Last Update: 12:20 AM 6/29/2012
(Norwegian mass killer Anders Behring Breivik gestures as he arrives for his terrorism and murder trial in a courtroom in Oslo April 16, 2012. REUTERS/Heiko Junge/Pool)
Mike Nova: Breivik Syndrome is the Grandiose - Persecutory type of Delusional Disorder with resulting mass murder in a messianic quest to promote militant far right ideology which serves as a defensive reaction formation and overcompensation in intense, elaborate, psychotic and delusional, antifeministic and "anti immigrant" castration phobia.
This psychopathology is both individual and social.
How many are afflicted with it, lurking there in the dark, behind their flags and "manifestos"?
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"Breivik's thought betrays an analogy between his monocultural nationalism and his veneration of a certain type of "warrior" masculinity, an analogy that revolves – as his manifesto's title implies – around the ideal of masculine independence... Alternatively, he suggests, we could "outsource breeding", and pursue surrogacy in low-cost countries or the development of artificial wombs...
the behaviour of Breivik must, and can, only be understood as insanity"
from guardian.co.uk
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Mike Nova:
Truth is Knowledge and Truth is Healing. Truth, despite its various meanings and interpretations by different thinkers has universal and transcendental, transpiring through times and cultures, self-sustaining value.
No extraneous considerations of political or ideological convenience should enter into reasoning regarding Breivik's "sanity" or "insanity" and legal responsibility.
In the opinion of this (Mike Nova) observer, Mr. Breivik suffers from Delusional Disorder (and not from "Schizophrenia, paranoid type"). His delusions are nonbizzare in content and presentations (although horrifying in their real life consequences), well systematised (and publicised) and have a quality of the "world view". These distinct psychopathological qualities make them (Breivic's delusions and behavior) a part of Delusional Disorder.
In all three (practiced in the USA) legal standards of "insanity" as a legal term and concept, the presence of identifiable and diagnosable mental illness ("defect of reason or disease of the mind" or "mental disease or defect") and its causal relationship with criminal behavior play the central, axial part.
If the presence of Delusional Disorder, based on mentioned above signs (objectively observed characteristics of disturbed behavior) can be shown to the court convincingly in a forensic psychiatric testimony, the chances of "insanity" ruling might be enhanced.
Links
Breivik Syndrome - Google Search
Apr 19 (12)
Thursday, April 19, 2012
Mike Nova: Does Breivik suffer from DELUSIONAL DISORDER, Grandiose - Persecutory Type?
Mike Nova:
Does Breivik suffer from DELUSIONAL DISORDER? (Grandiose - Persecutory Type)?
All symptoms and behaviors fit into this (relatively rare but very well recognised, well described, discrete - which is important for its clinical validity; and very interesting psychopathologically and also historically - Krepeline, Freud, etc.) syndrome quite nicely. If these diagnostic impressions are confirmed in further psychiatric evaluations and affirmed by the court, then Breivik definitely should not be considered legally responsible (although he is fit to proceed) for his crime and should be treated as an "insane" and mentally ill.
In addition to this, his habitus (square face and jaw, etc.) and quality of his emotional reactions (e.g. on questioning on Day 3 of the Trial) betray the signs of subtle yet visible organicity with some affective involvement. It would be surprising if his cognitive functioning and the results of neuropsychological testing are intact completely. The results of EEG, including sleep deprivation EEG, would be interesting to see; temporal lobes dysfunction is quite possible.
The results of projective tests could shed some light on the state of his emotional life.
Is it possible to influence or use for adverse purposes persons ill with Delusional Disorder, in other words, to "program" them? Yes, it is, if it is done skillfully and suggestions are incorporated into a subject's delusional system or if the delusions are shared.
Thus, a new vista of possibilities has opened, in the light of Day 3 of the Trial's revelatons of Breivik's connections with Serbian nationalists and history of his military or intelligence training in Belarus.
Does Breivik suffer from DELUSIONAL DISORDER? (Grandiose - Persecutory Type)?
All symptoms and behaviors fit into this (relatively rare but very well recognised, well described, discrete - which is important for its clinical validity; and very interesting psychopathologically and also historically - Krepeline, Freud, etc.) syndrome quite nicely. If these diagnostic impressions are confirmed in further psychiatric evaluations and affirmed by the court, then Breivik definitely should not be considered legally responsible (although he is fit to proceed) for his crime and should be treated as an "insane" and mentally ill.
In addition to this, his habitus (square face and jaw, etc.) and quality of his emotional reactions (e.g. on questioning on Day 3 of the Trial) betray the signs of subtle yet visible organicity with some affective involvement. It would be surprising if his cognitive functioning and the results of neuropsychological testing are intact completely. The results of EEG, including sleep deprivation EEG, would be interesting to see; temporal lobes dysfunction is quite possible.
The results of projective tests could shed some light on the state of his emotional life.
Is it possible to influence or use for adverse purposes persons ill with Delusional Disorder, in other words, to "program" them? Yes, it is, if it is done skillfully and suggestions are incorporated into a subject's delusional system or if the delusions are shared.
Thus, a new vista of possibilities has opened, in the light of Day 3 of the Trial's revelatons of Breivik's connections with Serbian nationalists and history of his military or intelligence training in Belarus.
Mike Nova: What makes Breivik's thinking and concepts abnormal and delusional?
Although arising from "legitimate" and relatively common concerns about the vicissitudes of "multiculturalism", Breivic's thinking, appearing formally logical and internally consistent, is taken to its socially and mentally illogical and abnormal ( markedly at odds with conventional norms and values of contemporary Norwegian society) and psychopathological (existing as a part of a recognisable clinical diagnostic pattern of Delusional Disorder and combined with a sense of "extraordinary and important" mission) extreme: overt behavior and horrendous criminal action, which due to their oddity and single minded obsessive conviction, confirm their delusional nature. At the times of "Knights Templar" in 13 century Europe his behavior and actions might not necessarily had been considered abnormal (the concept of "abnormal behavior" was not formed very well yet at that time). In cultures which are more tolerant of "righteous violence" and religious extremism his behavior would be probably viewed less in terms of mutually exclusive dichotomies of "normal vs abnormal" and more in terms of "goal justifying the means". In today's Norway his behavior is considered by many experts and non experts as being "abnormal" and "pathological". Psychopathology and sociopathology are always "culture bound". However, these issues, if they are to contain at least some elements of "scientific knowledge, truth and objectivity" (which are also always culture and time bound), cannot be decided by non experts or popular vote. The court, observing and assessing the defendant independently, will have to rely on the experts opinions (their contradictory and conflicting reports notwithstanding) and the state of current knowledge in the field of forensic psychiatry, whatever imperfect or scientifically unsatisfactory this state of knowledge might be.
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Mike Nova: Breivik's DELUSIONAL, castration-phobic antifeminism:
Anders Breivik's chilling anti-feminism | Jane Clare Jones | Comment is free | guardian.co.ukAnders Breivik's chilling anti-feminism
To Anders Breivik, the 'feminisation' of the European male corresponds to the 'feminisation' of Europe itself
A woman pays her respects at a temporary memorial on the shore in front of Utøya island. Photograph: Fabrizio Bensch/REUTERS
Following much of the media's initial "fact-free conjecture" about the origins of the atrocity in Norway, we have since had to reckon with Anders Behring Breivik's own account of his motivations put forward in his 1518-page manifesto entitled 2083: A European Declaration of Independence. Overlooked, however, in the focus on Islamism and Islamophobia's culpability for Breivik's pathology is the way his gargantuan manifesto presents multiculturalism as just one form of the "ideology" which "now looms over western European society like a colossus". This ideology, most often known as political correctness, has, Breivik tells us, several other names. One of them is cultural Marxism, and the other is feminism.
Breivik's introduction is entirely given over to a half-baked history of political correctness, "no aspect" of which, he tells us, is "more prominent … than feminist ideology". The PC-project is bent on "transforming a patriarchy into a matriarchy" and "intends to deny the intrinsic worth of native Christian European heterosexual males". But more than that, it has succeeded. The "feminisation of European culture" has been underway since the 1830s, and by now, men have been reduced to an "emasculate[d] … touchy-feely subspecies".
The antipathy to feminism – and women – threaded throughout Breivik's document is more than just incidental. The text is peppered with references to the pernicious effects of the "Sex and the City lifestyle, the propagation of sexual immorality (indexed by women's promiscuity), and the "erotic capital" women use to manipulate men. The degeneration of our civilisation is intimately linked to an epidemic of sexually transmitted disease and "emotionalism". Indeed, the danger of women's "unnatural" demand for equality is such that Breivik closes his introduction by claiming that "the fate of European civilisation depends on European men steadfastly resisting Politically Correct feminism".
A whole web of reasons are given for this conclusion, but two familiar constellations stand out. The first concerns feminism's purported sundering of the nuclear family and responsibility for a demographic collapse that opens Europe to Muslim colonisation. Too distracted by "having it all", western women are failing to breed enough to repel the amassing hordes. But, in their feminine naivety, they fail to realise that their comeuppance is on its way, their freedoms snatched by the invasion of the genuine oppressor. Barely submerged in this narrative – as in much cultural conservatism – is a profound anxiety about who controls women's bodies and reproductive capacities. In his concern to save us from ourselves, Breivik wants to drag us back to the 50s, limiting access to reproductive technology and discouraging women from pursuing education beyond a bachelor's degree. Alternatively, he suggests, we could "outsource breeding", and pursue surrogacy in low-cost countries or the development of artificial wombs.
This sci-fi fantasy of finally abolishing men's dependence on women's generative abilities is revealing. On the one hand, Breivik indicts feminism with causing our alleged "cultural suicide", both by encouraging reproductive treachery and also because women are apparently more supportive of multiculturalism. However, in another sense, Breivik's thought betrays an analogy between his monocultural nationalism and his veneration of a certain type of "warrior" masculinity, an analogy that revolves – as his manifesto's title implies – around the ideal of masculine independence. The "feminisation" of the European male corresponds to the "feminisation" of Europe itself. Our cultural purity is threatened by invasion from outside. Once proud, virile, and impregnable, Europe has been turned – Breivik suggests in Section 2.89 – into a woman, one who has submitted to rape rather than "risk serious injuries while resisting".
Unlike Breivik, we must resist the urge to make easy causal connections. No account of this man's background or beliefs about nationality, religion or gender can serve to explain his actions. His cool enumeration of technicalities about downloading the document, his careful inclusion of a press-pack of photos, the chilling reference to the sacrifices involved in its "marketing operation" – all this serves to exhibit an inhumanity which opens a chasm between ideas and action. Nevertheless, while the behaviour of Breivik must, and can, only be understood as insanity, we would do our understanding a disservice by accepting it as only that.
Breivik's introduction is entirely given over to a half-baked history of political correctness, "no aspect" of which, he tells us, is "more prominent … than feminist ideology". The PC-project is bent on "transforming a patriarchy into a matriarchy" and "intends to deny the intrinsic worth of native Christian European heterosexual males". But more than that, it has succeeded. The "feminisation of European culture" has been underway since the 1830s, and by now, men have been reduced to an "emasculate[d] … touchy-feely subspecies".
The antipathy to feminism – and women – threaded throughout Breivik's document is more than just incidental. The text is peppered with references to the pernicious effects of the "Sex and the City lifestyle, the propagation of sexual immorality (indexed by women's promiscuity), and the "erotic capital" women use to manipulate men. The degeneration of our civilisation is intimately linked to an epidemic of sexually transmitted disease and "emotionalism". Indeed, the danger of women's "unnatural" demand for equality is such that Breivik closes his introduction by claiming that "the fate of European civilisation depends on European men steadfastly resisting Politically Correct feminism".
A whole web of reasons are given for this conclusion, but two familiar constellations stand out. The first concerns feminism's purported sundering of the nuclear family and responsibility for a demographic collapse that opens Europe to Muslim colonisation. Too distracted by "having it all", western women are failing to breed enough to repel the amassing hordes. But, in their feminine naivety, they fail to realise that their comeuppance is on its way, their freedoms snatched by the invasion of the genuine oppressor. Barely submerged in this narrative – as in much cultural conservatism – is a profound anxiety about who controls women's bodies and reproductive capacities. In his concern to save us from ourselves, Breivik wants to drag us back to the 50s, limiting access to reproductive technology and discouraging women from pursuing education beyond a bachelor's degree. Alternatively, he suggests, we could "outsource breeding", and pursue surrogacy in low-cost countries or the development of artificial wombs.
This sci-fi fantasy of finally abolishing men's dependence on women's generative abilities is revealing. On the one hand, Breivik indicts feminism with causing our alleged "cultural suicide", both by encouraging reproductive treachery and also because women are apparently more supportive of multiculturalism. However, in another sense, Breivik's thought betrays an analogy between his monocultural nationalism and his veneration of a certain type of "warrior" masculinity, an analogy that revolves – as his manifesto's title implies – around the ideal of masculine independence. The "feminisation" of the European male corresponds to the "feminisation" of Europe itself. Our cultural purity is threatened by invasion from outside. Once proud, virile, and impregnable, Europe has been turned – Breivik suggests in Section 2.89 – into a woman, one who has submitted to rape rather than "risk serious injuries while resisting".
