tag:blogger.com,1999:blog-149433462024-03-12T20:32:22.043-05:00Psychiatry and HistoryA weblog to encourage the discussion of psychiatry and historyEMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.comBlogger143125tag:blogger.com,1999:blog-14943346.post-47030111181909461862018-11-05T07:48:00.000-05:002018-11-05T07:48:25.286-05:00Camille Claudel, 1915This beautiful, haunting and poignant film takes place in an asylum for the insane during a few days in 1915. The sculptor Camille Claudel, already in the asylum for many years, waits for a rare visit from her brother, the philosopher Paul Claudel.The backstory of how she came to be there is only alluded to. The film Camille Claudel (1988) provides a graphic depiction of that. This film focuses on the experience of a woman who has been abandoned by her family and lives in an environment that feels like a prison to her. The contrast between her intelligent and sensitive bearing and the behavior of the other inmates may seem exaggerated, but having spent many hours on a back ward of an American state hospital, I found it painfully familiar. The film is about loneliness. The contrast between Camille's demeanor before and after she learns that her brother is going to visit conveys her agony more forcefully than the moments where she breaks down into tears. Her brother's self absorption and indifference to her suffering locks the door that confines her. The slow pace of the film makes it hard to sit through, but succeeds in drawing the viewer into Camille's life. The performance by Juliet Binoche as Camille is simply riveting.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-43888644520453808992016-10-29T16:58:00.000-05:002016-10-29T16:58:12.712-05:00ThinLast evening I watched the 2006 Lauren Greenfield film "Thin."
Afterwards I read as many of the reviews and comments as I could find
online. Virginia Heffernan's <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.nytimes.com/2006/11/14/arts/television/14heff.html&source=gmail&ust=1477864472608000&usg=AFQjCNGL1Ysu1j6HWaci5N62OrFMhox-aw" href="http://www.nytimes.com/2006/11/14/arts/television/14heff.html" target="_blank">New York Times review</a>,
which referred to the film as “One Flew Over the Cuckoo’s Nest” for
women, certainly captured my reaction to the movie. I was also taken
with the number of women who posted statements expressing gratitude for
the treatment they received at this facility. Having practiced
psychiatry for forty years and read the critics from Foucault on, I
think it is fair to say this kind of polarization is present, not only
with regard to inpatient treatments for anorexia, but for all
psychiatric treatments. What should one make of such polarized views of a
psychiatric treatment?<br />
I think this is a question that has deep historical and philosophical roots.<br />
On
the same day that I saw 'Thin' I happened to be reading a wonderful
book by Brian Nance, "Turquet de Mayerne as Baroque Physician." I was
particularly interested in his description of the change in the
relationship between the concepts of sign and symptom that occurred
during the nineteenth century. While I was taught in medical school to
accept the term sign as referring to objective finds and symptom as referring to
subjective experience. In the late 16th and early 17th century, when
Turquet de Mayerne was practicing this was not the case. "A signum was
something," Nance points out, "indicative of any hidden process or event taking place in the
body while a symptoma was produced specifically by a disease [Nance,
2001, 72]." For Turquet de Mayerne signs and symptoms had equivalent
epistemological status. For us the data given by signs clearly trumps
the evidence produced by symptoms.<br />
As I see it this shift in the
relative epistemological weights of signs and symptoms indicates a shift
in the weighting of the knowledge produced by the observations of
doctors in relation to the knowledge produced by the experience of
patients. This shift has profound implications. It is baked into every
encounter between a medical professional and a patient.<br />
Most of the time we take this for granted. The doctor reads the x-ray and the patient accepts the results.<br />
In
psychiatry this is more complicated. While a psychiatrist's
observations may be called signs, they are not so obviously of greater
epistemological value than a patient's observations of his/her inner
life. While Freud certainly had no doubts about whose observations were
worth more in his consulting room, to their credit, psychoanalysts have
made real efforts to level the field.<br />
When one speaks about an
inpatient treatment facility for a disorder with manifest and serious
issues of self-deception such as anorexia the gap in the value given to
what therapists see and what patients say grows.<br />
As I see it,
much of the Cuckoo's Nest quality of the treatment portrayed in 'Thin'
arises from the acceptance of this distinction between the treatment
team's perspective and that of the patients. I have worked in facilities
that bear some resemblance to the one portrayed in the film. I can
remember the struggle between wanting to believe that I knew best and
accepting what the patient said at face value. The 'sicker' the patient
the easier it was to opt for the former and dismiss the patient as
'deluded.'<br />
I think that this is a struggle that is unavoidable in
contemporary psychiatry. For individual therapists working with
relatively healthy patients it is fairly easily resolved. For people
working in institutions, like the one depicted in the film, with sicker
patients the pull to doctor-knows-best is and will remain hard to
resist.<br />
We can criticize the treatment shown in 'Thin,' but we
should not forget that some of what we object to in that treatment is simply
baked into our way of offering medical care. And we shouldn't forget all
the women who say that they found this treatment helpful. Perhaps some
of the empathic capacities of the caregivers managed to break through
the cultural grip of our ideas about medical knowledge.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-77389159363931905522015-11-20T09:31:00.000-05:002015-11-20T09:31:19.760-05:00William Harvey: Rage and Heart DiseaseReading Walter Pagel's book <u>New Light on William Harvey</u> I ran across a case described by Harvey. Pagel writes "How much insight Harvey had into the deep interlocking of psychic and somatic aspects of the causation of disease is best shown in a case report…"<br />
<br />
<br />
<br />
"I knew another <span style="white-space: nowrap;"><a href="https://www.blogger.com/null" name="hl1"></a><span class="hilite1">stout man</span></span>,
who did so boyl with rage because he had suffer'd an injury, and
receiv'd an affront by one that was more powerfull than himself, that
his anger and hatred being increas'd every day (by reason he could not
be reveng'd) and discovering the passion of his mind to no body, which
was so exulcerate within him, at last he fell into a strange sort of a
disease, and was torur'd, and miserably tormented with great oppression
and pain in his <span class="rend-italic">heart,</span> and brest, so
that the most skilfull Physicians prescriptions doing no good upon him,
at last, after some years, he fell sick of the Scorbutick disease, pin'd
away, and dyed.<br />
This man only found ease as oft as his brest was prest down by a
