of that person (the mother). On the other hand, the prolonged dependence on this relationship also provides the potential for the richness of the human personality. It is a mistake, in my judgment, in psychotherapy to encourage or side with the patient's hostility to the mother. The patient has to become aware of and express it in therapy in order to grow but whatever the source of this hostility is in the past -- be it an actual memory or a fantasy to rationalize a feeling state -- the problem is now the patient's responsibility and he must work it out.

Fracturing of the psyche is said to be conducive to creating the phenomenon that has been termed sleeper assassins. According to such theories, the first psychiatrists employed to master mind control studied mental patients who had been diagnosed with Multiple Personality Disorder, which medical science has since renamed Dissociative Identity Disorder. Many of those psychiatrists are said to have been Paperclip Nazi doctors who were brought to the US after conducting radical psychiatric experiments on patients during the Holocaust – the same doctors whose victims not only included Jews, Gyspies, political agitators and homosexuals, but also the mentally ill.

Psychiatric illnesses were classified into two major groups—organic illnesses and functional illnesses—based on presumed differences in their origin. That classification, which dated to the nineteenth century, emerged from postmortem examinations of the brains of mental patients.

The uncomfortable, as well as the miraculous, fact about the human mind is how it varies from individual to individual. The process of treatment can therefore be long and complicated. Finding the right balance of drugs, whether lithium salts, anti-psychotics, SSRIs or other kinds of treatment can be a very hit or miss heuristic process requiring great patience and classy, caring doctoring. Some patients would rather reject the chemical path and look for ways of using diet, exercise and talk-therapy. For some the condition is so bad that ECT is indicated. One of my best friends regularly goes to a clinic for doses of electroconvulsive therapy, a treatment looked on by many as a kind of horrific torture that isn’t even understood by those who administer it. This friend of mine is just about one of the most intelligent people I have ever met and she says, “I know. It ought to be wrong. But it works. It makes me feel better. I sometimes forget my own name, but it makes me happier. It’s the only thing that works.” For her. Lord knows, I’m not a doctor, and I don’t understand the brain or the mind anything like enough to presume to judge or know better than any other semi-informed individual, but if it works for her…. well then, it works for her. Which is not to say that it will work for you, for me or for others.

The lifetime prevalence of dissociative disorders among women in a general urban Turkish community was 18.3%, with 1.1% having DID (ar, Akyüz, & Doan, 2007). In a study of an Ethiopian rural community, the prevalence of dissociative rural community, the prevalence of dissociative disorders was 6.3%, and these disorders were as prevalent as mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%) (Awas, Kebede, & Alem, 1999). A similar prevalence of ICD-10 dissociative disorders (7.3%) was reported for a sample of psychiatric patients from Saudi Arabia (AbuMadini & Rahim, 2002).

the single hero story that seemed to be repeating itself everywhere — in the oldest Sumerian epics, in folktales from the Pacific Islands and the Siberian forests and the African savannah, in the lives of great religious heroes like Gautama Śakyamūni and Jesus, in the case notes of psychiatric patients,

Somehow, like so many people who get depressed, we felt our depressions were more complicated and existentially based than they actually were. Antidepressants might be indicated for psychiatric patients, for those of weaker stock, but not for us. It was a costly attitude; our upbringing and pride held us hostage.

With a strange logic, [Rod Liddle] asserts that because ME patients deny that they have a psychiatric disorder, this proves they have a psychiatric disorder. Meanwhile, people are quietly dying of ME. ME sufferer Emily Collingridge died, aged 30; Victoria Webster died at just 18. People don’t die from ‘exercise phobia’. ME is not ‘lethargy’ and ‘aches and pains’, as Liddle claims. Severe ME is lying in a darkened room, alone, in agonising pain, tube-fed, catheterised, too weak to move or speak.

Frankl is credited with establishing logotherapy as a psychiatric technique that uses existential analysis to help patients resolve their emotional conflicts. He stimulated many therapists to look beyond patients’ past or present problems to help them choose productive futures by making personal choices and taking responsibility for them.

Most patients requiring psychiatric treatment have, at the root of their problem, an unreconciled hatred for someone, coupled with bitterness and unforgiveness.

Psychiatric cure is the "expanding of the self to such final effect that the patient as known to himself is much the same person as the patient behaving to others.

Patients are often taken by ambulance to emergency rooms, where they are boarded in general hospitals that lack psychiatric care.

Frankl is credited with establishing logotherapy as a psychiatric technique that uses existential analysis to help patients resolve their emotional conflicts. He stimulated many

Now to tell ya about our fellow inmates. Pay attention because there are a bunch of us an’ we each have a story.

my first visit to a secure psychiatric unit. Within a few minutes of my arrival, a patient had pulled down his pants, squatted and defecated in front of me. A stinking pile of shit.

It’s absolutely retrogressive to suggest [ME] CFS is in the heads of patients. I have seen patients commit suicide, or have been otherwise destroyed, because some professor has diagnosed them as having a psychiatric illness.

There is no evidence that suicide prevention prevents suicide. Psychiatrists and psychiatric hospitals are regularly sued and found liable for patient suicides. Psychiatrists kill themselves at three times the rate of the general public.

Sixty percent of lobotomies were conducted on women (one study in Europe found that 84 percent of lobotomies were conducted on female patients), even though women made up a smaller segment of the psychiatric population in state hospitals.

The off-drug patients also suffered less from depression, blunted emotions, and retarded movements. Indeed, they told Carpenter and McGlashan that they had found it "gratifying and informative" to have gone through their psychotic episodes without having their feelings numbed by the drugs. Medicated patients didn't have that same learning experience, and as a result Carpenter and McGlashan concluded, over the long term they "are less able to cope with subsequent life stresses.

