Show Notes for February 2, 2010: Nomenclature Past, Present and Future

Last month, Bob and I had a discussion off air about a variety of psychiatric and abnormal psychology terms, many of which are no longer used, but which are in conversational use. So, this month, we are going to explore a number of these terms from the past, the present, and even terms suggested for the future.

The definitions here are not intended to be exhaustive, but provide a little thumb-nail picture only.



Psychopath (psychopathy): A condition characterized by a lack of conscience, lack of empathy, lack of shame or guilt, and a high degree of interpersonal charm. Famous persons suspected of being psychopaths include Charles Manson, Jeffrey Dohmer, John Wayne Gacy, Jr., and Ted Bundy. Today, this condition is called Antisocial Personality Disorder.

Sociopath (sociopathy): Same as the above. The difference between psychopathy and sociopathy is based on the speaker's theory of cause. Psychopaths are born; sociopaths are made (by parental neglect, poverty, etc.). This condition is also called Antisocial Personality Disorder today.

Psychotic (psychosis): This term is still in limited use. This is an umbrella term that encompasses both hallucinations and delusions. Hallucinations are sensory experiences that are not real; delusions are false, fixed beliefs. Famous persons believed to be psychotic include John Hinckley, Jr. and Mary Todd Lincoln.

Psychoneurotic (psychoneurosis/neurosis): This term was popularized by Sigmund Freud and Carl Jung. In includes many, many conditions that are not psychotic, including anxiety, depression, and psychosomatic disorders. Famous persons believed to be neurotic include Woody Allen and Howard Hughes.

The American Psychiatric Association made an attempt at standardizing diagnoses in 1952 with the publication of the Diagnostic and Statistical Manual. The third edition (DSM-III), published in 1980, was the edition that brought reliability to the terms. The next edition (DSM-V), after many delays, is scheduled to be published in 2012.

The following website:

www.DSM5.org

is scheduled to launch on Feb 10, 2010 to provide current news on DSM-V development.

Under DSM-V rules, it now appears that ratings of depression, anxiety, cognitive impairment, and reality distortion will be part of all diagnoses. This will replace current diagnoses such as Schizoaffective Disorder, a condition in which mood symptoms co-occur with symptoms of Schizophrenia.

Possible future diagnoses will include:

Complex Post Traumatic Stress Disorder (C-PTSD), a condition that involves a loss of sense of self after prolonged captivity.

Post Traumatic Embitterment Disorder (PTED), a chronic feeling of embitterment and injustice following a single, negative event.

Relational Disorders, including Marital Relational Disorder with/without Violence and Parent-Child Abuse Disorder, will make domestic violence and child abuse issues that may be addressed by psychiatrist. This would be one of many controversial decisions, in this case possibly turning a crime into a disorder.

Show Notes for January 5, 2010: Defining Abnormality

What does it mean to be normal? What does it mean to be abnormal? Today on Mental Health Tuesday, we discuss the various definitions of normalcy and abnormality.

Clinical Definition
According to the clinical definition, abnormality is defined by an expert, the clinician. This definition is further subdivided according to the Medical Model or the Behavioral Model. According to the Medical Model, a condition either exists or it does not. For example, you cannot be "a little bit pregnant." The medical model assumes that symptoms are signs of an underlying condition defined by the clinician. According to the Behavioral Model, behavior is its own phenomenon and not connected to an underlying condition. Behavior is thought of as being on a continuum, extremes of which are considered abnormal. For example, thinking you hear someone call your name when no one is there, or thinking you hear the phone ring when it did not, are examples of common auditory hallucinations that most of us have had. This is the low end of the continuum and considered normal. Hearing voices give you detailed orders, however, is the high end of the same continuum and considered abnormal.