strong man, and was thump'd and beaten down as they do when they mould
bread: his friends <span class="pbtext"></span>thought he was bewitch'd, or possess'd with the Devil." [<a href="http://quod.lib.umich.edu/e/eebo/A86079.0001.001/1:2.2?rgn=div2;submit=Go;subview=detail;type=simple;view=fulltext;q1=stout+man">The Anatomical exercises of Dr. William Harvey, London, 1653, 63</a>]EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-57826214989154802952015-10-19T08:14:00.000-05:002015-10-19T08:14:15.566-05:00Sydenham's 'Equine Therapy'While reading Kenneth Dewhurst's book <u>Thomas Sydenham (1624-1689): His Life and Original Writings</u>, (University of California Press, 1966) I ran across an amusing instance of what appeared to me to be a psychological treatment:<br />
"Riding long journeys on horseback was one of Sydenham's favourite remedies ... After attending a … (wealthy patient) for several months without alleviating his symptoms, Sydenham frankly told him that he was unable to render any further service. But he added that a certain Dr. Robertson of Inverness had performed several remarkable cures in this particular malady. Armed with Sydenham's letter of introduction, the patient set out for Inverness where he lost no time in seeking Dr. Robertson. to his dismay he learned that there was no physician of that name in the city, nor had there ever been one in the memory of anyone there. Returning to London the gentleman vented his indignation of Sydenham for having him on such a long and fruitless journey. "Well," inquired Sydenham, "are you in any better health?"<br />
"Yes, I am not quite well, but no thanks ty you."<br />
"No," added Sydenham, "but you may thank Dr. Robertson for curing you. I wished to send you on a journey with some objective interest in view. I knew it would be of service to you; in going you had Dr. Robertson and his wonderful cures in contemplation, and in returning, you were equally engaged in thinking of scolding me." [pp. 53-4]<br />
<br />
If anyone knows of other instances of the therapeutic effects of such deceptions, I would be interested in learning about them.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com1tag:blogger.com,1999:blog-14943346.post-68494406442648344762015-06-21T07:53:00.000-05:002015-06-21T07:53:31.564-05:00Neuro: The New Brain Sciences and the Management of the Mind <h1 class="bookTitle" id="bookTitle" itemprop="name">
<span style="font-size: small;"><span style="font-weight: normal;">Neuro: The New Brain Sciences and the Management of the Mind by Nikolas Rose and Joelle M.Abi-Rached</span></span><span style="font-weight: normal;"><span class="readable reviewText"><span id="freeTextreview881365233"> </span></span></span><span itemprop="author" itemscope="" itemtype="http://schema.org/Person"><span style="font-weight: normal;"><span style="color: black;"><span itemprop="name"></span></span></span>
</span><span style="font-weight: normal;"><span class="readable reviewText"><span id="freeTextreview881365233"><span style="font-size: small;">looks at the development of the neurosciences historically. They stress that a number
of technological and conceptual developments in recent years have
changed not simply what we know about the brain, but the 'style' with
which we think about the brain and its relationship to our personhood.
New technologies of visualization [pet scan, fmri] which offer the idea that
the nervous system is plastic, and that is capable of change and growth have
led to technologies for changing brains. They have also led to a
self-help industry focused on brains, 'neurobics.' They suggest that
while much has changed, not much has changed.</span> <span style="font-size: small;">Essentially they argue
that the psy disciplines have been re-outfitted as 'neuro' without much
being added to our understanding of what matters in human life. While
they do take science seriously they offer a wise warning against hype.</span></span></span></span></h1>
<h1 class="bookTitle" id="bookTitle" itemprop="name">
<span style="font-weight: normal;"><span class="readable reviewText"><span id="freeTextreview881365233"><span style="font-size: small;"> I found their review of developments in the neurosciences helpful for someone like myself, who hasn't been following things too closely. Sharing their views about what we've gotten from the 'psy' industry I was sympathetic to their skepticism about the burgeoning 'neuro' field. </span></span></span></span></h1>
<h1 class="bookTitle" id="bookTitle" itemprop="name">
<span style="font-weight: normal;"><span class="readable reviewText"><span id="freeTextreview881365233"><span style="font-size: small;"> </span></span></span></span></h1>
EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-29855758186334009282015-02-25T07:31:00.000-05:002015-02-27T16:51:16.535-05:00Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry <span class="readable reviewText">
<span id="freeTextreview1116670626">I have been interested in
Adolf Meyer since my training as a psychiatrist forty years ago. While
one might say that Meyer, who was the most influential American
psychiatrist in the first half of the twentieth century, is the
forgotten psychiatrist of the twenty-first, his teachings were still in
the air in the 1970s. But they were just in the air. Freudian theories
and treatments were what we were taught. Trying to find out just what
Meyer thought and did was difficult, not just because his writings were
not a part of our curriculum, but because his writings were
impenetrable.<br />Many thanks are now due the historian Susan Lamb for
writing a lively and lucid account of Meyer's most creative period-- the
twenty years before the World War I. She provides a chapter on his life
and influences and another on his concept of psychobiology. She also
uses a day in the life of a typical patient at the Phipps Clinic that Meyer ran to
show how every detail of a patient's life was used in a therapeutic
effort. She then provides two lengthy case histories the show the
implications of Meyer's ideas. These are beautifully presented and
really gave me a sense of how psychiatrists thought about patients in
the early years of the twentieth century. She ends with a chapter that
tries to relate Meyer's ideas to issues that psychiatrists and others
struggle with today. <br />Now I finally feel that I understand Meyer and the many ways that breathing that Meyerian air in my youth influenced my life.</span></span><br />
<br />
<span class="readable reviewText"><span id="freeTextreview1116670626">Perhaps I wasn't clear. The title of Susan Lamb's book is <a href="http://www.amazon.com/Pathologist-Mind-Origins-American-Psychiatry/dp/1421414848/ref=sr_1_1?s=books&ie=UTF8&qid=1425073609&sr=1-1&keywords=pathologist+of+the+mind">Pathologist of the Mind</a>: Adolf Meyer and the Origins of American Psychiatry, (Johns Hopkins University Press, 2014) </span></span><br />
<br />
<span class="readable reviewText"><span id="freeTextreview1116670626"><br /></span></span>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-11035541122334825182014-12-23T07:37:00.002-05:002014-12-23T07:37:37.255-05:00The Invention of Nostalgia<a href="http://www.nytimes.com/2003/12/31/opinion/writing-in-the-new-year-the-invention-of-nostalgia.html">The Invention of Nostalgia</a><br />
Lawrence Raab<br />
------------------------<br />
Before 1688 nostalgia didn't exist<br />
People felt sad and thought about home,<br />
