Psychiatry Related Quotes

It is a rare person who can cut himself off from mediate and immediate relations with others for long spaces of time without undergoing a deterioration in personality.

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.

All the lessons of psychiatry, psychology, social work, indeed culture, have taught us over the last hundred years that it is the acceptance of differences, not the search for similarities which enables people to relate to each other in their personal or family lives.

A more fundamental problem with labelling human distress and deviance as mental disorder is that it reduces a complex, important, and distinct part of human life to nothing more than a biological illness or defect, not to be processed or understood, or in some cases even embraced, but to be ‘treated’ and ‘cured’ by any means possible—often with drugs that may be doing much more harm than good. This biological reductiveness, along with the stigma that it attracts, shapes the person’s interpretation and experience of his distress or deviance, and, ultimately, his relation to himself, to others, and to the world. Moreover, to call out every difference and deviance as mental disorder is also to circumscribe normality and define sanity, not as tranquillity or possibility, which are the products of the wisdom that is being denied, but as conformity, placidity, and a kind of mediocrity.

A belief has no relation to the truth, nevertheless it is a quintessential part of human existence.

It was Freud's ambition to discover the cause of hysteria, the archetypal female neurosis of his time. In his early investigations, he gained the trust and confidence of many women, who revealed their troubles to him.Time after time, Freud's patients, women from prosperous, conventional families, unburdened painful memories of childhood sexual encounters with men they had trusted: family friends, relatives, and fathers. Freud initially believed his patients and recognized the significance of their confessions. In 1896, with the publication of two works, The Aetiology of Hysteria and Studies on Hysteria, he announced that he had solved the mystery of the female neurosis. At the origin of every case of hysteria, Freud asserted, was a childhood sexual trauma. But Freud was never comfortable with this discovery, because of what it implied about the behavior of respectable family men. If his patients' reports were true, incest was not a rare abuse, confined to the poor and the mentally defective, but was endemic to the patriarchal family. Recognizing the implicit challenge to patriarchal values, Freud refused to identify fathers publicly as sexual aggressors. Though in his private correspondence he cited "seduction by the father" as the "essential point" in hysteria, he was never able to bring himself to make this statement in public. Scrupulously honest and courageous in other respects, Freud falsified his incest cases. In The Aetiology of Hysteria, Freud implausibly identified governessss, nurses, maids, and children of both sexes as the offenders. In Studies in Hysteria, he managed to name an uncle as the seducer in two cases. Many years later, Freud acknowledged that the "uncles" who had molested Rosaslia and Katharina were in fact their fathers. Though he had shown little reluctance to shock prudish sensibilities in other matters, Freud claimed that "discretion" had led him to suppress this essential information. Even though Freud had gone to such lengths to avoid publicly inculpating fathers, he remained so distressed by his seduction theory that within a year he repudiated it entirely. He concluded that his patients' numerous reports of sexual abuse were untrue. This conclusion was based not on any new evidence from patients, but rather on Freud's own growing unwillingness to believe that licentious behavior on the part of fathers could be so widespread. His correspondence of the period revealed that he was particularly troubled by awareness of his own incestuous wishes toward his daughter, and by suspicions of his father, who had died recently. p9-10

It is acknowledged that father-daughter incest occurs on a large scale in the United States. Sexual abuse has now been included in child abuse legislation. A conservative estimate is that more than 1 million women have been sexually victimized by their fathers or other male relatives, but the true figure probably is much higher. Many victims still fear reporting incest, and families continued to collude to keep the situation secret. Issues of family privacy and autonomy remain troublesome even when incest is reported and must be resolved for treatment to be effective. " Mary de Chesnay J. Psychosoc. Nurs. Med. Health Sep. 22:9-16 Sept 1984 reprinted in Talbott's 1986 edition

Men often have grievances against prominent and powerful persons. Historically, the grievances of the powerless against the powerful have furnished the steam for the engines of revolutions. My point is that in many of the famous medicolegal cases involving the issue of insanity, persons of relatively low social rank openly attacked their superiors. Perhaps their grievances were real and justified, and were vented on the contemporary social symbols of authority, the King and the Queen. Whether or not these grievances justified homicide is not our problem here. I merely wish to suggest that the issue of insanity may have been raised in these trials to obscure the social problems which the crimes intended to dramatize.

If you have to maintain self-esteem by pulling down the standing of others, you are extraordinarily unfortunate in a variety of ways. Since you have to protect your feeling of personal worth by noting how unworthy everybody around you is, you are not provided with any data that are convincing evidence of your having personal worth; so it gradually evolves into 'I am not as bad as the other swine.' To be the best of swine, when it would be nice to be a person, is not a particularly good way of furthering anything except security operations. When security is achieved that way, it strikes at the very roots of that which is essentially human -- the utterly vital role of interpersonal relations.' from The Interpersonal Theory of Psychiatry

Well, normality, you know, is a fiction in psychiatry. It’s all relative. No adult is without problems except a happy imbecile.

Therapy is a special kind of teaching or training which attempts to accomplish in a relatively short, intense period what should have established during normal growing up.

