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Enlightenment now

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If you want to read a book that will change your perspective, enlightenment now is the book for you. Even if you’re a skeptic, not believing that the world is actually getting better contrary to what the news tells us, you should read it. If it just is to argue about what he writes, that’s good too. We need good discussions, and the book gives you plenty of examples to impress others with. It’s so packed with new information that I used months reading it, just to digest everything before I continued with it. The trip to this surprising world, so much better than I though, was refreshing and showered me with hope and inspiration. Still not convinced? Why not check it out yourself ?

You can find the book here: Amazon.

If you want, I can even send it to a lucky follower of my book through audible. Just comment and it will be yours for free.

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Schizophrenia, Trauma, Dissociation, and Scientific Revolution

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This is a repost. Read the whole article by here.

In my mid-20s, at the beginning of my training as a clinical psychologist, I was placed on a psychiatric day treatment ward in one of the poorer parts of Boston. One day, the experienced therapist with whom I led a men’s group was sick, and I was called on to do the group by myself. A ball of nerves, I decided to ask the men about their ancestry (with the helpful presence of a globe in the room) rather than risk silence. I briefly spoke of my Russian and Eastern European great-grandparents to set the tone and then spoke with each man in turn. After a few minutes of this exercise, there was a pause. A fellow from across the room looked at me and said softly, “You think you’re better than us, don’t you? You think this could never happen to you.”

I was stunned. Somehow I stammered a denial, but of course he was right. Perhaps I didn’t think I was better than them, but I certainly thought I was different from them. Like most of us in Western societies, I had grown up believing that psychiatric disorders were illnesses—diseases like any other—and there had been nothing in my training until then to convince me otherwise.

But learning about trauma, dissociation, and attachment in the ensuing decades has changed my mind. And I am not the only one.

PARADIGMS IN CONFLICT

Over the past several decades, the study of schizophrenia and the study of the dissociative disorders have been dominated by opposing paradigms. For schizophrenia, the assumption of a genetic basis and biological causation has reigned supreme. Adverse childhood experiences are viewed as irrelevant at best and adult stressful or traumatic experiences as only “releasing” underlying disease mechanisms. Symptoms are considered meaningless—unrelated to a person’s life circumstances—and psychotherapeutic approaches, when used at all, are limited to supporting medical interventions. In diagnosing schizophrenia for clinical or research purposes, posttraumatic and dissociative disorders are rarely considered or ruled out; indeed, in adherents to this paradigm, posttraumatic disorders are frequently disdained, discredited, or simply ignored.

In contrast, the overriding paradigm for the study of dissociative disorders has focused almost exclusively on life events—traumatic or otherwise—that are assumed to be meaningfully related to the symptoms a person experiences. A wide range of psychotherapeutic approaches to treatment are supported and advocated, whereas most medical interventions are viewed as anathema. At the same time, many trauma-oriented clinicians and researchers think of schizophrenia only as something dissociative disorders are not—but are often confused with; schizophrenia’s validity as a biologically based entity is rarely questioned.

Consider how these two paradigms deal with auditory verbal hallucinations. To persons adhering to the dominant biological paradigm (or “medical model”), voices are psychotic symptoms to be treated with medications or coped with using distraction techniques. As Colin Ross (2008 Ross, C. A. 2008. “Dissociative schizophrenia”. In Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology, Edited by: Moskowitz, A.Schäfer, I. and Dorahy, M. J. 281294London, , EnglandWiley. [Google Scholar]) put it, from this perspective the notion of talking with someone’s voices would be as absurd as “asking a patient’s knee a question” (p. 284). In contrast, in a trauma/dissociation paradigm, voices are split-off parts of the personality that are ignored at one’s own peril—acknowledging and engaging these disowned parts, though often challenging, is typically advocated. The schizophrenia field views voices as biologically generated indications of a brain disorder, whereas the dissociation field views them as psychological indications of unresolved trauma or loss. Two more disparate perspectives cannot be imagined. Currently, these fields eye each other with considerable suspicion and, to a large extent, do not speak the same language or experience the world in the same way.