but in 1688 Johannes Hofer, a Swiss doctor,<br />
made up the word. It wasn't what he himself<br />
was feeling, but a malady he'd observed<br />
<br />
in soldiers posted far from home.<br />
Leeches and opium were the cure,<br />
and if those failed, a return to the Alps.<br />
Therefore: homesickness, nostalgia's symptom,<br />
the way your stomach felt that first nitht<br />
<br />
at summer camp, though if you cried<br />
so hard you had to leave, later<br />
you probably found yourself thinking,<br />
They'd be swimming now, they'd be having lunch.<br />
And you felt sad in a different way.<br />
<br />
Imagine how many places you can't<br />
go back to, how much it hurts<br />
to want what's lost--all those days,<br />
the ones that have left<br />
their cloudy picture in your mind.<br />
<br />
and the smell of certain rooms, the light<br />
through trees at a certain hour, a time<br />
before the first time you felt it,<br />
like all the years before 1688<br />
when no one had the right word to turn to.<br />
<br />
Lawrence Raab is author, mostly recently of "Visible Signs: New and<br />
Selected Poems"EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-83542311375420866592014-09-07T07:50:00.000-05:002014-09-07T07:50:44.823-05:00Erving Goffman's AsylumsWhile still in college and working as a volunteer at a 5,000 bed state hospital, I read Erving Goffman's <u>Asylums</u>. His descriptions of St. Elizabeth's Hospital matched what I was observing each Saturday afternoon during the 3 or 4 hours that I spent with a few of the 200 men housed on a so-called Cottage Ward. I accepted <u>Asylums</u> as the gospel. Recently I read a short article titled "<a href="https://www.academia.edu/8104064/Erving_Goffmans_Asylums_and_Institutional_Culture_in_the_Mid-twentieth-century_United_States">Erving Goffman's Asylums and Institutional Culture in the Mid-twentieth Century United State</a>s" by the historian Mathew Gambino, which takes a second look at Goffman's classic book. Gambino reviews materials, such as a patient edited newspaper, that were available to Goffman. Where Goffman saw indoctrination, Gambino hears the voices of patients. Even after more than fifty years he was able to locate statements by patients that suggested that they were quite active in shaping their lives at patients. Indeed, Gambino points out that for all the time Goffman spent as a participant-observer at St. Elizabeth's, he presented no interviews with patients. The difference in orientation between Goffman and Gambino suggests an evolution in our attitudes towards the mentally ill. While Goffman saw the patients as victims, Gambino asks us to consider these patients as agents. This does not suggest to me that we simply rewrite the history of asylum treatment in the United States. At the very least there is no way that I can erase my experiences with patients at a state hospital in the 1960s. It does suggest that when we write about the mentally ill we should not forget that they are people struggling not only with their illnesses, but with the institutions that shape their lives. Gambino's article should be required reading in classrooms where students are asked to read <u>Asylums</u>.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-17538059292310940192014-07-30T21:12:00.001-05:002014-07-30T21:12:10.158-05:00The Weariness of the Self<div class="p1">
The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age</div>
<div class="p1">
Alain Ehrenberg</div>
<div class="p1">
(McGill-Queens University Press, 2009)</div>
<div class="p2">
<br /></div>
<div class="p3">
It appears that we live in the midst of an epidemic of an illness that we call Depression. Looking back to my training as a psychiatrist in the early 1970s, the diagnosis of Depression was usually limited to states that were so disabling that a person could not work, was at risk of suicide, often needed hospitalization and was usually treated with tricyclic antidepressants or ECT. There was a diagnosis of Neurotic Depression that was milder and was always treated with psychotherapy. Our current epidemic is usually explained by two factors: first, the Diagnostic and Statistical Manual of 1980 which eliminated Neurotic Depression and created a vaguely defined category called Major Depression and second, the advent of Prozac, an easy to take medication that was effective for a broad range of symptoms. </div>
<div class="p3">
Ehrenberg takes a different tack. He traces the history of depression focusing on two models. The conflict model, initiated by Freud, sees people as whole, but divided by conflict. Transgression and guilt are the forces that drive it, especially in France where Lacan's version of psychoanalysis is dominant and about which Ehrenberg is writing. The key term in the second model is deficiency. Following the social and cultural changes of the 1960s, he argues, transgression and guilt were no longer dominant concerns. She, and Ehrenberg is religious about using that pronoun, can do anything she wants. Now what matters is feeling inadequate, that is to say deficient. Depression is no longer about conflict and guilt, but about feeling inadequate and deficient. Medications like Prozac help with this by allowing people to feel more capable. Ehrenberg seems nostalgic for the old days when conflict reigned and psychoanalysis was popular. He seems to hold the view that feeling better because of a chemical effect is not authentic. Nonetheless, because he sees the changes as cultural, and social he does not make case for going back to the old days. </div>
<br />
<div class="p3">
What to make of a book like this. It was certainly confusing at times, especially because most of his references are to twentieth century French psychiatry about which I am not very familiar. The broad idealistic/Foucauldian perspective where cultures change without clearly marked material causes is hard to follow. Nonetheless, posing a contrast between a view of human nature centered on the idea of conflict and one centered on a notion of deficiency is quite refreshing. It isn't a matter of a biological/psychological dichotomy. Ehrenberg is clear psychotherapies, going back to Janet, can be based on a deficiency model. Indeed as I think about discussions of psychotherapy in recent years it seems to me that these were often based on the premise that the patient was somehow injured and in need of repair, not that 'she' was in conflict about how to live. The medications and the psychotherapies that we use are consistent with one another in how they view human nature. In this regard it seems to me that Ehrenberg is onto something and that this book was worth reading.</div>
EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-56882811783898151532014-02-19T09:11:00.000-05:002014-02-19T09:11:23.636-05:00The Prisoner of Stress<div class="p1">