Unlike Breivik, we must resist the urge to make easy causal connections. No account of this man's background or beliefs about nationality, religion or gender can serve to explain his actions. His cool enumeration of technicalities about downloading the document, his careful inclusion of a press-pack of photos, the chilling reference to the sacrifices involved in its "marketing operation" – all this serves to exhibit an inhumanity which opens a chasm between ideas and action. Nevertheless, while the behaviour of Breivik must, and can, only be understood as insanity, we would do our understanding a disservice by accepting it as only that.
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Monday, April 30, 2012
Psychodynamic aspects of Delusional Disorder - post on this blog
Psychodynamic aspects of Delusional Disorder (Google Search),
of Persecutory type: "Paranoia" - Google Search
- Links to "castration anxiety and phobia" Searches
Psychodynamic aspects of Delusional Disorders - Topic
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Mike Nova: Psychoanalytic theory is deadeningly mechanistic and hopelessly outdated, but at this time we do not have any other theory which attempts to explain with such an allure and in more or less simple (if not simplistic) and coherent terms the dazzling and paradoxical complexities of human emotional life and behavior; although, confirming one of these paradoxes, "psychoanalysts" are famously known themselves for their predilection towards near-incoherence and "fuzzy thinking".
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castration phobia - Google Search
Psychol Rep. 2002 Dec;91(3 Pt 2):1244-6.
Castration anxiety and phobias.
Cogan R, Larrabee LK, Wyatt IM, Ontiberoz A, Waters SK, Werner ML, Miller AL, Lovelady AC, Hurt TJ, Hardin ED 3rd, Gonzalez PM.
Source
Department of Psychology, Texas Tech University, Box 42051, Lubbock, TX 79409-2051, USA.Abstract
Based on Freud's case study of "Little Hans," the authors tested the hypothesis that men with phobias would score higher on castration anxiety than men without phobias. College men with either average or high scores on the Fears Scale of the MMPI-2 (n = 10 men in each group) responded to the Thematic Apperception Test, which was scored for castration anxiety. Men with high scores on the Fears Scale had higher scores on castration anxiety than men with average scores on the Fears Scale. The findings are consistent with Freud's hypothesis about phobias.- PMID:
- 12585544
- [PubMed - indexed for MEDLINE]
castration phobia - Wikipedia Search
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overcompensation - Google Search
Men overcompensate when masculinity threatened
www.news.cornell.edu/stories/aug05/soc.gender.dea.htmlCached - Similar
You +1'd this publicly. Undo
2 Aug 2005 – Threaten a man's masculinity and his attitudes will become more macho, according to a study by Robb Willer, a Cornell Ph.D. candidate in ...
Aug. 2, 2005
Men overcompensate when their masculinity is threatened,
Cornell study shows
ITHACA, N.Y. -- Threaten a man's masculinity and he will assume more macho
attitudes, according to a study by a Cornell University researcher.
"Masculine overcompensation is the idea that men who are insecure about their masculinity will behave in an extremely masculine way as compensation. I wanted to test this idea and also explore whether overcompensation could help explain some attitudes like support for war and animosity to homosexuals," Willer said. Willer administered a gender identity survey to a sample of male and female Cornell undergraduates in the fall of 2004. Participants were randomly assigned to receive feedback that their responses indicated either a masculine or a feminine identity. While women's responses were unchanged regardless of the feedback they received, men's reactions "were strongly affected by this feedback," Willer said. "Masculinity-threatened men also reported feeling more ashamed, guilty, upset and hostile than did masculinity-confirmed men," states Willer's report, "Overdoing Gender: Testing the Masculine Overcompensation Thesis." "The masculine overcompensation thesis has its roots in Freudian psychology, but it has become a popularly accepted idea that I felt should be empirically tested and evaluated," Willer said. He questioned subjects about their political attitudes, including how they felt about a same-sex marriage ban and their support for President Bush's handling of the Iraq War. "I created composites from subjects' answers to these and other questions," he said. "I also gave subjects a car-buying vignette, presented as part of a study of purchasing a new car." Masculinity-threatened participants also showed more interest in buying an SUV. "There were no increases for other types of cars," Willer said. The study produced "the predicted results," he said. "The intention of the study was to explore whether masculine overcompensation exists and where. But the point isn't to suggest these are the only factors that can explain these behaviors. Likewise, there may be a wide variety of other behaviors that could increase when men are concerned about their levels of masculinity." In a separate study, Willer verified that support for the Iraq War, homophobia and interest in purchasing an SUV were all considered masculine by study participants. Willer said he and a colleague are planning additional research on subjects' attitudes regarding violence toward women, using the same method for manipulating masculine insecurity. "I'm planning another follow-up to the study that involves taking testosterone samples from participants to see if testosterone levels are a mediating factor in this process," he added. The research involved 111 Cornell undergraduates and was funded by the Department of Sociology at Cornell.
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overcompensation - definition of overcompensation by the Free ...
o·ver·com·pen·sa·tion ( v r-k m p n-s sh n). n. Excessive compensation, especially the exertion of effort in excess of that needed to compensate for a physical or ...
Overcompensation - Medical Definition and More from Merriam ...
www.merriam-webster.com/medical/overcompensationCached
over·com·pen·sa·tion. noun \-ˌkäm-pən-ˈsā-shən, -ˌpen-\. Definition of OVERCOMPENSATION. : excessive compensation; specifically : excessive reaction to a ...Top 10 Huge Examples Of Overcompensation | Top 10 Lists ...
www.toptenz.net/top-10-huge-examples-of-overcompensation.phpCached
5 Oct 2010 – While women and doctors can insist that 'size doesn't matter' ad infinitum, some guys still worry that they don't measure up. In extreme cases ...Men overcompensate when masculinity threatened
www.news.cornell.edu/stories/aug05/soc.gender.dea.htmlCached - Similar
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2 Aug 2005 – Threaten a man's masculinity and his attitudes will become more macho, according to a study by Robb Willer, a Cornell Ph.D. candidate in ..
Overcompensation | Define Overcompensation at Dictionary.com
Overcompensation definition at Dictionary.com, a free online dictionary with pronunciation, synonyms and translation. Look it up now!
Masculine Overcompensation - Science Updates - Science NetLinks
sciencenetlinks.com/science-news/.../masculine-overcompensation/Cached
In this Science Update, hear about a study looking for any truth to the idea that men act especially macho when they feel their manhood is threatened.The CEO overcompensation trap - AlterNet - Salon.com
www.salon.com/2012/04/03/the_ceo_overcompensation_trap/Cached
3 Apr 2012 – The fact that Dimon and Blankfein make such absurd salaries isn't just unfair. It's destroying the economy.____________________________________________
Mike Nova: Breivik's DELUSIONAL, castration-phobic antifeminism:
Anders Breivik's chilling anti-feminism | Jane Clare Jones | Comment is free | guardian.co.uk"Several thousand pages of rambling paranoia" | An...
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Saturday, April 28, 2012
"According to German psychiatrist, Emil Kraepelin, patients with Delusional Disorder, remain coherent, sensible and reasonable[4]" - Wikipedia - Mike Nova's starred items - 4.28.12
via Forensic
and General Psychiatry Review by Mike Nova on 4/28/12
Response to Dr. Kringlen
Dr. Kringlen: “My professional experience
suggests he is unlikely to have been able to act in such an adequate fashion if
he is psychotic, in particular schizophrenic,” he declared, saying it is
extremely unlikely Breivik has managed to mislead him in his battle to appear as
sane.
Response by Michael Novakhov, M.D.:
"According to German psychiatrist, Emil Kraepelin, patients
with Delusional Disorder, remain coherent, sensible and reasonable[4].
"
...
"The delusions do not interfere with general logical reasoning
(although within the delusional system the logic is perverted) and there is
usually no general disturbance of behavior. If disturbed behavior does occur, it
is directly related to the delusional beliefs."
References and
Links
Saturday, April 28, 2012
‘Two days in court changed my opinion of Breivik’,...
‘Two days in court changed my opinion of Breivik’, says top psychiatrist / News / The Foreigner — Norwegian News in English.
‘Two
days in court changed my opinion of Breivik’, says top psychiatrist / News / The
Foreigner — Norwegian News in English.
‘Two days in court changed my opinion of Breivik’, says top psychiatrist
One of Norway’s top psychiatric
professors has withdrawn his earlier conclusion Anders Behring Breivik is
psychotic.
Informing weekly publication Dag og Tid actually seeing
Breivik for two days in Oslo District Court was “useful”, Einar Kringlen
continued, “it gives a completely different picture to reading the minutes in
the paper and the impression I got of the man from the first [psychiatric]
report.”
The professor, who has never changed his opinion about criminal sanity to such a degree, according to NRK, was in no doubt Synne Sørheim and Torgeir Husby were correct that Breivik was psychotic.
Now, he observes the accused can answer questions logically, flexibly, and in a relaxed fashion. The expert supports Terje Tørrisen’s and Agnar Aspaas’ conclusions.
“He [Breivik] is not submissive, either, but protests with some annoyance if he thinks the judge’s questions are unreasonable, Einar Kringlen told the broadcaster.
“My professional experience suggests he is unlikely to have been able to act in such an adequate fashion if he is psychotic, in particular schizophrenic,” he declared, saying it is extremely unlikely Breivik has managed to mislead him in his battle to appear as sane.
The professor concluded, “perhaps one can say he has a paranoid personality, is suspicious, but that’s where it ends.”
Today’s 10th day of the trial will see continued focus on the Oslo bombing, it’s victims and the aggrieved.
The professor, who has never changed his opinion about criminal sanity to such a degree, according to NRK, was in no doubt Synne Sørheim and Torgeir Husby were correct that Breivik was psychotic.
Now, he observes the accused can answer questions logically, flexibly, and in a relaxed fashion. The expert supports Terje Tørrisen’s and Agnar Aspaas’ conclusions.
“He [Breivik] is not submissive, either, but protests with some annoyance if he thinks the judge’s questions are unreasonable, Einar Kringlen told the broadcaster.
“My professional experience suggests he is unlikely to have been able to act in such an adequate fashion if he is psychotic, in particular schizophrenic,” he declared, saying it is extremely unlikely Breivik has managed to mislead him in his battle to appear as sane.
The professor concluded, “perhaps one can say he has a paranoid personality, is suspicious, but that’s where it ends.”
Today’s 10th day of the trial will see continued focus on the Oslo bombing, it’s victims and the aggrieved.
via Forensic
and General Psychiatry Review by Mike Nova on 4/27/12
Response to Dr. Wessely
Normality or psychopathology of belief or belief
system is determined first of all by the intrinsic qualities of belief in
question. It is not determined by the fact that belief is shared or not shared:
"Delusions are beliefs that are not only wrong, in the sense of not
corresponding to the world as we know it, but they must also not be shared with
others of the same cultural background."
There are many delusional beliefs
that are or were shared, and some of them on a rather large scale. For example,
the precolumbian Maya believed, that for the sun to rise they had to offer human
sacrifices (of their best and brightest) every day, otherwise all kind of life
on earth would come to a halt. This belief was shared very widely in precolumbian
Maya culture, which does not make it any less delusional.
Breivik's ultra
nationalist anti-immigrant ideology is shared by great many people of various
cultural backgrounds. The goal of his forensic psychiatric evaluation is to
assess his own particular belief system, with all its peculiarities and
idiosyncrasies, in order to determine its nature, qualities and
psychopathological aspects, regardless of other similar beliefs. In the end, it
was him, not others, who took these ideas to their logical (or rather illogical
and "sick") extreme, although the (possibly facilitating) role of "significant
others" in his case still has to be determined.
Neither the "monstrosity"
and "grievous consequences" of his actions nor "popular misconceptions" should
cloud the picture. The most important factor in his forensic psychiatric
assessment is the presence or absence of identifiable and diagnosable mental
illness and the degree of its causal relationship with the crime. In my opinion,
whatever it is worth, psychopathological qualities of Breivic's beliefs: their
highly systematised, structured, all embracing "world view" quality, along with
their unshakable, messianic conviction and "call for action", indicate with high
degree of probability the presence of Delusional Disorder, mixed,
persecutory-paranoid type, and the direct and overwhelming causal connection of
his psychopathology with the criminal act.
The cognitive aspect in
psychopathology of Delusional Disorders (abnormalities and/or dysfunctions in
concept selection, elimination and confirmation), indicating possible subtle but
decisive organic involvement is much under-researched area, probably due to our
neglect or inattention to biological aspects of these disorders and
overestimation of its psychodynamic aspects. Delusional jealousy, secondary to
chronic alcoholism (a very discrete and specific syndrome) is the case in point.