Environmental influences also affect dopamine. From animal studies, we know that social stimulation is necessary for the growth of the nerve endings that release dopamine and for the growth of receptors that dopamine needs to bind to in order to do its work. In four-month-old monkeys, major alterations of dopamine and other neurotransmitter systems were found after only six days of separation from their mothers. “In these experiments,” writes Steven Dubovsky, Professor of Psychiatry and Medicine at the University of Colorado, “loss of an important attachment appears to lead to less of an important neurotransmitter in the brain. Once these circuits stop functioning normally, it becomes more and more difficult to activate the mind.” A neuroscientific study published in 1998 showed that adult rats whose mothers had given them more licking, grooming and other physical-emotional contact during infancy had more efficient brain circuitry for reducing anxiety, as well as more receptors on nerve cells for the brain’s own natural tranquilizing chemicals. In other words, early interactions with the mother shaped the adult rat’s neurophysiological capacity to respond to stress. In another study, newborn animals reared in isolation had reduced dopamine activity in their prefrontal cortex — but not in other areas of the brain. That is, emotional stress particularly affects the chemistry of the prefrontal cortex, the center for selective attention, motivation and self-regulation. Given the relative complexity of human emotional interactions, the influence of the infant-parent relationship on human neurochemistry is bound to be even stronger. In the human infant, the growth of dopamine-rich nerve terminals and the development of dopamine receptors is stimulated by chemicals released in the brain during the experience of joy, the ecstatic joy that comes from the perfectly attuned mother-child mutual gaze interaction. Happy interactions between mother and infant generate motivation and arousal by activating cells in the midbrain that release endorphins, thereby inducing in the infant a joyful, exhilarated state. They also trigger the release of dopamine. Both endorphins and dopamine promote the development of new connections in the prefrontal cortex. Dopamine released from the midbrain also triggers the growth of nerve cells and blood vessels in the right prefrontal cortex and promotes the growth of dopamine receptors. A relative scarcity of such receptors and blood supply is thought to be one of the major physiological dimensions of ADD. The letters ADD may equally well stand for Attunement Deficit Disorder.

Some alters are what Dr Ross describes in Multiple Personality Disorder as 'fragments'. which are 'relatively limited psychic states that express only one feeling, hold one memory, or carry out a limited task in the person's life. A fragment might be a frightened child who holds the memory of one particular abuse incident.' In complex multiples, Dr Ross continues, the 'personalities are relatively full-bodied, complete states capable of a range of emotions and behaviours.' The alters will have 'executive control some substantial amount of time over the person's life'. He stresses, and I repeat his emphasis, 'Complex MPD with over 15 alter personalities and complicated amnesia barriers are associated with 100 percent frequency of childhood physical, sexual and emotional abuse.' Did I imagine the castle, the dungeon, the ritual orgies and violations? Did Lucy, Billy, Samuel, Eliza, Shirley and Kato make it all up? I went back to the industrial estate and found the castle. It was an old factory that had burned to the ground, but the charred ruins of the basement remained. I closed my eyes and could see the black candles, the dancing shadows, the inverted pentagram, the people chanting through hooded robes. I could see myself among other children being abused in ways that defy imagination. I have no doubt now that the cult of devil worshippers was nothing more than a ring of paedophiles, the satanic paraphernalia a cover for their true lusts: the innocent bodies of young children.

Frosh (2002) has suggested that therapeutic spaces provide children and adults with the rare opportunity to articulate experiences that are otherwise excluded from the dominant symbolic order. However, since the 1990s, post-modern and post-structural theory has often been deployed in ways that attempt to ‘manage’ from; afar the perturbing disclosures of abuse and trauma that arise in therapeutic spaces (Frosh 2002). Nowhere is this clearer than in relation to organised abuse, where the testimony of girls and women has been deconstructed as symptoms of cultural hysteria (Showalter 1997) and the colonisation of women’s minds by therapeutic discourse (Hacking 1995). However, behind words and discourse, ‘a real world and real lives do exist, howsoever we interpret, construct and recycle accounts of these by a variety of symbolic means’ (Stanley 1993: 214). Summit (1994: 5) once described organised abuse as a ‘subject of smoke and mirrors’, observing the ways in which it has persistently defied conceptualisation or explanation. Explanations for serious or sadistic child sex offending have typically rested on psychiatric concepts of ‘paedophilia’ or particular psychological categories that have limited utility for the study of the cultures of sexual abuse that emerge in the families or institutions in which organised abuse takes pace. For those clinicians and researchers who take organised abuse seriously, their reliance upon individualistic rather than sociological explanations for child sexual abuse has left them unable to explain the emergence of coordinated, and often sadistic, multi—perpetrator sexual abuse in a range of contexts around the world.

Although stigmatizing attitudes are not limited to mental illness, the public seems to disapprove persons with psychiatric disabilities significantly more than persons with related conditions such as physical illness (34-36). Severe mental illness has been likened to drug addiction, prostitution, and criminality (37,38). Unlike physical disabilities, persons with mental illness are perceived by the public to be in control of their disabilities and responsible for causing them (34,36). Furthermore, research respondents are less likely to pity persons with mental illness, instead reacting to psychiatric disability with anger and believing that help is not deserved (35,36,39)." 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

Sessions which do not bear directly on the patient's problems are not as wasted as long as they relate to his growing awareness that he is a part of the world and that perhaps he can cope with it. When values, standards, and responsibility are in the background, all discussion is relevant to therapy.