<span class="s1">Having seen Scott Stossel's book</span><span class="s2"> </span>“<a href="http://www.amazon.com/My-Age-Anxiety-Scott-Stossel-ebook/dp/B00F8F7M58/ref=sr_1_1?s=books&ie=UTF8&qid=1392818876&sr=1-1&keywords=scott+stossel+my+age+of+anxiety&tag=s601000020-20"><span class="s3">My Age of Anxiety</span></a>” (Knopf) in a bookstore, I was interested in reading <a href="http://www.newyorker.com/arts/critics/atlarge/2014/01/27/140127crat_atlarge_menand?currentPage=all"><span class="s3">Louis Menand's review</span></a>. Menand, as usual, goes beyond simply giving his opinion about the book under review. In this case he has written an interesting essay on the many meanings of anxiety. Is it an illness? Is it due to unconscious conflicts? Is it an existential condition? Is it due to stressors? None of the above or all of the above. Is it even 'somthing'? In the course of the review he sketches a brief history of our current ideas about and methods for treating anxiety. While he doesn't mention Andrea Tone's book <a href="http://www.amazon.com/Age-Anxiety-Americas-Turbulent-Tranquilizers-ebook/dp/B001P2NI38/ref=sr_1_4?s=books&ie=UTF8&qid=1392818051&sr=1-4&keywords=andrea+tone"><span class="s4"><b>The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers</b></span></a><span class="s5">, </span><span class="s6">I </span><span class="s7">would suggest it as a good place to get a fuller description of this history. </span></div>
<br />
<div class="p1">
<span class="s7">In the end Menand seems to take an agnostic position about theories of anxiety. His final word leaves room for both biology and psychology. He writes</span><span class="s8"> </span>"As a species, we lucked out: natural selection gave us minds, and that freed us from the prison of biological determinism. We can put our genetic assets to positive account if and as we choose, and sometimes we have to try to do the same thing with our genetic deficits. " Not a bad approach to something we may not be able to avoid.</div>
<div class="data" style="background-color: white; display: table; margin-bottom: 0px; padding-bottom: 6px;">
<span class="dingbat" style="font-family: 'Courier New', Symbol; font-size: 17px; line-height: 25px;"><br /></span><div style="font-size: 13.63636302947998px;">
<span style="color: black; font-family: Georgia, Times New Roman, serif;"><br /></span></div>
</div>
EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com1tag:blogger.com,1999:blog-14943346.post-32113909095337788162013-01-09T09:48:00.000-05:002013-01-09T09:48:01.246-05:00The Science of Sex Abuse This week's issue of the New Yorker has an <a href="http://www.newyorker.com/reporting/2013/01/14/130114fa_fact_aviv">article by Rachel Aviv</a> on the medicalization of sex abuse crimes. It is well researched, well written and worth reading. She focuses the piece around the story of a man named John, who was drawn to child pornography on the internet, then to a chat room and finally to a rendezvous with undercover police officers. She describes his time in prison and on probation, his relapse, and his re-incarceration. The heart of the article is about the use of civil commitment to keep John "in treatment" after finishing his prison sentence. She describes civil court hearings, psychiatric testimony and life in the treatment facility where John winds up. Aviv is particularly interested in the fact that while John has not harmed anyone [other than indirectly through his support for the child pornography industry], the judicial system seems almost unable to release him for fear that he might assault a child. She discusses the psychological tests and psychotherapy which contribute to the view that John is a risk. Since the advent of the internet and the emergence of internet child pornography there has been a virtual epidemic of cases like that of John. As yet, however, as I read Aviv, we don't have a way to distinguish those men who will assault children from those who won't, nor do we have effective means of stopping such men from indulging in pedophile fantasies. As she describes it this creates a catch 22 situation that leaves men like John to spend years in involuntary treatment. Aviv quotes psychiatrists who deplore the profession being used to medicalize what they regard as a criminal issue. But, of course, there are also those psychiatrists who make a living testifying in civil court and running involuntary treatment programs.<br />
<br />
<br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com3tag:blogger.com,1999:blog-14943346.post-25568156778322607502012-12-28T10:56:00.001-05:002012-12-28T10:56:41.931-05:00Laura's LawIn case you missed it the PBS News Hour had an interesting piece on<a href="http://www.pbs.org/newshour/bb/health/july-dec12/lauraslaw_12-26.html"> court ordered outpatient</a> treatment. California has a new law allowing for court ordered outpatient psychiatric treatment for psychiatric patients thought to be dangerous. <a href="http://en.wikipedia.org/wiki/Laura's_Law">The law, which is named for a young woman</a> who was killed by a paranoid patient, hasn't been funded. The state, in its wisdom, is leaving this to localities. So far only one county has done so. The piece gives various people an opportunity to speak for and against the law, but doesn't say anything about those few states that have such a law. From my limited experience working in a state that allows for court ordered outpatient treatment I would say that it is neither as helpful nor as harmful as as the two sides quoted in this story suggest. It would be interesting to know whether there is data on how such laws work.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-28583973596621300922012-12-26T08:22:00.000-05:002012-12-26T08:22:33.873-05:00A Dark Day for Psychiatry<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzddTLYfkXGV_uCzoeyJS-AD48U2UN0x3I1eWmmksPVNr2sNhC8X7JHzBfKneYpoRuGTLc6Hor6cFLBZkhdFRG_OaySTAi3Y4OdMjyu3v2f852L42mSFJLzRkjlm1Xh-xUqLDn/s1600/manifestation-de-soutien-a-la-psychiatre-daniele-canarelli-a_943896.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzddTLYfkXGV_uCzoeyJS-AD48U2UN0x3I1eWmmksPVNr2sNhC8X7JHzBfKneYpoRuGTLc6Hor6cFLBZkhdFRG_OaySTAi3Y4OdMjyu3v2f852L42mSFJLzRkjlm1Xh-xUqLDn/s320/manifestation-de-soutien-a-la-psychiatre-daniele-canarelli-a_943896.jpeg" width="212" /></a></div>
<br />
<br />
<br />
An <a href="http://www.guardian.co.uk/world/2012/dec/19/french-psychiatrists-unions-doctors-sentence">article in the Guardian report</a>s that in the first case of its kind in France, Danièle Canarelli, a 58 year old psychiatrist was sentenced to one year's suspended sentence for failing to recognize the grave danger posed by a patient she had been treating for four years.<br />
<br />
The union for French state psychiatrists, which backed Canarelli during the trial, said that the landmark verdict was worrying and risked scapegoating the profession over a complex case.<br />
<br />
I thought the case raised interesting questions about when or whether negligence should ever be considered as a criminal offense. Beyond that the case highlights psychiatry's sometimes conflicting responsibilities-- caring for patients and protecting society from the actions of some of those patients.<br />
<br />
A more detailed <a href="http://www.lemonde.fr/societe/article/2012/11/14/a-marseille-une-psychiatre-sur-le-banc-des-prevenus_1790218_3224.html">report of the case in Le Monde</a> gives something of the flavor of the case. Here is my attempt at a summary.<br />
<br />
At the opening of the trial the President of the Court, aware of the controversial nature of the trial, spoke directly to the psychiatrists who had come to protest in support for their colleague. "We can understand the legitimate emotion of a profession," he said, "but we are not judging psychiatry or psychiatrists. For us it is a question of knowing if, in a concrete situation, serious misconduct has been committed." Referring to an article in the penal code under which 'unintentional offenses' may be charged, he added that, "There can be no impunity, society does not accept it."<br />