EUGEN BLEULER: THE MARRIAGE OF DISSOCIATION AND SCHIZOPHRENIA

But it was not always this way. When Eugen Bleuler published his Dementia Praecox oder Gruppe der Schizophrenien (Dementia Praecox or the Group of Schizophrenias) 100 years ago, the construct of schizophrenia was infused with dissociative concepts (Moskowitz, 2008Moskowitz, A. 2008. “Association and dissociation in the historical concept of schizophrenia”. In Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology, Edited by: Moskowitz, A.Schäfer, I. and Dorahy, M. J. 3549London, , EnglandWiley. [Google Scholar]Moskowitz & Heim, 2011Moskowitz, A. and Heim, G. in press. “Affect, dissociation, psychosis: Essential components of the historical concept of schizophrenia”. In Psychosis and emotion: The role of emotions in understanding psychosis, therapy and recovery, Edited by: Gumley, A.Gilham, A.Taylor, K. and Schwannauer, M.London, , EnglandRoutledge. [Google Scholar]). While insisting on an organic basis for the disorder, Bleuler recognized the symptoms his patients described as meaningfully related to their life experiences and used hypnotherapy and psychotherapy in his clinical work. He justified changing the name of the disorder largely on the basis that the “splitting” of the “different psychic functions” was central to its pathology (Bleuler, 1911/1950Bleuler, E. 1950Dementia praecox or the group of schizophrenias, Edited by: Zinkin, J. New York, NYInternational Universities Press. Original work published 1911 [Google Scholar], p. 8). Bleuler’s 1911Moskowitz, A. and Heim, G. 2011Eugen Bleuler’s Dementia praecox or the group of schizophrenias (1911): A centenary appreciation and reconsiderationSchizophrenia Bulletin, 37(3): 471479. [Google Scholar]“definition” of schizophrenia reads almost as a calling card for dissociative disorders:

If the disease is marked, the personality loses its unity; at different times different psychic complexes seem to represent the personality … one set of complexes dominates the personality for a time, while other groups of ideas or drives are “split off” and seem either partly or completely impotent. (p. 9)

The profoundly dissociative nature of Bleuler’s concept of schizophrenia has been ignored for many decades but should be apparent to any unbiased reader, as has been recognized by Colin Ross (2004Ross, C. A. 2004Schizophrenia: Innovations in diagnosis and treatmentNew York, NYHaworth Press. [Google Scholar]) and myself (Moskowitz, 2008Moskowitz, A. 2008. “Association and dissociation in the historical concept of schizophrenia”. In Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology, Edited by: Moskowitz, A.Schäfer, I. and Dorahy, M. J. 3549London, , EnglandWiley. [Google Scholar]; Moskowitz & Heim, in press).

However, Bleuler’s ideas about schizophrenia have little currency in today’s nosological world; all but the name has been jettisoned, and even that has been retained with considerable squeamishness—requiring constant vigilance against its interpretation as “split personality.” Instead, the architects of our current diagnostic system harked back to Bleuler’s predecessor, Emil Kraepelin, for inspiration.

EMIL KRAEPELIN, TAXONOMIES, AND GENERAL PARESIS

Despite Kraepelin’s experimental psychology pedigree (he studied with Wilhelm Wundt early in his career), his ideas on Dementia Praecox were far less informed by psychology than those of Bleuler (who used Jung’s word association experiments to aid his understanding), and he saw concepts of dissociation as irrelevant to diagnostic conceptualization. Rather, Kraepelin’s approach to parsing mental disorders was strongly influenced by biological classifications, such as Linnæus’s taxonomy of plants and the system developed by his own esteemed older brother, the biologist Karl Kraepelin (Weber & Engstrom, 1997Weber, M. M. and Engstrom, E. J. 1997Kraepelin’s “diagnostic cards”: The confluence of clinical research and preconceived categoriesHistory of Psychiatry, 8: 375385. [Google Scholar]). In addition, the model on which Kraepelin based his concept of Dementia Praecox was General Paresis of the Insane—sometimes called Dementia Paralytica. General Paresis was a terminal condition that combined psychotic symptoms with paralysis and ultimately death and was widespread in Europe during the early part of the 19th century. The triumphant linking of its symptoms with a brain disorder caused by late-stage syphilitic infections in the mid-19th century clearly provided Kraepelin with a template or paradigm—a “model disease entity”—for mental disorders in general and dementia praecox in particular (Jablensky, 1995Jablensky, A. 1995Kraepelin’s legacy: Paradigm or pitfall for modern psychiatry?European Archives of Psychiatry and Clinical Neuroscience, 245: 186188. [Google Scholar], p. 186).

THE NEO-KRAEPELINIAN PARADIGM OF MENTAL DISORDERS

The example of General Paresis, mental disorders were brain disorders but that any classification of psychopathology was best pursued through identifying brain pathology, not only drove Kraepelin’s typology but also still underpins that of the current diagnostic systems influenced by his thinking—the Diagnostic and Statistical Manual of Mental Disorders(3rd ed. [DSM–III]), the International Classification of Diseases–9, and their related progeny (Jablensky, 2007Jablensky, A. 2007Living in a Kraepelinian world: Kraepelin’s impact on modern psychiatryHistory of Psychiatry, 18: 381388. [Google Scholar]). For the past three or four decades, the classification of mental disorders has been dominated by this approach, which came out of a group of primarily American psychiatrists self-identified as neo-Kraepelinian (frequently referred to as a movement or even a revolution).