The Diagnostic and Statistical Manual, Fourth Edition
The main reference in the United States for the Clinical Definition is the DSM-IV published by the American Psychiatric Association. Primarily based on the Medical Model, the DSM-IV outlines the symptoms of each disorder. A nod is made to the Behavioral Model, however, in that symptoms must cause impairment in "social or occupational functioning" to qualify for diagnosis. In a nod to the Distress Definition, below, the DSM-IV does allow for diagnosis in the absence of impaired functioning in the presence of "clinically significant distress."

Distress Definition
This is the inverse of the Clinical Definition. According to the Distress Definition, abnormality is defined by the person experiencing the abnormality. If you are concerned enough about certain thoughts, behaviors, or experiences to talk to a therapist, then you, yourself, have judged them to be abnormal.

Statistical Definition
This definition takes whatever behavior is under discussion and measures it within a population. Abnormality is then defined as a certain degree of variation from that mean. For example, general intelligence, the IQ, is defined based on a standard score that has a mean of 100 and a standard deviation of 15 (the Wechsler Scale). Two standard deviations before this mean (IQ=70) is one criterion, but not the only one, for a diagnosis of Mental Retardation. Two standard deviations above the mean (IQ=130) is defined as the "Superior" range. While this may be socially desirable, it is as statistically abnormal as Mental Retardation. Notice that according to this definition, there could never be an "obesity epidemic." The same percentage of people always vary to the same degree from the mean, though the mean may change among a population. (The obesity problem is based on a clinical definition).

Cultural Definition
According to the Cultural Definition, normalcy is conformity to one's culture, or to the culture in which one lives. Failure to meet the expectations of one's culture is considered abnormal. This means that those who advocate cultural change are seen as abnormal. Totalitarian governments may use the cultural definition as a tool of oppression. For contrast and example, in the United States, if a person is delusional or suicidal, we may deprive them liberty if there are judged to be a danger to others or to themselves. In the former Soviet Union, a political dissident could be deprived of liberty if judged to be a danger to the State. Cartoons that we might see as political satire are judged as blasphemy in some Middle Eastern cultures and producing them carry the death penalty.

Legal Definition
The legal definition of insanity varies by state, but, in general, means that a person could not tell the difference between right and wrong at a given time because of the effect of a mental illness. A person is never diagnosed as insane by a professional; they are found to be insane by a court. Most persons with mental illness, under the Clinical Definition, are quite sane under the Legal Definition. A person who kills someone to steal money from them is a criminal. A person who kills someone because they believe some mystical force has replaced that person with an android duplicate and, that be killing them, the original person will be returned, is quite likely insane.

Show Notes for December 1, 2009: The Attitude of Gratitude

Emerging research shows that attitudes are a key factor in determining levels of happiness. Chief among these attitudes is gratitude.

Gratitude is defined as a "knowing awareness that we are recipients of goodness." Knowing awareness means that it is conscious and thoughtful, not automatic. In other words, "thankfulness requires thoughtfulness."

In one study, an experimental group that kept a gratitude journal was compared to a control group that kept a journal of daily events and a third group that kept a journal of negative events. At the end of the study, those in the gratitude group reported 25% more happiness, slept 12% longer, exercised 30% more per week, and showed a 10% lowering of blood pressure compared to controls in the other two groups.

A summary is located here:

The New Science of Thank You.PDF

A portion of a podcast with one of the authors mentioned is here:

Podcast Portion

Finally, below, we have the "Gratitude Stream," using technology to be grateful:

Show Notes for November 2, 2009: Communication Tips

"The difference between the almost right word and the right word is really a large matter - its the difference between the lightning bug and the lightening." -- Mark Twain

Today, we had a rather open discussion on ways to improve communication. These include:

1) Using I-statements. This is the practice of only talking about what you know about - which is your own thoughts and feelings. Statements, therefore, begin with "I," as in "I think...." or "I feel..."

2) Active Listening. This is the practice of paying close attention to what is being said to you, rather than taking a defensive posture and only half-listening while planning your reply. Active listening can be accomplished by listening well enough to paraphrase, reflect, or summarize what was said to you.