In psychiatry, patients don't produce information as easily as they do in other medical settings. Most patients with physical disorders are frightened by their pain and eager to give information about it. Psychiatric patients have a very different relationship to their symptoms and don't always want to answer questions. Gertrude's patient probably found his rituals deeply embarrassing. He probably wanted the help, but he also probably wanted to tell this stranger as little as possible to get it. The paranoid patient, who has an unrealistic fixed belief that people are out to get him, may not feel, at the time, that it is of any relevance to the doctor that there is a conspiracy of aliens against him. The manic-depressive patient, whose judgment is usually quite poor during periods of illness, may take a dislike to the doctor and say that she has been behaving perfectly normally. Interviewing a psychiatric patient can be like trying to catch fish with your hands.

According to the most outspoken and vituperative Skeptics, therapists specializing in recovered memory therapy operate in a neverland of fairy dust and mythic monsters. Woefully out of touch with modern research, engaging in “crude psychiatric analysis,” guilty of oversimplification, overextension, and “incestuous opinion citing,” these misguided, undertrained, and overzealous clinicians are implanting false memories in the minds of suggestible clients, making “therapeutic lifers” out of their patients and ripping families apart. This

The depressives, far from seeing themselves through dark lenses as we had presumed, were cursed by twenty-twenty vision: compared with other groups, their self-ratings of positive qualities most closely matched how the observers rated them. In contrast, both the nondepressed psychiatric patients and the control group had inflated self-ratings, seeing themselves more positively than the observers saw them. The depressive patients simply did not see themselves through the rose-colored glasses that the others used when evaluating themselves.

...the vast majority of these [dissociative identity disorder] patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as posttraumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.2,10 A history of multiple treatment providers, hospitalizations, and good medication trials, many of which result in only partial or no benefit, is often an indicator of dissociative identity disorder or another form of complex PTSD.

It was not easy to go from being one of the seven righteous pillars holding up the whole planet and human race to being just another mental patient. I remember talking to a woman who was ending racism and asking her if it was part of a bigger program or if racism was the whole deal. As someone who had gone back to the beginning of time and dealt with issues of whether or not life itself was a good idea, I wasn’t sure that just getting rid of racism was a big enough prize. ....In the eighties when I was called out of retirement to defeat communism, it was over my strenuous objections. “I don’t even dislike communism all that much,” I objected. “It seems so beside the point.” “The Republicans are going to take credit for this and ride it into the ground,” I correctly predicted. After winning many many preliminary rounds which I honestly hoped I’d lose, I was smuggled into what was thought to be just another psychiatric hospital where the Russian bear took one look at me, declined to dance, and the rest is history. My delusional world always felt kind of tinny and hollow, but that never helped me get out of it.

According to Goffman, the Wise are those people (often with a close personal relationship to a stigmatised individual, such as the wife of a psychiatric patient) who do not subscribe to the prejudicial and stigmatising behaviours prevalent throughout society and do not let the stigmatisable status of an individual cloud their judgment on such persons. They are often afforded honorary status as “one of us” within communities of stigmatised people, and in return help the stigmatised people pass for Normals (as such they can often spot an otherwise passing individual because they are familiar with techniques which are employed to this end).

A chart review (Herman, 1986) found that 67 percent of twelve psychiatric outpatients with BPD had a history of abuse in childhood or adolescence. And a qualitative study (Bryer, Nelson, Miller, & Krol, 1987) found that 86 percent of fourteen hospitalized patients with BPD had experienced sexual abuse before the age of sixteen.

Twenty-four percent of the patients treated with Saint-John’s-wort had a “full response,” 25 percent of the Zoloft patients, and 32 percent of the placebo group. “This study fails to support the efficacy of H perforatum in moderately severe depression,” the investigators concluded, glossing over the fact that their drug had failed this test too.29

In the words of one observer, “the reliance on the patient’s subjective symptoms, the clinician’s interpretation of the symptoms, and the absence of objective measure (such as a blood test) implant the seeds of diagnostic unreliability of psychiatric disorders.” In this sense, psychiatry may prove especially resistant to attempts at noise reduction.

Among the factors that the schema of the differing severity of mental illness fails to take into account is an ephemeral something in the individual patient which might be called 'a will to grow.' It is possible for an individual to be extremely ill and yet at the same time possess an equally strong 'will to grow,' in which case healing will occur. On the other hand, a person who is only mildly ill, as best as we can define psychiatric illness, but who lacks the will to grow, will not budge an inch from an unhealthy position. I therefore believe that a patient's will to grow is one crucial determinant of success or failure of psychotherapy. Yet it is a factor that is not at all understood or even recognized by contemporary psychiatric theory.

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment-the powerlessness, depersonalization, segregation, mortification, and self-labeling-seem undoubtedly countertherapeutic.

At McLean Hospital in Belmont, Massachusetts, one of the premier psychiatric hospitals in the nation, women represented eighty-two percent of the total number of lobotomy patients from 1938 to 1954. In hospitals across the country, women constituted between sixty and eighty percent of all lobotomy recipients, in spite of the fact that men comprised the majority of institutionalized patients.

Je découvris qu'en bluffant les psychiatres on pouvait tirer des trésors inépuisables de divertissement gratifiants: vous les menez habilement en bateau, leur cachez soigneusement que vous connaissez toutes les ficelles du métier; vous inventez à leur intention des rêves élaborés, de purs classiques du genre qui provoquent chez eux, ces extorqueurs de rêves, de tels cauchemars qu'ils se réveillent en hurlant; vous les affriolez avec des "scènes primitives" apocryphes; le tout sans jamais leur permettre d'entrevoir si peu que ce soit le véritable état de votre sexualité. En soudoyant une infirmière, j'eus accès à quelques dossiers et découvris, avec jubilation, des fiches me qualifiant d' "homosexuel en puissance" et d' "impuissant invétéré". Ce sport était si merveilleux, et ses résultats - dans mon cas - si mirifiques, que je restai un bon mois supplémentaire après ma guérison complète (dormant admirablement et mangeant comme une écolière). Puis j'ajoutai encore une semaine rien que pour le plaisir de me mesurer à un nouveau venu redoutable, une célébrité déplacée (et manifestement égarée) comme pour son habileté à persuader ses patients qu'ils avaient été témoins de leur propre conception.

