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psychosis

Work mode

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Today has been an exhausting day at work. With five client consultations where two of them were new patients, my head was so overloaded at the end of the day that I actually had an headache, something I normally don`t get. In between the sessions, people came into my office with urgent matters. A social worked contacted me after a conversation she had with a patient we have, unsure about what to do now. I did not come with any useful suggestions, as I am not certain what the next steps should be. In addition I also had to get some things for the city marathon on Saturday, so in the end I had to work longer than I should have.

Thankfully, when I came home, I had a 15 minute run. I am proud to say 15 minutes is quite an accomplishment, since I normally give up whenever I find an excuse. But when I keep on running, it gets better.

Now I feel good. The head-ache is completely gone, but I still think about my day at work. Since I started working with psychosis I have felt like I`m walking on thin ice. I have almost no experience, and yet dont know what questions I should ask or how I can move forward in a conversations. Some of the conversations are even a bit confusing, since they often have thoughts they have problems with explaining, or speak in an unorganized way. The contrast to my other patients is huge, so it is getting some time to get used to.

But, it has also been an interesting experience, and I am learning so much. About their deep fear, about how their minds try to organize the chaos inside. Out comes symbolic hallucinations, and sometimes delusions that might be a last resort for them to find meaning in the voices, or the feeling they have of somebody planting thoughts in their had. I have immense respect for their fight to get a better life, and my collages are equally amazing. So empathic, understanding and clever. That makes it easier, because I can talk with them about my uncertainties when I feel I have no idea about what I`m doing.

Time to get to bed, but I just needed to let out some steam.

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Making cards when I need to relax
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Writing my book

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It’s been a while since I’ve been written here. That’s not a bad thing, since my priorities has been elsewhere. In October I started writing a book, concentrating on writing for half an hour each day. It’s been a new experience to finally knit a story together, seeing it becoming a book by taking one step at a time. The next weeks will be devoted to check for spelling mistakes and correct things, and then I finally will have a book created by me.

Other than that I’ve read a lot, and work has been more relaxed since I have been in a process of changing who I work with. I will work with psychosis and will be a group therapist, so I’m currently reading and learning a lot. I still have some trauma-patients, and like that. In my heart I never want to quit working with trauma, and I think that will be achievable. Patients who have been psychotic often have been traumatized as well.

That will be all for now! Hope all my readers are doing well, and I would love to hear from you!

The sound of love knocking on heavens door

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Falling in love activates the same brain areas that are active during a psychosis. I guess being crazy is a necessary part of the infatuation period. It’s when nothing else matters, when you willingly fall into open air. Even if you normally would dread letting everything go, you suddenly take the leap of faith like a bungee jumper. You become a sensation seeker, and you can’t stop. It’s a craving that can only be quieted by another dose of the person you have fallen in love with. You keep thinking about him or her, check your phone constantly and do everything you can to make him or her realize that you are meant to be together. And if the love is reciprocated, they join you in the madness. They take that leap of faith together with you. You both fly in thin air, hoping that the parachute will be there when you are closing in towards the ground. You grab each other’s hand, smiling blissfully, secure in the knowledge that together nothing is scary. Every minute is precious; Sleep, food and other basic needs are second priority, until you both fall into each other’s arms, exhausted.

When love knocks on your door, let it in.

More on love in the brain:

love and psychosis. why does love make us crazy?

Love and psychosis, the similarities of symptoms

Protected: Close to the edge

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Epistemic Trust, Psychopathology and the Great Psychotherapy Debate

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Over the past decades, meta-analyses have found almost no clinically meaningful differences in efficacy between the various evidence-based psychotherapies. This has led to the formulation of the so-called “Dodo bird verdict”, based on the Alice in Wonderland story, which argues that “all [psychotherapies] have won and all must have prizes”.

Consequently, major figures in the field have questioned the notion that theory-specific techniques or interventions, such as addressing dysfunctional cognitions in cognitive-behavioral therapy, or the relationship between past and present in psychodynamic therapy, are mainly responsible for therapeutic outcome. They argue that, instead, factors that are common to effective treatments – providing the patient with hope and with a comprehensive theory that explains the patient’s complaints – would typically explain a greater proportion of the therapeutic outcome. This would be particularly the case if the therapist is able to establish a warm and empathic therapeutic relationship with the patient. Hence, the “Dodo bird” still looms unresolved over the field of psychotherapy.

We have recently proposed a new, evolutionarily informed approach to the “Dodo bird” controversy that also has important implications for understanding psychopathology more generally.

