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Psychiatry

Compassion Fatigue: When Listening Hurts

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The psychological and emotional demands placed on the practitioner have never been more intense, clinicians and researchers agree. Psychologists are expected to have the broadest of shoulders, absorbing without complaint the suffering and anxiety of their clients. But who takes care of the caretaker when the stress of a clinical case load becomes too great to bear alone? Psychologists should look to their own profession for help, practitioners say, but pride and concerns about confidentiality often stand in the way. In recent years, psychologists have suffered increased stress from the demands of the changing health-care environment, said Daniel Abrahamson, PhD, a clinical psychologist and co-founder of the Traumatic Stress Institute/Center for Adult and Adolescent Psychotherapy, or TSI/CAAP, in South Windsor, Conn. Managed-care organizations and other insurance providers require therapists to document their work with each patient in excruciating detail. That leaves providers feeling they must risk breaking a patient's confidentiality to collect reimbursement, Abrahamson said.

But psychotherapy has always been challenging, even...

Additional Resource: Compassion fatigue: when listening hurts (2821 downloads )

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Electroconvulsive Therapy Part II: A Biopsychosocial Perspective

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Abstract

The myths surrounding electroconvulsive therapy (ECT) and the misconceptions held by the general public, clinicians, and patients have interfered with acceptance of this treatment throughout its history. Misunderstandings surrounding ECT, and its consequent stigmatization, are reviewed, including negative depictions of ECT in film, print media, and on the Internet. Clinicians involved in the delivery of ECT benefit from gaining an understanding of how ECT may be perceived by patients and other mental health professionals; they can play a vital role in educating patients and helping ensure the delivery of a successful course of ECT. Guidance is provided for clinicians on how to support patients and families through the ECT process using a model team approach. Anxiety reduction, meeting individual needs, patient and family psycho education, assessment of psychosocial supports, and discharge planning are discussed.

The first article in this two-part series addressed common misconceptions about ECT by presenting a historical perspective and discussed indications for treatment, research initiatives, technical features, and treatment side effects.

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Indoctrination in Psychotherapy and Psychoanalysis:

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Indoctrination in Psychotherapy and Psychoanalysis:

The Double Whammy, Interrogation and Other Methods of Covert Control

Theodore L. Dorpat

In treatment, the psychotherapist is in a position of power. Often, this power is unintentionally abused. While trying to embody a compassionate concern for patients, therapists use accepted techniques that can inadvertently lead to control, indoctrination, and therapeutic failure. Contrary to the stated tradition and values of psychotherapy, they subtly coerce patients rather than respect and genuinely help them. The more gross kinds of patient abuse, deliberate ones such as sexual and financial exploitation, are expressly forbidden by professional organizations. However, there are no regulations discouraging the more covert forms of manipulation, which are not even considered exploitative by many clinicians. In this book, noted psychiatrist Theo. L. Dorpat strongly disagrees. Using a contemporary interactional perspective Dorpat demonstrates the destructive potential of manipulation and indoctrination in treatment.

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Intelligence Community’s use of Mind-Control and Thought- Manipulation

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The preceding briefing is to educate the reader on the Intelligence Community’s use of Mind-Control and Thought- Manipulation that may be implemented today, as well as a few actual case scenarios of successful operations conducted by the Central Intelligence Agency, The Office of Naval Intelligence, and, in some limited capacity, Intelligence Support Activities units.

The senarios described in this briefing have been selected for their recognition factor for members of intelligence teams as “well known” events in recent history and for their direct involvements with various U.S. Intelligence agencies and selected operations connected to these events.

These manipulations and degrees of control are easily achieved after years of intensive research by both the CIA and the Office of Naval Intelligence. The methods cover the range of actual hypno-programming, through either overt or covert methods as utilized by the agency concerned in the use of R.H.I.C., U.S.I.C. , E.E.O.M. and E.D.O.M. techniques.