3) Ask Questions. If you don't understand something, or if there seems to be a discrepancy between speech and body language, then ask questions to clarify the message.

4) Empathy. Try to put yourself in the other person's shoes.

5) Focus on Shared Goals. This is one means of resolving conflict, or, at least, being able to discuss conflicts without anger interfering in the message.

Some Examples:

Dr. Shelly Gable has been researching what goes right in close relationships for many years and has found that partners' reactions to good news is a better predictor of the quality of the relationship and whether it will endure than partners' reactions to bad news. For example:

Your spouse comes home and announces that he or she got a great promotion at work. You could react with:

Active Constructive Response (correct): "That's great, you've earned it, I'm so proud of you!" followed by asking questions. This conveys enthusiasm, support and interest.

Passive Constructive Response (incorrect): "That's great. What's for dinner?"

Active Destructive Response (incorrect): or "finding a cloud in the silver lining" like, "Does that mean you'll be working later hours? Are they going to pay you more? I can't believe they picked you out of all the candidates!"

Passive Destructive Response (incorrect): which can be either, "Wow! Wait until I tell you what happened to me today." or ignoring the event all together, "What's for dinner?"

Show Notes for October 6, 2009: Domestic Violence Awareness Month

October is Domestic Violence Awareness Month. Some current publications from the American Psychological Association are linked here:

The Mind of the Batterer.pdf

Partner Violence: What you can do

A good website for the State of Kansas is:

helpchangekansas.com

Statistics:

A United States Department of Justice study found that 22% of women and 7% of men had been physically abused by an intimate partner at some point in their lives. The study also found that 1.3% of the women and 0.9% of the men had been abused within the past 30 days. Of those abused, 39% of the women and 23% of the men were injured.

Effects on the victim:

Physical abuse is often accompanied by humiliation, manipulation, and economic control. The effects on the victim include fear, the belief that escape is impossible, post-traumatic stress symptoms and sometimes substance abuse.

The risk of death or serious injury increases once the decision to leave is made.

How to respond if someone tells you of domestic violence:

DON'T minimize the abuse
DON'T blame the victim
DON'T shift the focus (to alcohol or some other problem)

DO be empathetic
DO tell the victim it is not her fault
DO offer to get her help (if you can)

Important Phone Numbers:

As always, if you are in danger, dial 9-1-1

Area Mental Health Center, Ulysses outpatient office for Grant, Stanton and Morton Counties:
1-620-356-3198

Domestic Violence Emergency Shelter (DoVES) of Grant County:
1-620-356-1049

Kansas Crisis Hotline:
1-888-END-ABUSE (1-888-363-2287)

National Domestic Violence Hotline:
1-800-799-SAFE (1-800-799-7233)

Show Notes for September 1, 2009: The Schools of Psychotherapy

Today we talked about the three main "schools" or types of psychotherapy. Most therapy done today is an eclectic mix drawing on ideas from each of the schools to the extent that the ideas fit the problem that the client wishes to address.


The psychodynamic-systems schools:

Largely the product of early 20th Century European psychiatry, this view conceptualizes that each person or system (which can be a family, a workplace, or so forth) contains a given amount of energy (libido) that never leaves the system but that can be channeled to productive pursuits or psychiatric symptoms. The direction of this energy can be changed by gaining insights in fixation within a person or boundaries within a group. If this is not done properly, a person may substitute one symptom for another, or a different person in a family or group may develop symptoms.

Key figures: Sigmund Freud, Alfred Adler, Carl Jung, Dennis Dailey

Scientific note: The concept of symptom substitution has failed to be verified experimentally. Other concepts cannot be empirically tested.

The cognitive-behavioral schools:

Largely the product of mid-20th Century American psychology, the behaviorists hold that only observable (overt) behavior that can be measured is the proper subject matter for scientific psychology. This lead to the development of Learning Theory. The cognitive therapists believe that unobservable (covert) behavior (thinking, feeling) may be measured indirectly through verbal report and that covert behavior follows the same principles of learning theory as does overt behavior.