Mentalizing and attachment: Evolutionary advantages

Our starting point is contemporary evolutionary theories concerning social cognition. Evolutionary theory suggests that as the human mind needed to respond to ever more challenging, complex, and competitive conditions, norms for social behavior and understanding could not be “fixed” by genetics or constitution. These norms had to be optimized through a prolonged period of development within a close circle of people – people who we would term attachment figures. Attachment figures not only provided young children with the basis for feelings of security and exploration (Bowlby, 1973; Main, Kaplan, & Cassidy, 1985), but also provided a training ground for the ability to mentalize – the capacity to understand ourselves and others in terms of intentional mental states (Fonagy & Luyten, in press).

Mentalizing provided an evolutionary advantage because it allowed these early humans to adapt better to their physical environment, by facilitating social collaboration and well-functioning kinship groups, but also by supporting competition for survival when different social groups were at odds. Hence, mentalizing is a key element of our species’ uniquely developed level of social cognition.

The link between attachment and mentalizing is clear. Attachment contexts provide the ideal conditions for fostering mentalizing. Secure attachment relationships, where attachment figures are interested in the child’s mind and the child is safe to explore the mind of the attachment figure (Fonagy, Lorenzini, Campbell, & Luyten, 2014), allow the infant to explore other subjectivities, including that of his/her caregiver. Finding him/herself accurately represented in the mind of the caregiver as a thinking and feeling intentional being ensures that the infant’s own capacities for mentalizing will develop well (Fonagy, Gergely, Jurist, & Target, 2002).

Epistemic trust and the transmission of culture

Recent elaborations of thinking on mentalizing have taken the argument one step further to point to another important function of attachment relationships. This is the development of epistemic trust, that is, trust in the authenticity and personal relevance of interpersonally transmitted knowledge. Epistemic trust enables social learning in an ever-changing social and cultural context and allows individuals to benefit from their (social) environment (Fonagy & Allison, 2014; Fonagy, Luyten, & Allison, 2014; Fonagy and Luyten, in press).

Gergely and Csibra’s theory of natural pedagogy (Csibra & Gergely, 2009) helps to clarify the key issues here. Human beings are faced with a major learnability problem: they are born into a world that is populated with objects, attributes, and customs whose function or use is epistemically opaque (that is, not obvious from their appearance). Humans are thus evolved to both teach and learn new and relevant cultural information rapidly.

Human communication is specifically adapted to allow the transmission of epistemically opaque information: the communication of such knowledge is enabled by an epistemically trusting relationship. Epistemic trust allows the recipient of the information being conveyed to relax their natural, epistemic vigilance – a vigilance that is self-protective and naturally occurring because, after all, it is not in our interest to believe everything indiscriminately. The relaxation of epistemic vigilance allows us to accept that what we are being told matters to us.

These views do not diminish the importance of attachment, but put theories concerning the role of attachment in a very different perspective. Recent research suggests that the long-term relationship between attachment in infancy and attachment status in adolescence and into adulthood is complex. It seems likely that there is a fluctuating relationship between attachment, genes, and the social environment across the life course (Ellis et al., 2011; Fearon et al., 2014).

In terms of psychopathology, we suggest that the most significant implication of the developmental triad of attachment, mentalization, and epistemic trust lies in the consequences of a breakdown in epistemic trust. What we are suggesting here is that many, if not all, types of psychopathology might be characterized by temporary or permanent disruption of epistemic trust and the social learning process it enables.

An infant whose channels for learning about the social world have been disrupted – in other words, whose social experiences with caregivers have caused a breakdown in epistemic trust – is left in a quandary of uncertainty and permanent epistemic vigilance. Everybody seeks social knowledge, but when such reassurance and input is sought, the content of this communication may be rejected, its meaning confused, or it may be misinterpreted as having hostile intent.

In that sense, many forms of mental disorder might be considered manifestations of failings in social communication arising from epistemic mistrust, hypervigilance, or outright epistemic freezing, a complete inability to trust others as a source of knowledge about the world, which may be characteristic of many individuals with marked trauma and personality problems. An individual who was traumatized in childhood, for instance, has little reason to trust others and will reject information that is inconsistent with their pre-existing beliefs. As therapists, we may consider such people “hard to reach”, yet they are simply showing an adaptation to a social environment where information from attachment figures was likely to be misleading.

The “p factor”: Epistemic mistrust as a common factor in psychopathology?

A serious challenge for our thinking about psychopathology arises from the fact that when we consider many individuals’ psychiatric history over their life course, it rarely follows the discrete, symptom-defined, and diagnosis-led categories that extant cross-sectional research uses when conceptualizing specific disorders.

This lack of specificity may relate to compelling evidence presented by Caspi et al. (2013) suggesting that there is, in fact, a “general psychopathology factor” in the structure of psychiatric disorders. Caspi and colleagues’ findings suggest that a hierarchical three-level structure explains the relationships among psychiatric disorders:

  • A general psychopathology factor (labelled the “p factor” as a conceptual parallel to the “g factor”, the well-established dimension by which general intelligence is understood);
  • Clusters of symptoms (internalizing, externalizing, and psychosis); and
  • Individual disorders, for example, schizophrenia, generalized anxiety disorder, and depression.