"The... misconception... that the purpose of psychiatry is to “get people
off”" might be as wide spread as any other misconception, which does not make it
any less of a misconception. The historically formed legal concept of "NGRI: not
guilty by reason of insanity" is a witness to humanity and rationality on the
part of society, not to mention other, less important but present factors, such
as political and social convenience, expediency and cultural traditions. (E.g.:
Disraeli to Queen Victoria: "Only a madman can think about assassinating your
Majesty..."). Modern psychiatry, very likely, was born out of the M'Naghten
rules, as some psychiatric historians suppose.
And last, but certainly not
least, is the difficult and complex subject of "Schizophrenia", its clinical
concept (and/or misconcept) and diagnosis (and/or misdiagnosis). The diagnostic
label of "Schizophrenia" became so broadly used and all encompassing (because it
is so easy to apply, and is applied almost indiscriminately), as to loose its
meaning and clinical value. In our rush to nosological (and reimbursement)
parity with the rest of medicine we jumped over our heads too soon, introducing
the (man made) diagnostic criteria based "nosological" system, which leads to
premature ossification and codification of clinical concepts and experience,
impeding the independent minded research greatly and precluding the normal
development (albeit slow and lagging) of psychiatry as a medical science. Is it
not more correct and probably clinically more productive, especially in the
field of psychopharmacology, to return to syndromologically based classification
system and to try to define, refine and research these historically formed
clinical syndromes further, before rushing to judgements about their
pseudonosological "pigeon holes"?
This is what Breivic trial, along with
other issues, brings to the front. And these issues deserve a deep and long
thought.
Michael Novakhov, M.D.
References and Links
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References and Links
Sanity - Wikipedia, the free
encyclopedia
In The Sane Society, published in 1955, psychologist Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in sanity". Fromm argued that one of the most deceptive features of social life involves "consensual validation."[3]:
In The Sane Society, published in 1955, psychologist Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in sanity". Fromm argued that one of the most deceptive features of social life involves "consensual validation."[3]:
| “ | It is naively assumed that the fact that the majority of people share
certain ideas or feelings proves the validity of these ideas and feelings.
Nothing is further from the truth... Just as there is a folie
à deux there is a folie à millions. The fact that millions of
people share the same vices does not make these vices
virtues, the fact that they share so many errors does not make the errors to be
truths, and the fact that millions of people share the same form of mental
pathology does not make these people sane.[4] Fromm, Erich. The Sane Society, Routledge, 1955, pp.14–15. |
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Thursday, April 19, 2012
Mike Nova: Breivik Trial and The Crisis Of Psychiatry As A Science
Mike Nova
The second evaluation, about 300 pages long, made by the psychiatrists Terje Toerrissen and Agnar Aspaas on a request from the court after widespread criticism of the first one, was completed on April 10, 2012, just six days before the trial, but was not released, and according to the leaked information, found him afflicted with "narcissistic personality disorder" with "grandiose self" and not psychotic at the time of the alleged crime and presently and therefore legally "sane".
The latest psychiatric report was confidential, but national broadcaster NRK and other Norwegian media who claimed to have seen its conclusions said it described Breivik as narcissistic but not psychotic.
Torgensen gets the impression that Breivik found an ideal place to nourish his delusions of grandeur in the anti-Islamic scene full of crusader fantasies. “This was coupled with an extremely sadistic disorder,” Torgensen says. “This disastrous combination could explain the scale of his violence.”
The new report from forensic psychiatrists Terje Tørrissen and Agnar Aspaas concludes that he did not have “significantly weakened capacity for realistic evaluation of his relations with the outside world, and did not act under severely impaired consciousness”.
"Our conclusion is that he (was) not psychotic at the time of the actions of terrorism and he is not psychotic now," Terje Toerrissen, one of the psychiatrists who examined Breivik in prison, told The Associated Press.
Thus, as it almost always happens in complex forensic psychiatric cases, it was left for the infinite wisdom and common sense of the court, unburdened by the "sophisticated" and empty psychiatric jargon, to decide by itself, and rightly so, the "main questions" of the accused's mental illness or mental health and his "sanity" or "insanity" and to make its own, judicial decision regarding the issue of legal responsibility. Both mutually conflicting (but not mutually exclusive) forensic psychiatric evaluations, which, no doubt, were performed in good faith and with utmost professional diligence, will be taken into account by the court, but were rendered almost irrelevant by their contradictions. Once again, psychiatry, pretending to be a medical discipline and a science, was humiliated and reduced to the position of a laughing stock for the public and the media.
Mr. Breivik's skillful and astute lead defense lawyer, Mr. Geri Lippestad, treating his client with respect and at the same time with appropriate professional distance and apparently convinced of his client's mental illness and "insanity", chose a strategy of presenting Mr. Breivik to the court and to the public "as is", letting him to reveal himself and his presumed mental illness fully as the engine of alleged criminal behavior, apparently counting that it will be convincing enough for both the judges and for the court of public opinion.
“This whole case indicated that he is insane,” Geir Lippestad told reporters. “He looks upon himself as a warrior. He starts this war and takes some kind of pride in that,” Lippestad said. Lippestad said Breivik had used “some kind of drugs” before the crime to keep strong and awake, and was surprised he had not been killed during the attacks or en route to Monday’s court hearing.
Lippestad, a member of the Labour party whose youth wing had been the target of Friday’s shooting rampage, said he would quit if Breivik did not agree to psychological tests.
Geir Lippestad said the new report means Breivik's testimony will be crucial "when the judges decide whether he is insane or not." The trial started on April 16 and is scheduled to last 10 weeks.
Mr. Breivik declared himself undoubtedly and completely "sane" and consistently, if somewhat eerily out of place and time, painted a self-portrait as a model and self-sacrificing ideological warrior, taking as an insult any, including "professional" opinions to the contrary and dismissed them with anger and indignation.
“On this day,” he said, “I was waging a one-man war against all the regimes of Western Europe. I felt traumatized every second that blood and brains were spurting out. War is hell.”
"Breivik told the court that "ridiculous" lies had been told about him, rattling off a list which accused him of being a narcissist who was obsessed with the red jumper he wore to his first court hearing, of having a "bacterial phobia", "an incestuous relationship with my mother", "of being a child killer despite no one who died on Utoya being under 14".
He was not insane, he repeated many times. He claimed it was Norway's politicians who should be locked up in the sort of mental institution he can expect to spend the rest of his days if the court declares him criminally insane at the end of the ten-week trial. He said: "They expect us to applaud our ethnic and cultural doom... They should be characterised as insane, not me. Why is this the real insanity? This is the real insanity because it is not rational to work to deconstruct ones own ethnic group, culture and religion."
All this is fine and dandy, and, no doubt, the aforementioned infinite wisdom of Scandinavian level headed justice (embodied in a stern but motherly demeanor of the presiding Judge Wenche Elisabeth Arntzen) will eventually and somehow emanate from somewhere in between of its somewhat obscure, slowly but surely turning and unstoppable wheels, hopefully to almost every one's satisfaction. And eventually, this horrendous crime, the purp and the trial will be almost forgotten and placed into archives for further studies.
But the nagging questions remain and will remain for some, and probably a long time: is psychiatry really a science? Or is it just a collection of "professional" opinions, mixed with convenient labels and outdated jargon? What is "sane" and what is "insane"? And how far should the justice go in its modern "humane" stance?
"Grete Faremo, Norway’s justice minister, has said that it plans to establish a committee to examine the role of forensic psychiatrists. She told Norwegian daily Aftenposten on April 13 the committee would have a “broad mandate” that would examine three key questions: What is sanity? What is the role of the forensic psychiatrist? And how do we take care of security when an insane man is sentenced?
“Much suggests that the medical principle is inadequate,” said Faremo. “It is a historic step we are now taking. It is an important step in light of the terrible incident and the trial we face and in consideration of people's sense of justice.”
“This is a big thing,” says Abrahamsen. “If it hadn’t been for Breivik, we wouldn’t have discussed this.”
References and Links
Psychiatry May Also Face Scrutiny at Norway Killer's Trial - NYTimes.com
Breivik trial: Norwegians rethink role of psychiatry in courts - CSMonitor.com
Breivik Trial and The Crisis Of Psychiatry As Science - Links
Breivik Trial and The Crisis Of Psychiatry As A Science
Breivik is not the only one who is on this trial. Psychiatry as a science is on this trial also, just like on many other trials where forensic psychiatric involvement is sought. This is highlighted by the two contradictory psychiatric assessments of the accused, with their directly opposing diagnostic impressions and directly conflicting main general conclusions. The first forensic psychiatric evaluation, completed on November 29, 2011 by the psychiatrists Torgeir Husby and Synne Sørheim found Breivik to be "paranoid schizophrenic" and "psychotic" at the time of the alleged crime and presently and therefore legally "insane". A leaked copy of the initial psychiatric examination described his crusader fantasy as a product of the "bizarre, grandiose delusions" of a "sick mind".The second evaluation, about 300 pages long, made by the psychiatrists Terje Toerrissen and Agnar Aspaas on a request from the court after widespread criticism of the first one, was completed on April 10, 2012, just six days before the trial, but was not released, and according to the leaked information, found him afflicted with "narcissistic personality disorder" with "grandiose self" and not psychotic at the time of the alleged crime and presently and therefore legally "sane".
The latest psychiatric report was confidential, but national broadcaster NRK and other Norwegian media who claimed to have seen its conclusions said it described Breivik as narcissistic but not psychotic.
Torgensen gets the impression that Breivik found an ideal place to nourish his delusions of grandeur in the anti-Islamic scene full of crusader fantasies. “This was coupled with an extremely sadistic disorder,” Torgensen says. “This disastrous combination could explain the scale of his violence.”
The new report from forensic psychiatrists Terje Tørrissen and Agnar Aspaas concludes that he did not have “significantly weakened capacity for realistic evaluation of his relations with the outside world, and did not act under severely impaired consciousness”.
"Our conclusion is that he (was) not psychotic at the time of the actions of terrorism and he is not psychotic now," Terje Toerrissen, one of the psychiatrists who examined Breivik in prison, told The Associated Press.
Thus, as it almost always happens in complex forensic psychiatric cases, it was left for the infinite wisdom and common sense of the court, unburdened by the "sophisticated" and empty psychiatric jargon, to decide by itself, and rightly so, the "main questions" of the accused's mental illness or mental health and his "sanity" or "insanity" and to make its own, judicial decision regarding the issue of legal responsibility. Both mutually conflicting (but not mutually exclusive) forensic psychiatric evaluations, which, no doubt, were performed in good faith and with utmost professional diligence, will be taken into account by the court, but were rendered almost irrelevant by their contradictions. Once again, psychiatry, pretending to be a medical discipline and a science, was humiliated and reduced to the position of a laughing stock for the public and the media.
Mr. Breivik's skillful and astute lead defense lawyer, Mr. Geri Lippestad, treating his client with respect and at the same time with appropriate professional distance and apparently convinced of his client's mental illness and "insanity", chose a strategy of presenting Mr. Breivik to the court and to the public "as is", letting him to reveal himself and his presumed mental illness fully as the engine of alleged criminal behavior, apparently counting that it will be convincing enough for both the judges and for the court of public opinion.
“This whole case indicated that he is insane,” Geir Lippestad told reporters. “He looks upon himself as a warrior. He starts this war and takes some kind of pride in that,” Lippestad said. Lippestad said Breivik had used “some kind of drugs” before the crime to keep strong and awake, and was surprised he had not been killed during the attacks or en route to Monday’s court hearing.
Lippestad, a member of the Labour party whose youth wing had been the target of Friday’s shooting rampage, said he would quit if Breivik did not agree to psychological tests.
Geir Lippestad said the new report means Breivik's testimony will be crucial "when the judges decide whether he is insane or not." The trial started on April 16 and is scheduled to last 10 weeks.
Mr. Breivik declared himself undoubtedly and completely "sane" and consistently, if somewhat eerily out of place and time, painted a self-portrait as a model and self-sacrificing ideological warrior, taking as an insult any, including "professional" opinions to the contrary and dismissed them with anger and indignation.
“On this day,” he said, “I was waging a one-man war against all the regimes of Western Europe. I felt traumatized every second that blood and brains were spurting out. War is hell.”
"Breivik told the court that "ridiculous" lies had been told about him, rattling off a list which accused him of being a narcissist who was obsessed with the red jumper he wore to his first court hearing, of having a "bacterial phobia", "an incestuous relationship with my mother", "of being a child killer despite no one who died on Utoya being under 14".
He was not insane, he repeated many times. He claimed it was Norway's politicians who should be locked up in the sort of mental institution he can expect to spend the rest of his days if the court declares him criminally insane at the end of the ten-week trial. He said: "They expect us to applaud our ethnic and cultural doom... They should be characterised as insane, not me. Why is this the real insanity? This is the real insanity because it is not rational to work to deconstruct ones own ethnic group, culture and religion."
All this is fine and dandy, and, no doubt, the aforementioned infinite wisdom of Scandinavian level headed justice (embodied in a stern but motherly demeanor of the presiding Judge Wenche Elisabeth Arntzen) will eventually and somehow emanate from somewhere in between of its somewhat obscure, slowly but surely turning and unstoppable wheels, hopefully to almost every one's satisfaction. And eventually, this horrendous crime, the purp and the trial will be almost forgotten and placed into archives for further studies.
