Biomedical subjects
E Witztum
Publications and source records attributed to E Witztum.
Therapeutic response to combat stress reaction during Israel's wars.
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Lessons denied: a history of therapeutic response to combat stress reaction during Israel's War of Independence (1948), the Sinai Campaign (1956) and the Six Day War (1967)
The current article examines the history of therapeutic response in the Israel Defense Forces toward combat stress reaction during two decades, and in the course of three wars: the 1948 War of Independence, the 1956 Sinai Campaign, and the 1967 Six Day War. Three independent sources were used: recorded debriefing materials; interviews conducted with therapists, commanders and military historians; and professional literature on the wars in Hebrew and other languages. The collected material is described and issues of attitudes, treatment approaches and preparedness are discussed.
Lessons relearned--when denial becomes impossible: therapeutic response to combat stress reaction during the Yom Kippur War (1973), the Lebanon War (1982) and the Intifada.
This article presents the attitudes toward CSR during and after the 1973 Yom Kippur War, the 1982 Lebanon War and the Intifada. It analyzes the transition from denial to recognition which evolved following the Yom Kippur War. Several explanations are suggested and discussed, including structural, political and psychoanalytic perspectives.
The erroneous diagnosis of malingering in a military setting.
The paper describes difficulties in diagnosing individuals from different cultures, focusing specifically on cases of erroneous diagnosis of malingering among ultraorthodox Jewish inductees. During one year, 24 inductees diagnosed as malingerers by several army psychiatrists were re-examined by the authors and subsequently re-diagnosed as psychotic, suffering from a personality disorder, or mentally retarded. Factors underlying the misdiagnosis are discussed.
[Sexual relations between doctors and patients: state of the art].
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Jacob--the case of a serial killer.
This paper describes a rare forensic psychiatric syndrome which has been the subject of massive publicity in the last decade. Despite the widespread interest, the psychodynamic process whereby a person becomes a serial murderer remains largely unknown. "Jacob" was convicted of a series of murders that he carried out over a decade. The case material is based on the psychiatric reports that were presented to the court and the many articles published in the local press at the time. Despite the limitations imposed by the material, the available information on "Jacob" bears some similarity to the phenomenological and psychodynamic models described in the literature. An attempt is made to understand the transformation of a person into a serial killer considering the life events, psychopathology and stressors that lead to the emergence from the world of imagination and fantasy of a potential murderer to the deeds that comprise the syndrome.
[Consequences of misdiagnosis and labeling in psychiatry].
Differences in diagnostic approaches between psychiatry and other medical specialties were examined and problems resulting from misdiagnosis are presented. The labelling and stigma resulting from misdiagnosis have severe implications and there is inherent difficulty in correcting misdiagnoses of major psychiatric disorders. We present a 38-year-old man who underwent numerous psychiatric and psychological examinations in order to change a previous misdiagnosis. The difficulties examiners had in accepting the possibility of misdiagnosis, and its severe consequences, are described.
Between sacred and medical realities: culturally sensitive therapy with Jewish ultra-orthodox patients.
One disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra-orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that focus on the patient's mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post-traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self-reconstruction.
[Misdiagnosis and labeling in psychiatry and their consequences: Part II].
The complexity of arriving at a correct psychiatric diagnosis in cases in which physical and mental disorders are interrelated is discussed. A case is presented in which a psychiatric diagnosis had been made and malingering suspected, although the patient actually had a severe neurological disorder. The psychiatric diagnosis had not been changed despite recurrent medical and psychological examinations which clearly indicated a physical disorder. The difficulties that follow misdiagnosing organic disorders as psychiatric disorders are illustrated. Various aspects of the effects of psychiatric misdiagnosis on functional, legal and civil aspects of life are discussed. Emphasis is given to the problems facing those discharged from military service for medical reasons, especially mental disorders. Important measures are currently being applied to overcome some of these problems. It is strongly emphasized that there is need for greater openness and tolerance among psychiatrists when making psychiatric diagnoses.