As the neo-Kraepelinians set about revising the psychiatric diagnostic system in the 1970s, and reached their goal with the 1980 publication of the DSM–III, they were ostensibly creating an atheoretical system with improved reliability over its precursors. But in reality, they were clearly motivated by the belief that these conditions were medical disorders like any other; indeed, in a publication from that time, two prominent researchers spoke of “coveting” for schizophrenia the solid genetic grounding of “pellagra, paresis, tuberculosis, polio, and PKU [phenylketonuria]” (Gottesman & Shields, 1973Gottesman, I. I. and Shields, J. 1973Genetic theorizing and schizophreniaBritish Journal of Psychiatry, 122: 1530. [Google Scholar], p. 15).

A fundamental task for the neo-Kraepelinians was to shore up the distinction between schizophrenia and manic depression, a distinction that had been blurred by Bleuler’s broad category. They accomplished this primarily by strongly emphasizing specific psychotic symptoms in the diagnostic criteria for schizophrenia (particular auditory hallucinations and delusions proposed by Kurt Schneider—so-called first rank symptoms) and by undermining the validity of the schizoaffective disorder category in a number of ways (Moskowitz & Heim, in press-a). The Kraepelinian dichotomy of schizophrenia and bipolar disorder has been explicitly seen as providing the foundation for a biologically based nosology; indeed, challenges to the clear differentiation of schizophrenia and bipolar disorder are often viewed as undermining the validity of the entire diagnostic system (Kendell, 1987Kendell, R. E. 1987Diagnosis and classification of functional psychosesBritish Medical Bulletin, 43: 499513. [Google Scholar]). In addition, the neo-Kraepelinians have articulated a number of more general assumptions, including (a) that mental disorders are discrete from one another and from “normality” and (b) that advances in understanding mental disorders will come primarily from focusing on neurobiology (Klerman, 1978Klerman, G. L. 1978. “The evolution of a scientific nosology”. In Schizophrenia: science and practice, Edited by: Shersow, J. C. 91121Cambridge, MAHarvard University Press. [Google Scholar]). This level of domination over research and practice (for example, DSM–IV diagnoses are required for insurance payments and frequently for journal article acceptance) clearly constitutes what Thomas Kuhn termed a scientific paradigm.

PARADIGMS AND SCIENTIFIC REVOLUTIONS

According to Kuhn (1970Kuhn, T. S. 1970The structure of scientific revolutions2ndChicago, ILUniversity of Chicago Press. [Google Scholar]), in The Structure of Scientific Revolutions, the idea that science advances in a linear fashion with knowledge continually accruing so that “reality” or “truth” is more and more closely approximated over time is a myth. Rather, he argued, a field advances under the influence of a dominant paradigm, meaning both a particular past scientific achievement held up as a model or exemplar (as in the case of General Paresis and psychopathology) and the generally accepted beliefs and attitudes of a particular scientific community. A paradigm exerts an organizing influence on a field and guides research, determining to a large extent what types of research questions are considered legitimate and what sorts of answers are considered acceptable.

Kuhn (1970Kuhn, T. S. 1970The structure of scientific revolutions2ndChicago, ILUniversity of Chicago Press. [Google Scholar]) argued that paradigms change and a scientific revolution ensues when three conditions are met: (a) a period of crisis develops in which the paradigm fails to adequately answer questions considered fundamental; (b) serious “anomalies” occur in which phenomena not clearly compatible with the paradigm are observed; and, importantly (c) a suitable alternative paradigm that explains many of the previous findings and at least some of the observed anomalies comes to light. Kuhn saw scientific revolutions as taking time to resolve; he argued that changing such strongly held beliefs involved a process of persuasion and fundamental reorganization not unlike that of religious conversion: “Conversions will occur a few at a time until, after the last holdouts have died, the whole profession will again be practicing under a single, but now different paradigm” (Kuhn, 1970Kuhn, T. S. 1970The structure of scientific revolutions2ndChicago, ILUniversity of Chicago Press. [Google Scholar], p. 152).

Since the publication of the DSM–III in 1980, the ascendance of the neo-Kraepelinianparadigm in the psychiatric world has been paramount. It has driven our view of schizophrenia and marginalized acceptance of the dissociative disorders and posttraumatic stress disorder (PTSD). However, this paradigm is now under threat from many quarters—from within its ranks as well as from outside—and there is good reason to view it as a paradigm in crisis.

FAILURES OF THE NEO-KRAEPELINIAN PARADIGM

Evidence for fundamental tenets of the neo-Kraepelinian paradigm—that there are clear genetic or biological bases for schizophrenia and other mental disorders and that mental disorders are discrete from one another and from normal experiences—have not been supported.