<br />
This case began after charges against a murderer were dismissed because he was declared irresponsible as a result of psychiatric troubles. The victim's son opened a civil case against the doctor during which the judged referred the case for criminal prosecution because of a breach of duties of caution and safety. In France such prosecution is allowed if an indirect link between misconduct and damage exposes others to particularly serious risk that "could not be ignored."<br />
<br />
In making this ruling the judge relied on the testimony of a psychiatric expert. Over a period of years, the expert pointed out, the murderer had been back and forth between prison and a psychiatric hospital for assault with a knife, arson and attempted murder. During this time he was repeatedly diagnosed as suffering suffering from schizophrenia 'with established dangerousness.'<br />
<br />
While other doctors came to this conclusion, Dr. Canarelli did not make this diagnosis, regularly voided his involuntary status in the hospital and granted him furloughs. When asked by the judge why she had done this she replied, "You cannot keep someone involuntarily forever." When the judge asked how else one could treat someone who was unwilling to be treated, the doctor answered, "I was in a trusting relationship with him. He came to all of his appointments, which is rare, and there were no behavioral incidents during his hospitalization."<br />
<br />
When confronted with her repeated disagreements with other doctors about this patient's diagnosis, she responded that , "He was a patient who was more complicated than others. I was faced with a conundrum. I was convinced that he had a psychotic condition, but I was puzzled [embarrassée] by the absence of symptoms."<br />
<br />
The case against the doctor was strengthened when she was questioned about the patient's exit from her clinic three weeks prior to the murder. At that time, the patient's sister warned the doctor that her brother was making death threats. In addition he failed an appointment with the doctor because of a wound received during an altercation. At Dr. Canarelli's request the patient was sent to her office after treatment of his wound. However, he refused her offer of hospitalization and abruptly left her office. She said that she was alone with a nurse and felt she couldn't detain him, but she didn't call for help. She waited three hours to call the police.<br />
<br />
In response to this testimony the judge commented that the doctor's failure to call the police for three hours meant that the patient was "in the city, while you told us that he was sick and could do harm." This comment sparked indignation among the psychiatrists in the courtroom. "Judges should do internships in psychiatric hospitals," one audience member commented to another.<br />
<br />
The prosecutor argued successfully that "there is a moment when social defense must come before the patient."<br />
<br />
On December 18 Dr. Canarelli was sentenced to one year's suspended sentence for manslaughter [homicide involontaire]. The court concluded that 'shortcomings identified in monitoring the patient' were 'at the origin' of the behavior leading to the murder. These shortcomings, court concluded, constituted serious misconduct and warranted the criminal liability of the psychiatrist. Recalling the multiple incidents that should have alerted the doctor to the patient's dangerousness, the judge said that Dr. Canelli's attitude "bordered on blindness."<br />
<br />
Above all, the judge noted, this doctor had time to see her patient evolve. The judge was careful avoid including all errors made by doctors in his judgement noting that, "contrary to other doctors …who must act and react in emergencies, she was able to register clinical observations over time."<br />
<br />
The president of the Union syndical de la psychiatrie <a href="http://www.lemonde.fr/societe/article/2012/11/14/la-psychiatrie-n-est-pas-une-science-exacte_1790238_3224.html">responded to the court proceedings</a> by answering several questions. Here are two questions and answers.<br />
<br />
1. Why do you support Dr. Canarelli?<br />
"What bothers us in this process, is the impression that we must find a scapegoat. We consider unacceptable and will make this the main responsible psychiatrist, because here this was a complex situation where the responsibility of the physician is practically zero. What exactly is she being criticized for. … failing to ensure public safety, as if that was her role and not that of the police. In spite of her reporting his flight, he was not arrested. We are not police officers. Between the patient and the psychiatrist, everything must be based on trust and therapeutic care, not security.<br />
2. What impact would the conviction of Dr. Canarelli have?<br />
This would surely lead to there being a sword of Damocles over every practitioner. This pressure transform psychiatrists into guardians of public order. The risk that patients would then remain confined to the hospital longer -while you reducing the number of beds ! Fortunately, this kind of case is rare, because the police normally intervene in reported cases, and, it is always useful to remember, because psychiatric patients are not more dangerous than the rest of the population. .<br />
<br />
<br />
<br />
<br />
<br />
<br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com4tag:blogger.com,1999:blog-14943346.post-880094603926270352012-12-18T10:50:00.000-05:002012-12-18T10:50:45.887-05:00I am Adam Lanza's motherMy daughter sent me <a href="http://gawker.com/5968818/i-am-adam-lanzas-mother">this article</a> following the Newtown masacre. What struck me was the mother's view that the choices for her son were between prison and shuttered hospitals. I had thought that the twentieth century had created comprehensive community programs for difficult cases such as hers. Reading her impassioned plea I felt that I had returned to the nineteenth century. Are community programs also shuttered in her area or is access to them so difficult that it amounts to the same thing. It does seem to me that the question of access to such programs should be an important part of the 'conversation' that we are having in the wake of this most recent tragedy. Certainly in the area where I practiced psychiatry, funding for comprehensive public programs are being cut. Such programs are necessary because the incentives in the private sector do not favor providing adequate treatment for difficult people such this woman's son.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-3889627102175929782012-08-24T06:40:00.000-05:002012-08-24T06:40:49.926-05:00More on Breivik<b id="internal-source-marker_0.8989187232218683" style="font-weight: normal;"><br /><span style="font-family: Georgia; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><br />
</b><br />
<div class="p1">