Stigma, labelling and psychiatric misdiagnosis: origins and outcomes.
The sources and consequences of inaccurate psychiatric diagnosis are discussed. The philosophy of the DSM diagnosis system is described, and the hazards of the practice of labelling together with its resulting social stigma are explored. The dangers and complications of psychiatric misdiagnosis are illustrated with a case example. Recommendations are made for extreme caution to be exercised in the making of psychiatric diagnoses and the need to revise misdiagnoses is strongly emphasized.
The efficacy of naltrexone in preventing reabuse of heroin after detoxification.
The efficacy of Naltrexone in preventing reabuse of heroin among heroin addicts in Israel was studied in a double-blind, controlled design. Naltrexone (or placebo) treatment was given as part of a general treatment plan that continued for 12 weeks. Thirty-two addicts who successfully completed a detoxification program and met research criteria, were included in the study. Fifty milligrams of Naltrexone were taken orally three times a week (25 mg twice a week for the first 2 weeks). The follow-up procedure included an interview, urine tests, and screening for possible adverse effects. In addition, social and psychological parameters were evaluated. Fewer heroin-positive urine tests were found the Naltrexone group than in the placebo group. Throughout the entire study, the number of drug-free patients in the Naltrexone group was higher than in the placebo group. The Naltrexone group showed a significant improvement in most psychological parameters as compared with the placebo group. No differences were found in compliance or ratio of adverse effects between the Naltrexone and placebo groups. The concept "heroin abuse load" based on daily heroin consumption and duration of addiction enabled us to predict which addicts would complete the treatment program. The results suggest that heroin addicts in Israel may benefit from treatment with Naltrexone.
[Medical secrecy, privilege and privacy].
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[Familial characteristics in schizophrenia].
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Patients, chaperons and healers: enlarging the therapeutic encounter.
The common assumption in most therapy is that the process is initiated by a need in the patient and managed or directed by the therapist. If there are other people involved, except for the case of group or family therapy, they are at best marginal to the ongoing process as conducted in the therapy room. This paper, jointly written by a social anthropologist and psychiatrist, presents a model of therapy in an ultra-Orthodox Jewish community in which chaperons accompanying the patient (a common feature in the setting) may fulfil important functions as cultural bridges, sometimes even going so far as serving as active co-therapists. Ethnographic data is offered to demonstrate how chaperons may assist in enabling the healers to overcome feelings of 'cultural distress' and discomfiture on the part of the patients and how they assist the therapists to be 'culturally sensitive' in their use of psychiatric methods in a population which has deep misgivings about such procedures. The paper concludes with an argument for increased openness and flexibility in the practice of psycho-therapy, particularly in cross-cultural encounters, which would allow for greater use of chaperons.
A case of posttraumatic stress disorder masked by pseudoseizures in a Jewish Iranian immigrant in Israel.
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Culturally sensitive therapy with ultra-orthodox patients: the strategic employment of religious idioms of distress.
The article deals with the problem of administering therapy in multicultural settings where the therapist and the patient hold divergent explanatory models in regard to the patient's symptoms. Different conceptualizations of the universal structure of symbolic healing stress the importance of therapist-patient compatibility for therapeutic success. In order to reach this compatibility, strategic therapists seek to join the patients' explanatory models and employ metaphors and symbols derived from their cultural world. From a psychodynamic perspective, strategic techniques are often presented as superficial treatments limited to the symptomatic level. In order to deal with this argument, we present a case study of an ultra-orthodox patient with a major depressive episode and describe the treatment which was based on a strategic, culturally sensitive approach. We use the case to discuss theoretical issues arising in the context of multicultural therapy such as the translatability of culturally divergent idioms of distress and the possibility to bring about significant, nonsymptomatic changes through strategic employment of culturally congruent metaphors and symbols.
Ultra-orthodox Jewish attitudes towards mental health care.
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