Comorbidity of diagnoses, incompatible with viewing diagnoses as discrete categories, is rampant in the DSM–IV system and typically viewed as a major problem. Psychotic symptoms are now recognized as common to many disorders other than schizophrenia, and their presence in a significant portion of the community with no diagnosed mental disorder firmly suggests that the line between “normality” and “pathology” is not hard and fast (Van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2008Van Os, J.Linscott, R. J.Myin-Germeys, I.Delespaul, P. and Krabbendam, L.2008A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness—persistence—impairment model of psychotic disorderPsychological Medicine, 39: 179195.[Crossref][PubMed][Web of Science ®][Google Scholar]). In addition, evidence for the validity of schizoaffective disorder, a fundamental challenge to the Kraepelinian dichotomy, has accumulated over the years. The demonstrated existence of persons with prominent schizophrenic and affective symptoms undermines the core distinction between schizophrenia and bipolar disorder and provides an argument for viewing even severe psychopathology as a dimension or series of dimensions instead of as categories. Finally, the abject failure of genetic-based research to find any strong link with schizophrenia or bipolar disorder provides a further anomaly for the neo-Kraepelinianparadigm to explain or attempt to ignore (if anything, the genetic evidence points to a “shared neurobiology across the two disorders,” Thaker, 2008Thaker, G. 2008Psychosis endophenotypes in schizophrenia and bipolar disorderSchizophrenia Bulletin, 34: 720721. [Google Scholar], p. 720).

All of this is taking its toll on the medical model. As the neo-Kraepelinian edifice begins to crumble, adherents resort to stronger and stronger biological language, as though words such as neuropsychiatry and endophenotypes have the power to restore its once shining façade. The emphasis on endophenotypes is particularly telling, as this concept involves exploring putative underlying biological variables that may have only an indirectrelationship to the signs and symptoms of mental disorders. For example, a recent large-scale twin and family study focused on apparent genetic impairments in memory and intelligence as conveying liability for schizophrenia (Toulopoulou et al., 2010Toulopoulou, T.Goldberg, T. E.Mesa, I. R.Picchioni, M.Rijsdijk, F.Stahl, D.and … Murray, R. M. 2010Impaired intellect and memory: A missing link between genetic risk and schizophrenia?Archives of General Psychiatry, 67: 905913.[Crossref][PubMed][Web of Science ®][Google Scholar]). The strong emphasis on endophenotypes, arising from a failure to find clear connections between genetic makeup and psychiatric diagnoses or symptoms, suggests that the neo-Kraepelinianstalwarts have beaten a strategic retreat; at the same time that psychological approaches to treating and understanding psychiatric symptoms, including delusions and hallucinations, have made great strides, the dominant paradigm has given up the traditional territory of mental disorders—the signs and symptoms that people suffer from and that treatments target.

So, the neo-Kraepelinian, categorical, medically based diagnostic system clearly seems to be in a state of crisis. But, as Kuhn has noted, a discipline such as psychopathology will not loosen its grip on a paradigm unless a suitable alternative is available to take its place. What is the evidence that one is appearing?