<b id="internal-source-marker_0.8989187232218683" style="font-weight: normal;"><span class="s1"><a href="http://www.washingtonpost.com/world/europe/norway-killer-to-face-sentence-for-bomb-and-gun-rampage-that-killed-77/2012/08/24/4c36394c-edbd-11e1-866f-60a00f604425_story.html">The Washington Post reports</a></span> that a Norwegian court sentenced Anders Behring Breivik to prison on Friday, denying prosecutors the insanity ruling they hoped would show that his massacre of 77 people was the work of a madman, not part of an anti-Muslim crusade. In a reversal of my expectations the prosecution continued to argue that he was insane while the defense argued that he was an anti-Muslim terrorist. Importantly Breivik wanted to be considered a terrorist. As I said in my earlier post this seems significant in showing that insanity is two edged in that it can be used both as an exculpating defense and a delegitimizing accusation. </b></div>
<b id="internal-source-marker_0.8989187232218683" style="font-weight: normal;">
<div class="p1">
<span class="s1"><a href="http://en.wikipedia.org/wiki/Mark_David_Chapman">I recently learned David Mark Chapman</a></span>, who was convicted for murdering John Lennon in 1980 also refused an opportunity to plead insanity and insisted on pleading guilty.</div>
</b>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-16988406998872552682012-06-23T06:48:00.000-05:002012-06-23T06:48:26.399-05:00Prosecutors in Norway Seek Hospital for Gunman<br />
<div class="p1">
<span class="s1"><a href="http://www.nytimes.com/2012/06/22/world/europe/anders-breivik-prosecutors-seek-psychiatric-confinement.html?smid=pl-share">The New York Times has reported</a></span><span class="s2"> that in a remarkable turn of events prosecutors in Norway asked that </span> <span class="s2">Anders Behring Breivik be committed to a hospital rather than sent to prison. What seemed particularly significant was their reasoning: </span>“In our opinion, they said, it is worse that a psychotic person is sentenced to preventative detention than a nonpsychotic person is sentenced to compulsory mental health care.” The following day the Times reported that <a href="http://www.nytimes.com/2012/06/23/world/europe/oslo-killers-lawyers-say-he-is-sane.html?smid=pl-share"><span class="s3">Breivik's defense lawyers were arguing that he was of sound mind</span></a> when he committed the crimes. Understanding why these arguments are the reverse from what I would ordinarily expect is certainly a puzzle. <span class="s4">Later I learned that </span><span class="s5">Members of the defense team evoked Mr. Breivik’s human rights in their conclusion that he should be held accountable for his crimes. Mr. Breivik has said that the killings were committed in self-defense to combat what he has called the “Islamic colonization” of Europe. He has argued that an insanity judgment would detract from his cause. "The defendant has a radical political project, said Geir Lippestad, onf of his lawyers. "To make his acts something pathological and sick deprives him of his right to take responsibility for his own actions."I am curious about other cases where the defense and prosecution have made similar arguments. </span></div>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com2tag:blogger.com,1999:blog-14943346.post-5812479057663761012012-06-05T10:33:00.000-05:002012-06-05T10:33:41.429-05:00LovesicknessThe Archives of General Psychiatry has published another of James Harris' wonderful discussions of art and psychiatry. This month Harris discusses the American painter Benjamin West's (1738-1820) painting of <a href="http://archpsyc.jamanetwork.com/article.aspx?articleID=1171952&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=Archives_of_General_Psychiatry%3A_New_Issue_06%2F04%2F2012">Erasistratus Discovering the Cause of Antichochus' Disease</a>. He uses the painting as an opportunity to provide brief, incisive discussion of Lovesickness. I have had a longstanding interest in <a href="https://sites.google.com/site/psychiatryfootnotes/case-histories-from-the-history-of-psychiatry/love-sickness">lovesickness</a>. As Stanley Jackson pointed out many years ago Lovesickness provided one of the earliest circumstances where doctors diagnosed and treated <a href="https://sites.google.com/site/psychiatryfootnotes/case-histories-from-the-history-of-psychiatry/a-pathogenic-secret">pathogenic secrets</a> as the cause of illness. <span style="color: #333333; font-family: Helvetica, Arial, Verdana, sans-serif; line-height: 1.3;"> </span><span style="color: #333333; line-height: 1.3;"><span style="font-family: Georgia, 'Times New Roman', serif;"> Thanks to Harris for expanding my appreciation of this interesting disorder. </span></span>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-63592482261872445012012-05-31T14:22:00.002-05:002012-05-31T14:22:31.270-05:00How I Became a Historian of Psychiatry: Gerald GrobGerald Grob, one of the great historians of psychiatry, has submitted his statement to the blog h-madness' series on "<a href="http://historypsychiatry.com/2012/05/27/how-i-became-a-historian-of-psychiatry-gerald-grob/">How I Became a Historian of Psychiatry</a>." Having read much of Grob's work many years ago and been much impressed by his intelligence and good judgment, I was quite moved by this piece. I pass it along for those who don't regularly read h-madness.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-38401610385711911552012-05-18T13:25:00.000-05:002012-05-18T13:25:38.850-05:00Spitzer ApologizesPsychiatry seems endlessly political. Having read <a href="http://www.amazon.com/Homosexuality-American-Psychiatry-Politics-Diagnosis/dp/0691028370/ref=sr_1_1?s=books&ie=UTF8&qid=1337364567&sr=1-1">Ronald Bayer's excellent chronicle</a> of the story of homosexuality being read out of psychiatry's Diagnostic and Statistical Manual I was puzzled when I read the New York Times headline " <a href="http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-noted-psychiatrist-apologizes-for-study-on-gay-cure.html?smid=pl-share">Leading Psychiatrist apologizes for Study Supporting Gay 'Cure'</a>." I was completely unfamiliar with the story it relates of Robert Spitzer's sponsoring and publishing a study on treating homosexuality in 2001.<span style="color: #333333; font-family: Georgia, serif;"> </span> The author of the article, Benedict Cary, suggests that it was Spitzer's anti-establishment impulses manifesting themselves again that led him to conduct the study. I found myself wondering if the study didn't express some reservations that Spitzer still had about his advocacy for the de-medicalization of homosexuality. At the end of the article Spitzer, clearly thinking about his legacy in the history of psychiatry says of his apology: " You know, it's the only regret I have; the only professional one, … And I think, in the history of psychiatry, I don't know that I've ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologized to his readers."<span class="s1"> He might have added that it would be hard to find a psychiatrist turning 180 degrees from one politically controversial position to another -- not to mention in the wrong direction.</span><br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-18643747776005603552012-05-16T11:50:00.000-05:002012-05-16T11:50:03.932-05:00Diagnosing the DSMAllen Frances' May 11, 2012 op-ed piece in the New York Times "<a href="http://www.nytimes.com/2012/05/12/opinion/break-up-the-psychiatric-monopoly.html?smid=pl-share">Diagnosing the DSM</a>" is a wonderful piece of common sense. He argues that we don't need to insist that psychiatrists are in cahoots with drug companies to see that conflicts of interests render the American Psychiatric Association incapable of developing a diagnostic manual that does not overreach and medicalize much of everyday life. His suggestion that some presumably neutral arbiter such as the National Institutes of Health should take on this task is worth discussion.<br />