But the nagging questions remain and will remain for some, and probably a long time: is psychiatry really a science? Or is it just a collection of "professional" opinions, mixed with convenient labels and outdated jargon? What is "sane" and what is "insane"? And how far should the justice go in its modern "humane" stance?
"Grete Faremo, Norway’s justice minister, has said that it plans to establish a committee to examine the role of forensic psychiatrists. She told Norwegian daily Aftenposten on April 13 the committee would have a “broad mandate” that would examine three key questions: What is sanity? What is the role of the forensic psychiatrist? And how do we take care of security when an insane man is sentenced?
“Much suggests that the medical principle is inadequate,” said Faremo. “It is a historic step we are now taking. It is an important step in light of the terrible incident and the trial we face and in consideration of people's sense of justice.”
“This is a big thing,” says Abrahamsen. “If it hadn’t been for Breivik, we wouldn’t have discussed this.”
References and Links
Psychiatry May Also Face Scrutiny at Norway Killer's Trial - NYTimes.com
Breivik trial: Norwegians rethink role of psychiatry in courts - CSMonitor.com
Breivik Trial and The Crisis Of Psychiatry As Science - Links
_____________________________________________________________________
References and
Links
Anders Breivik, the public, and psychiatry : The Lancet
The Lancet, Volume 379, Issue 9826, Pages 1563 - 1564, 28
April 2012
doi:10.1016/S0140-6736(12)60655-2
Cite or Link Using DOI
Cite or Link Using DOI
May 01 (15)
Tuesday, May 1, 2012
"Delusions are... now conceptualized as dimensional entities rather than categorical ones, lying at the extreme end of a "belief continuum"... A truly comprehensive model of the persecutory delusion requires further elucidation at the neurochemical and genetic levels." - PsychiatryOnline | American Journal of Psychiatry | Cognitive Neuropsychiatric Models of Persecutory Delusions
"Delusions are... now conceptualized as
dimensional entities rather than categorical ones, lying at the extreme end of a
"belief continuum"...
A truly comprehensive model of the persecutory delusion requires further elucidation at the neurochemical and genetic levels.
Finally, genetic studies, in the absence of a definitively linked genomic region of, for example, schizophrenia R1584BABBEHIC, currently are being designed to reduce genetic heterogeneity at the entry point of proband ascertainment. Thus, dimensional variables (e.g., delusional ideation, social cognitive skills) or symptom clusters (e.g., reality distortion) become intermediate phenotypes worthy of study (for preliminary examples of this approach, see references R1584BABJIDCA–R1584BABEFBIB). If the relevant social cognitive mechanisms can be reliably characterized and shown to be heritable, this approach could lead to more definitive linkage results and to the elucidation of the genetic background of the illnesses in which persecutory delusions arise."
PsychiatryOnline | American Journal of Psychiatry | Cognitive Neuropsychiatric Models of Persecutory Delusions
The American Journal of Psychiatry, VOL. 158, No. 4
A truly comprehensive model of the persecutory delusion requires further elucidation at the neurochemical and genetic levels.
Finally, genetic studies, in the absence of a definitively linked genomic region of, for example, schizophrenia R1584BABBEHIC, currently are being designed to reduce genetic heterogeneity at the entry point of proband ascertainment. Thus, dimensional variables (e.g., delusional ideation, social cognitive skills) or symptom clusters (e.g., reality distortion) become intermediate phenotypes worthy of study (for preliminary examples of this approach, see references R1584BABJIDCA–R1584BABEFBIB). If the relevant social cognitive mechanisms can be reliably characterized and shown to be heritable, this approach could lead to more definitive linkage results and to the elucidation of the genetic background of the illnesses in which persecutory delusions arise."
PsychiatryOnline | American Journal of Psychiatry | Cognitive Neuropsychiatric Models of Persecutory Delusions
The American Journal of Psychiatry, VOL. 158, No. 4
__________________________________________________________
Delusion - Wikipedia, the free encyclopedia
Paranoia - Wikipedia, the free encyclopedia
_______________________________________________________________
Thursday, April 26, 2012
Anders Breivik, the public, and psychiatry : The L...
Anders Breivik, the public, and psychiatry : The Lancet
Anders
Breivik, the public, and psychiatry : The Lancet
*
*
The Lancet, Volume
379, Issue 9826, Pages 1563 - 1564, 28 April 2012
doi:10.1016/S0140-6736(12)60655-2Cite
or Link Using DOI
Cite
or Link Using DOIAnders Breivik, the public, and psychiatry
On July 22, 2011, Anders Breivik detonated a car bomb
outside the office of the Norwegian Prime Minister. The explosion killed eight
people, and inflicted grievous damage on the infrastructure of the Norwegian
Government. If he had done nothing else, that was already the worst act of
terrorism in the history of Scandinavia. But as we know he did not stop there.
Dressed in a police uniform he drove to Utøya, where he murdered a further 69
people, mainly teenagers attending a summer camp organised by Norway's Labour
party's youth league.
In September, 2011, I was asked by the Norwegian
Government to join an International Advisory Council tasked with reviewing the
emergency response, both medical and psychosocial, to the dreadful events of
July 22. Before coming to our conclusions, which were that the “Norwegian Health
Service had responded very well to the greatest challenge it had ever faced”,1 we were briefed by many of
those intimately involved in the events. We were left in no doubt that the
crimes had shaken Norwegian society to the core. Nevertheless, much of the world
came to admire the way in which the nation came together to reaffirm its
commitment to a tolerant liberal society.2 But people remained
perplexed about Breivik himself. What were his motives, and how should justice
be done?
When people struggle to comprehend what lies behind the
mass murder of adolescents gathered for a weekend of discussions and campfires,
the simplest response is that the killer “must be mad”. The inexplicable can
only be explained as an act of insanity, which by definition cannot be
rationally explained. The act was so monstrous, the consequences so grievous,
that the perpetrator had to be insane. Yet whilst I was in Oslo, the country was
preparing to learn the results of Breivik's psychiatric examinations and all
those who we spoke to were insistent that he should not be regarded as mad. And
when, to everyone's surprise including my own, the psychiatrists did indeed
state that Breivik was suffering from schizophrenia,3 there was an outcry.4 Such reactions are common.
All the psychiatrists who interviewed Peter Sutcliffe, the so-called Yorkshire
Ripper in the UK, agreed that he had schizophrenia. Normally this would lead to
a finding of diminished responsibility and admission to a secure hospital
facility. But despite defence and prosecution being in agreement the Judge
insisted that the matter had to be put to a jury, because the general public
would feel that otherwise Sutcliffe had escaped punishment.5 In practice it made little
difference. Sutcliffe was convicted of murder and sent to prison, but soon
transferred to Broadmoor Secure Hospital, where he will end his days. Whether he
was being punished in prison, or treated in hospital, there was no doubt that he
would never be released, since no Home Secretary would agree to that.
But Norway should be different. Norway is a country with
one of the best developed mental health systems in the world.6 It prides itself on its
tolerant attitude towards mental disorders. When former Prime Minister Kjell
Magne Bondevik took leave of absence to be treated for depression in 1998 his
career did not come to a halt.7 Offenders diagnosed with
mental illness are dealt with within the health, not the criminal justice,
system. And if the person then recovered, they would be released from hospital
on the authority of the psychiatrists, without the possibility of political
interference.8 But tolerance can only go so
far, and the majority of the Norwegian public saw a label of schizophrenia as
allowing Breivik to avoid having to answer to his crimes, and worse, that a
psychiatric diagnosis raised the spectre that he could be free again.9
In fact that was always improbable. Many Norwegians
themselves were confused about the checks and balances within their own judicial
system. A prosecutor can, although they rarely do, challenge the psychiatrist's
decision and the matter be returned to Court. And even if the offender has
recovered, the power exists to transfer him to prison indefinitely if judged a
continuing threat to society.8 Although at the time of
writing the Court's verdict remains unknown, as Breivik gives his chilling
testimony in Court the chances that he receives a psychiatric disposal rather
than a criminal conviction seem to be receding.
The Breivik case highlights two popular misconceptions.
First, that outrageous crimes must mean mental illness. Diagnoses in psychiatry
are made on the basis of symptoms and motivations, rather than outcomes. For
schizophrenia to explain Breivik's actions, they would have to be the result of
delusions. Delusions are beliefs that are not only wrong, in the sense of not
corresponding to the world as we know it, but they must also not be shared with
others of the same cultural background. A psychiatric classic established that
individuals with schizophrenia can identify others as mad, even when they share
the same delusions.10
Breivik's views on the evils of multiculturalism,
immigration, and the threat of Islam mixed in with nonsense about the Knights
Templar and so on, are absurd, reprehensible, and abhorrent, but he is not
alone. One fears that in the backwoods of Montana or among those who subscribe
to what is loosely called “anti Jihadism” are other people like him, who may
also have devoted a summer to playing World of Warcraft and believe that Dan
Brown writes history. The meticulous way in which he planned his attacks does
not speak to the disorganisation of schizophrenia. My colleagues in forensic
psychiatry struggle to think of anyone who has had the foresight to bring along
a sign stating “sewer cleaning in progress” to avoid drawing attention to the
smell of sulphur from the homemade explosives in the back of his vehicle. If a
psychiatric parallel is needed, the closest might be the classic case of German
school teacher Ernst Wagner, who murdered 15 people in a small village, and was
diagnosed with paranoia, or delusional disorder as it is now known.11
The second misconception is that the purpose of
psychiatry is to “get people off”. In the UK, however, if you commit murder and
want to spend as little time in detention as you can, putting forward a mental
illness defence may mean that you will spend more—not fewer—years behind bars.12 And the forensic
psychiatry system is not a soft or popular option either. Most offenders have
the same prejudices towards mental illness as the general population, and would
rather take their chances in prison than be what they call “nutted off”.
Similarly, it is a commonplace observation among British forensic psychiatrists
that those who have experienced both prison and hospital often prefer the former
because “at least they don't try to do your head in”. The widespread anger when
it seemed that Breivik was going to be sent to hospital rather than prison
reminds us that liberal attitudes to mental illness are still often only skin
deep.
I declare that I have no conflicts of interest.
I declare that I have no conflicts of
interest.
References
1
International Advisory Council on the Health Sector
Response to the Terrorist Attacks of June 22, 2011. Lessons for better
preparedness. Health effort after the acts of terror July 22, 2011 [in
Norwegian]. http://www.helsedirektoratet.no/publikasjoner/lering-for-bedre-beredskap-/Sider/default.aspx.
(accessed April 23, 2012).
2
. “Answer hatred with love”: how Norway tried to cope with
the horror of Anders Breivik. The Observer. http://www.guardian.co.uk/world/2012/apr/15/anders-breivik-norway-copes-horror.
(accessed April 23, 2012).
3
Rettspsykiatrisk erklaering Breivik, Anders f. 130279
[in Norwegian]. http://pub.tv2.no/multimedia/TV2/archive/00927/Breivik_rapport_927719a.pdf.
(accessed April 23, 2012).
4
. Norwegian disbelief at
Breivik's insanity. Nov 29, 2011. BBC News World. http://www.bbc.co.uk/news/world-15954370. (accessed April 23, 2012).
6
. Mental health services in Norway.
Prevention—treatment—care. http://www.regjeringen.no/upload/kilde/hod/red/2005/0011/ddd/pdfv/233840-mentalhealthweb.pdf.
(accessed April 23, 2012).
7
. Depression and recovery. Interview with Kjell Magne
Bondevik by Sarah Mitchell. J
Ment Health 2010; 19: 369-372. PubMed
8
. Scandinavian forensic psychiatric practices : an
overview and evaluation. Nord
J Psychiatry 2005; 59: 92-102. CrossRef | PubMed
*
Scandinavian forensic psychiatric practices--an overview and evaluation.
Source
Centre for Research and Education in Forensic Psychiatry, Ullevaal University Hospital, Oslo, Norway. pagron@c2i.netAbstract
The Scandinavian countries share a social-democratic and humanistic view in that mentally disturbed offenders should not be punished or sentenced to prison if they are considered unaccountable for their actions. The countries differ, however, for example regarding referrals for medico-legal examinations. This article gives: 1) an overview of the Scandinavian forensic psychiatric practices regarding organization, legislation, resources and use of methods, and 2) a study of forensic psychiatric assessment as they are done in the Scandinavian countries. From each country 20 forensic psychiatric court reports concerning male murderers were examined. Each report was scored in five sections: characteristics of the defendant, setting of the observation, acting professions, methods used and premises for the experts' conclusions. Data were summarized with descriptive measures. Danish and Swedish experts had a more frequent use of tests and instruments than Norwegian experts. Swedish experts used the Global Assessment of Functioning Scale (GAF), and they diagnosed the observant according to DSM-IV. The Scandinavian experts rarely referred to the tests they had applied nor did they refer to any kind of theory or literature as a basis for their conclusion. Only a few reports expressed doubt concerning the validity of the conclusion. Stating all the premises of the forensic psychiatric examination might improve the quality of the reports by doing them more explicit and verifiable. More use of standardized actuarial-based methods and more attention to knowledge about clinical judgmental processes is recommended.- PMID:
- 16195105
- [PubMed - indexed for MEDLINE] ]
9
. The Norwegian system can produce many
exonerations.Aftenposten April 13, 2012 [in
Norwegian]. http://www.aftenposten.no/nyheter/iriks/22juli/—Det-norske-systemet-kan-gi-mange-feilaktige-frifinnelser-6803402.html.