THE EMERGING TRAUMA/DISSOCIATION PARADIGM

In recent years, evidence has accumulated that traumatizing events are strongly linked to psychopathology in general and psychotic symptoms in particular. Kenneth Kendler, a prominent psychiatric geneticist, concluded from a carefully designed large-scale twin study that childhood sexual abuse was “causally related” to the development of psychiatric and substance abuse disorders (Kendler et al., 2000Kendler, K. S.Bulik, C. M.Silberg, J.Hettema, J. M.Myers, J. and Prescott, C. A. 2000Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysisArchives of General Psychiatry, 57: 953959.[Crossref][PubMed][Web of Science ®][Google Scholar], p. 953). In a subsequent commentary, he noted that the more than threefold increase in major depression attributable to severe sexual abuse was “much greater” than the odds ratios associated with any gene putatively linked to schizophrenia or bipolar disorder (Kendler, 2006Kendler, K. S. 2006Reflections on the relationship between psychiatric genetics and psychiatric nosologyAmerican Journal of Psychiatry, 163: 11381146.[Crossref][PubMed][Web of Science ®][Google Scholar], p. 1140); he soberly concluded, “The project to ground our messy psychiatric categories in genes … may be in fundamental trouble” (Kendler, 2006Kendler, K. S. 2006Reflections on the relationship between psychiatric genetics and psychiatric nosologyAmerican Journal of Psychiatry, 163: 11381146.[Crossref][PubMed][Web of Science ®][Google Scholar], p. 1145). Psychotic symptoms in particular appear to be strongly linked to trauma, both adult trauma (particularly when associated with PTSD; e.g., Scott, Chant, Andrews, Martin, & McGrath, 2007Scott, J.Chant, D.Andrews, G.Martin, G. and McGrath, J. 2007Association between trauma exposure and delusional experiences in a large community-based sampleBritish Journal of Psychiatry, 190: 339343.[Crossref][PubMed][Web of Science ®][Google Scholar]) and childhood interpersonal traumas (including in longitudinal studies such as Arseneault et al., 2011Arseneault, L.Cannon, M.Fisher, H. L.Polanczyk, G.Moffitt, T. E. and Caspi, A. 2011Childhood trauma and children’s emerging psychotic symptoms: A genetically sensitive longitudinal cohort studyAmerican Journal of Psychiatry, 168: 6572.[Crossref][PubMed][Web of Science ®][Google Scholar]). These studies are becoming increasingly well designed, typically controlling for many potentially confounding variables, even apparently genetic ones. Furthermore, psychological trauma has been strongly linked to the development of delusions and hallucinations (Moskowitz, Read, Farrelly, Rudegeair, & Williams, 2009Moskowitz, A.Read, J.Farrelly, S.Rudegeair, T. and Williams, O. 2009. “Are psychotic symptoms traumatic in origin and dissociative in kind?”. In Dissociation and the dissociative disorders: DSM–V and beyond, Edited by: Dell, P. and ’Neil, J. O521533New York, NYRoutledge. [Google Scholar]), and dissociation has been found to consistently and powerfully predict auditory hallucinations (but not delusions) in a range of populations (Moskowitz & Corstens, 2007Moskowitz, A. and Corstens, D. 2007. “Auditory hallucinations: Psychotic symptom or dissociative experience?”. In Trauma and serious mental illness, Edited by: Gold, S. N. and Elhai, J. D. 3563Binghamton, NYHaworth Press. [Google Scholar]; several recently published studies have supported this relationship). Finally, brain changes long assumed to indicate a core genetic or biological neurodevelopmental disturbance in schizophrenia have been linked with chronic stressful or traumatic childhood experiences (Read, Perry, Moskowitz, & Connolly, 2001Read, J.Perry, B.Moskowitz, A. and Connolly, J. 2001The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental modelPsychiatry: Interpersonal and Biological Processes, 64: 319345.[Taylor & Francis Online][Web of Science ®][Google Scholar]Teicher et al., 2003Teicher, M. H.Andersen, S. L.Polcari, A.Anderson, C. M.Navalta, C. P. and Kim, D. M. 2003The neurobiological consequences of early stress and childhood maltreatmentNeuroscience and Biobehavioral Reviews, 27: 3344.[Crossref][PubMed][Web of Science ®][Google Scholar]). And these trauma-based brain changes are entirely consistent with emerging evolutionary-based explanations for psychotic symptoms (Grace, 2010Grace, A. A. 2010Ventral hippocampus, interneurons, and schizophrenia: A new understanding of the pathophysiology of schizophrenia and its implications for treatment and preventionCurrent Directions in Psychological Science, 19: 232237. [Google Scholar]Moskowitz, 2004Moskowitz, A. 2004“Scared stiff”: Catatonia as an evolutionary-based fear responsePsychological Review, 111: 9841002.[Crossref][PubMed][Web of Science ®][Google Scholar]).

IS THERE A SCIENTIFIC REVOLUTION IN THE HOUSE?

The failures of the current dominant medically based neo-Kraepelinian paradigm, coupled with the successes of an alternative paradigm focusing on adverse life experiences (including attachment disturbances) and dissociation, could herald the approach of a scientific revolution. Evidence that this may be occurring includes the increased willingness of prominent medical journals such as the American Journal of Psychiatry and Archives of General Psychiatry to publish studies supportive of this view (e.g., Arseneault et al., 2011Arseneault, L.Cannon, M.Fisher, H. L.Polanczyk, G.Moffitt, T. E. and Caspi, A. 2011Childhood trauma and children’s emerging psychotic symptoms: A genetically sensitive longitudinal cohort studyAmerican Journal of Psychiatry, 168: 6572.[Crossref][PubMed][Web of Science ®][Google Scholar]Kendler et al., 2000Kendler, K. S.Bulik, C. M.Silberg, J.Hettema, J. M.Myers, J. and Prescott, C. A. 2000Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysisArchives of General Psychiatry, 57: 953959.[Crossref][PubMed][Web of Science ®][Google Scholar]Scott et al., 2007Scott, J.Chant, D.Andrews, G.Martin, G. and McGrath, J. 2007Association between trauma exposure and delusional experiences in a large community-based sampleBritish Journal of Psychiatry, 190: 339343.[Crossref][PubMed][Web of Science ®][Google Scholar]). As more and more psychiatrists are shifting paradigms, it must be recognized that many medically trained individuals within the trauma and dissociative disorders field have long championed this perspective (of course, there are psychologists and other non-physicians who continue to firmly embrace the “medical model” as well, but these paradigms to a large extent do map onto disciplinary distinctions and tensions).