Ultrasound technology is most frequently used by the lesser intelligence agencies in their various

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Adventures With an Ice Pick

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AMERICA, 1847: a highly competent and, by all accounts, pleasant manual labourer of Irish extraction named Phineas Gage is involved in rock-blasting operations in mountainous terrain. In the course of one sadly uncontrolled explosion, an iron bar is picked up by the force of the blast and driven clean through the front part of his head. Phineas is sent flying, but, to everybody's surprise, he survives the removal of the protruding bar. As he recovers, however, it is observed that his personality has dramatically changed, though his memory and intelligence remain apparently unaffected. In 1868, a physician named Harlow from Boston writes about him: "His equilibrium, or balance, so to speak, between his intellectual faculties and animal propensities seems to have been destroyed. He is fitful, irreverent, indulging in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires." The now extremely rude Phineas Gage is an...

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British Psychiatry: From Eugenics to Assassination

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A behavior control research project was begun in the 1950s , coordinated by the British psychological warfare unit called the Tavist J!Ck Institute, with the Scottish Rite Masons , the Central Intelligence Agency, and the British, U. S., Canadian, and United Nations agencies. The project became famous in the 1970s under a CIA code name, "MK-Ultra." Its notoriety for brain washing by drugs, hypnosis, electroshock, and other tortures caused many books tb be written about the project, and the U. S. Senate conducted hearings which exposed many of its abusive features. President Gerald Ford appointed a commission headed by Vice President Nelson Rockefeller, to correct the CIA's misconduct. There was a widespread anti-establishment view at the time, that here was e fox appointed to guard the hen house. The intelligence agencies offered a public rationale for the project: the need to counteract and compete with the mind-control capabilities of the communists. This was largely based on the fact that U.S....

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Harmful Psychiatric Treatments

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The psychiatric profession purports to be the sole arbiter on the subject of mental health and “diseases” of the mind. The facts, however, demonstrate otherwise:

1. PSYCHIATRIC “DISORDERS” ARE NOT MEDICAL DISEASES.

In medicine, strict criteria exist for calling a condition a disease: a predictable group of symptoms and the cause of the symptoms or an understanding of their physiology (function) must be proven and established. Chills and fever are symptoms. Malaria and typhoid are diseases. Diseases are proven to exist by objective evidence and physical tests. Yet, no mental “diseases” have ever been proven to medically exist.

2. PSYCHIATRISTS DEAL EXCLUSIVELY WITH MENTAL “DISORDERS,” NOT PROVEN DISEASES.

While mainstream physical medicine treats diseases, psychiatry can only deal with “disorders.” In the absence of a known cause or physiology, a group of symptoms seen in many different patients is called a disorder or syndrome. Harvard Medical School’s Joseph Glenmullen, M.D., says that in psychiatry, “all of its diagnoses are merely syndromes [or disorders], clusters of...

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Sleep Architecture In Homicidal Women With Antisocial Personality Disorder—a Preliminary Study

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Abstract

The aim of the present study was to characterize sleep in severely violent women with antisocial personality disorder (ASP) as the primary diagnosis. Participants for this preliminary study were three drug-free female offenders ordered to undergo a forensic mental examination in a maximum security state mental hospital after committing homicide or attempted homicide. Ten healthy age- and gender-matched controls PSconsisted of hospital staff with no history of physical violence. The most striking finding was the increased amount of slow wave sleep, particularly the deepest sleep stage, S4, in women with ASP. This finding is in agreement with previously reported results in habitually violent male criminals with ASP. Severe female aggression seems to be associated with profound changes in sleep architecture. Whether this reflects specific brain pathology, or a delay in the normal development of sleep patterns in the course of aging, needs to be clarified. From the perspective of sleep research,...

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Psychiatric Effects of Solitary Confinement

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I. OVERVIEW

Solitary confinement—that is the confinement of a prisoner alone in a cell for all, or nearly all, of the day with minimal environmental stimulation and minimal opportunity for social interaction—can cause severe psychiatric harm. It has indeed long been known that severe restriction of environmental and social stimulation has a profoundly deleterious effect on mental functioning; this issue has been a major concern for many groups of patients including, for example, patients in intensive care units, spinal patients immobilized by the need for prolonged traction, and patients with impairment of their sensory apparatus (such as eye-patched or hearing-impaired patients). This issue has also been a very significant concern in military situations, polar and submarine expeditions, and in preparations for space travel. The United States was actually the world leader in introducing prolonged incarceration, and solitary confinement, as a means of dealing with criminal behavior....