(accessed April 23, 2012).
a Department of
Psychological Medicine, Institute of Psychiatry, King's College London Weston
Education Centre, London SE5 9RS, UK
References and Links
Monday, April 30, 2012
"Delusions are... now conceptualized as dimensional entities rather than categorical ones, lying at the extreme end of a "belief continuum"...
A truly comprehensive model of the persecutory delusion requires further elucidation at the neurochemical and genetic levels.
PsychiatryOnline | American Journal of Psychiatry | Cognitive Neuropsychiatric Models of Persecutory Delusions
The American Journal of Psychiatry, VOL. 158, No. 4
A truly comprehensive model of the persecutory delusion requires further elucidation at the neurochemical and genetic levels.
PsychiatryOnline | American Journal of Psychiatry | Cognitive Neuropsychiatric Models of Persecutory Delusions
The American Journal of Psychiatry, VOL. 158, No. 4
Neuropsychological aspects of delusional disorder are poorly understood | Cognitive neuropsychiatry is a new field of cognitive psychology
The neuropsychology of DDs is poorly understood |
Cognitive neuropsychiatry is a new field of cognitive psychology
Neuropsychological aspects of delusional disorder.
Abdel-Hamid M, Brüne
M
Curr Psychiatry Rep. 2008 Jun;10(3):229-34
Authors: Abdel-Hamid M, Brüne M
Abstract
Delusional disorders (DDs) are clinically rare syndromes characterized by false beliefs that are held with firm conviction despite counterevidence. The neuropsychology of DDs is poorly understood. Two partially opposing models--a cognitive bias model and a cognitive deficit model--have received mixed empiric support, partly because most research has been carried out in patients with paranoid schizophrenia, with which the nosologic association of DDs is unknown. Based on these models, we review empiric findings concerning the neuropsychology of DDs (narrowly defined). We conclude that DDs can best be seen as extreme variations of cognitive mechanisms involved in rapid threat detection and defensive harm avoidance. From this viewpoint, the two models seem to be complementary in explanatory power rather than contradictory. Future research may help to clarify the question of gene-environment interaction involvement in the formation of delusional beliefs.
PMID: 18652791 [PubMed - indexed for MEDLINE]
Cognitive neuropsychiatry and delusional belief.
Coltheart M
Q J Exp Psychol (Hove). 2007 Aug;60(8):1041-62
Authors: Coltheart M
Abstract
Cognitive neuropsychiatry is a new field of cognitive psychology which seeks to learn more about the normal operation of high-level aspects of cognition such as belief formation, reasoning, decision making, theory of mind, and pragmatics by studying people in whom such processes are abnormal. So far, the high-level cognitive process most widely studied in cognitive neuropsychiatry has been belief formation, investigated by examining people with delusional beliefs. This paper describes some of the forms of delusional belief that have been examined from this perspective and offers a general two-deficit cognitive-neuropsychiatric account of delusional belief.
PMID: 17654390 [PubMed - indexed for MEDLINE]
*
Associated Drug and Alcohol Use
Alcohol and drug misuse has a well-recognized association with morbid jealousy. “In two studies, morbid jealousy was present in 27% and 34% respectively of men recruited from alcohol treatment services” (Shrestha et al., 1985; Michael et al., 1995). Amphetamine and cocaine increase the possibility of a delusion of infidelity that can continue after intoxication stops. (Shepherd, 1961). Once case study by Pillai & Kraya discovered a man that was prescribed dexaphetamine for adult attention-deficit hyperactivity disorder, and he later developed morbid jealousy (2000).
______________________________________________________________
Psychodynamic aspects of Delusional Disorder, Perse...
Monday, April 30, 2012
Psychodynamic aspects of Delusional Disorder, Persecutory type ("Paranoia") - Links to "castration anxiety and phobia" Searches
Mike Nova: Psychoanalytic theory is deadeningly mechanistic and hopelessly outdated,
but at this time we do not have any other theory which attempts to explain with such an allure and in
more or less simple (if not simplistic) and coherent terms
the dazzling and paradoxical complexities of human emotional life and behavior; although, confirming one of these paradoxes, "psychoanalysts" are famously known themselves for their predilection towards near-incoherence and "fuzzy thinking".
castration phobia - Google Search
Psychol Rep. 2002 Dec;91(3 Pt 2):1244-6.
Castration anxiety and phobias.
Cogan R, Larrabee LK, Wyatt IM, Ontiberoz A, Waters SK, Werner ML, Miller AL, Lovelady AC, Hurt TJ, Hardin ED 3rd, Gonzalez PM.
Source
Department of Psychology, Texas Tech University, Box 42051, Lubbock, TX 79409-2051, USA.Abstract
Based on Freud's case study of "Little Hans," the authors tested the hypothesis that men with phobias would score higher on castration anxiety than men without phobias. College men with either average or high scores on the Fears Scale of the MMPI-2 (n = 10 men in each group) responded to the Thematic Apperception Test, which was scored for castration anxiety. Men with high scores on the Fears Scale had higher scores on castration anxiety than men with average scores on the Fears Scale. The findings are consistent with Freud's hypothesis about phobias.- PMID:
- 12585544
- [PubMed - indexed for MEDLINE]
castration phobia - Wikipedia Search
discussed in Freud's 1909 study Analysis of a Phobia in a Five-year-old Boy.' ... extensive
study of castration anxiety and the Oedipus
complex . ...
*
, a Freudian, explained the delusion as displaced castration anxiety . ... crippled with
depression and anxiety and phobia about wolves
from childhood. ...
*
complexes differently — he via castration anxiety , she via penis ... Oedipal
case study-In Analysis of a Phobia in a
Five-year-old Boy (1909 ...
__________________________________________________________________________
via anders
behring breivik - Google News on 4/28/12
 MiamiHerald.com |
Norway Muslims question focus on Breivik's sanity
Kansas City Star
By JULIA GRONNEVET AP FILE- This is a April 23, 2012 file photo showing Mehtab Afsar, leader of the Islamic Council in Norway, in the courthouse in Oslo where he attended the proceedings Anders Behring Breivik. Muslim leaders in Norway say they are ... Norway survivors of Breivik massacre tell of painChicago Tribune Experts: Norway mass killer Anders Behring Breivik likely not insane despite ...CBS News Experts: Mass killer Breivik likely not insaneMiamiHerald.com Detroit Free Press all 446 news articles » |
via anders behring
breivik - YouTube on 4/28/12
Breivik - Song He Hates Protest Oslo To Drown His Words Out
The lyrics of Children of the Rainbow were sung by 40000 Norwegians in Oslo in response to a week of testimony by_____________________________________________________________________________
References and Links
Forensic psychiatry - From Wikipedia, the free encyclopedia
Mental state opinion
This gives the Court an opinion, and only an opinion, as to whether a defendant was able to understand what he was doing at the time of the crime. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant Court rulings or laws that bear on this area which include the following three standards[4]:
- M'Naghten rules: Excuses a defendant who, by virtue of a defect of reason or disease of the mind, does not know the nature and quality of the act, or, if he does, does not know that the act is wrong.[5]
- Durham rule: Excuses a defendant whose conduct is the product of mental disease or defect.[6]
- ALI test: Excuses a defendant who, because of a mental disease or defect, lacks substantial capacity to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law.[7]
Forensic psychiatrists are also involved in the care of prisoners, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity).
Delusional disorder
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| Delusional disorder | |
|---|---|
| Classification and external resources | |
| ICD-10 | F22.0 |
| ICD-9 | 297.1 |
| eMedicine | article/292991 |
| MeSH | D010259 |
See also: Delusion
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect.[1] For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present.[2]To be diagnosed with delusional disorder, the delusion or delusions cannot be due to the effects of a drug, medication, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life as this disorder bears no relation to one's IQ[3], and may not exhibit odd or bizarre behavior aside from these delusion. According to German psychiatrist, Emil Kraepelin, patients with Delusional Disorder, remain coherent, sensible and reasonable[4]. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines six subtypes of the disorder characterized as erotomanic (believes that someone is in love with him/her), grandiose (believes that he/she is the greatest, strongest, fastest, richest, and/or most intelligent person ever), jealous (believes that the love partner is cheating on him/her), persecutory (believes that someone is following him/her to do some harm in some way), somatic (believes that he/she has a disease or medical condition), and mixed, i.e., having features of more than one subtypes.[2] Delusions also occur as symptoms of many other mental disorders, especially the other psychotic disorders.
The DSM-IV, and psychologists, generally agree that personal beliefs should be evaluated with great respect to complexity of cultural and religious differences since some cultures have widely accepted beliefs that may be considered delusional in other cultures.[5]
Contents[hide] |
[edit] Indicators of a delusion
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- The patient expresses an idea or belief with unusual persistence or force.
- That idea appears to exert an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent.
- Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
- The individual tends to be humorless and oversensitive, especially about the belief.
- There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
- An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
- The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
- The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche.
- The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
- Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien.
[edit] Features
The following features are found:[6]- It is a primary disorder.
- It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
- The illness is chronic and frequently lifelong.
- The delusions are logically constructed and internally consistent.
- The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
- The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.
[edit] Types
Diagnosis of a specific type of delusional disorder can sometimes be made based on the content of the delusions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) enumerates six types:- Erotomanic Type (erotomania): delusion that another person is in love with the individual, quite frequently a famous person. The individual may breach the law as he/she tries to obsessively make contact with the desired person.
- Grandiose Type: delusion of inflated worth, power, knowledge, identity or believes himself/herself to be a famous person, claiming the actual person is an impostor or an impersonator.
- Jealous Type: delusion that the individual's sexual partner is unfaithful when it is untrue. The patient may follow the partner, check text messages, emails, phone calls etc. in an attempt to find "evidence" of the infidelity.
- Persecutory Type: This delusion is a common subtype. It includes the belief that the person (or someone to whom the person is close) is being malevolently treated in some way. The patient may believe that he/she has been drugged, spied-on, harassed and so on and may seek "justice" by making police reports, taking court action or even acting violently.
- Somatic Type: delusions that the person has some physical defect or general medical condition (for example, see delusional parasitosis).
- Mixed Type: delusions with characteristics of more than one of the above types but with no one theme predominating.
[edit] Delusional disorder: Somatic type - A real life example
A 40 year old woman lost a significant amount of weight over the course of 2 years. She originally weighed 60kg. She dropped down to 29kg body weight, which can be unhealthy and potentially life threatening. Initially the doctors diagnosed her with anorexia nervosa, as she was malnourished due to her undereating. A further examination of the patient revealed that she was delusional and convinced that eating food would harm her body. Thus, she decided to stop eating. The doctors decided that she didn't suffer from anorexia nervosa, but rather a somatic delusion disorder. She was later treated and the doctors were able to help her get back to a healthy weight. [8]A teenager named Dean Fick suddenly gained major delusions regarding his life and the people around him. He began to believe that he was part of an elite group of people called the Illumnati, claimed to be friends with multiple celebrities, and had huge thoughts of grandeur regarding his physical state. It first seemed that he was just lying, but through several months of observation, doctors saw severe cognitive dissonance, to the point where he actually believed what he was saying, although they were obvious lies. A longitudinal study is currently being conducted through monthly sessions, however treatment was never sought out because of depth of his dissonance, and Dean continues to suffer from a major delusional disorder. [9]
[edit] Causes
When delusional disorders occur late in life they suggest a hereditary predisposition. Researchers also suggest that these disorders are the result of early childhood experiences with an authoritarian family structure. According to other researchers, any person with a sensitive personality is particularly vulnerable to developing a delusional disorder.[10]Although its exact cause is unknown, it is believed that genetic, biochemical and environmental factors play a significant role in the development of delusional disorder.[11]
[edit] Diagnosis
The symptoms expressed by a delusional disorder can also be part of a much more serious problem, such as bipolar disorder or schizophrenia, therefore diagnosing the delusional disorder is conducted partially by process of elimination. This occurs because delusions can be part of many other illnesses including dementia, schizophrenia and schizoaffective disorder. They may also be part of a response to physical, medical conditions, or reactions when drugs are ingested.[12]Interviews are useful tools to obtain information about the patient's life situation and past history to help identifying the delusional disorder. Clinicians may review earlier medical records, with the patient's permission. Clinicians also interview the patient's immediate family. This is a very helpful measure in determining the presence of delusions. The mental status examination is used to assess the patient's memory, concentration, and understanding the individual's situation and logical thinking.[12]
Another psychological test used in the diagnosis of the delusional disorder is the Peters Delusion Inventory (PDI) which focuses on identifying and understanding delusional thinking. However, this test is more likely used in research than in clinical practice.[12]
[edit] Treatment
Treatment of delusional disorders includes a combination of drug therapy and psychotherapy although it is a challenging disorder to treat for many reasons such as the patient's denial that they have a problem of a psychological nature.Atypical antipsychotic medications (also known as novel or newer-generation) are used in the treatment of delusional disorder as well as in schizophrenic disorders. Some examples of such medications are risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa). These medications work by blocking postsynaptic dopamine receptors and reduce the incidence of psychotic symptoms including hallucinations and delusions. They also relieve anxiety and agitation. When these drugs are tried but the symptoms do not improve, other types of antipsychotics may be prescribed. Some examples are: fluphenazine decanoate and fluphenazine enanthate. One very effective drug in delusional disorders is also pimozide.[13]
In some cases agitation may occur as a response to severe or harsh confrontation when dealing with the existence of the delusions.[14] If agitation occurs, different antipsychotics can be administered to conclude its outbreak. For instance, an injection of haloperidol (Haldol) can decrease anxiety and slow behavior, it is often combined with medications including lorazepam (Ativan).