Key figures: J.B. Watson, B.F. Skinner, Albert Ellis, Aaron Beck

Scientific note: Cognitive-behavioral therapy is scientifically validated for the treatment of depression and many forms of anxiety.

The humanist-existentialist schools:

Largely the product of late-20th Century American psychology, the humanists and existentialists believe that something is unique about human beings that cannot be explained by learning theory. They hold that human beings have potentials that need to be made real (actualized). The humanists and existentialists base their understanding of the human being on a priori philosophical ideas such as free will and the existence of the human spirit.

Key figures: Carl Rogers, Abraham Maslow, Rollo May, Viktor Frankl

Scientific note: Members of these schools tend to research the results of psychotherapy. Their philosophical assumptions are not able to be empirically tested.

Show Notes for August 4, 2009: Viktor Frankl and Logotherapy

About Viktor Frankl


Viktor E. Frankl, MD, PhD (1905-1997) is the founder of Logotherapy. He practiced psychiatry and neurology in Vienna, Austria throughout the middle of the 20th Century, interrupted by internment in four Nazi concentration camps. Frankl’s experiences in the camps provided the proving ground for his assertion that human life has meaning under any and all circumstances, no matter how grim, and that the human spirit has a defiant power to take a stand in the face of any adversity.

Frankl is the author of 31 works on psychotherapy, philosophy and neurology. His books have been translated into 31 languages. His classic Man’s Search for Meaning has sold over 12 million copies worldwide. A 1991 Library of Congress/Book-of-the-Month survey rated Man’s Search for Meaning as one of the ten most influential books in the United States.

The work of Viktor Frankl is carried on by Viktor Frankl Institutes around the world. The Viktor Frankl Institute of Logotherapy in the United States is located in Abilene, Texas. One therapist from the Ulysses Office of the Area Mental Health Center receives training there and recently returned from the 17th World Congress on Logotherapy. The coursework of the Viktor Frankl Institute is approved by the American Psychological Association and the National Board of Certified Counselors. Logotherapy is a recognized treatment by the American Psychiatric Association.


About Logotherapy

Logotherapy is a meaning-centered or existential form of psychotherapy. The “logo” in logotherapy comes from the Greek word logos which means word, meaning, or philosophical argument. Unlike many other forms of existential therapy, Frankl’s logotherapy is down-to-earth and practical. It works in a complementary way with a variety of other therapies, including the cognitive therapies most often used in the United States today.

Logotherapy teaches that the human spirit is incorruptible and can be a source of strength and health despite the weaknesses of the body and the mind.

The three basic tenets of Logotherapy are:

The Meaning of Life: Logotherapy holds that human life is meaningful under any and all circumstances.

The Will to Meaning: Logotherapy believes that part of what makes us human is an innate pull to discover the meaning of our lives.

The Freedom of the Will: Logotherapy holds that human beings have the ability to choose to live meaningful lives by actualizing values.

Three classes of values lead to the discovery of meaning in life:

The creative value is the work that we do as only we can, that which we create in life.

The experiential value is the love we discover in relationships, or the beauty we find in the world around us through nature, art, music, and so forth.

The attitudinal value is the stand we choose to take toward pain and suffering in our lives that we cannot change.

More can be learned about Viktor Frankl and Logotherapy at:

The Viktor Frankl Institut (Austria)

The Viktor Frankl Institute of Logotherapy (United States)

LogoTalk.net


About the Logo

The logo of the Viktor Frankl Institute is pictured above.

The BOAT, seen in the image, is the Greek symbol for wisdom.

The OIL LAMP, also seen, is the Hebrew symbol for eternity.

L-O-G-O-S is what you are really seeing superimposed on the globe above, the letters L-O-G-O-S.

“En archa ain ho Logos, kai ho Logos ain tou Theou, kai ho Logos ain Theo.” John 1:1

In the beginning was the Logos (word, meaning, that which is meant), and the Logos was with God, and the Logos was God.”