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Necrophilia and Sexual Homicide

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Abstract

A closed case-file review of 211 sexual homicides identified 16 cases of necrophilia. The results of this unique descriptive study of necrophilia associated with sexual homicide provide information on crime-scene locations, methods of killing, body disposition, premortem sexual assault, specifics of the necrophilic acts, methods of victim abduction, and motivational dynamics. The findings suggest that the most common explanation for necrophilia—the offender’s desire to have an unresisting partner—may not always be applicable in cases where this rare paraphilia is connected to sexual murder. The possibility of using crime-scene behaviors in these cases to investigate serial sexual murders is offered.

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The Utility Of Rorschach In Forensic Psychiatric Evaluations—a Case Study.

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Abstract

The use of the Rorschach Comprehensive System (RCS) in forensic psychiatric evaluations has evoked criticism. This study examined the use of the RCS in forensic psychiatric evaluations by studying to what extent a valid interpretation and an assessment can be made on information based solely on the RCS. Psychological assessments (N 34) based solely on RCS information were compared with the responses made by a forensic psychiatrist who had evaluated one offender. Agreement was found in 14 of 19 statements, which were related to the capacities and personality characteristics underlying criminal responsibility and mental state at the time of offense. The findings support the use of the RCS in forensic psychiatric evaluations, although no explicit conclusion can be drawn from one case. Further studies with more cases are needed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)...

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Inferring Motives in Psychology and Psychoanalysis

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Abstract

Grünbaum (1984) argues that psychoanalysis cannot justify its inferences regarding motives using its own methodology, as only the employment of Mill’s canons can justify causal inferences (which inferences to motives are). I consider an argument offered by Hopkins (1988) regarding the nature and status of our everyday inferences from other people’s behavior to their motives that seeks to rebut Grünbaum’s charge by defending a form of inference to the best explanation that makes use of connections in intentional content between behavior and motives. I argue that Hopkins succeeds in defeating Grünbaum’s objection as it is presented, but that work in social psychology presents a further challenge. I discuss the extent to which the challenge can be met, and conclude that certain types of inference in psychoanalysis are justifiable, but others, including those which are the target of Grünbaum’s objection, cannot be justified by the methods defended by Hopkins...

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Mass violence: Why do they do it? What can we do about it?

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Q This week it was northern Illinois. But it seems like every time you turn around, somebody’s shooting up a school, workplace, or public area.  What makes a person snap and go on this kind of killing rampage?  Is there anything the public can do to protect themselves?  And what’s law enforcement’s role in preventing and responding to mass violence attacks?

A:  Mass murder is defined as the killing of multiple victims in a single incident, typically using the highest level of lethal technology available to the killer, which in most cases involves handguns, assault weapons, explosives, or arson.  Some types of mass murder are committed in the name of a political, religious, or ideological cause; we label these terrorism, but this is not what we’re talking about here.  In the case of the Omaha mall, and other like it, it is usually one disturbed individual whose fantasies of outrage and revenge...

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Psychiatric Aspects Of Homicide

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Abstract

Author Information

Homicide is a significant public health problem in the USA and a pervasive concern in other nations as well.This paper evaluates the past year's contributions to the psychiatric literature with special emphasis on etiological considerations. In particular, advances in predictive capability and the growing importance of biological factors are examined...

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Concealment Of Psychopathology In Forensic Evaluations: A Pilot Study Of Intentional And Uninsightful Dissimulators.

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Abstract

Dissimulation is the concealment of genuine psychiatric symptoms in an attempt to present a picture of psychiatric health. In this pilot study, the authors set out to demonstrate that defendants may conceal psychiatric illness even in forensic settings, contrary to their apparent self-interest. They reviewed their records for forensic assessments of dissimulators and malingerers and classified dissimulators as "intentional" or "uninsightful" depending on whether their concealment of symptoms appeared to be a volitional act or driven by a lack of insight. Although there were obvious diagnostic differences, the only other significant difference between malingerers and dissimulators was that malingerers were more likely to be facing charges related to financial crimes. Uninsightful dissimulators were significantly older than were intentional dissimulators. Uninsightful dissimulators were also more likely to be psychotic, particularly delusional and schizophrenic, than were intentional dissimulators. While forensic psychiatrists are vigilant in attempts to detect malingering, these data suggest that they...

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