Should a new paradigm emerge, it will be a genuine biopsychosocial one, recognizing that genetics plays a role in psychopathology, likely in providing vulnerability to certain broad forms of mental disorders or to mental disorders in general. It will also recognize that life experiences from gestation on play a major role not only in the expression of psychiatric symptoms but also in the expression of the genes that underlie vulnerability to mental disorders. This new paradigm must also recognize some form of dimension or dimensions across apparently different types of mental disorders (evaporating the comorbidity “problem”) and between pathology and so-called normality. It will require recognition of the extent and severity of childhood trauma, a reality that has long faced considerable resistance from adherents to the medical model. Finally, the presence of dissociative conditions, with the corollary that such individuals are radically different at different times, must be taken into account not only clinically but also in the design of research—something to which the current paradigm has been blind.

The DSM–5 committees appear to have some awareness of these challenges. Dimensional perspectives are being considered for personality disorders and possibly as an axis alongside other categories. What is striking is that the schizophrenia committee is recommending the elimination of the (currently pathognomic) first rank symptoms (voices conversing or commenting, delusions involving intrusions or withdrawals of thoughts or behavior), belatedly recognizing that they have “no unique diagnostic specificity” for schizophrenia (American Psychiatric Association, 2011American Psychiatric Association. (2011). Schizophrenia.http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=411# (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=411#) [Google Scholar]). This is obviously welcome news (an early indication of a paradigm shift?), as the association of these clearly dissociative symptoms with schizophrenia has led to substantial misdiagnosis of dissociative identity disorder patients. But it also reminds us of the enigma that practically every attempt to define schizophrenia, from Bleuler to the present day, has invariably called forth dissociative identity disorder. That the paradigmatic biological disorder can be so easily confused with the paradigmatic environmental disorder should already be shaking the rafters of this house (but of course, as the dominant paradigm does not recognize dissociative identity disorder, it does not recognize this enigma!). The explanation for this puzzle should help us to understand the nature of schizophrenia—until then, we can firmly state that whatever schizophrenia is, it is not psychotic symptoms and certainly not auditory hallucinations. Unfortunately, the DSM–5 schizophrenia committee has not gone this far and continues to emphasize psychotic symptoms, even as the head of that committee, William Carpenter, warns against this approach (“Psychotic experience is to the diagnosis of mental illness as fever is to the diagnosis of infection—important, but non-decisive in differential diagnosis,” Fischer & Carpenter, 2009Fischer, B. A. and Carpenter, W. T.2009Will the Kraepelinian dichotomy survive DSM–V?Neuropsychopharmacology, 34: 20812087.[Crossref][PubMed][Web of Science ®][Google Scholar], p. 2081).

If a new paradigm does emerge, we can be sure that Kraepelin’s paradigmatic disease entity—General Paresis of the Insane—will be replaced. Perhaps it may not be possible to find a new exemplar for mental disorders in general, but PTSD would seem a worthwhile candidate for at least some of them—those clearly linked to trauma and characterized by dissociation (as, for example, has been proposed by Van der Hart, Nijenhuis, & Steele, 2006Van der Hart, O.Nijenhuis, E. and Steele, K. 2006The haunted self: Structural dissociation and the treatment of chronic traumatizationNew York, NYNorton. [Google Scholar], in their structural dissociation model). And the possibility that schizophrenia, or at least some form of psychotic disorder, could fit this model should not be rejected outright. Even Bleuler, the progenitor of schizophrenia, despite his commitment to an organic etiology, seemed to recognize this. A growing appreciation of this possibility could, quite literally, trigger a scientific revolution in our view of mental disorders altogether.