Don't you find it interesting that people even use that term, 'act of God'? Considering that most want to believe that God is about lambs and love and babies and mangers. And yet this same so-called benevolent being smites innocent people left and right, indicating an anger management problem, maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy.

Walter, don’t you find it interesting that people even use that term ‘act of God’? Considering that most want to believe that God is about lambs and love and babies in mangers, and yet this same so-called benevolent being smites innocent people left and right, indicating an anger management problem—maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy.

same so-called benevolent being smites innocent people left and right, indicating an anger management problem—maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy. Which I don’t favor. Electroshock therapy is still largely unproven. But isn’t it interesting that acts of God and electroshock therapy share so much in common? In terms of being violent, cruel

Walter, don’t you find it interesting that people even use that term ‘act of God’? Considering that most want to believe that God is about lambs and love and babies in mangers, and yet this same so-called benevolent being smites innocent people left and right, indicating an anger management problem—maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy. Which

in 1972 Governor Ronald Reagan with one bold, brilliant stroke abolished mental illness in California by not only closing the large state psychiatric hospitals but also eradicating most of the public aftercare programs. As a result hospital staffs were forced, day after day, to go through the charade of treating patients and discharging them back into the same noxious setting that had necessitated their hospitalization.

An aha experienced decades ago by one of us is relevant to this point. Halfway through a grueling clinical internship, CP [Christopher Peterson] complained to his supervisor, “No one [meaning the patients] ever says thank you for anything I try to do.” The response from the experienced psychiatrist stopped CP mid-whine: “If they [the patients] could say thank you, how many of them do you think would be in a psychiatric hospital?

Some psychiatric clinicians appear to be so biologically or behaviorally oriented that they do not believe in the unconscious. Others have been so indoctrinated in the Freudian psychoanalytic model that they believe all accounts of incest are fantasy. A few of the older clinicians allow pride to get in their way and refuse to believe that they may have missed the diagnosis [of Dissociative Identity Disorder] in some of their patients.

The innermost core of the patient's personality is not even touched by a psychosis. An incurably psychotic individual may lose his usefulness but yet retain the dignity of a human being. This is my psychiatric credo. Without it I should not think it worthwhile to be a psychiatrist. For whose sake? Just for the sake of a damaged brain machine which cannot be repaired? If the patient were not definitely more, euthanasia would be justified.

Patients are often taken by ambulance to emergency rooms, where they are boarded in general hospitals that lack psychiatric care. The hospitals then can’t discharge their patients to psychiatric facilities because more often than not, there are no beds available. It creates a logjammed system that fails everyone, as movement is stymied in almost every direction except to the streets or to jails and prisons, also known as “the beds that never say no,

He told me that his sister is clinically depressed and read Naked during a month-long visit to a psychiatric hospital. According to him, once she’d finished, she loaned it to a fellow patient, who, in turn, loaned it to someone else. The book seemed to lift people’s spirits, and as a result, the hospital has made it recommended reading. I’m not sure whether I believe this, but it’s extremely flattering to think my book is being passed around a German asylum.

For nearly a hundred years, psychiatry has been striving to apply medical model thinking to psychiatric disorders. In this model, the symptoms besieging patients are sorted into specific disease entities and the causes then identified and removed. For doctors of internal medicine, this works. In the case of diabetes mellitus, for example, the symptoms of urinary frequency, fatigue, and confusion often lead to suspicion of the underlying cause, which is confirmed by blood sugar monitoring and then treated by insulin replacement. But psychiatric symptoms are much harder to sort into diagnoses. People with depression sometimes become paranoid. People with schizophrenia sometimes become depressed. Some people who hear voices have no other symptoms whatsoever, and others who hear voices also fall victim to terrible mood swings. Thus far, the hope that psychiatry would be able to identify homogeneous disease states, uncover the biological underpinnings, and remedy them has been largely a barren one. Kappler's symptoms, however, evolved when the hope for psychiatry's becoming a true medical specialty was bright to the point of being blinding. Over the years he would collect over a dozen diagnoses and cavalierly take a myriad of medicines, but no one would be able to bring him close to confronting the past he had disowned, to stand a chance of making peace with it and, ultimately, overcoming it. (46)

Some judicial officials began to notice the unusual frequency of deaths among the inmates of institutions and some prosecutors even considered asking the Gestapo to investigate the killings. However, none went so far as Lothar Kreyssig, a judge in Brandenburg who specialized in matters of wardship and adoption. A war veteran and a member of the Confessing Church, Kreyssig became suspicious when psychiatric patients who were wards of the court and therefore fell within his area of responsibility began to be transferred from their institutions and were shortly afterwards reported to have died suddenly. Kreyssig wrote Justice Minister Gortner to protest against what he described as an illegal and immoral programme of mass murder. The Justice Minister's response to this and other, similar, queries from local law officers was to try once more to draft a law giving effective immunity to the murderers, only to have it vetoed by Hitler on the grounds that the publicity would give dangerous ammunition to Allied propaganda. Late in April 1941 the Justice Ministry organized a briefing of senior judges and prosecutors by Brack and Heyde, to try to set their minds at rest. In the meantime, Kreyssig was summoned to an interview with the Ministry's top official, State Secretary Roland Freisler, who informed him that the killings were being carried out on Hitler's orders. Refusing to accept this explanation, Kreyssig wrote to the directors of psychiatric hospitals in his district informing them that transfers to killing centres were illegal, and threatening legal action should they transport any of their patients who came within his jurisdiction. It was his legal duty, he proclaimed, to protect the interests and indeed the lives of his charges. A further interview with Gortner failed to persuade him that he was wrong to do this, and he was compulsorily retired in December 1941.

