Dynamic Psychiatry Research Articles

Applications of Chaos Theories to Psychiatry: A Review and Future Perspectives

AbstractThe great revolution that took place in physics at the beginning of this century, which led to a total reshaping of the science and a different approach to natural phenomena, could serve as a model for future developments in other disciplines such as neuroscience. When investigated by traditional methods, the complexity of brain mechanisms remains quite elusive; the use of new strategies should, therefore, be a high priority.Although holistic interpretations of brain functions and dysfunctions still seem futuristic, the application of chaos theories may be one way of making these interpretations more understandable. In fact, chaos mathematics can be applied to brain activity, such as that recorded, by electroencephalogram (EEG), and to the interpretation of psychopathology. Similarly, clinical phenomena could be explained in terms of nonlinear dynamics. Moreover, the application of chaos theories to psychiatry might permit the study of the relationships between genetic and environmental factors in determining syndromes and symptoms. This could encourage the development of a nonlinear dynamic psychiatry which, in turn, would allow a better understanding of research findings and, perhaps, open new horizons to psychiatric intervention.

After Suicide: Who Counsels the Therapist?

ColumnsAfter Suicide: Who Counsels the Therapist?The Perspective of a Volunteer-Based Suicide Prevention OrganizationSimon ArmsonSimon ArmsonSearch for more papers by this authorPublished Online:January 01, 1997https://doi.org/10.1027/0227-5910.18.3.131PDFView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byPeer‐based interventions targeting suicide prevention: A scoping review15 March 2021 | American Journal of Community Psychology, Vol. 68, No. 1-2Configuring the caller in ambiguous encounters: Volunteer handling of calls to Samaritans emotional support services20 May 2013 | Communication & Medicine, Vol. 9, No. 2When Depression Becomes Terminal: The Impact of Patient Suicide during ResidencyThe Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, Vol. 31, No. 3 Volume 18Issue 3May 1997ISSN: 0227-5910eISSN: 2151-2396 Published online1997 InformationCrisis (1997), 18, pp. 131-131 https://doi.org/10.1027/0227-5910.18.3.131.© 1997Hogrefe & Huber PublishersPDF download

The Dynamics of Plenary Groups in the Hospital for Dynamic Psychiatry

The Dynamics of Plenary Groups in the Hospital for Dynamic Psychiatry

Can poetry help us become better psychiatrists?

Learning medicine and psychiatry is a moral as well as an intellectual challenge. Successful training in psychiatry can lead to significant personality maturation. Using poetic examples, the paper explores aspects of emotional development relevant to the traditional values of dynamic psychiatry. Such values are contrasted with those of the prevailing bureaucracy.