A higher p factor score is associated with increased severity of impairment, more developmental adversity, and greater biological risk. The p factor concept convincingly explains why, so far, it has proved so difficult to identify isolated causes, consequences, or biomarkers and to develop specific, tailored treatments for individual psychiatric disorders.

The p factor is thus far a statistical construct. We propose that the p factor may be a proxy for impairments in epistemic trust: An individual with a high p factor score is one who, because of developmental adversity (whether biological or social), is in a state of epistemic hypervigilance and epistemic mistrust. If this is true, it may have major consequences for psychosocial interventions. It would mean, for instance, that people with relatively low p factor scores might be most responsive to psychosocial interventions.

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A depressed patient with a low p factor score may, for instance, recover with the help of brief cognitive-behavioral therapy or psychodynamic therapy, perhaps even when delivered via an e-platform. These patients may be relatively “easy to reach” in terms of treatment because they are open to social learning in the form of therapeutic intervention. In contrast, a depressed patient with a high p factor score, who is suffering from high levels of comorbidity, longer-term difficulties, and greater impairment, is likely to show intense treatment resistance because of their high levels of epistemic mistrust, or outright epistemic freezing. We consider it likely that such patients will require more long-term therapy to first stimulate epistemic trust and openness.

Epistemic trust as the key to effective psychotherapies

In proposing that epistemic mistrust might underpin the p factor that underlies long-term impairment, we thus also consider that (the relearning of) epistemic trust may be at the heart of all effective psychotherapeutic interventions. Put simply, we suggest that effective interventions specialize in generating epistemic trust in individuals who struggle to relax their epistemic vigilance in more ordinary social situations. Patients with BPD, for example, are typically experienced as “rigid” and “hard to reach”, and the difficulties involved in stimulating epistemic trust have historically blighted attempts to intervene effectively with these individuals.

“Psychotherapy” in its many forms thus may simply be a specialized variant of an activity that has been part the repertoire of communicative behavior for a very long time – turning to others in times of need to make sense of what is happening to us. It is the seeking out of perspective and the reassurance of another’s social knowledge. But for it to be meaningful there needs to be a workable level of epistemic trust.

The psychotherapeutic communication systems

Based on the above considerations, we propose that there are three distinct processes of communication that cumulatively make psychotherapy effective:

Communication System 1: The teaching and learning of content

The different therapeutic schools belong to this system. They may be effective primarily because they involve the therapist conveying to the patient a model for understanding the mind that the patient can understand as involving a convincing recognition and identification of his/her own state. This may in itself lower the patient’s epistemic vigilance.

Communication System 2: The re-emergence of robust mentalizing

When the patient is once again open to social communication in contexts that had previously been blighted by epistemic hypervigilance, he/she shows increased interest in the therapist’s mind and the therapist’s use of thoughts and feelings, which stimulates and strengthens the patient’s capacity for mentalizing. Improvements in mentalizing or social cognition may thus be a common factor across different interventions.

Communication System 3: The re-emergence of social learning

The relaxation of the patient’s hypervigilance via the first two systems of communication enables the patient to become open to social learning. This allows the patient to apply his/her new mentalizing and communicative capabilities to wider social learning, outside the consulting room. This final part of the process depends upon the patient having a sufficiently benign social environment to allow him/her to gain the necessary experiences to validate and bolster improved his/her mentalizing, and to continue to facilitate relaxation of epistemic mistrust, in the wider social world.

Conclusion

What this view suggests is that the effectiveness of psychotherapies, regardless of their “brand names”, should be investigated at the three levels of communication. Furthermore, it redirects our attention to the social environment, and to interventions that may directly target environmental factors that could contribute to the origin and maintenance of psychopathology, but could also have the potential to support recovery and the individual’s capacity to benefit from benign aspects of the environment.

Editor’s note: Drs. Fonagy and Allison recently published an article titled “The Role of Mentalizing and Epistemic Trust in the Therapeutic Relationship” in Psychotherapy. Read below for their further thoughts on epistemic trust in psychotherapy.

If you’re a member of the Society for the Advancement of Psychotherapy  you can access the Psychotherapy article via our App or login to your APA member page.

Not a member? Purchase the Psychotherapy article for $11.95 here.

Or, Join the Society for $40 a year and receive access to more than 50 years of articles.

Cite This ArticleFonagy, P., Luyten, P., Campbell, C., & Allison, L. (2014, December). Epistemic trust, psychopathology and the great psychotherapy debate. [Web Article]. Retrieved from http://www.societyforpsychotherapy.org/epistemic-trust-psychopathology-and-the-great-psychotherapy-debate

References

Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation: Anxiety and anger. London, UK: Hogarth Press and Institute of Psycho-Analysis.

Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., . . . Moffitt, T. E. (2013). The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science, 2, 119-137. doi: 10.1177/2167702613497473

Csibra, G., & Gergely, G. (2009). Natural pedagogy. Trends in Cognitive Sciences, 13, 148-153. doi: 10.1016/j.tics.2009.01.005

Ellis, B. J., Boyce, W. T., Belsky, J., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2011). Differential susceptibility to the environment: An evolutionary–neurodevelopmental theory. Development and Psychopathology, 23, 7-28. doi: 10.1017/S0954579410000611

Fearon, P., Shmueli-Goetz, Y., Viding, E., Fonagy, P., & Plomin, R. (2014). Genetic and environmental influences on adolescent attachment. Journal of Child Psychology and Psychiatry, 55, 1033-1041. doi: 10.1111/jcpp.12171

Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy, 51, 372-380. doi: 10.1037/a0036505

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York, NY: Other Press.

Fonagy, P., Lorenzini, N., Campbell, C., & Luyten, P. (2014). Why are we interested in attachments? In P. Holmes & S. Farnfield (Eds.), The Routledge handbook of attachment: Theory (pp. 31-48). Hove, UK: Routledge.

Fonagy, P., & Luyten, P. (in press). A multilevel perspective on the development of borderline personality disorder. In D. Cicchetti (Ed.), Development and psychopathology (3rd ed.). New York, NY: John Wiley & Sons.

Fonagy, P., Luyten, P., & Allison, E. (2014). Epistemic petrification and the restoration of epistemic trust: A new conceptualization of borderline personality disorder and its psychosocial treatment. Manuscript submitted for publication.

Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. Monographs of the Society for Research in Child Development, 50, 66-104. doi: 10.2307/3333827

What is Schizotypal personality disorder?

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Schizotypal personality disorder



Schizotypal Personality Disorder 843

Photo by: Vlue

Definition

Schizotypal personality disorder is characterized by an ongoing pattern in which the affected person distances him- or herself from social and interpersonal relationships. Affected people typically have an acute discomfort when put in circumstances where they must relate to others. These individuals are also prone to cognitive and perceptual distortions and a display a variety of eccentric behaviors that others often find confusing.

Description

People with schizotypal personality disorder are more comfortable turning inward, away from others, than learning to have meaningful interpersonal relationships. This preferred isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. These individuals remain on the periphery of life and often drift from one aimless activity to another with few, if any, meaningful relationships.

A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes. Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal’s unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.

Causes and symptoms

Causes

Schizotypal personality disorder is believed to stem from the affected person’s original family, or family of origin. Usually the parents of the affected person were emotionally distant, formal, and displayed confusing parental communication. This modeling of remote, unaffectionate relationships is then reenacted in the social relationships encountered in the developing years. The social development of people with schizotypal personality disorder shows that many were also regularly humiliated by their parents, siblings, and peers resulting in significant relational mistrust. Many display low self-esteem, self-criticism and self-deprecating behavior. This further contributes to a sense that they are socially incapable of having meaningful interpersonal relationships.

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders , a professional manual, specifies nine diagnostic criteria for schizotypal personality disorder:

  • Incorrect interpretations of events. Individuals with schizotypal personality disorder often have difficulty seeing the correct cause and effect of situations and how they affect others. For instance, the schizotypal may misread a simple non-verbal communication cue, such as a frown, as someone being displeased with them, when in reality it may have nothing to do with them. Their perceptions are often distortions of what is really happening externally, but they tend to believe their perceptions more than what others might say or do.
  • Odd beliefs or magical thinking. These individuals may be superstitious or preoccupied with the paranormal. They often engage in these behaviors as a desperate means to find some emotional connection with the world they live in. This behavior is seen as a coping mechanism to add meaning in a world devoid of much meaning because of the social isolation these individuals experience.
  • Unusual perceptual experiences. These might include having illusions, or attributing a particular event to some mysterious force or person who is not present. Affected people may also feel they have special powers to influence events or predict an event before it happens.
  • Odd thinking and speech. People with schizotypal personality disorder may have speech patterns that appear strange in their structure and phrasing. Their ideas are often loosely associated, prone to tangents, or vague in description. Some may verbalize responses by being overly concrete or abstract and insert words that serve to confuse rather than clarify a particular situation, yet make sense to them. They are typically unable to have ongoing conversation and tend to talk only about matters that need immediate attention.
  • Suspicious or paranoid thoughts. Individuals with schizotypal personality disorder are often suspicious of others and display paranoid tendencies.
  • Emotionally inexpressive. Their general social demeanor is to appear aloof and isolated, behaving in a way that communicates they derive little joy from life. Most have an intense fear of being humiliated or rejected, yet repress most of these feelings for protective reasons.
  • Eccentric behavior. People with schizotypal personality disorder are often viewed as odd or eccentric due to their unusual mannerisms or unconventional clothing choices. Their personal appearance may look unkempt—clothing choices that do not “fit together,” clothes may be too small or large, or clothes may be noticeably unclean.
  • Lack of close friends. Because they lack the skills and confidence to develop meaningful interpersonal relationships, they prefer privacy and isolation. As they withdraw from relationships, they increasingly turn inward to avoid possible social rejection or ridicule. If they do have any ongoing social contact, it is usually restricted to immediate family members.
  • Socially anxious. Schizotypals are noticeably anxious in social situations, especially with those they are not familiar with. They can interact with people when necessary, but prefer to avoid as much interaction as possible because their self-perception is that they do not “fit in.” Even when exposed to the same group of people over time, their social anxiety does not seem to lessen. In fact, it may progress into distorted perceptions of paranoia involving the people with whom they are in social contact.