As it happens I was just rereading a wonderful essay by <a href="http://www.petersedgwick.org/articles/biographical/NewStatesmanObituary.html">Peter Sedgwick</a> in his 1982 book <a href="http://www.amazon.com/Psycho-Politics-Foucault-Goffman-Psychiatry/dp/0060909641/ref=sr_1_5?s=books&ie=UTF8&qid=1337186066&sr=1-5">Psychopolitics</a>, titled "Illness--Mental and Otherwise." While it is aimed at the anti-psychiatry theorists of the day, its central point is that all diagnosis, whether of mental or of physical disorders, involves value judgments. The great success of the DSM as well as its scientific pretentions make it clear that we must take Sedgwick's arguments seriously if we are going to have an honest debate over the reasonable limits of psychiatric diagnosis.<br />
<br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-8433278132243204752012-05-01T21:28:00.000-05:002012-05-01T21:28:29.432-05:00More on straitjackets In a 2006 post I wrote that the camisole de force was invented at the Bicêtre in 1790. I recently realized that my source got that wrong. Most sources cite the same inventor, but give the date as 1770. In addition it seems that the strait waistcoat was in use at least by that date and probably much earlier. In 1772 David MacBride gives a detailed <a href="http://books.google.com/books?id=sVo_AAAAcAAJ&printsec=frontcover&dq=david+macbride&hl=en&sa=X&ei=ZpwUT8z8BMji0QG0w6ClAw&ved=0CEIQ6AEwAQ#v=onepage&q=strait%20waistcoat&f=false">description of construction of the strait waistcoat</a>, implying that it was well known in Britain by that time.<br />
By 1784, and perhaps as early as 1777, the very influential Scottish physician William Cullen in his First Lines of the Practice of Physick was praising the waistcoat not only as a means of restraint, but also as a remedy and even suggesting a physiological rationale for its benefit. This passage is so striking that it is worth quoting at length.<br />
<br />
<blockquote class="tr_bq">
"Restraining the anger and violence of madmen is always necessary for preventing their hurting themselves or others: but this restraint is also to be considered as a remedy. Angry passions are always rendered more violent by the indulgence of the impetuous motions they produce; and even in madmen, the feeling of restraint will sometimes prevent the efforts which their passion would otherwise occasion. Restraint, therefore, is useful, and ought to be complete; but it should be executed in the easiest manner possible for the patient, and the strait waistcoat answers every purpose better than any other that has been yet thought of. The restraining madmen by force of other men as occasioning a constant struggle and violent agitation is often hurtful. although there may be no symptoms of any preternatural fulness or increased impetus of blood in the vessels of the brain, a horizontal posture always increases the fulness and tension of these vessels, and may thereby increase the excitement of the brain."</blockquote>
<br />
Philippe Pinel may have learned about the strait waist coat from Cullen when he translated this passage in 1785, incidentally using the term chemisette serrèe, suggesting that he was not yet familiar with the commonly used term camisole de force. In his Treatise on Insanity in 1800, Pinel argued that his use of the camisole de force was evidence that he subscribe to the same philanthropic principles as those of the York Retreat:<br />
<blockquote class="tr_bq">
<span style="text-align: left;"> We are doubtless without the advantages of Dr. [Thomas] Fowler's establishment in Scotland [actually the Retreat in York] with its expansive grounds and fine accommodations. But I can attest after two years of diligent observation that the same principles of philanthropy prevail in the management of the insane at Bicêtre. The attendants, under no pretext whatever, ever raise a hand, even in reprisal. Strait jackets [<i>Gilets de force</i>] and seclusion, for short periods, are the only punishments inflicted. When kind treatment or the imposing trappings of repression fail, a clever ploy sometimes produces unexpected cures [TAM. 1800, 65-6].</span></blockquote>
<div style="text-align: left;">
<blockquote class="tr_bq">
</blockquote>
</div>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-31353485456796888732012-05-01T08:37:00.000-05:002012-05-01T08:37:04.087-05:00Defending Psychoanalysis in France<b id="internal-source-marker_0.10720543353818357"><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">The dispute in France over the role of psychoanalysis in treating autism brought a </span><a href="http://tempsreel.nouvelobs.com/le-dossier-de-l-obs/20120418.OBS6476/faut-il-bruler-la-psychanalyse.html"><span style="color: #1155cc; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">defense of analysis in the Nouvelle Observateur</span></a><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"> [NO] from Elisabeth Roudinesco [ER] and Alain Badiou [AB]. I found one section of their comments of particular interest, not because it related to the issue of autism, but rather because it offered a social psychological interpretation of the plight of psychoanalysis. Here is my effort at a translation: </span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[ER]The dissatisfaction [of the relatives of autistic children] does not come from nowhere. However, all the critiques are not acceptable. For example, we are witnessing a new phenomenon: patients want to decide their treatments and consider in particular that their symptoms belong to their identity. [she uses the term boufées délirantes. I would paraphrase the CNRTL dictionary definition of this term as a sudden, short lived mental disturbance manifesting itself through hallucinations, sensory illusions and accompanied by mental confusion.] They do not see why they should be numbed by medication on the pretext that they hear voices. In which case one must listen to them. But we are going towards the patient as master of his destiny, and this is not desirable. Here again, psychoanalysts bear part of the responsibility, because by enclosing themselves in chapels they lose their authority. At bottom what has been lost in psychoanalytic societies is the position of master to the benefit of that of little chiefs [petit chefs].</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[NO] What do you mean by “master?”</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[ER] The position of master permits the transference: the psychoanalyst is “supposed to know” what the analysand is going to discover. Without that, trying to discover the origin of the suffering is almost impossible.</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[NO] Is it really necessary to go through the restoration of the master?</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[AB] The master is what helps the individual become a subject. Because if one admits that the subject emerges in the tension between the individual and universality, then it is evident that there is a need for mediation to advance on this road. And therefore the need for an authority. The crisis of the master is the logical consequence of the crisis of the subject, and psychoanalysis is no escape from it. It is necessary to restore the position of the master, </span><span style="background-color: whitesmoke; color: #333333; font-family: Arial; font-size: 16px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">but it is not true that one can do without it, even and especially from the perspective of emancipation.</span><br /><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">[ER] When the master disappears, he is replaced by the chief, authoritarianism, and that ends always, sooner or later, in fascism- history has, alas, proved this.</span></b><br />