Freud's Hatchet Man in an Age of Deidealization

Freud’s Hatchet Man in an Age of Deidealization Eli Zaretsky When Freud died in exile in 1939, he was already a legend. By the 1950s, he exerted a grip on many imaginations comparable to that of the great figures—Dostoyevsky, Moses, Leonardo—about whom he wrote. There had always been critics and dissenters, of course, but they remained in the minority. In the 1970s and 80s, however, several substantial works called for a downward revision in his standing. Henri Ellenberger’s The Discovery of the Unconscious (1971) challenged Freud’s originality by situating his discoveries in the context of nineteenth century dynamic psychiatry. Frank Sulloway’s Freud, Biologist of the Mind (1979) did the same with nineteenth century biology. Adolf Grünbaum’s The Foundations of Psychoanalysis (1986) rejected Freud’s claims to scientific standing on philosophical grounds. Despite their criticism, these books were all respectful and complex engagements with Freud’s thought. In this respect, they are unlike the later spate of anti-Freud writings, especially Frederick Crews’s articles in The New York Review of Books (1994 and 1993). No earlier critique had the immediate and dramatic impact of Crews’s. In part, this was the result of Crews’s unprecedented tone of disdain and contempt. One commentator called them “iconoclastic reaction[s] against [Freud’s] iconic status” (Goodheart 1995). It is perhaps not widely realized how effective these articles have been in at least temporarily vitiating Freud’s reputation, and how many people, perhaps especially among the young, now regard Freud as disproved, old hat, sexist, conservative, replaced by Foucault and the like. Crews performed his function—that of hatchet man—very effectively, but hatchets do not fell great trees unless many axe blows have first prepared the way. These axe blows did not primarily come from the scholars, such as Ellenberger, Sulloway, or Grünbaum, whom Crews cited, but [End Page 385] more importantly from social movements and cultural revaluations whose passions Crews effectively and disingenuously manipulated. The purpose of this article is to situate Crews’s attack in the context of those movements and changes. The attack on Freud is about much more than Freud. At stake is a whole set of hopes and possibilities to which Freud, and psychoanalysis, are historically linked, sometimes reluctantly. Crews’s attack on Freud’s person is, in fact, an attack on Freud’s imago; as such it was an attempt to reconfigure the multitudinous lines of thought and emotion that imago condenses. By defying Freud’s authority, especially contemptuously, Crews seeks to claim that authority for himself. On its basis he advances a series of assumptions concerning the nature of morality and personal integrity, the character and value of modern knowledge (i.e., science) and the relevance of the welfare state to modern “technologies of the self” or “therapy.” I will show that his narrow and ungenerous views on all of these matters reflect a time of diminished possibilities in which optimism and the belief in progress are at a low point. Above all, the Crews episode reflects the significance of “post-feminism”: confusion over the meaning and future place of the feminist and gay movements. To argue these points, I will first supply the historical context so strikingly absent from Crews’s account. Next, I need to discuss the specifics of Crews’s criticisms, and I need to refute them. Situating Crews’s attack in its historical context raises the question of whether our culture at this time can actually tolerate the analytic enterprise when the fullness of its vision is noted. But it also opens the way, finally, for a positive discussion concerning the role that psychoanalysis might play in the culture now emerging. How did Freud become such a commanding figure in modern Western culture? In part, I believe it was because of the subject matter Freud addressed. Freud mapped out and for a while presided over an historically new realm that emerged in the West during his lifetime—that of personal life. Earlier, the family was the basic economic unit in society. This meant that personal identity was rooted in one’s place in the system of production. The advance of industry separated...

Anti-Psychoanalytic Cultural Forces in the Development of Western Civilization

Why did a Freud appear on the world stage at the end of the nineteenth century? Why did dynamic psychiatry originate in this period and not before or later? An historian or a sociologist could attempt to solve this problem by the usual method; that is, by investigating what chains of events or what previous discoveries were necessary for the development of psychoanalysis. This method is best illustrated by examples from the field of mathematics and physics, where it is impossible, for instance, to conceive an Einstein without a previous Newton, a Newton without a Galileo, a Galileo without a Copernicus, and so on, backward to Euclid, Archimedes and Pythagoras. However the situation of dynamic psychiatry is different from that of physics, or any other science, including every other branch of medicine. In other words, there is no series of previous necessary discoveries which made a Freud possible only at the end of the nineteenth century, and not, let us say, in the fifteenth or twelfth century, or even before the Christian Era. I suspect that many readers may doubt the validity of this statement. They might think that there would be no psychoanalysis without hypnosis and its application to psychiatry by the French school. Others might feel that a Charcot was necessary to orient Freud toward the psychoneuroses. Still others might think that it is impossible to conceive of a Freud without a previous Darwin, because Freud's thinking was so greatly influenced by Darwin's evolutionary and genetic concepts. As to hypnosis, it is true that it was, for the first time in Western history, officially accepted as a therapeutic method by the French medical schools of the nineteenth century, especially on account of the teachings of Mesmer, Braid and Bernheim. Actually, hypnosis has been practiced since ancient times. It is well known not only that the Babylonian soothsayers and the Hebrew physicians practiced hypnosis repeatedly, but that in Europe, too, throughout the Middle Ages, alchemists were concerned with it and officially accepted it in the scientific world of those times. Therefore, what is really strange is not that Freud and Breuer were able to observe that forgotten memories reappear under hypnosis, but that nobody else before them ever paid serious attention to these rescued memories. As to Charcot, he undoubtedly influenced Freud's thinking and career like many others did; but it is one thing to influence a man's thinking and another to have the kind of effect without which no further growth is possible. Few people nowadays attribute to Charcot such a decisive influence for the development of psychoanalysis. Darwin's influence on Freud has to be considered more seriously. Horney, too, has discussed this influence in her book, New Ways in Psychoanalysis ( 1). Freud believed that stages of development are repetitions of phylogenetic stages, and such belief has influenced his theories of fixation and regression of the libido. However, these theories, conceived probably under Darwin's influence, are not fundamental in psychoanalysis. Horney, in her school of thought, conceives and practices a psychoanalysis deprived of these Darwinian influences. Furthermore, similar ideas, similar comparisons about phylogenetic and ontogenetic developments had been formulated previously, but did not evolve into anything comparable to psychoanalysis. The philosopher Giambattista Vico (2), in the seventeenth century, compared primitive people to children, and studied myths and mores in a way which has great resemblance to the analytic method. Though his writings became part of the background of every philosopher, they did not hasten the development of psychoanalysis. In his writings Freud shows no evidence of having been influenced by Vico, either directly or through some other indirect source. In my opinion it is not true that psychoanalysis could have been born only at the end of the nineteenth century and not before, because the state of knowledge and science prior to that period would have made it impossible. …