The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR. While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false. Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.

For what is at stake is fundamentally a woman’s femininity: just as the white Victorian woman unhappy with a life of petticoats and socializing might have had her uterus injected with tea in an attempt to bring her in line with the ideal female of her time, the twenty-first-century mother who is struggling to stay steeped in ever-patient love and fun might need psychiatric internment to accept proper intensive motherhood. Thurer summed up the progression of the twentieth century nicely when she wrote, “[Experts] have invented a motherhood that excluded the experience of the mother.

Walter, don’t you find it interesting that people even use that term ‘act of God’? Considering that most want to believe that God is about lambs and love and babies in mangers, and yet this same so-called benevolent being smites innocent people left and right, indicating an anger management problem—maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy. Which I don’t favor. Electroshock therapy is still largely unproven. But isn’t it interesting that acts of God and electroshock therapy share so much in common? In terms of being violent, cruel—

Had it been uttered by a patient to a doctor in the mid-twentieth century, the doctor would almost certainly have responded that the patient had a psychiatric problem and that his mind needed to be treated so as to bring its feelings into line with his physical body. Today, the doctor is more likely to respond that the problem is such that the patient’s body needs to be brought into alignment with those inner feelings. Indeed, were a doctor to respond in the earlier fashion today, he might well find himself subject to legal action. What has changed in our society and in the social imaginary to bring this new situation about?

I believe the perception of what people think about DID is I might be crazy, unstable, and low functioning. After my diagnosis, I took a risk by sharing my story with a few friends. It was quite upsetting to lose a long term relationship with a friend because she could not accept my diagnosis. But it spurred me to take action. I wanted people to be informed that anyone can have DID and achieve highly functioning lives. I was successful in a career, I was married with children, and very active in numerous activities. I was highly functioning because I could dissociate the trauma from my life through my alters. Essentially, I survived because of DID. That's not to say I didn't fall down along the way. There were long term therapy visits, and plenty of hospitalizations for depression, medication adjustments, and suicide attempts. After a year, it became evident I was truly a patient with the diagnosis of DID from my therapist and psychiatrist. I had two choices. First, I could accept it and make choices about how I was going to deal with it. My therapist told me when faced with DID, a patient can learn to live with the live with the alters and make them part of one's life. Or, perhaps, the patient would like to have the alters integrate into one person, the host, so there are no more alters. Everyone is different. The patient and the therapist need to decide which is best for the patient. Secondly, the other choice was to resist having alters all together and be miserable, stuck in an existence that would continue to be crippling. Most people with DID are cognizant something is not right with themselves even if they are not properly diagnosed. My therapist was trustworthy, honest, and compassionate. Never for a moment did I believe she would steer me in the wrong direction. With her help and guidance, I chose to learn and understand my disorder. It was a turning point.

ME/CFS is not synonymous with depression or other psychiatric illnesses. The belief by some that they are the same has caused much con- fusion in the past, and inappropriate treatment. Nonpsychotic depression (major depression and dysthymia), anxiety disorders and somatization disorders are not diagnostically exclusionary, but may cause significant symptom overlap. Careful attention to the timing and correlation of symptoms, and a search for those characteristics of the symptoms that help to differentiate between diagnoses may be informative, e.g., exercise will tend to ameliorate depression whereas excessive exercise tends to have an adverse effect on ME/CFS patients.

Walter, don’t you find it interesting that people even use that term ‘act of God’? Considering that most want to believe that God is about lambs and love and babies in mangers, and yet this same so-called benevolent being smites innocent people left and right, indicating an anger management problem—maybe even manic depression. In a psychiatric ward, such a patient would be subjected to electroshock therapy. Which I don’t favor. Electroshock therapy is still largely unproven. But isn’t it interesting that acts of God and electroshock therapy share so much in common? In terms of being violent, cruel—” “Sixty seconds, Zott.” “—unforgiving, barbarous—” “Jesus, Elizabeth, please.

Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied.

Because DID requires the presence of amnesia, DID patients are, by DSM-5 definition (American Psychiatric Association, 2013), unaware of some of their behavior in different states. Progress in treatment includes helping patients become more aware of, and in better control of, their behavior across all states. To those who have not had training in treating DID, this increased awareness may make it seem as if patients are creating new self-states, and “getting worse,” when in fact they are becoming aware of aspects of themselves for which they previously had limited or no awareness or control. Although some DID patients create new self-states in adulthood, clinicians strongly advise patients against so doing (Fine, 1989; ISSTD, 2011; Kluft, 1989).

While all of us dread being blamed, we all would wish to be more responsible—that is, to have the ability to respond with awareness to the circumstances of our lives rather than just reacting. We want to be the authoritative person in our own lives: in charge, able to make the authentic decisions that affect us. There is no true responsibility without awareness. One of the weaknesses of the Western medical approach is that we have made the physician the only authority, with the patient too often a mere recipient of the treatment or cure. People are deprived of the opportunity to become truly responsible. None of us are to be blamed if we succumb to illness and death. Any one of us might succumb at any time, but the more we can learn about ourselves, the less prone we are to become passive victims. Mind and body links have to be seen not only for our understanding of illness but also for our understanding of health. Dr. Robert Maunder, on the psychiatric faculty of the University of Toronto, has written about the mindbody interface in disease. “Trying to identify and to answer the question of stress,” he said to me in an interview, “is more likely to lead to health than ignoring the question.” In healing, every bit of information, every piece of the truth, may be crucial. If a link exists between emotions and physiology, not to inform people of it will deprive them of a powerful tool. And here we confront the inadequacy of language. Even to speak about links between mind and body is to imply that two discrete entities are somehow connected to each other. Yet in life there is no such separation; there is no body that is not mind, no mind that is not body. The word mindbody has been suggested to convey the real state of things. Not even in the West is mind-body thinking completely new. In one of Plato’s dialogues, Socrates quotes a Thracian doctor’s criticism of his Greek colleagues: “This is the reason why the cure of so many diseases is unknown to the physicians of Hellas; they are ignorant of the whole. For this is the great error of our day in the treatment of the human body, that physicians separate the mind from the body.” You cannot split mind from body, said Socrates—nearly two and a half millennia before the advent of psychoneuroimmunoendocrinology!