In cases when severely ill patients do not respond to standard treatment, Clozapine may be prescribed although it may cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, seizures and agranulocytosis.[14]
To treat long term symptoms, an oral novel antipsychotic is often prescribed on a daily basis. Antidepressants and anxiolytics are also prescribed to control associated symptoms.[13]
Psychotherapy for patients with delusional disorder include cognitive therapy which is conducted with the use of empathy. During the process, the therapist asks hypothetical questions in a form of therapeutic Socratic dialogue.[14] This therapy has been mostly studied in patients with the persecutory type. The combination of pharmacotherapy with cognitive therapy integrates treating the possible underlying biological problems and decreasing the symptoms with psychotherapy as well. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship. [15] The therapist is there for support and must not show any signs that implicate that the patient is mentally ill. [15]
Supportive therapy has also shown to be helpful. Its goal is to facilitate treatment adherence and provide education about the illness and its treatment.
Furthermore, providing social skills training has been applicable to a high number of persons. It should focus on promoting interpersonal competence as well as confidence and comfort when interacting with those individuals perceived as a threat.[16]
Reports have shown successful use of insight-oriented therapy although it may also be contraindicated for delusional disorder. Its goals are to develop therapeutic alliance, containment of projected feelings of hatred, impotence, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. The latter requires the empathy with the patient's defensive position.[16]
[edit] See also
[edit] References
- ^ Semple.David."Oxford Hand Book of Psychiatry" Oxford Press. 2005. p230
- ^ a b American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text revision). Washington, DC: American Psychiatric Association.
- ^ Winokur, G. (1977). Delusional Disorder (Paranoia). Comprehensive Psychiatry, 18(6), 513. Retrieved March 17, 2012, from <http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/0010440x/v18i0006/511_dd>
- ^ Winokur, G. (1977). Delusional Disorder (Paranoia). Comprehensive Psychiatry, 18(6), 511. Retrieved March 17, 2012, from http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/1230440208560715363.pdf
- ^ Shivani Chopra. Delusional Disorder. eMedicine. http://emedicine.medscape.com/article/292991-overview
- ^ a b Munro, Alistair (1999). Delusional disorder: paranoia and related illnesses. Cambridge, UK: Cambridge University Press. ISBN 0-521-58180-X
- ^ Schultz J.M., Videbeck S.L., 2008. Lippincott's Manual of Psychiatric Nursing Care Plans8th ed,Raven Publishers, USA.
- ^ [1], A.E. Geka, C. Venetis, D. Apatangelos, S. Kalimeris, V. Psarra, N. Drakonakis, G. Doulgeraki, R. Evangelatou, C. Garnetas, P03-550 - Delusional disorder with severe weight loss, European Psychiatry, Volume 26, Supplement 1, 2011, Page 1720, ISSN 0924-9338, 10.1016/S0924-9338(11)73424-1.
- ^ Gleitman, Henry (2010). Psychology, Eighth Edition. New York, USA: W. W. Norton & Company. pp. 715. ISBN 978-0-393-93250-8.
- ^ "Delusional Disorders:Causes and Incidence". http://www.wrongdiagnosis.com/d/delusional_disorder/causes.htm. Retrieved 2010-08-06.
- ^ "Causes of Delusional Disorder". http://www.wrongdiagnosis.com/d/delusional_disorder/causes.htm. Retrieved 2010-08-06.
- ^ a b c "Delusion and Other Disorders". http://www.minddisorders.com/Br-Del/Delusional-disorder.html. Retrieved 2010-08-06.
- ^ a b "Delusional Disorders:Treatment". http://www.wrongdiagnosis.com/d/delusional_disorder/treatments.htm. Retrieved 2010-08-06.
- ^ a b c "Treatments". http://www.minddisorders.com/Br-Del/Delusional-disorder.html. Retrieved 2010-08-06.
- ^ a b Grohol, John. "Delusional Disorder Treatment". Psych Central. http://psychcentral.com/disorders/sx11t.htm. Retrieved 24 November 2011.
- ^ a b "Psychotherapy". http://emedicine.medscape.com/article/292991-overview. Retrieved 2010-08-06.
[edit] Further reading
- Sims, A. (1995) Symptoms in the mind: An introduction to descriptive psychopathology. Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1.
- American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text revision). Washington, DC: American Psychiatric Association. ISBN 978-0-89042-024-9
[edit] External links
- Mental Health Matters: Delusional Disorder
- Psych Forums: Delusional Disorder Forum
- Delusional Disorder Symptoms and Their Various Types
| ||
- ^ Semple.David."Oxford Hand Book of Psychiatry" Oxford Press. 2005. p230
- ^ a b American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text revision). Washington, DC: American Psychiatric Association.
- ^ Winokur, G. (1977). Delusional Disorder (Paranoia). Comprehensive Psychiatry, 18(6), 513. Retrieved March 17, 2012, from <http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/0010440x/v18i0006/511_dd>
- ^ Winokur, G. (1977). Delusional Disorder (Paranoia). Comprehensive Psychiatry, 18(6), 511. Retrieved March 17, 2012, from http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/1230440208560715363.pdf
- ^ Shivani Chopra. Delusional Disorder. eMedicine. http://emedicine.medscape.com/article/292991-overview
- ^ a b Munro, Alistair (1999). Delusional disorder: paranoia and related illnesses. Cambridge, UK: Cambridge University Press. ISBN 0-521-58180-X
- ^ Schultz J.M., Videbeck S.L., 2008. Lippincott's Manual of Psychiatric Nursing Care Plans8th ed,Raven Publishers, USA.
- ^ [1], A.E. Geka, C. Venetis, D. Apatangelos, S. Kalimeris, V. Psarra, N. Drakonakis, G. Doulgeraki, R. Evangelatou, C. Garnetas, P03-550 - Delusional disorder with severe weight loss, European Psychiatry, Volume 26, Supplement 1, 2011, Page 1720, ISSN 0924-9338, 10.1016/S0924-9338(11)73424-1.
- ^ Gleitman, Henry (2010). Psychology, Eighth Edition. New York, USA: W. W. Norton & Company. pp. 715. ISBN 978-0-393-93250-8.
- ^ "Delusional Disorders:Causes and Incidence". http://www.wrongdiagnosis.com/d/delusional_disorder/causes.htm. Retrieved 2010-08-06.
- ^ "Causes of Delusional Disorder". http://www.wrongdiagnosis.com/d/delusional_disorder/causes.htm. Retrieved 2010-08-06.
- ^ a b c "Delusion and Other Disorders". http://www.minddisorders.com/Br-Del/Delusional-disorder.html. Retrieved 2010-08-06.
- ^ a b "Delusional Disorders:Treatment". http://www.wrongdiagnosis.com/d/delusional_disorder/treatments.htm. Retrieved 2010-08-06.
- ^ a b c "Treatments". http://www.minddisorders.com/Br-Del/Delusional-disorder.html. Retrieved 2010-08-06.
- ^ a b Grohol, John. "Delusional Disorder Treatment". Psych Central. http://psychcentral.com/disorders/sx11t.htm. Retrieved 24 November 2011.
- ^ a b "Psychotherapy". http://emedicine.medscape.com/article/292991-overview. Retrieved 2010-08-06.
__________________________________________________________________________
Psychiatry's identity crisis : The Lancet
The Lancet, Volume
379, Issue 9823, Page 1274, 7 April 2012
doi:10.1016/S0140-6736(12)60540-6
Cite or
Link Using DOI
Cite or
Link Using DOIPsychiatry's identity crisis
Last week, the American Psychiatric Association issued a press release
highlighting an ongoing decline in the recruitment of medical students into the
specialty—at a time when the numbers of practising psychiatric professionals in
the USA is falling. Various reasons are proposed, including the short-term
nature of placements (usually just 4 weeks); the sheer breadth of an evolving
specialty, which is drawing students towards newer areas such as clinical
neuroscience; and concerns that psychiatry is not as lucrative as other
specialties.
Tom Brown, Assistant Registrar of Recruitment at the Royal
College of Psychiatrists (RCPsych), UK, views psychiatry's identity crisis
as an international problem, and for profound reasons. He told The
Lancet: “Common perceptions within the medical profession include the view
that psychiatry is just not scientific enough, is too remote from the rest of
medicine, is often viewed negatively by other medical professionals, and is a
specialty too often characterised by difficult doctor—patient relationships and
limited success rates of therapeutic interventions”.
So, what kind of therapy is psychiatry in need of? The
RCPsych views the current problem crucial enough for a concerted campaign to
promote the specialty, not just to medical students and doctors at foundation
stage, but even to senior-school pupils studying psychology. While such
initiatives may help raise the profile of psychiatry, perhaps there are more
fundamental issues that need to change.
Psychiatrists, first and foremost, are clinicians.
Evidence-based approaches should be at the core of the psychiatrist and
non-clinical members of any mental health team. The evidence that psychiatric
patients have poorer overall health than the general population should ensure
that psychiatry is strongly connected to other medical specialties. But more
fundamental still, it is time for the specialty to stop devaluing itself because
of its chequered history of mental asylums and pseudo-science, and to realign
itself as a key biomedical specialty at the heart of mental health.
______________________________________________________________________
Thursday, April 26, 2012
Cognitive Aspects of Normal and Delusional Belief Formations
Cognitive Aspects of Normal and Delusional Belief Formations
References and Links
via pubmed:
belief formation del... by Abdel-Hamid M, Brüne M on 4/26/12
Neuropsychological aspects of delusional disorder.
Curr Psychiatry Rep. 2008
Jun;10(3):229-34
Authors: Abdel-Hamid M, Brüne M
Abstract
Delusional
disorders (DDs) are clinically rare syndromes characterized by false beliefs
that are held with firm conviction despite counterevidence. The neuropsychology
of DDs is poorly understood. Two partially opposing models--a cognitive bias
model and a cognitive deficit model--have received mixed empiric support, partly
because most research has been carried out in patients with paranoid
schizophrenia, with which the nosologic association of DDs is unknown. Based on
these models, we review empiric findings concerning the neuropsychology of DDs
(narrowly defined). We conclude that DDs can best be seen as extreme variations
of cognitive mechanisms involved in rapid threat detection and defensive harm
avoidance. From this viewpoint, the two models seem to be complementary in
explanatory power rather than contradictory. Future research may help to clarify
the question of gene-environment interaction involvement in the formation of
delusional beliefs.
PMID: 18652791 [PubMed - indexed for MEDLINE]
*
via pubmed:
belief formation del... by Coltheart M on 4/26/12
Q J Exp Psychol (Hove). 2007 Aug;60(8):1041-62
Authors: Coltheart M
Abstract
Cognitive neuropsychiatry is a new field of cognitive psychology which seeks to learn more about the normal operation of high-level aspects of cognition such as belief formation, reasoning, decision making, theory of mind, and pragmatics by studying people in whom such processes are abnormal. So far, the high-level cognitive process most widely studied in cognitive neuropsychiatry has been belief formation, investigated by examining people with delusional beliefs. This paper describes some of the forms of delusional belief that have been examined from this perspective and offers a general two-deficit cognitive-neuropsychiatric account of delusional belief.
PMID: 17654390 [PubMed - indexed for MEDLINE]
___________________________________________________________
via pubmed:
belief formation del... by Lawrence E, Peters E on 4/26/12
J Nerv Ment Dis. 2004 Nov;192(11):727-33
Authors: Lawrence E, Peters E
Abstract
Reasoning biases have been identified in deluded patients, delusion-prone individuals, and believers in the paranormal. This study examined content-specific reasoning and delusional ideation in believers in the paranormal. A total of 174 members of the Society for Psychical Research completed a delusional ideation questionnaire and a deductive reasoning task. The reasoning statements were manipulated for congruency with paranormal beliefs. As predicted, individuals who reported a strong belief in the paranormal made more errors and displayed more delusional ideation than skeptical individuals. However, no differences were found with statements that were congruent with their belief system, confirming the domain-specificity of reasoning. This reasoning bias was limited to people who reported a belief in, rather than experience of, paranormal phenomena. These results suggest that reasoning abnormalities may have a causal role in the formation of unusual beliefs. The dissociation between experiences and beliefs implies that such abnormalities operate at the evaluative, rather than the perceptual, stage of processing.