Liber Novus thus presents a series of active imaginations together with Jung's attempt to understand their significance. This work of understanding encompasses a number of interlinked threads: an attempt to understand himself and to integrate and develop the various components of his personality; an attempt to understand the structure of the human personality in general; an attempt to understand the relation of the individual to present-day society and to the community of the dead; an attempt to understand the psychological and historical effects of Christianity; and an attempt to grasp the future religious development of the West. Jung discusses many other themes in the work, including the nature of self-knowledge; the nature of the soul; the relations of thinking and feeling and the psychological types; the relation of inner and outer masculinity and femininity; the uniting of opposites; solitude; the value of scholarship and learning; the status of science; the significance of symbols and how they are to be understood; the meaning of the war; madness, divine madness, and psychiatry; how the Imitation of Christ is to be understood today; the death of God; the historical significance of Nietzsche; and the relation of magic and reason.

Painful or frightening affect becomes traumatic when the attunement that the child needs to assist in its tolerance, containment, and integration is profoundly absent,”8 writes Robert Stolorow, a philosopher, psychologist, and clinical professor of psychiatry at UCLA, in his book about trauma. “One consequence of developmental trauma, relationally conceived, is that affect states take on enduring, crushing meanings. From recurring experiences of malattunement, the child acquires the unconscious conviction that unmet developmental yearnings and reactive painful feeling states are manifestations of a loathsome defect or of an inherent inner badness.

Our desires, dreams and hopes, open portals. These portals manifest in our conscience and five senses, in the form of decisions related to the material world but also opportunities. Now, at the exact same time, or maybe even slightly before in time, we get the exact opposite, the temptation, the illusion and deception. And when we are about to make a decision, as if by magic, the two things come stronger to us, as if pushing us into a duality that makes it hard to decide. Now, this brings me to another super interesting fact: Most people assume that they have freewill, and that choices are hard to be made, and that life is full of dualities. And I've learned that this is just a great deception related to our planet, which, as human beings, we must transcend. And what I'm really saying here is that the duality and the freewill don't exist. There's only one choice to be made, the one that bring us upwards. Self-destruction is not a choice. And yet, every duality presents exactly that, and not really a choice.

Strong selection for extreme mental capacities may have given us all minds like the legs of racehorses, fast but vulnerable to catastrophic failures. This model fits well with the idea that schizophrenia is intimately related to language and cognitive ability.93 It also fits well with the observation that schizophrenia may be intimately related to the human capacity for “theory of mind,” our ability to intuit other people’s motives and cognitive abilities in general.

Despite the growing clinical and research interest in dissociative symptoms and disorders, it is also true that the substantial prevalence rates for dissociative disorders are still disproportional to the number of studies addressing these conditions. For example, schizophrenia has a reported rate of 0.55% to 1% of the normal population (Goldner, Hus, Waraich, & Somers, more or less similar to the prevalence of DID. Yet a PubMed search generated 25,421 papers on research related to schizophrenia, whereas only 73 publications were found for DID-related research.

What I do know is that when a person is first asked to explain what is wrong, they may find it almost impossible to articulate exactly what the problem is. They may not yet have matched words to the feelings they can sense in the hidden rooms of their mind. They may still have no clear ideas about the "what", "why" or "how" relating to the origins of their difficulties. Instead of words, their angst may be expressed in behaviour which may be hard for them, or anyone else, to make sense of and can manifest itself as irritability, anger or withdrawal. Sometimes they will delay seeking help until they are in a state of crisis. It's not easy to ask; I struggled at first, too.

The traditional hospital practice of excluding parents ignored the importance of attachment relationships as regulators of the child’s emotions, behaviour and physiology. The child’s biological status would be vastly different under the circumstances of parental presence or absence. Her neurochemical output, the electrical activity in her brain’s emotional centres, her heart rate, blood pressure and the serum levels of the various hormones related to stress would all vary significantly. Life is possible only within certain well-defined limits, internal or external. We can no more survive, say, high sugar levels in our bloodstream than we can withstand high levels of radiation emanating from a nuclear explosion. The role of self-regulation, whether emotional or physical, may be likened to that of a thermostat ensuring that the temperature in a home remains constant despite the extremes of weather conditions outside. When the environment becomes too cold, the heating system is switched on. If the air becomes overheated, the air conditioner begins to work. In the animal kingdom, self-regulation is illustrated by the capacity of the warm-blooded creature to exist in a broad range of environments. It can survive more extreme variations of hot and cold without either chilling or overheating than can a coldblooded species. The latter is restricted to a much narrower range of habitats because it does not have the capacity to self-regulate the internal environment. Children and infant animals have virtually no capacity for biological self-regulation; their internal biological states—heart rates, hormone levels, nervous system activity — depend completely on their relationships with caregiving grown-ups. Emotions such as love, fear or anger serve the needs of protecting the self while maintaining essential relationships with parents and other caregivers. Psychological stress is whatever threatens the young creature’s perception of a safe relationship with the adults, because any disruption in the relationship will cause turbulence in the internal milieu. Emotional and social relationships remain important biological influences beyond childhood. “Independent self-regulation may not exist even in adulthood,” Dr. Myron Hofer, then of the Departments of Psychiatry and Neuroscience at Albert Einstein College of Medicine in New York, wrote in 1984. “Social interactions may continue to play an important role in the everyday regulation of internal biologic systems throughout life.” Our biological response to environmental challenge is profoundly influenced by the context and by the set of relationships that connect us with other human beings. As one prominent researcher has expressed it most aptly, “Adaptation does not occur wholly within the individual.” Human beings as a species did not evolve as solitary creatures but as social animals whose survival was contingent on powerful emotional connections with family and tribe. Social and emotional connections are an integral part of our neurological and chemical makeup. We all know this from the daily experience of dramatic physiological shifts in our bodies as we interact with others. “You’ve burnt the toast again,” evokes markedly different bodily responses from us, depending on whether it is shouted in anger or said with a smile. When one considers our evolutionary history and the scientific evidence at hand, it is absurd even to imagine that health and disease could ever be understood in isolation from our psychoemotional networks. “The basic premise is that, like other social animals, human physiologic homeostasis and ultimate health status are influenced not only by the physical environment but also by the social environment.” From such a biopsychosocial perspective, individual biology, psychological functioning and interpersonal and social relationships work together, each influencing the other.