The stronger the affects, the less pronounced the dissociative tendencies need to be in order to produce the emotional desolation. Thus, in many cases of severe disease, we find that only quite ordinary everyday conflicts of life have caused the marked mental impairment; but in milder cases, the acute episodes may have been released by powerful affects. And not infrequently, after a careful analysis, we had to pose the question whether we are not merely dealing with the effect of a particularly powerful psychological trauma on a very sensitive person, rather than with a disease in the narrow sense of the word. (Bleuler, 1911/1950Bleuler, E. 1950Dementia praecox or the group of schizophrenias, Edited by: Zinkin, J. New York, NYInternational Universities Press. Original work published 1911 [Google Scholar], p. 300; Sünje Matthiesen, translation)

Protected: The dreamseller

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Protected: It’s my life

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The sound of crawling out of a black hole

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Recently, I wrote about a book called “Emotional Blackmail” by Susan Forward. At the end of the book, she writes about traps people fall into, that makes us vulnerable when dealing with difficult relationships. One of those traps, is the fear of falling into a “black hole” of loneliness and unhappiness. Forward describes this as a normal reaction that many can have, the fear is often worse than reality, but this fear can be so powerful that people stay in unhealthy relationships or situations. She has a concrete tip on how to handle those insecure feelings. First, she sits there with the patient and ask them to go “into” the black hole in their thoughts. While there, feeling vulnerable and like life never will be okay again, she asks the client to bring forward a good memory. In the book, a woman who is afraid of loosing her husband even if she wants a divorce herself, tells Susan that she feels so alone and afraid that she never will have anyone around her again. Forward then asks her to come up with a positive memory, and to think about what makes her happy in her day to day life. For this patient, a memory of when she was a child and got a horse, comes up. Susan asks her to remember this memory, and the patient immediately feels better and stronger. In this more positive mood, it is easier for her to remember other good things: She has friends, family and pleasurable interests, and she realizes that she can feel afraid and helpless, and still be able to get out of that feeling by thinking about happy memories and what she has today.

 

When reading that paragraph, I remember a dream I had many years ago. It started as a nightmare. I didn`t know where to go, and felt completely disoriented. I was trying to find my way back after walking in the mountains, but everything looked unfamiliar. I kept on walking, with panic growing inside. Suddenly, I followed a path that lead my to the most beautiful waterfall I`ve ever seen. It was surrounded by a tranquil space that made me cry because it was so wonderful. I felt completely safe and protected, and when I woke, the afterimage of this beautiful place, was still there. I can still feel relaxed and reassured when I think about this place, because it reminds me of beauty in the most difficult of circumstances. Whenever I feel down, I can bring that memory back, and it reminds me that sometimes, you just need to walk for a bit longer, and you will find something that takes your breath away and makes you happy.

So, are you afraid of falling into a black hole you can`t get out of? And do you have happy memories or good things in your life that you can bring forward if you feel alone and helpless?

The house of sorrow and opportunities

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We all have a house with different rooms. A house filled with memories behind every door. Some rooms contain memories we rather forget, some with past love and some with tools we need to walk into the rooms that scare us. It might be a torch driving away the shadows lurking in a corner. It can be a shovel we can use in the garden to bury what we don`t need anymore. How the house looks, varies. We all have different stories, and need different tools to get where we need to go. In one book about dissociation, they recommended creating a room the with everything you need to be strong. It could be potions filled with strengthening concoctions or impenetrable armor. You could then go into the room, take a mental sip of the potion, put your armor on and be ready for a battle.

  
What would you put in your house? Which rooms must be locked until you are ready to open them? What do you need when you go in there? Do you need to fill the house with people that can guide you if you get lost? Is there a dog sitting next to you in the couch, ready to defend you whenever you need it? And where is your room of past achievements? Where do you put your medals for getting where you are today, for winning the most important battles of all: Surviving another day.

Do you have any blog-posts related to psychology you would like to have in a book?

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Like some of you know, I am working on a book version of this blog. After 500 posts I have shared my own reflections and reblogged interesting posts. But, I want the book to entail a number of posts written by others, so if you write about psychology and would like to share those posts, write a comment or an email (forfreepsychology@gmail.com). Feel free to add a link to the post you are especially proud of. You can share your own struggle With mental illness, or more theoretical posts. You can also share your thought on the Health care system, or on society at large.

I am looking forward to hear from you!

uten navn

The sound of little boxes on the hillsides

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Since I took the dissociation course with Nijenhuis the last year, one message has been firmly learnt. “NEVER think that you know or understand more than the person in front of you”. Trauma-patients are especially vulnerable when it comes to suggestions, and often try to please others by becoming who you want them to be. For this reason, I had to look at myself in the mirror again and again, while remembering that I can`t see or understand what`s behind it more than anyone else. By letting go of my need to understand, to interpret, I`ve understood more (or so I think). By accepting what is, I`ve seen my clients reality more clearly, but I have to keep cleaning the cool surface of the mirror when necessary. What scares me, though, is how easily everyone forgets to do just this. We can walk in dirt until it drowns us, until it pokes us in the face. When the dirt has infected everything, we finally start to clean up. Almost like using a dirty rag to clean up the mess. I´ve heard stories of abuse and neglect, of babies with their diapers so full of shit, that it falls to their knees. That is horrible enough, but I wonder: Is it not worse that grown-ups never change their diapers? Shouldn`t they have learnt that? What kept them from noticing how bad it got?

