Friday, December 20, 2013

Psychiatric Diagnosis: Core Reactions & Reasons

Influential psychiatrists Sigmund Freud & Patrick McGorry
McGorry is "the guru" of early intervention in psychosis.
Diagnostic categorizations in the hands of the educated & therefore “qualified,” yet still emotionally immature, DO have a devastating affect on many people’s lives.

Please consider:
“First of all, let’s back off a little bit from clear cut diagnostic categories because diagnostic categories are totally resultant of a consensus of a series of behavioral and psychological features; so basically, a fever-type model.

What I’m going to talk a lot about are common cores that seem to transcend diagnostic categories.” _Stephen Porges.


Professor Stephen Porges, is the genius behind “The Polyvagal Theory,” (Porges, 2011) which helped me resolve my experience of “affective psychoses.”

In my own first episode of psychosis (FEP), in my case a euphoric mania, my 34 year journey to understand affective psychosis from the “inside out,” may have been happily short circuited, if I’d seen a mature and empathic psychiatrist, like professor Patrick McGorry, instead of the emotionally immature one, who “reactively” pronounced me schizophrenic within fifteen minutes. Of course he’d read the referral letter from a G.P. “Exhibits signs of schizophrenia,” and sadly so had I, and lacking real-life experience, I trusted doctors back in 1980. So did my family and friends, due to the “paternalistic” nature of human societies.

Another influential psychiatrist
Consider an excerpt from Allen Frances book “Saving Normal,” a title which begs the question; do psychiatrist’s understand their own brain-body function:

Susan’s Story: The Fad Overdiagnosis of Adult Bipolar Disorder

The long story, short:
Susan asked to see a psychiatrist. “Near the session’s end, Dr. A very nonchalantly said, ‘I think you’re a little bipolar.’ I was shocked and started to cry. Dr. A explained her reasoning: I was worse on antidepressants, couldn’t sleep, and had a slight family history of bipolar. She prescribed two atypical antipsychotics: Abilify and Seroquel.”

“The diagnosis didn’t sit well with me, but I trusted my doctor.” She shouldn’t have.

The doctor surely meant well but was dead wrong— shooting from the hip she had missed the diagnostic target. Just as “schizophrenia” had been the fad diagnosis in the 1960s, bipolar disorder has recently exploded as the diagnosis du jour— pushed aggressively by misleading drug company marketing. Dr. A had fallen for it and was seeing a “little bit of bipolar” where in fact there was none. That’s how fads work. Surely, Dr. A would have been more careful had she anticipated the enduring harm caused by her misdiagnosis. Done carelessly and callously, diagnosis can trigger an extended treatment nightmare. (Frances, 2013)

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"Education is what remains after one has forgotten
everything he learned in school." _Albert Einstein.

In the inherent anxiety of the lived-moment, how “aware” is the average psychiatrist of their own subconscious processes? Has a wholesale embrace of the “fever-type” medical model, led to a Descartian Error of senseless belief? A senseless mindset, encapsulated in the current myopic focus on the brain, as the epicentre of our being. Where, is an understanding of the body and the constant feedback from our major organs, which unconsciously underpins, this “affective state” we label, mind? Do psychiatrist’s read the literature of any other scientific discipline, beyond their own self-serving prism of habituated diagnosis? Are psychiatrist’s not capable of sensing their own nervous system activity, and exploring their unconscious any more? Is Freud’s iceberg metaphor, for our human experience not relevant these days? “So last century,” as one educated wit, writes on ISPS-AUNZ.

Such an embrace of a “fever-type” model of psychotic experience WILL block a cognitive acceptance of my resolution story, of course. The apparently well educated and qualified psychiatrist, (although others would suggest “indoctrinated” is these days, a more accurate term) will experience a cognitive dissonance towards my written and spoken words. A taken for granted and unconsciously stimulated reaction, to the image of my lack of recognizable status. Did we ever really take on board Moses ancient parental injunction about worshiping false idols? Is our taken for granted reaction to the image of status, a senseless reaction? Which in my experience, is an “image/affect” at the core of our “mind” experience? And, perhaps, what lies a the heart of our “common cores that seem to transcend diagnostic categories.” Please contemplate:

Cognitive Dissonance:
This is the uncomfortable feeling that develops when people are confronted by “things that shouldn’t ought to be, but are.” If the dissonance is sufficiently strong, and is not reduced in some way, the uncomfortable feeling will grow, and that feeling can develop into anger, fear and even hostility. To avoid cognitive dissonance people will often react to any evidence which disconfirms their beliefs by actually strengthening their original beliefs and create rationalizations for the disconfirming evidence. The drive to avoid cognitive dissonance is especially strong when the belief has led to public commitment. 
There are three common strategies for reducing cognitive dissonance. One way is to adopt what others believe. Parents often see this change when their children begin school. Children rapidly conform to “group-think,” and after a few years, they need this particular pair of shoes, and that particular haircut or they will simply die. The need to conform to social pressure can be as psychically painful as physical pain.