Ethical use of placebos and provocative testing in diagnosing nonepileptic seizures.

important reason for therapeutic failure of epilepsy treatment is misdiagnosis of epilepsy. Several imitators of epilepsy [1] can confound even experienced clinicians. Among these imitators, nonepileptic (psychogenic) seizures (NES) can be particularly difficult to diagnose. Induction of NES by hypnosis or suggestion has been used since 1955. [2] This diagnostic maneuver, although useful, raises ethical issues pertaining to employment of placebos, informed consent, and the effect of deception on the patient-doctor relationship. In this review, we examine provocative testing for seizures in light of these issues. Neurologists use placebos during provocative testing to diagnose suspected conversion symptoms. Recent reviews address ethical issues of placebo use in controlled studies. [3] Here, we review brief history of the placebo and consider ethical issues related to placebo use in provocative testing. The therapeutic benefits of placebos have been recognized, directly or indirectly, since the dawn of civilization. Given the severe limitations of pharmacologic and surgical therapies until the current century, administration of placebo was among the most effective therapeutic strategies. Robert Burton (1628) [4] recognized that a silly chirurgeon, doth more strange cures than rational physician ... because the patient puts his confidence in him. Mesmer's use of animal magnetism during the late 18th century, although disproved as fraudulent, became the forerunner of hypnotism and helped shape the future of dynamic psychiatry. [5] Thomas Jefferson (1807) viewed placebos as pious fraud, but noted that One of the most successful physicians ... used more of bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together. [6] In the late 19th century, Charcot used hypnosis and suggestion to explore various neuropsychiatric disorders, including conversion. In pioneering studies, he hypnotized patients to produce and relieve hysterical paralysis, mutism, and amnesia. Unfortunately, some of …

Janet and Freud: revealing the roots of dynamic psychiatry.

Interest in the work of Pierre Janet is presently undergoing a scholarly revival and, in the process, his contribution to dynamic psychiatry is increasingly being recognised. This article compares and contrasts Pierre Janet's early studies on hysteria and the neuroses with those of Freud. The study surveys original works by Janet and Freud and contemporary scholarly exegeses. It particularly focuses on ideation and memory, consciousness and dissociation, psychological trauma, the self, therapeutic influence, and treatment by integration versus abreaction. Grounds are presented for either preferring Janet's notions to Freud's or for integrating them. It is concluded that a number of Janet's contributions to psychopathology and psychotherapy, particularly in the field of dissociative disorders, deserve further exploration and application.

A Brief History of Multiple Personality Disorder

This brief review of multiple personality disorder (MPD) focuses on a number of historical threads of inquiry spanning the past century. Nineteenth-century investigations of dissociation paved the way for multilevel models of the mind and the development of dynamic psychiatry. Modern controversies, such as the role of trauma in dissociation, cultural influences on the expression of dissociation, the portrayal of MPD in the popular media, and the validity of MPD, grow out of nineteenth-century debates. The recognition of child and adolescent dissociative disorders and the adoption of a developmental focus of investigation offers an opportunity to resolve many of these contentious issues.

Contact between psychotherapists and psychiatric residents who provide medication backup

Psychiatric residents frequently prescribe medication for patients who are in psychotherapy with another clinician. This study examined the extent and characteristics of communication between psychiatric residents and psychotherapists who treated patients in a university outpatient clinic. Thirteen psychiatric residents who prescribed medications for 83 patients seen by other clinicians for therapy were surveyed about whether and how often during a five-month period they had contact with the therapist, who initiated the contact, and whether it took place with the patient's consent. Patients' charts were reviewed to determine if contacts were documented. The psychiatric residents indicated they had contact with the therapist in 44 of 83 cases (53 percent). Contact was initiated by the prescribing psychiatrist in 47.7 percent of the cases and by the therapist in 43.2 percent of the cases. The charts of only seven patients (8.4 percent) included written documentation of contact. Several steps are necessary to optimize communication between treating clinicians and documentation of such communication. They include initial contact to discuss the treatment contract and clarify each clinician's responsibilities, formal written consent from the patient, regular contacts between clinicians to discuss the patient's progress, and collaboration between clinicians on the patient's treatment plan.

Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders

A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.

On Symbols and the Palaeolithic

Previous articleNext article No AccessDiscussion and CriticismOn Symbols and the PalaeolithicPhilip G. ChasePhilip G. Chase Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Current Anthropology Volume 35, Number 5Dec., 1994 Sponsored by the Wenner-Gren Foundation for Anthropological Research Article DOIhttps://doi.org/10.1086/204322 Views: 9Total views on this site Citations: 12Citations are reported from Crossref Copyright 1994 The Wenner-Gren Foundation for Anthropological ResearchPDF download Crossref reports the following articles citing this article:Duilio Garofoli, Antonis Iliopoulos Replacing Epiphenomenalism: a Pluralistic Enactive Take on the Metaplasticity of Early Body Ornamentation, Philosophy & Technology 32, no.22 (Nov 2017): 215–242.https://doi.org/10.1007/s13347-017-0296-9John Knight Human–Animal Relations, (Sep 2018): 1–8.https://doi.org/10.1002/9781118924396.wbiea1997Marc Kissel, Agustín Fuentes ‘Behavioral modernity’ as a process, not an event, in the human niche, Time and Mind 11, no.22 (Jun 2018): 163–183.https://doi.org/10.1080/1751696X.2018.1469230Ian Watts, Michael Chazan, and Jayne Wilkins Early Evidence for Brilliant Ritualized Display: Specularite Use in the Northern Cape (South Africa) between ∼500 and ∼300 Ka, Current Anthropology 57, no.33 (Apr 2016): 287–310.https://doi.org/10.1086/686484Antonis Iliopoulos The material dimensions of signification: Rethinking the nature and emergence of semiosis in the debate on human origins, Quaternary International 405 (Jun 2016): 111–124.https://doi.org/10.1016/j.quaint.2015.08.033Erkki Luuk The structure and evolution of symbol, New Ideas in Psychology 31, no.22 (Aug 2013): 87–97.https://doi.org/10.1016/j.newideapsych.2012.06.001Lawrence Josephs The Co-Evolution of Sexual Desire, Narcissistic Vulnerability, and Adaptations for Reproductive Advantage, The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 38, no.11 (Mar 2010): 3–25.https://doi.org/10.1521/jaap.2010.38.1.3Chris Knight The Origins of Symbolic Culture, (Jul 2010): 193–211.https://doi.org/10.1007/978-3-642-12142-5_14Alex Mackay, Aara Welz Engraved ochre from a Middle Stone Age context at Klein Kliphuis in the Western Cape of South Africa, Journal of Archaeological Science 35, no.66 (Jun 2008): 1521–1532.https://doi.org/10.1016/j.jas.2007.10.015Robert E. Morley The Self-blinding of Oedipus and the Theory of Repression, Psychoanalytic Studies 2, no.22 (Aug 2010): 159–176.https://doi.org/10.1080/14608950050013341Chris Knight, Camilla Power, Ian Watts The Human Symbolic Revolution: A Darwinian Account, Cambridge Archaeological Journal 5, no.11 (Dec 2008): 75–114.https://doi.org/10.1017/S0959774300001190Ian Watts, Andrew J. Elliot, Mark D. Fairchild, Anna Franklin Early color symbolism, (): 319–339.https://doi.org/10.1017/CBO9781107337930.016

A History of Medical Hypnosis

From the origins of mysticism and theatrics, trivialized by stage performers, psychics, and charlatans, modern medical hypnosis has struggled to achieve and maintain a sense of professional integrity. Many of the principles of dynamic psychiatry are deeply rooted in the work of the early healers. Yet hypnosis as a clinical entity continues to fall in and out of favor over the years; again it is now being pushed beyond the limits of that which is reasonable and valid.