PMID: 15505516 [PubMed - indexed for MEDLINE]
via pubmed:
belief formation del... by Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H
on 4/26/12
Psychopathology. 2003 Jan-Feb;36(1):6-12
Authors: Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H
Abstract
A number of recent case reports published during the last 20 years described a quick inclusion of new technologies and cultural innovations into schizophrenic delusions which led many of the authors to the conclusion that the 'Zeitgeist' is creating new delusional contents. On the other hand, long-term comparisons and comparative transcultural studies on delusions showed, despite a certain degree of variability, a stability of delusional themes over longer periods of time. Combining anthropological and historical theories of the development of societies with a differentiated psychopathological approach (Klosterkötter's three-stage model of the formation of schizophrenic delusions), we were able to resolve the problem of the ostensibly divergent results: there are only a few themes of extraordinary anthropological importance for the organization of human relationships which can be found in every epoch and in different cultures (persecution, grandiosity, guilt, religion, hypochondria, jealousy, and love). With the exception of persecution and grandiosity, these themes showed a certain variability over time and between cultures. The 'new' themes, referring to the development of modern technology and the rapid changes of 'cultural patterns' turned out to be only the shaping of the basic delusional themes on the 3rd stage of Klosterkötter's phase model (concretization).
PMID: 12679586 [PubMed - indexed for MEDLINE]
via pubmed:
belief formation del... by Garety PA, Hemsley DR, Wessely S on 4/26/12
J Nerv Ment Dis. 1991 Apr;179(4):194-201
Authors: Garety PA, Hemsley DR, Wessely S
Abstract
An experiment is described in which deluded subjects with a diagnosis of schizophrenia or of delusional disorder (paranoia) were compared with a nondeluded psychiatric control group and a normal control group on a probabilistic inference task. Factors relevant to belief formation and maintenance were investigated. Deluded subjects requested less information before reaching a decision and were more ready to change their estimates of the likelihood of an event when confronted with potentially disconfirmatory information. No differences were found between the two diagnostic groups of deluded subjects. The results are discussed in light of prevailing theories of the importance of abnormal experience rather than reasoning biases in the formation and maintenance of delusional beliefs. It is suggested that a reasoning abnormality is involved, which may coexist with perceptual abnormalities.
PMID: 2007889 [PubMed - indexed for MEDLINE]
*
belief formation neuropsychiatry - pubmed search RSS
via pubmed:
belief formation neu... by Gerrans P on 4/26/12
Cogn Neuropsychiatry. 2001 Aug;6(3):161-73
Authors: Gerrans P
Abstract
UNLABELLED: Delusions are explanations of anomalous experiences. A theory of delusion requires an explanation of both the anomalous experience and the apparently irrational explanation generated by the delusional subject. Hence, we require a model of rational belief formation against which the belief formation of delusional subjects can be evaluated.
METHOD: I first describe such a model, distinguishing procedural from pragmatic rationality. Procedural rationality is the use of rules or procedures, deductive or inductive, that produce an inferentially coherent set of propositions. Pragmatic rationality is the use of procedural rationality in context. I then apply the distinction to the explanation of the Capgras and the Cotard delusions. I then argue that delusions are failures of pragmatic rationality. I examine the nature of these failures employing the distinction between performance and competence familiar from Chomskian linguistics.
RESULTS: This approach to the irrationality of delusions reconciles accounts in which the explanation of the anomalous experience exhausts the explanation of delusion, accounts that appeal to further deficits within the reasoning processes of delusional subjects, and accounts that argue that delusions are not beliefs at all. (Respectively, one-stage, two-stage, and expressive accounts.)
CONCLUSION: In paradigm cases that concern cognitive neuropsychiatry the irrationality of delusional subjects should be thought of as a performance deficit in pragmatic rationality.
PMID: 16571516 [PubMed]
via pubmed:
belief formation neu... by Coltheart M on 4/26/12
Q J Exp Psychol (Hove). 2007 Aug;60(8):1041-62
Authors: Coltheart M
Abstract
Cognitive neuropsychiatry is a new field of cognitive psychology which seeks to learn more about the normal operation of high-level aspects of cognition such as belief formation, reasoning, decision making, theory of mind, and pragmatics by studying people in whom such processes are abnormal. So far, the high-level cognitive process most widely studied in cognitive neuropsychiatry has been belief formation, investigated by examining people with delusional beliefs. This paper describes some of the forms of delusional belief that have been examined from this perspective and offers a general two-deficit cognitive-neuropsychiatric account of delusional belief.
PMID: 17654390 [PubMed - indexed for MEDLINE]
Flaskerud JH.
Issues Ment Health Nurs. 2000
Jan-Feb;21(1):5-29. Review.
*
via pubmed:
belief formation neu... by Ladowsky-Brooks R, Alcock JE on 4/26/12
Cogn Neuropsychiatry. 2007 Mar;12(2):97-111
Authors: Ladowsky-Brooks R, Alcock JE
Abstract
INTRODUCTION: The purpose of this paper is to outline ways in which characteristics of memory functioning determine truth judgements regarding verbally transmitted information.
METHOD: Findings on belief formation from several areas of psychology were reviewed in order to identify general principles that appear to underlie the designation of information in memory as "true" or "false".
RESULTS: Studies on belief formation have demonstrated that individuals have a tendency to encode information as "true" and that an additional encoding step is required to tag information as "false". This additional step can involve acquisition and later recall of semantic-episodic associations between message content and contextual cues that signal that information is "false". Semantic-episodic interactions also appear to prevent new information from being accepted as "true" through encoding bias or the assignment of a "false" tag to data that is incompatible with prior knowledge.
CONCLUSIONS: It is proposed that truth judgements are made through a combined weighting of the reliability of the information source and the compatibility of this information with already stored data. This requires interactions in memory. Failure to integrate different types of memories, such as semantic and episodic memories, can arise from mild hippocampal dysfunction and might result in delusions.
PMID: 17453893 [PubMed - indexed for MEDLINE]
via pubmed:
belief formation neu... by Cashmore AR on 4/26/12
|
Proc Natl Acad Sci U S A. 2010 Mar 9;107(10):4499-504
Authors: Cashmore AR
Abstract
It is widely believed, at least in scientific circles, that living systems, including mankind, obey the natural physical laws. However, it is also commonly accepted that man has the capacity to make "free" conscious decisions that do not simply reflect the chemical makeup of the individual at the time of decision--this chemical makeup reflecting both the genetic and environmental history and a degree of stochasticism. Whereas philosophers have discussed for centuries the apparent lack of a causal component for free will, many biologists still seem to be remarkably at ease with this notion of free will; and furthermore, our judicial system is based on such a belief. It is the author's contention that a belief in free will is nothing other than a continuing belief in vitalism--something biologists proudly believe they discarded well over 100 years ago.
PMID: 20142481 [PubMed - indexed for MEDLINE]
_______________________________________________________________________
Monothematic delusion
From Wikipedia, the free
encyclopedia
(Redirected from Monothematic
delusions)
A monothematic delusion is a delusional state
that only concerns one particular topic. This is contrasted by what is sometimes
called multi-thematic or polythematic delusions where the person
has a range of delusions (typically the case of schizophrenia). These
disorders can occur within the context of schizophrenia or dementia or they can occur
without any other signs of mental illness. When these disorders are found
outside the context of mental illness, they are often caused by organic
disfunction as a result of traumatic brain
injury, stroke, or neurological
illness.
People who suffer from these delusions
as a result of organic dysfunction
often do not suffer from any obvious intellectual deficiency nor do they have
any other symptoms. Additionally, a few of these people even have some awareness
that their beliefs are bizarre, yet they cannot be persuaded that their beliefs
are false.[citation
needed]
Contents[hide] |
[edit] Types
The delusions that fall under this
category are:
- Capgras delusion: the belief that (usually) a close relative or spouse has been replaced by an identical-looking impostor.
- Fregoli delusion: the belief that various people who the believer meets are actually the same person in disguise.
- Intermetamorphosis: the belief that people in one's environment swap identities with each other whilst maintaining the same appearance.
- Subjective doubles: a person believes there is a doppelgänger or double of him or herself carrying out independent actions.
- Cotard delusion: the belief that oneself is dead or does not exist; sometimes coupled with the belief that one is putrifying or missing internal organs.
- Mirrored-self misidentification: the belief that one's reflection in a mirror is some other person.
- Reduplicative paramnesia: the belief that a familiar person, place, object or body part has been duplicated. For example, a person may believe that they are in fact not in the hospital to which they were admitted, but in an identical-looking hospital in a different part of the country.
- Somatoparaphrenia: the delusion where one denies ownership of a limb or an entire side of one's body (often connected with stroke).
Note that some of these delusions are sometimes
grouped under the umbrella term of delusional
misidentification syndrome.
[edit] Causes
Current cognitive
neuropsychology research points toward a two-factor approach to the cause of
monothematic delusions.[1]
The first factor being the anomalous experience—often a neurological
defect—which leads to the delusion and the second factor being an impairment of
the belief formation cognitive process.
For example of one of these first factors,
several studies point toward Capgras delusion being the result of a disorder of
the affect component of
face perception. As a
result, while the person can recognize their spouse (or other close relation)
they do not feel the typical emotional reaction and thus the spouse does not
seem like the person they once knew.
As studies have shown, these neurological defects
are not enough on their own to cause delusional thinking. An additional second
factor, a bias or impairment of the belief formation cognitive process is
required to solidify and maintain the delusion. Since we do not currently have a
solid cognitive model of the belief formation process, this second factor is
still somewhat of an unknown.
Some research has shown that delusional people
are more prone to jumping to conclusions[2][3][4]
and thus they would be more likely to take their anomalous experience as
veridical and make snap judgments based on these experiences. Additionally,
studies[4]
have shown that they are more prone to making errors due to matching
bias—indicative of a tendency to try and confirm the rule. These two judgment
biases help explain how delusion prone people could grasp onto extreme delusions
and be very resistant to change.
Researchers claim this is enough to explain the
delusional thinking. However other researchers still argue that these biases are
not enough to explain why they remain completely impervious to evidence over
time. They believe that there must be some additional unknown neurological
defect in the patient's belief system (probably in the right hemisphere).
[edit] See also
[edit] References
- ^ Davies, M., Coltheart, M., Langdon, R., Breen, N. (2001). "Monothematic delusions: Towards a two-factor account" (PDF). Philosophy, Psychiatry and Psychology 8: 133–158. doi:10.1353/ppp.2001.0007. http://philrsss.anu.edu.au/~mdavies/papers/mono.pdf.
- ^ Sellen, J., Oaksford, M., Langdon, R., Gray, N. (2005). "Schizotypy and Conditional Reasoning". Schizophrenia Bulletin 31 (1): 105–116. doi:10.1093/schbul/sbi012. http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/31/1/105.
- ^ Dudley RE, John CH, Young AW, Over DE (May 1997). "Normal and abnormal reasoning in people with delusions". Br J Clin Psychol 36 (Pt 2): 243–58. PMID 9167864.
- ^ a b Stone, T. (2005). "Delusions and Belief Formation" (Powerpoint). http://www.lsbu.ac.uk/psycho/teaching/ppfiles/cicp-l5.ppt.
- Stone, T. (2005). "Face Recognition and Delusions" (Powerpoint). http://www.lsbu.ac.uk/psycho/teaching/ppfiles/cicp-l4.ppt.
[edit] External links
- The Belief Formation Project a project of the Macquarie Centre for Cognitive Science, which uses research on delusions with the aim of developing a cognitive model of beliefs
______________________________________________________________
Monday, April 30, 2012
Religion & Brain: Belief Decreases With Analytical Thinking, Study Shows
Daily
Mail-
Religion & Brain: Belief Decreases With Analytical Thinking, Study Shows
Huffington Post - 2 days agoMany people with religious convictions feel that their faith is rock solid. But a new study finds that prompting people to engage in analytical ...
-
Discovery News - 3 days ago
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_____________________________________________________________________________
Sunday, April 29, 2012
"It is clear that DSM-5 has lost touch with clinic...
"It is clear that DSM-5 has lost touch with clinical reality. It has been prepared by researchers with little real world clinical experience and little understanding of how their proposals will be distorted by drug company marketing." - DSM5 In Distress – Why Social Workers Should Oppose DSM5 - General Psychiatry News
Google
Reader - General Psychiatry News
via Mental Health Writers'
Guild by boldkevin on 4/27/12
Yesterday evening I spent sometime reading a very
interesting article by Allen Francis MD and published in Psychology
Today.
It appears to be a part of their (Psychology Today’s) series DSM5 In Distress and made some excellent and very interesting points.
Now I need to be candid with you all here. I live in Ireland and the DSM5 is not something which I am very familiar with but because of the fact that many of our members are from the States and thus affected by it, I have been trying to keep up to date with it all on your behalf.