Dissociative disorders (DDs) were first recognized as official psychiatric disorders in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III) in 1980. Prior to this, the related symptoms were listed under ‘hysterical neuroses’ in the second edition of the DSM.[1,2] Interestingly, all of the current DDs that have been described were discovered prior to 1900 but decades passed with little study or research of this spectrum of psychiatric pathology.

Until fairly recently, there has been precious little research on expectant fathers’ emotional and psychological experiences during pregnancy. The very title of one of the first articles to appear on the subject should give you some idea of the medical and psychiatric communities’ attitude toward the impact of pregnancy on men. Written by William H. Wainwright, M.D., and published in the July 1966 issue of the American Journal of Psychiatry, it was called “Fatherhood as a Precipitant of Mental Illness.” (Another wonderful title that came out at about the same time was: “Psychoses in Males in Relation to Their Wives’ Pregnancy and Childbirth.”)

The more than 2,500 respondents to the WCS that I constructed while at the University of Missouri reported that they “occasionally” experienced the pain of a loved one at a distance. In Stevenson’s review of 160 published simulpathity cases, one-third involved a parent and child. Friends and acquaintances were in- volved in about 28 percent. Husband and wife pairs were involved in about 14 per- cent and siblings about 15 percent. The similar relatively high percentages of par- ent-child and friend-acquaintance simulpathity suggests that emotional bonds, rather than genetic similarities, facilitate these interactions. Stevenson’s reports are well-documented by follow-up interviews with both the coincider and the people who witnessed the event. I decided to name this coincidence pattern simulpathity, from the Latin word simul, which means “simultaneous,” and the Greek root pathy, which means both “suffering” and “feeling,” as in the words sympathy and empathy. With sympathy (“suffering together”), the sympathetic person is aware of the suffering of the other. With simulpathity, the person involved is usually not consciously aware of the suffering of the other (except for those pairs with whom this shared pain is a regular occurrence). Only later is the simultaneity of the distress recognized. No explanatory mechanism is implied.

Disbelief is the universal Western affective countertransference, both to abuse and shifts in identity.

The two sides of this trade-off at the root of mental conflict are supported by genetic studies that have found two global pathways to mental disorders.44,45 One pathway is via internalizing, that is, inhibition, anxiety, self-blame, neurosis, and depression. The other pathway is via externalizing, that is, by pursuing self-interest with little inhibition in ways that often lead to social conflicts and addiction. For the first group of patients, social selection has worked all too well; they are acutely attuned to what others want, and they work hard to please others. For the second group, the tendency to pursue self-interest leaves them with limited moral moorings or committed social support. Most of us muddle along somewhere in between. These two global strategies are closely related to fast and slow life history strategies and their possible relationship to mental disorders.46 Early adversity has been proposed to discount the perceived value of long-term benefits and set behavior to take advantage of opportunities now, even at the expense of long-term relationships.47,48,49 This may help explain the association of early adversity with borderline personality.50

psychoanalyst” without fear of being laughed at—or at least with confidence that the scoffers are uninformed. In the last few decades a new discovery of Kierkegaard has been taking place, a discovery that is momentous because it links him into the whole structure of knowledge in the humanities in our time. We used to think that there was a strict difference between science and belief and that psychiatry and religion were consequently far apart. But now we find that psychiatric and religious perspectives on reality are intimately related. For one thing they grow out of one another historically, as we shall see in a later section. Even more importantly for now, they reinforce one another. Psychiatric experience and religious experience cannot be separated either subjectively in the person’s own eyes or objectively in the theory of character development. Nowhere is this merger of religious and psychiatric categories clearer than in the work of Kierkegaard. He gave us some of the best empirical

It is not an overstatement if one characterizes this revision of the false metaphysical classification of beings as the contemporary gigantomachy that reaches deeply into ingrained human self-relations. Very many view this revision suspiciously as an expropriation of the self and condemn it as technological devilry. The uncanniness of the process is not to be denied, precisely because it impresses by means of its results. The humanistically minded observer cannot withdraw his fascination because everything that happens on the technological front leads to consequences for human self-understanding. In the progress of technological evolution the citadel of subjectivity, that is to say, the thinking and experiencing ego, is impinged on, and to be sure not only by symbolic deconstructions that were, incidentally, anticipated in various ways in regional high cultures—one might think here of the mystical and yogic systems, of negative theology and Romantic irony—but also by material modifications, for instance, the alteration of mental states with the help of psychotropic substances (a procedure that for millennia has been common in drug cultures, and for decades in Western psychiatry). In addition, a time is foreseeable when the contents of ideas and experience will be induced by means of nootropic substances.

Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations related to the trauma take on a life of their own. The sensory fragments of memory intrude into the present, where they are literally relived.

The first hints of this emerged in the early and mid-1990s, at the tail end of the crack epidemic. Suniya Luthar is now sixty-two, with an infectious smile, bright brown eyes, and short snow-white hair. Back then, she was a fledgling psychologist working as an assistant professor and researcher in the department of psychiatry at the Yale School of Medicine. She was studying resiliency among teenagers in low-income urban communities, and one of her early findings was that the most popular kids were also among the most destructive and aggressive at school. Was this a demographic phenomenon, she wondered, or merely an adolescent one, this tendency to look up to peers who acted out? To find out, she needed a comparison group. A research assistant suggested they recruit students from his former high school in an affluent suburb. Luthar’s team ultimately enlisted 488 tenth graders—about half from her assistant’s high school and half from a scruffy urban high school. The affluent community’s median household income was 80 percent higher than the national median, and more than twice that of the low-income community. The rich community also had far fewer families on food stamps (0.3 percent vs. 19 percent) and fewer kids getting free or reduced-price school lunches (1 percent vs. 86 percent). The suburban teens were 82 percent white, while the urban teens were 87 percent nonwhite. Luthar surveyed the kids, asking a series of questions related to depression and anxiety, drug use ranging from alcohol and nicotine to LSD and cocaine, and participation in delinquent acts at home, at school, and in the community. Also examined were grades, “social competence,” and teachers’ assessments of each student. After crunching the numbers, she was floored. The affluent teens fared poorly relative to the low-income teens on “all indicators of substance use, including hard drugs.” This flipped the conventional wisdom on its head. “I was quite taken aback,” Luthar recalls.

Contemplation, normally regarded as a private pursuit, needs communal support. We are most likely to risk its vulnerabilities and be faithful to its implications when we are embedded in a community that both invokes and witnesses our truth, a rare form of community in which we learn to be alone together, to support one another on a solitary journey. We practice being present to others without being invasive or evasive, neither trying to fix them with advice nor turning away when they share something distressing. Imagine yourself sitting by the bedside of a dying person, who is making the most solitary journey of all. Here, we must lose both the arrogance that makes us think we can fix the other, and the cowardice that tempts us to turn away. Since we are all dying all the time, why not practice this way of relating before the final hour?

The great questioner. the social animal, in a limitless world of mystery, intrigue and dangers. Why did the sun rise and fall and influence the growth of plants and food? What were the stars that moved silently through the sky and the planets that wandered between them? What had happened to our relatives who had died, or what would happen to our children in the future? What excitement and wonder when they met an outside group, tried to communicate and exchanged and bartered goods, hearing tales of other lands and frightening beasts.

The great questioner, the social animal, in a limitless world of mystery, intrigue and dangers. Why did the sun rise and fall and influence the growth of plants and food? What were the stars that moved silently through the sky and the planets that wandered between them? What had happened to our relatives who had died, or what would happen to our children in the future? What excitement and wonder when they met an outside group, tried to communicate and exchanged and bartered goods, hearing tales of other lands and frightening beasts.

Every therapy session belongs to both patient and therapist, to the interaction between them. It was the psychoanalyst Harry Stack Sullivan who, in the early twentieth century, developed a theory of psychiatry based on interpersonal relationships. Breaking away from Freud’s position that mental disorders were intrapsychic in origin (meaning “in one’s mind”), Sullivan believed that our struggles were interactional (meaning “relational”). He went so far as to say, “It’s the mark of a senior clinician that he or she is the same person in their living room that they are in their office.” We can’t teach patients to be relational if we aren’t relational with them.

Going to therapy and talking about healing may just be the go-to flex of our time. It is supposedly an indicator of how profoundly self-aware, enlightened, emotionally mature, or “evolved” an individual is. Social media is obsessed and saturated with pop psychology and psychiatry content related to “healing”, trauma, embodiment, neurodiversity, psychiatric diagnoses, treatments alongside productivity hacks, self-care tips and advice on how to love yourself without depending on anyone else, cut people out of your life, manifest your goals to be successful, etc. Therapy isn’t a universal indicator of morality or enlightenment. Therapy isn’t a one-size-fits-all solution that everyone must pursue. There are many complex political and cultural reasons why some people don’t go to therapy, and some may actually have more sustainable support or care practices rooted in the community. This is similar to other messaging, like “You have to learn to love yourself first before someone else can love you”. It all feeds into the lie that we are alone and that happiness comes from total independence. Mainstream therapy blames you for your problems or blames other people, and often it oscillates between both extremes. If we point fingers at ourselves or each other, we are too distracted to notice the exploitative systems making us all sick and sad. Oftentimes, people come out of therapy feeling fully affirmed and unconditionally validated, and this ego-caressing can feel rewarding in the moment even if it doesn’t help ignite any growth or transformation. People are convinced that they can do no wrong, are infallible, incapable of causing harm, and that other people are the problem. Treatment then focuses on inflating self-confidence, self-worth, self-acceptance, and self-love to chase one’s self-centered dreams, ambitions, and aspirations without taking any accountability for one’s own actions. This sort of individualistic therapeutic approach encourages isolation and a general mistrust of others who are framed as threats to our inner peace or extractors of energy, and it further breeds a superiority complex. People are encouraged to see relationships as accessories and means to a greater selfish end. The focus is on what someone can do for you and not on how to give, care for, or show up for other people. People are not pushed to examine how oppressive conditioning under these systems shows up in their relationships because that level of introspection and growth is simply too invalidating. “You don’t owe anyone anything. No one is entitled to your time and energy. If anyone invalidates you and disturbs your peace, they are toxic; cut them out of your life. You don’t need that negativity. You don’t need anyone else; you alone are enough. Put yourself first. You are perfect just the way you are.” In reality, we all have work to do. We are all socialized within these systems, and real support requires accountability. Our liberation is contingent on us being aware of our bullshit, understanding the values of the empire that we may have internalized as our own, and working on changing these patterns. Therapized people may fixate on dissecting, healing, improving, and optimizing themselves in isolation, guided by a therapist, without necessarily practicing vulnerability and accountability in relationships, or they may simply chase validation while rejecting the discomfort that comes from accountability. Healing in any form requires growth and a willingness to practice in relationships; it is not solely validating or invalidating; it is complex; it is not a goal to achieve but a lifelong process that no one is above; it is both liberating and difficult; it is about acceptance and a willingness to change or transform into something new; and ultimately, it is going to require many invalidating ego deaths so we can let go of the fixation of the “self” to ease into interdependence and community care.