From the year of his death, 1963, to the publication of Rosenhan’s study in 1973, the total resident population in state and county psychiatric hospitals dropped by almost 50 percent, from 504,600 to 255,000. Ten years later, the US psychiatric population would drop another 50 percent to 132,164. Today 90 percent of the beds available when JFK made his speech have closed as the country’s population has nearly doubled. Trouble is, for all of its idealism and promise, the dreams of community care were never actualized because the funds never materialized. The money was intended to follow the patients. It didn’t. The community care model at its very best provided nominal care to the least impaired. Those with the most severe forms of these disorders were ignored or cast aside.

In 1978, an activist named Judi Chamberlin published one of the movement's most revered manifestos called 'On Our Own: Patient-Controlled Alternatives to the Mental Health System.' Chamberlin had been diagnosed with a mental illness and found traditional psychiatric intervention unhelpful and even traumatic. She did recover, however, and she credited that recovery to an alternative mental health care facility she stayed at in Canada. Chamberlin and many other madness pride activists believe that people with 'lived experience' should not only have a proverbial seat at the table when it comes to the creation of mental health care systems, but that such people are uniquely equipped to understand what constitutes the best treatment. A slogan Chamberlin sought to make famous was 'Nothing about us without us.

It is necessary to make this point in answer to the `iatrogenic' theory that the unveiling of repressed memories in MPD sufferers, paranoids and schizophrenics can be created in analysis; a fabrication of the doctor—patient relationship. According to Dr Ross, this theory, a sort of psychiatric ping-pong 'has never been stated in print in a complete and clearly argued way'. My case endorses Dr Ross's assertions. My memories were coming back to me in fragments and flashbacks long before I began therapy. Indications of that abuse, ritual or otherwise, can be found in my medical records and in notebooks and poems dating back before Adele Armstrong and Jo Lewin entered my life. There have been a number of cases in recent years where the police have charged groups of people with subjecting children to so-called satanic or ritual abuse in paedophile rings. Few cases result in a conviction. But that is not proof that the abuse didn't take place, and the police must have been very certain of the evidence to have brought the cases to court in the first place. The abuse happens. I know it happens. Girls in psychiatric units don't always talk to the shrinks, but they need to talk and they talk to each other. As a child I had been taken to see Dr Bradshaw on countless occasions; it was in his surgery that Billy had first discovered Lego. As I was growing up, I also saw Dr Robinson, the marathon runner. Now that I was living back at home, he was again my GP. When Mother bravely told him I was undergoing treatment for MPD/DID as a result of childhood sexual abuse, he buried his head in hands and wept. (Alice refers to her constant infections as a child, which were never recognised as caused by sexual abuse)

My own odyssey of therapy, over my forty-five-year career, is as follows: a 750-hour, five-time-a-week orthodox Freudian psychoanalysis in my psychiatric residency (with a training analyst in the conservative Baltimore Washington School), a year’s analysis with Charles Rycroft (an analyst in the “middle school” of the British Psychoanalytic Institute), two years with Pat Baumgartner (a gestalt therapist), three years of psychotherapy with Rollo May (an interpersonally and existentially oriented analyst of the William Alanson White Institute), and numerous briefer stints with therapists from a variety of disciplines, including behavioral therapy, bioenergetics, Rolfing, marital-couples work, an ongoing ten-year (at this writing) leaderless support group of male therapists, and, in the 1960s, encounter groups of a whole rainbow of flavors, including a nude marathon group.

Among DID individuals, the sharing of conscious awareness between alters exists in varying degrees. I have seen cases where there has appeared to be no amnestic barriers between individual alters, where the host and alters appeared to be fully cognizant of each other. On the other hand, I have seen cases where the host was absolutely unaware of any alters despite clear evidence of their presence. In those cases, while the host was not aware of the alters, there were alters with an awareness of the host as well as having some limited awareness of at least a few other alters. So, according to my experience, there is a spectrum of shared consciousness in DID patients. From a therapeutic point of view, while treatment of patients without amnestic barriers differs in some ways from treatment of those with such barriers, the fundamental goal of therapy is the same: to support the healing of the early childhood trauma that gave rise to the dissociation and its attendant alters. Good DID therapy involves promoting co­-consciousness. With co-­consciousness, it is possible to begin teaching the patient’s system the value of cooperation among the alters. Enjoin them to emulate the spirit of a champion football team, with each member utilizing their full potential and working together to achieve a common goal. Returning to the patients that seemed to lack amnestic barriers, it is important to understand that such co-consciousness did not mean that the host and alters were well-­coordinated or living in harmony. If they were all in harmony, there would be no “dis­ease.” There would be little likelihood of a need or even desire for psychiatric intervention. It is when there is conflict between the host and/or among alters that treatment is needed.

The way we define their problems, our diagnosis, will determine how we approach their care. Such patients typically receive five or six different unrelated diagnoses in the course of their psychiatric treatment. If their doctors focus on their mood swings, they will be defined as bipolar and prescribed lithium or valproate. If the professionals are most impressed with their despair, they will be told they are suffering from major depression and given antidepressants. If the doctors focus on their restlessness and lack of attention, they may be categorized as ADHD and treated with Ritalin or other stimulants. And if the clinic staff happens to take a trauma history, and the patient actually volunteers the relevant information, he or she might receive the diagnosis of PTSD. None of the diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from.