In response to the title statement, “Why Social Workers Should Oppose DSM5?” he gives the statement “Because they bring a missing and much-needed perspective.”
Fair point well made! Is this writer’s response to that! Something which appears to be validated by the opening paragraph which states..
Social workers make up by far the largest single constituency among all the potential users of DSM-5, a plurality of over 200,000 mental health clinicians. Until recently, they have been silent while psychologists, counselors, psychiatrists, the press, and the public have all strongly opposed DSM-5. Things are changing. Recently, two prominent social workers have stepped forward to explain why it is important for their profession to take a stand on DSM-5. 1
I really do think that members will be interested in reading this article (if they haven’t already) which is why I have referenced it here.
BUT what may be of even more interest to readers is a reference made within that article to an open petition that people can sign.
I tried accessing that petition from the link provided in the article but it appears to be broken. I did however notice that there was a possible rogue character at the end of the link and so tried it without that character and it worked. So here is a working link for you to that open petition. Open Letter to the DSM-5
This open letter of petition is a long read BUT given the weight of importance associated with this whole matter it pretty much needs to be and I would therefore encourage members to plough through it and if appropriate to add their nam to those signing it.
Kind Regards.
Kevin.
It appears to be a part of their (Psychology Today’s) series DSM5 In Distress and made some excellent and very interesting points.
Now I need to be candid with you all here. I live in Ireland and the DSM5 is not something which I am very familiar with but because of the fact that many of our members are from the States and thus affected by it, I have been trying to keep up to date with it all on your behalf.
In response to the title statement, “Why Social Workers Should Oppose DSM5?” he gives the statement “Because they bring a missing and much-needed perspective.”
Fair point well made! Is this writer’s response to that! Something which appears to be validated by the opening paragraph which states..
Social workers make up by far the largest single constituency among all the potential users of DSM-5, a plurality of over 200,000 mental health clinicians. Until recently, they have been silent while psychologists, counselors, psychiatrists, the press, and the public have all strongly opposed DSM-5. Things are changing. Recently, two prominent social workers have stepped forward to explain why it is important for their profession to take a stand on DSM-5. 1
I really do think that members will be interested in reading this article (if they haven’t already) which is why I have referenced it here.
BUT what may be of even more interest to readers is a reference made within that article to an open petition that people can sign.
I tried accessing that petition from the link provided in the article but it appears to be broken. I did however notice that there was a possible rogue character at the end of the link and so tried it without that character and it worked. So here is a working link for you to that open petition. Open Letter to the DSM-5
This open letter of petition is a long read BUT given the weight of importance associated with this whole matter it pretty much needs to be and I would therefore encourage members to plough through it and if appropriate to add their nam to those signing it.
Kind Regards.
Kevin.
The DSM's impact on mental health practice
and research.
Why Social Workers Should Oppose DSM-5
Because they bring a missing and much needed
perspective
Social workers make
up by far the largest single constituency among all the potential users of
DSM-5, a plurality of over 200,000 mental health clinicians. Until
recently, they have been silent while psychologists, counselors, psychiatrists,
the press, and the public have all strongly opposed DSM-5. Things are
changing. Recently, two prominent social workers have stepped forward to explain
why it is important for their profession to take a stand on
DSM-5.
Jack Carney, DSW, is a social worker with over forty years in the public mental health system as clinician and program director. Dr. Carney writes:
"Where are the social workers? Where are the NASW and its local and state-wide chapters? Over 12,000 individuals mental health professionals have publicly declared their concern at the planned 2013 publication of the DSM-5. They’ve signed the petition launched six months ago by the Society for Humanistic Psychology requesting that the DSM-5 Task Force delay publication of the new DSM and subject it to an independent scientific review. Fifty-one professional organizations have also endorsed the petition. It is extremely puzzling that the National Association of Social Workers and its local affiliates are not to be found among them."
Jack Carney, DSW, is a social worker with over forty years in the public mental health system as clinician and program director. Dr. Carney writes:
"Where are the social workers? Where are the NASW and its local and state-wide chapters? Over 12,000 individuals mental health professionals have publicly declared their concern at the planned 2013 publication of the DSM-5. They’ve signed the petition launched six months ago by the Society for Humanistic Psychology requesting that the DSM-5 Task Force delay publication of the new DSM and subject it to an independent scientific review. Fifty-one professional organizations have also endorsed the petition. It is extremely puzzling that the National Association of Social Workers and its local affiliates are not to be found among them."
"So what’s going on with social workers?
It’s almost like asking 'What’s the matter with Kansas … ?' It seems like they
and their professional organizations are voting against their own
self-interest... Ultimately, however, most social workers, like most Kansas
voters, are not motivated by self-interest but by core values and beliefs. Their
acquiescence to the DSM-5 as currently composed signifies for me an
abandonment of core principles—service to others; pursuit of social justice;
respect for the worth of the persons being served; the importance of human
relationships; and the salience of integrity and competence in social work
practice (Code of Ethics @ www.socialworker.org)—and seriously
undermines their fundamental mission of helping those who need it."
"The Open
Letter which the Society for Humanistic Psychology states that 'the proposal to
lower diagnostic thresholds is scientifically premature and holds numerous risks
… (that) increasing the number of people who qualify for a diagnosis may lead to
excessive medicalization' and the increased prescription of neuroleptic
medications, with all their attendant risks."
"The DSM-5 Task Force will soon announce its last public commentary period—check its website @ www.dsm5.org—after which it will begin to finalize the new edition. Accordingly, if you’re a social worker dismayed with a public mental health system in disarray, alarmed at the distortions resulting from the system’s sole reliance on the biomedical model, determined to re-commit to core social work values and promote change in a system that no longer works, here’s what you need to do:
1. Read the Open Letter and sign the petition … http://www.ipetitions.com/petition/dsm5/;
2. E-mail the Board of Directors of NASW and ask them to endorse the petition … President@naswdc.org;
3. Spread the word to your social work brothers and sisters. There’s still time to put a stop to the DSM. Don’t mourn, organize!!"
(excerpted from "1984 & DSM5 Revisited: Where Are the Social Workers?" ... posted 3/27/12 on www.madinamerica.com)
Dr Joanne Cacciatore is a university researcher who studies grief, the founder of an international foundation to support grieving parents, and the writer of a blog on grief that attracted 100,000 viewers in its first ten days. Dr Cacciatore writes: "It appears that APA is moving forward in its willful quest to remove the bereavement exclusion from DSM-5—despite the vociferous concerns expressed by 51 mental health organizations, practicing clinicians of all disciplines, two Lancet editorials, more than 100 articles in the world press, and the appeal of more than 100,000 grievers worldwide. Recently, I exchanged letters with the president of APA—but to no avail. Indeed, he was polite, but the letter did not address any of the strong arguments against the DSM-5 proposals."
"Frankly, social workers have a big stake in this because these changes will adversely affect our clients. They are at risk for being inaccurately diagnosed and possibly prescribed psychiatric medication as a first line treatment. There is no evidence that these medications work in treating grief or in any of the other new disorders suggested by DSM-5."
"Social workers have been left out of DSM-5 process, with no representation and no consultation. Should those of us in social work who so fiercely oppose DSM-5 changes continue to remain silent? My area is bereavement and it is clear that those who serve the bereaved must move from compassion to action. Current DSM proposals are over-reaching and fail to heed the warnings of critics, many of whom have spent decades in direct psychotherapeutic practice with those who are suffering."
"According to the ethical standards of our discipline, social workers have a duty to act on the behalf of those we serve. In particular, we have a responsibility to influence peripheral forces that would further harm vulnerable populations. The acutely bereaved are defined in the literature as vulnerable and many state laws protect them from exploitation (for example from predatory funeral practices). The bereaved are often unable to use their own voices and need us to advocate for them."
"We must also speak up for the many other people—especially children—who will be over-diagnosed by DSM-5 and may receive harmful and unnecessary medications that can cause huge weight gains. Social workers should protect people from being medicated when they don't need it and from the stigma of being labeled with illnesses they don't really have."
"What can social workers do? We can raise our voices individually and as a profession. Write to the DSM-5 work groups and APA Trustees and to the NASW leadership. Sign the American Psychological Association's 32nd Division's petition. Work with clients on a sliding scale so that you can forego the diagnostic process when it is unnecessary. Volunteer in your community to help those who suffer. There are many, many wonderful nonprofit groups that provide direct, compassionate, mindful services to families."
"And, if we cannot use our voices to alter the trajectory of DSM-5, we may be forced to take political action at the state and congressional levels and to organize a boycott of DSM-5."
Thanks Drs Carney and Cacciatore. It is clear that DSM-5 has lost touch with clinical reality. It has been prepared by researchers with little real world clinical experience and little understanding of how their proposals will be distorted by drug company marketing. With their very different and necessary perspective, social workers have an important responsibility to protect their clients from over-diagnosis and the consequent excessive exposure to medication. Previously, social workers have been given no role in the development of DSM-5. At this eleventh hour and before all the final decisions have been set in stone, social workers need finally to have their say and their message should be heard.
http://www.psychologytoday.com/blog/dsm5-in-distress/201204/why-social-workers-should-oppose-dsm-5
"The DSM-5 Task Force will soon announce its last public commentary period—check its website @ www.dsm5.org—after which it will begin to finalize the new edition. Accordingly, if you’re a social worker dismayed with a public mental health system in disarray, alarmed at the distortions resulting from the system’s sole reliance on the biomedical model, determined to re-commit to core social work values and promote change in a system that no longer works, here’s what you need to do:
1. Read the Open Letter and sign the petition … http://www.ipetitions.com/petition/dsm5/;
2. E-mail the Board of Directors of NASW and ask them to endorse the petition … President@naswdc.org;
3. Spread the word to your social work brothers and sisters. There’s still time to put a stop to the DSM. Don’t mourn, organize!!"
(excerpted from "1984 & DSM5 Revisited: Where Are the Social Workers?" ... posted 3/27/12 on www.madinamerica.com)
Dr Joanne Cacciatore is a university researcher who studies grief, the founder of an international foundation to support grieving parents, and the writer of a blog on grief that attracted 100,000 viewers in its first ten days. Dr Cacciatore writes: "It appears that APA is moving forward in its willful quest to remove the bereavement exclusion from DSM-5—despite the vociferous concerns expressed by 51 mental health organizations, practicing clinicians of all disciplines, two Lancet editorials, more than 100 articles in the world press, and the appeal of more than 100,000 grievers worldwide. Recently, I exchanged letters with the president of APA—but to no avail. Indeed, he was polite, but the letter did not address any of the strong arguments against the DSM-5 proposals."
"Frankly, social workers have a big stake in this because these changes will adversely affect our clients. They are at risk for being inaccurately diagnosed and possibly prescribed psychiatric medication as a first line treatment. There is no evidence that these medications work in treating grief or in any of the other new disorders suggested by DSM-5."
"Social workers have been left out of DSM-5 process, with no representation and no consultation. Should those of us in social work who so fiercely oppose DSM-5 changes continue to remain silent? My area is bereavement and it is clear that those who serve the bereaved must move from compassion to action. Current DSM proposals are over-reaching and fail to heed the warnings of critics, many of whom have spent decades in direct psychotherapeutic practice with those who are suffering."
"According to the ethical standards of our discipline, social workers have a duty to act on the behalf of those we serve. In particular, we have a responsibility to influence peripheral forces that would further harm vulnerable populations. The acutely bereaved are defined in the literature as vulnerable and many state laws protect them from exploitation (for example from predatory funeral practices). The bereaved are often unable to use their own voices and need us to advocate for them."
"We must also speak up for the many other people—especially children—who will be over-diagnosed by DSM-5 and may receive harmful and unnecessary medications that can cause huge weight gains. Social workers should protect people from being medicated when they don't need it and from the stigma of being labeled with illnesses they don't really have."
"What can social workers do? We can raise our voices individually and as a profession. Write to the DSM-5 work groups and APA Trustees and to the NASW leadership. Sign the American Psychological Association's 32nd Division's petition. Work with clients on a sliding scale so that you can forego the diagnostic process when it is unnecessary. Volunteer in your community to help those who suffer. There are many, many wonderful nonprofit groups that provide direct, compassionate, mindful services to families."
"And, if we cannot use our voices to alter the trajectory of DSM-5, we may be forced to take political action at the state and congressional levels and to organize a boycott of DSM-5."
Thanks Drs Carney and Cacciatore. It is clear that DSM-5 has lost touch with clinical reality. It has been prepared by researchers with little real world clinical experience and little understanding of how their proposals will be distorted by drug company marketing. With their very different and necessary perspective, social workers have an important responsibility to protect their clients from over-diagnosis and the consequent excessive exposure to medication. Previously, social workers have been given no role in the development of DSM-5. At this eleventh hour and before all the final decisions have been set in stone, social workers need finally to have their say and their message should be heard.
http://www.psychologytoday.com/blog/dsm5-in-distress/201204/why-social-workers-should-oppose-dsm-5
-
_________________________________________________________________________
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