Demographics

Schizotypal personality disorder appears to occur more frequently in individuals who have an immediate family member with schizophrenia . The prevalence of schizotypal personality disorder is approximately 3% of the general population and is believed to occur slightly more often in males.

Symptoms that characterize a typical diagnosis of schizotypal personality disorder should be evaluated in the context of the individual’s cultural situation, particularly those regarding superstitious or religious beliefs and practices. (Some behaviors that Western cultures may view as psychotic are viewed within the range of normal behavior in other cultures.)

Diagnosis

The symptoms of schizotypal personality disorder may begin in childhood or adolescence showing as a tendency toward solitary pursuit of activities, poor peer relationships, pronounced social anxiety, and underachievement in school. Other symptoms that may be present during the developmental years are hypersensitivity to criticism or correction, unusual use of language, odd thoughts, or bizarre fantasies. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel. For a diagnosis of schizotypal personality disorder to be accurately made, there must also be the presence of at least four of the above-mentioned symptoms.

The symptoms of schizotypal personality disorder can sometimes be confused with the symptoms seen in schizophrenia. The bizarre thinking associated with schizotypal personality disorder can be perceived as a psychotic episode and misdiagnosed. While brief psychotic episodes can occur in the patient with schizotypal personality disorder, the psychosis is not as pronounced, frequent, or as intense as in schizophrenia. For an accurate diagnosis of schizotypal personality disorder, the symptoms for schizotypal cannot occur exclusively during the course of schizophrenia or other mood disorder that has psychotic features.

Another common difficulty in diagnosing schizotypal personality disorder is distinguishing it from other the schizoid, avoidant, and paranoidpersonality disorders . Some researchers believe that schizotypal personality disorder is essentially the same disorder as schizoid, but many feel there are distinguishing characteristics. Schizoids are deficient in their ability to experience emotion, while schizotypals are more pronounced in their inability to understand human motivation and communication. While avoidant personality disorder has many of the same symptoms as schizotypal personality disorder, the distinguishing symptom in schizotypal is the presence of behavior that is noticeably eccentric. The schizotypal differs from the paranoid by tangential thinking and eccentric behavior.

The diagnosis of schizotypal personality disorder is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in confirming the diagnosis of schizotypal personality disorder include:

  • Minnesota Multiphasic Personality Inventory (MMPI-2)
  • Millon Clinical Multiaxial Inventory (MCMI-II)
  • Rorschach Psychodiagnostic Test
  • Thematic Apperception Test (TAT)

Treatments

The patient with schizotypal personality disorder finds it difficult to engage and remain in treatment. For those higher-functioning individuals who seek treatment, the goal will be to help them function more effectively in relationships rather than restructuring their personality.

Psychodynamically oriented therapies

A psychodynamic approach would typically seek to build a therapeutically trusting relationship that attempts to counter the mistrust most people with this disorder intrinsically hold. The hope is that some degree of attachment in a therapeutic relationship could be generalized to other relationships. Offering interpretations about the patient’s behavior will not typically be helpful. More highly functioning schizotypals who have some capacity for empathy and emotional warmth tend to have better outcomes in psychodynamic approaches to treatment.

Cognitive-behavioral therapy

Cognitive approaches will most likely focus on attempting to identify and alter the content of the schizotypal’s thoughts. Distortions that occur in both perception and thought processes would be addressed. An important foundation for this work would be the establishment of a trusting therapeutic relationship. This would relax some of the social anxiety felt in most interpersonal relationships and allow for some exploration of the thought processes. Constructive ways of accomplishing this might include communication skills training, the use of videotape feedback to help the affected person perceive his or her behavior and appearance objectively, and practical suggestions about personal hygiene, employment, among others.