Ideally, work is consecrated. It is something that happens within the present moment . . . Ideally, work is just another beautiful form of joining the cosmic sparkle. But this is an ideal. . . . I worked as a psychiatrist in public institutions . . . for nearly 20 years. During the last 12 of those years, I was consciously trying to be mindful of love, to practice the presence of God. It was the most frustrating thing I ever tried to do. . . . as soon as I entered the ward everything changed. I was immediately kidnapped. I was gone: away from the present, away from any sense of love or its source, away from even appreciating my own being. . . Looking back, it seems clear that I went into my sense of responsibility for the diagnosis and care of the patients. . . . And there was so much paperwork! Most days I would remain forgetful until my work was done and I was driving home. Then I would remember, and such sadness would fill me. Where had I been? How could I have allowed myself to be so captured? I can remember driving home one day after I had spent a long time feeling helpless with a very disturbed patient. I actually slapped myself in the face when I realized I could have been praying for her and praying for myself instead of just worrying about what to do. I tried everything . . . and still it did not “work”. . . . It stopped only when I left the psychiatric institutions and started working full-time with Shalem. . . . I go into this detail because what I am saying does not apply only to psychiatric institutions. It applies, to some extent, to almost every institution we have. It applies to education and social work, to government and business, and to religious institutions as well. People are stuck in all these places, and they can neither get out of them nor find a loving quality of presence within them. Love demands defenselessness, and in many if not most of our workplaces that is just too high a price.

By contrast, moderate identity alteration differs from its milder countepart in that the alterations are not always under the person's control. In addition, moderate identity alteration does not always manifest the presence of distinct alter personalities. Someone who experiences moderate identity alteration may present with mood changes and behaviors that they perceive as uncontrollable. Patients with nondissociative psychiatric disorders (e.g., manic depressive illness) may report moderate alterations in behavior/demeanor that they cannot control; for example, one patient diagnosed as manic depressive mentioned being bothered by his inability to "keep his mind from racing" (SCID-D interview, unpublished transcript). However, these alterations do not coalesce around distinct personalities. Similarly, individuals who have borderline personality disorder tend to fluctuate rapidly between radically different behaviors and moods; however, these changes do not involve different names, memories, preferences, distinct ages, or amnesia for past events.

The issues of antidepressant-associated suicide has become front-page news, the result of an analysis suggesting a link between medication use and suicidal ideation among children, adolescents, a link between medication use and suicidal ideation among children, adolescents, and adults up to age 24 in short term (4 to 16 weeks), placebo-controlled trials of nine newer antidepressant drugs. The data from trials involving more than 4.4(K) patients suggested that the average risk of suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants was 4 percent, twice the placebo risk of 2 percent. No suicides occured in these trials. The analysis also showed no increase in suicide risk among the 25 to 65 age group. Antidepressants reduced suicidality among those over age 65. Following public hearings on the subject, in October 2004, the FDA requested the addition of “black box” warnings—the most serious warning placed on the labeling of a prescription medication—to all antidepressant drugs, old and new.

Although there are no set methods to test for psychiatric disorders like psychopathy, we can determine some facets of a patient’s mental state by studying his brain with imaging techniques like PET (positron emission tomography) and fMRI (functional magnetic resonance imaging) scanning, as well as genetics, behavioral and psychometric testing, and other pieces of information gathered from a full medical and psychiatric workup. Taken together, these tests can reveal symptoms that might indicate a psychiatric disorder. Since psychiatric disorders are often characterized by more than one symptom, a patient will be diagnosed based on the number and severity of various symptoms. For most disorders, a diagnosis is also classified on a sliding scale—more often called a spectrum—that indicates whether the patient’s case is mild, moderate, or severe. The most common spectrum associated with such disorders is the autism spectrum. At the low end are delayed language learning and narrow interests, and at the high end are strongly repetitive behaviors and an inability to communicate.

In studies of first-episode bipolar patients, investigators at McLean Hospital, the University of Pittsburgh, and the University of Cincinnati Hospital found that at least one-third had used marijuana or some other illegal drug prior to their first manic or psychotic episode.10 This substance abuse, the University of Cincinnati investigators concluded, may “initiate progressively more severe affective responses, culminating in manic or depressive episodes, that then become self-perpetuating.”11 Even the one-third figure may be low; in 2008, researchers at Mt. Sinai Medical School reported that nearly two-thirds of the bipolar patients hospitalized at Silver Hill Hospital in Connecticut in 2005 and 2006 experienced their first bout of “mood instability” after they had abused illicit drugs.12 Stimulants, cocaine, marijuana, and hallucinogens were common culprits. In 2007, Dutch investigators reported that marijuana use “is associated with a fivefold increase in the risk of a first diagnosis of bipolar disorder” and that one-third of new bipolar cases in the Netherlands resulted from it.13

If it were true that the unconscious consists of nothing but contents accidentally deprived of consciousness but otherwise indistinguishable from the conscious material, then one could identify the ego more or less with the totality of the psyche. But actually the situation is not quite so simple. Both theories are based mainly on observations in the field of neurosis. Neither Janet nor Freud had any specifically psychiatric experience. If they had, they would surely have been struck by the fact that the unconscious displays contents that are utterly different from conscious ones, so strange, indeed, that nobody can understand them, neither the patient himself nor his doctors. The patient is inundated by a flood of thoughts that are as strange to him as they are to a normal person. That is why we call him “crazy”: we cannot understand his ideas. We understand something only if we have the necessary premises for doing so. But here the premises are just as remote from our consciousness as they were from the mind of the patient before he went mad. Otherwise he would never have become insane.