A second way of dealing with cognitive dissonance is to “apply pressure” to people who hold different ideas. This explains why mavericks are so routinely shunned by conventional wisdom. To function without the annoying psychic pain of cognitive dissonance, groups will use almost any means to achieve a consensus reality.

A third way of reducing cognitive dissonance is to make the person who holds a different opinion significantly different from oneself. This is normally done by applying disparaging labels. The heretic is disavowed as stupid, malicious, foolish, sloppy, insane, or evil and their opinion simply does not matter. (which will be an unconsciously stimulated reaction to my writing here)

When we are publicly committed to a belief, it is disturbing even to consider that any evidence contradicting our position may be true, because a fear of public ridicule adds to the psychic pain of cognitive dissonance. Commitment stirs the fires of cognitive dissonance and makes it progressively more difficult to even casually entertain alternative views.

“Without deep and active involvement in controversy, and/or a degree of philosophical self-consciousness about the social process of science, people may not notice how far scientific practice can stray from the text book model of science.” (Radin, 2009) (In brackets mine)

According to a taken for granted “fever-type” medical model of psychotic experience, my resolution story, “shouldn’t ought to be,” but is. But I suspect that most psychiatrist’s have never read John Weir Perry’s “Trails of the Visionary Mind” or even considered psychosis as “as an attempt to heal, or as a stage in a developmental process that transports the subject beyond “illness” or “normalcy” into a positive transformation of the self.” (Perry, 1999)


Jacob's Ladder - William Blake

I suspect that most psychiatrist’s have never really contemplated the “paradox,” in an acceptance that “mania” has led some people to saintly revelation and others like William Blake, to heavenly artistic creation. But I don’t judge psychiatrists here, I know they have to make a living.

Yet we humans can be so paradoxical and exasperating, aspects of our divine nature I suspect. Although, apparently well educated (psychologists & psychiatrists) may judge my comment on divinity, as just “raving …?” After all, I have been categorized and certified by so many of them. You can read a a somewhat mystical analysis of my psychosis resolution journey here



These days, I’d love to have my first psychiatrist present in a group therapy session. Perhaps he’d discover that “identified patients,” another so last century term, DO discover the value of lived experience, and the wisdom only experience teaches us. Real-life wisdom, beyond the senseless reactions of the educated & therefore “qualified,” yet still emotionally immature. Should we really be so “paternalistically” trusting of all doctors and our educated priesthood? Consider:

In the “personification” of the human condition, story of Jesus Christ, was it not, an ever present, educated priesthood, who so desperately needed to “shoot the messenger?” And what's love got to do with the taken for granted symbols of status and rank, in our human societies? Consider some sage advice:

"When the power of love overcomes the love of power,
 the world will know peace." _Jimi Hendrix.

* * * * * * *

Please contemplate the unconscious affects of an emotionally adolescent ego:

Affect and Ego: Lacan dates the era of the ego from the late seventeenth century, while Foucault assigns an intensification of knowledge as the will to power, to the same period. Both are aware how the passion to control the other, causes a person to seek knowledge as a means to control, and that the exercise of such knowledge is aligned with discipline from without, or “objectification.” Taken to its objectifying extreme, this process leads to our present madness, which is the destruction of future life, even our own, for the sake of immediate gratification. (Brennan, 2004)

The above quotation is from a great Australian academic, who like professor Patrick McGorry, hailed from the University of Melbourne. Teresa Brennan, died before completing her book, “The Transmission of Affect,” which helped me enormously in my quest to understand the internal nature of my affective psychoses. In her book professor Brennan explores the nature of what Silvan Tomkins describes as nine "innate affects" and the probability of their contagion. Consider another excerpt from the late Teresa Brennan's book:

In the 20th century’s cognitive psychology, a distinction between affect as a present thing--and desire--as an imagined affect, holds significance to deal with the cognitive component in desires, which involve goals and thinking. Critical to the transmission of affect though, is the moment of “judgment,” when the “projection” or “introjection” of affect takes place. By “affect,” I mean the physiological shift accompanying a judgment. By judgment I mean “any evaluative (positive or negative) orientation towards an object.”

The evaluative or judgmental aspects of affects, is critical in distinguishing between these physiological phenomena we call affects, and the phenomena we call feeling or discernment. In other words feelings are not the same thing as affects. At present, feelings are a subset of affects, along with moods, sentiments and emotions. This distinction between affects and feelings comes into its own once the focus is on “the transmission of affect.”

There is no need to challenge an existing view that emotions are synonymous with affect, yet what needs to be borne in mind is that affects are material, physiological things. Affects have an “energetic” dimension, which is why they can enhance or deplete.