Interpersonal therapy

Treatment using an interpersonal approach would allow the individual with schizotypal personality disorder to remain relationally distant while he or she “warms up” to the therapist. Gradually the therapist would hope to engage the patient after becoming “safe” through lack of coercion. The goal would be to develop trust in order to help the patient gain insight into the distorted and magical thinking that dominates. New self-talk can be introduced to help orient the individual to reality-based experience. The therapist can mirror this objectivity to the patient.

Group therapy

Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It is typically recommended only for schizotypals who do not display severe eccentric or paranoid behavior. Most group members would be uncomfortable with these behavioral displays and it would likely prove destructive to the group dynamic.

Family and marital therapy

It is unlikely that a person with schizoid personality disorder will seek family or marital therapy. Many schizoid types do not marry and end up living with and being dependent upon first-degree family members. If they do marry they often have problems centered on insensitivity to their partner’s feelings or behavior. Marital therapy ( couples therapy ) may focus on helping the couple to become more involved in each other’s lives or improve communication patterns.

Medications

There is considerable research on the use of medications for the treatment of schizotypal personality disorder due to its close symptomatic relationship with schizophrenia. Among the most helpful medications are the antipsychotics that have been shown to control symptoms such as illusions and phobic anxiety, among others. Amoxapine (trade name Asendin), is a tricyclic antidepressant with antipsychotic properties, and has been effective in improving schizophrenic-like and depressive symptoms in schizotypal patients. Other antidepressants such asfluoxetine (Prozac) have also been used successfully to reduce symptoms of anxiety, paranoid thinking, and depression.

Prognosis

The prognosis for the individual with schizotypal personality disorder is poor due to the ingrained nature of the coping mechanisms already in place. Schizotypals who depend heavily on family members or others are likely to regress into a state of apathy and further isolation. While some measurable gains can be made with mildly affected individuals, most are not able to alter their ingrained ways of perceiving or interpreting reality. When combined with poor social support structure, most will not enter any type of treatment.

Prevention

Since schizotypal personality disorder originates in the patient’s family of origin, the only known preventative measure is a nurturing, emotionally stimulating and expressive caretaking environment.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., M.D., and Robert Berkow, M.D., eds. The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories,1999.

Millon, Theodore, Ph.D., D.Sc. Disorders of Personality: DSM IV and Beyond. New York: John Wiley and Sons, Inc., 1996.

Sperry, Len, M.D., Ph.D. Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. New York: Brunner/Mazel, Inc., 1995.

PERIODICALS

International Society for the Study of Personality Disorders. Journal of Personality Disorders. Guilford Publications, 72 Spring St., New York, NY 10012. <http://www.guilford.com> . (800) 365-7006.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005. <http://www.psych.org> .

Gary Gilles, M.A.


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The sound of shifting perspectives

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In the  I run. Another tree, green needles nipping my soles. Another blind road. Turning back, my dress fluttering behind me, breathing heavily. Where now?
Back again? I run to the left instead, a shrub scraping my leg as I fly past it. My pulse lifts anxiety sharply. UpthereWhere? Another step forward in the confusing forest. Back and forth. How many hours have I been running? How much further, before I collapse in a tired heap and let leaves cover my body? The pulse is on its brink. Colorful explosions lurk behind the next breath piercing my lungs. I must stop, my thoughts manage to whisper. As I take another step forward, I notice something strange happening. Like I was the main character in , my foot step on air. The air hardens, builds under me and push me upwards. My eyes wide open from bewilderment. Needles from the trees now scrape against my ungracious flailing hands. I never learnt to fly. Am I supposed to do swimming motions? Flapping my hands up and down? Suddenly I realize I`m floating over the tree-tops. I see I was running in circles. To my satisfaction, I realize my castle was in the clouds and not on earth, after all.

Such is the feeling of shifting perspectives

The bridges we build

I was in my bed, head throbbing from the most fun I`ve had in months. Suddenly Sherlock Holmes knocks on my mind, begging to be let in.

In Re: Sherlock Holmes

He is a determined man, and the solution is never out of his reach. An example is the story about the horse who vanished. A man has been killed,  at the same time as a price-winning horse disappear right under everyone`s eyes.  All suspects are questioned, but before long, every possibility has been exhausted . That is when Mr Neuroscience puts his feet on the same invisible air-step and fly over everyone`s theories. He breaks free from all details, the impossibilities and arrives safely at eureka station. The killer was the horse, and the horse was not who they thought it was. It’s the obvious logic of looking at something upside-down.