Trauma is not an artificial concept. Trauma is a very real and complex psychological and physiological phenomena studied and understood within the fields of psychology, psychiatry, and related disciplines, and it is recognized as a significant aspect of human experience.

To understand mismatch, we should note that yhe human lineage lived for 99% of its evolutionary history in relatively small, mobile, foraging, kin-based groups. It is under these conditions that human psychological mechanisms were shaped by selection. The seeds for mismatch were sown with the advent of agriculture, which resulted in permanently settled living around 10,000 - 20,000 years ago, and this radically altered the human physical and social environment with major implications for eating disorders EDs.

To understand mismatch, we should note that the human lineage lived for 99% of its evolutionary history in relatively small, mobile, foraging, kin-based groups. It is under these conditions that human psychological mechanisms were shaped by selection. The seeds for mismatch were sown with the advent of agriculture, which resulted in permanently settled living around 10,000 - 20,000 years ago, and this radically altered the human physical and social environment with major implications for eating disorders EDs.

Drug use has been found in all human societies throughout historical and prehistorical times, as well as being evident in closely related species. These observations warrant serious evolutionary exploration.

Emotional Labour: The f Word, by Jane Caro and Catherine Fox "Work inside the home is not always about chores. One of the most onerous roles is managing the dynamics of the home. The running of the schedule, the attention to details about band practice and sports training, the purchase of presents for next Saturday’s birthday party, the check up at the dentist, all usually fall on one person's shoulders. Woody Allen, in the much-publicised custody case for his children with Mia Farrow, eventually lost, in part because unlike Farrow, he could not name the children’s dentist or paediatrician. It’s a guardianship role and it is not only physically time consuming but demands enormous intellectual and emotional attention. Sociologists call it kin work. It involves: 'keeping in touch with relations, preparing holiday celebrations and remembering birthdays. Another aspect of family work is being attentive to the emotions within a family - what sociologists call ‘emotion work.’ This means being attentive to the emotional tone among family members, troubleshooting and facing problems in a constructive way. In our society, women do a disproportionate amount of this important work. If any one of these activities is performed outside the home, it is called work - management work, psychiatry, event planning, advance works - and often highly remunerated. The key point here is that most adults do two important kinds of work: market work and family work, and that both kinds of work are required to make the world go round.' (Interview with Joan Williams, mothersandmore.org, 2000) This pressure culminates at Christmas. Like many women, Jane remembers loving Christmas as a child and young woman. As a mother, she hates it. Suddenly on top of all the usual paid and unpaid labour, there is the additional mountain of shopping, cooking, cleaning, decorating, card writing, present wrapping, ritual phone calls, peacekeeping and emotional care taking. And then on bloody Boxing Day it all has to be cleaned up. If you want to give your mother a fabulous Christmas present just cancel the whole thing. Bah humbug!

It is also true, however, that many patients experience psychotropic medication as in itself a further source of confusion and discomfort, since it may alter their perception of the world in an idiosyncratic way, so that their experience seems to bear no relation to the meaning of actual events of their world.

The fading relevance of the nature–nurture argument has recently been revived by the rise of evolutionary psychology. A more sophisticated understanding of Darwinian evolution (survival of the fittest) has led to theories about the possible evolutionary value of some psychiatric disorders. A simplistic view would predict that all mental illnesses with a genetic component should lower survival and ought to die out. ‘Inclusive fitness’, however, assesses the evolutionary value of a characteristic not simply on whether it helps that individual to survive but whether it makes it more likely that their offspring will survive. Richard Dawkins’s 1976 book The Selfish Gene gives convincing explanations of the evolutionary advantages of group support and altruism when individuals sacrifice themselves for others. A range of speculative hypotheses have since been proposed for the evolutionary advantage of various behaviour differences and mental illnesses. Many of these draw on ethological games-theory (i.e. the benefits of any behaviour can only be understood in the context of the behaviour of other members of the group). So depression might be seen as a safe response to ‘defeat’ in a hierarchical group because it makes the individual withdraw from conflict while they recover. Mania, conversely, with its expansiveness and increased sexual activity, is proposed as a response to success in a hierarchical tussle promoting the propagation of that individual’s genes. Changes in behaviour that look like depression and hypomania can be clearly seen in primates as they move up and down the pecking order that dominates their lives. The habitual isolation and limited need for social contact of individuals with schizophrenia has been rather imaginatively proposed as adaptive to remote habitats with low food supplies (and also a protection against the risk of infectious diseases and epidemics). Evolutionary psychology will undoubtedly increasingly influence psychiatric thinking – many of our disorders fit poorly into a classical ‘medical model’. Already it has helped establish a less either–or approach to the discussion. It is, however, a highly controversial area – not so much around mental disorders but in relation to social behaviour and particularly to gender specific behaviour. Here it is often interpreted as excusing a very male-orientated, exploitative worldview. Luckily that is someone else’s battle.