They enhance when they are projected outward, when we are relieved of them; in popular parlance this is called “dumping.” Frequently, affects deplete when they are “introjected,” when we carry the “affective” burden of another, either by a straightforward transfer, or because the other’s anger becomes your depression. But other’s feeling can also enhance as affect, as when you become energized just being with loved ones or friends. Yet with some other’s you are bored or drained, tired or even depressed. All this means that we are not completely self-contained in terms of our affective energies. There is no secure distinction between the “individual” and the “environment.” (Brennan, 2004)

Astute readers with a deep interest in the nature of the mental illness experience, may be wondering about the link between "affective psychosis" a well worn term in the literature of psychiatry, as is an assumption of non-affective psychosis, and this uncommon term "affect?" It certainly became of prime interest to me, after I'd stumbled on Allan N Schore's "Affect Dysregulation & Disorders of the Self." Allan Schore, known amongst his many admirers as "the Einstein of Neurobiology" presents a language beyond the common vocabulary, in his epic tome "Affect Regulation & the Origins of the Self," while making a quite specific statement about the unconscious nature of human motivation. "The attempt to regulate affect - to minimize unpleasant feelings and to maximize pleasant ones - is the driving force in human motivation."

Hence I ask the question above "do psychiatrist’s understand their own brain-body function," while pondering why there are no references to Schore's work in “The Recognition and Management of Early Psychosis. A Preventive Approach. Second Edition” (McGorry et al, 2012). Neither does the word "unconscious" appear once. I'm sure the intention of early prevention, is filled with sincere and good intent. Yet as Allen Frances points out, in the hands of those less mature than people like professor McGorry, "diagnosis can trigger an extended treatment nightmare." And I'm sure many readers will recall the commonsense proverb of how "the road to hell is paved..." Perhaps it would be useful to consider and the economics of survival and unconscious motivations in our era of a knowledge economy:

Perception, PhD's & other Misconceptions:
In our current age of a Knowledge Economy. Is PhD research into mental health about the livelihood of researchers, more so, than the mental health of other people? Read more here


* * * * * * *

PSYCHIATRIST: ‘But euphoric mania is so emotional, so irrational, isn’t it?’

YET CONTEMPLATE THE BODY & EMOTION, AS A WELL OF TRUTH:

“However men may differ in disposition and in education, the foundations of human nature are the same in everyone. And every human being can draw in the course of his education from the inexhaustible wellspring of the divine in man's nature. But here likewise two dangers threaten: a man may fail in his education to penetrate to the real roots of humanity and remain fixed in convention a partial education of this sort is as bad as none or he may suddenly collapse and neglect his self-development.” _I Ching #48 “The Well”

Read more about deeper truths and my experiential journey to understand psychosis, from the inside out, here

Well, I hope this post may have stirred your interest in your primarily unconscious nature, dear reader. What do you think? Or more importantly, what do you feel? And do you remember your first days of life? Your first thought or your first spoken word? Did you crawl before you were taught how to think? Do we all forget the nurture in our nature? And is there an unconscious image/affect, beneath your vaunted intellect? Are there core reactions for your reasons? Please consider ancient words of wisdom:

"The words of truth are always paradoxical." _Lao Tzu.


* * * * * * *

You might like to read more about my journey here and Unconscious Reactions, Beneath Our Sense of Reason? Or read more about the influential psychiatrists mentioned in this essay.

The unconscious mind (or the unconscious) consists of the processes in the mind that occur automatically and are not available to introspection, and include thought processes, memory, affect, and motivation. Even though these processes exist well under the surface of conscious awareness they are theorized to exert an impact on behavior. The term was coined by the 18th-century German romantic philosopher Friedrich Schelling and later introduced into English by the poet and essayist Samuel Taylor Coleridge. The concept was developed and popularized by the Austrian neurologist and psychoanalyst Sigmund Freud. From Wikipedia, the free encyclopedia

McGorry is Professor of Youth Mental Health at the University of Melbourne. He has written numerous peer reviewed articles, published in journals including The Lancet, the British Journal of Psychiatry, the American Journal of Psychiatry and the Medical Journal of Australia. He is executive director of Orygen Youth Health and founding editor of Early Intervention in Psychiatry published by the International Early Psychosis Association. From Wikipedia, the free encyclopedia

Allen J. Frances, MD (born 1942) is an American psychiatrist best known for chairing the task force that produced the fourth revision of Diagnostic and Statistical Manual (DSM-IV) and for his critique of the current version, DSM-5. He warns that the expanding boundary of psychiatry is causing a diagnostic inflation that is swallowing up normality and that the over-treatment of the "worried well" is distracting attention from the core mission of treating the more severely ill. From Wikipedia, the free encyclopedia 

References:

Porges, S, 2011, Radio interview transcript, “http://www.stephenporges.com/Images/Porges%20Shrink%20Rap.pdf”

Porges, S, 2011, “The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation," Norton, USA

Frances, A, 2013, "Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life," Harper Collins, USA

Brennan, T, 2004, “The Transmission of Affect,” Cornell University Press, USA

Radin, D, 2009, “The Neotic Universe,” Corgi Books, UK

Perry, J, 1999, “Trails of The Visionary Mind,” New York University Press, USA

Schore, A, 1998, “Affect Dysregulation and Disorders of the Self,” Norton, USA

Schore, A, 1995, “Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development” Norton, USA

Jackson, J, McGorry, P, 2012, "The Recognition and Management of Early Psychosis: A Preventive Approach," Corgi Books, UK

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