Handsome insights

Another handsome smile rise inside my mental fantasies. The main character from Perception`s face change into his personal aha-moment, and the features align to the attractive “off-course look” I`d gladly sell my iPad for. The episode is about a serial killer who begins a new killing spree after a 20-year sabbatical. The detectives and hunky Dr. neuroscience have found his diaries, but still search in vain for the persons described in it. After a while it hits him like a bullet from outer space: The killer had never had the experiences he described. Everything was a twisted dream the killer needed to feel happy

Lifting thoughts away from the dusty ruts, is a wonderful experience. It is those moments when everything you thought you knew is thrown away. You still feel that things make sense like never before.

The importance of our minds taking leaps like these, are obvious. When we are able to rise from one network of associated cells to a new one, the result is insight. Just think about the color red. What will automatically also pop up in your head? I would think other colors, a rose or a heart might just have been on your mind. Our nerve-cells are a fine spiderweb of interconnecting stations, and where we go off and on usually follow a typical pattern.

Disorganized 

Did you know that manic and schizophrenic`s have associations that often create a mess? And what about the dissociative patients, who in their mind’s eye transform their fright to a little girl shaking in a corner. In anxiety the nerve-cells clump together in shaking companionship. They have enough with the task of protecting their walls, and do not stretch out to their neighbor cells. The outside focus likewise shrink to some threatening hotspots, leaving

Drawing of Purkinje cells (A) and granule cell...

out any other source of stimuli. This is the way our cells of life behave. Sometimes they erratically send sparks in every direction, at other times not bothering with sending signals at all, when the sun has sunken and let depression clip their wings of dendrites. So, when is it likely that Eureka comes? When will the the sound of weaving make its masterpiece?

Creative connections

Some minds are naturally more flexible than others. They consist of a social bunch of nerve-cells that love to connect with fat-shrouded cells from a variety of areas. They are not afraid of flying, even if they risk falling. To not make a mess, like an enraged cook who takes everything he sees and throws it blindly into the frying pan would do, their cell-knots are balanced carefully.  Read the rest of this entry »

Raising our voices!

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This Sunday`s recommendation:

The war against prejudice has lasted far too long. We have produced every type of commercial good, but the production of systems that take care of the people who buy the products, have not come so far.

Where is the logic in that? Production of weapons rather then another hospital for the sufferers. Millions on technology when people in Africa, Asia, America, South America and Europe die from diseases, hunger and mental illnesses? Sadly, no matter how “intelligent” the human race has become, still people are dying between our helpless hands. The logical intelligence has been prized and applauded for centuries, while the people who are peaceful and nice never came in the news, at least not before they already had died. When we know that 97 % of us are emotional human beings, where most of us derive meaning from emotional relationships with others, how could this happen?

Is this our legacy? Are we okay with it? I think not. Luckily, many others agree with me. One of the people who want to focus on a world were we pay attention to other human beings, is Elanor Lodgen, who dared to speak up in front of thousands of both normal and famous people. Would you? If you want to do some part, feel free to read this inspirational story. For those who want to take everything a step further, feel free to share this blog, its message or go to the post “project validation” and read how you after 30 seconds can make somebody`s day better, without paying anything other than a pleasant smile.
Thanks to all our guest-bloggers, readers and people who so far have fought for others. You are invaluable.

Raising Our Voices at TED 2013

4
Eleanor Longden

August 8, 2013

It was a real pleasure and privilege to be invited to write for Mad in America. Partly because, like anyone with a shred of sense and (in)sanity, I am a great admirer and believer in Robert Whitaker’s work: epitomizing, as it does, George Orwell’s observation that “In a time of universal deceit, telling the truth is a revolutionary act.” But also because of the MiA community itself. As a relative newcomer to the site, I was immediately struck by the vibrancy, fellowship, and solidarity between individuals with differing views but a shared cause.

Community is a valuable concept for me, because the essence of my own madness was betrayal and isolation. Similarly, for many of us, the main crucibles for madness (loss, discrimination, abuse, or other injustices) are enacted on a silent, shameful, and lonesome stage. Social bonds, in contrast, foster the sense of reconnection, reclamation, and emancipation that are so important for recovery (Herman, 1992).

It was that sense of kinship and convergence – of shared perspective and shared beliefs – that fortified and sustained me when I was asked to present about my experience of voice hearing at the TED 2013 conference. In the run-up to the event, and constantly afterwards, people would ask, “How can you bear the pressure of doing a TED talk?!” A quick scan through the attendee list showed that, amongst 1,700+ other audience members, were Ben Affleck, Cameron Diaz, Bill Gates, Al Gore, Matt Groening, and Goldie Hawn. In my own session, amongst other brilliant individuals, was Vint Cerf, widely credited as a ‘founding father’ of the Internet. And there was me, a mad woman from Yorkshire! But it was the knowledge of all those others out there, “the rebels and renegades, truth-tellers, pioneers and freedom fighters” as Jacqui Dillon (2010) puts it, “all walking along the same path … seeking the same kind of justice” – that stayed with me and helped ensure I didn’t falter.