This hypothesis, referred to as the monoamine hypothesis, grew primarily out of two main observations made in the 1950s and ’60s.14 One was seen in patients being treated for tuberculosis who experienced mood-related side effects from the antitubercular drug iproniazid, which can change the levels of serotonin in the brain. Another was the claim that reserpine, a medication introduced for seizures and high blood pressure, depleted these chemicals and caused depression—that is, until there was a fifty-four person study that demonstrated that it resolved depression.15 From these preliminary and largely inconsistent observations a theory was born, crystallized by the work and writings of the late Dr. Joseph Schildkraut, who threw fairy dust into the field in 1965 with his speculative manifesto “The Catecholamine Hypothesis of Affective Disorders.”16 Dr. Schildkraut was a prominent psychiatrist at Harvard who studied catecholamines, a class of naturally occurring compounds that act as chemical messengers, or neurotransmitters, within the brain. He looked at one neurochemical in particular, norepinephrine, in people before and during treatment with antidepressants and found that depression suppressed its effectiveness as a chemical messenger. Based on his findings, he theorized broadly about the biochemical underpinnings of mental illnesses. In a field struggling to establish legitimacy (beyond the therapeutic lobotomy!), psychiatry was desperate for a rebranding, and the pharmaceutical industry was all too happy to partner in the effort. This idea that these medications correct an imbalance that has something to do with a brain chemical has been so universally accepted that no one bothers to question it or even research it using modern rigors of science. According to Dr. Joanna Moncrieff, we have been led to believe that these medications have disease-based effects—that they’re actually fixing, curing, correcting a real disease in human physiology. Six decades of study, however, have revealed conflicting, confusing, and inconclusive data.17 That’s right: there has never been a human study that successfully links low serotonin levels and depression. Imaging studies, blood and urine tests, postmortem suicide assessments, and even animal research have never validated the link between neurotransmitter levels and depression.18 In other words, the serotonin theory of depression is a total myth that has been unjustly supported by the manipulation of data. Much to the contrary, high serotonin levels have been linked to a range of problems, including schizophrenia and autism.19 Paul Andrews, an assistant professor

If you have to maintain self-esteem by pulling down the standing of others, you are extraordinarily unfortunate in a variety of ways. Since you have to protect your feeling of personal worth by noting how unworthy everybody around you is, you are not provided with any data that are convincing evidence of your having personal worth; so it gradually evolves into 'I am not as bad as the other swine.' To be the best of swine, when it would be nice to be a person, is not a particularly good way of furthering anything except security operations. When security is achieved that way, it strikes at the very roots of that which is essentially human — the utterly vital role of interpersonal relations.

Psychiatry and neuropathology are not merely two closely related fields, they are but one field in which only one language is spoken and the same laws rule. Wilhelm Griesinger (1868) I have always been intrigued by the specific moment when, as we sit awaiting in the auditorium, the door to the stage opens and a performer steps into the light, or, to take the other perspective, the moment when a performer who waits in semidarkness sees the same door open, revealing the lights, the stage, and the audience … as I reflect on what I have written, I sense that stepping into the light is also a powerful metaphor for consciousness, for the birth of the knowing mind, for the simple and momentous coming of the self into the world of the mental.

Chen H, Li C, Zhou Z, Liang H. Fast-evolving human-specific neural enhancers are associated with aging-related diseases. Cell Syst. 2018 May;6(5):604–11.

And whereas in WWI and WWII the symptoms of stress were apparent during or just after combat, and were treated using frontline clinical care (sometimes called “forward psychiatry”), combat stress during the brutal Vietnam War was rare.62 The spike in the prevalence of combat-related trauma among veterans of the Vietnam War only occurred well after the United States left Vietnam—hence the postwar development of the apt term “post-traumatic stress disorder.”63