Little boxes on the hillside....

Our society has a both good and bad sides. The world will probably never reach a perfect balance, but we must still strive for it. How can we heal and preserve? For many therapists, diagnosis helps to find a direction for the right treatment and possibilities. I won`t rant against the system of classification for too long, but I just want to make one point: Who likes to be put in a box? Who likes to be told who they are, from people they barely know? Who likes to get their lives transferred to a DMS-IV classification that lead to life-altering consequences, with the justification of “this is how we do it” attached to it?

I sure don`t. What about you?

Six ways to get the most out of seeing a psychologist

The butterfly effect

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The butterfly effect is a metaphor that encapsulates the concept of sensitive dependence on initial conditions in chaos theory; namely a small change at one place in a complex system can have large effects elsewhere.

As a psychologist, I believe in the butterfly effect. What if everyone did one kind act every week? How many would be affected and inspired to do kind things to others? Could it change the world? If you find this interesting, feel free to read about my kindness project. I have interviewed people about kind things they do, and hope this might inspire others to do the same. More can be read on my kindness blog: Kindness to a stranger

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Project kindness to a stranger

To introduce the idea, I will ask everyone to watch this short movie first. Even if it takes 18 minutes, and afterwards you will feel good.

We go about our everyday lives wanting things to always be getting better. We hope that our work can make a difference. We also hope our children will have a good future. As anyone knows who has heard Martin Luther King Jr.’s famous speech—delivered fifty years ago this August~ dreams are at the center of any effort to make things better. And today we have something with more power than we might realize: The internet.

It’s not without reason that China and North-Korea tried to keep their inhabitants away from news. The media also have immense power, and even if some might argue that they focus on the wrong things, a lot of journalist really want to make the world a better place. Combine good journalists, the internet and kindness, and you have a wonderful recipe: People who actually do something.

http://ow.ly/nk7U1

So, by now you might be thinking: Yeah, sure, but what can I DO?

If you have watched the movie, you have seen the immense effect some words can have. When we have the possibility to help, by little effort, we do it. For example, most people help the world by sorting our paper, so that we can preserve the rainforest. So, what about potentially making somebody happy by smiling a little?

trueResearch shows that our mirror-neurons respond automatically by creating a smile on your own lips. This means that smiling AT someone, actually MAKE both parties happier. Research also shows that taking care of our own needs, makes it more likely that we can be there for others. So, like in the video, I would challenge the readers of this blog to do JUST one nice thing for somebody else (preferably a stranger, because that would have the biggest impact) the next week.

When you have done that, write WHAT you did, and if you want, leave your email at the end. This will be like signing a petition for releasing prisoners. Your contribution might become the new butterfly effect.

Related

http://ow.ly/nk7U1

2013 My 100 Day Challenge (my100daychallenge.com)

(never stop dreaming!) http://www.lollydaskal.com/leadership/lolly-daskal-i-have-a-dream/

Validation: You can change things (forfreepsychology.wordpress.com)

A women who writes brilliantly about how to think for yourself and fight for what others say is “naive”:http://theoeditrix.com/2013/06/24/im-naive-not-stupid-theres-a-difference/

http://www.austinchronicle.com/news/2013-06-21/the-mad-men-senate-votes-to-impose-new-abortion-limits/

http://www.dpsinfo.com/

https://www.facebook.com/TheValidationProject

Enter now for the 2014 Charlotte Bacon Act of Kindness Awards!
http://newtownkindness.org/

Facebook: Pay it forward group. Meet and connect with others!

Dani`s story

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A good book! Read it!

Since the story “the Girl in the Window” about Dani Lierow was published in the St. Petersburg Times newspaper on August 1st, 2008 hundreds of thousands of readers across the world have been moved by her story. Readers from around the world continue to read the story of Dani, written by Lane DeGregory, online and hundreds have been inspired to comment. Most of those who have reached out to communicate with Dani and her family have wanted to express their good wishes and support. Many people have requested a way that they can donate funds to support Dani’s long term care and ongoing therapy.

October 2010
Danielle is doing well; she has grown a lot and is almost as tall as us! She enjoys swimming, horseback riding, and attended “Empower Me Day Camp” over the summer, which kept her busy with lots of crafts, water play, and activities during the summer. We also had two foster girls stay with us over the summer, so there was a lot going on and no boredom at our house over summer break! She started school at the beginning of August, and is doing very well in her special Ed classroom, with a lot less tantrums than last year! She attended several county fairs where brother William showed his goats and chickens in 4-H competitions, and enjoyed the rides, ice cream, cotton candy, as well as looking at all the exhibits