At the end of my talk June Cohen, one of the conference’s wonderful co-hosts, came onto the stage and asked me, with a respectful interest, whether I still hear voices. For a split second I hesitated, wondering whether to play it down with an airy “oh, not all that much now.” Instead I opted for the truth: “All the time,” I said cheerfully, “In fact I heard them while I did the talk – they were reminding me what to say!”

In the words of the British activist Peter Bullimore, “I’m a voice hearer, but more than that I’m proud to be a voice hearer – because I’ve reclaimed my experience.” And it’s the healing power of a community that’s enabled me to feel this way, particularly that which is embodied by theInternational Hearing Voices Movement (see ‘The Voices Others Cannot Hear’). Representing this critical, empowered perspective at TED really was a case of standing on the shoulders of giants, because I’ve been so fortunate to encounter an assemblage of extraordinary people – far too numerous to name – who have inspired, guided, educated, and encouraged me in both my personal and professional journey.

This includes, but is not limited to, courageous family members/carers who tirelessly fight alongside their loved ones, the heroic and dedicated clinicians prepared to challenge an established system, and revolutionary academics seeking and proclaiming the truth, no matter how unpalatable their contemporaries might find it. And, of course, fellow survivors: those who have been victimized and demoralized beyond endurance, but who have nevertheless negotiated their way out of the blackness and emerged, triumphant and phoenix-like, with a spirit, awareness, and energy that gives others the inspiration to do the same. It was the fusion of these alliances and perspectives that enabled me to stand on the TED stage and talk about the delirious, frenzied depths and exhilarating rewards of my voice hearing voyage; not as an ex-psychiatric patient with a ‘Bad Brain,’ but as a proud and maddened survivor.

The communication opportunities made possible by the internet means it’s easier than ever before to seek out a healing community: a listening ear, a space to be, a place in which to speak truth to power. Communities that acknowledge our right to own our experiences and make sense of them in our own way; our right to freedom, dignity, justice, respect, and a voice that can be heard. The Amnesty International founder Peter Benenson observed that it’s “Better to light even a little candle than to curse the darkness” and over the years these little candles are flickering ever brighter, all over the world, illuminating the massive flaws and injustices in a system that blames and denies, protects the powerful, and pathologizes the survivor. And, equally, the light from these candles are blending together to forge a social and psychiatric response to mental health crises that promote genuine healing and growth (however the person in crisis might choose to define it).

There is still a long way to go, many more obstacles to overcome, many more untruths to expose and misconceptions to challenge. But I believe, without doubt or reservation, that it’s happening. And it is empowered and empowering communities that have made it happen, and will continue to energize and sustain that change: the impetus to change the world! In The Impossible Will Take a Little While: A Citizen’s Guide to Hope in Time of Fear, Paul Rogat Loeb states that “Those who make us believe that anything’s possible and fire our imagination over the long haul, are often the ones who have survived the bleakest of circumstances. The men and women who have every reason to despair, but don’t, may have the most to teach us, not only about how to hold true to our beliefs, but about how such a life can bring about seemingly impossible social change.” Increasingly, these are no longer battles that we are condemned to fight alone. Rather the growing strength and solidarity of our communities show the doubters and deniers that, for all their opposition and resistance, it’s too late: the revolution is already taking place.

So, as a final thought… Robert Whitaker, Jacqui Dillon, and John Read for TED 2014. Viva la revolution!

Eleanor Longden’s talk is available to view on TED.com. The accompanying e-book ‘Learning From the Voices in my Head’ can be purchased via Amazon.com, Apple’s iBookstore, Barnes and Noble online, and the TED Books app for iPhone and iPad.

 

References

Dillon, J. (2010). The tale of an ordinary little girl. Psychosis: Psychological, Social and Integrative Approaches, 2(1), 79-83.

Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York, NY: Basic Books.

 

Of further interest:

A first-class recovery: From hopeless case to graduate (The Independent)
How to Live with Voice Hearing (Scientific American)
Living with Voices inside Your Head (Scientific American)

Eleanor LongdenEleanor Longden is a doctoral researcher who has lectured and published internationally on aspects of voice hearing, trauma, psychosis, and recovery. She is current coordinator of the Intervoice Scientific Committee and a trustee of the UK Soteria Network.

 

Movies about all the mental illnesses (from anxiety to personality disorder)

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

This summary was derived from several of the articles listed in the resource list, from the suggestions of our ADMSEP colleagues, and from our own personal experience. We have not personally reviewed all of the movies on the list, and suggest you view any film before choosing it for teaching purposes.


Axis I Disorders

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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summary was derived from several of the articles listed in the resource list, from the suggestions of our ADMSEP colleagues, and from our own personal experience. We have not personally reviewed all of the movies on the list, and suggest you view any

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