COULD IT BE B12 DEFICIENCY? The neurological symptoms of B12 deficiency that occur in young and middle-aged people are very similar to those in older people. They include the following: • Numbness, tingling, or burning sensations of the hands, feet, extremities, or truncal area, often misdiagnosed as diabetic neuropathy or chronic inflammatory demyelinating polyneuropathy (CIDP) • Tremor, often misdiagnosed as essential tremor or pre-Parkinson’s disease • Muscle weakness, paresthesias, and paralysis, sometimes attributed to Guillain-Barré syndrome • Pain, fatigue, and debility, often labeled as “chronic fatigue syndrome” • “Shaky leg” syndrome (leg trembling) • Confusion and mental fogginess, often misdiagnosed as early-onset dementia • Unsteadiness, dizziness, and paresthesias, often misdiagnosed as multiple sclerosis • Weakness of extremities, clumsiness, muscle cramps, twitching, or foot drop, often misdiagnosed as amyotrophic lateral sclerosis (ALS) • Psychiatric symptoms, such as depression or psychosis (covered in greater length in the next chapter) • Visual disturbances, vision loss, or blindness In contrast, a doctor ignorant about the effects of B12 deficiency can destroy a patient’s life. The

One year later the society claimed victory in another case which again did not fit within the parameters of the syndrome, nor did the court find on the issue. Fiona Reay, a 33 year old care assistant, accused her father of systematic sexual abuse during her childhood. The facts of her childhood were not in dispute: she had run away from home on a number of occasions and there was evidence that she had never been enrolled in secondary school. Her father said it was because she was ‘young and stupid’. He had physically assaulted Fiona on a number of occasions, one of which occurred when she was sixteen. The police had been called to the house by her boyfriend; after he had dropped her home, he heard her screaming as her father beat her with a dog chain. As before there was no evidence of repression of memory in this case. Fiona Reay had been telling the same story to different health professionals for years. Her medical records document her consistent reference to family problems from the age of 14. She finally made a clear statement in 1982 when she asked a gynaecologist if her need for a hysterectomy could be related to the fact that she had been sexually abused by her father. Five years later she was admitted to psychiatric hospital stating that one of the precipitant factors causing her breakdown had been an unexpected visit from her father. She found him stroking her daughter. There had been no therapy, no regression and no hypnosis prior to the allegations being made public. The jury took 27 minutes to find Fiona Reay’s father not guilty of rape and indecent assault. As before, the court did not hear evidence from expert witnesses stating that Fiona was suffering from false memory syndrome. The only suggestion of this was by the defence counsel, Toby Hed­worth. In his closing remarks he referred to the ‘worrying phenomenon of people coming to believe in phantom memories’. The next case which was claimed as a triumph for false memory was heard in March 1995. A father was aquitted of raping his daughter. The claims of the BFMS followed the familiar pattern of not fitting within the parameters of false memory at all. The daughter made the allegations to staff members whom she had befriended during her stay in psychiatric hospital. As before there was no evidence of memory repression or recovery during therapy and again the case failed due to lack of corrobo­rating evidence. Yet the society picked up on the defence solicitor’s statements that the daughter was a prone to ‘fantasise’ about sexual matters and had been sexually promiscuous with other patients in the hospital. ~ Trouble and Strife, Issues 37-43

The story begins with the revelation Alicia murdered her husband. Why do you think the author made this admission at the very start?   2.  Alicia’s diary plays a key role in the book. What purpose do you think it serves? And does your perception of Alicia change the more you read?   3.  Alicia’s silence is related to the Greek myth of Alcestis. How do you feel about the story of the myth? Why do you think Alicia is silent?   4.  Theo’s motives to work with Alicia are complicated. Do you think he wanted to help her?   5.  Both Alicia and Theo had difficult childhoods. Early on, Theo says no one is born evil. That who we become depends on the environment into which we are born. By the end of the novel he appears to change his mind, saying that perhaps some of us are born evil, and, despite therapy, we remain that way. Which do you think is true?   6.  Weather plays a large role in the book, such as the heat wave during the summer. What purpose do you think the description of the weather serves in the novel?   7.  Do you think the world of a psychiatric unit was convincingly portrayed? How do you feel about Diomedes and the other psychiatrists?   8.  We never enter Kathy’s mind in the book. Do you have any sympathy for her?   9.  What do you think happens at the end of the book? The last line is ambiguous. 10.  It’s a psychological thriller with a twist. The author has said he was influenced by Agatha Christie. Did you feel this was simply a detective story or are there any other influences you can spot?

When we consider the major role intimidation plays in this ideology, which was still at the peak of its popularity at the turn of the century, it is not surprising that Sigmund Freud had to conceal his surprising discovery of adults' sexual abuse of their children, a discovery he was led to by the testimony of his patients. He disguised his insight with the aid of a theory that nullified this inadmissible knowledge. Children of his day were not allowed, under the severest of threats, to be aware of what adults were doing to them. and if Freud had persisted in his seduction theory, he not only would have had his introjected parents to fear but would no doubt have been discredited, and probably ostracized, by middle-class society. In order to protect himself, he had to devise a theory that would preserve appearances by attributing all “evil”, guilt and wrongdoing to the child's fantasies. in which the parents served only as the objects of projection. We can understand why this theory omitted the fact that it is the parents who not only project their sexual and aggressive fantasies onto the child but also are able to act out these fantasies because they wield the power. It is probably thanks to this omission that many professionals in the psychiatric field, themselves the products of "poisonous pedagogy" have been able to accept the Freudian theory of drives, because it did not force them to question their idealized image of their parents. With the aid of Freud's drive and structural theories, they have been able to continue obeying the commandment they internalized in early childhood: "Thou shalt not be aware of what your parents are doing to you.