<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt; text-indent: 36pt;">
<b id="internal-source-marker_0.10720543353818357"><span style="font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">I found this part of the interview interesting because it suggests that for psychoanalysis to be successful as an individual therapy and as a therapeutic institution the analyst must be accepted as a ‘master,. that is as one who is ‘supposed to know.’ While the priestly role of the doctor is an important part of many, if not most, areas of medicine, these remarks indicate that for psychoanalysis this role is the critical ingredient. Indeed, they seem to say that without the analyst being able to assume the role of master the process cannot occur. In a patriarchal society, such as the one Freud lived in, the doctor as a ‘master’ could be assumed. What the authors seem to be suggesting is that the challenge to psychoanalysis posed by such people as the relatives of ‘autistes’ is part of a larger challenge to patriarchal norms that may be occurring in France somewhat later that it did in the United States. This raises the question of what role of the challenge to patriarchal norms in the United States has played in the decline in the fortunes of psychoanalysis. </span></b></div>EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com1tag:blogger.com,1999:blog-14943346.post-72909571058262575662012-04-28T08:16:00.000-05:002012-04-28T08:16:04.671-05:00The WallAlthough the controversy over Sophie Robert's documentary film "The Wall: Psychoanalysis put to the test for autism" has been going on for a while, I first learned about this week when I ran into an article in the Nouvelle Observateur titled "<span style="font-family: Georgia; text-align: left;"><a href="http://tempsreel.nouvelobs.com/le-dossier-de-l-obs/20120418.OBS6476/faut-il-bruler-la-psychanalyse.html">Faut-il brûler la psychanalyse ?</a>" in which </span><span style="font-family: Georgia, 'Times New Roman', serif; text-align: left;">Elisabeth Roudinesco and Alain Badiou defend psychoanalysis. Frustrated with reading this I learned that</span> in January 2012 The New York Times published an article "<a href="http://www.nytimes.com/2012/01/20/health/film-about-treatment-of-autism-strongly-criticized-in-france.html">A French Film Takes Issue with the Psychoanalytic Approach to Autism</a>," which reviews the controversy quite clearly. However, clicking on the link to the Youtube version of the film in the article, I found that it had been removed from Youtube. This act of censorship got me interested in finding a way to view the film. Indeed several sites no longer had the film available. I did find <a href="http://www.dailymotion.com/runmagali">one site where the film is available</a>. As a document in the history of psychiatry, it is well worth viewing. It reminded me of the controversies over psychoanalytic theories of Tourette Syndrome that Howard Kushner describes so well in his book <u>A Cursing Brain? Histories of Tourette Syndrome</u>.<br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-34723077078453014702012-04-22T16:01:00.000-05:002012-04-22T16:01:21.916-05:00Rabbi's Little HelperPsychiatry has long been accused of being an agent of social control. It appears that a new chapter to this story is being written in Israel. A few weeks ago Haaretz published "<a href="http://www.haaretz.com/weekend/week-s-end/rabbi-s-little-helper-1.422985">Rabbi's Little Helper</a>," which related stories of people being taken to psychiatrists by their rabbis for medication, presumably in the hopes that their behavior will better conform to community standards. Today Haaretz published a follow-up titled "<a href="http://www.haaretz.com/news/features/psychiatric-drugs-become-talk-of-the-ultra-orthodox-community-1.425727">Psychiatric drugs become talk of the ultra-Orthodox community</a>.EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com0tag:blogger.com,1999:blog-14943346.post-9396757088961870422012-01-10T10:26:00.000-05:002012-01-10T12:36:25.520-05:00Biology vs. Psychology in the 1920s Some years ago, while rummaging around in a room full of psychiatric hospital records from the 1920s, I ran across the verbatim typescript of a memorable case conference. During this period two perspectives on understanding patients were actively competing. Psychoanalytic ideas were still relatively new and attempting to explain all sorts of phenomena that had previously been explained biologically. At the same time new biological treatments were infusing biologically oriented psychiatrists with new confidence. At this hospital the ambitious medical director had recruited a number of young clinicians from each of these perspectives. The case presented on that day was a middle aged man who had been treated with mercury some ten years earlier for symptoms of general paresis of the insane. Now he was admitted to the hospital for symptoms of depression with some suspicion that his general paresis had returned. In the days before penicillin, general paresis, which is a form of tertiary syphilis was a common frightening cause of madness and death. Its early psychiatric manifestations were quite variable, though most often they were mood related--mania and depression. While severe dementia eventually dominated the clinical picture, symptoms of dementia were, in the early stages, often subtle and easy to miss.<br />
Why was this man depressed? The medical director posed this question to his young new staff somewhat in the manner of a professor presenting a question to a class. A lively discussion broke out. The biologically oriented psychiatrists noted that mood symptoms were common in such cases of general paresis. The psychoanalytically oriented psychiatrists argued that the sexual nature of the disorder ws producing guilt and that was leading to the symptoms of depression. The discussion went on for some time without resolution since the two perspectives were incommensurable. Eventually the medical director asked that they simply review the facts of the case. After some further discussion, he pointed out that ten years earlier the patient had thought himself cured of syphilis and free from the possibility of general paresis. Now, perhaps, the patient was able to subtle signs of dementia in himself and understood what was in store for himself. "Isn't that," the medical director concluded, "reason enough to be depressed."<br />
Reading that case many years ago, I thought about how ideological arguments have the power to distract psychiatrists from what is staring them in the face. Over the years that I have practiced psychiatry, i have often had occasion to recall the lesson of that case conference.<br />
<br />
<br />EMBhttp://www.blogger.com/profile/11142230982010566372noreply@blogger.com1