As mandatory reporting laws and community awareness drove an increase its child protection investigations throughout the 1980s, some children began to disclose premeditated, sadistic and organised abuse by their parents, relatives and other caregivers such as priests and teachers (Hechler 1988). Adults in psychotherapy described similar experiences. The dichotomies that had previously associated organised abuse with the dangerous, external ‘Other’ had been breached, and the incendiary debate that followed is an illustration of the depth of the collective desire to see them restored. Campbell (1988) noted the paradox that, whilst journalists and politicians often demand that the authorities respond more decisively in response to a ‘crisis’ of sexual abuse, the action that is taken is then subsequently construed as a ‘crisis’. There has been a particularly pronounced tendency of the public reception to allegations of organised abuse. The removal of children from their parents due to disclosures of organised abuse, the provision of mental health care to survivors of organised abuse, police investigations of allegations of organised abuse and the prosecution of alleged perpetrators of organised abuse have all generated their own controversies. These were disagreements that were cloaked in the vocabulary of science and objectivity but nonetheless were played out in sensationalised fashion on primetime television, glossy news magazines and populist books, drawing textual analysis. The role of therapy and social work in the construction of testimony of abuse and trauma. in particular, has come under sustained postmodern attack. Frosh (2002) has suggested that therapeutic spaces provide children and adults with the rare opportunity to articulate experiences that are otherwise excluded from the dominant symbolic order. However, since the 1990s, post-modern and post-structural theory has often been deployed in ways that attempt to ‘manage’ from; afar the perturbing disclosures of abuse and trauma that arise in therapeutic spaces (Frosh 2002). Nowhere is this clearer than in relation to organised abuse, where the testimony of girls and women has been deconstructed as symptoms of cultural hysteria (Showalter 1997) and the colonisation of women’s minds by therapeutic discourse (Hacking 1995). However, behind words and discourse, ‘a real world and real lives do exist, howsoever we interpret, construct and recycle accounts of these by a variety of symbolic means’ (Stanley 1993: 214). Summit (1994: 5) once described organised abuse as a ‘subject of smoke and mirrors’, observing the ways in which it has persistently defied conceptualisation or explanation.

Suicide can help pass on an individual's genes to the next generation in a situation where that individual is a burden to their close relatives and their own reproductive potential is weak. By taking their life, an individual may contribute to the reproductive success of their close relatives and thus to the proliferation of their own genes. In such a case, that individual's close relatives would have one mouth less to feed and no sick individual to look after. Indeed, several studies have shown that suicidal thoughts and suicides are more common in those who have poor chances of reproduction and who feel they are merely a burden to their loved ones.

The belief that one is unattractive can be as intractable as the belief that one has an undiagnosed disease. It's often present in people who are, to other people's perceptions, very attractive indeed. However, once the belief in one's unattractiveness gets established it can be used to account for all manner of experiences, such as being rejected by a date. The normal trait related to this disorder is wanting to be attractive. In the usual range, this is almost certainly useful.

William C. Schutz was educated at the University of California, Los Angeles, where he took his doctorate in psychology in 1951. After a year on the faculty at the University of Chicago Psychology Department, he conducted a research program in group social psychology while serving as an officer for the United States Navy. At Harvard, from 1954 to 1958, he was a lecturer and research associate in the Department of Social Relations. He was research psychologist at the University of California, Berkeley, and a lecturer in psychiatry, School of Medicine, at the same university. Since 1963, Dr. Schutz has been Director, Group Process Section, Division of Social and Community Psychiatry, Albert Einstein School of Medicine. As a consultant for several business corporations, he has advised on group behavioral problems and conducted small training groups for many public and private institutions, including the RAND Corporation. Dr. Schutz is author of FIRO: A Theree Dimensional Theory of Interpersonal Behavior (Rinehart, 1958) and of numerous articles published in magazines, psychological journals, and books (cf. William C. Schutz, JOY: EXPANDING HUMAN AWARENESS, contracapa da sobrecapa, Grove Press, New York, 1967).

William C. Schutz was educated at the University of California, Los Angeles, where he took his doctorate in psychology in 1951. After a year on the faculty at the University of Chicago Psychology Department, he conducted a research program in group social psychology while serving as an officer for the United States Navy. At Harvard, from 1954 to 1958, he was a lecturer and research associate in the Department of Social Relations. He was research psychologist at the University of California, Berkeley, and a lecturer in psychiatry, School of Medicine, at the same university. Since 1963, Dr. Schutz has been Director, Group Process Section, Division of Social and Community Psychiatry, Albert Einstein School of Medicine. As a consultant for several business corporations, he has advised on group behavioral problems and conducted small training groups for many public and private institutions, including the RAND Corporation. Dr. Schutz is author of FIRO: A Theree Dimensional Theory of Interpersonal Behavior (Rinehart, 1958) and of numerous articles published in magazines, psychological journals, and books (cf. William C. Schutz, JOY: EXPANDING HUMAN AWARENESS, contracapa da sobrecapa, Grove Press, New York, 1967).

As the pumping engines for the circulatory system, ventricles must have a particular ovoid, lemonlike shape for strong, swift ejection of blood. If the end of the left ventricle balloons out, as it does in takotsubo hearts, the firm, healthy contractions are reduced to inefficient spasms—floppy and unpredictable. But what’s remarkable about takotsubo is what causes the bulge. Seeing a loved one die. Being left at the altar or losing your life savings with a bad roll of the dice. Intense, painful emotions in the brain can set off alarming, life-threatening physical changes in the heart. This new diagnosis was proof of the powerful connection between heart and mind. Takotsubo cardiomyopathy confirmed a relationship many doctors had considered more metaphoric than diagnostic. As a clinical cardiologist, I needed to know how to recognize and treat takotsubo cardiomyopathy. But years before pursuing cardiology, I had completed a residency in psychiatry at the UCLA Neuropsychiatric Institute. Having also trained as a psychiatrist, I was captivated by this syndrome, which lay at the intersection of my two professional passions. That background put me in a unique position that day at the zoo. I reflexively placed the human phenomenon side by side with the animal one. Emotional trigger … surge of stress hormones … failing heart muscle … possible death. An unexpected “aha!” suddenly hit me. Takotsubo in humans and the heart effects of capture myopathy in animals were almost certainly related—perhaps even the same syndrome with different names.