25. Introduction to Psychiatry - Update 15 Aug. 2021
The following descending topics are met in order of reading the chapter.
Concerning the psychoses
neurosis
personality disorders
An old medical school joke defines psychosis and neurosis
Psychiatry is the youngest health science
non-Freudian psychoanalytic approach
Psychiatry can help one understand behavior: to control one's own or protect oneself from others'. Also—- to know the treatments and diagnoses of mental diseases, which include the psychoses—-schizophrenia, bipolar mania, severe depressive and acute situational—-and the neuroses of depression, paranoia, obsessive-compulsion.
Psychiatric Diagnosis and Classifications Remain Problematic In contrast to most other medical diagnoses, psychiatric diagnoses are all checklists of patient behavior from the psychiatrist questioning and observing the patient to reports from friends and family. There are no definitive tests like blood sugar in diabetes. This results not only in inaccuracy and possibility of faking but also, more and more, for a tendency for psychiatric diagnoses to be continuous, i.e.,lumped together as “spectrums, i.e, “autism spectrum,”, “schizophrenia spectrum”. This is not necessarily bad but it blurs distinctions and makes evaluation difficult.
Concerning the psychoses, we too often think about them as purely crazy behavior by obviously insane persons. But it is more practical to recognize an acute situational psychosis as it happens, not infrequently, to a previously (and afterwards) normal person like you or I.
A psychosis is a case where the sufferer loses her or his reality, temporarily (psychotic break) or permanently (severe delusional paranoia). A person in the midst of psychosis is eobviously in the grip of a destructive genie; for example, the semi-coherent talking jag of a manic-depressive (bipolar); a socially destructive behavior in a previously normal person after ICU near-death experience (acute situational); or a weird delusion of a schizophrenic (cf. the schizophrenic's delusion in the 2001 movie, A Beautiful Mind). Sometimes, especially in acute situational psychoses, the surface behavior seems normal; it is only when the psychosis gives out a crazy theory or believes a hallucination or does a totally inappropriate behavior that it becomes clear. An example drawn from recent experience follows: A professional 50-year-old family man, previously normally balanced, developed a deadly illness that required major emergency surgery from which he nearly died and which caused 1 week unconsciousness on a ventilator in hospital ICU. Then he recovered and was discharged home 3 days after awakening. I happened to be visiting. At first on arriving home his behavior seemed normal, but he began to verbally abuse his wife and children and this was done in my presence and he had not previously been abusive. We might be sitting around a table at home - his wife, myself and he - and he would suddenly blurt out to her "You dumb cunt! You never had any brains! Couldn't even go to college!" And so forth. And his wife unused to such abuse burst into tears and later confided to me she was going to take her children and leave him. Some have labeled it the ICU syndrome but I think better to call it the near death reactive response. In the particular case, the person in question, I knew, had been raised by parents who engaged in mutually verbally abusive behavior, and he had been exposed to this as a child but as he grew up his socialization allowed him to realize that one does not voice abusive critical thoughts to a loved one (or close associate) especially in the presence of another person. But the close call to death had temporarily overcome the psychological defense barrier allowing his abusive behavior to surface and for a week it almost destroyed his family. Luckily, my presence as an older respected authority figure and my expertise allowed me to recognize the acute psychosis and to do a rapid short term psychoanalysis which I interpreted to the wife and counseled her to simply "Take all the verbal abuse he gives humbly without comment." Understanding that it was a form of illness, she and her children followed my advice and after a week the patient had rebuilt his defenses and stopped the behavior and has since been a loving husband and parent. Incidentally, note I did not try to interpret the psychosis to the patient himself or even advise him to stop his bad behavior. Psychotic patients cannot tolerate interpretation and take advice poorly; so as long as they are not breaking laws and not harming others or themselves physically they may be left to recover or, if they see a physician with experience, given a brief course of anti-psychotic medication.
A neurosis is an understandable disorder or behavior due to environmental upsets or mild brain problems or drugs. Most of us have one or more neuroses about particular aspects of life - like high anxiety, or mild paranoia, or hyper personality or depressive personality.Finally, and most difficult to deal with or diagnose and treat are the sometime severe personality disorders.These are cases of an otherwise normal person who talks and thinks logically so cannot be called psychotic and whose disorder is not episodic. But there is one overarching defect in personality almost always related to an abnormal response to one's feeling state. An example is the infamous Unibomber, Ted Kaczynski, who terrorized the USA by sending bombs through the mail triggered to explode on opening. Between 1978 and 1995 he sent out 23 bomb letters many of which exploded and which killed 3 persons and injured others and almost brought down a commercial jet with hundreds aboard. After he was caught and his mind analyzed from letters and interviews it turns out that he was motivated by an overwhelming anger. But 2 facts about this anger made it a serious personality disorder: it was free-floating, i.e., no obvious single target, and 2) it settled upon various aspects of Ted's life like his family (for not understanding him), his lawyers (for seeking an insanity plea) and worst of all, and the main reason for his bad works, on modern technology leaders, and whom he identified as key purveyors of the technology.
The Unibomber is a worst example of the personality disorder but also suggests that we (society) take personality aberrations more seriously and try to extend psychiatric diagnosis and medication to such persons before they act out their deadly plans.
An old medical school joke defines psychosis and neurosis as follows: A neurotic constantly dreams of castles in air, a psychotic lives in one, and the psychiatrist collects the rents. As implied, many, if not most neuroses are tolerated or cured by the patient himself but some get out of control and require short term psychoanalysis (non Freudian, see Chapter 33) and medication.
Psychiatry is the youngest health science. Perhaps a searcher will discover why almost all of us have crises of depression, why 1% get the mysterious and terrible schizophrenia, why so many are killing ourselves and each other, why many of us can't seem to achieve happiness in today's world of techno-superabundance. But even if I do not stimulate you to win a Nobel Prize, I'll hope to offer knowledge to make you happier and more successful.
Today in 2021 psychiatry is dominated by medication—-anti-depression, anti-psychotics and tranquilizers. Sparingly and intelligently used, these can be a boon as assist against crippling symptom. But the key to mental health is a well-ordered, intelligently run, humane society; a good family; a life of much encountering (wide range of meeting things and persons); and a successful self psychoanalysis that may be assisted by others.
For further reading, Kaplan & Sadock’s Synopsis of Psychiatry has recently come out (April 2021) in its newest 12th Ed.
Notebooks hopes to pioneer the non-Freudian psychoanalytic approach you can read in Section 9.33 with fictional examples in Slim Novels 13 to 15.
Note: psychiatric medications are discussed
as well as in chapters of Notebooks 9, and in
chapter, and of course can be accessed from Internet Wikipedia.
END OF CHAPTER. To read next click.The next 3 chapters—-Life Cycle, Personality, and Mental Health Normality—-are not directly hypertexted; so, you will not directly get their texts to read by clicking. Instead you will get Table of Contents and by scrolling you can continue the TOC of all the chapters, which is hypertexted to each chapter by clicking.
9.26 Behavior As Control - BF Skinner & Behaviori...
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