Biomedical subjects
Publications and source records attributed to R S Blacher.
From the patient's point of view, the Intensive Care Unit is both a frightening place and a safe haven. Psychologically, what we see most commonly are regression, delirium and paranola. Regression requires no treatment; delirium is treatable not only medically but psychologically as well; paranoia is best treated by prevention.
The liaison psychiatrist is often called upon to deal with psychological problems that may create medical emergencies. This paper describes a series of brief psychological interventions along a spectrum from shamanism to interpretation of unconscious conflict. Behind all of these maneuvers must be an understanding of the psychodynamics of the situation. These interventions may spell the difference between comfort and distress, illness and cure, and even occasionally life and death.
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Throughout history the belief in magic has existed in all cultures. This paper outlines the effects that some of these beliefs have on medical conditions and focuses on the magical belief that "things happen in threes." Case histories are given in illustration, and the use of "counter magic" is described in the treatment of the anxieties evoked by the superstition.
The fantasy of life after death is universal, and every culture attempts to deal with concepts of resurrection and rebirth. In the past, these fantasies have dealt with religious and symbolic meanings, but cardiac resuscitation and cardiac surgery have introduced a new dimension: the patients' concept that they die in reality and are reborn or resurrected. This study, which was based on pre- and postoperative psychiatric interviews with cardiac patients, has focused on the problems such patients face. Their defensive immortality-formations appear to confirm Freud's speculations in Thoughts for the Times on War and Death concerning the human being's difficulty in accepting death as an end to life. Case history vignettes were presented, showing how these fantasies of death and resurrection can influence patients' ability to undergo necessary surgery. It was suggested that the idea of rebirth indicates starting life anew without blemish, whereas resurrection fantasies involve having another chance to live but with the same defective body.
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A study of patients who developed depression immediately after heart surgery is presented. Nineteen of the twenty patients shared a history of having lost a close object who had died as a result of complications following a minor surgical procedure or illness, or had suffered from a disease similar to the one the patient now had, but for which there had been no surgical help at the time. The patients are compared with other survivors and are discussed in terms of both survival and paradoxical reaction. Almost all of the patients showed quick recovery when these issues were pointed out.
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We have observed several cases of a traumatic neurotic syndrome in patients who awakened from light anesthesia while still unable to move. The subsequent symptoms of anxiety and irritability, preoccupation with death, and repetitive nightmares should lead the physician to suspect the condition even though the patient is reluctant to talk about it. A direct explanation of the situation often serves as a dramatic cure.
Observations are presented about patients' psychological reactions to the experience of having a heart valve replaced or repaired. The importance of the patient's conceptualization of the cardiac valve and the surgical procedure is discussed. By understanding what such a procedure may mean to the patient, the medical staff can help make a terrifying experience more bearable.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.