From Mesmer to Freud: Magnetic Sleep and the Roots of Psychological Healing

Adam Crabtree, in a scholarly and thoughtful book, has clearly established the seminal role of in modern dynamic psychiatry. In a carefully documented and exquisitely referenced text, Crabtree has established how the concepts initiated by Mesmer and his colleagues under the rubric animal magnetism have led to our current conceptualizations of psychodynamic processes and psychopathology. This book will be quite a revelation for those who conceive of Franz Anton Mesmer only as a purple-cloaked charlatan preying on vulnerable hysterics to his own profit, finally unmasked by the Franklin Commission empaneled by Louis XVI of France. In point of fact, Mesmer was a gifted musician, a friend of the Mozarts, and a graduate of one of the most distinguished medical schools in the world at that time, the University of Vienna. He was effective in treating a large number of seriously ill patients who had been deemed hopeless by

The concept of boundaries in clinical practice: theoretical and risk- management dimensions

The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact. While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context. Heightened awareness of the concepts of boundaries, boundary crossings, and boundary violations will both improve patient care and contribute to effective risk management.

Multiple Personality Disorder and Iatrogenesis: The Cautionary Tale of Anna O

An examination of Breuer's treatment of Anna O. illustrates some of the controversies surrounding the recent rise of case reports of multiple personality disorder. Anna O., the first patient of the cathartic method, psychoanalysis, and dynamic psychiatry, fits current criteria for multiple personality disorder. Breuer's treatment, however, may have contributed to her states of absence; the timing, type, and intensity of Breuer's interventions make it possible that he unwittingly encouraged and amplified Anna's dissociations, reified her ego fragments, and then explained Anna's symptoms with the pseudomemories and confabulations recovered from Anna while she was hypnotized. A review of Breuer's treatment highlights some of the controversial aspects of multiple personality disorder, specifically its possible vulnerability to iatrogenesis via suggestion and unconscious collusion and other factors. The current stance of some multiple personality disorder enthusiasts, opaque to their participation in interactions that may lead to certain patient productions, resembles the older psychoanalytic stance exemplified by the early Breuer and Freud. The dialectic of the therapist as a neutral observer versus as an influential participant continues to be a focus of controversy, both within psychoanalysis and psychotherapy and in the understandings of the etiology and treatment of multiple personality disorder.

The Person-Key to Understanding Mental Illness: Towards a New Dynamic Psychiatry, III

The Person-Key to Understanding Mental Illness: Towards a New Dynamic Psychiatry, III

An outcome study of psychotherapy for patients with borderline personality disorder.

This study evaluated the effectiveness of well-defined outpatient psychotherapy for patients with borderline personality disorder. Thirty patients with borderline personality disorder diagnosed according to the DSM-III criteria were given twice weekly outpatient psychotherapy for 12 months by trainee therapists who were closely supervised. The treatment approach was based on a psychology of self (this term being used in its broad sense), and strong efforts were made to ensure that all therapists adhered to the treatment model. Outcome measures included frequency of use of drugs (both prescribed and illegal), number of visits to medical professionals, number of episodes of violence and self-harm, time away from work, number of hospital admissions, time spent as an inpatient, score on a self-report index of symptoms, and number of DSM-III criteria (weighted for frequency, severity, and duration) fulfilled. The subjects showed statistically significant improvement from the initial assessment to the end of the year of follow-up on every measure. Moreover, 30% of the subjects no longer fulfilled the DSM-III criteria for borderline personality disorder. This improvement had persisted 1 year after the cessation of therapy. The results suggest that a specific form of psychotherapy is of benefit for patients with borderline personality disorder.

Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview

Diagnosis and treatment of the dissociative disorders may be delayed for many years because of difficulties in detecting patients at high risk for dissociative disorders. This study investigates the utility of the Dissociative Experiences Scale (DES), a self-report instrument for dissociative experiences, in detecting patients at high risk for dissociative disorders. The clinician-administered Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) was used as the diagnostic standard, and 36 outpatients with mixed diagnoses and nine normal subjects were evaluated for the presence and absence of a dissociative disorder. DES scores were then compared. Results indicate that a DES cutoff score of 15-20 yields good to excellent sensitivity and specificity as a screening instrument. However, for higher cutoff points the sensitivity can be much lower. Thus, although the DES can be used to identify some high-risk patients, they should be further evaluated with such diagnostic instruments as the SCID-D or by in-depth clinical follow-up.

Dr. Siever and Colleagues Reply

Dr. Siever and Colleagues Reply