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

Treating Abuse Today (Tat), 3(4), pp. 26-33 Freyd: You were also looking for some operational criteria for false memory syndrome: what a clinician could look for or test for, and so on. I spoke with several of our scientific advisory board members and I have some information for you that isn't really in writing at this point but I think it's a direction you want us to go in. So if I can read some of these notes . . . TAT: Please do. Freyd: One would look for false memory syndrome: 1. If a patient reports having been sexually abused by a parent, relative or someone in very early childhood, but then claims that she or he had complete amnesia about it for a decade or more; 2. If the patient attributes his or her current reason for being in therapy to delayed-memories. And this is where one would want to look for evidence suggesting that the abuse did not occur as demonstrated by a list of things, including firm, confident denials by the alleged perpetrators; 3. If there is denial by the entire family; 4. In the absence of evidence of familial disturbances or psychiatric illnesses. For example, if there's no evidence that the perpetrator had alcohol dependency or bipolar disorder or tendencies to pedophilia; 5. If some of the accusations are preposterous or impossible or they contain impossible or implausible elements such as a person being made pregnant prior to menarche, being forced to engage in sex with animals, or participating in the ritual killing of animals, and; 6. In the absence of evidence of distress surrounding the putative abuse. That is, despite alleged abuse going from age two to 27 or from three to 16, the child displayed normal social and academic functioning and that there was no evidence of any kind of psychopathology. Are these the kind of things you were asking for? TAT: Yeah, it's a little bit more specific. I take issue with several, but at least it gives us more of a sense of what you all mean when you say "false memory syndrome." Freyd: Right. Well, you know I think that things are moving in that direction since that seems to be what people are requesting. Nobody's denying that people are abused and there's no one denying that someone who was abused a decade ago or two decades ago probably would not have talked about it to anybody. I think I mentioned to you that somebody who works in this office had that very experience of having been abused when she was a young teenager-not extremely abused, but made very uncomfortable by an uncle who was older-and she dealt with it for about three days at the time and then it got pushed to the back of her mind and she completely forgot about it until she was in therapy. TAT: There you go. That's how dissociation works! Freyd: That's how it worked. And after this came up and she had discussed and dealt with it in therapy, she could again put it to one side and go on with her life. Certainly confronting her uncle and doing all these other things was not a part of what she had to do. Interestingly, though, at the same time, she has a daughter who went into therapy and came up with memories of having been abused by her parents. This daughter ran away and is cutoff from the family-hasn't spoken to anyone for three years. And there has never been any meeting between the therapist and the whole family to try to find out what was involved. TAT: If we take the first example -- that of her own abuse -- and follow the criteria you gave, we would have a very strong disbelief in the truth of what she told.

Our patients predict the culture by living out consciously what the masses of people are able to keep unconscious for the time being. The neurotic is cast by destiny into a Cassandra role. In vain does Cassandra, sitting on the steps of the palace at Mycenae when Agamemnon brings her back from Troy, cry, “Oh for the nightingale’s pure song and a fate like hers!” She knows, in her ill-starred life, that “the pain flooding the song of sorrow is [hers] alone,” and that she must predict the doom she sees will occur there. The Mycenaeans speak of her as mad, but they also believe she does speak the truth, and that she has a special power to anticipate events. Today, the person with psychological problems bears the burdens of the conflicts of the times in his blood, and is fated to predict in his actions and struggles the issues which will later erupt on all sides in the society. The first and clearest demonstration of this thesis is seen in the sexual problems which Freud found in his Victorian patients in the two decades before World War I. These sexual topics‒even down to the words‒were entirely denied and repressed by the accepted society at the time. But the problems burst violently forth into endemic form two decades later after World War II. In the 1920's, everybody was preoccupied with sex and its functions. Not by the furthest stretch of the imagination can anyone argue that Freud "caused" this emergence. He rather reflected and interpreted, through the data revealed by his patients, the underlying conflicts of the society, which the “normal” members could and did succeed in repressing for the time being. Neurotic problems are the language of the unconscious emerging into social awareness. A second, more minor example is seen in the great amount of hostility which was found in patients in the 1930's. This was written about by Horney, among others, and it emerged more broadly and openly as a conscious phenomenon in our society a decade later. A third major example may be seen in the problem of anxiety. In the late 1930's and early 1940's, some therapists, including myself, were impressed by the fact that in many of our patients anxiety was appearing not merely as a symptom of repression or pathology, but as a generalized character state. My research on anxiety, and that of Hobart Mowrer and others, began in the early 1940's. In those days very little concern had been shown in this country for anxiety other than as a symptom of pathology. I recall arguing in the late 1940's, in my doctoral orals, for the concept of normal anxiety, and my professors heard me with respectful silence but with considerable frowning. Predictive as the artists are, the poet W. H. Auden published his Age of Anxiety in 1947, and just after that Bernstein wrote his symphony on that theme. Camus was then writing (1947) about this “century of fear,” and Kafka already had created powerful vignettes of the coming age of anxiety in his novels, most of them as yet untranslated. The formulations of the scientific establishment, as is normal, lagged behind what our patients were trying to tell us. Thus, at the annual convention of the American Psychopathological Association in 1949 on the theme “Anxiety,” the concept of normal anxiety, presented in a paper by me, was still denied by most of the psychiatrists and psychologists present. But in the 1950's a radical change became evident; everyone was talking about anxiety and there were conferences on the problem on every hand. Now the concept of "normal" anxiety gradually became accepted in the psychiatric literature. Everybody, normal as well as neurotic, seemed aware that he was living in the “age of anxiety.” What had been presented by the artists and had appeared in our patients in the late 30's and 40's was now endemic in the land.

Our society always wants to believe in cures by the “magic” pill, but I have found from my years of experience in treating psychiatric and sexual issues that it is even better if a patient never has to take medication.

The dislike of her was general. I wonder now about the treatment of psychiatric and other patients who release, as if it were a chemical, an invitation to be disliked and who therefore have to fight (inducing further dislike and antagonism) for sympathy and fairness.